10 Facts About The Chronic Pain Cycle And How To Break It

Chronic pain is a complex condition that affects millions of people worldwide. It is defined as pain lasting longer than three months and can have a significant impact on an individual's quality of life. 

Chronic pain often involves a cycle where pain leads to reduced activity, which in turn leads to muscle weakness, decreased mobility, and more pain. This cycle can be difficult to break without targeted interventions that address both the physical and psychological aspects of pain.

Some common chronic pain conditions:

The three types of pain

  1. Nociceptive - Acute inflammation, injury or damage. Pain is caused by damage to body tissue that can feel sharp, aching or throbbing. 

  2. Neuropathic - Nerve tissue damage that can occur from an injury (such as sciatica), result from viral infections (e.g. shingles) and can also originate from complications from diabetes or vitamin B1 or B12 deficiencies. 

  3. Nociplastic - Persistent pain that can occur from altered pain perception, often found in conditions such as fibromyalgia and chronic pain conditions. 

Conventional treatment for chronic pain

Chronic pain is a very difficult thing to treat. Doctors often prescribe anti-inflammatory medications to help reduce inflammation, alongside pain relief medication. If this is unsuccessful, they can often prescribe tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and gabapentinoids as a treatment for chronic pain. 

TCAs are often prescribed for nociplastic pain (like fibromyalgia pain) and they are found to be more effective than prescribing SNRI(s), but sadly older patients seem to have adverse reactions to this medication. Gabapentiniods are also helpful for chronic pain but can leave people feeling drowsy which can be off-putting for some patients.

Reducing inflammation can help with encouraging more mobility and movement which can also reduce pain. Active reduction of inflammation can be achieved by taking anti-inflammatory medications such as non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol or muscle relaxants.

The downside of taking too many NSAIDs can be the side effects, in particular for the digestive system. It's important to remember that addressing the chronic pain cycle involves targeting both the physical and psychological aspects of pain. Below we detail some ways that can help support you in breaking the chronic pain cycle.

1. Address the stress

Chronic pain can increase stress levels, which further contributes to the pain cycle. Stress can exacerbate existing inflammation, so it is important to support the nervous system and work at lowering cortisol. Natural health practices such as meditation, deep breathing, and yoga can help to reduce stress and manage chronic pain. 

Some people find that anti-depressants and anti-anxiety medication can be helpful when addressing long-term stressors related to chronic pain. However, if you were looking for a natural option, you could consider ashwagandha, chamomile, Californian poppy, passionflower, lemon balm and St John’s wort. These plants have a long history of traditional use that shows they may help lower stress, and anxiety and support a more balanced mood.

2. Support your sleep

Many people with chronic pain obviously experience sleep disturbances, which can exacerbate the chronic pain cycle. Being unable to get comfortable or only sleeping for small amounts of time can greatly impact your health and your ability to get through each day. Medication such as melatonin and sedatives can be helpful if you are struggling. However, prescription sedatives can come with unwanted side effects such as drowsiness. 

Herbal sedatives such as valerian root, kava, hops, Jamaican dogwood, lavender and lemon balm can also support a more regular sleeping routine and do not have the same side effects as prescription medication. However, it can take a bit of trial and error to find the right combination of plants to suit you. 

3. Incorporate gentle movement 

When chronic pain leads to reduced activity, it can cause muscle stiffness and loss of flexibility. Gentle exercises like swimming or yoga can help increase mobility and promote regular movement. We understand that this is difficult when movement is painful, but supporting your mobility with plants like turmeric and willow bark can help with pain reduction as well support the musculoskeletal system. 

4. Take a look at your diet

Foods high in sugar and processed ingredients have been found to increase inflammation. While these foods are often easy to find and prepare, they are often not the best options to support long-term inflammation. A diet that is seasonal and high in whole foods, which includes omega-3 fatty acids from fish or algae can help manage pain. 

5. Support your mental health

Being unable to physically partake in the activities you want severely impacts your quality of life which in turn can lead to struggles with depression, anxiety, and isolation. While it can be hard to accept these limitations, working with a health professional works to address the toll the chronic pain cycle can take on your mental health and may provide you with coping mechanisms.

If you’re looking for an alternative to antidepressant medication, plants like St. John's Wort, rhodiola, lemon balm and saffron can help manage mild depression and anxiety. St John’s wort can be incredibly helpful in the winter months to help with seasonal affective disorder that some people experience concurrently with chronic pain.

Maintaining regular social interactions with friends and family is important as being unable to participate actively in life can feel isolating, leading to feelings of loneliness and depression. There are also support groups available for people with chronic health conditions that can help improve emotional well-being and social interactions. 

6. Natural pain management techiniques can help

Herbal remedies can provide natural pain relief without the side effects of synthetic drugs. For example, capsaicin, derived from chilli peppers, can reduce nerve-related pain when applied topically. The shingles virus often results in a painful rash, and commonly prescribed is a capsaicin cream to help with pain relief.   

7. Magnesium

Magnesium is commonly recommended for people who are in pain. This is because it can help relax nerve fibres and can help to reduce pain sensitivity. It does this by influencing how the multiple pain signalling mechanisms are received within the central nervous system. Magnesium is a water soluble mineral that needs to be replaced daily, this can be through food or supplemental forms. 

Magnesium is required for hundreds of chemical reactions within the body daily and it helps to regulate or balance;
  • Skeletal muscle contraction
  • Nerve transmission
  • Neuromuscular conduction
  • Blood pressure
  • Endothelial function
  • Vasodilation within smooth muscle
Having adequate magnesium is a vital component in pain management. Supplemental magnesium comes in different forms so it is important to know what form will be best. With pain and discomfort amino acid chelates are often recommended.
Certain essential oils, like lavender and eucalyptus, can provide soothing effects topically; however, essential oils should always be diluted and never applied directly to open sores. Topical St John’s wort oil has traditionally been used to support nerve pain, help with growing pains, irritated skin, and painful rashes (such as with shingles).

8. PEA

Recently a new supplement called Palmitoylethanolamide (PEA) has entered the market to help with chronic pain. PEA is a naturally occurring fatty acid amide, that is becoming a popular supplement to help with nerve and inflammatory pain. PEA is able to help downregulate (reduce) pain and inflammation and indirectly act on the body’s endocannabinoid system which helps with pain processing and modulation, which can support a reduction in pain.

As PEA is relatively new, human data on how PEA acts on different types of pain is limited, but with its popularity growing there will be more published studies available. Of note one study found that PEA was effective in reducing post herpetic pain at the dose of 900mg. Another 2022 study found that there was a 20% perceived pain reduction after taking PEA. PEA is often found through natural health practitioners or in limited over the counter products.

9. Holistic approaches to pain management 

Holistic therapies such as acupuncture, massage, and chiropractic care can address the underlying causes of chronic pain. Regular physical therapy can help reduce the tension and discomfort that many people with chronic pain suffer from. Combined with herbal or vitamin/mineral support these therapies can offer a comprehensive approach to helping to break or reduce the pain cycle.

10. The importance of lifestyle changes

Breaking the chronic pain cycle can require lifestyle changes that promote overall health and wellness.  Regular physical activity, stress management, a balanced diet, and herbal medicine can work together to try and help reduce pain and improve quality of life. 

A way to track whether your interventions are helping is to document what you are trying and note your pain on a scale of 1- 10. This way, you can clearly look back and see if introducing something new has helped.

However, as a caveat, sometimes even with the best intentions and plans, some people may still struggle with chronic pain. This is where your support and understanding as a family member of friend is invaluable as they navigate life in chronic pain.

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