Why is pain so exhausting?
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One of the most common feelings associated with persisting pain is fatigue and this fatigue can become overwhelming. People with chronic pain can report being drained of energy and motivation to engage with others or the world around them.
In fact, a study from the United Kingdom on people with long-term health conditions found pain and fatigue are the two biggest barriers to an active and meaningful life.
But why is long-term pain so exhausting? One clue is the nature of pain and its powerful effect on our thoughts and behaviours.
Short-term pain can protect you
Modern ways of thinking about pain emphasise its protective effect – the way it grabs your attention and compels you to change your behaviour to keep a body part safe.
Try this. Slowly pinch your skin. As you increase the pressure, you’ll notice the feeling changes until, at some point, it becomes painful. It is the pain that stops you squeezing harder, right? In this way, pain protects us.
When we are injured, tissue damage or inflammation makes our pain system become more sensitive. This pain stops us from mechanically loading the damaged tissue while it heals. For instance, the pain of a broken leg or a cut under our foot means we avoid walking on it.
The concept that “pain protects us and promotes healing” is one of the most important things people who were in chronic pain tell us they learned that helped them recover.
But long-term pain can overprotect you
In the short term, pain does a terrific job of protecting us and the longer our pain system is active, the more protective it becomes.
But persistent pain can overprotect us and prevent recovery. People in pain have called this “pain system hypersensitivity”. Think of this as your pain system being on red alert. And this is where exhaustion comes in.
When pain becomes a daily experience, triggered or amplified by a widening range of activities, contexts and cues, it becomes a constant drain on one’s resources. Going about life with pain requires substantial and constant effort, and this makes us fatigued.
About 80% of us are lucky enough to not know what it is like to have pain, day in day out, for months or years. But take a moment to imagine what it would be like.
Imagine having to concentrate hard, to muster energy and use distraction techniques, just to go about your everyday tasks, let alone to complete work, caring or other duties.
Whenever you are in pain, you are faced with a choice of whether, and how, to act on it. Constantly making this choice requires thought, effort and strategy.
Mentioning your pain, or explaining its impact on each moment, task or activity, is also tiring and difficult to get across when no-one else can see or feel your pain. For those who do listen, it can become tedious, draining or worrying.
No wonder pain is exhausting
In chronic pain, it’s not just the pain system on red alert. Increased inflammation throughout the body (the immune system on red alert), disrupted output of the hormone cortisol (the endocrine system on red alert), and stiff and guarded movements (the motor system on red alert) also go hand in hand with chronic pain.
Each of these adds to fatigue and exhaustion. So learning how to manage and resolve chronic pain often includes learning how to best manage the over-activation of these systems.
Loss of sleep is also a factor in both fatigue and pain. Pain causes disruptions to sleep, and loss of sleep contributes to pain.
In other words, chronic pain is seldom “just” pain. No wonder being in long-term pain can become all-consuming and exhausting.
What actually works?
People with chronic pain are stigmatised, dismissed and misunderstood, which can lead to them not getting the care they need. Ongoing pain may prevent people working, limit their socialising and impact their relationships. This can lead to a descending spiral of social, personal and economic disadvantage.
So we need better access to evidence-based care, with high-quality education for people with chronic pain.
There is good news here though. Modern care for chronic pain, which is grounded in first gaining a modern understanding of the underlying biology of chronic pain, helps.
The key seems to be recognising, and accepting, that a hypersensitive pain system is a key player in chronic pain. This makes a quick fix highly unlikely but a program of gradual change – perhaps over months or even years – promising.
Understanding how pain works, how persisting pain becomes overprotective, how our brains and bodies adapt to training, and then learning new skills and strategies to gradually retrain both brain and body, offers scientifically based hope; there’s strong supportive evidence from clinical trials.
Every bit of support helps
The best treatments we have for chronic pain take effort, patience, persistence, courage and often a good coach. All that is a pretty overwhelming proposition for someone already exhausted.
So, if you are in the 80% of the population without chronic pain, spare a thought for what’s required and support your colleague, friend, partner, child or parent as they take on the journey.
More information about chronic pain is available from Pain Revolution.
Michael Henry, Physiotherapist and PhD candidate, Body in Mind Research Group, University of South Australia and Lorimer Moseley, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Treadmill vs Road
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Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝Why do I get tired much more quickly running outside, than I do on the treadmill? Every time I get worn out quickly but at home I can go for much longer!❞
Short answer: the reason is Newton’s laws of motion.
In other words: on a treadmill, you need only maintain your position in space relative the the Earth while the treadmill moves beneath you, whereas on the road, you need to push against the Earth with sufficient force to move it relative to your body.
Illustrative thought experiment to make that clearer: if you were to stand on a treadmill with roller skates, and hold onto the bar with even just one finger, you would maintain your speed as far as the treadmill’s computer is concerned—whereas to maintain your speed on a flat road, you’d still need to push with your back foot every few yards or so.
More interesting answer: it’s a qualitatively different exercise (i.e. not just quantitively different). This is because of all that pushing you’re having to do on the road, while on a treadmill, the only pushing you have to do is just enough to counteract gravity (i.e. to keep you upright).
As such, both forms of running are a cardio exercise (because simply moving your legs quickly, even without having to apply much force, is still something that requires oxygenated blood feeding the muscles), but road-running adds an extra element of resistance exercise for the muscles of your lower body. Thus, road-running will enable you to build-maintain muscle much more than treadmill-running will.
Some extra things to bear in mind, however:
1) You can increase the resistance work for either form of running, by adding weight (such as by wearing a weight vest):
Weight Vests Against Osteoporosis: Do They Really Build Bone?
…and while road-running will still be the superior form of resistance work (for the reasons we outlined above), adding a weight vest will still be improving your stabilization muscles, just as it would if you were standing still while holding the weight up.
2) Stationary cycling does not have the same physics differences as stationary running. By this we mean: an exercise bike will require your muscles to do just as much pushing as they would on a road. This makes stationary cycling an excellent choice for high intensity resistance training (HIRT):
3) The best form of exercise is the one that you will actually do. Thus, when it’s raining sidewise outside, a treadmill inside will get exercise done better than no running at all. Similarly, a treadmill exercise session takes a lot less preparation (“switch it on”) than a running session outside (“get dressed appropriately for the weather, apply sunscreen if necessary, remember to bring water, etc etc”), and thus is also much more likely to actually occur. The ability to stop whenever one wants is also a reassuring factor that makes one much more likely to start. See for example:
How To Do HIIT (Without Wrecking Your Body)
Take care!
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What does it mean to be immunocompromised?
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Our immune systems help us fight off disease, but certain health conditions and medications can weaken our immune systems. People whose immune systems don’t work as well as they should are considered immunocompromised.
Read on to learn more about how the immune system works, what causes people to be immunocompromised, and how we can protect ourselves and the immunocompromised people around us from illness.
What is the immune system?
The immune system is a network of cells, organs, and chemicals that helps our bodies fight off infections caused by invaders, such as bacteria, viruses, fungi, and parasites.
Some important parts of the immune system include:
- White blood cells, which attack and kill germs that don’t belong inside our bodies.
- Lymph nodes, which help our bodies filter out germs.
- Antibodies, which help our bodies recognize invaders.
- Cytokines, which tell our immune cells what to do.
What causes people to be immunocompromised?
Some health conditions and medications can prevent our immune systems from functioning optimally, which makes us more vulnerable to infection. Health conditions that compromise the immune system fall into two categories: primary immunodeficiency and secondary immunodeficiency.
Primary immunodeficiency
People with primary immunodeficiency are born with genetic mutations that prevent their immune systems from functioning as they should. There are hundreds of types of primary immunodeficiencies. Since these mutations affect the immune system to varying degrees, some people may experience symptoms and get diagnosed early in life, while others may not know they’re immunocompromised until adulthood.
Secondary immunodeficiency
Secondary immunodeficiency happens later in life due to an infection like HIV, which weakens the immune system over time, or certain types of cancer, which prevent the body from producing enough white blood cells to adequately fight off infection. Studies have also shown that getting infected with COVID-19 may cause immunodeficiency by reducing our production of “killer T-cells,” which help fight off infections.
Sometimes necessary treatments for certain medical conditions can also cause secondary immunodeficiency. For example, people with autoimmune disorders—which cause the immune system to become overactive and attack healthy cells—may need to take immunosuppressant drugs to manage their symptoms. However, the drugs can make them more vulnerable to infection.
People who receive organ transplants may also need to take immunosuppressant medications for life to prevent their body from rejecting the new organ. (Given the risk of infection, scientists continue to research alternative ways for the immune system to tolerate transplantation.)
Chemotherapy for cancer patients can also cause secondary immunodeficiency because it kills the immune system’s white blood cells as it’s trying to kill cancer cells.
What are the symptoms of a compromised immune system?
People who are immunocompromised may become sick more frequently than others or may experience more severe or longer-term symptoms than others who contract the same disease.
Other symptoms of a compromised immune system may include fatigue; digestive problems like cramping, nausea, and diarrhea; and slow wound healing.
How can I find out if I’m immunocompromised?
If you think you may be immunocompromised, talk to your health care provider about your medical history, your symptoms, and any medications you take. Blood tests can determine whether your immune system is producing adequate proteins and cells to fight off infection.
I’m immunocompromised—how can I protect myself from infection?
If you’re immunocompromised, take precautions to protect yourself from illness.
Wash your hands regularly, wear a well-fitting mask around others to protect against respiratory viruses, and ensure that you’re up to date on recommended vaccines.
Immunocompromised people may need more doses of vaccines than people who are not immunocompromised—including COVID-19 vaccines. Talk to your health care provider about which vaccines you need.
How can I protect the immunocompromised people around me?
You never know who may be immunocompromised. The best way to protect immunocompromised people around you is to avoid spreading illnesses.
If you know you’re sick, isolate whenever possible. Wear a well-fitting mask around others—especially if you know that you’re sick or that you’ve been exposed to germs. Make sure you’re up to date on recommended vaccines, and practice regular hand-washing.
If you’re planning to spend time with someone who is immunocompromised, ask them what steps you can take to keep them safe.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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10 Ways To Lower Blood Pressure Naturally
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Increasingly many people, especially over a certain age, are taking so many medications that it precipitates a train of other medications to deal with the side effects of the previous ones. This is neither fun nor healthy. Of course, sometimes it’s a necessity, but often it’s not, so if you’d like to avoid blood pressure meds, here are some good first-line things, as recommended by Dr. Siobhan Deshauer:
No-med options
Dr. Deshauer recommends:
- Diet: follow the DASH diet by eating whole foods, lean / plant-based proteins, and reducing salt and processed foods to lower blood pressure by 5–6 points.
- Sodium reduction: limit sodium intake to 2g/day, focusing on reducing processed foods, which account for 80% of sodium consumption.
- Increase potassium intake: eat potassium-rich foods (e.g. fruit, vegetables) to lower blood pressure by 5–7 points but consult a doctor if you have kidney issues or take certain medications.
- Exercise: engage in isometric exercises like wall squats or planks, which lower systolic pressure by up to 8 points; any exercise is beneficial.
- Weight loss: lose weight (specifically: fat) if (and only if!) carrying excess fat, as each 1 kg (2.2 lbs) excess adiposity reduction can decrease blood pressure by 1 point.
- Limit alcohol: avoid consuming more than two alcoholic drinks per day, as it raises blood pressure.
- Quit smoking: stop smoking to prevent increased blood pressure and long-term vessel damage caused by nicotine.
- Improve sleep: aim for at least 6 hours of sleep per night, ideally 7–9, and seek medical advice if you suspect sleep apnea.
- Manage stress: adopt healthy stress management strategies to avoid the indirect effects of stress on blood pressure.
- Adopt a pet: pet ownership, particularly dogs, can lower blood pressure more effectively than some medications.
For more on each of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Ideal Blood Pressure Numbers Explained
Take care!
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Rushing Woman’s Syndrome – by Dr. Libby Weaver
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It’s well-known that very many women suffer from “the triple burden” of professional work, housework, and childcare. And it’s not even necessarily that we resent any of those things or feel like they’re a burden; we (hopefully) love our professions, homes, children. But, here’s the thing: no amount of love will add extra hours to the day!
On the psychological level, a lot is about making more conscious decisions and fewer automatic reactions. For example, everyone wants everything from us right now, if not by yesterday, but when do they need it? And, is it even our responsibility? Not everything is, and many of us take on more than we should in our effort to be “enough”.
On the physical level, she covers hormones, including the menstrual/menopausal and the metabolic, as well as liver health, digestive issues, and sleep.
The style is direct and friendly, making frequent references to science but not getting deep into it.
It’s worth noting that while she acknowledges other demographics exist, she’s writing mainly for an audience of otherwise healthy straight white women with children and at least moderate financial resources, so if you fall outside of those things, there may be things that society will penalize you for and expect more from you in return for less, so that is a limitation of the book.
Bottom line: if the above describes you, you will probably get value out of this book.
Click here to check out Rushing Woman’s Syndrome, and take care of yourself too!
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Frozen/Thawed/Refrozen Meat: How Much Is Safety, And How Much Is Taste?
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What You Can (And Can’t) Safely Do With Frozen Meat
Yesterday, we asked you:
❝You have meat in the freezer. How long is it really safe to keep it?❞
…and got a range of answers, mostly indicating to a) follow the instructions (a very safe general policy) and b) do not refreeze if thawed because that would be unsafe. Fewer respondents indicated that meat could be kept for much longer than guidelines say, or conversely, that it should only be kept for weeks or less.
So, what does the science say?
Meat can be kept indefinitely (for all intents and purposes) in a freezer; it just might get tougher: True or False?
False, assuming we are talking about a normal household electrical freezer that bottoms out at about -18℃ / 0℉.
Fun fact: cryobiologists cryopreserve tissue samples (so basically, meat) at -196℃ / -320℉, and down at those temperatures, the tissues will last a lot longer than you will (and, for all practical purposes: indefinitely). There are other complications with doing so (such as getting the sample through the glass transition point without cracking it during the vitrification process) but those are beyond the scope of this article.
If you remember back to your physics or perhaps chemistry classes at school, you’ll know that molecules move more quickly at higher temperatures, and more slowly at lower ones, only approaching true stillness as they near absolute zero (-273℃ / -459℉ / 0K ← we’re not saying it’s ok, although it is; rather, that is zero kelvin; no degree sign is used with kelvins)
That means that when food is frozen, the internal processes aren’t truly paused; it’s just slowed to a point of near imperceptibility.
So, all the way up at the relatively warm temperatures of a household freezer, a lot of processes are still going on.
What this means in practical terms: those guidelines saying “keep in the freezer for up to 4 months”, “keep in the freezer for up to 9 months”, “keep in the freezer for up to 12 months” etc are being honest with you.
More or less, anyway! They’ll usually underestimate a little to be on the safe side—but so should you.
Bad things start happening within weeks at most: True or False?
False, for all practical purposes. Again, assuming a normal and properly-working household freezer as described above.
(True, technically but misleadingly: the bad things never stopped; they just slowed down to a near imperceptible pace—again, as described above)
By “bad” here we should clarify we mean “dangerous”. One subscriber wrote:
❝Meat starts losing color and flavor after being in the freezer for too long. I keep meat in the freezer for about 2 months at the most❞
…and as a matter of taste, that’s fair enough!
It is unsafe to refreeze meat that has been thawed: True or False?
False! Assuming it has otherwise been kept chilled, just the same as for fresh meat.
Food poisoning comes from bacteria, and there is nothing about the meat previously having been frozen that will make it now have more bacteria.
That means, for example…
- if it was thawed (but chilled) for a period of time, treat it like you would any other meat that has been chilled for that period of time (so probably: use it or freeze it, unless it’s been more than a few days)
- if it was thawed (and at room temperature) for a period of time, treat it like you would any other meat that has been at room temperature for that period of time (so probably: throw it out, unless the period of time is very small indeed)
The USDA gives for 2 hours max at room temperature before considering it unsalvageable, by the way.
However! Whenever you freeze meat (or almost anything with cells, really), ice crystals will form in and between cells. How much ice crystallization occurs depends on several variables, with how much water there is present in the food is usually the biggest factor (remember that animal cells are—just like us—mostly water).
Those ice crystals will damage the cell walls, causing the food to lose structural integrity. When you thaw it out, the ice crystals will disappear but the damage will be left behind (this is what “freezer burn” is).
So if your food seems a little “squishy” after having been frozen and thawed, that’s why. It’s not rotten; it’s just been stabbed countless times on a microscopic level.
The more times you freeze and thaw and refreeze food, the more this will happen. Your food will degrade in structural integrity each time, but the safety of it won’t have changed meaningfully.
Want to know more?
Further reading:
You can thaw and refreeze meat: five food safety myths busted
Take care!
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Five Advance Warnings of Multiple Sclerosis
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Five Advance Warnings of Multiple Sclerosis
First things first, a quick check-in with regard to how much you know about multiple sclerosis (MS):
- Do you know what causes it?
- Do you know how it happens?
- Do you know how it can be fixed?
If your answer to the above questions is “no”, then take solace in the fact that modern science doesn’t know either.
What we do know is that it’s an autoimmune condition, and that it results in the degradation of myelin, the “insulator” of nerves, in the central nervous system.
- How exactly this is brought about remains unclear, though there are several leading hypotheses including autoimmune attack of myelin itself, or disruption to the production of myelin.
- Treatments look to reduce/mitigate inflammation, and/or treat other symptoms (which are many and various) on an as-needed basis.
If you’re wondering about the prognosis after diagnosis, the scientific consensus on that is also “we don’t know”:
Read: Personalized medicine in multiple sclerosis: hope or reality?
this paper, like every other one we considered putting in that spot, concludes with basically begging for research to be done to identify biomarkers in a useful fashion that could help classify many distinct forms of MS, rather than the current “you have MS, but who knows what that will mean for you personally because it’s so varied” approach.
The Five Advance Warning Signs
Something we do know! First, we’ll quote directly the researchers’ conclusion:
❝We identified 5 health conditions associated with subsequent MS diagnosis, which may be considered not only prodromal but also early-stage symptoms.
However, these health conditions overlap with prodrome of two other autoimmune diseases, hence they lack specificity to MS.❞
So, these things are a warning, five alarm bells, but not necessarily diagnostic criteria.
Without further ado, the five things are:
- depression
- sexual disorders
- constipation
- cystitis
- urinary tract infections
❝This association was sufficiently robust at the statistical level for us to state that these are early clinical warning signs, probably related to damage to the nervous system, in patients who will later be diagnosed with multiple sclerosis.
The overrepresentation of these symptoms persisted and even increased over the five years after diagnosis.❞
Read the paper for yourself:
Hot off the press! Published only yesterday!
Want to know more about MS?
Here’s a very comprehensive guide:
National clinical guideline for diagnosis and management of multiple sclerosis
Take care!
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