Meals while living with chronic pain. Part 2 - What to eat and how it helps you.

In Part 1 of this series, I talk about why emphasis on the kind of meals we have while living with chronic pain is important. Part 2 will cover what I recommend my occupational therapy clients eat and how eating like this would help you maintain optimal health even while you have chronic pain.

This is the Havard School of Public Health (HSPH) Healthy Eating Plate.

I am a big fan of the HSPH Healthy Eating Plate. I always show this to all my occupational therapy clients, regardless of what health conditions they may have. This Healthy Eating Plate is an excellent guideline to use for clients who want to lose and maintain weight, to regulate their blood pressure, blood cholesterol and blood sugar, to regulate their sleep (yes!) and also for clients who have chronic pain too.

So what does this Healthy Eating Plate have to do with recovering from pain?

1. It is full of antioxidants which have anti-inflammatory properties.

If you notice, half the plate is full of fruits and vegetables. Now everybody knows fruits and vegetables are good for your health because they are full of fibre and nutrients which your body would need to maintain optimal functioning. In my earlier post I talked about how taking foods that are inflammatory can actually aggravate your pain. So anti-inflammatory foods, reduce inflammation and reduce pain, good right?

Also, take note that the portion of vegetables is double that of fruits. Fruit to vegetable ratio should ideally be 1:2 at every meal. Why? This is because of the sugars that fruits contain, and we want less sugar for less inflammation, right?

2. Healthy oils - you can refer to my post about omega 3, it's anti-inflammatory properties and how it has helped my clients reduce pain for further details.

3. Proteins

Your cells are made out of protein, so taking enough protein is an absolutely necessary part to aid recovery and for your body to be able to rebuild the damage done to them. If you notice, proteins are a quarter of your plate.

4. Whole grains

Yes, whole grains, not white grains, not refined grains. Try to cut down on the mee hoon, the mee sua, the noodles, the biscuits and bread - I know Malaysians seem to think these are "healthy" substitutes for rice, but they are not. They are actually worse for your health than rice is, so yes - you can go back to eating rice with a clear conscience now. ;) They are more processed than rice is, and ideally we would want to eat things that are as close to their original form as possible. Grains are essentially sugars and as mentioned in Part 1, sugars trigger inflammation.

Also, do note that the composition of a typical Malaysian meal is typically 99% grain (fried rice, fried noodles, char kuey teow, nasi lemak, roti canai, etc) so I would suggest to take this seriously if you're living with chronic pain and start reviewing your eating habits!

In Part 3 of this series, we will talk about how to make eating healthily easier for people living with chronic pain.

Meals while living with chronic pain. Part 1: Why is this important??

When people talk about living with pain, rarely do they talk about the kind of food that one has to eat. Of course, if you're Malaysian, and you go to traditional treatments (i.e. Chinese medicine etc) then there is especial emphasis on certain herbs and soups to eat to help certain conditions, etc. But rarely do we spend much time talking about the composition of our every day eating. However, knowing what to eat to maintain our bodies in optimal condition is just as important as many other aspects of pain management that are typically covered by conventional treatment. In fact, it may help support a faster recovery too.

When do people living with pain need are not careful how they organise their meals:

1. they are at risk of putting on weight.

This is very common and I do see it happening in my occupational therapy clients. Besides reducing physical activity, our body goes into a fight or flight response while we are experiencing pain - this is equivalent to our body experiencing stress. This can cause cravings - or perhaps a more appropriate word, as they don't really feel like cravings sometimes, "increased attraction" to sugar-containing foods that could lead to weight gain.

2. They are at risk of causing further inflammation which leads to increased pain.

Sugar is a major cause of inflammation. It doesn't help that when our bodies are stressed, it leads us to be attracted to more sugar. Pain can be sign of inflammation (as mentioned in the post about nutrition, one of my clients has reduced pain when she takes salmon omega 3 which is anti-inflammatory) and while inflammation is a natural part of the healing process, it may not necessarily be a good idea to stimulate even more inflammation (and more pain!) than the body finds necessary.

3. They are at risk of leading to further diseases and health problems that could further weaken their already weakened physical state.

Chronic inflammation then leads to further complications. Did you know that the root cause of heart disease is actually inflammation rather than high cholesterol? Read this post on my stroke blog to find out how that happens. If you're already feeling that chronic pain is inconvenient to you, are you sure you want to complicate things further with more health problems and further hospital visits?

In Part 2 of this series, we would be talking about what to eat to maintain optimal health while living with chronic pain.

Update - other posts on this topic:

Part 2 of meals while living with chronic pain, what to eat and how it helps you  - http://painmalaysia.blogspot.com/2015/01/meals-while-living-with-chronic-pain_9.html

Part 3 of meals while living with chronic pain, shopping solutions - http://painmalaysia.blogspot.com/2015/01/meals-while-living-with-chronic-pain_20.html

Not part of the series but still helpful and relevant: Supplements for pain management

Compromised activity performance with pain Part 1 - understanding what leads to poor performance.

From my observations, people in pain tend to gradually cut down on their physical activity. As a result, they would also start to reduce the amount of everyday activities they do, as well as cut down on the quality of the activity. For instance, the hypothetical client in the activity log post, by the time she gets back from grocery shopping with a pain level of 9 - she would be rushing to get home as soon as possible. This could compromise the qualify of performance in the following activities: driving (to get home), and putting the groceries away, even getting from the vehicle to the house.

What leads to poor performance when in pain?

1. Fatigue and physical exhaustion

Pain can be very physically taxing and energy zapping, particularly if the client doesn't know how to manage their bodies in a certain manner. In the example of the hypothetical client above, fatigue and exhaustion can affect her in the following ways:

a) safety when driving - losing control of the car and putting herself and other road users in danger
b) at risk of dropping groceries when getting them from vehicle to house or when putting the groceries away
c) at risk of falling when moving groceries from vehicle to house or when putting them away

2. Frustration and clouded judgement

Frustration creeps up very easily when experiencing pain. Pain can easily distract on our focus from a task at hand, and if we are trying to perform the task while addressing the pain at the same time, this could easily result in:

a) missed turns
b) not noticing the movements of other vehicles around us
c) not noticing what's happening to the car (this actually happens to my clients - they didn't realise that the car had overheated or that the car was running low on fuel)

As a result they end up stranded in an emergency situation that is very difficult to deal with because of pain + physical exhaustion + frustration from the buildup of all the errors that could have possibly happened. This is very real and has happened to my clients before, resulting in falls and subsequently escalated pain that puts them in bed for a few days in order to be able to recover, resulting in what could be perceived as "wasted" time and "wasted" money (if treatment is involved - there would be money spent, and even if treatment is not involved, there would be missed opportunities for potential income. For some people, they would still have money flowing out of their pocket when they are not at work even if they don't make a deliberate effort to spend money - this is particularly true for self employed business owners who still have overheads in their business that would keep taking money out of their pocket while they are unable to work - rental, etc.)

I'll show you solutions which has worked very successfully for me (yes, I experience pain too - and am very fortunate that my occupational therapy skills have helped me deal with it) and my occupational therapy clients in another post. :)

How to keep an activity / pain log

People with chronic pain may not realise that how they schedule their every day activities, including how they fit sleep and rest into the schedule, can influence the level of pain they are feeling in each day. I always get my occupational therapy clients to keep an activity / pain log to show me how they are currently planning their day (when in uncomfortable situations, planning can really go a long way - regardless if the discomfort is referring to health or even other parts of life like parenting and finances.)

Example of an activity log.

Time	Activity	Pain Level (0-10)
7.00am	Wake Up, climb out of bed to go into toilet, morning toilet activities	0
7.30am	Prepare breakfast for family, wake the kids	0
8.00am	Eat breakfast together with kids	0
8.30am	Drive kids to school	1 (pain slowly creeps up while driving)
9.00am	Shopping for groceries at market.	5 (still tolerable)
10.00am	Completed shopping, start the drive home	7
10.30am	Reached home completely exhausted, quickly sorts out groceries and urgently needs to rest	9

And the details of the rest of the day until my occupational therapy client goes to bed. This log provides the occupational therapist with lots of very valuable data, which the client and the therapist can use to come up with strategies to manage pain better.

How this occupational therapist got into pain management.

Skills to deal with pain should be on every occupational therapists' personal "occupational therapy tool kit". However, based on my observation of occupational therapy in Malaysia, not enough emphasis is being given to learning about the condition of pain and how to address it in our occupational therapy work (there are many other things that I feel occupational therapy education in Malaysia doesn't really teach us to address in our work, but that's for another blog post).

As a Taekwondo athlete and coach (my life before qualifying as an occupational therapy practitioner), dealing with pain and injury was part and parcel of my work. I had to learn:

1) proper movement to prevent injury (important when you've got a last a few rounds of fighting)
2) how to address and care for acute injury (so you can move on to the next match)
3) how to recover properly from injury - caring for injuries in the long run (so that your sporting career can last longer)

So I was already equipped with skills to manage pain and injury even before being an occupational therapist. (Note: not all Taekwondo and sports coaches are trained as such though, and that's a topic for another blog post. If you're a Taekwondo or sports coach who is keen to pick up these skills, I am actually lecturing this topic for Taekwondo Malaysia, the national body - you can feel free to invite me to conduct a course for you and the instructors / coaches in your club / association).

The need for occupational therapists to have skills to deal with pain came rather unexpectedly through my work with clients suffering from obesity-related conditions that eventually led to the GR:IN Lifestyle Modification Approach. When I started working with these people, the idea was that they would mainly be coming to me for weight management. What I didn't really think of (although it would seem pretty obvious!) was that people who were overweight would also come with knee and back pains, and that people with nerve damage from diabetes and stroke would also develop pain, and at the same time they would also have various unhealthy habits that also lead to other sorts of pain (like carpal tunnel syndrome - especially if they have lead a rather sedentary, computer-using lifestyle). There's plenty of people suffering from pain out there (that's why massages are very popular!) but we overlook it too easily!