Category Archives: Diet and Exercise

Arm reaching up behind gauzy fabric with text reading 'Can exercise really help alleviate chronic pain?' and a link to the Euston Arch website

Can Exercise Really Help Alleviate Chronic Pain?


I was asked to share the infographic in this post, and I decided to do so. I think there’s some information contained in it that could be helpful to some readers, and that’s pretty much my main criteria for whether or not to share something under the Euston Arch banner.

So, yep, thar she blows, and enjoy.


I have … thoughts.

And y’all know me. I’m not genetically capable of being quiet.

So I’ve also shared those thoughts beneath the infographic. Please note those are my (considered, educated, but strictly personal) opinions, and not those of the infographic’s creator, that site, or anyone associated with that site. Mine, and mine alone.

First though, as with any new resource I share, I want to give a few warnings:

  • Every chronic pain experience — and condition — is different. Your experience may not correspond to someone else’s, even if that person has the same diagnosis as you do.
  • As with any new treatment modality or suggestion, whether it’s prescription medication, conservative, or surgical, please check with your own primary care physician first.
  • Your PCP can tell you whether the suggestions in this graphic are a good idea for you, given your specific condition and treatment plan, and how to proceed safely.

The Infographic

Put a Pep Back in Your Step: How to Exercise with Chronic Pain
Courtesy of: Pain Management and Injury Relief

Annie’s Thoughts on Exercise and Chronic Pain

The big problem with any blanket recommendation to chronic pain patients to “Just exercise more!” is post-exertional malaise. One researcher called PEM “an illness within an illness,” and I think that’s about as accurate a metaphor as any you’ll find.

PEM hits people with a variety of CP-related illnesses, one of the most common being ME/CFS (or “chronic fatigue,” as some erroneously refer to it). Fibromyalgia also carries an increased risk of post-exertional pain and malaise.

And what you may not know is that even though PEM is a self-reported symptom, and thus treated just as skeptically as any pain, researchers have actually proven it’s real .

PEM isn’t simply the muscle soreness healthy individuals often experience after exercise. That soreness is a normal physiological response. PEM is wholly different. It usually represents a worsening (sometimes significantly so) of already existing pain levels.

And it’s triggered by exertion – i.e., by exercise. Hence, the name “post-exertional malaise.”

(Although to be honest “malaise” always sounded to me like something a Victorian gothic novel’s heroine would complain of, shortly before sinking ever so gracefully onto her damask fainting couch in a swoon. I dunno. Maybe that’s just me. PEM ain’t for wusses, in any event.)

So that’s my first problem with this infographic: Exercise can make your pain worse for many of us, and that’s not mentioned anywhere that I can see.

There is one sentence that acknowledges the possibility of PEM, albeit in a terribly vague, roundabout way. It’s the statement halfway down reading:

If you feel abnormally fatigued or experience more pain than usual, stop exercise until your symptoms decrease, and then gradually start exercising again.

Here, the assumption is that the PEM is itself a rarity, and that when (not if!) it goes away, you’ll be able to resume the very activity that caused it in the first place.

And I’m over here like …

Three older women in a living room, one saying "That's not how this works. That's not how any of this works."

And what’s more, PEM can last for an unknown length of time. Every time you get it, it’s like waiting for the other shoe to drop, for — as one blogger put it ….

Two days? Two weeks? Two months? Two years?

Studies currently suggest that there may be an immune system response behind PEM. It could well be that exercise in FM patients retards the production of growth hormone, which in turn triggers cytokines to prompt increased pain from muscular cells.

So FEM is real, and it can be as distressing – or even more so – than the primary pain caused by the underlying condition.

And, again, just to drive the point home: this is just what exercise does to many people with chronic pain.

“Tough it up and push through the pain” is therefore really crappy advice to give to someone living with chronic pain.

My Experience Exercising With Fibromyalgia and Scoliosis

The kind of exercise that I can do, for example, is nowhere near enough to ward off the detrimental effects attributable to a sedentary lifestyle, according to the medical community.

I can walk for 10 to 15 minutes.

I can do 10 minutes of yoga.

I can handle maybe 5 minutes of ballet barre exercises (plies, battements – but not grand battements – and tendus, that’s it, stick a fork in me, I’m done).

Many days, I can do one of those three things, but not the other two.

On really good days, I can handle all three – but maybe a third of the those really good days are then followed by fibromyalgia flare-ups, which put me flat on my back in bed with a heated-up rice pack for at least 24 hours, and creeping around like a frail octogenarian for 48 hours thereafter.

What am I saying, then? “Don’t exercise, ever”?

No. Of course not.

I’m saying stuff like this infographic can be really aspirational and inspiring for folks like us who have lived with chronic pain, maybe for years, and still miss the active lives we used to enjoy.

But it can also be dangerous.

Life is different post-diagnosis. It just is.

A new reality means that you cannot simply assume the old rules still apply. Rules like “exercise is good for you.”

Because for many of us, it isn’t.

On the flip side, movement has helped me reclaim some of my health, and I cannot deny this fact: Being completely still – for example, during those days when I’m cautiously nursing some painful part of me – also makes my pain worse.

If this is you – if you’re like me, if PEM is a fact of life for you – what I recommend instead of exercise is movement. (Of course, you should always talk to your doctor about this first and get her input.)

Movement is not exercise – at least not the way this infographic seems to define it. Movement is gentle. It’s the minimal amount of activity necessary to no longer qualify for the word “still.”

Get up and move every 30 minutes or so. Take an extended movement break of 10 minutes or so every hour. And when I say movement, I do not mean “aerobic movement.” Or “strenuous movement.”

I mean stand up, if you’re able to.

Walk around the house, if you can.

Walk around the yard or the neighborhood, if you’re that lucky.

Or move your arms a bit. Move your fingers. Move your feet and ankles. Lift your lower leg, straightening it out from the knee, while you’re sitting in your chair. Do that once. If that’s OK and doesn’t hurt, do it another time. Then move some other body part.

Move gently. Move cautiously. And move just a little, especially at first, especially if you haven’t been moving at all.

Do that for a week or so. See how you feel, both immediately after and the next day.

The second week, try doing just a little bit more. One more leg lift. Thirty more seconds of walking.

Is this terribly trying and frustrating? Will it just make you even more keenly aware of what you can no longer do?

Yep, and holy Christ, yes. I won’t lie to you. It sucks a lot.

I used to do 90-minute ballet classes several times a week, for Pete’s sake. Here I am barely able to manage a few minutes of baby ballet at a makeshift barre. I MEAN, C’MON.

But the alternative to moving is not-moving.

You know what else is not-moving?

Death. (Sleeping isn’t even not-moving, because as any parent who’s ever shared a bed with their kid knows, sleepers sometimes move a lot.)

I don’t know about you but I’m not ready to be not-moving. I’ll move as much as I can for as long as I can, but I know my body, and I know when to quit.

Until you get there with your new-reality body, you’ll have to work to learn just where your new limits are, and how to stop just short of them.

But please don’t look at messages like the one in this infographic and think “oh yeah, I should be able to do that.” Or “I can’t do that, therefore I’m truly pathetic.”

Use it instead as a starting point for a discussion with your doctor.

Come to terms with what your diagnosis means for your new physical reality, and then begin to explore – gently – those new borders.

Calendar showing January 1, 2014

A New Year – A New Plan

Calendar showing January 1, 2014 Happy New Year!

I just finished doing something I’m a little ashamed to admit I haven’t done in months.

I exercised.

Not much, mind you.

I used to work out regularly. Thrice-weekly hour-long yoga sessions, twice a week hour-long sessions at a gym on an elliptical and with the free weights, daily half-hour walks.

Before that, I was a dancer.

I say that now, and people look at me skeptically. I certainly don’t look like a dancer any more. Ahem.

But this year, I’m determined to do things differently.

I’d love to lose some weight – excess weight is bad for fibromyalgia, and it’s bad for people with degenerative disk disease, and it’s bad for people with scoliosis. And I have all three.

Plus hypertension – it’s also bad for that.

And a family history of heart disease – you get the picture.

But the weight for me is just one part of the picture.

I have this long-held belief that if I could just lose the excess weight, my pain levels would decrease dramatically.

I don’t know for sure if that’s true, but it feels true. And it’s worth trying, for many reasons (see: all the above).

So the last week or so, I’ve been hashing out some things I can do differently that might put me on a more productive path, health-wise.

The plan consists of gradually stepped-up movement plus a series of simple adjustments to my diet. NOT resolutions – a new way of being.

And I really wanted to start the new year on the right foot, so to speak.

Initially, I’m focusing just on increasing movement, in simple and relatively small ways.

While my coffee heats up in the microwave, I do 28 wall pushups.

While I’m sipping the coffee on the porch, instead of sitting down, I stand and do 15 front and back leg lifts, each leg. Or 20 side bends to each side, or 20 stomach isolation moves from belly dance.

And I do these several times a day. At least that’s the plan. (Hey, we just started.)

I’m tracking my progress on a page in my Circa agenda for the year. (If you haven’t experienced the awesomeness of Circa, allow me to introduce you.)

I’m focusing on the doing, not the results. But I do plan to measure myself with a tape measure on the first of each month, and record those in the agenda too.

The plan is to take these exercise breaks five times a day for the first two weeks. On January 15th, I’m going to add in a fifteen-minute walk every day. On February 1st, I’ll add in some morning yoga, about 15 minutes or so. Then every two weeks, I’ll step up one element of this three-part plan.

By increasing my effort slowly & gradually in this way, I’m hoping to avoid serious flare-ups of the fibro, and form the exercise habit.

In addition to my “guinea pig” experiment, I’m hoping this approach will lead to a marked improvement in my health, wellbeing and pain levels.

What are you doing for yourself in 2014? How can I help?
Photo credit: danielmoyle via photopin cc

Back to the Grind

Picture of Large Ocean Wave Breaking Near Shore Ugh.

I just wanna throw my hands up and go “UGH” some days.

There’s the micro-level of “UGH” — little mini-waves on the shore of life. The dish disposal grinds to a halt and you have to kneel down on the hard cold floor to reset it with that weird little wrench thingie. Or the kid committed you to 4 dozen Italian Wedding Cookies for the fall festival bake sale at school. And it’s THIS WEEKEND.

Then there’s the macro-level “UGH”: you get a notice from the landlord that he’s sold the house you’re renting and you have to move in 30 days. Or your previously static level of chronic pain suddenly decided to be not so static after all and started degenerating rapidly.

Finally, there’s something I like to call “the Universal UGH.” This is when several mini-ughs, which would have been totally handle-able on their own, or even just one at a time in succession, conspire to take place all at once. Or, well, at least within the same four-to-six day period of time.

Life’s like that, of course. Of course we know that.

But somehow when you’re coping with chronic pain, those mini-ughs — even the micro-ughs — just seem grossly magnified. Full on Monets, as Cher said.

And when it’s a Universal UGH?


But life being what it is, the Universal UGH will show up from time to time. Yes, even for the chronically pained.

Take me, for instance. Right now, I’m dealing with a Universal UGH of fairly massive proportions. I mean, as far as these things go, it’s not on par with, say, the massive shitstorm I dealt with four years back. (Now that, my friends, was a Universal UGGGHHHH.)

But it’s bad enough. It’s got all the usual biblical stuff — y’know, survival, life, death (no lust though, damn it) — and it’s been something I’ve had to weather for several months now. I hope (oh God pleasepleasepleaseletitbeso) that it’s almost over. (Well, either that, or the light I see is, in point of fact, the oncoming train and I’ll be squashed like a bug here any day now. Either way: win/win.)

And I noticed something kinda funny this time around. This sort of escaped me in previous Universal UGH-times, though I’m not sure why. I mean, it’s only logical and entirely foreseeable, when you think about it. So here’s my DUH moment:

When you’re in life-crisis, you forget to manage your health and your pain.

I mean, I FORGOT.

I took my meds, of course, because – well, I’m really not so keen on the whole withdrawal thing.

But it was like I woke up one day recently here and said “Dude. WTF is going on here? I haven’t … ”

Here’s what I “haven’t”:

  • Hit the yoga mat in the AM for the “getting the muscles warmed up” routine
  • Hit the yoga mat in the PM for the “winding down and relaxing kinked-up muscles” routine
  • Taken my vitamins
  • Paid attention to the no-sodas, no inflammation-trigger foods rules
  • Meditated. MEDITATED.
  • Walked a mile

Now, I’ve done these things sporadically over the last several months. It’s not like the yoga mat is lost somewhere in the house, buried under a foot of dust bunnies.

But I haven’t done all of them routinely. And it’s that routine that keeps the pain managed.

So, now I’m paying the price. Walking my child to the bus stop (a mile total, most of it on a steep incline) has become a serious physical effort. I fear I have gained a little weight. (OK, more than a little.) My blood pressure is up (yes, I’m taking my medication). I feel scattered throughout the day, and — duh — I hurt more.

Why on earth do we do this to ourselves? We know better. And it’s not like we don’t have immediate and noticeable proof that this stuff works. And yet, when times get tough and we arguably oughtta be doing more of this stuff, instead it’s the first thing that goes.

WTF are we thinking?!

WTF was I thinking?!

Back to the grind, dammit. I might not be able to resolve the UGHs but I can damn sure make certain I don’t hurt any more than absolutely necessary while they’re paying a visit.


Move It, But Not Too Much: Pain-Free Exercise for Chronic Pain

Woman doing yoga (pigeon pose) on grass lawn by a lake

Yoga is one of the top five recommended forms of physical exercise for chronic pain patients.

We all know exercise is important to overall health, and more specifically to successful management of our chronic pain illnesses.

But too much exercise, or the wrong kind of exercise, can and often does lead to what’s called post-exertional pain: an increase in our pain levels that follows physical activity.

Fortunately, there are options for women with fibromyalgia, reflexive sympathetic dystrophy, chronic fatigue syndrome and other chronic pain illnesses.

Specifically, you might want to talk to your doctor about implementing an exercise program into your chronic pain management plan that incorporates one or more of the following five kinds of exercise, all of which have benefits for pain management.

CAUTION: As always, talk to your doctor
before starting any new exercise regimen.

Yoga: Strike a Pose

Yoga is one of the most often recommended forms of exercise for fibromyalgia and other chronic pain patients. It’s easily adapted to a home-based practice, although you can often find classes in your area taught by instructors with experience working with chronic pain patients.

Consisting of a series of poses or asanas that are held for a period of time, yoga is a form of mind-body exercise that bears special benefits for pain patients. Lowered blood pressure, increased stamina and flexibility (which reduce the chance of injury in daily activities), and a greater ease of movement are among those benefits.

There are many different kinds of yoga, though, and not all are suitable for the chronically pained. You might want to skip the hot-room Bikram yoga and the energetic Ashtanga forms, and instead try gentle or restorative yoga.

Recommendation :

Kelly McGonigal’s book (read a guest post from Kelly on Euston Arch about yoga and chronic pain here) is a must-have for all chronic pain patients interested in trying out yoga for health and pain relief.

Walk It Off

Walking is one of the easiest kinds of exercise for a chronic pain patient to begin. You need nothing more than a good pair of walking shoes and comfortable clothing to start, and there’s no special skill to learn. Plus, it’s free!

Start slowly with an easy pace and a short duration if you’re not used to walking for any length of time. You can then gradually increase your time and exertion level as you feel more comfortable and progress in your program.

Tai Chi: Ancient Chinese Secret for Better Health

Studies have shown that Tai Chi can improve fibromyalgia symptoms and offer pain relief.

This ancient form of Chinese movement should be learned first from an instructor or reputable DVD from an expert. Once you learn the movements and their sequence, though, tai chi — like yoga — can be practiced at home or outside.

As with walking, the expense is minimal. All you need are clothes that allow for free movement and the space to do the sequences.


This DVD has been highly recommended by a friend who does tai chi. I haven’t tried it yet, but if you have, let me know in the comments what you think!

Pilates: Strengthen Your Core

Pilates is a form of floor-based exercise (although there are routines that also depend on the use of a complex contraption that’s found in Pilates studios) like calisthenics or yoga.

The difference is the special emphasis Pilates places on the core muscles: the girdle of musculature in your trunk and back that support proper movement and posture.

The resulting sequences demand more exertion than you’ll find with tai chi, but the results can’t be argued with: strong, supple muscles; leaner lines; and a newfound freedom in movement that help combat chronic pain symptoms.

As with yoga and tai chi, you might want to start first with an instructor or a good DVD. You’ll need clothes that permit free movement and some kind of exercise or yoga mat.


This is a three-DVD set designed specifically for newcomers to Pilates. It’s not specifically for chronic pain patients, but it’s a good introduction.

Swimming: A Little Water Therapy Can Ease Your Pain

The simple act of floating in water, with its accompanying feeling of weightlessness, can itself be a form of pain relief. Little wonder, then, that chronic pain patients are often advised to start swimming for fitness and pain management.

Adopting a swimming program will require a bit more effort, as most of us don’t have a pool readily available for daily or regular use. You’ll need a swimsuit, of course, and that fact alone can be intimidating for some folks.

But if you can find a swimming pool in your area, and aren’t put off by the attire, twenty minutes of swimming can help tone your arms, back, stomach, and legs, and do so without the damage to knees, hips, and other joints that running, walking, and other forms of weight-bearing exercise can wreak on the body.

Our Bodies Are Meant for Movement

We weren’t meant to live sedentary lives, sitting at desks or on couches. Our physical bodies were designed for movement, for action. Chronic pain can make that movement a little tricky, but it doesn’t have to stop us in our tracks.

Whatever form or forms of exercise you choose, keep in mind a few general guidelines for safety and as relatively painless an experience as possible:

  1. As always, talk to your doctor about your desire to get moving, before you begin to incorporate exercise into your treatment plan.
  2. Go slowly, and get instruction where you need it.
  3. Most importantly, pick an activity that you will enjoy and can commit to doing regularly. Aim for three times a week to start, and increase your duration and effort gradually over time.


Exercise: Pain Relief or Pain Trigger? The Answer Might Surprise You

Person lacing up a pair of exercise shoes

Prescription for pain relief: medication, nutrition, sleep hygiene ... and exercise?

Here’s a particularly nasty little Catch-22 for CP dolls: We’re told over and over that exercise will help us feel better, yet post-exertional pain — that is, exercise-triggered pain — is a prime cause of our bad days and fibromyalgia flares.

The truth of this quandary has been driven home in a very in-your-face kind of way to me in the last month. Four weeks ago, I began feeling bad — I mean really, really bad. Most of the day, every day, I rated my overall pain levels at a six out of ten, often increasing to seven or eight at times. (Normally, my mean pain level is three or four, topping out at six right before the next dose of tramadol is due.)

And what happened next is easily predictable by anyone living with a chronic pain illness: I stopped moving. I withdrew into myself, stayed glued to the heating pad on the couch, and whimpered through my day.

Doing so only made logical sense: when I had to move — say, when I went to the bathroom, or took a shower, or cooked dinner (on the days I was even capable of making dinner — there were a boatload of pizza boxes passing through our house last month!) — the pain levels increased. I walked around the house with a shuffling, “disabled old woman” gait, grabbing my back or hip in futile attempts to stop the searing pain.

And as for sticking to my daily routine of 20 minutes of walking and 30 minutes of gentle yoga? Forget it.

This went on for four weeks. I might feel slightly better for a few days, but then I’d go right back into debilitating pain. I joked that I’d invented a new yoga pose: the Couch Potato position.

A “DIY” Two-Day Intensive Pain Relief Program

Then, this past weekend, I decided it was time to get serious about feeling better. For two solid days, the only thing I paid attention to was my health and my pain level:

  • I ate low on the food chain: vegetables, fruits, whole grains, minimal meat.
  • I took my multivitamin every morning.
  • I drank water and caffeine-free tea, eliminating all sodas and artificial sweeteners.
  • I took hot baths, followed by a rub-in of Tiger Balm on the particularly sore spots.
  • I meditated three times a day.
  • I took my full complement of prescribed pain medication (flexeril and tramadol), as well as the maximum safe dose of acetaminophen.

It was extreme, but desperate times call for desperate measures. Yet as exhausting as that list may seem, there was one more thing I did for those two days, and it’s what I think truly tipped the scales for me:

I moved, almost constantly.

Movement vs. Exercise for Chronic Pain

I won’t dignify what I actually did by calling it “exercise” — mostly, it consisted of simple stretches from a seated or prone position, twisting from side to side in a very gentle arc while standing, and so forth. I set a goal for myself: for every five minutes of inactivity, I’d do one minute of movement.

Sitting on the couch watching cartoons with my daughter? Flex and point my feet, alternating left and right. Or reach up to the ceiling and stretch one side of my ribcage and then other.

Cooking dinner? I’d do simple calf and hamstring stretches. Or gentle shoulder circles.

And yesterday, after two days of this intensive approach, I felt good. Not just better, but actually good.

Now, I do not think that not moving caused the flare-up in the first place. As I said, I usually walk and practice yoga every day. But that gingerly-moving, couch-sitting approach, born out of self-preservation as it was, may well have made things a whole lot worse.

The Painful Results of Inactivity

Like the amateur scientist I fancy myself to be, I treated this as an experiment. I had a working hypothesis — gentle, regular, consistent movement helps to stave off flare-ups of chronic pain, while a lack of movement will increase pain levels.

So I set about testing it. To test the hypothesis, I willingly went immobile this morning. No movement. Sat on the couch and watched Law & Order: SVU for hours on end.

And right now, as I write this, at 2 PM EST, one full hour after my afternoon dose of pain medication, I do hurt a little more than I did at any point yesterday.

Is this proof? No, of course not. But it does support the experts who have been telling us all along to get up and move, if we want to feel less pain.

I’m not about to suggest exercise is the end-all, be-all of pain management. That’s ridiculous. But I am suggesting that some form of movement or exercise may be a vital part of a comprehensive pain management program.

Finding Your Movement Sweet Spot

So why am I not advising you to go join the Y or start running? Because I think the experts have only half the picture right. The other half is just as important, and it’s this: the reality of post-exertional pain flare-ups.

We all know it. Move too much — do too much — walk too much — practice yoga too long, even — and you’re going to pay for it the next few days.

What this tells me, the pseudo-scientist with the curious mind and the half-full bottle of tramadol, is this: there’s a sweet spot, and it’s the job of each CP doll to find her own.

In between the “extremes” of post-exertional pain and couch-potato-induced pain lies a middle ground that will help you feel better. The problem is that those “extremes” can be pretty darn close together on a spectrum of effort and movement. Walk ten minutes and you’re feeling great. Walk another five minutes and you’re in bed for two days.

And there’s another complication: sweet spots for the chronically pained — even those with the same exact CP illness — will, I suspect, vary wildly. That’s true for the same reason that our general experiences with chronic pain illnesses vary so much from person to person: because chronic pain illnesses implicate so very many different facets of daily life.

From nutrition to stress to genetics to medication to body chemistry to sleep hygiene … it all plays a part, and every new facet gives the illness another level of complexity.

Exercise — movement — whether and how we use our bodies — this plays a part, too. Your mission: find your sweet spot, and attain that level of movement each day you are physically able to do so.

How to Get Moving and Find Your Sweet Spot

A few tips before you get going:

  • Talk to your doctor first. Make sure you’re healthy enough to do some activity.
  • Start slowly and gently, with movements and stretches such as the ones I described above.
  • Begin with where you are — not where you want to be, or where you used to be. This one’s hard for me, personally. I used to be a dancer, and in some part of my mind, I can still go for thirty minutes at the barre and sixty on the floor. Of course, I can’t. I have to get my ego out of the equation, and stick to my “sick person” routine. Because that’s where I am now.

Let me know in the comments what you think about exercise as part of a pain relief program. Do you exercise? Can you tell what’s going to trigger a post-exertional flare when you’re doing it, or does it always surprise you when you can’t crawl out of bed the next day? Are you physically capable of exercise? Also, be sure to visit Euston Arch on Thursday, when I’ll look at some commonly suggested forms of exercise for chronic pain conditions.

Going Mediterranean: Healthful Eating Choices Can Minimize Chronic Pain

Image of olive oil, tomatoes, peppers, garlic and pasta on burlap cloth with black background

Now, admit it: doesn't that look a wee bit delicious?

“Conflicting diet advice” – can we add that to “taxes” and “death” under the category of “Sucky Things We KNOW We’re Gonna Get”?

It’s become a joke at this point. Some studies say the controversial Atkins diet minimizes cardiac disease risk. Others say it exacerbates the risk. Scientists used to caution us away from eating eggs; now we find out they actually contain a cholesterol-lowering ingredient.

I threw my hands up a long time ago and decided that if the scientists couldn’t figure it all out, there was no way I could either. So, that being the case, maybe it didn’t make a whole lot of sense that one kind of food would be so much better for me than another. Or some other food would increase my symptoms so much more than another kind of food.

Maybe, it occurred to me, just maybe it made more sense to get back to basics …

Mediterranean Diet: The Back to Basics Way of Eating

And that’s pretty much what I found in the so-called Mediterranean Diet.

Right off the bat, I have to caution that there really is no such thing as “the” “Mediterranean” “Diet.” People on a Greek island don’t necessarily eat the same foods as Sicilians. Heck, they might not eat the same things as people living in a Greek coastal village. There is no one list of acceptable foods or foods that you can never eat, no one set of recipes, not even one set of guiding principles that are universally acceptable all over the Mediterranean region.

What we do have, however, is a list of generally accepted principles for what’s come to be called “the Mediterranean Diet.” And it’s a winner, in my book.

For me, this way of eating is terrific because, quite simply, I like the way it tastes. I love the “sensory” aspect of the dishes — the textures, the flavors, the colors. Mediterranean dishes really appeal to every one of my senses.

It’s also pretty darned simple, and that fits the way I generally cook. I don’t like to follow recipes usually. I prefer just adding a few ingredients to a basic “structure” and seeing what comes out. This way of cooking lends itself really nicely to that approach.

Since I’ve been eating this way, I can say I have lost quite a bit of weight, though I can’t attribute that entirely to the diet. More importantly for our purposes, my pain levels have tapered off and diminished in a few key respects. It’s not gone, but I “feel better.” And that’s worth just about any change of diet, in my cookbook.

Principles Behind Mediterranean Diet for Health Management

The general approach is pretty simple: Heavy on the fruits and vegetables, fish and chicken, light on the red meat; whole grains; low-fat dairy; olive oil and olives; and red wine (optional).

There’s no trick here – no super-secret science at work that will suddenly heal your chronic pain, I’m sorry to say. But it is a healthful, balanced approach that will reduce your overall health risks (especially for diabetes and cardiac illness), increase your general wellbeing and energy, and possibly reduce inflammation , which in turn can reduce your chronic pain levels.

Getting Started With the Mediterranean Diet

There’s no need to go buy a ton of new cookbooks, if you want to implement the principles behind the Mediterranean Diet into your own nutritional program.

Start simply and colorfully by choosing whole fruits and vegetables at the local produce market: carrots, colored peppers, broccoli, squash, berries, apples (go for organic if you’re concerned about pesticide use in your area, or if you don’t have access to a farmer’s market or co-op).

Add some olives. I love kalamatas, but there are several delicious varieties available at most chain groceries. Get a good-quality olive oil, while you’re at it. Cook with it (watch carefully and make sure it doesn’t hit the smoke point before you add in your meats and veggies) and add it to salads with some balsamic vinegar for an awesome and cheap salad dressing.

Rely on non-farmed fish and chicken, with an occasional dish including red meat (experts recommend twice a month or less, though I confess I eat it more often – more like once a week). Do a meatless meal once or twice a week; use beans and pasta to supplement veggies. Experiment with various spices – basil and oregano are my two go-to favorites – and garlic, which has some antibacterial and anti-inflammatory properties.

Now, about that wine … many iterations of the Mediterranean Diet recommend a daily glass of red wine, which some studies suggest reduces the risk of cardiac disease. Other studies suggest that it might increase inflammation. What’s a poor Doll to do?

Personally, I skip the wine because I take prescription medication. If you’re not taking medication, or at least not taking medication that’s contraindicated for alcohol consumption, you might want to try it once in awhile. I have to say, I do miss that occasional glass, even though I was never a big drinker. (Pause while all my college friends stop laughing…) But stick with just one a day, no more.

Resources for Further Reading on the Mediterranean Diet

If you want to experiment and play with these principles, I encourage you to check out two cookbooks that I’ve particularly enjoyed.

One is called The Mediterranean Prescription: Meal Plans and Recipes to Help You Stay Healthy for the Rest of Your Life by Angelo Acquista, M.D. (affiliate link). This book is more geared towards weight loss than general health, and it’s got a definite Sicilian bent. But whether you’re aiming to lose weight or just get healthy, the recipes are amazing.

The other is called simply The Mediterranean Diet (affiliate link), and it’s coauthored by Marissa Cloutier and Eve Adamson. It’s strong on nutritional information and also contains a seven-day meal plan suggestion, as well as a little exercise program you can try (though it might be unsuitable for chronic pain patients).

You can also take a look at the following links that I can personally recommend:

Buono appetito, and here’s to your health!

Why and How Yoga Works to Relieve Chronic Pain (Guest Post/Virtual Book Tour — Kelly McGonigal)

Euston Arch’ First Virtual Book Tour Proudly Presents Kelly McGonigal and Yoga for Pain Relief

From Annie: As I noted here earlier , Kelly McGonigal is a yoga instructor and Stanford University psychology instructor. Most importantly for our purposes, she’s just published a book titled Yoga for Pain Relief , and as a long-time Tramadol Diaries reader, she wanted to share some of the fruits of her labors with other TD readers in a virtual book tour.

Of course, I grabbed that opportunity! I’ve written about my experiences with yoga before, both here and in articles for other sites, but I really can’t say enough good things about yoga.

I joke that tramadol saved my life, and it did — but the truth is, so did yoga. Without my daily practice, I honestly doubt that I’d be here right now, joyfully writing this introduction in support of Kelly’s “labor of love.” Chronic pain not only means we don’t move our bodies as we want to and should — it also means our psyches are burdened as well. It shouldn’t be a surprise to anyone that chronic pain patients have a high incidence of depression; as many of us say, “Let me stand on your chest for ten years and let’s see how long it takes YOU to get depressed.”

Yoga not only helps relieve the physical pain but it also gives me the tools I need to eliminate the suffering aspect of pain. That, in turn, greatly and positively enhances my quality of life and sense of wellbeing. Yes, I still hurt. The difference is, I’m not letting it define me, nor am I burdened with all those fearful, tense feelings that collectively comprise suffering.

So, without further ado, here’s Kelly with an excerpt from her new book, Yoga for Pain Relief: Simple Practices to Calm Your Mind & Heal Your Chronic Pain (Whole Body Healing) ( disclosure: that’s an affiliate link to Amazon – costs you nothing extra, adds a few pennies to my bank account). This excerpt includes instructions for a special practice sequence that might help anyone coping with chronic pain. Also be sure to check out the special bonus guided meditations at the end of the post!

CAUTION: As always, talk to your doctor before starting any new exercise regimen.

Lisa’s Story: Finding Hope Through Yoga

Lisa’s achey fatigue was both mysterious and maddening. When it first showed up during the winter holidays, she thought it was just the flu combined with exhaustion from overdoing things. But as the holidays passed and her fatigue didn’t, her family became alarmed and encouraged her to see a doctor. Her general physician couldn’t give her a definite diagnosis and referred her to a specialist.

The specialist gave her lots of tests but also couldn’t tell Lisa for sure what was causing her exhaustion. Eventually Lisa was diagnosed with chronic fatigue syndrome. By this time, she had taken an extended sick leave from work and was wondering if she would ever be able to return.

Lisa’s physician gave her two prescriptions: an anti-inflammatory drug and an antidepressant. What she wasn’t given was an explanation for her symptoms, or any answers about when or even whether she would recover.

To Lisa, the lack of medical understanding meant lack of hope. Her growing sense of hopelessness was accompanied by greater fatigue. Some days she was so tired, she crawled back into bed less than an hour after waking. The worst part was that even though she was almost always exhausted, she had trouble sleeping. This left her plenty of time alone with her worries and frustrations. She described it as a “wide-awake nightmare.”

Without a clear path for recovery, Lisa needed some way to feel like she was taking care of herself. She wanted to be able to do something every day that felt like an active step toward improving her energy and mood. Lisa didn’t have the strength for exercise, but she found great solace in restorative yoga. It was something she could do every day, knowing that it made her feel better both physically and emotionally.

Lisa kept her yoga mat and props out so that there would be no barrier to practicing. She took great care in choosing inspirational music to play while she practiced, knowing that her favorite songs would lift her spirits. She took seriously the idea that focusing on gratitude, joy, connection, and courage could change the state of her body. She chose one meditation each day to practice in her final restorative pose, imagining the thoughts and sensations of each meditation restoring her strength and well-being.

Lisa thought of her restorative yoga practice as her third daily prescription. It became the one part of her self-care program that consistently made her feel optimistic about her future.

Many types of pain and illness are physically and emotionally overwhelming, especially when they pull you out of your normal life and put you into the role of patient. When pain or illness is this overwhelming, even a few minutes of focusing on health can restore hope and inspire courage in the journey of healing. Whenever you find yourself lowest in spirit, you can always turn to yoga to affirm the part of you that is healthy and whole, despite pain or illness.

A Simple Restorative Yoga Practice: Supported Inversion

Benefits: By gently bringing the legs above the heart, this pose improves circulation and has a healing effect on many systems of the body, including the nervous system, the lymphatic system, and cardiovascular system. It can be done no matter how little energy you have, and can help make “rest” more restful and less stressful.

Props needed:

  • A wall, chair, or sofa.
  • Optional: a small rolled towel or blanket to support your neck and head
  • Optional: an eye pillow or cloth to drape over your eyes.

Instructions: [Annie’s Note: there are three parts to this practice — the physical asana, breathing, and the meditation. Read through the entire description at least twice before attempting. You might also want to consider tape-recording these instructions and playing them back as you go, or having a friend or loved one read through them as you move through the asana, at least the first time you try it.]

  1. Find yourself seated on the floor near the wall or your chair, with one side of your body facing the wall or chair.
  2. If you are using extra support for your head and neck, place it about one arm’s length away from the wall or chair, where your head will rest.
  3. Start to lean back on your arms as you raise your legs onto the support of the wall or chair.
  4. Let your hips turn as you do so, until you find yourself lying comfortably on your back, with your legs resting on the wall or chair.
  5. If you are at the wall, make sure that you do not feel a strain behind the knees, in the back of your legs and hips, or in your lower back. If you do, try the pose with hips further away from the wall, to reduce pressure on the legs and back. If you continue to feel any strain in the wall version, you may find the bent-leg version using a chair or sofa much more comfortable.
  6. Let yourself relax into the support of the pose.

Breathing: Once you are settled in the pose, bring your hands to rest on your belly. Feel the belly rise and fall as you breathe.

Meditation: This pose is in invitation to drop your usual worries and burdens. As you inhale, say silently in your mind, “Let,” and as you exhale, “go.” Yoga is about feeling safe and supported, in both your body and in all areas of your life. You can also repeat silently in your mind, “I am safe” or “I am supported.” If there are other words, images, or memories that make you feel safe and supported — such as loved ones, a favorite place, or a prayer — bring them to mind.

Bonus For Euston Arch Readers! Meditations Just For Chronic Pain Dolls

In addition to the awesome meditation/yoga asana practice Kelly shares above, she’s offering something special just for Tramadol Diaries readers. At Kelly’s website, Yoga For Pain Relief, you can also download or stream a guided meditation that will guide you through practices of breath awareness, body gratitude, and listening to your body. There’s one for befriending your body, and another for listening to your body (both links are to MP3 files).

I’d like to thank Kelly both for writing such an amazing resource for those of us living with chronic pain, and for sharing her words of wisdom with Euston Arch and its readers. I’ve learned a lot, and I hope you have, too. Kelly has an open invitation to stop back by anytime she likes!

HUGE Announcement: TTD’s Very First Virtual Book Tour Participation — Kelly McGonigal’s Yoga for Pain Relief!

Regular Euston Arch reader Kelly McGonigal contacted me this week with some amazing, awesome news: her book, Yoga for Pain Relief: Simple Practices to Calm Your Mind & Heal Your Chronic Pain (New Harbinger, Dec 2009) is now in stock at Amazon! (Yep, that’s an affiliate link. So is the one at the bottom of the post.)

Even better? Kelly’s going to do a virtual book tour to promote Yoga for Pain Relief and one of her stops? Right here! UPDATE: Check out Kelly’s guest post right here!

That’s right– Kelly will be the guest blogger here at Euston Arch very, very soon — date to be announced just as soon as we pin that down. I’ve already gotten a sneak peek at what she’s got in mind, and it’s good stuff — practical, helpful, and very, very cool.

In the meantime, I encourage everyone to get a copy of Kelly’s book. Just as much as tramadol has, yoga has saved my life in the face of chronic pain. From specific postures that relieve specific pains, to the mental shift that removes the suffering element from the perception of pain, yoga’s been an important part of my treatment plan.

Why should you listen to Kelly? Well, simply put: she knows whereof she writes. Kelly is a former chronic pain sufferer herself (that’s right — I wrote “former”! Aren’t you already intrigued?), and she’s not only a Stanford psychology instructor but also a prominent yoga teacher as well.

Personally, I can’t wait to get my copy of Kelly’s book and put her suggestions into practice.

OH — and if you’re reading this blog because someone you know has chronic pain? This would make a great Christmas present. I’m just sayin’ …

Congratulations to Kelly McGonigal, Euston Arch’ first published reader/author! May you enjoy every success.

Do Nutritional Supplements for Fibromyalgia Really Work?

Update – 12/5/09: the promo code for the Vitamin World site at the end of this post was good for December 2 only, but this one’s good today – Dec. 5th: One day only! $10 off $75 + FREE Shipping at Vitamin World. Use code TAVHOL5 at checkout. Valid 12.05.09

I’ll keep updating this post as long as the VW promotion is going on, so check back if you’re not ready to buy now. Again, that’s an affiliate link which might put a few cents back into the web-hosting account for this site! Gracias.

Many fibromyalgia experts and texts recommend nutritional supplements as a way to offset or eliminate fibro symptoms. But do those supplements really work?

Following is a rundown of a few of the most-often recommended supplements, as well as my own personal experience with some of them.

CAUTION: Remember that, as with every potential treatment, you should always consult with your physician before trying any of these supplements out. Even so-called natural remedies can interact dangerously with other remedies and medications, so talk to your doctor first.

Malic Acid and Magnesium

Particularly when taken together, experts suggest, malic acid and magnesium can alleviate the more painful fibro symptoms. Malic acid is derived from tart apples, while magnesium is, of course, an essential mineral necessary for more than 300 bodily biochemcial functions.

Among the most important of these functions are muscular function and the creation/processing of ATP in the body. (ATP, briefly, is adenosine triphosphate, and results from the enzyme-catalyzed processing of sugar and fat.) Magnesium activates the process, and malic acid helps the body make ATP more efficiently.

Past research also suggests that magnesium may work to dampen the processing of some types of pain signals in fibromyalgia sufferers.

You can view more information on magnesium at the NIH fact sheet here, and an abstract of one study’s results looking at the combination of malic acid and magnesium can be found here (results: “significant reduction” in pain symptoms in increased dosages in open trial). However, it should be noted that an earlier double-blind phase of that same study showed no appreciable effect on FM patients who took magnesium/malic acid supplements.

Possible side effects:

  • Diarrhea
  • Nausea or diminished appetite
  • Respiratory difficulties
  • Hypotension
  • Adverse interactions with some medications (including osteoporosis drugs, certain hypertension medications, antibiotics, and muscle relaxers)

S-adenosylmethionine (SAMe)

A naturally-occuring chemical compound found in the human body, SAMe plays an important role in several critical functions, including the immune system response and the creation and processing of chemical neurotransmitters such as serotonin and dopamine.

Some research indicates that SAMe might be beneficial for FM patients. In one double-blind study looking at SAMe’s effects on 17 fibromites (more than half of whom also had been diagnosed with depression), both the number of painful tender points and assessed depression decreased appreciably with SAMe as compared to the placebo group. While intriguing, the relatively small number of subjects in this study warrants caution in evaluating its results.

Other study results conflict with each other. In one slightly larger study (44 subjects), there was appreciable decrease in some symptoms (pain, tiredness) but not others (tender points, mood). Another study delivered SAMe via IV, but found no measurable decrease in tender points.

Possible side effects:

  • Indigestion and other digestive disorders
  • Insomnia
  • More rarely: diarrhea, acid reflux
  • Caution: FM patients who are diagnosed with bipolar disorder should not take SAMe; it may increase the occurrence and severity of manic episodes. SAMe may be contraindicated for those taking antidepressants; consult your doctor first (as you should before taking any new supplement or medication).

5-HTP (5-hydroxytryptophan)

There is some promising research on 5-HTP and fibromyalgia, showing that it can reduce tender points and increase serotonin, the “feel good” neurotransmitter.

There is no fact sheet for 5-HTP at NIH, but you can find good information on it at this site. While it’s found in low levels in some foods (turkey, for one), most will want to choose a supplement form.

Possible Side Effects :

  • Loss of appetite, nausea, and vomiting
  • Diarrhea
  • Pupil dilation
  • Muscular coordination problems
  • Blurred vision
  • Irregular cardiac rhythms
  • Caution : Do not take 5-HTP if you’re currently taking any antidepressant.

Vitamin B12

A few studies with relatively small subject numbers indicate that FM patients may have lower levels of vitamin B12. As B12 is an essential vitamin, it’s certainly worth looking into your intake.

Good dietary sources of B12 are animal products — meats, fish, eggs — and fortified cereals. It’s not usually found in fruits and vegetables. The current RDA for mature men and women ranges from 2.4 to 2.8 micrograms.

You can also take a multivitamin that has B12 in it, or an individual supplement pill for B12 or B Complex (includes B12 as well as B1, B2, B3, and B6).

You can read more information on Vitamin B12 at the NIH website’s fact sheet.

Possible side effects:

  • B12 has a very low risk of toxicity but it can be contraindicated with certain medications. As always, talk to your doctor.

Vitamin D

Some researchers have found a connection between vitamin D deficiency and general musculoskeletal pain. Certainly, vitamin D is generally recommended for overall nutritional health and wellbeing.

The current recommended intake level for vitamin D in the US is 200 I.U. for men and women up to age 50, rising up to 600 I.U. for older patients. Toxicity has been established at 50,000 I.U.

It’s difficult to get all the Vitamin D you need from foods, but it is present in fortified milk products and certain fatty fish (particularly the skins). You can also increase your body’s own production of the vitamin with sunlight exposure without sunscreen (just a few minutes a day are all that’s required).

Get more info from the NIH Fact Sheet on Vitamin D.

Possible Side Effects :

With too-high intakes of Vitamin D, certain side effects are known:

  • Nausea
  • Vomiting
  • Decreased appetite
  • Constipation
  • High blood levels of calcium may also lead to confusion and irregular heart rhythms

Personal Experience With Supplements for Fibromyalgia

Of these commonly-recommended supplements, I’ve given two-month trials to malic acid and magnesium (taken together); vitamin B12; SAMe; and 5-HTP. I’m currently experimenting with vitamin D.

I experienced no measurable relief with malic acid and magnesium. While on increased levels of B12 (a multivitamin plus an additional supplement, providing a total of 580 mcg, I did notice a slight increase in my energy level, but no decrease in pain symptoms.

SAMe and 5-HTP both produced some interesting results. I believe my pain symptoms leveled off — I had fewer flare-ups, and when I did experience increased pain days, it seemed that my “lows” weren’t quite as low as previously. Also with 5-HTP (but not SAMe), I felt my neck/shoulder tender points were a little diminished in terms of sensitivity.

Of course, in each of these try-outs, I knew what I was taking. My results could be attributable to a placebo effect (although that doesn’t explain why I didn’t experience any benefit with malic acid and magnesium; 10 years ago, when I was first diagnosed, it was the first- and most-often-recommended supplement).

You should never take any one person’s recommendation for a treatment option. Do your own research, talk to your doctor, and if you do want to try one of these supplements, try going in without any expectations.

Special Promo Code for Tramadol Diaries Readers from Vitamin World

If you’re interested in trying out some of these supplements, Vitamin World is offering a series of specials for the next few days. Today’s special, good for December 2, 2009 only: One Day Only! $1 Shipping on ANY order at Vitamin World! Use code TAVHOL2 at checkout. Valid 12.02.09 Today (12/5/09)’s code: Dec. 5th: One day only! $10 off $75 + FREE Shipping at Vitamin World. Use code TAVHOL5 at checkout. Valid 12.05.09 Yes, that’s an affiliate link and might just net me enough to help offset the hosting for this site … maybe.