My treatment

One of the questions I often get asked is: "What is your treatment? And above all, how are you? "I would say that it is a legitimate question.

This blog was created on the wave of enthusiasm, after having understood that my well-being, born of having met the "biopsychosocial", multidimensional and science-based approach, was not temporary. The desire, therefore, was to tell those suffering from persistent pain, like me, that when following the path of the latest scientific discoveries, persistent pain is no longer a life sentence.

So, I'm fine. I feel good, according to my parameters. There is no one standard of "well-being" that is the same for everyone, but my pains, everyone, of any location, has decreased in intensity or frequency, while some pains and symptoms have completely disappeared.

In this journey it is necessary to keep in mind that one of the most difficult things to learn is that healing must be intentional. There is no day of grace when you wake up, suddenly freed😊 from all your suffering. Healing is a practice. You have to decide that it is what you want to do and do it actively. You have to make it a habit. Because unfortunately, to date, the pill to treat persistent pain does not exist.

Persistent pain can be managed by knowing its "pathophysiology": what it is, how it works, where it comes from. A famous neuroscientist / physiotherapist, Dr. Lorimer Moseley, says: "Know pain, or no gain". More or less: "Know pain, or you will not get any results": in short, only by knowing how the enemy works, you can defeat it.

On pain, science knows many things. To understand well what I do, but above all because, there are two fundamental concepts to keep in mind: neuroplasticity and central sensitization. On the contrary to what one might think, the nervous system is not immutable: it adapts to changes inside the body and in the surrounding environment. The ability of the brain and nervous system to adapt and change is called neuroplasticity. We all experience useful forms of neuroplasticity on a daily basis: learning to play an instrument, riding a bicycle, remembering the way back home ...Neuroplasticity also has disadvantages, and the development of chronic pain could be an example. In this case, neuroplasticity makes the brain and nervous system hypersensitive and hyperactive to stimuli, sensations, movements and normal activities, which should not cause any pain, so it is possible to feel harmless stimuli, movements or activities like painful sensations. This type of neuroplasticity could be subtended by the so-called "central sensitization".Central sensitization is a physiological phenomenon characterized by widespread hypersensitivity that results from an increased response in central neurons to receptor activity. A hypersensitive nervous system and immune cells (called "glia") release chemicals that increase the number of connections and signals whizzing through the brain and spinal cord. Because of this "raised volume", pain can be felt during activities and movements that should not normally cause pain. Pain can also be felt without moving, anywhere in the body. Central sensitization explains why people with persistent pain may experience pain when an x-ray or scan looks "normal". The good news is that neuroplasticity can be used to reprogram the way the nervous system responds to danger signals and how the brain interprets this as pain. The purpose of "pain management" is to reduce central sensitization, reduce pain, promote normal movement and daily activity and restore well-being. I apologize for the biblical premise, but as I said I need it to make sense of what I do.
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I go to the gym twice a week (and also to run, with little competence for now). Saying this, don't imagine me in the hands of personal trainers without skills on persistent pain. I have a strenght and conditioning coach that works with my physiotherapist. Do not even think that I do "gymnastics for old women". Quite the contrary. I became a discreet dock worker. But I started from scratch (Giacomo Leopardi level), with the movement administered scientifically, with the precision of a drug. The movement helps to lower the "volume of pain", allowing access to the "internal pharmacy" of the body, facilitates pain inhibiting systems, helps regulate sleep, reduces stress, improves mood and immune function. Movement and exercise act like drugs, if used well. The movement allows pain management by exploiting neuroplasticity to reprogram and reduce the danger signals in the hyperactive brain and nervous system. Sure, it is essential to proceed with "small steps": often, attempts conducted independently or without the help of competent people, result in exacerbations of pain and failures.
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I try to have adequate sleep hygiene (yes, all that stuff ... chamomile, classical music, reading a book ...). Insomnia can play an important role in persistent pain, because it is often impossible for people with chronic pain to access the third and fourth stages of the NREM phase of deep sleep, with the result that they experience a continuous sense of fatigue, drowsiness and unrefreshing sleep. The neurologist told me: "You must sleep, your body has not rested for years". Coming back to sleep has actually changed the things and the medications prescribed by my doctor (not benzodiazepines, so not common sleeping pills, which are not supposed to reach these NREM stages) have helped me a lot.
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I try to eat as best I can (I try, I admit, it's not my forte). Good nutrition is vital for general health and well-being. It should therefore not be surprising that nutrition can influence persistent pain. Every time we eat, we change the chemistry of our body. I try, as always, to simplify. The correct diet can help support the immune system by "turning it on and off" at the right time, while a poor diet can alter the immune system, which therefore acts abnormally and can contribute to low-grade persistent inflammation. Why are we interested in inflammation so much if we are talking about chronic pain and food? The molecules produced by the activity of the immune system, normally associated with infections, inflammations and lesions, stimulate the nerve endings (nociception). Information is sent to the spinal cord and to the brain to be taken into consideration, where the experience of pain may or may not be generated (but probably will be). How a healthy diet directly aids the immune system is still not entirely clear, however, some evidence suggests that deficiencies in various micronutrients - such as zinc, selenium, iron, folic acid and vitamins A, B6, C and E, can alter the features of the immune system and cause chronic inflammation that can determine and sustain chronic pain. The best dietary approach to help the immune system, and thus help reduce chronic inflammation, and consequently pain, is to eliminate inflammatory foods and adopt anti-inflammatory foods. These foods include many of the main foods of the Mediterranean diet, fruits, dark green leafy vegetables, nuts, legumes and whole grains. Scientific evidence suggests that foods rich in a group of antioxidants known as polyphenols can have an anti-inflammatory effect that helps soothe and prevent painful exacerbations. Polyphenols are found in many vegetables and in many fruits, and in other foods such as seeds and whole grains. The polyphenols are found in vegetables with a marked green and leaf color, as well as in fruits with a reddish color. Furthermore, green tea is an important resource of polyphenols, collecting in a single food more types of phenolic compounds. Following the seasonality and choosing vegetables and colored fruit allows you to fill up with polyphenols. Some research has suggested that the omega-3 fatty acids found in olive oil, flaxseed oil and fatty fish (such as salmon, sardines and mackerel) can help control inflammation. Ideally, junk food with low nutritional value, white bread, non-whole grain pasta and other foods rich in refined carbohydrates should be avoided as much as possible. Patients with chronic pain should prefer a high protein diet, this for some main reasons: endogenous analgesics (endorphins, dopamine, serotonin and γ-aminobutyric acid -GABA), are derivatives of proteins, also many protein foods, like fish and green vegetables, contain anti-inflammatory agents. If you want directions and a food plan that can help you alleviate and manage your symptoms, compare yourself to a specialized nutritionist for your problem, it will definitely help you a lot.
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I chatted about my pain with a shrink to increase my self-efficacy.
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I take specific drugs for the CNS.
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Every piece of the puzzle is crucial.
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Having said that, each person is different. What works for me is not said to work for everyone. We need the appropriate "customizations". There are other options, which I don't use on a daily basis, but which are there and are useful: meditation, hypnosis, yoga, a new hobby ... learning ways to manage the stress response, feelings of distress and reduce focus on pain persistent is vital.
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What I want you to know is that Pain Science exists, like those who know it. And those who know can seriously help us.

 

Sources:
Pelletier R, Higgins J, Bourbonnais Q. Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders? BMC musculoskeletal disorders 2015; 16: 25. PubMed #25887644
Siddall PJ. Neuroplasticity and pain: what does it all mean? The Medical journal of Australia 2013; 198 (4): 177-8. PubMed #23451946

www.painscience.com

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A Diet for Patients With Chronic Pain By Forest Tennant, on www.practicalpainmanagement.com

Combining pain therapy with lifestyle: SIMPAR Feed Your Destiny Approach Manuela De Gregori, Carolina Muscoli, Michael E Schatman, Tiziana Stallone, Fabio Intelligente, Mariangela Rondanelli, Francesco Franceschi, Laura Isabel Arranz, Silvia Lorente-Cebrián, Maurizio Salamone, Sara Ilari, Inna Belfer, and Massimo Allegri on J Pain Res. 2016; 9: 1179 – 1189. PubMed #5153285

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Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials James W. Daily, Mini Yang, and Sunmin Park on J Med Food. 2016 Aug 1; 19 (8): 717 – 729. PubMed #5003001

Chronic Insomnia and Pain. Under-reported and under-treated, chronic insomnia coexists with - and perpetuates - chronic pain, by Randall Lee Oliver, MD, April Taylor, RN, BSN, CDE and Rebecca Oliver on www.practicalpainmanagement.com

www.painhealth.csse.uwa.edu.au

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Exercise-induced pain and analgesia? Underlying mechanisms and clinical translation, by Kathleen A. Slukaa, Laura Frey-Lawa, Marie Hoeger Bementd, on PAIN, September 2018, Volume 159, Number 9, Supplement 1

Increasing Neuroplasticity to Bolster Chronic Pain Treatment: A Role for Intermittent Fasting and Glucose Administration? KT Sibille, F Bartsch, D Reddy, RB Fillingim, and A Keil on J Pain. 2016 Mar; 17 (3): 275 – 281 PubMed #4824292

Exercise, not to exercise, patients with chronic pain? Applying science to practice. Daenen L, Varkey E, Kellmann M, Nijs J. The Clinical journal of pain 2015; 31 (2): 108-14. PubMed #24662498