Did you know that 2020 was the Global Year for the Prevention of Pain?
The International Association for the Study of Pain (IASP) selects a topic each year
to raise international awareness of pain. The focus for the 2020 campaign was on
disseminating pain prevention strategies to researchers, clinicians, and patients.
This past year there were many events organized by IASP and lots
of scientific papers published on this topic. I attended the webinars, read the papers and
there were so many things that I learned about what we can do to prevent pain, especially how
to prevent that acute pain becomes chronic pain. In this video, I will summarize the 30 points
that I learned this year. You can access all of these materials on the website of the IASP.
I’ll summarize here 30 ways to prevent chronic pain that are relevant to the general public,
patients and their caregivers. The IASP website also
contains a lot of additional materials for clinicians, researchers and policy makers.
So let's learn a few things about chronic pain
How does acute pain transition to chronic pain? There are various biological factors like
the extension of the injury, the condition of the tissues and organs affected,
problems with posture, muscle imbalances, allergies, ongoing diseases, congenital diseases,
nutritional deficiencies and inadequate sleep. There are also many psychological and
environmental factors that include mood, social isolation, abuse, trauma and others. Any of these
factors can contribute to the initiation of acute pain and allow for transition into chronic pain.
As these conditions persist, the pain may change or remain constant.And it is thought that around
3 months of persistent pain, that changes in the central nervous system begin to occur.
These changes involve rewiring of the neural pathways to compensate for the ongoing pain,
and there are brain changes. As this occurs, even if the local site of pain has healed or
is treated, the rewired central nervous system could enable the experience of pain to continue,
which means, the pain is becoming “chronic”.Once pain becomes chronic, it is much more difficult
to treat, and this may be because reversing the rewiring of the central nervous system
is more difficult than improving the original site of pain.
How to avoid debilitating chronic pain? The 30 points are divided into 3 categories:
9 points are related to your general health. These are things that you
can do even before you have pain, to avoid pain from happening in your life.
However, acute pain is unavoidable. There are 8 points related to how you manage acute pain,
and these points will help you to prevent that the acute pain becomes chronic.
And the last 13 points are for people who are starting to have chronic pain, and what they can
do to avoid it from becoming really debilitating and interfering with their enjoyment of life.
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If you go to the description of this video below, you will find lots of
resources and links that I posted there for you to get additional information.
So, let's see the first nine points
The first nine points are about “GENERAL HEALTH” These are ways that you can prevent pain
from happening in your life. Number 1 Maintain a healthy diet
Reduce inflammation to help protect your body from oxidant damage. Polyphenols are
compounds found in fruits and vegetables and have antioxidants and anti-inflammatory properties
Good quality fats: Omega-3 fats and olive oil both help to reduce
inflammation and enhance the immune system Prevent vitamin and mineral deficiencies: Common
micronutrient deficiencies in people experiencing pain include Vitamin D, vitamin B12 and Magnesium.
Water intake: dehydration can increase sensitivity to pain. It can also have other effects on health
outcomes, especially in older populations, such as poor wound healing and constipation.
Increase fibre. Fibre is important for proper digestion and maintenance of a
healthy microbiome and weight management. Reduce and limit ultra-processed foods
and sugar intake. These foods and drinks contain high amounts of energy and very low
(or no) amounts of beneficial nutrients. These foods can increase inflammation and
oxidation which can worsen pain experiences. Number 2 Maintain a healthy weight.
Body mass index (BMI) is a measure of body fat based on height and weight
that applies to adult men and women. Body Mass Index (BMI) is a person's
weight in kilograms divided by the square of height in meters.
So, if a person’s weight is 70 kilograms and measures 1 meter and 70 centimeters,
you divide 70 it by their height in meters (1.7) equals 41, then you divide again by 1.7 = 24
BMI Categories:
24 is normal weight, according to the BMI category.
Number 3 Exercise regularly Physical activity and exercises
have broad health benefits due to their effect on the musculoskeletal,
cardiovascular and central nerve system. Physical activity is “any bodily
movement” and exercise is a “planned, structured and repetitive bodily movement
that is performed to improve or maintain one or more components of physical fitness”.
Physical activity and exercises are also considered as strategies
to improve mental health status, which is frequently associated with chronic pain.
Number 4 Eliminate unhealthy practices like excessive alcohol
In Canada, the low-risk drinking guidelines say that
Women: 10 drinks a week, with no more than 2 drinks a day most days
Men: 15 drinks a week, with no more than 3 drinks a day most days
What does “a drink mean”? For beverages containing 5% alcohol
like beer and coolers, a drink is about 12 ounces or 341 mililiters
For drinks containing 12% alcohol like wine, a drink means 5 ounces or 142 ml
And drinks containing 40% alcohol like gin and rum, a drink means 1.5 ounce or 43 ml
Number 5 Eliminate smoking.
One in three patients that I treat with chronic pain smoke.
We know that nicotine is a painkiller, but it is very addictive, and the other substances
in the cigarette are very harmful to the body and cause chronic pain.
So, it is very important to quit smoking if you want to avoid future problems with chronic pain.
Number 6 Work and rest in healthy posture
We spend one thirds of our lives working, so working posture or we call it ergonomics is
very important. It is also important to pay attention how we rest from our normal work.
So, if your work involves sitting in front of a computer the whole day, you need to stand up
and do some stretches. And if your work involves being on your feet, carrying and lifting weights,
you need to take breaks where you relax the tension in your muscles, and relax your mind.
Number 7 Cultivate healthy sleep habits
This is so important,
if you want to avoid problems with pain, start taking care of your sleep quality now.
First, you may download some sleep questionnaires from the internet and find out if you have a sleep
problem. If you do, talk to your doctor. Then, you may download some Apps to your
smartphone and monitor your sleep. You will be surprised how poor the quality of your sleep is.
In the description of this video below you will find some links to a document
that I prepared that summarizes some things you can do to improve your sleep.
Number 8 Manage stress in your life First recognize that stress is part of our lives
Then, identify situations that are more stressed and recognize how they affect your pain
Start practicing body awareness like body scanning and record in a dairy
Practice breathing exercises when you notice your stress levels are higher.
You can start with breathing for awareness, then for releasing tension, then for symptom control.
If you keep practicing, you may start with other techniques
like progressive relaxation, meditation, visualization, and self-hypnosis.
Number 9 Seek counsel or Mind-body therapy whenever needed.
Mental health problems are very common, and people with mental health disorders
are more susceptible to develop chronic pain. Things like depression, anxiety, panic attacks,
post-traumatic stress disorders (PTSD), insomnia, substance use disorders and personality disorders.
Some people need help form a professional mental health worker to help them treat these conditions.
Don’t be afraid to seek a psychologist or a psychiatrist
and get professional help for these problems.
Don’t think that these problems will go away with time,
in fact, the longer you wait to start treating them, the harder it is for them to be eliminated.
We know acute pain is inevitable in life.
We can get hurt in an accident or get a disease that causes pain.
The next 8 points are related to HOW TO MANAGE ACUTE PAIN
Number 10 Medications, over-the-counter (OTC) non-steroidal anti-inflammatory drugs NSAIDs and
analgesics. Talk to your pharmacist about your options, interactions with other medications,
common side effects and for how long you should be taking them.
Number 11 Apply ice or heat to affected areas. Some people prefer ice for acute swelling,
inflammation or sports injury. Some people prefer heat for muscle aches, muscle tension
and relaxation. Be careful when you apply ice to the area, use a fabric to protect your skin.
And also, if you use a heating pad, don’t sleep on it. I’ve seen many burns caused
by heating pads that were left on during the night and burned the patient’s skin.
Number 12 Engage with physical activity, or movement.
Number 13 Receive manual therapies, some examples are massage, manipulation, and mobilizations.
Number 14 Manage your stress levels.
Number 15 Seek mind-body therapies when indicated. You may find a mental health
provider that offers cognitive-behaviour therapy or acceptance and commitment therapy.
Number 16 Check with your doctor if there are other prescription medications you can take
Number 17 Eat a low-inflammatory diet rich in fruits, vegetables, nuts, lean proteins.
Get rid of processed foods, sugars, pops, and stay away form of smoke, from cigarettes or cannabis.
HOW TO PREVENT WORSENING OF CHRONIC PAIN Number 18 Understand that chronic pain is
common and often difficult to completely cure Number 19 Start building your toolbox of
“self-management” tools. Multimodal treatments are best, and include the 5 Ms that I always explain:
modalities, movement, mind-body, manual therapies and medications.
Continue engaging in movement-based activities, including mild to moderate exercises
Number 20 Take over-the-counter (or OTC) medications that do not need a prescription.
Some examples are non-steroidal anti-inflammatory drugs (or NSAIDs)
Number 21 Apply modalities like cold/heat. They also work for chronic pain.
Number 22 Try alternative modalities, like complementary non-drug therapies.
This might include acupuncture, massage, and water-based therapies
Number 23 Have positive and realistic expectations for treatments
Number 24 Find a doctor and supportive healthcare professionals that you trust
Number 25 Seek medical advice from a pain specialist or a pain clinic if one is
available in your area. Ask if the clinic has an interprofessional team. This might include
physicians, nurses, pharmacists, psychologists, physiotherapists, and occupational therapists.
Number 26 Ask about nerve blocks, injections, and or steroids
Number 27 Consider other prescription medications like antidepressants,
anti-epileptics, steroids and topicals
Number 28 Begin seeing a physiotherapist, ideally someone who works with a pain clinic
Number 29 Receive mind-body therapies, ideally from a trained pain psychologist
Number 30 If opioids are indicated for pain after a risk assessment is performed, have a
plan with your doctor, review risks and benefits and ensure that you are taking the medication
only as prescribed with specific realist goals as determined by you and your doctor.
I hope you enjoyed this summary of a year-long campaign to increase
awareness about how to prevent chronic pain and stimulate discussion among clinicians,
educators, scientists, patients, caregivers, and policy makers around this very important topic.
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Please remember that this video is for educational purposes only,
and that if you have an urgent condition or pain, please consult your nearest emergency department.
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Bye