Patient Information > Pain Management > Lifestyle

Pain and difficulty with sitting

If you have pain sitting it may be a huge challenge to something which will relieve your pain to some extent. Many people have tried cushions of various material and shapes. Much of this is trial and error: Some people design their own from foam and cut out the shape which suits them best and then cover it with a cotton cover. There are mobility shops in most countries which may stock a selection of cushions which you can try out before buying one. The exact location of the pain is important if you are thinking of trying a cushion to relieve pressure on a nerve or a particular part of the genital/buttock area. Many cushions have been designed to relieve pressure on the coccyx area but there are some that are designed to help other areas of the anatomy such as the area affected by the pudendal nerve.

The following page gives an idea of some cushions that are available.www.coccyx.org/coping/cushions.htm

If you are unable to sit at all, some people use lightweight loungers that can be easily carried.

There are a few standing desks that are available, some have a motor to adjust the table height for people who need to use a computer. However, this can be hard on the legs and back. It is a good idea to change position, not spend too long in one position and to take frequent breaks from the screen.

      How effective are expert patient education programmes                                                                  for  chronic disease ?

 An analysis of four randomized controlled trials carried out in the UK on the effectiveness of self-management programmes was published in the BMJ in June 2007. The research was carried out by the National Primary Care Research Centre in Manchester. Of the four evaluations in the UK, two of these studies test the arthritis programme and two the chronic disease management programme  (generic). The results showed that the programmes can lead to a modest improvement in psychological health in terms of increased confidence and self-efficacy. There were also negative findings: measures of self-rated health were unchanged in three of the four studies and the use of healthcare was unchanged. Three trials of the programme in the United States show inconsistent effects on use of healthcare.

There are many questions arising from the results of the above trials. It is hoped that a forthcoming Cochrane review will help answer some of these questions. The article concludes that well designed trials are needed before further large sums of money are invested in the programmes. The current data suggests that it would be premature for leaders in general practice to include referral to the programme in the Quality and Outcomes Framework. 

Reference:

Analysis: How effective are expert patient education programmes for chronic disease ? 

Chris Griffiths et al BMJ 2007;334;1254-1256 (16 June ) 

The report of the programme by the National Primary Care Research and Development can be read here: click here

                                                     Nutrition

There are some studies suggesting that good nutrition may help to reduce some of the symptoms associated with pelvic pain. Everyone’s experience is different but some conditions linked to pelvic pain include painful periods, (dysmenorrhoea) endometriosis and Irritable Bowel Syndrome. Simple dietary guidelines to help ensure you get the nutrients that you need from the food that you eat may help alleviate some of these symptoms.

Increase water intake
Aim to drink at least a litre of water each day (preferably filtered). If you find it difficult to manage this amount try to intersperse glasses of water with herbal tea or diluted unsweetened fruit juices. Increasing your water intake will help to prevent constipation by keeping stools soft..

Herbal teas are particularly beneficial for sufferers of Irritable Bowel Syndrome (IBS) and other digestive disorders – camomile helps release trapped wind, fennel and peppermint can help reduce cramps and ginger can help to reduce pain associated with inflammation.

Eat a rainbow of colours of fruit and vegetables
Eating a wide variety of fruit and vegetables maximises the nutrient content of your diet. Red, yellow and purple vegetables such as tomatoes, peppers and aubergine contain good levels of antioxidants (Vitamins A, C & E) which help to protect the body from damage by free radicals (free radicals are naturally formed in our body when we use food for energy. They are also present in the environment, particularly in areas of high pollution. In excess they can cause damage to body cells) in the environment; green leafy vegetables such as broccoli and kale are packed with B vitamins which help to protect the nervous system from damage, increase energy and help prevent low mood. They also contain important minerals such as magnesium, which is needed for muscular relaxation, and may assist with pain relief. Other good sources of magnesium include nuts, seeds and whole grains.

By providing your body with these vital nutrients you are helping to strengthen your natural defences against disease and the stresses of everyday life, which means that you should have more energy and vitality to cope with pain.

The vitamins in fruit and vegetables can be destroyed during cooking so try to eat as many of them as possible in their raw state. Steam or lightly stir fry vegetables if you do cook them to retain as many nutrients as possible, and buy local organic produce if you can as it does not have pesticide residues. .

Oily fish nuts & seeds
Essential fatty acids are found in oily fish, nuts, seeds and seed oils and should be incorporated into the diet because our bodies cannot produce them.
Aim to eat oily fish 2-3 times per week to incorporate omega 3 into your diet and 2-3 tablespoons of mixed seeds or 2 tablespoons of cold pressed seed oil daily to incorporate optimum levels of omega 6. If this is not possible then take a good quality supplement to ensure you are providing your body with the essential fats it needs to regulate hormones and help prevent excess oestrogen, which may lead to certain pelvic pain conditions.
Linseed also known as ground flax seed is particularly beneficial as it contains both omega 3 and 6 and is also effective at regulating bowel movements and reducing constipation – a common problem in those with pelvic pain as nerve damage can often make bowel movements difficult. You could try sprinkling it onto salads, soups or cereals.

Quality Protein
A high intake of beef, red meat and ham was associated with an increase of risk of endometriosis in an Italian study whereas consumption of milk, cheese, fish, and whole grain foods were not significantly related to endometriosis.(1) Try eating lean red meat no more than once per week and aim to include oily and white fish, white meat, tofu, eggs, beans, peas, lentils and a small amount of dairy. These are all good sources of quality protein.
Select organic beef and dairy where possible. Non-organic beef and dairy products may contain residual hormones and these may be absorbed into our bodies and disrupt hormone balance.

Opt for whole grains
White flour products such as white bread and pasta, cakes and biscuits form a major part of the western diet today but contain few nutrients.
To increase the vitamins, minerals and fibre content of your diet and to balance your blood sugar levels so energy is sustained throughout the day, aim to eat whole grains in place of white flour products. This means opting for wholemeal flour, brown rice and whole grain pasta. Other delicious whole grains include rye, oats, barley, quinoa and buckwheat which can all be found in large supermarkets and health food stores.

Check for allergies/intolerance
Wheat typically forms a large part of the western diet and eating too much of one food group can cause sensitivities in some people. If you believe that wheat may be contributing to your symptoms then try removing it from your diet for one month and replacing it with wheat alternatives such as brown rice, corn, buckwheat and quinoa. Slowly reintroduce after one month and note any changes such as flu like symptoms, headaches or flare ups of pain. Other common sensitivities are dairy and citrus fruit. Food groups should not be eliminated from the diet without guidance and advice from a qualified therapist.
(See links below )

Avoid anti-nutrients
Caffeine, alcohol, smoking, pollution and pesticides affect the body’s ability to absorb nutrients. If the body lacks certain nutrients your energy levels suffer and your ability to fight infection and illness is reduced.

• Caffeine has a diuretic effect, which causes key vitamins to be flushed from the body. Caffeine is found in coffee, tea, cola and chocolate and intake should be limited. Drink herbal tea or hot water with lemon as a tasty alternative to caffeinated drinks.

• Alcohol robs the body of several key vitamins and the mineral magnesium. It also stores as fat in the body and, as more fat equals more oestrogen, it may cause oestrogen dominance, which is linked to endometriosis. Alcohol intake should be limited to 1-2 units per day maximum.

• Smoking depletes vitamin C and the nicotine in cigarettes prevents calcium, all of the B vitamins and vitamin C from entering the body cells. It also raises levels of Cadmium in the body, which is a toxic heavy metal that may impact ovarian function.

• Pollution and pesticides all reduce our ability to absorb nutrients. They encourage the build up of toxins in the body, which may disturb hormone function. There is research indicating that certain pesticides may be contributing to oestrogen dominance and increased prevalence of endometriosis in young girls (2)

How Nutritional Therapy can help

A qualified Nutritional Therapist may help you to manage many of the symptoms associated with pelvic pain by:

• assessing the effectiveness of your digestion and absorption of nutrients and correcting any imbalances with the help of supplements and dietary recommendations
• identifying allergies and intolerances that may be contributing to digestive problems, muscular aches and inflammation, without losing key nutrients from your diet
• introducing foods to help to reduce inflammation and associated pain
• providing ongoing support, diet and lifestyle advice and menu plans to make change easier and more manageable.

Sharon Sutcliffe Dip ONT (MBANT)

British Association of Nutritional Therapists- www.bant.org
Nutritional Therapy Council – www.nutritionaltherapycouncil.org.uk

(1) Selected food intake and risk of endometriosis Parazinni F et al Human Reprod 2004;19(8):1755-9

(2) Environmental chemicals and child development Dietrich KN J Paediatr. 1999 Jan;134 (1):7-9 Review