Addressing the Repair Deficits That Underlie Chronic Pain

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Roughly one in five people suffer from chronic pain of some sort. It is one of the leading causes of disability, reduced productivity, and escalating medical care costs. 

While pain is often multifactorial, there’s a lot we as clinicians can do to help our chronic pain patients once we understand the relationship between inflammation, repair deficit, and the symptoms patients are experiencing.

The Cleveland Clinic defines pain simply as a sign that something is wrong somewhere in the body. Acute pain arises quickly and resolves quickly once the pain stimulus ends or is removed. Chronic pain is pain that persists for longer than six months stretching into years. While many disease states can cause chronic pain, so can injury, and psychological factors. Often, it’s a complete mix of causes.  

Persisting inflammation means there are accumulating repair deficits. The body continues to call for pro-inflammatory responses, even as the immune system machinery is unable to resolve the initial problem. The result is a self-reinforcing cycle of tissue damage.

Since there are usually multiple factors, it can be difficult to identify and treat the “root” cause, especially in cases where pain has persisted for years.

Inflammation & Repair Deficit

Inflammation is a factor in most if not all chronic pain cases, and from a treatment perspective, it’s a good place to start.

Most pain syndromes have an inflammatory profile, whether its rheumatoid arthritis, fibromyalgia, migraines, or interstitial cystitis, to name just a few common conditions. Irrespective of the characteristic of the pain, whether it is sharp, dull, aching, burning, stabbing, numbing, or tingling, it is safe to say that inflammation and inflammatory responses are at work.

But it is important to understand that chronic inflammation occurs when repair deficits persist.  What do we mean?

Think of it like this: following an injury or tissue damage following an infection, the body calls for defense and then repair. But in many people—especially older people or those with poor health status–the first-responder team is unable to complete the defense and repair mission. Recruits are called, via pro-inflammatory signals e.g., cytokines. Typically, in a healthy individual, those urgent signals will diminish as the body heals, and inflammation will subside.

Persisting inflammation means there are accumulating repair deficits. The body continues to call for pro-inflammatory responses, even as the immune system machinery is unable to resolve the initial problem. The result is a self-reinforcing cycle of tissue damage.

Over time, this ongoing unresolved inflammatory response can damage healthy cells and organs, causing constant pain in muscles, tissues, and joints. Silent or unappreciated inflammation is due to loss of tolerance and homeostasis in the immune defense and repair system.

Persisting inflammation means there are accumulating repair deficits. The body continues to call for pro-inflammatory responses, even as the immune system machinery is unable to resolve the initial problem. The result is a self-reinforcing cycle of tissue damage.

Repair deficits account for more than two thirds of all chronic disease including metabolic syndrome, diabetes, heart disease, Alzheimer’s neurodegeneration, autoimmune conditions, and some forms of cancer. Chronic inflammation is quite naturally considered one of the major underlying causes of conditions such as fibromyalgia, chronic low back pain, rheumatoid arthritis, myofascial pain syndrome, and osteoarthritis.

So what can we do?  Here are our top three lifestyle tips to minimize pain:

  • Plant-Based Diet: There’s ample research to show that a plant-based diet can improve the status of those with chronic pain and disability associated with musculoskeletal conditions.  One reason for this is that over time a vegetable-rich diet will tend to alkalinize the body, which reduces inflammation. The pH status can be a guiding light for knowing whether the body is in acid alkaline balance. We recommend that patients aim to maintain a healthy first morning urine pH – between 6.5 and 7.5.
  • Drink Water: Hydrate, hydrate, hydrate! Slacking on those 8 glasses a day of water can be costly. Not drinking enough may increase pain sensitivity.  In a 2016 study, voluntary hypohydration altered pain thresholds and increased pain perception in a cohort of 17 healthy male subjects.  Drinking enough water can also keep joints healthy and well-lubricated. It also flushes out unwanted toxins and irritants that can cause an undue burden on all of the body’s systems.  
  • Integrate Mind and Body: The mind, emotions, and attention play an important role in the experience of pain. Generally, movement-based practices like yoga, Tai chi, even walking, are helpful for people with chronic pain, provided they are undertaken carefully. It is even better if the mind is involved as well. Somatic education techniques like Feldenkrais and Alexander can be particularly helpful in reducing chronic pain. By becoming aware of how one’s body interacts with its surroundings, it becomes possible to relinquish habitual movement patterns that cause or contribute to chronic pain. Other helpful mind-body approaches include progressive muscle relaxation, meditation, laughter, mindfulness meditation, hypnosis, guided imagery, biofeedback, and cognitive behavioral therapy. 

Helpful Supplements

There are many botanical and nutritional supplements that can be helpful for patients with chronic pain. Here are four must-haves: 

  • Polyphenols: This group of plant compounds includes flavonoids like quercetin dihydrate and flavanols like oligomeric proanthocyanidins (OPC). They are linked to improved cognitive health and mental function.  They also have a profound antioxidant function and can decrease the extent of inflammation. All of this is very helpful for someone who is fraught with pain.
  • Magnesium and Choline Citrate: Magnesium is a grossly under-recognized and under-utilized nutrient. It affects many different physiological systems, and it is so versatile in its function. In the context of pain, magnesium decreases nerve pain and since it offsets the effects of calcium, it acts as a muscle relaxant and helps with muscular pain as well. Magnesium deficiency is often what leads to muscle stiffness and cramps.  I recommend magnesium citrate glycinate and ascorbate, taken along with choline citrate, which optimizes magnesium absorption.Beyond pain itself, magnesium helps to mitigate anxiety, insomnia, chronic stress, and systemic inflammation.
  • Omega-3 Fatty Acids: EPA and DHA can naturally help reduce pro- inflammatory signals that play a role in pain. They’re helpful in decreasing  the intensity of joint pain and stiffness in rheumatoid arthritis, neck, and back pain, as well as pain caused by inflammatory bowel disease and menstrual cramps.
  • Vitamin B12: This is a must for anyone with pain, especially of the neuropathic type. As detailed in a recent systematic review, B12 can alleviate pain by a number of mechanisms: it promotes myelination, increases nerve regeneration and decreases ectopic nerve firing. We recommend using the hydroxocobalamin form of B12.  

Chronic pain is undoubtedly a complex situation. Some patients may need interventions beyond what we’ve covered here. But we have found that the recommendations above can help many people effectively navigate their way to significant pain relief, better overall health, and improved wellbeing.  

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