CHAPTER 1
FATIGUE, PAIN, AND HOW THEY RELATE TO AGING
Throughout my thirty-eight years of medical practice, most patient visits involve complaints of either fatigue, pain or both. I have come to understand that they are inextricably linked by how inflammation works. Pain can cause or effect fatigue and fatigue is often linked to all types of chronic pain. Because these symptoms are so encompassing and often require different levels of urgency to diagnose and treat, the root cause(s) are easily overlooked. Far too often, the diagnosis is whitewashed in disease treatment and reduced to band aid approaches involving addictive painkillers, antianxiety medications, antidepressants, sleeping pills, muscle relaxants, or combinations of some or all of them. Often imaging and surgery are recommended but fail to control symptoms after periods of time.
While these treatments are well intentioned and offer some semblance of symptom relief, the long-term consequences of drug addiction and brain fog from untoward and addictive side effects nag a productive life. The choice is often to live with debilitating fatigue and pain, or accept the side effects, and brain fog from painkillers, antianxiety and sleeping pills. The fact is simple, all the drugs used to ameliorate pain and fatigue produce their own set of problems that can be just as bad over time as the pain and fatigue. The basis for this fact is that these medications often only relieve symptoms, can be very addictive, have their own sets of side effects and tend to lose their effectiveness over time. Remarkably they do not address the chronic inflammatory root cause(s) of pain and fatigue.
With the passage of time, as tolerance to treatments increases, even more addictive medication is required to alleviate symptoms. This creates an unrelenting spiral of potentially adverse outcomes that leave patients with even less capacity to function. Normal living gets reduced to basic subsistence and dependency upon addictive drugs. Depression, disability and suicide can be just around the corner.
Identifying the root cause is notjust about which end organ is involved in the pain and fatigue complex. Although one end organ appears to be causing symptoms, there are usually underlying inflammatory conditions that are affecting all end organs. The inflammatory condition thus becomes a root cause. For example, chronic low back pain is often associated with a protruding intervertebral disc, or arthritis in joint spaces that affects nerve roots. What becomes perplexing in the treatment of low back pain is that predictability of who has the most pain based on imaging of the back is a crap shoot. Some patients have no back pain with horrific x-rays while others have severe back pain with very little evidence of arthritis. In other words, there is often no correlation between back pain and abnormalities seen on imaging. Could the difference be tied to the presence or absence of chronic inflammation?
I would suggest that any end organ pain or fatigue increases or decreases based on the presence or absence of chronic inflammation. Mitigating chronic inflammation, as root cause, has a significant impact on all types of different end organ pain or fatigue. While it is reasonable to focus resources on urgently alleviating disabling pain, the inflammatory elephant in the room should not be ignored. Identifying the root cause(s) of inflammatory pain and fatigue therefore takes on a more holistic understanding of health, as it biases discussion about anti-inflammatory lifestyles. When implemented, pain and fatigue often remit regardless of which end organ these symptoms appear to originate from. In the context of lifestyle and prevention, evaluating pain and fatigue takes on a different narrative, as reversing inflammation becomes a top priority.
In the case involving low back pain, this would mean mitigating inflammatory risks. Besides reducing dietary sugars, cigarettes, and stress, behavioral prevention programs involving low back stretching, sleep positons, as well as utilizing proper techniques in bending and lifting in aggregate substantially improve low back pain. As important as these behaviors are to addressing root cause, the fall out is that the back pain has a far greater likelihood of decreasing without relying on drugs or surgery. When lifestyle management causes a regression in pain or fatigue, patients gain greater confidence in managing their health which reinforces more wellness while making them less vulnerable to addicting narcotics or sleeping pills.
Reducing inflammation by reducing vascular inflammatory free radicals allows not only low back pain to improve but cascades occult improvements in other end organs. In the holistic, root-cause approach, the low back pain becomes the red flag to underlying inflammation that needs to be addressed with lifestyle adjustments. Doing so may also improve cognition, breathing and other end organ attributes.
In this chapter, we will see how the symptoms of chronic pain and fatigue tie into the cellular basis for inflammation caused by the loss of the capillary cell dance. Inflammatory influences that block this dance can be identified as those that affect the capillary cell from the inside out, from the outside in.
Outside- In Inflammation
Outside-in inflammation is caused by the macro environment we live in. These inflammatory mediators or free radicals come from the food or toxins we ingest, air we breathe, water we drink and the outside stressors that impact our emotional health and affect our sleep. Highly processed sugary-salty foods that are often packed with hidden transfats obliterate our intestinal microbiome, induce leaky gut, and form the foundation for serious chronic inflammation throughout our bodies. Being a couch potato, cigarette smoke, chronic alcoholism, and drug abuse all can increase risks for insomnia and stress and contribute to cascades of other chronic inflammatory conditions.
Outside-in inflammation can cluster attract and stack to accelerate inflammation when inflammatory mediator exposures link with each other. They are known as primary inflammatory mediator risks, first-line vascular inflammatory risk factors, or vascular inflammatory free radical seeds. They are notable in that they initiate or seed inflammation to endothelial or capillary-cell basement membranes...
