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Chronic Pain and Your Emotions: Is There A Connection?

Dr. Eric Viegas, ND

www.medicineismusic.ca

@medicineismusic

chronic pain emotions

You’re in pain. You decide to go to your doctor to address it, but you feel like the physical approach used is lacking something specific to how you feel.

 

Pain is a very interesting sensation; it is highly individualized and subjective. The perception of pain can be limited or worsened by stress.

 

When our bodies encounter physical trauma, a damage to nerve fibres can result in physical pain. If you are suffering from depression, your mental health can worsen the physical pain. Social factors like isolation and loneliness can further complicate the picture of your pain.

 

So as you can see, your emotions and how you deal with them can affect how you experience your pain.

 

Fibromyalgia (FM) and Irritable Bowel Syndrome (IBS) are both conditions where people experience a high degree of pain and discomfort without obvious clinical or laboratory evidence to indicate damage to the affected areas. Also, FM and IBS may occur at the same time, further complicating treatment.

 

A recent theory called central sensitivity syndrome (CSS) attempts to explain the persistent pain felt from these conditions. CSS notes a hyper-excitement of the central nervous system (brain and spinal cord) rather than a direct issue with the affected areas. CSS may explain the emotional component of pain and the need for it to be addressed in chronic persistent pain syndromes (1).

 

Now let’s talk about feelings of fear and anxiety, common forms of stress response.

 

Fear is experienced when we encounter a threat, and it motivates defensive behaviours like running away to escape.

 

Anxiety is usually the anticipation of a threat and results in hyper-alertness and defensive responses.

 

Acutely, fear has the ability to decrease pain, while anxiety may increase it. Eventually, repeated experiences with fear may lead to anticipatory anxiety and persistent pain.

 

Positive emotions, on the other hand, are associated with pain relief. Dopamine is a neurotransmitter involved in the brain’s reward center and is triggered by stimulants like food, water, sex, and drugs. Dopamine makes us feel good by reducing anxiety and fear. As a result, addiction to substances that boost dopamine is often seen in people with chronic pain.

 

Interestingly, pleasant music may also trigger the dopamine reward center and suppress pain (2).

 

Pain is complex, and what works for one person’s pain may not work for you.

 

It is important to be able to identify and label your emotions if you deal with chronic pain, because a difficulty in experiencing, expressing, and describing emotional responses has been shown to be elevated in conditions like low back pain, fibromyalgia, and TMJ disorder. This emotional difficulty, called alexithymia, is often elevated in people with high levels of chronic pain (3).

 

So how can you move forward and address your emotional well being? A good way to start is to draw a picture of how you are feeling if labelling your emotions through spoken word or journalling is difficult.

 

Certain MDs, NDs, psychotherapists, counsellors, and other professional therapists use mindfulness based therapies to further help you work through emotional traumas that might be affecting your pain.

 

Expression of your emotions is helpful if done in a healthy way; perhaps writing, painting, yoga, exercise, singing or dancing may allow for a healthy expression of your emotions.

 

Local community support groups may also be helpful if addiction is a main factor numbing you from your emotions.

 

References:

 

  1. Arendt-Nielsen L, Nie H, Laursen MB, Madeleine P, Simonsen OH, Graven-Nielsen T. Sensitization in patients with painful knee osteoarthritis. Pain 2010; 149: 573-581.
  2. Fields HL. Understanding how opioids contribute to reward and analgesia. Regional Anesthesia and Pain Medicine 2007; 32: 242-246.
  3. Lumley MA, Neely LC, Burger AJ. The assessment of alexithymia in medical settings: Implications for understanding and treating health problems. Journal of Personality Assessment 2007; 89: 230-246.

Herbal Medicine for Anxiety and Depression: New Evidence

Dr. Eric Viegas, ND

March 2018

depression anxiety herbal medicine naturopath ottawa

 

Depression is estimated to affect 5.4% of Canadians aged 15+ (1).  1 in 8 adults will meet the criteria for a mood disorder in their lifetime (1). Women have higher rates of depression than men.

 

Anxiety can also be present with a diagnosis of depression, further impacting a person’s quality of life.

 

People living with depression experience a lack of pleasure in activities that once brought them joy, sleep issues, fatigue, guilt and feelings of worthlessness, memory and concentration issues, and thoughts of suicide.

 

Depression and anxiety also contribute to a high burden of stress in people with cancer.

 

In a survey of 3370 cancer survivors, 20% identified with moderate to severe levels of depression, and 40% were living with moderate to severe anxiety lasting 6 years after diagnosis (2).

 

Due to the large number of adverse effects, and interactions with chemotherapeutics, conventional antidepressant and anti-anxiety medications are not favourable for cancer people (3). It’s no surprise then that this population seems to favour herbal remedies for anxiety and depression.

 

A recent systematic review summarized the evidence from 100 single herb clinical trials for depression and anxiety from 1996-2016 (4).

 

Here are the top herbal remedies for anxiety and depression as identified by this study:

 

Lavender

A fragrant and relaxing plant to grow in your garden, lavender is also used in perfumes and aromatherapy products. Lavender extracts, taken orally, show a stronger anti-anxiety effect than placebo and are comparable in effect to prescription drugs (eg. paroxetine, lorazepam) in human trials. Lavender also has fewer adverse effects than these drugs.

lavender anxiety depression naturopath ottawa

A tea made from lavender buds may improve the effect of citalopram; a commonly prescribed antidepressant medication.

 

Passionflower

Used by Native Americans as a remedy to improve sleep and anxiety, passionflower tea may improve sleep quality. When used with clonidine, passionflower extract was also shown to improve mental-emotional well-being for people undergoing opioid withdrawal.

passionflower depression anxiety sleep naturopath ottawa

Compared to the anti-anxiety medications oxazepam and sertraline, passionflower extract was not more effective in reducing severity of symptoms, but it had much fewer adverse effects.

 

Saffron

A commonly used spice in South Asia and the Middle East.

saffron depression anxiety premenstrual naturopath ottawa

Saffron was found to be most beneficial for people that identified with mild to moderate anxiety. Some studies also showed that saffron was superior to standard antidepressant drugs (fluoxetine and imipramine).

 

Women who have a flare-up of anxiety and/or depression premenstrually also benefited from saffron extract.

Black Cohosh

Commonly found in most herbal preparations for menopausal symptoms, black cohosh may have a positive effect on hot flashes.

black cohosh depression anxiety hormones naturopath ottawa

One study using a patented extract called Remifemin® was shown to be as effective as low dose topical estrogen in reducing hot flashes, anxiety, and depression without the adverse effects of hormone therapy.

Chamomile

Popular in sleep teas, chamomile is an effective anti-anxiety herb for people dealing with mild to moderate anxiety.

chamomile anxiety depression naturopath ottawa

Chamomile was also shown to be effective in the long-term (the study looked at 38 weeks of treatment) but had no effect on relapse rates.

 

Chaste Tree

Another herbal remedy for hormonal issues, chaste tree/vitex is often taken for premenstrual and fertility issues.

chaste tree vitex anxiety depression fertility naturopath ottawa

Chaste tree, when compared to the antidepressant fluoxetine, was shown to be more effective in reducing physical symptoms associated with depression in postmenopausal women.

 

Always check with your doctor before starting any nutritional supplement, herb, or medication.

 

Follow the links for additional information on anxiety, insomnia, and fatigue.

 

References

 

  1. Pearson, Caryn, Teresa Janz and Jennifer Ali. 2013. “Mental and substance use disorders in Canada” Health at a Glance. September. Statistics Canada Catalogue no. 82-624-X.
  2. Inhestern, L., Beierlein, V., Bultmann, J. C., Moller, B., Romer, G., Koch, U., & Bergelt, C. (2017). Anxiety and depression in working‐age cancer survivors: A register‐based study. BMC Cancer, 17(1), 347.
  3. Fajemiroye, J. O., da Silva, D. M., de Oliveira, D. R., & Costa, E. A. (2016). Treatment of anxiety and depression: Medicinal plants in retrospect. Fundamental & Clinical Pharmacology, 30(3), 198–215.
  4. Yeung, K., et al. Herbal medicine for depression and anxiety: a systematic review with assessment of potential psycho-oncologic relevance (2018). Phytotherapy Research, 1-27.

Mindset and Holistic Health

Mindset and Holistic Health: What’s serving you, and what isn’t?

Dr. Eric Viegas, ND

 

mindset dr. eric viegas naturopath ottawa

I often have people with chronic illnesses approach me for treatment. Sometimes, they do quite well with just minor lifestyle and nutritional changes. These treatments can be thought of as addressing an underlying, physical, cause.

 

However, I have also treated cases that require healing of a deeper underlying cause.

 

Our minds and bodies are very closely connected to one another, and their influence on each other should not be overlooked.

 

There are numerous clinical studies emphasizing the importance of diet, exercise, and stress management when it comes to a healthy mood balance, but what about the other way around?

 

What about your mindset? What do you focus on in your attitudes, beliefs, and behaviours?

 

Can the connection between your physical health and your mindset (that is, your emotional health) be the underlying cause of your distress?

 

A good example of this is insomnia.

insomnia mindset dr. eric viegas naturopath ottawa

Chronic insomnia is a common problem for many Canadians. Since supplements are easy to get over the counter, I find most people self-prescribe remedies to help themselves sleep. In some cases, the self-prescription may work, but it will not deal directly with the underlying cause of insomnia if you don’t do the work of asking “why?”.

 

When you are trying to fall asleep how do you feel? Anxious? Frustrated? Scared?

 

Your individual emotional response to your insomnia is an important factor in assessing and treating it.

 

Taking a melatonin supplement recommended by a supplement store employee for insomnia may initially help you, but it does not address your underlying emotional health and mindset.

 

What makes you feel anxious? How long have you felt this way? Has the feeling changed with time? In what other areas of your life do you find yourself feeling that way? I often ask questions of this nature to understand a person as a whole being; what makes them who they are and how do they react to their stress on the physical, mental-emotional, and spiritual planes?

 

Asking non-directional questions, either with the help of a health professional or on your own, will help you to reframe your perceptions. When we take a step back from our habitual behaviours, attitudes, and beliefs we have the opportunity to foster a deeper understanding of why it is we do what we do.

 

Ultimately, the question of  “do these beliefs/emotions/thoughts serve you?” will arise, and it is not an easy question to answer.

 

Perhaps your anxiety is helpful when it comes to meeting deadlines at work. But, if you cannot recover from a stressful day with a healthy sleep because your anxiety is keeping you awake, then your mindset is not serving you as a whole person.

 

I am not a fan of New Year’s resolutions. In 2018, instead of making a New Year’s resolution, think about your emotional health. Ask yourself “what makes me feel this way?” and explore the inner workings of your mindset.

 

Fibromyalgia and Chronic Fatigue Syndrome: A Matter of Boundaries

Fibromyalgia Chronic Fatigue Dr. Eric Viegas Naturopathic Medicine Ottawa

Fibromyalgia and Chronic Fatigue Syndrome: A Matter of Boundaries

 

Dr. Eric Viegas, ND

 

Fibromyalgia (FM) affects 1.5% (444, 000) of Canadians over 12 years of age (1). Those who are most affected are women, people over 40, smokers, the obese, low income earners, and the physically inactive (1). However, it is unclear whether or not low income, educational status, smoking, and physical inactivity are consequences or determinants of the disease.

 

People who suffer with FM have disturbed sleep due to chronic systemic muscular and skeletal pain. Oftentimes FM co-occurs with chronic fatigue syndrome (CFS), a condition characterized by disabling physical and cognitive exhaustion. Unfortunately, 2 out of every 3 people with CFS and/or FM have at least 3 other chronic health conditions (1). As a result, CFS and FM cause significant impairment and stress, both at work and at home.

 

So how does one develop CFS or FM? About 50% of CFS patients can recall a viral infection triggering their CFS. Others triggers include motor vehicle accidents, surgery, or an unexpected fall (2). Adverse effects of some psychiatric medications may cause overwhelming fatigue.

 

Some environmental triggers to avoid when living with a diagnosis of CFS and FM include changes in sleep schedule, cold exposure, physical & mental overexertion, sensory & information overload, excessive stress, prolonged driving & air travel, alcohol, and caffeine.

 

Above all, scheduling “me time” and setting boundaries (both emotional and personal) will help to build energy and reduce the risk of burnout (3).

 

10 Ways to Kick Fatigue

 

It is not uncommon for digestive complaints to occur in the presence of CFS and FM (3). Optimizing your digestive function through the use of mindful eating, an elimination diet, and/or hypoallergenic diet may help to lessen digestive burden. Your naturopath may also opt for botanicals and/or supplements to increase digestive function. These interventions may include digestive enzymes, and/or bitters.

 

In terms of possible vitamin deficiencies in FM and CFS, it is important to know your vitamin B12 status. Deficiency of B12 can lead to anemia, and fatigue (4). Your family doctor, and your naturopath can test for serum values of vitamin B12. Other nutrients shown to be helpful in improving symptoms of CFS and FM target mitochondria and glutathione; the powerhouse of the cell, and your body’s main antioxidant, respectively. These nutrients include N-Acetylcysteine, Alpha-Lipoic Acid, L-Carnitine, and CoQ10.

 

For more information on what can be done to help your symptoms of FM & CFS, and to find the specific nutritional protocol best suited for you, contact your local naturopath.

 

References:

  1. Rusu C., Gee M.E., Lagace C., Parlor M. Chronic fatigue syndrome and fibromyalgia in canada: prevalence and associations with six health status indicators. Health Promotion and Chronic Disease Prevention Canada: Research, Policy, and Practice 2015; 35(1): 1-9.
  2. Komaroff AL, Fagioli LR, Geiger AM, et al. An examination of the working case definition of chronic fatigue syndrome. American J Med 1996; 100: 56-64.
  3. Carruthers BM, Jain AK, De Meirleir KL, et al. Myalgic encephalomyelitis/chronic fatigue syndrome: clinical working case definition, diagnostic and treatment protocols. J Chronic Fatigue Syndr 2003; 11: 7-115.
  4. Beck WS. Cobalamin and the nervous system. NEJM 1988; 318: 1752-1754.

Osteoarthritis: How to manage your pain and have a better quality of life

osteoarthritis Dr. Eric Viegas Naturopathic Medicine Ottawa

Osteoarthritis: How to manage your pain and have a better quality of life

Dr. Eric Viegas, ND

 

An estimated 10% of Canadians over the age of 15 live with a diagnosis of osteoarthritis [OA] (1). 70% of these Canadians experience the majority of their arthritic symptoms in their hips and knees (1). Unfortunately, among Canadians with a diagnosis of arthritis, the average time between onset of their symptoms and an accurate diagnosis can be up to 7.7 years (1). This period of time between onset of symptoms and diagnosis of the disease could be spent making dietary and lifestyle changes to reduce pain and improve quality of life. By 2036 an estimated 7.5 million Canadian adults will have a diagnosis of OA.

 

So what are the symptoms of OA? Increased stress and aging of our joints leads to breakdown of joint tissue known as cartilage. Cartilage acts as a cushion between the bones of our joints, and without it bones begin to rub against each other. When cartilage is sufficiently worn down, joints are left with bone-on-bone contact; limiting range of motion. As a result, people with OA experience pain, stiffness, and swelling in their affected joints (2).

 

Lifestyle treatments for OA aim to reduce further injury, relieve pain, and improve joint function. Some of these treatments are as simple as self-management; avoiding repetitive stress on the affected joints. For example, musicians and dancers place repetitive stress on their joints, and they may be at higher risk of developing OA. Obese Canadians are also at risk for OA, and adhering to a lifestyle plan of healthy eating and weight management will help to reduce the pain and damage of OA. Deep breathing and massage therapy can help to relax tense muscles around an inflamed and stiff joint (2). In some cases, joint replacement surgery is required to limit the damage of OA and provide a better quality of life.

 

So how can naturopathic medicine help with the prognosis of OA?

 

Naturopathic doctors are able to provide acupuncture, which has been shown to help with the pain, stiffness, and limited range of motion observed in OA.

 

Curcumin, a strong anti-inflammatory component of the spice turmeric, may help to reduce the pain and stiffness of OA (3,4). Curcumin has also been shown to be an effective remedy to alleviate symptoms of Ulcerative Colitis.

 

Fish oil also has great evidence for use as a strong anti-inflammatory and antioxidant in OA (5).

 

Certain people also benefit from a hypoallergenic diet; cutting out potentially aggravating foods that may be contributing to pain and dysfunction.

 

Finally, for topical pain relief, boswellia serrata AKA frankincense oil mixed with your favourite carrier oil (think sweet almond, olive, coconut, etc) and applied to your affected joints daily may help reduce inflammation and pain (6). In one study of 30 patients with OA of the knee, 8 weeks of boswellia extract significantly improved knee pain, swelling, range of motion, and walking distance compared to placebo (7).

 

If you are interested in learning more about how naturopathic medicine can benefit your arthritis, please book a visit with your local naturopathic doctor.

 

References:

 

  1. MacDonald KV, et al. Symptom onset, diagnosis and management of osteoarthritis. Stats Can Sept 2014.
  2. https://arthritis.ca/understand-arthritis/types-of-arthritis/osteoarthritis accessed Sept 5, 2017.
  3. Belcaro G, Cesarone MR, Dugall M, et al. Efficacy and safety of Meriva®, a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients. Altern Med Rev. 2010:15(4):337-344.
  4. Nakagawa Y, Mukai S, Yamada S, et al. Short-term effects of highly bioavailable curcumin for treating knee osteoarthritis: a randomized, double-blind, placebo-controlled prospective study. J Orthop Sci. 2014;19(6):933-939.
  5. Chen Y, Huang YC, Lu WW. Low-dose versus high-dose fish oil for pain reduction and function improvement in patients with knee osteoarthritis. Ann Rheum Dis. 2016;75(1):e7.
  6. Kimmatkar N, Thawani V, Hingorani L, Khiyani R: Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee—a randomized double blind placebo controlled trial. Phytomedicine 2003, 10:3–7.
  7. Kimmatkar N, Thawani V, Hingorani L, Khiyani R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis on knee-a randomized double blind placebo controlled trial. Phytomedicine. 2003;10:3–7.