This is the second part of an 8-part series on the acronym “SPLENDID” for holistic management of MCAS. See previous blog post here for the starter in this series!
Pain is a big deal, especially in patients with chronic illness. Patients with MCAS experience all different types of pain. Many will experience intermittent visceral pain that can refer pain to other areas. Abdominal pain and some type of gastrointestinal discomfort is usually present. Many patients with MCAS fall somewhere on the joint hypermobility spectrum and tend to suffer from a wide range of orthopedic injuries that are often exacerbated by ergonomic and biomechanical factors. Patients often report night pain alongside neuropathy and insomnia. Migraines are common in this population and can be especially painful. Patients who have a high bacterial or viral burden often experience regular achiness and flu-like symptoms. It’s also common for patients to experience joint pain and inflammation on a regular basis. And the list goes on…
Pain is our body’s alarm system, and it’s an important signal to our conscious mind so that we know when to let go of the sharp object, or when to allow our system to rest and recover. However, when pain becomes chronic, it can play into a vicious cycle scenario with cortisol, one of the body’s major stress hormones, which can lead to a predominance of sympathetic nervous system (fight or flight) activation and adrenal problems, which can perpetuate the cycle.
Stress and pain can definitely feed off each other, but it’s much more complex than it may seem. There are a number of physiological changes that occur when the system experiences pain. These influence the resting muscle length, the presence of trigger points (tight fibrous bands in muscle tissue), the circulatory system, the way we breathe, and in turn often affect the quality of sleep, which can influence the body’s ability to detoxify and clean up waste, which can create a sluggish liver/gut/lymphatic system… when you add extra cortisol being pumped around due to stress, this can easily turn into a big obstacle for healing.
When the brain is receiving chronic pain inputs over time, several peripheral and central nervous system changes have been documented to occur. Patients can develop hyperalgesia (an exaggerated response to noxious stimulus) or allodynia (the perception of pain from normally innocuous stimuli).
A systematic review on musculoskeletal pain (2016) noted that there are changes in the somatosensory, affective and cognitive processing areas of brain in response to chronic pain. Morphological and functional structural alterations in the brain have been noted, in addition to less gray matter volume in frontal and temporal lobes, the cingulate cortex, and insula.
Pain can be viewed in light of the total load concept. Patients with MCAS are likely exposed to a tremendous amount of health stressors. This list is not all-inclusive, but here are a number of factors to consider:
- Viruses
- Bacterial infections
- Oxidative stress
- Mold exposure
- Dental issues
- Mechanical stress
- Gastrointestinal problems
- Heavy metals
- Emotional stress
- Medications and supplements
- Other environmental toxins
- Food triggers
- Health and beauty products
- (etc.)
When the body is overburdened, it’s going to try to perform triage, and if the pain signals are blaring, those mechanical stressors like pain could take priority/attention. Simply put, a physiologic focus of attention to pain/inflammation in one specific area diverts the body’s resources that it needs in order to support detox organs and engage in deep healing. And it is also likely putting fuel on the inflammatory fire.
There’s a multitude of strategies for management of chronic pain. There’s no one-size-fits-all approach, but most patients find that some combination of the below items helps reduce inflammation and calm the system. Pain management doesn’t have to be expensive or complicated. It can certainly include some at home self -care strategies such as regular breathing exercises, meditation, and yoga. Just as it’s important to figure out the underlying issues and triggers responsible for mast cell over-activity, the same principle applies for the pain. (For example, if it’s neck pain, are there postural and ergonomic factors that are perpetuating the repetitive strain?)
It’s also especially important to address sleep. Sleep and pain go hand in hand and sleep “hygiene” is essential – see a recent blog post on this topic. It’s also important to get regular exercise (in the right manner) and to fuel the body with clean nutrients in order to promote tissue healing and reduction in pain. (More to come on these topics soon…)
Here are some of my favorite approaches for reducing pain:
- Physical therapy
- Acupuncture and dry needling
- Reiki
- Massage therapy
- Visceral manipulation
- Breathing exercises
- Craniosacral therapy
- Sound healing
- Customized exercise programs
- Meditation and visualization
- Cannabinoids and other supplements to reduce pain and inflammation
- Addressing psychological stress
- Nervous system re-training programs
- Prevention of repetitive stress/strain
- Ergonomic assessments
During acute attacks of a painful and unpredictable condition like hereditary angioedema, I also find it helpful to have a routine. Mantras are especially useful here, like “This, too, shall pass.” Whether it’s a warm bath and essential oils or that favorite tea and a Netflix marathon, find out what works for you. And remember to give yourself some grace in this aspect of your journey.
What works for you? What are your go-to approaches for pain?
Reference
- Coppieters, I., Meeus, M., Kregel, J., Caeyenberghs, K., De Pauw, R., Goubert, D., & Cagnie, B. (2016). Relations Between Brain Alterations and Clinical Pain Measures in Chronic Musculoskeletal Pain: A Systematic Review. In Journal of Pain (Vol. 17, Issue 9, pp. 949–962). Churchill Livingstone Inc. https://doi.org/10.1016/j.jpain.2016.04.005
