Living a Healthy Life with Chronic Pain (31 page)

A comfortable sexual position can minimize pain and fear of injury during sex for both partners. Experimentation may be the best way to find the right positions for you and your partner. Everybody is different; no one position is good for everyone. Experiment with different positions that lessen strain, such as lying side by side or sitting on a chair. Experiment with placement of pillows under different parts of your body to make you more comfortable. You might want to try these new positions before you and your partner are too aroused. Experimentation itself can be erotic.

No matter which position you try, it is often helpful to do some warm-up exercises before sex. Look at some of the exercises in the Moving Easy Program in
Chapters 8
. Exercise can help your sex life in other ways as well as
increasing your general fitness. Becoming more fit is an excellent way to increase your comfort and endurance during sex. Walking, swimming, bicycling, and other activities can benefit you in bed by reducing shortness of breath, fatigue, and pain. They also help you learn your limits and how to pace yourself during sexual activity, just as in any other physical activity.

During sexual activity, it may be advisable to change positions once in a while. This is especially true if your symptoms come on or increase when you stay in one position too long. This can be done in a playful fashion, whereby it becomes fun for both of you. As with any exercise, pacing activity and stopping to rest is okay.

Of course other health conditions, not just chronic pain, can cause concerns about sex and intimacy. For example, people who are recovering from a heart attack or stroke are often afraid to resume sexual relations. They fear they will be unable to perform, or sex will bring on another attack or even death. This fear is even more common for their partners. Fortunately, there is no basis for this fear, and sexual relations can be resumed as soon as you feel ready to do so. Studies show that the risk of sexual activity contributing to a heart attack is less than 1 percent. This risk is even lower in individuals who do regular physical exercise. After a stroke, any remaining paralysis or weakness may require that you pay a little more attention to finding the best positions for support and comfort and the most sensitive areas of the body to caress. There may also be concerns about bowel and bladder control. The American Heart Association (
www.heart.org
) has some excellent guides about sex after a heart attack or stroke.

People with diabetes sometimes report problems with sexual function. Men may have difficulty achieving or maintaining an erection. These difficulties can be caused by medication side effects or other medical conditions associated with diabetes. Women and men may also have reduced feeling in the genital area. The most common complaint from women with diabetes is not enough vaginal lubrication.

If you have diabetes, the most effective ways to prevent or lessen these problems are to maintain tight management of blood sugar, exercise, keep a positive outlook, and generally take care of yourself. Lubricants can help with sensitivity for both men and women. If you are using condoms, be sure to use a water-based lubricant; petroleum-based lubricants destroy latex. A vibrator can be very helpful for individuals with neuropathy, and concentrating on the most sensual parts of the body for stimulation can help make sex pleasurable. There are new therapies for men with erectile problems. The American Diabetes Association (
www.diabetes.org
) has more detailed information about sex and diabetes.

People who are missing a breast, testicle, or another part of their body as a result of their treatment for cancer or other medical condition may also have fears about sex and intimacy.
The same is true of people with surgical scars or swollen or disfigured joints from arthritis. In these cases, people may worry about what their partner will think. Will their partner or potential partner find them undesirable? Although this may happen sometimes, it actually occurs less often than you think. Usually when we fall in love with someone, we fall in love with who the person is, not that person’s breast, testicle, or other body part. Here again, good communication and sharing your concerns and fears with your partner can help. If this is difficult, talking with a couples counselor may help you. Often what you imagine will be a problem really is not.

Fatigue is another symptom that can kill sexual desire. In
Chapters 4
we discuss dealing with fatigue. Here we will add one more hint: plan your sexual activities around your fatigue. That is, try to engage in sex during the times you are less tired. This might mean that mornings are better than evenings.

Many mental health conditions and the medications used to treat their symptoms can also interfere with sexual function and desire. It is important to talk with your doctor or nurse practitioner about these side effects so that together you can find alternatives. Sometimes the provider may find another medication, change the dosage and timing of the medication, or refer you to a therapist who may help you and your partner learn alternative coping strategies to decrease or eliminate symptoms. Individual or couples therapy can also help in dealing with personal relationship, intimacy, and sexual problems unrelated to your medications.

Your doctor or nurse practitioner should be your first consultant on sexual problems related to your condition. It’s unlikely that your problem is unique. Your doctor has probably heard about it many times before and may have some solutions. Remember, this is just another problem associated with your chronic condition, just like pain, fatigue, and physical limitations, and it is a problem that can be addressed. Chronic health problems need not end sex. Through good communication and planning, satisfying sex can prevail. By being creative and willing to experiment, both the sex and the relationship can actually be better.

To learn more about the topics discussed in this chapter, we suggest that you explore the following resources:

Agravat, Pravin.
A Guide to Sexual and Erectile Dysfunction in Men
. Leicester, England: Troubador, 2010.

American Heart Association.
Sex and Heart Disease
. Dallas, Tex.: American Heart Association, 2008.

American Heart Association and American Stroke Association.
Sex After Stroke: Our Guide to Intimacy After Stroke
. Dallas, Tex.: American Heart Association and American Stroke Association, 2011.

Ford, Vicki.
Overcoming Sexual Problems
. London: Constable & Robinson, 2010.

Garrison, Eric Marlowe.
Mastering Multiple-Position Sex: Mind-Blowing Lovemaking Techniques That Create Unforgettable Orgasms
. Beverly, Mass.: Quiver Books, 2009.

Hall, Kathryn.
Reclaiming Your Sexual Self: How You Can Bring Desire Back into Your Life
. Hoboken, N.J.: Wiley, 2004.

Kaufman, Miriam, Cory Silverberg, and Fran Odette.
The Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities, Chronic Pain, and Illness
. Berkeley, Calif.: Cleis Press, 2007.

Klein, Marty.
Beyond Orgasm: Dare to Be Honest About the Sex You Really Want
. Berkeley, Calif.: Celestial Arts, 2002.

McCarthy, Barry W., and Michael E. Metz.
Men’s Sexual Health: Fitness for Satisfying Sex
.

New York: Routledge, 2008.

Schnarch, David.
Intimacy and Desire: Awaken the Passion in Your Relationship
. New York: Beaufort Books, 2009.

Schnarch, David.
Resurrecting Sex: Solving Sexual Problems and Revolutionizing Your Relationship
. New York: HarperCollins, 2002.

H
EALTHY EATING IS ONE OF
THE WISEST
personal investments you can make. The food you consume is a central player that influences your health.

Eating healthy simply means that most of the time you make good and healthful food choices. It does not mean being rigid or perfect. No matter what the media or your friends say, there is no one best way of eating that fits everyone; there is no perfect food. Eating healthy can mean finding new or different ways to prepare your meals to make them tasty and appealing. If you have certain health conditions, it may mean that you have to be choosier. Eating well does not usually mean you can never have the foods you like most.

Thanks to the Internet, books, other media, friends, and relatives, we can get overloaded with information about what we should and should not eat. The whole eating thing gets very confusing. In this chapter we give you basic science-based nutrition
and dietary information. We do not tell you what to eat or how to eat. That is your decision. We do tell you what is known about nutrition for adults, some new information about nutrition and chronic pain, and some ways to help you fit that information to your specific likes and needs. We hope this chapter will put you on the path to healthier eating.

Special thanks to Bonnie Bruce, DrPH, RD, and Yvonne Mullan, MSc, RD, for their help with this chapter
.

Please note that most of the nutrition information presented in this chapter is from the United States Department of Agriculture (USDA) Dietary Guidelines for Americans published in 2010 and the USDA MyPlate program launched in 2011. Health Canada also has dietary recommendations called
Eating Well with Canada’s Food Guide
, first published in 2007. Most of the Canadian recommendations are similar to the American ones, but there are some differences. Food amounts in this chapter are listed in both imperial and metric measure. See the Health Canada website listed under Other Resources at the end of the chapter for more Canadian-specific information.

The human body is a complex and marvelous machine, much like an automobile. Autos need the proper mix of fuel to run right. Without it, they may run rough and may even stop working. The human body is similar. It needs the proper mix of good food (fuel) to keep it running well. It does not run right on the wrong fuel or on empty.

Healthy eating cuts across every part of your life. It is linked to your body and your mind’s well-being, including how your body responds to some illnesses and conditions.

When you give your body the right fuel and nourishment, here’s what happens:

• You have more energy and feel less tired.
  

• You increase your chances of preventing or lessening health conditions such as heart disease, diabetes, cancer, and some chronic pain conditions.
  

• You feed your central nervous system and brain, which can help you handle life’s challenges as well as its emotional ups and downs.
  

At the heart of healthy eating are the choices we make over the long run. Healthy eating is being flexible and allowing yourself to occasionally enjoy small amounts of foods that may not be so healthy. There is no such thing as a perfect eating style. Being too strict or rigid and not allowing yourself to ever have treats will likely cause your best efforts to fail.

If you have chronic pain or other conditions, healthy eating means having to be somewhat choosy about the foods you eat. For example, some people with migraines need to avoid certain foods that might trigger a headache. People with diabetes need to watch their carbohydrate intake to manage their blood sugar levels. They do best by deciding which carbohydrate foods (fruit,
breads, cereals, rice, etc.) they will eat each day. People who have or are at risk for heart disease control their blood cholesterol levels by watching the amount and kinds of fat they eat. Consuming the right amount and types of fat can also reduce inflammation for some kinds of chronic pain conditions. Those with high blood pressure can help lower it by eating lots of fruits, vegetables, and low-fat dairy foods. For some, cutting back on salt also lowers high blood pressure. And, to maintain, lose, or gain weight, everyone needs to pay attention to how many calories we eat.

We have come a long way since meat and potatoes were considered the backbone of a great diet. Today, vegetables, fruits, whole grains, low-fat milk and milk products, lean meats, poultry, and fish are at the core of a healthy diet. There is still a place for meat and potatoes; it is just not the most important place.

The real issue for most of us is not the healthy foods we consume but the less healthy ones. One-third of most North American diets is made up of foods that are high in added sugars, solid fats (butter, beef fat, pork fat, chicken fat, stick margarine, shortening), and salt. We also eat a lot of food that is made from white flour and other refined grains. These added sugars, fats, and salt contribute to high blood pressure, diabetes, and obesity. There is some evidence that unhealthy diets may be associated with chronic pain as well.

Trade-offs are a big part of healthy eating. This means learning how food affects you and then deciding when you can treat yourself and when you should pass. For instance, it may be important for you to have a special meal on your birthday. If so, then you can make healthier choices when you are out for casual lunches on days that are not special occasions. Trading off like this can help you stay on the path of healthy eating. It gets easier with practice, and it even becomes part of your everyday life.

A good starting place is to move toward eating more plant foods: fruits, vegetables, whole grains, legumes, nuts, and seeds. This does not mean giving up meats and foods that may be high in sugar, fat, or salt but rather eating them in smaller amounts or less often. The goal is to maintain a healthy balance in the kinds of foods you eat and how much you eat. (We’ll have more to say about this a little later in this chapter.)

This all sounds simple, but every day we are faced with hundreds of food choices. It is often easier and quicker to grab something less healthy than to think about what we will eat. So how do we put together meals that are tasty and enjoyable yet healthful? In this chapter, we try to make it as simple as possible.