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How Sleep Quality Affects Healing and Pain

by Pain Doc | Feb 18, 2020 | Uncategorized

Can Poor Sleep Make Pain Worse?

We’ve all experienced a bad night’s sleep, and know the results: low energy in the morning, mental fog, grumpy attitude, slow reaction time, difficulty concentrating and basically feeling crappy all day.

On the contrary, we know what a good night’s sleep does for us, which is the exact opposite: feeling energized upon waking, good attitude for the day, and mental clarity and alertness.

The way your body and mind feel communicates health information, so obviously sleep is essential to your health since you feel and function better when you get good sleep, and feel and function worse when you are denied sleep.

While the precise, biological relationship between sleep and physiology is still a mystery, we do know that sleep impacts nearly every tissue and system in the body: brain, heart, lungs, kidneys and gut; metabolism, immune function, learning ability, memory, mood, and disease resistance. Research shows that chronically poor quality sleep increases the risk of many disorders, including high blood pressure, cardiovascular disease, diabetes, depression, and obesity.

But can sleep problems also interfere with your body’s ability to heal itself, and therefore affect pain levels of an injury?

It stands to reason that the answer is yes. Let’s say you fell and broke your leg bone. Your body’s innate healing response immediately kicks in: a cascade of biochemicals spring to action, thanks to functional proteins present in your blood and tissues. These proteins initiate inflammation to quarantine the injury; limit movement by generating pain; activate immune cells to kill microorganisms and remove debris; stem bleeding, regrow blood vessels and patch the injury with scar tissue. While the exact mechanism is not known, sleep can influence the quality of this healing process at many levels.

One study evaluated the healing rate of oral ulcers in rats. The test group of rats was denied sleep and the control group was allowed to sleep. It found that sleep deprivation worsened oral ulcers and significantly delayed their healing, compared to the control group. Sleep deprivation resulted in elevated levels of tumor necrosis factor alpha, a pro-inflammatory substance, and a decrease in superoxide dismutase, which cells use to neutralize oxidative stress (damage). Together, these changes worked to interfere with tissue healing.

While chronic pain can cause poor sleep due to over-stimulation to the brain, there is interest in examining whether the reciprocal is true—if poor sleep can cause an increase in pain. A review of independent studies analyzing the effects of sleep deprivation on pain processing found that for most of the studies, sleep deprivation produced hyperalgesic changes; i.e. made pain perception worse.

The lesson here is that if you have recent pain (acute injury or onset) or even chronic pain, it is important that you get quality sleep every day. The research is clear that sleep is essential to optimal injury healing and minimizing pain perception.

Of equal importance is maintaining a healthy diet consisting of protein, good fats (i.e. nuts, seeds, olive oil, fish oil, avocado, egg yolks), and generous amounts of vegetables while minimizing sugar and grain carbohydrates. Your diet provides the proteins needed for structural repair and micro nutrients (vitamins and minerals) needed for critical biological processes, many related to tissue healing.

To take it a step further, I recommend you try intermittent fasting, where you don’t eat for long stretches during a 24 hour period. Check out this article I wrote to see how intermittent fasting can reduce inflammation and pain. Despite the conventional wisdom of “three square meals a day” and “breakfast being the most important meal of the day,” your body is actually optimized to go without eating for long periods of time. Lowering your caloric intake via intermittent fasting lowers oxidative stress, keeps blood sugar in check and burns excess body fat. This can have an overall effect of lowering chronic pain.

Back to the importance of sleep: If you have difficulty sleeping, The National Institute of Neurological Disorders and Stroke (NIDDS) offers the following tips to improve your sleep:

Set a schedule – go to bed and wake up at the same time each day.
Exercise 20 to 30 minutes a day but no later than a few hours before going to bed.
Avoid caffeine and nicotine late in the day and alcoholic drinks before bed.
Relax before bed – try a warm bath, reading, or another relaxing routine.
Create a room for sleep – avoid bright lights and loud sounds, keep the room at a comfortable temperature, and don’t watch TV or have a computer in your bedroom.
Don’t lie in bed awake. If you can’t get to sleep, do something else, like reading or listening to music, until you feel tired.
See a doctor if you have a problem sleeping or if you feel unusually tired during the day. Most sleep disorders can be treated effectively.

And let me share you a tip that helps me sleep when I’m having trouble sleeping: keep your eyes open as you lie in bed in the dark. It may sound counter-intuitive, but it works for me. After all, you can’t get drowsy if you are forcing your eyes closed when trying to sleep. Leaving your eyes open will eventually lead to the “drowsiness reflex,” which will transition you to sleep.

One more personal tip– use blackout blinds in your bedroom (not venetian blinds). These block 100% of light outside your room. Make sure to get the exact width to minimize light leaks around the perimeter. Even trace light that enters your eye can inhibit your pineal gland from producing melatonin, the substance that initiates sleep.

The Holistic Sleep Summit

If you have trouble falling asleep, or feel that you are not getting enough quality sleep and wish to do something about it, you might want to consider attending the Holistic Sleep Summit this coming March 5-8. It’s a live webinar featuring 27+ leading experts in the science of sleep. You do not have to drive anywhere, just have a computer and internet connection, and make sure your speakers are on.

Discover Simple Ways To Sleep Quickly And Soundly
Learn How To Be More Alert And Feel Well-Rested
Sleep Soundly All Night Long, The Easy Way
How to Sleep On Demand

This online event is free. It is structured like a professional course, with each expert speaking on a topic related to sleep. There are no sales pitches, just pure content. If you have pain, or don’t feel your best, quality sleep will help you feel and function better–mentally, emotionally and physically.

If you do attend, as I will as I am a big advocate of telehealth, please do me a favor and comment below to let me know what you thought of it. The mission of this site is to bring together the best minds in self-management of common ailments, and the Holistic Sleep Summit is just another form of telehealth that has the potential to improve the lives of many people via online health education and guidance. If you are plagued by insomnia, restless sleep, sleep apnea or simply have bad habits or addictions that interfere with your sleep, I hope you check it out because you just might find the solution to your problem.

Can Your Pain and Aches be Partly Due to Oxidative Stress?

by Pain Doc | Jul 29, 2015 | Nutrition

If you have pain or aches in your joints, tendons or muscles that varies in intensity but never seems to go away, you might be experiencing oxidative stress to these areas. Oxidative stress is the cumulative effects of oxidation, a chemical reaction where electrons are stripped off tissues by reactive oxygen species (ROS). ROS or free radicals are atoms or group of atoms that have one or more unpaired electrons. When an atom or molecule has an unpaired electron, it is unstable, and since nature likes stability the radical will seek out electrons elsewhere to “balance” itself. Free radicals are highly reactive to molecules they come in contact with and are therefore dangerous to them. They can destroy them or change their shape and therefore function by altering their molecular structure.

Radicals can have positive, negative or neutral charge. They are formed as intermediates in normal biochemical reactions in cells (cell metabolism), but when generated in excess or not appropriately controlled/ neutralized, radicals can damage adjacent cell structures and tissues. ROS types includes superoxide anion (O2-), hydrogen peroxide (H2O2) and the hydroxide ion (OH-). Think of these things as the cell’s equivalent of noxious exhaust gases generated by an internal combustion engine.

Now, imagine a bunch of these free radicals roaming inside your knees. It’s akin to termites eating away at the frame of your home. At some point, a structural failure will occur; and in the case of the knees, damage to cartilage or synovium (joint inner lining) followed by knee pain and stiffness.

Your body also makes and uses reactive oxygen species for good things. White blood cells generate them to kill bacteria and other pathogens. ROS also influence cell signaling (such as signals to divide, increase membrane permeability and repair membranes) and activate (up-regulate) genes to produce needed substances during certain times. Only when they get to unacceptably high levels, and/or when they aren’t adequately neutralized do ROS become harmful.

Some of the scenarios that can cause excessive ROS formation include:

Hypoxia (low oxygen levels), hyperoxia (high oxygen levels) and excess heat exposure
Ionizing radiation — UV rays, gamma rays trigger massive ROS formation
Prolonged, physical exertion— marathon running, extreme races, hard labor under grueling conditions generates massive amounts of ROS. Oxygen consumption increases by multiples, generating large amounts of free radicals and making it difficult for cellular anti-oxidant defenses to keep up.
Pollution ingestion. This includes smoking, chemical fumes, carbon monoxide, organophosphate pesticides and other substances toxic to humans.
Electromagnetic field exposure. Some studies suggest EMF can cause biological changes that result in excessive free radical formation.

Anti-Oxidants to the Rescue

Anti-oxidants are substances that act as reducing agents, where they donate an electron to a reactive oxygen species; thereby neutralizing it.

There are two main categories- enzymatic anti-oxidants and non-enzymatic anti-oxidants.

Enzymatic anti-oxidants include glutathione peroxidase, superoxide dismutase and catalase. Basically, these components are inside or adjacent to cells (water soluble) and degrade superoxide and hydrogen peroxide by-products of cell metabolism.

Non-enzymatic anti-oxidants include Vitamins A, E, and C, and glutathione. Vitamin E is the major fat soluble anti-oxidant that is responsible for degrading hydrogen peroxide radicals that form along lipid based cell membranes. Glutathione is an important anti-oxidant present in the cell cytoplasm that attracts free radicals, becomes radical itself but then recycles into an anti-oxidant via a special pathway and scavenges again for more free radicals.

Polyphenols, of which there are thousands, are substances (phytochemicals) found in plants that have anti-oxidant properties. This includes blueberries, pomegranate, citrus, green vegetables, apples, cantaloupe, cherries, grapes, plums and other dark and colorful plants. Tannins, quercetin and flavonoids are types of polyphenols.

Turmeric, the rhizome of the flower Curcura Longa contains a well-known powerful anti-oxidant called curcumin. Since it is fat soluble (doesn’t stick to water molecules for transport), it has a hard time getting into your cells. Scientists found that if you consume it with piperine, a natural compound found in black pepper, it increases absorption into your cells by 2,000% which is why most curcumin supplements contain black pepper. A fat soluble anti-oxidant, curcumin is believed to protect the lipid-containing cell membrane from free radical damage.

The Bad News

So, at this point you might be thinking that fixing the oxidative stress problem is simple– just take a bunch of anti-oxidant supplements every day, and good bye free radicals, right?

Unfortunately, most of the research done to test this is inconclusive. This means that, at the present, we cannot say that taking anti-oxidant supplements reduces the risk for any type of disease.

While it’s true that people who eat lots of vegetables and fruits in their diet tend to be healthier than those that do not, the causative factor may be something other than anti-oxidant content in the fruits and vegetables. It could be that people who eat more vegetables and fruit are more health conscious overall and take better care of themselves in other ways (avoid smoking, drinking in moderation, avoiding junk food, etc.) that might explain their longevity.

And for some people, anti-oxidants can act as anti-nutrients by binding with essential minerals in the digestive tract such as iron and zinc, preventing them from being absorbed. They may also interfere with post-exercise trauma repair to muscles, as white blood cells use ROS during repair of muscle tissue; anti-oxidants may inhibit this.

So what is the solution if you’re being constantly attacked by reactive oxygen species?

The Solution

The solution is to do what you need to do anyways in order to be healthy in the long-term:

eat in moderation (less food to metabolize means less free radical generation)
make at least 80% of your diet naturally occurring foods emphasizing green vegetables and to a lesser extent colorful fruits
avoid sugary drinks
exercise in moderation regularly
avoid “chronic cardio” exercises such as long-distance running and ultra-workouts as they are counter-productive.
get adequate rest
remove stress in your life (or find a counter to your stress)

Secondly, be aware of the exogenous sources of ROS generation and avoid them as best you can. This means:

avoiding environmental pollution in the air, water and food
staying away from second-hand smoke
minimize your exposure to commercial electromagnetic fields especially when you sleep (see how to counter this here).
minimizing exposure to strong, mid-day sun rays
If you work near an X-ray machine or other radiation source, make sure to wear adequate protection

Lastly, avoid binge eating and gorging on food, especially on an empty stomach! This stresses your digestive system and generates a barrage of free radicals over several hours as your digestive cells stay fired up to metabolize all that food. Those free radicals that weren’t zapped by glutathione and other anti-oxidant defenses roam throughout your body, snatching electrons from cell membranes, DNA, proteins and other important structures. Keep those buggers down; don’t stir up the ant nest.

When you turn off oxidative stress in your body, your body will be able to heal itself faster and those achy muscles and joints will actually start to feel better and stay that way.

The Origins of Musculoskeletal Pain – Which Describes Yours?

by Pain Doc | Mar 7, 2014 | Hand and Wrist Pain, Low Back Pain, Myofascial Pain

Musculoskeletal pain refers to pain affecting the muscles, ligaments, tendons, joints and sometimes bones. Sometimes it is straight-forward; other times it is not. Before you convince yourself that you know the origin/cause of your musculoskeletal pain, consider the following:

Pain can be due to trauma/injury where the tissue itself is generating the pain due to ruptured cells and the effects of inflammation. This is the most unambiguous case because it is connected to an identifiable event. This pain can be acute, meaning relatively recent onset; sub-acute, referring to a state where the injury still is healing but pain and some swelling is still present; and chronic, which basically means symptoms that remain after the body has done all it can at the moment to heal the injury.

Pain can manifest in one area of your body due to abnormal movement in a distal location. The abnormal movement might be caused by a previous trauma event like a car accident or sports injury, it can be congenital (developed at birth) and it can be from repetitive movements required by a certain occupation or hobby/sport. Abnormal movement (called dyskinesia) can also arise from muscle imbalances, where one muscle loses strength due to inactivity, decreasing joint stability and facilitating excessive, restricted, or other abnormal movement of that joint, forcing distal joints to make up the difference in lost movement or compensate to create more stabilization. The distal muscle(s)/joint(s) then work in a fashion that they were not designed for, leading to strain, spasm and even injury to the muscle or joint.

This is the most tricky type of pain manifestation because it is often mis-diagnosed resulting in the wrong treatment approach and lack of resolution. An example of this is sciatica (pain in the buttock) from a spasmed piriformis muscle scissoring the sciatic nerve due to an unlevel pelvis coming from hyperactive same-side erector spinae musculature. If the back muscle and pelvic imbalance is not corrected and the patient simply gets massage to the piriformis muscle, you can see how this pain will never go away with this type of treatment.

Pain can be referred pain. In referred pain, the brain senses the pain to be in one area of the body when the abnormal site is actually in another area. Despite an increasing amount of literature on the subject, the mechanism of referred pain is still unknown. Going back to the heart attack example, myocardial infarction can cause referred pain to the left jaw and left arm. The image below illustrates commonly observed types of referred pain and their true source (credit to Wikipedia).

Pain can arise from hypoxia (insufficient oxygen to the tissues). An extreme example of this kind of pain is a myocardial infarction, or “heart attack” where a major artery to the heart muscle is blocked, preventing oxygen from reaching a section of the heart. Biochemical reactions take place when this happens, which generate pain.

Thoracic outlet syndrome is a condition where the nerves and blood vessels supplying the arm get compressed in the neck region by tight scalene muscles or the collar bone. The resulting hypoxia can contribute to pain in the arms and hands.

Pain can come from trigger points, also known as trigger sites or muscle knots, are described as “hyper-irritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers.” Trigger points are usually only a few centimeters in diameter.

Clinical textbooks on the subject establish the following requirements to meet the definition of trigger points:

Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection.
The painful point can be felt as a nodule or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point.
Palpation of the trigger point reproduces the patient’s complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point.
The pain cannot be explained by findings on neurological examination.

As in referred pain, the mechanism of trigger points is still being debated. Trigger point tissues have been biopsied, and findings indicate the presence of hyperactive muscle spindles, special cells whose function is to detect the rate of lengthening in a contracting skeletal muscle and initiating the firing of complementary muscles to complete the desired goal.

Wikipedia gives a nice summary of what causes trigger points to form:

Activation of trigger points may be caused by a number of factors, including acute or chronic muscle overload, activation by other trigger points (key/satellite, primary/secondary), disease, psychological distress (via systemic inflammation), homeostatic imbalances, direct trauma to the region, collision trauma (such as a car crash which stresses many muscles and causes instant trigger points) radiculopathy, infections and health issues such as smoking.

Finally, there are more highly-complex causes of pain related to dysfunction of the central nervous system, sympathetic nerves, biochemical and hormonal issues, and even psychosomatic. These types of cases are difficult to diagnose and are often treated using pharmacological agents, and on the other side of the spectrum, holistic approaches with mixed results.

NO MATTER what pain you may be experiencing, know that it always, always helps to detoxify your body as best you can via a nutritionally-dense diet centered on naturally-occurring, non-GMO, organic unprocessed food sources; reducing your processed sugar and grain intake; regular exercise, getting enough sunshine to your body; targeted supplementation, meditation or other relaxation methods, and even nurturing social support. This is the theme of this blog, because there is no shortage of treatment methods for pain and not enough emphasis coming from doctors or the government on prevention, wellness and health optimization; i.e. Healthy Lifestyle Education.

In the next couple of blog posts, I will talk about real, practical ways you can reduce your pain without the help of your doctor by making strategic lifestyle modifications. Your body has a potent array of disease-fighting systems and has an innate ability to repair and regenerate itself. The problem is that in many pain sufferers, these systems are burdened by unhealthy habits and are not running at their full potential. Imagine what can happen if those systems were brought back on line, constantly doing what they are naturally programmed to do– protect you and keep you alive; fighting germs, cancer cells and developing diseases; and repairing injured sites so that you can function better. Isn’t this a goal worthy of your efforts?

More to come, stay tuned!

Dr. Perez

An Often Neglected Approach to Self-Treat Disc Bulging

by Pain Doc | Aug 27, 2013 | Uncategorized

Disc bulges, or herniations, come in a variety of presentations. They usually are limited to the lower lumbar spine (L3/4 to L5/S1) and the neck (C4/5-C7/T1). In taking the medical history of patients suffering from disc bulges, there is usually a history of a sedentary office job that requires sitting long hours; a previous injury like a sports, work, or car accident injury; and in rare cases, no significant event or habit that could explain how the disc bulge occurred. In fact, there are studies that indicate that degenerative disc disease, which can include varying degrees of disc bulging, can be hereditary.

A common theoretical model for degenerative discs goes like this: something happens that causes the disc to bear excessive weight, which over time forces fluid out of the disc causing it to dessicate. The outer fibers responsible for keeping the disc intact and the nucleus in place weaken, allowing the center nucleus to bulge outwards. Chiropractors often attribute this scenario to subtle misalignments in the vertebrae caused by minor trauma, prolonged sitting and insufficient support from the abdominal muscles and lumbar muscles. Normally the disc should support 80% of the weight above it and the facet joints (the smaller joints behind the disc) about 20%. But if a physical event changes the orientation of the vertebra, it can force the disc to support 90-100% of the weight, accelerating its demise.

Other models reference calcification of the vertebral end plates,the surfaces of the vertebrae above and below the disc, which then prohibits capillaries from feeding nutrients to the disc causing it to die. Bone calcifies in response to trauma; vertebral end plates can sustain “micro-compression” injuries from activities that place a heavy, axial load (perpendicular) to the disc. Examples include basketball, gymnastics, running, and parachuting.

An acute herniated disc can be extremely debilitating, as it tends to last a lot longer than a typical sprain/strain injury. It hurts, limits movement, can make sleep difficult and restricts you from work and physical activity. If it presses on a nerve root it can send shooting pains down the buttock and leg and cause numbness and weakness. The general recommendation for most cases of non-emergency disc herniations is to manage the pain using physiotherapy (ice, heat, muscle stim, laser), do physical therapy including stretching and strengthening exercises and wait for the disc bulge to self-resolve in 2-3 weeks. Once it heals and the inflammation goes down, the pain usually goes down as well.

If your disc herniation is pressing on a nerve root, the disc may shrink as it heals, removing pressure from the nerve. This is the best scenario obviously, as you avoid surgery and get your life back. At this point, it is prudent to avoid activity that risks re-injury (heavy lifting while turning torso) and do everything you can to strengthen your core muscles and spinal muscles to guard against re-injury. Functional exercises should be emphasized, for this purpose.

The thing that can dramatically increase the chances of full recovery without surgery is healing your insides– reduce systemic inflammation by getting down to a healthy weight and maintaining it; stop smoking, avoid alcohol as best you can, reduce stress, reduce insulin levels, maintain normal blood glucose levels, ensure that your gut micro flora is in balance, and get adequate sleep every day. Eat healthy, decrease your portions, and drink enough water to stay hydrated throughout the day. Exercise consistently, 20-40 minutes each time. This is what a healthy lifestyle routine is made of.

People who are in pain usually are concerned about knocking down the pain first, and ignore the health of the rest of their body. Remember, your entire body is essentially a colony of specialized cells that are interconnected via the bloodstream, nerves, and hormones. When one area is injured, the rest can come to its aid.

If you suffer from disc herniations, joint pain or other musculoskeletal form of pain and are overweight, pay more attention to getting yourself healthy inside; it’s the often ignored self-help method to treat pain.

The Dangers of Using Opioid Drugs to Treat Pain

by Pain Doc | Sep 25, 2012 | Uncategorized

Opioids are strong drugs that are typically prescribed for cases of acute pain such as that from major trauma or post-surgery, and also for patients experiencing severe, chronic, debilitating pain; primarily from terminal cancer and rheumatoid arthritis. Opioids chemically bind to receptors in the central and peripheral nervous system and produce an analgesic effect via decreased pain perception, decreased reaction to pain, and increased pain tolerance.

Morphine and codeine are opioid drugs derived from natural opiates of the opium poppy plant; hydromorphone, hydrocodone, oxycodone, oxymorphone, ethylmorphine and buprenorphine are semi-synthetic and created from either natural opiates or from morphine esters; fentanyl, pethidine, levorphanol, methadone, tramadol and dextropropoxyphene are fully synthetic opioids.

Doctors usually prescribe opioids with caution because of their side effects and propensity of addiction. Known side effects include nausea and vomiting, drowsiness, itching, dry mouth, miosis, and constipation. More potent doses can result in respiratory depression, confusion, hallucinations, itching, hypothermia, bradycardia/tachycardia (abnormally slow/fast heart rate), orthostatic hypotension, dizziness, headaches, urinary retention, ureteric or biliary spasm, muscle rigidity, myoclonus (involuntary muscle twitches) and flushing of the skin. If the dose is not closely monitored and adjusted appropriately to the patient, side effects can often lead to serious consequences. There is a troubling trend where

opioid drugs are increasingly being prescribed for less serious forms of pain such as back pain. Not surprisingly, the number of documented cases of adverse drug reactions has risen accordingly.

When patients are not properly informed about how to take opioid painkillers or are prescribed too high a dose of these drugs, or too long a course of treatment, serious and potentially fatal side effects may result, including respiratory depression (reduced respiration or breathing). If left untreated, patients who develop respiratory depression as a result of a painkiller overdose may die from a lack of oxygen due to shallow breathing caused by the medication.

Thousands of patients die each year as a result of a prescription painkiller overdose.

The CDC reports that prescription painkiller overdoses were responsible for more than 15,500 deaths in 2009. While all prescription painkillers have contributed to an increase in overdose deaths over the last decade, methadone has played a central role in the epidemic. More than 30% of prescription painkiller deaths involve methadone, even though only 2% of painkiller prescriptions are for this drug. Six times as many people died of methadone overdoses in 2009 than a decade before.

When these deaths are the result of patients who were given excessive doses of pain medications, improperly warned about the side effects of the drug, or prescribed more potent drugs than were necessary, the doctors or hospital that prescribed these medications may be at fault. The law firm of Heygood, Orr & Pearson is one of many in the country that offer legal assistance to those injured or damaged by taking prescription drugs. The firm recently launched a website, Painkiller Overdose Lawyers . The site will serve as a resource with the latest news and legal information for patients who believe they were injured after using a prescription opioid painkiller.