Chronic inflammation is present in most individuals with chronic pain, adversely impacting their body’s ability to achieve inflammatory homeostasis. Lifestyle behavior change recommendations offer a first-line intervention.
Immune Response Leads to Inflammatory Pain
Inflammation is the immune system’s response to a stimulus that is viewed as foreign or toxic to the body. The immune system is constantly monitoring for anything that appears foreign, always ready to signal highly specialized troops of cells and molecules to attack and dispose of the foreign material. Inflammation is, in fact, the body’s first response to healing.1
When the immune system is disrupted, however, it puts itself unnecessarily on constant defense, chronically inflaming the body. The immune system is then working against the body, instead of for the body. It does this by switching focus from the antigen itintends to attack over to the body’s own cells or tissues.2
This article reviews the impact of the evolution of the modern Western lifestyle on the inflammatory response, which often leads to pain, and offers recommendations to encourage a return to homeostasis.
Chronic Inflammation Signs and Risks
Serhan and Chiang introduced the term “resoleomics” to refer to the process whereby the acute inflammation response ceases and the body returns to its normal state.3 The current Western lifestyle has been found to impede resoleomics.4,5 Moreover, chronic inflammation results in an inadequate acute stress response, making the body less prepared to fight other disease states and injuries.6
Medical Conditions Associated with Chronic Inflammation
There are several conditions that are associated with chronic inflammation, including:
- allergies/autoimmune problems: pollen/food allergies, celiac, and lupus
- arthritis: osteoarthritis and rheumatoid arthritis
- cancers: gastric, lung, breast, and prostate
- cardiovascular: CAD, myocarditis, hypertension, stroke, and varicose veins
- dental: gingivitis and periodontitis
- digestive tract: gastritis, ulcers, Crohn’s disease, ulcerative colitis, and diverticulitis
- eye: conjunctivitis and uveitis
- infections: colds, influenzas, ear, Hepatitis C, HIV, parasites, and Epstein-Barr
- injuries: sport injuries, bruises, and surgery
- miscellaneous: sinusitis, multiple sclerosis, and fibromyalgia
- neurological: Alzheimer’s disease
- prediabetes, diabetes, overweight, and obesity
- pulmonary: asthma, COPD, and bronchitis
- skin: sunburn, eczema, dermatitis, and psoriasis
When looking for symptoms that may signal chronic inflammation, consider: joint pain, fatigue, depression, digestive upset, skin problems, food sensitivities, and resistant weight loss.
Risk Factors for Chronic inflammation
Chronic inflammation risk factors may include genetics, a malfunctioning immune system, persistent injury or infection, insulin resistance, excess body fat, environmental toxins, stress, nutrition, sedentary lifestyle, and a combination of the aforementioned.7 In fact, virtually all of the top 10 leading causes of death in US adults are moderately to strongly influenced by lifestyle patterns and behavioral factors.8
Inflammation Connected to Diet, Activity, and Mental Health
Lifestyle changes have evolved over time to negatively affect our health. One of the life components is nutrition. US food supplies have largely been altered by the use of pesticides on crops, antibiotics and hormones in farm animals, grain instead of grass to feed cattle, food preservatives and artificial colorings, and the emergence of fast and highly refined/processed foods (see how the “Swamp Diet” impacts obesity and pain). Further, high glycemic foods,9-11 increased saturated fats, and high omega-6 and low omega-3 imbalances12 have been found to increase inflammation.
Physical activity, or a lack thereof, is another lifestyle component impacting inflammation, as are personal hygiene and mental health.13 Increases in stress, anxiety, depression, and decreases in social support can impact immune response.
What is a Healthy Lifestyle in the Pain Management Context?
Maintaining a healthy lifestyle helps individuals take care of their bodies. It contributes to hardening, stability, and strength. There are several elements of a healthy lifestyle, including sleep, nutrition, exercise, personal hygiene, stress management, and refusing or minimizing bad habits.14
Sleep. A lack of sleep produces some of the most striking impairments in mental performance. Not only is a good night’s sleep particularly important for memory, but sleep deprivation can negatively affect muscle control and mood.
Factors to consider when thinking about improving sleep in a person with a pain disorder:
- Obstructive sleep apnea: being sedentary and obese and some pain medications increase risk
- Medications: some medications increase arousal or potentially contribute to sleep disorders
- Bed and pillows: using a comfortable mattress and the right pillow may reduce sleep problems
- Traumatic brain injury is often accompanied with higher than normal comorbid sleep disorders
- Daytime bed use: napping weakens the drive to sleep, making it more difficult to sleep at bedtime
- Daytime activity: increasing activity (at least before 4 hours of bedtime) can help increase tiredness
- Alcoholic beverages may induce drowsiness but later lead to restlessness and disturbed sleep
- Caffeine remains in the body for up to 10 hours and thus should avoid any caffeine after lunch
- Nicotine remains in the body for about 2 hours and should be avoided within 2 hours of bedtime
- Eating and drinking can induce indigestion or acid reflux; should limit liquid intake at nigh
- Schedule: setting a consistent bedtime and wake-time can provide cues to the body for sleep
- Emotional issues: address concerns with an action plan and increase useful coping skills
- Environment: recommend the bedroom be cool, dark, quiet, and free from sensory distractions
Nutrition. To eat properly means to eat nutritionally dense foods that help it grow and function.15 Proper nutrition should be exceptionally balanced.16 Biomarkers have been found to be significantly positively influenced after a 10-day paleolithic diet.17
One of the first steps in addressing nutrition in a person with chronic pain is increasing awareness of eating and food choices. Using a mindfulness eating exercise can help increase eating awareness.18 Here is one example clinicians may share with a patient struggling with overweight or obesity that is impacting their pain:
- Find a small piece of food, such as one raisin or nut.
- Begin by exploring this little piece of food, using as many of your senses as possible.
- First, look at the food. Notice its texture. Notice its color.
- Now, close your eyes, and explore the food with your sense of touch. What does it feel like?
- Before you eat, explore this food with your sense of smell. What do you notice?
- Now, begin eating. No matter how small the bite of food, take at least two bites to finish it.
- Take your first bite. Please chew very slowly, noticing the actual sensory experience of tasting.
- Notice the texture; the way it feels in your mouth. Notice if the intensity of its flavor changes.
- Now, please take your second and last bite. As before, pay attention to the sensory experience.
Exercise. Stretching improves flexibility and may be a good option if one does not want to engage in endurance-building or strengthening. Stretching can specifically be a good tool for managing chronic low back pain and fibromyalgia as it works on muscles to help give added strength for strenuous activities.
Aerobic exercises work the large muscles of the arms and legs, and can include walking, biking, swimming, and other exercises. Recreational activities, such as yoga, Tai Chi, water aerobics, adaptive sports, and golf, are other, alternative forms of exercise.
Past research has shown that extended exercise programs generally reduce markers of inflammation in elderly Japanese women,19 in Americans who frequently engage in physical activity, in people with type-2 diabetes,20 in young healthy women, in obese post-menopausal women, in elite volleyball players, and in people with cardiovascular disease.21
Sexual activity is yet another form of exercise with positive benefits for the body. There may, however, be barriers to engaging in sexual activity when pain is present in one or both partners. A person with chronic pain may need to work to find positions that will minimize pain. Consequently, it is important that the person with pain and their partner(s) work together on how they can express intimacy without creating worse pain. Importantly, the use of opiates can also negatively impact sexual function and may lead to erectile dysfunction in males.
Personal hygiene. One classification we tend not to think about as a lifestyle factor impacting inflammation personal hygiene. Hygienic practices will save one from the risk of getting disease associated with the multiplication of bacteria and parasites.
Stress management. Clinicians know that the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, commonly referred to as the fight-or-flight response, adversely impacts the inflammation and resolemics process. Self-soothing is a way to buffer this response and refers to any behavior an individual uses that engages the parasympathetic nervous system, disrupting the sympathetic nervous system process of preparing the threatened body. Shifts may include changes in workload and/or engaging in pleasant activities.
Pain psychologists or psychiatrists, or physicians working with biopsychosocial models might ask the patient to come up with a list of pleasant activities they previously enjoyed doing, engaged in to a limited but not ideal degree currently, or have always wanted to try. Once activities are listed, two to three activities are identified. The activities can then be scheduled into the week to likely increase implementation and follow through. It is important that the activities chosen and schedule devised are reasonable and achievable. It is important to set a time limit for the activity so that the individual does not push themselves, exacerbating pain and inflammation. Suggest time-based pacing instead of relying on pain cues, to avoid overexertion and sustain the activities.22
Another way to manage stress and self-sooth is by using different types of relaxation exercises.22 Deep breathing, or “diaphragmatic breathing,” is the foundation for all other relaxation techniques. This activity engages the parasympathetic nervous system, slowing breathing, increasing oxygen intake, and even increasing energy – this brief, portable strategy can be done anywhere and at any time.
Progressive muscle relaxation (PMR)is another approach to engaging the parasympathetic nervous system. This practice entails systematically tensing and relaxing specific muscle groups. The underlying explanation for utility of this technique is that a muscle group cannot be both tense and relaxed at same time. By deliberately tensing muscles and then relaxing them, individuals learn to observe differences between these two sensations.
Visual imagery, or “guided imagery,” can be used to further calm the body and engage the parasympathetic nervous system.
Finally, clinicians can discuss with patients the reduction of habits such as tobacco/nicotine use, known to interfere with pain management and chronic pain treatment in several ways:23
Interventions for Reducing Inflammatory Pain
It is important that each clinician and/or caregiver assess their own lifestyle before initiating the conversation with someone about making lifestyle changes that may reduce their inflammatory pain.
Behavioral Change Techniques
Behavior change is well accepted in addressing lifestyle-related diseases. As noted, there is compelling evidence demonstrating the role of negative lifestyle behaviors on chronic pain. This research highlights the importance of positive lifestyle behaviors on the incidence, and the effective management, of pain. Using a motivational interviewing style, addressing lifestyle behavior change in chronic pain as a first-line intervention might constitute a novel approach and reduce socioeconomic burden. Small and slow change is best at creating lasting change. Further, many medications can interfere with the immune system and resoleomic process.4
The field of complementary and integrative health offers several other options to consider when addressing inflammation,24 including:
- dietary supplements such as herbs, vitamins, minerals and probiotics
- meditation, deep breathing, or guided imagery
- somatic movement therapies (yoga, tai-chi, or qi-gong)
- spinal manipulation
- healing touch
- other fields of medicine (Traditional Chinese, Ayurvedic, homeopathy, naturopathy)
Sleep hygiene, nutrition, stress management, and exercise have all been found to reduce chronic inflammation. Chronic inflammation, such as that which is present in individuals with chronic pain, adversely impacts the body’s return to an anti-inflammatory homeostasis, a process referred to as resoleomics. Further, it reduces the effectiveness of acute inflammatory responses when the body is presented with disease or injury. Therefore, it is important to take steps to minimize chronic inflammation.
A few key takeaways:
- Modern lifestyles have evolved in a way that contributes to chronic inflammation. Resoleomics is the resolution of the inflammation response. Chronic inflammation impedes resoleomics and impedes an effective acute inflammation response.
- Changing lifestyle patterns/habits are difficult. There are several elements including sleep, nutrition, exercise, personal hygiene, stress management, and refusing or minimizing bad habits.
Behavioral change techniques, including motivational interviewing, suggest ways to help make slow, lasting changes without pushing and shaming. Complementary and integrative health modalities, such as meditation and somatic movement, encourage resoleomics.
Last updated on: March 1, 2022