Looking for an ultimate chronic pain solution? Focus on flexibility and diversity 1
Jan 19, 2020
Part one - metabolic flexibility
Metabolism and energy production is a major issue in any chronic pain condition. There is no person with prolonged daily physical pain without problems with fatigue, although there are people who had fatigue before the physical pain. Healthy metabolic flexibility, which allows smooth switching between different fuel sources and adaptability to shifts in demand, allows maximum functional capacity for a given task, at the level of the brain and muscle, to name the two most critical energy users. The lack of it means a struggle to perform even basic daily tasks.
At the musculoskeletal level, pain sensations can be symptoms of both a metabolic imbalance - caused by an energy crisis at the cellular level of the muscle, and a mechanical relative overload, the trigger we only focus on when analysing cause and effect of movement and pain. The trigger point theory of myofascial pain, often found in various chronic pain conditions, focuses on the energy crisis as the source of nociceptive signalling. At the moment, no one doubts that the energy crisis actually exists at the site of trigger point contraction. However, the question of its origin remains open.
What about the brain? Have you ever thought of brain fog as a result of such discrepancies? Or mood lows and pain outbursts as a result of "boom'n'bust" cycles? The brain is a huge consumer of energy, more exposed to oxidative stress than any other organ in the body.
Persistent discrepancies between need.
which is any kind of activity in the body that requires energy production
and the capacity to meet the demand.
- the actual ATP production at the mitochondrial level.
So the real problem could be on either side of the equation - too high a demand over too long a period of time (demand made primarily by conscious or unconscious behavioural dictates, self-imposed stress in any form - immune, autonomic, emotional, cognitive, motor) or too low a capacity (innate mitochondrial condition inherited from mother - or acquired weakening of energy production capacity over time due to mitochondrial stress or disuse). Those who live with chronic pain for years usually get into trouble with both, creating a state of rigid metabolic insufficiency and higher oxidative stress load that the body must counteract. In part, it's a problem of ageing per se, but "ageing" as it relates to mitochondrial fitness gets on the fast track here, which often affects the internal state of the body differently. So you may still look good and young on the outside (physically), but feel old and worn out on the inside (mentally).
The solution - address both sides - need and capacity - at the same time. The goal is to regain the metabolic flexibility and bioenergetic sustainability of the body. Only addressing the status of bioenergetics (the capacity side) and trying to fix it through supplements, diet plans, exercise, etc. will not work in the long run if we do not address the drives of impulsive overactivity - psychologically (the need side). The same is true in reverse - just doing talk therapy per se - doesn't change the state of affairs at the mitochondrial level.
In the (near - I hope) future, maybe some clever shortcuts or bio-hacks will come out to regain metabolic flexibility and energetic sustainability of the body. My own hope is in the manipulation of the microbiota, especially in cases where the disruption of the microbiota is a primary disorder leading to changes in the innate immune system and gut-brain signalling. What does bioenergetics have to do with this? With a microbiota disorder, the body is exposed to many more stressors (infections, asthma, mood issues, to name a few) compared to a body with a healthy and strengthening microbiota. Stress overload means higher energy demands, which can put the body in a state of the aforementioned discrepancy and possible development of chronic pain, if we think of the chronic pain condition as a problem of allostasis. But anyway, we're not there yet. For now, we still have to do the hard work of behavioural change on all of the above to regain some of the metabolic flexibility and energetic sustainability of the body to live a life of greater satisfaction alongside the remaining pain.
You are welcome to read more posts from this series:
Looking for the ultimate solution to chronic pain? Go for Flexibility and Variety: Dietary Diversity
