Understanding spirituality & Pain Behavior: Insights from Two Decades of Clinical Experience

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 Understanding spirituality & Pain Behavior: Insights from Two Decades of Clinical Experience

Hai 

This is Dr. Arunachalam Ramachandran, Director, SaIRaM Physiotherapy, Chennai.

Pain is an intricate and multifaceted experience that affects individuals physically, emotionally, and behaviorally. Having spent 20 years as a physiotherapist, I've seen firsthand how pain behavior can significantly influence the perception and management of pain. Understanding the distinction between positive and negative pain behaviors is crucial for effective treatment and rehabilitation. Let's delve into the physiological aspects of pain behavior and its implications, backed by empirical evidence and clinical insights.

Positive Pain Behavior

Positive pain behaviors are adaptive responses that contribute to the management and alleviation of pain. These behaviors include:

1.    Active Engagement in Therapy: Patients who actively participate in their rehabilitation exercises tend to experience better outcomes. Engaging in prescribed exercises helps maintain mobility, reduce stiffness, and promote healing.

2.    Relaxation Techniques: Practices such as deep breathing, meditation, and progressive muscle relaxation can help reduce pain by decreasing muscle tension and promoting a sense of well-being.

3.    Positive Attitude and Coping Strategies: Adopting a positive outlook and employing coping strategies like goal setting and self-affirmation can modulate pain perception. Studies have shown that positive psychological states can influence pain pathways and reduce the intensity of pain experienced.

4.    Social Support: Engaging with a supportive network of family and friends provides emotional support, which can mitigate the perception of pain. Social interactions can trigger the release of endorphins, the body's natural painkillers, enhancing pain tolerance.

 

Negative Pain Behavior

Negative pain behaviors are maladaptive responses that can exacerbate pain and hinder recovery. These behaviors include:

 

1.    Catastrophizing: Patients who have a tendency to magnify the threat of pain and feel helpless often experience higher levels of pain. Catastrophizing can activate the body's stress response, leading to increased muscle tension and heightened pain sensitivity.

2.    Avoidance: Avoiding activities due to fear of pain can lead to deconditioning, muscle atrophy, and reduced functional capacity. This behavior can create a cycle of pain and disability, making recovery more challenging.

3.    Excessive Medication Use: Relying heavily on pain medication without addressing the underlying causes of pain can lead to dependency and potential side effects, including increased sensitivity to pain over time.

4.    Isolation and Withdrawal: Withdrawing from social activities and isolating oneself due to pain can lead to feelings of depression and anxiety, which can, in turn, amplify the perception of pain.

For a better understanding of this behavioral science, you need to know the physiology (how things work in the human body)

The Physiology of Pain Behavior

From a physiological perspective, pain behavior is influenced by the complex interaction between the nervous system and the brain. Here is how it works:

Nociception and Pain Perception: Nociceptors, the sensory receptors that detect harmful stimuli, send signals to the brain through the spinal cord. The brain then interprets these signals as pain. Positive behaviors, like relaxation techniques, can modulate this pathway by reducing the intensity of the signals or altering the brain’s interpretation of pain.

Neuroplasticity: The brain's ability to reorganize itself, known as neuroplasticity, plays a role in how pain is experienced. Positive pain behaviors can promote beneficial neuroplastic changes, enhancing pain tolerance and recovery. Negative behaviors, on the other hand, can lead to maladaptive changes, reinforcing pain pathways.

Endogenous Pain Modulation: The body has an intrinsic system for modulating pain, involving endogenous opioids like endorphins. Positive behaviors such as exercise and social interactions can stimulate the release of these natural pain-relieving chemicals. Negative behaviors like catastrophizing can inhibit this system, leading to a heightened perception of pain.

 

In this line I see more spiritual people deal better with pain but there are some exceptions too. So we need to understand what’s the influence of spirituality on pain management.

 

The Role of Spirituality in Pain Management: Insights from Clinical Experience

Pain management is a multifaceted discipline that integrates various approaches to alleviate suffering and improve quality of life. Over my 20 years of clinical experience in physiotherapy, I have observed that spirituality can play a significant role in the effective management of pain. While conventional medical treatments are crucial, incorporating spirituality can provide a holistic approach to pain relief, addressing both the physical and psychological dimensions of pain.

 

Understanding Spirituality in Pain Management

Spirituality is a broad concept that encompasses a sense of connection to something greater than oneself, which can be expressed through religion, personal beliefs, and a sense of purpose or meaning in life. In the context of pain management, spirituality can offer several benefits:

 

Emotional Resilience: Spiritual practices such as prayer, meditation, and mindfulness can enhance emotional resilience. These practices help individuals cultivate a sense of inner peace and acceptance, which can be particularly beneficial in coping with chronic pain.

 

Stress Reduction: Spirituality often involves practices that promote relaxation and reduce stress, such as deep breathing exercises, meditation, and yoga. Reducing stress can lower the body’s production of stress hormones like cortisol, which can exacerbate pain.

 

Positive Outlook: A spiritual perspective can foster a positive outlook and hope, even in the face of chronic pain. This positive mindset can influence pain perception and improve overall well-being.

 

Community Support: Many spiritual practices involve community and social support, which can provide emotional comfort and reduce feelings of isolation often associated with chronic pain.

 

Empirical Evidence Supporting Spirituality in Pain Management

Research has increasingly highlighted the positive impact of spirituality on pain management. Here are some key findings:

 

Improved Pain Tolerance: Studies have shown that individuals who engage in regular spiritual or religious practices often report higher pain tolerance and lower pain intensity. This is attributed to the enhanced coping mechanisms and emotional support that spirituality provides.

 

Enhanced Psychological Well-being: Research published in the Journal of Pain and Symptom Management indicates that spiritual well-being is strongly associated with lower levels of pain and improved psychological well-being in patients with chronic pain conditions.

 

Mind-Body Connection: A study in the Journal of Behavioral Medicine found that mindfulness meditation, a practice rooted in spiritual traditions, significantly reduced pain intensity and improved functional outcomes in chronic pain patients. This highlights the importance of the mind-body connection in pain perception and management.

Integrating Spirituality into Pain Management

Incorporating spirituality into pain management does not require adherence to a specific religion or belief system. It can be personalized to fit each individual's unique spiritual needs and preferences. Here are some practical ways to integrate spirituality into pain management:

Mindfulness and Meditation: Encouraging patients to practice mindfulness and meditation can help them develop greater awareness of their pain and learn to respond to it with acceptance and calmness.

 

Yoga and Tai Chi: These ancient practices combine physical movement with spiritual elements, promoting both physical and mental well-being. They can be particularly effective in reducing pain and enhancing mobility.

Spiritual Counseling: Providing access to spiritual counselors or chaplains can offer patients additional support and guidance in exploring their spiritual beliefs and how they can aid in pain management.

Support Groups: Facilitating support groups that incorporate spiritual discussions can provide a sense of community and shared experience, which can be comforting and empowering for individuals dealing with chronic pain.

For further details and pain councelling and management contact

SaiRaM Physiotherapy clinic

Porur & Iyyapanthangal

9952975670 

YouTube channel - (4)  SaiRaM Physio Academy - YouTube

Instagram - Arunachalam Ramachandran (@arunstar19) • Instagram photos and videos

4 important criteria for Advanced Physiotherapy

Understanding Vitamin D Deficiency in India: Causes and Solutions by Dr. Arunachalam Ramachandran

Hello, I am Dr. Arunachalam Ramachandran, a physiotherapist with 18 years of clinical experience and a rich research background. Today, I want to talk about a puzzling issue I've seen throughout my career – the high rate of vitamin D deficiency in India, despite our abundant sunshine.

You might wonder how a country with so much sunlight can have so many people lacking vitamin D. Several factors contribute to this paradox. One major reason is our cultural and lifestyle habits. In many parts of India, traditional clothing such as sarees and burqas cover most of the body, limiting skin exposure to sunlight. This prevents enough UVB rays from reaching the skin, which are essential for producing vitamin D. Additionally, our modern lifestyle keeps us indoors more than ever. Office jobs, indoor schooling, and spending leisure time inside reduce the time we spend outdoors in the sun.

Skin pigmentation also plays a significant role. The high melanin content in the skin of many Indians acts as a natural sunscreen. While this helps protect against UV radiation, it also reduces the skin's ability to produce vitamin D. Darker skin requires more sun exposure to generate the same amount of vitamin D as lighter skin.

Geographical and environmental factors further complicate the situation. Although India is a tropical country, the angle of the sun and atmospheric conditions can affect the availability of UVB radiation. During certain seasons, especially the monsoon, heavy cloud cover and pollution can significantly reduce UVB exposure. In many urban areas, high pollution levels block UVB rays from reaching the ground, hampering vitamin D synthesis even when the sun is shining.

Dietary habits in India also contribute to vitamin D deficiency. Traditional diets often lack foods rich in vitamin D, such as fatty fish, egg yolks, and fortified products. Vegetarian and vegan diets, which are common, further restrict these sources. There is also a general lack of awareness about the importance of vitamin D and how to obtain it. Supplements and fortified foods might not be easily accessible or affordable for everyone.

Health conditions like gastrointestinal disorders can impair the absorption of vitamin D. Obesity, which is increasing in India, can sequester vitamin D in fat tissues, making it less available for the body to use. The intense heat in many parts of India can lead people to avoid sun exposure to prevent heat-related health issues, adding to the deficiency problem.

Vitamin D is produced in the skin through UVB rays, which convert 7-dehydrocholesterol to pre-vitamin D3, and then to vitamin D3 (cholecalciferol). This is metabolized in the liver and kidneys to its active form, calcitriol, which is crucial for calcium absorption and bone health. Without enough UVB exposure, the body can't produce enough vitamin D3, leading to deficiency.

To address vitamin D deficiency in India, we need a comprehensive approach. Public health initiatives should focus on raising awareness, promoting dietary changes, and encouraging safe sun exposure. Fortifying common foods with vitamin D and improving air quality are also essential steps. As a physiotherapist, I encourage everyone to be mindful of their vitamin D levels and take proactive steps to ensure they get enough. Regular check-ups, a balanced diet, and mindful sun exposure can significantly affect your overall health. With our recent research on Athletes from Kerala, we understood that exercise can marginally influence Vitamin D absorption.  (Selvan, Vijay & Ramachandran, Arunachalam & Mohamed, Althaaf. (2021). Influence of Exercise in the Absorption of Vitamin D among Professional Athletes with Deficiency or Insufficiency of Vitamin D Levels in the State of Kerala. 12. ) Still, there were many confounding variables that we couldn't control to the best. However, exercise with all its other health benefits can definitely be recommended for this scenario.

Stay healthy and stay informed!

Dr. Arunachalam Ramachandran

arunachalamphysio@gmail.com

9884471255

Reading contents 

Single bout of exercise triggers the increase of vitamin D blood concentration in adolescent trained boys: a pilot study | Scientific Reports (nature.com)

Impact of Vitamin D on Physical Efficiency and Exercise Performance—A Review - PMC (nih.gov) 

Tamil version

வணக்கம், நான் டாக்டர் அருணாச்சலம் இராமச்சந்திரன், 18 ஆண்டுகள் அனுபவமிக்க உடற்கல்வி நிபுணர் மற்றும் வளமான ஆராய்ச்சி பின்னணி கொண்டவன். இன்று, எங்கள் நாட்டில் பரவலாகக் காணப்படும் ஒரு புதிரான பிரச்சினையைப் பற்றி பேச விரும்புகிறேன் - அதிகமான வெயிலுள்ள நாடாக இந்தியாவில், ஏன் இந்தளவு அதிகமான மக்கள் வைட்டமின் D குறைவால் பாதிக்கப்படுகிறார்கள் என்பதை.

வெயிலுள்ள நாடாக இந்தியா இருப்பினும், அதிகமான மக்கள் வைட்டமின் D குறைவால் பாதிக்கப்படுவது பல காரணங்களால் ஏற்படுகிறது. முதன்மையான காரணம் எங்கள் பண்பாட்டு மற்றும் வாழ்க்கை முறையாகும். இந்தியாவின் பல பகுதிகளில் பாரம்பரிய உடைகள், جیسے சேலைகள் மற்றும் பூர்காக்கள், உடலின் பெரும்பகுதியை மூடுகின்றன, இதனால் சூரிய ஒளியின் கதிர்வீச்சு சருமத்தில் அடைவது குறைக்கப்படுகிறது. இது சருமத்தில் UVB கதிர்களைப் பெறுவதைத் தடுக்கிறது, இது வைட்டமின் D உருவாக மிகவும் முக்கியமானது. மேலும், நமது நவீன வாழ்க்கை முறை நம்மை அதிக நேரம் உட்புறத்தில் வைத்திருக்கிறது. அலுவலக வேலைகள், பள்ளிகள் மற்றும் உட்புற வேடிக்கைகள் காரணமாக நாம் வெளியில் செலவிடும் நேரம் குறைகிறது.

சருமத்தின் வண்ணம்சம் முக்கிய பங்கு வகிக்கிறது. இந்தியர்களின் சருமத்தில் அதிக அளவிலான மெலனின் உள்ளது, இது ஒரு இயற்கை சூரிய கதிர் தடுப்பூசியாக செயல்படுகிறது. இது UV கதிர்வீச்சுகளைத் தடுக்கும் போதிலும், வைட்டமின் D உற்பத்தியை குறைக்கிறது. அடர்த்தியான சருமம், சாதாரணமாக இந்தியர்களுக்கு இருப்பதால், நிறைய சூரிய ஒளியைப் பெற வேண்டும்.

புவியியல் மற்றும் சுற்றுச்சூழல் காரணிகளும் இதை மேலும் சிக்கலாக்குகின்றன. இந்தியா ஒரு வெப்பமண்டல நாடு என்றாலும், சூரியனின் கோணமும் வாயு நிலைமைகளும் UVB கதிர்வீச்சின் கிடைக்கும் அளவை பாதிக்க முடியும். குறிப்பாக மழைக்காலத்தில், மேகக்கவசம் மற்றும் மாசு UVB கதிர்வீச்சின் கிடைக்கும் அளவை குறைத்து விடுகிறது. பல நகர்ப்புறங்களில், அதிக மாசு நிலைகள் UVB கதிர்களை தரை மட்டத்தில் அடையத் தடுக்கும், சூரியன் காய்ந்தாலும் கூட வைட்டமின் D உற்பத்தியைத் தடைசெய்கிறது.

இந்தியாவின் உணவுப் பழக்கவழக்கங்களும் வைட்டமின் D குறைவுக்கு காரணமாகின்றன. பாரம்பரிய உணவுப் பழக்கவழக்கங்களில், கொழுப்பு மீன்கள், முட்டை மஞ்சள், மற்றும் உறிஞ்சப்பட்ட பொருட்கள் போன்றவை குறைவாகவே உள்ளன. பரிசுத்த உணவுகள் மற்றும் சைவ உணவுகள், பொதுவாக காணப்படும் உணவுகள், இந்த மூலங்களை மேலும் கட்டுப்படுத்துகின்றன. வைட்டமின் D இன் முக்கியத்துவம் மற்றும் அதைப் பெறுவது எப்படி என்பதில் பொதுவாக ஒரு விழிப்புணர்வு குறைவாக உள்ளது. உறிஞ்சப்பட்ட பொருட்கள் மற்றும் உறிஞ்சிகள் அனைவருக்கும் எளிதாகக் கிடைக்கவில்லை அல்லது மதிப்படிக்கக்கூடியதாக இல்லை.

சுகாதார நிலைமைகள், குறிப்பாக குடல் சுகாதாரக் கோளாறுகள், வைட்டமின் D உறிஞ்சலைத் தடுக்கும். அதிகம் பார்க்கப்படும் ஒபேசிட்டி, இந்தியாவில் அதிகரித்து வருகிறது, உடலில் வைட்டமின் D ஐக் கொழுப்பு திசுக்களில் சிக்க வைத்து, பயன்படுத்த முடியாதபடி செய்யிறது. இந்தியாவின் பல பகுதிகளில், அதிக வெப்பம் சூரிய ஒளி வெளிப்பாட்டைத் தவிர்க்க மக்கள் தூண்டும், இதனால் குறைபாடு பிரச்சனை அதிகரிக்கிறது.

வைட்டமின் D UVB கதிர்களைப் பெற்று சருமத்தில் தயாரிக்கப்படுகிறது, இது 7-டிஹைட்ரோகோலஸ்டெராலிலிருந்து முன்னோடி வைட்டமின் D3 ஆக மாற்றுகிறது, பின்னர் வைட்டமின் D3 (கோல்கால்சிபெரால்) ஆக மாற்றுகிறது. இது கல்லீரல் மற்றும் சிறுநீரகங்களில் செயல்பாட்டிற்கான கால்சிட்ரியோல் ஆக மாற்றப்படுகிறது, இது கால்சியம் உறிஞ்சல் மற்றும் எலும்பு ஆரோக்கியத்திற்கு முக்கியமானது. UVB கதிர்வீச்சு குறைவாக இருப்பதால், உடல் வைட்டமின் D3 ஐப் போதுமான அளவில் உற்பத்தி செய்ய முடியாது, இதனால் குறைபாடு ஏற்படுகிறது.

இந்தியாவில் வைட்டமின் D குறைவைக் கையாள பல்துறை அணுகுமுறையைக் கொண்டிருக்க வேண்டும். பொதுச் சுகாதார முயற்சிகள் விழிப்புணர்வை எழுப்ப, உணவு மாற்றங்களை ஊக்குவிக்க, மற்றும் பாதுகாப்பான சூரிய வெளிப்பாட்டை ஊக்குவிக்க வேண்டும். பொதுவான உணவுகளை வைட்டமின் D உடன் உறிஞ்சப்படுத்துவது மற்றும் காற்று தரத்தை மேம்படுத்துவது முக்கியமான படிகள். ஒரு உடற்கல்வி நிபுணராக, நான் அனைவருக்கும் தங்கள் வைட்டமின் D அளவுகளைப் பொருட்படுத்துமாறு மற்றும் போதுமான அளவில் பெறுவதற்கான நடவடிக்கைகளை எடுக்குமாறு ஊக்குவிக்கிறேன். நிலையான சோதனைகள், சமநிலை உணவுகள், மற்றும் நிதானமான சூரிய வெளிப்பாடு உங்கள் ஒட்டுமொத்த ஆரோக்கியத்தில் பெரும் மாற்றத்தை ஏற்படுத்த முடியும்.

நலமுடனும் விழிப்புணர்வுடனும் இருங்கள்!

• டாக்டர் அருணாச்சலம் இராமச்சந்திரன்

Workshop at Apollo College, Chittoor By our Director Dr. Arunachalam Ramachandran (Professor in Physiotherapy)

 Chittoor: Neurodevelopment workshop gets impressive response (thehansindia.com)

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 Chittoor: Neurodevelopment workshop gets impressive response (thehansindia.com)

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Problem of convention-How to prescribe #exercises scientifically

A recent systematic review conducted in part for the 2018 Health and Human Services Physical Activity Guidelines for Americans Advisory Committee, summarized the existing evidence for the effects of exercise interventions on cognitive function across the life span, as well as in clinical disorders [11]. This umbrella review concluded that there is moderately strong evidence that moderate–vigorous exercise leads to improvements in cognition, especially processing speed, memory, and executive function. By far the strongest evidence for the cognitive-enhancing effects of exercise come from studies focusing on two age windows, that is, children aged 6–13 years and adults aged N50 years, as well as populations with dementia or other cognition-impairing condition (e.g., schizophrenia). Notably, although evidence for the effects of exercise in children and older adults is the strongest, it is still marred by inconsistencies and deficiencies in study design [12]. There is therefore still a need for rigorous and adequately powered RCTs in these groups to more definitively evaluate the effects of exercise on cognition. There is also emerging evidence that exercise has beneficial effects on cognition in nonneurological or psychiatric conditions, such as in women treated for breast cancer who experience co-occurring cognitive symptoms and complaints (Box 1). While there are complexities in defining specific age ranges for developmental periods such as adolescence [13], age groups are used to simplify the presentation of the studies discussed here. With that, there are major gaps in our understanding of the effects of exercise on cognition, particularly in early childhood (b6 years old), adolescence (approximate age range 14–17 years), and young to middle-age adulthood (ages 18–50 years). Work in these areas is emerging [14], but there is currently insufficient evidence from studies that used causal designs to support firm conclusions regarding the effects of exercise on cognitive outcomes in these age ranges.

What Is Known about Cellular and Molecular (Level 1) Mechanisms of Exercise? Aerobic exercise induces significant biochemical changes in the brains of animals [2,5,10]. Some of the most widely studied molecules in animal models are: (i) brain-derived neurotrophic factor (BDNF), which initiates a host of downstream effects including long-term potentiation and proliferation of neurons; (ii) vascular endothelial growth factor (VEGF), which supports blood vessel survival and growth; and (iii) insulin-like growth factor (IGF)-1, which influences several neural and angiogenic processes [2]. In humans, most studies on exercise-induced cellular/molecular changes have focused on analytes measurable in the bloodstream or cerebrospinal fluid. For example, meta-analyses and reviews have concluded that there are increases in BDNF after long-term exercise in children, adolescents, younger adults, older adults, Alzheimer’s disease patients, and those with psychiatric disorders, despite some inconsistency in the findings across individual studies [15,16]. In addition, circulating levels of BDNF in humans statistically mediate exercise-related improvements in executive functioning [17] in adults older than 71 years. This pattern of evidence supports the hypothesis that BDNF may be a mechanism of exercise that is conserved across species and age groups in humans (Figure 1, Key Figure). In older adults, there is also evidence that IGF-1 levels increase following exercise, although this effect is again somewhat inconsistent across studies (see [18] for a recent meta-analysis). A major open question is whether exercise influences IGF-1 levels across the lifespan, as studies of exercise and IGF-1 in age groups other than older adults are lacking. The evidence linking VEGF and exercise in humans is similarly limited [19]. An overarching limitation of assessing Level 1 mechanisms in humans is that it is notoriously difficult to assess these molecular pathways in vivo. That is, rather than measuring the relevantbiomolecules directly from the brain, as is typical in animals, indirect measures of them (i.e., circulating analytes) are often used to infer brain levels in humans. However, there are also non-neuronal sources, kinetics, and roles of these biomolecules in humans [20], which introduces an inherent source of error into inferences about their brain levels. Furthermore, these biomolecules could play different roles in childhood versus older adulthood or across health states [21], and this could potentially influence their sensitivity to exercise. For example, it is possible that older adults or patients deficient in one or more of these biomolecules may experience greater increases in response to exercise compared with groups with normal levels.

Know when to use #Sham and #placebo terms - Prof. Arunachalam Ramachandran

 

How to know whether your invention can be patented in India?

How to know whether your invention can be patented in India?

This is probably the first question that may arise in your mind if you are looking to get protection for your research and development (invention). so lets see how to patent an idea in India 

• Invention should be Patentable subject matter
• It should be Novel
• It should be Non-obvious (inventive-step)
• Invention should have Industrial application
• And it should be enabling 

 Let’s discuss all 5 criteria’s one by one

Invention should be patentable subject matter:

Patent act in India has specified certain subject matters are not eligible for getting patent in India. Some of these areas are;

• Inventions related to atomic energy
• abstract ideas
• laws of nature or anything contrary to well established natural laws
• physical phenomenon
• discovery of any living thing or non living substance
• method of agriculture or horticulture
• new form of know substances
• method of playing games
• any aesthetic creations
• anything that causes a serious harm to human
• animal, plant life 

etc, are NOT patentable subject matter in accordance with section 3 and section 4 as per Indian patent act. (link to Indian patent act)

Novelty means the information you have written in the specification of your patent application (subject matter) is not published or know to or available to public in India or elsewhere before the date of filing of the patent.

An inventive step: a subject matter in patent application having inventive step means, the invention disclosed is not obvious to a person skilled in the art. Especially with reference to the prior art or the information already know or available to the public. In other words, the invention should not be obvious to people who are form the same field of invention.  

In other words, the inventive step means an aspect of the invention that involves a Technical advance or economic significance or both with respect to existing knowledge, thus making invention non obvious to a person skilled in the art.

Industrial application: as the name suggest, invention to be patented should have a utility that is it is capable of being made and used in an industry.

Enabling: This criterion suggests that the information disclosed in the proposed invention should be sufficient to reduce it in to practice. And this information must be included in to the patent application for the invention.

In accordance with Indian patent act,

The term enabling means : Any person, who is ordinary skilled in the art, should be able to reduce the invention in to practice by the help of the information disclosed in the patent application.

to help you find out if your invention is patentable or not you can reach top patent attorneys and patent agents in India here.

Session 1- Theories Of Motor Control - Part C - Systems Theory

Epley Maneuver to Treat BPPV Vertigo

brandt-daroff habituation exercise