Widespread pain needs a widespread approach.
If you have pain in multiple areas of your body for no apparent cause, you could have a number of isolated injuries, but more likely, you need to start thinking systemically.
“What could be going on that could be triggering pain in so many areas without a specific injury?”
“What can I do to target all of these pains at the same time?”
The extreme of widespread pain is inflammatory arthritis. In this disease, your immune system confuses a particular tissue in your body as non-self and creates an immune response, causing inflammation in that tissue. A classic example of this is rheumatoid arthritis. In many cases, inflammatory arthritis can be measured by looking at inflammatory markers in the blood. However, widespread pain can exist without any measurable markers in the blood. Fibromyalgia is a classic example. This does not meant there isn’t something biological going on, but rather that we are not yet able to determine through what the cause is blood tests. Osteoarthritis can also effect multiple areas of the body at the same time, but the relationship between osteoarthritis and pain is inconsistent. Some people will suffer greatly with a low degree of osteoarthritis, and some people have significant osteoarthritis with nearly no pain at all.
Often, I’ll have a person sitting with me in the consult room, explaining their case of widespread pain. They will explain that the doctor has performed blood tests but nothing showed up. That’s often the end of the story. My immediate response to this is always that there has to be more to this person’s issues than a jumble of isolated pains. I want to find Australia’s best rheumatologist to organize an appointment for the person, in the hope of providing them with a diagnosis that explains their pain. But then I think, what would happen next? Either they would have an inflammatory arthritis confirmed and be prescribed some pretty nasty medications, or they will be told it’s “just osteo,” or “fibro”, or “polymyalgia.”
A better first line of action would be to answer the second question! “What can we do, right now, that can have an impact of the systemic health of the body, and target all of these pains at the same time?”
We can apply strategies that;
1. Are safe
2. Improve your overall well-being
3. May have a significant impact for some people
Diet
I'm going to start this with an obvious cliche... Water. Drink it. Simple. You know this! water carries healthy nutrients through your body and clears unwanted and foreign substances.
Researchers are doing loads of work to look at the potential role some food groups play at triggering inflammation in the body. But scientists don’t know what will trigger inflammation for YOU. So, one effecting way to consider this is to start writing notes about how you feel in the hours or days following certain foods. Over time, some patterns might start emerging. You may be perfectly tolerant of lactose but react to gluten, fructose, egg, or tomato… We are all different.
The extreme of this is an exclusion diet, where you start with a very restricted diet, then add food groups individually so you can specifically assess your reaction to each food group. This approach is great but very difficult and you certainly need to seek the help of a good dietitian if you’re even thinking of something like that.
The effect that a high sugar diet has on inflammatory markers has a lot of growing support. Studies such as >this< and >this< suggest that there is a correlation between a high sugar diet and increased inflammatory markers. We know a high sugar diet is also linked to many chronic conditions such as diabetes and heart disease, so what have you got to loose? 1,2
Exercise
Exercise makes you feel good! It affects your mood, improves cardiovascular fitness, strengthens your muscles to support you joints, and is very likely to reduce your pain. Everyone can do something, even if it is in the comfort of your own home. If weight bearing exercises are causing you pain, get to a hydrotherapy pool. If you hate the water, jump on an exercise bike. What works for you will be different to what works for your friends. Nobody moves like YouMove!
Mindfulness
I am going to keep this brief because the role that the brain plays in pain is huge. Pain is an output from the brain, not an input to the brain from the tissues. It is influenced by many factors beyond the biological injury. This is such a complicated topic so I couldn’t possibly breach the border of it here. This is also an area best managed by some of the amazing psychologists we are lucky to have in Australia.
Mindfulness is the state of mind when your awareness is focused on the present moment, not thinking about future worries or anything from the past.
Formal meditation is an exercise which can be used to train your capacity to keep your awareness on the present moment. In the same way that holding a plank can improve your core strength, formal meditation can improve your ability to stay present.
You can start by setting your alarm for 5 minutes and spending that entire time focusing on your breath. Feel your tummy rise and fall as you breathe. Don’t try to change it, just observe it and keep your mind focused on it. You will fail at first, your mind will drift off. Bring your focus back to your breathing again and again. Over the course of a few weeks, gradually increase the time-frame you spend doing this, just like you would if you were trying to lengthen the amount of time you can hold a plank.
Sleep
How easy is that, right? Sleep deprivation produces hyperalgesic changes (increased pain). It also increases mood swings and makes you more vulnerable to infections.
So, if you’re not getting your 8 hours sleep, or your sleep is restless or disturbed, implement a good night routine. Do what works for you! I think the following routine is realistic for our crazy western world;
Dim the lights in your home 1 hour before bed. Read a book instead of watching TV, or talk to your partner. Brush your teeth, wash, and do all that bathroom stuff 30 minutes before bed.
Brain dump.
The most common explanation people give as to why they aren’t drifting off is that they have a lot on their mind. If this is you, grab a pen and start writing. Write what you have to do tomorrow, who you have to call, or pay, or email. Write what’s frustrating you, what’s making you anxious and most importantly, finish by writing down something you are grateful for. Think this is all a bit lame? JUST GIVE IT A GO! See how you feel, then call me lame as much as you want.
Now, set an alarm for 5 minutes and have a crack at formal meditation.
Set your alarm, flick your phone to aeroplane mode and don’t touch it again until the morning.
Instead of scrolling through your socials, drift off to sleep with the soft light of a bedside lamp and a good book. I prefer non-fiction books for this time of the day to eliminate overthinking as you drift off to sleep.
Thinking about widespread pain requires thinking about whole body health. Osteopaths see the body as a unit and not just a series of connected parts, we aim to establish a treatment plan which targets your overall well-being and the specific goals that are important to you.
References
Scott Dickinson, Dale P Hancock, Peter Petocz, Antonio Ceriello, Jennie Brand-Miller, High–glycemic index carbohydrate increases nuclear factor-κB activation in mononuclear cells of young, lean healthy subjects, The American Journal of Clinical Nutrition, Volume 87, Issue 5, May 2008, Pages 1188–1193, https://doi.org/10.1093/ajcn/87.5.1188
Isabelle Aeberli, Philipp A Gerber, Michel Hochuli, Sibylle Kohler, Sarah R Haile, Ioanna Gouni-Berthold, Heiner K Berthold, Giatgen A Spinas, Kaspar Berneis, Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial, The American Journal of Clinical Nutrition, Volume 94, Issue 2, August 2011, Pages 479–485, https://doi.org/10.3945/ajcn.111.013540
