Pain Rehab: Building Strength To Push Back Pain
People living with pain are most successful at taking back their lives when they take an active role in their recovery. (That’s one of the reasons that 1step2life focuses on emotions, activities, and functioning.) For most of us, there is no ‘magic jelly bean’ that will suddenly cure our pain.
Rehabilitation science suggests that the most effective way for people in pain to get out into the world is through lifestyle changes. These changes compliment all other medical and pharmacological treatments.
Lifestyle changes include:
- Healthy diet
- Drinking lots of fluids
- Healthy sleep patterns
- Reducing stress through biofeedback, mindfulness practices, or disciplines like yoga or tai chi
Making these changes is tough – particularly when it’s all you can do to make it from your bed to the bathroom. But they are critical. Research on teens living with severe chronic pain consistently shows that getting out and into the world comes before pain reduction, not after. The more you commit to exercising regularly, the more time you spend out of your room with people you care about, and the more you focus on things you enjoy, the stronger you will become. The stronger you are, the easier it is to treat the underlying causes of your pain.
High quality sleep is an essential first step
Sleep is your body’s way of letting the brain rest, replenish itself, rid itself of toxins and clear neural pathways. Many hormones and neurochemicals are only released during sleep.
Because of these housekeeping functions, good quality sleep improves concentration, metabolism, immune system functioning, and reduces both depression and inflammation.
Lack of sleep can block signals in the nociceptive pathways, which increases the perception of pain. Everything hurts more when you’re tried. It’s harder to think when you’re tired, so your coping skills fray at the edges. Lack of sleep also increases body aches – adding more pain to that you normally experience.
Sleep is even more important when you have a chronic condition. Your body is working harder than usual to maintain functioning. It’s not just that you feel everything takes more energy. It really does. Plus your body is more active and you burn more calories and energy to keep it going.
Research suggests that the quality of sleep is even more important than the duration of sleep. Deep restful sleep where you reach a REM (dreaming) state, is important for you brain to replenish itself and clear neural pathways.
“Painsominia”. What Should I Do If I Can’t Sleep?
Sleep disorders and chronic pain often go together. Too little sleep can lead to higher bodily pain. On the other hand, too much sleep can result in higher rates of headaches. Sleep and chronic pain can form a negative cycle where poor sleep will increase pain, leading to poor sleep.
This is one reason that good sleep hygiene is important. According to the Center for Disease Control, good sleep hygiene includes:
- Being consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends
- Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature
- Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom
- Avoid large meals, caffeine, and alcohol before bedtime
- Being physically active during the day can help you fall asleep more easily at night.
Sleep hygiene when you have a hard time getting out of bed.
I want to unpack some of those recommendations.
It can be really hard to be consistent if you have a flare that makes it hard to get out of bed, let alone be physically active.
A few points . . .
It is more important to have a consistent WAKE time than a consistent bed time. Thus setting an alarm is important. Get up. Go to the bathroom. Change your clothes – even to comfy loungewear or day pajamas. Remind your body and brain that it is day time! You want to keep that circadian rhythm stable. The last thing you need is jet lag when you haven’t even left your bedroom.
I talk a lot about light in this post. That’s because your brain is incredibly sensitive to light and dependent on cyclic light to maintain a healthy, stable wake/sleep cycle. As soon as you get up, OPEN THE SHADES. Look out the window and feel that light within you. Walking outside in the morning – even for a moment to the car – is great. If you can’t, sit by a window and look.
Is this a day when things are too overwhelming to get up? Consider moving from the bed to a couch or chair. Or prop yourself in bed, so you can focus on what your body needs, but also signal to yourself that it’s day and not night.
Rituals help at bedtime too. Parents of toddlers unwilling to go to bed are told that rituals help to get you read for bed. That’s because they do.
Get dressed for bed. Brush your teeth – develop rituals that help you know that sleep will come next.
Turn off electronics. Open a book or listen to a book on tape. When I was having a particularly bad bout of stress-induced insomnia, I would make myself warm milk with nutmeg and take a bath two hours before bed. Listen to one of the many relaxing meditative YouTube videos out there. Anything relaxing. Your body is ridiculously good at learning new patterns. Give it cues to start winding down for sleep.
Turn off those twinkling power lights. Ever been camping and notice how you are ready for sleep at 9 or 10? That’s because it’s DARK. Your eyes are really sensitive to light – it signals to your brain that it’s time to wake up. Blue light is particularly problematic. And what color are most LEDs? You guessed it.
That’s one of the things that makes it hard for many people to sleep right now. Every charging laptop, phone, wireless headset, and speaker has a little red, white, or blue diode shining out at you in the darkness. Your alarm clock has a light. My watch keeps blinking at me when it charges or when it decides to check my pulse. Even with your eyes CLOSED your brain is registering those light changes.
And then there’s the light from your windows and headlights driving by.
Take this seriously. Invest in shades or curtains that really make it DARK. Close them at night. OPEN them in the morning (make it part of your -It’s daytime! I should be awake! – ritual). If you can’t afford dark curtains, towels work really well to darken rooms.
Buy black tape and tape over all those charging lights. I like to see the time in the middle of the night, but the clock’s light wakes me up. I taped an index card over the display so I can flip it up when I need to see it, but flip it down when I’m trying to sleep.
Many phones and laptops can be set to change their color to reduce blue and increase yellow so it interferes less with sleeping. Programs like f.lux can help as well.
And in the morning, OPEN the shades and let that light warm your face.
Exercise, but not just before bed. It’s hard to sleep at night if you’ve been inactive and in bed all day. Exercise and tiring yourself out really helps sleep. But you don’t want your heart rate up and cortisol rushing before settling to sleep. My son’s neuro recommended at least two hour between aerobic exercise and bedtime.
Can’t exercise in the traditional sense? It is remarkable how much exercise you can get in your bedroom.
There are easy and hard exercises to do without leaving your bed. In addition, you can do more complicated exercises while sitting or standing in your room. Especially during the pandemic, many articles have been written on exercising at home and in limited space. There are entire forms of tai chi that are meant to be done in very small spaces (‘jailhouse forms’) that can both build strength and become part of a meditative stress reducing practice. This is a place where Google really is your friend.
Medications and Sleep
Some medications can make it even worse. Some painkillers contain stimulants like caffeine to make the drug kick in faster. Although that can help them work, it can also stimulate the nervous system, keeping you up at night.
Beta-blockers and other medications that target blood pressure suppress REM sleep, the phase in which the brain actually rests. Medications that make you drowsy, such as opioids, can throw your circadian rhythm off, making you more tired during the day but awake at night.
The National Sleep Foundation recommends limiting the intake of certain medications that may interfere with your sleep cycle unless you feel they are necessary. Medications that make you drowsy can help you sleep at night, for example, but may not be ideal to take in the afternoon unless you cannot make it through the day without them.
The NSF also recommends that you should not worry about how long you are able to sleep, just how well you can.
What Can I Do To Improve My Sleep?
For better sleep quality, mindfulness can help train the mind to be more relaxed. Acknowledge your thoughts and stressors, acknowledge your pain, and let them flow away as you are preparing to fall asleep to reduce the cognitive load on your brain.
Body-centric meditational can also help relax the body if you are able to manage small movements of specific areas. Tense up concentrated areas of muscle, then relax them.
And When You Can’t Sleep?
If you can’t get to sleep and you feel anxious, getting up and doing something that requires some mental energy, but not too much, is better than staring at the ceiling.
I have books I’ve read or listened to hundreds of time that I take out to read when I’m sleepless. James Herriott. Mary Stewart. Louisa May Alcott. Something I find relaxing that holds my attention but won’t get me riled up. (The newspaper is RIGHT OUT.)
Be mindful of your sleep cycle. Sleep cycles in 90-110 minutes. You’ll feel yourself go from alert to drowsier. As you move towards drowsy, it’s time to flip out the light and let yourself drift. I put my book down and rest my eyes and day dream. Often that lets my drift into sleep.
I can also be kept awake by worries. Taking out a journal and writing down what I did during the day and what I have coming up can help me clear all those ‘open loops’ and let me mind relax. Using the ‘Getting Things Done’ system helps me release a lot of anxiety that keeps me awake.
Finally, if you think you have a serious sleep problem, consider a specialist. Sleep apnea can seriously interfere with sleep and exacerbate headaches and migraines.