Hello and welcome to Airing Pain, a programme brought to you by Pain Concern, a UK charity that provides information and support for those who live with pain. Pain Concern was awarded first prize in the 2009 NAP Awards in Chronic Pain and with additional funding from the Big Lottery Fund's Awards for All programme and the Voluntary Action Fund Community Chest, this has enabled us to make these programmes. I'm Paul Evans, and each fortnight Airing Pain will look at the topics that affect us. The coping mechanisms, medical interventions and therapies that might help us regain control of our lives. And in today's programme... People need to think carefully about what they're eating. Not only the contents of what they're eating, but how many times a day they eat. It really was made plain to me that my situation was incurable. And so whether I was going to have a good life or a life full of distress and suffering was partially dependent on whether I was willing to take responsibility for how I lived. Some are the older people with arthritic pain.
do find it difficult to do the exercises, and yet there are others, and I can name one who's 86 years old, who religiously does her exercises every day in bed before she gets up, and she knows the benefit of it. More on those stories coming up. But first a word of caution, that whilst we believe the information and opinions on airing pain are accurate, based on the best judgments available, you should always consult your health professional on any matter relating to your health and well-being. He or she is the only person who knows you and your circumstances, and therefore the appropriate action to take on your behalf. Now bearing that in mind, one of our aims on airing pain is to find answers to questions you've raised with us. So please do take advantage of this opportunity to connect with our experts via our message board, email and not forgetting pen and paper. The first question today is about back pain. My doctors told me that I will be in less pain if I lose weight. Now will I? And why? Today's expert is consultant anaesthetist and pain specialist, Dr Mark Turtle. A large variety of effects tends to reduce a person's self-esteem. Being overweight, also overweight, can have an adverse effect on the overall situation and therefore make the person less tolerant.
And it's often suggested that there is a relationship between weight and spinal cord, not a straight-line relationship. And nobody who is a little bit will not have, and somebody who's excessively... In fact, what happens is that if you look at the instances, and then the increase in pain goes up excessively, unless you are quite markedly overweight. Now, quite apart from this evidence, it does seem that somebody might lose a bit of weight. It's the only structure which is the top part of the body. The top part of the body weighs less. And therefore, one would assume the final comment is that the evidence shows that levels of activity, that makes them worse.
That's consultant anaesthetist and pain management specialist Dr Mark Turtle. He's also president of the Welsh Pain Society. Later in the programme we'll be talking about nutrition and its role in pain management. But staying with lower back pain and physical activity for the moment, Ron Parsons lives with this condition and he's also patient representative to the Fife Pain Management Committee. I've got a lower back problem, which is basically fair wear and tear, probably from an old rugby injury. I've also got upper back fair wear and tear, which is causing pain in the neck and shoulder areas. And just over 18 months ago I broke a wrist badly.
which is turning arthritic now. First thing in the morning, it's very, very stiff. What I did originally was went to a chiropractor with a lower back problem because it was really getting very painful. He did a good job on me, but then advised me that if I wanted to keep the back in as good a condition as it could possibly be, that I'd have to go through a fairly serenuous set of exercises daily. which I have done religiously for 20 years. I still am quite painful first thing in the morning. Once I've done the workout, I can manage the day. I still get twinges, but I'm able to play golf and really participate in all the sports I want to. First of all, I do a light warm-up in the morning just to get the body moving and get the body warm. And then I go through a series of about...
13, 14 stretching exercises, exercising different aspects of the lower back. There are a whole lot, I mean, it's a set of about 14 exercises and the whole thing with the warm-up takes me about 35 minutes. I also now, of course, have started doing exercising on the wrist as well and the neck. And the neck is more, again, a series of six exercises with the neck followed by a relaxation exercise. So my whole exercise routine for the hand and the neck at the back now works out to be about 50 minutes every morning.
You're listening to Airing Pain, presented this week by me, Paul Evans, and brought to you by Pain Concern, a UK charity providing information and support for people who live with pain, and also for those who care for and about us. You'll hear about the importance of physical activity many times during the course of these programmes, but another keystone of a self-help pain management regime is diet. Ray Bell is head of the multidisciplinary clinic at Hoekland University Hospital, Bergen in Norway. Clinicians should start to examine their pain patients' diets because this hasn't been the usual workup for a chronic pain patient. I know that my colleagues at the pain clinic at Hoekland in Norway initially were rather sceptical, but they also began to ask their patients what they ate, and the first thing they discovered was the same that I had noted, that many patients have poor diets. Many of our patients are depressed, they don't feel like making food, they don't earn a lot of money, so they can't buy.
everything they want to eat. And so it's especially important, I think, that chronic pain patients have a good, healthy, balanced diet. And there are several reasons for this. Firstly, the nervous system has the capacity to dampen pain. I'm sure most people have heard of the body's own morphine-like substances called endorphins. In order to be able to function optimally, the nervous system requires specific nutrients, such as essential amino acids. There's one called tryptophan, which is very important in the body's own pain-dampening systems.
And tryptophan is found in chicken and seafood, turkey, avocados, bananas. That's just sort of an example. So on the very basic level, the nervous system needs nutrients. We know that specific vitamin deficiencies can cause pain problems. For example, vitamin B12 deficiency can cause a very unpleasant peripheral polyneuropathy, which is nerve pain in the feet and also possibly in the hands. Vitamin D deficiency can cause diffuse musculoskeletal pain. Now the media is full of claim and counterclaim of what is and what isn't good for us.
So what should we know about food before believing the headlines? I think it's really important that common sense is involved when considering what kind of food we should eat because we are bombarded with a jungle of misinformation and lots of weird diets, and I don't think pain patients should be on weird diets. The World Health Organization published a report in 2003 where they described how... There's been a huge change globally, moving from predominantly plant-based foods to high-energy foods. And they were especially focusing on the balance between the intake of omega-3 fatty acids and omega-6 fatty acids. And the ideal ratio in these fatty acids is 4 to 1, 4 times the amount of omega-6 compared to omega-3. But in, for example, the average American diet today, the amount of omega-6 is around 15 to 25 times.
the amount of omega-3 intake. Omega-6 fatty acids are found in red meat, dairy products, and especially in, for example, soya oil. And soya oil is used to make a lot of fast foods and snacks. So that's, I think, the widespread use of soya oil has contributed to high levels of omega-6. Omega-3 is found in fatty fish, oily fish, also in flaxseed oil, flaxseed and walnuts. That's some examples of foodstuffs having relatively high levels of omega-3. And omega-6 has to do with inflammation. We need to have a certain supply of omega-6 because we need to be able to have inflammation in the body to heal injury. But if we get too much, that can create its own problems. And omega-3...
has an anti-inflammatory effect. So one aspect with regard to diet, and I think for pain patients, is to ensure that one has sufficient levels of omega-3 and that one reduces the amount of omega-6. And we'll stay with the subject of diet because it's so important and should be so easy to address in our lives as we try and manage our pain. Here's Ray Bell of Oakland University Hospital in Norway again. There are actually a number of foodstuffs that have been demonstrated to have anti-inflammatory effects, just like non-steroidal anti-inflammatory drugs. For example, in virgin olive oil, there's a substance called oleocanthal.
and it has been shown to have a similar effect to ibuprofen. And this is really interesting because non-steroidal anti-inflammatory drugs have a lot of adverse effects. So if we can achieve some of the same effect through our diet, that would be ideal. Now, if we think about antioxidants, antioxidants are found in many foodstuffs, and many antioxidants have anti-inflammatory effects. For example, resveratrol is an antioxidant which is formed in certain plants when they're under attack by bacteria or insects, and it's found in the skin of red grapes, and I'm sure everyone will be happy to know in red wine, and it has a powerful anti-inflammatory effect.
Other antioxidants are found in the reddy blue pigments, like blueberry skins and cherries. But the problem is that there's a lot of hype in the media. And when you watch television, there are lots of advertisements saying, buy this antioxidant product. But actually, you don't really need a huge intake. And the best way to get antioxidants is through the diet, not through pills. And I think most people know.
whether their diet is healthy or not. If we're busy, we're on the run, and we just have a little snack here and there, it's not good enough. We need to be getting vitamins, we need to be eating fish, more fish, less red meat, lots of fresh vegetables, green leafy, and brightly coloured vegetables, because it's the colour pigments which contain the antioxidants. So if you think of a colourful Mediterranean kind of diet, then you're on the right track. So that's what we should eat, but what should we avoid? Specific foodstuffs can increase pain.
I have some colleagues in France who are doing very good science on an area called polyamines, which is very interesting. Polyamines regulate a receptor in the nervous system which is involved in increasing pain. Orange juice contains very high levels of polyamines. That doesn't mean you should stop drinking orange juice. It just means you should think twice before drinking many glasses a day or huge numbers of oranges. Peanuts have quite high levels of polyamines. Then there's the whole question of coffee. For the chronic pain patient...
Coffee can disturb sleep. Maybe one knows about that. And when you have chronic pain and you sleep poorly, then you'll feel the pain more strongly. If it is consumed on a regular basis, it can increase risk of developing a chronic daily headache. It has interactions with analgesic drugs. It increases the effect of paracetamol and aspirin, and that's why it's used as what we call a co-analgesic. There are some pain-relieving drugs which contain caffeine. But caffeine has other attributes which are not beneficial at all, actually deleterious. High levels of caffeine are linked to osteoporosis. So if you drink more than six cups of coffee a day, your risk of developing osteoporosis is increased. And this is also the same for cola.
I'm amazed by how much cola my patients drink. And I have patients that drink regularly every day four litres of some kind of cola beverage. And cola contains phosphoric acid, caffeine and sugar. I mean, the taste might be nice, but it has nothing positive about it otherwise. And it can cause osteoporosis in the same way as drinking large amounts of coffee because it has such high caffeine levels. That was Ray Bell of Holtland University Hospital in Norway.
Back to our message board, and this is another question we've received. I've just finished a three-month course at a pain management clinic. I've had chronic pain for eight years, and it's taken me all that time and a new GP to get help. For five years, I was housebound and depressed. Why don't all GPs know about pain management, and why does it take so long to get help? Answering your questions today is Dr Mark Turtle, President of the Welsh Pain Society.
from health professionals and thinking in terms of understanding of the remedies are, how you manage it. It's not taught, for example, to any great degree. Tied up with it, often it's not a sort of conventional illness, people understand. It doesn't follow the medical model. What I mean by that is that somebody presents with a symptom, the health professional attributes it to a particular disease process, applies the appropriate remedy for that condition, and then expects the symptoms to disappear. The trouble is with chronic pain is that it often defines the cause, or we've got a lack of understanding and an inability sometimes to take, and maybe even disenfranchise, actually not know has a chronic pain problem. It is likely that it's going to have to be some sort of strain somewhere in the system.
Mark Total referred there to Cognitive Behavioral Therapy, or CBT. So what is that? Chris Main is Professor of Clinical Psychology at Keeley University, where he's researching how best to develop patient-centred approaches to care, particularly with people who have low back pain. Cognitive behavioural therapy is a way of looking at the patient and the situation they're in, looking at their beliefs about pain, looking at what they're actually doing. And it's surprising how often we're unaware of habits that we developed. We're all quite capable of building up good habits and bad habits. And I think that sometimes looking at this carefully, doing a bit of detective work perhaps on yourself, perhaps keeping a diary under some guidance, will help you identify things that you're doing that perhaps you weren't aware of.
I think more importantly, identifying things that are in fact unhelpful, almost superstitions that we have that are really not very useful. But the role of the professional in this situation is to offer some guidance in terms of their experience of working with people that have got pain and indeed in pain management programs for many years. We've built up patient stories of all sorts of different ways that people have caught with situations. And really the whole pain management movement has been developed on the basis of real concerns, real problems that patients actually have. We've known for a long time that showing people how to relax.
is helpful, can counteract muscle spasm, and surprisingly, can make people less tired. And there's clinics in the country which are teaching things like mindfulness, which patients find helpful. Not everyone, but certainly there's a proportion of people that are helped by various types of relaxation that help them to get rid of some of the stress in their bodies, because pain is a stressor. Now, Professor Chris Mayne mentioned clinics that offer mindfulness. What is mindfulness? Well, one of the organisations that offers training in this area is Breathworks. They run programmes for a wide variety of organisations, ranging from local authorities to NHS trusts.
Fidia Marlapowicz founded the organisation in 2001, and it's based on her own experience of living with chronic pain for the last 35 years. I was in hospital in New Zealand, in Auckland. I was very ill, had a big sort of personal crisis. And there were a few significant events in that time. One is that I had a terrible night. It was a real sort of dark night of the soul. And I thought, oh my God, you know, I just cannot get through till the morning. And then I had this other voice that came in that said to me very, very clearly, you don't have to get through till the morning, you just have to get through the moment. And my whole experience completely changed. I relaxed, I softened, and I thought, well, I can do that.
I can get through this moment and I can get through this moment and I can get through this moment. And that was such a personally significant experience that it changed my life. It completely changed my perspective on how I related to the past and how I related to the future. So rather than caught up in all these regrets about the past or anxieties about the future, I thought, well, that's all just in my head. The only thing that I'm really ever experiencing is just this moment. And I can do more than just survive this moment. I can live this moment fully. Another thing that happened during that time in hospital is they sent the chaplain to see me, I think, because they didn't quite know what to do with this young woman who had an incurable spinal injury.
and it was obvious that I needed help. So the chaplain was this lovely elder gentleman that came and sat by my bed and held my hand, and he asked me to visualise a time when I'd been happy and a place when I'd been happy. And so I went back to the mountains of New Zealand where I'd done a lot of climbing in my teens, and then he brought me back to my hospital bed. And that was also very significant because I felt totally different because of what I'd done with my mind. My actual experience of pain lying in a hospital bed hadn't changed at all. And yet my overall experience of myself as a human being had completely transformed by what I'd done with my mind. And I came out of hospital realising I had this huge tool at my disposal, which was my mind. So that's the background. But what is the central principle that Vidya Marla Birch and Breathworks is teaching? It's awareness. We're teaching people to be aware of their experience in the moment, physically, mentally and emotionally. And if you're aware of what's happening, you can then divide it up into two different components that we call primary and secondary suffering.
So in the case of my back pain, the primary suffering is the unpleasant sensations in my back and my legs and my neck and various other places as I'm sitting here. The secondary suffering are all the ways, if I'm not aware, that I react automatically to that primary suffering. So physically, it will be secondary tension. So because I've got these unpleasant sensations, I tense against them, makes my pain worse. I may have mental states which are unaware reactions to the pain, like catastrophizing, thinking, oh my God, when's it going to end? I can't bear it, I've had it forever, it's not fair, poor me, why me? Those kind of things. And the emotional secondary suffering will be things like fear, anxiety and depression. So we accept that an individual will have all these experiences going on, that's normal. But what we do is we encourage people to turn towards their experience, get to know it and then tease apart the primary and the secondary.
and then teach people how to accept the primary suffering, so to accept the unpleasant sensations that are unavoidable if you're living with chronic pain, but not to accept the secondary suffering. We teach people how to reduce or even overcome the secondary suffering, which is the fear and the anxiety, the catastrophizing, the secondary tension and so on. What we do on our courses is on the first week, we're very welcoming, we're very kind, and then we get everyone to lie down, those people that can, we get them to lie down, we pay attention to their comfort. Have you got the right height of pillow? Is it just right? Would you like a blanket? Would you like an eye bag? Would you like something under your knees to support your lower back? Et cetera, et cetera. And then we'll lead a body scan, which is this way of going through the body and just very, very gently, very, very gradually inviting awareness inside the body. And at the end of that, people have had an experience of accepting their pain. Because for most people, actually, it's such a relief to stop fighting. It's so exhausting running away from yourself all the time. Vidya Marla Buic of Breathworks. And mindfulness is something that might be relevant to the last of today's questioners on our message board.
I've been living with back pain for the past 10 years and I normally use relaxation to manage it. However, I find dental treatment very stressful and the pain of having fillings makes it absolutely impossible to relax and makes my pain a lot worse. What can you suggest I do? Dr Mark Turtle. Well done. You've obviously worked out ways in your problem. You've accepted that there's a difficulty which isn't going to evaporate. And you've demonstrated that there are strategies which you can employ to turn your situation into one that's tolerable. And I'm sure you can find some help to explain what you're doing to enable you to be uniquely unique. It is well recognised that people find they're going and visiting the dentist and yet without...
having a logical explanation. The first thing I would suggest is that you try and find somebody to give you a little bit of help in talking it through. So planning in advance is the key, is working out what you're going to do. Consciously, you have in the back of your mind a fear that you're some way towards being able to take that situation. Some people will find alternative practice. None of this really gets you anywhere, and it may be considered more than appropriate to be a sedative to take. You'd want to involve your dental practice. Dr Mark Turtle. And don't forget that Erin Payne is here to help you. So if you'd like to put a question to our panel of experts, then please do via Payne Concerns message board, email, or good old-fashioned pen and paper.
And you can download or subscribe to all the previous editions of Airing Pain from ableradio.com forward slash podcasts forward slash airing dash pain. And finally, I leave you with some sound advice from Ray Bell. Pain patients should be increasing the amount of omega-3, reducing the amount of omega-6, thinking of eating a colourful meal with fresh fruit and vegetables, cutting out cola, reducing the amount of coffee, don't drink coffee with caffeine in it after 12 in the middle of the day if you have sleep problems. People need to think carefully about what they're eating, not only the contents of what they're eating, but how many times a day they eat. I have a number of pain patients who...
perhaps only once or twice a day. And if you have a tension headache, that can be triggered or exacerbated by irregular eating too long intervals between meals. So we recommend that our patients eat three main meals and two light meals between the main meals, so that you're eating regularly through the day.