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MSWA Bulletin Magazine Summer 2022

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Keeping your cool this summer | Welcome Melanie Kiely CEO | MSWA Stationary Cycle results | Pain and pain management series: Part 3

PAIN & PAIN MANAGEMENT

PAIN & PAIN MANAGEMENT SERIES Welcome to the third instalment in our series of articles on pain and pain management. Below, Senior Occupational Therapist Lina Ghulami and Neurological Liaison Nurse Bronwyn Innes, who has a speciality background in pain management, explore the relationship between pain and sleep. Future editions will explore more strategies to combat pain. If you would like to read the previous articles in our Pain & Pain Management series, all previous editions of Bulletin can be viewed online at publications.mswa.org.au SLEEP AND PAIN Sleep and pain appear to have a two-way relationship. There is an unquestionable link between sleep and pain, but emerging evidence suggests that the effect of sleep on pain may be even stronger than the effect of pain on sleep. SLEEP SIMPLIFIED Chronic pain may lead to a self-perpetuating cycle, illustrated here: During sleep, we cycle through: / light sleep, / slow-wave sleep, and / rapid eye movement (REM) sleep. Sleep Pain and anxiety make it hard to sleep. Lack of sleep makes pain worse and decreases energy. To feel well-rested, we need a balance of all these sleep stages, especially slow-wave sleep and REM sleep. Disrupting this cycle interferes with the progression of the sleep stages and leads to less restful sleep and next-day tiredness. Chronic pain can affect sleep differently, depending on the nature of the pain. Some conditions may flare up at night or be provoked by certain sleeping positions. Others may cause persistent pain that does Energy Coping with pain drains energy. Lack of energy makes it hard to be active and stay in shape. Activity Pain and lack of energy make it hard to be active. Lack of exercise worsens pain. THE SELF-PERPETUATING CYCLE OF PAIN Mood Chronic pain and the limits it puts on your life can lead to depression, anger and anxiety. These feelings make coping with pain harder. not ease at night. Some people with chronic pain also experience other disorders, such as / obstructive sleep apnoea or / restless legs syndrome. Someone who is in pain may become anxious when they cannot sleep. They may sleep poorly and wake up feeling depressed, which increases their sensitivity to pain. The next night, they are in pain again, so they cannot sleep well, and the cycle continues. Over time, this negative cocktail may worsen existing conditions and even have an influence on a person’s level of disability. People with chronic pain may feel fatigued during the day. Depending on their level of disability, they may be less likely to exercise or follow a healthy diet, both of which are important for getting a good night’s sleep. 20

STRATEGIES TO ASSIST WITH A GOOD SLEEP Appropriate tools for a good night’s sleep: When learning how to sleep with pain, the type of pain may dictate your sleeping position. A mattress and pillow designed to cushion pressure points and support the natural curvature of the spine may help alleviate some of the pain. When pain causes the need to switch sleeping positions more frequently to avoid numbness and tingling, a more responsive mattress that facilitates movement on top of the bed may be beneficial. Following some basic sleep hygiene strategies can help prepare your body for sleep. / Get enough sunlight. / Exercise early in the day. / Follow a healthy diet. / Avoid stimulants like screens, caffeine, or alcohol close to bedtime. / Meditation can also help cope with the pain and help with a better quality of sleep. The bedroom should be a calming haven used only for sleep and private / intimate moments. / Keep it cool, dark, and quiet at night. / Go to bed and wake up at the same time every day. / It may help to carry out a bedtime routine in a set order, such as having a bath, brushing your teeth, reading a light book, and then turning out the light. Mindfulness for Chronic Pain: Deep breathing, mindfulness techniques, or guided imagery may allow you to rethink pain in a way that’s easier to deal with. One of the main ways in which pain affects sleep is by keeping the central nervous system aroused. Therefore, to be effective, these strategies need to promote relaxation and calm. The theory of mindfulness is paying attention to something on purpose with fresh eyes, therefore we can use it to pay attention to our pain to help us change our attitude towards pain. It is not about being pain free and achieving a certain ‘pain goal’, however it is about accepting your pain and learning to relate to your pain differently. MINDFULNESS TECHNIQUES Body scan 1. Sit or lie down in a comfortable position 2. Starting with your feet, pay attention to the physical feelings in them: any pain, discomfort, coolness, warmth, tension, tightness, whatever. 3. Simply pay attention to the physical feelings and sensations. Don’t judge them as good or bad, don’t try to change them, just be aware of them. 4. Start with your feet and slowly let your awareness drift further up your body, doing the same gentle noticing for all of the parts of your body – your upper legs, hips, buttocks, pelvic region, stomach, chest, your lower back, upper back, fingers and hands, lower arms, upper arms, shoulders, neck, your head, forehead, temples, face – eyes, cheeks, nose, mouth, jaw line. 5. Then let your awareness drift gently and slowly back down your body, noticing any other places where there is pain, discomfort or tension and simply noticing this, until your awareness settles back at your feet. MINDFULNESS RESOURCES / painHEALTH painhealth.csse.uwa.edu.au / Mindfulness-Based Stress Reduction Course ummhealth.org/center-mindfulness / Breathworks Online Mindfulness Course breathworks-mindfulness.org.uk Abdominal Breathing Exercises Pain rings alarm bells and we automatically think ‘I hate this, what am I going to do?’. Grounding your breath can help keep you calm. 1. Close your eyes and focus on your breathing. 2. Place one hand over your stomach and the other on your chest. Pay attention to how your hands rise. 3. Slowly breathe in through your nose and count to four. Try to breathe in a way that the hand on your stomach rises, whereas the hand on your chest only slightly rises. 4. Hold your breath for four seconds, then breathe out through pursed lips for four seconds. 5. Continue this for five minutes. 6. Once you have learnt abdomen breathing you can place your hands by your side. Talk to your doctor or mental health professional for more help with sleep and pain management. They may be able to recommend additional therapies or prescribe medication to help you sleep better. BRONWYN INNES MSWA NEUROLOGICAL LIAISON NURSE LINA GHULAMI SENIOR OCCUPATIONAL THERAPIST / Mindfulness for Wellbeing and Peak Performance (Online Monash University) futurelearn.com/courses/mindfulness-wellbeing-performance / Mindfulness-Based Cognitive Therapy Course (Headspace App) headspace.com 21