By: Susan Geiger, PT, DPT
Persistent pain and chronic stress are often two sides of the same coin. Chronic stress leads to a chemical change in our body related to cortisol that can lead to increased inflammation and enhanced fear-based stress responses. Stress is linked to fibromyalgia, chronic fatigue syndrome, chronic pelvic and low back pain.
First steps to addressing chronic stress (and therefore pain, in some cases) are lifestyle interventions including physical exercise, patient education, and mindfulness-based stress reduction. This is where a physical therapist, who is a movement specialist, can help!
One major lifestyle education piece of the chronic pain puzzle is “sleep hygiene”. Sleep dysfunction has high prevalence in chronic pain. When you experience poor quality sleep, you tend to be more reactive to stressful situations. On the other hand, good sleep quality or restorative sleep, seems protective against future stressful/painful situations. Here are some goals for good sleep hygiene:
Sleep quantity: aim for 7-9 hours of sleep
Sleep quality = (total sleep time – time to fall asleep – time awake during the night) / total time asleep
Goal of >85%
Tips for improved sleep quality
Have a set sleep/wake time (even on the weekends!)
Avoid naps
No caffeine after 2pm
Avoid alcohol within 3 hours of sleep and avoid smoking, especially in the evening
Exercise is good, but not within 3-4 hours of sleep
Avoid screen time 90 min before sleep
Don’t force sleep – if you are unable to fall asleep after 10-15 min, leave the room and sit in the dark/read book etc (no screens!)
Get 15 minutes of morning sun to help regulate melatonin and circadian rhythm.
Mindfulness-based stress reduction (MBSR) strategies/interventions including breath work also help manage and reduce stress. A study by Cherkin in 2016 showed MBSR resulted in at least 15% more patients experiencing clinically meaningful improvement in back pain compared to usual care. In that same study, the success rates were nearly equal to those that participated in cognitive behavioral therapy with a licensed therapist.
Breath work examples include:
‘Square breathing’ which involves breathing in, holding, breathing out, holding all for the same count. Think ‘breathe in 2 seconds, hold for 2 seconds, breathe out 2 seconds, and hold for 2 seconds’ and continue that in repetition.
‘Diaphragmatic breathing’ is another way to learn how to control where your breath is coming from. This technique is best thought about as ‘belly breathing’ to start, thinking about your belly rising when you breathe in instead of your rib cage or chest.
These strategies can be utilized during stressful situations and to prepare for bed. Our therapists can help you utilize these MBSR techniques in conjunction with providing graded exposure through painful movements/range of motion as a part of your program to better manage pain.
If you are struggling with chronic and persistent pain don’t keep thinking “Oh, it will get better.” Schedule an appointment with one of physical or occupational therapist and start addressing your chronic pain today.