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by Duke Reeves Respiratory Resource Center - Life PT Medical
11-6-17

https://lifeptmedical.com/blogs/resp...u-need-to-know

COPD is best known for it's respiratory symptoms, like coughing and difficulty breathing, but people with COPD have to deal with a plethora of other symptoms as well. One of these is chronic pain, which stems from a variety of COPD-related symptoms and complications.

Studies show that people with COPD are about twice as likely to experience chronic pain compared to people with no chronic disease. In fact, researchers found that the pain experienced by many COPD patients is severe enough to rival arthritis pain and often requires opiate medications to manage.

If you have COPD it's important to understand that the disease doesn't just affect your lungs; it has many direct and indirect effects on the body. COPD can spawn several types of temporary and chronic pain, including pain in your chest, spine, muscles, joints, and even your bones.

Some chronic pains are the result of respiratory strain and lung damage, while others are caused by poor exercise, malnutrition, and even medication. Many COPD patients struggle to eat enough and get enough physical activity, and neglecting these vital habits is a common reason for chronic muscle and joint pain.

If you or someone you love has COPD, then you'll need to know what kinds of pains COPD can cause and how to treat them. More than 45% of COPD patients are plagued by chronic pain, and some of those pains can be relieved with professional support, proper diet, exercise, and other at-home therapies.

COPD is a difficult disease to manage, and it's even harder when you have to deal with chronic aches and pains. That's why, in this article, we're going to help you understand how COPD causes pain in different parts of the body and what you can do to manage and relieve these pains.

What Kinds of Chronic Pains are Caused by COPD?

COPD can cause many different types of pain, and every patient's experience with chronic pain is different. However, there are a few particularly prominent causes of chronic pain that affect a large percentage of COPD patients.

Disuse Syndrome

COPD symptoms like coughing, wheezing, and shortness of breath can be very hard on your body. These symptoms are unpleasant on their own, but they can also cause a variety of chronic and acute pains.

Struggling for air during exercise or bouts of breathlessness is a common cause of chest pain and tightness for COPD patients. Coughing, especially a chronic cough, can also cause serious chest pain and strain the muscles in your shoulders, neck, and back.

However, the most damaging effect of these symptoms is that they make physical activity challenging and uncomfortable. Breathlessness, coughing, and chronic pains all discourage people with COPD from exercising, practicing breathing exercises, and participating in other forms of physical therapy.

Unfortunately, these physical activities are necessary to reduce COPD-related pain and improve patients' ability to breathe. Avoiding exercise only accelerates muscle wasting, loss of mobility, and serious physical decline.

What's worse, inactivity on its own causes even more chronic pain and discomfort due to a phenomenon known as disuse syndrome. Disuse syndrome refers to a variety of chronic pains, illnesses, and even mental disorders that result from a lack of physical activity.

Disuse syndrome occurs as a result of muscle wasting, cardiovascular disease, and nervous system changes that happen when you live a sedentary lifestyle and don't use your body enough. Luckily, disuse syndrome can be reversed with regular exercise and a healthy lifestyle.

Osteoporosis

At least 20 percent of people with COPD also suffer from osteoporosis, a condition that occurs when your bones become thin, weak, and prone to breaking. This is a result of a variety of COPD-related factors, including malnutrition, lack of exercise, chronic inflammation, and even corticosteroid medications.

Your bones are made of living tissue that is constantly being worn down and built back up again, but age and illness can hurt their ability to fully regenerate. Osteoporosis occurs when your body lacks the nutrients it needs to build up your bones at the same rate as old bone tissue is broken down.

Often osteoporosis is “silent,” having no outward signs or symptoms. Many people don't realize that their bones are weakened until they get a minor injury that fractures a bone.

However, once osteoporosis becomes severe it can lead to frequent injuries that cause chronic aches and pains. People with osteoporosis are particularly prone to spinal compression fractures, which can cause severe back pain and spine disfigurement.

If you have osteoporosis even minor actions like twisting, lifting, or minor falls can cause bone fractures that take months or longer to mend. Until they heal, fractures cause chronic pain that often requires prescription pain medication to manage.

Osteoporosis is more common than usual in all subsets of the COPD patient population, but it becomes more likely with age and in the later stages of the disease. COPD patients who have had many exacerbations, have a history of smoking, or who take inhaled or oral corticosteroids are most at risk than others for osteoporosis.

Chest Pain

Moderate to severe chest pain is common ailment that affects COPD patients, especially emphysema patients, day after day.

Emphysema is a common form of COPD that results from damage to the air sacs (alveoli) in the lungs. Over time, emphysema causes your lungs to balloon and over-inflate, which hurts their ability to push all of the air out when you exhale.

Emphysema patients' lungs can become so large that they press on their rib cage and diaphragm, which causes severe pain. The pain can strike at any time and can be triggered by activities as light as walking.

Although lung over-inflation is one of the most common reasons for chest pain, another common cause is muscle tightness and fatigue. COPD symptoms like coughing and shortness of breath over-exert the muscles in your chest that you use to breathe, making them tired and sore.

Chronic coughing and gasping for air can also strain the muscles in your neck, shoulders, and back. Luckily, chronic chest, neck, and back pain can often be lessened with regular exercise, good posture, breathing techniques, and proper symptom management.

Muscle Cramps and Soreness

Muscle soreness and cramps are also common pains that affect people with COPD. These pains can result from a variety of COPD-related conditions, including malnutrition and a sedentary lifestyle.

Because COPD is an age-related disease, many patients are elderly with muscles that can't stand up to the same amount of activity and strain that they used to. This puts COPD patients at a much greater risk for muscle weakness, cramps, and pain, especially when combined with a greater risk of muscle wasting due to the disease.

Muscle cramps can also be caused by poor blood circulation, which can occur along with other cardiovascular complications in the later stages of the disease. And since COPD makes it very difficult to exercise, many patients avoid physical activity, which makes muscle weakness and pain even worse.

What's more, certain medications like corticosteroids can cause vitamin and mineral imbalances in your body that starve your muscles of the nutrients they need to function. This can lead to severe muscle cramping and weakness, adding yet another risk factor for muscle problems in people with COPD.

While muscle cramps tend to be sudden, acute pains, rather than chronic pains, they can come as an indirect consequence of chronic pain. It happens like this:

Chronic muscle soreness and weakness makes it difficult to exercise, leading to inactivity.

Lack of physical activity and stretching exercises causes your muscles to get even more stiff and painful to move.

You then become even more prone to getting additional muscle injuries and pains, including cramps, because your muscles are stiff and under-used.

This can then lead to even more exercise avoidance out of fear that you will experience more painful muscle cramps and soreness.

Muscle pains are very important to treat because they make it more difficult to exercise, leading to an even more unhealthy and sedentary lifestyle. This compounds the problem, making your muscles and joints even more stiff and cramped from inactivity.

In fact, strengthening your leg muscles and treating chronic pains that make it difficult to move around are some of the most important things you can do for your COPD. Any intervention that makes your body stronger and improves your capacity for exercise has the potential to significantly improve COPD symptoms and even delay the progression of the disease.

Treatment for muscle cramps and soreness usually includes pain relievers, gentle stretching, and physical activity to reduce stiffness and improve limb mobility. We'll go into these treatments in more detail in the next sections so you can learn how to treat muscle pains and stay active with COPD.

General Treatments for Pains Caused by COPD

Over the Counter Pain Relievers

Over-the-counter pain relievers like Ibuprofen and Aspirin aren't usually strong enough for severe pains, but they can be very effective for minor ailments. If you experience muscle cramps, chest pain, sore joints, or other small pains, these non-prescription medications could help.

For example, you could use mild pain relievers to treat sore muscles after a workout or a particularly active day. You could also use them to reduce mild chronic joint pains and muscle cramps so that you can exercise and perform daily activities without significant discomfort.

If you have COPD, you should always talk to your doctor before taking any new medication, even over-the-counter medications. Your doctor can ensure that they won't interfere with any of your other prescriptions or treatments and warn you about any side effects or complications you should look out for.

Mental Health Support

It's well-known that people who are anxious and depressed experience more aches and physical pains than people with good mental health. Therefore, one way to reduce chronic physical pain is to treat the emotional pain that amplifies it.

It's not difficult to understand why mental health support is so important for people living with COPD. A COPD diagnosis is extremely distressing to receive and can cause a great deal of fear, anxiety, sadness, and regret. Most people need as much extra support as they can get, both practical and emotional, to get through this difficult time.

Even after the initial diagnosis, people with COPD have to devote a significant amount of time and mental effort to managing their disease and its symptoms, which can cause even more worry and stress. Without professional help, the severe anxiety and emotional distress that many COPD patients feel can develop into more serious conditions like chronic anxiety and clinical depression.

If you feel depressed, anxious, or are struggling with increased chronic pain, don't hesitate to seek help from a therapist or psychiatrist. They can give you emotional support, help you manage negative thoughts and emotions, and prescribe you medication like antidepressants if you need them.

Once you take care of your mental health, you will likely notice that your chronic aches and pains have lessened as well. And without the burden of chronic emotional distress, it is much easier to stick to an exercise schedule and treatment plan to properly manage your disease.

Pulmonary Rehabilitation

Pulmonary rehabilitation is a special class designed to help people with respiratory diseases like COPD take charge of their health. It includes instruction on how to exercise right, breathe better, and use medications effectively, along with a variety of other practical advice for managing chronic lung diseases.

Pulmonary rehab is a great opportunity to practice effective exercise techniques and breathing exercises that can improve your endurance for physical activity. It includes COPD-specific physical therapy lessons and tailored exercise classes that can help you reduce a variety of chronic pains, especially chest and muscle pain.

Pulmonary rehab also teaches you to strengthen the muscles in your chest and abdomen that you use to breathe, which can reduce chest tightness and pain that comes from over-inflated lungs and struggling to breathe. You can reduce muscle strain, cramps, and joint aches over the course of pulmonary rehab by learning exercise techniques that strengthen your muscles and joints.

Physical Therapy

If aches and pains in your muscles and joints are preventing you from exercising, you might need some physical therapy before you start working out on your own. Especially if you've been sedentary for awhile, your body might not be ready to jump into action just yet.

That's what physical therapy is good for; it helps you work with and around any physical conditions that limit your ability to move. A good physical therapist will teach you how to safely stretch and move the parts of your body that ache and help you recover from injuries and pains.

Through physical therapy, you can improve your muscle strength, flexibility, and overall range of motion. In many cases, this is enough to significantly reduce aches and pains in your muscles and joints and make it much easier to tolerate exercise and daily activities.

If you're suffering from any of the chronic aches, pains, or mental effects of disuse syndrome, physical therapy is one of the best ways to jump-start your recovery. Anything that makes it easier to exercise and move your body, like physical therapy and pulmonary rehab, can help you fight chronic pains and other symptoms caused by COPD.

Massage

There's no doubt that massages are relaxing and feel wonderful, but research shows that it's an effective treatment for muscle and joint pain, too.

Massage therapy is great for COPD because it helps relax sore muscles, limber up stiff joints, and reduce chronic pain. It can also help improve your range of motion, which makes it easier to exercise and do other everyday activities.

If you suffer from chronic pain in your muscles and joints, consider getting a massage once or twice a month. Depending on your insurance provider, your policy might even cover some of the expense. Just make sure to tell your massage therapist about any and all of your health conditions so that you can have a safe and pleasant experience.

Better Posture

Poor sitting, standing and sleeping posture can lead to a variety of chronic aches and pains. If you have COPD, it's especially important to practice a healthy, straight posture to keep your spine, muscles, bones, and joints healthy.

Bad posture leads to muscle and tendon strain that can severely limit your mobility and physical endurance. Since people with COPD are especially prone to sedentary living and exercise avoidance, they are also more prone to bad posture and the negative consequences that come with it. These negative effects include muscle wasting, stiffness, chronic pain, and permanent changes to the shape and curvature of the spine.

To practice good posture, you should always keep your back straight, your chin up, and your shoulders parallel with your hips. This will prevent you from leaning, slouching, and hunching, which put enormous strain on your spine, shoulders, and neck.

To learn more about how posture affects your COPD, visit our previous article here. https://lifeptmedical.com/blogs/resp...h-good-posture It will show you in more detail what good posture looks like and give you a variety of tips and advice for building better postural habits.

Targeted Treatments for Pains Caused by COPD

Now that you've read some general tips for reducing chronic pains and keeping your body strong, we're going to introduce you to some targeted treatments and techniques for treating specific aches and pains. We'll show you techniques for relieving a variety of common COPD pains, including chest pain, joint aches, and muscle cramps.

Breathing Exercises

One of the best ways to prevent COPD-related chest pain is to strengthen the muscles in your chest and improve your breathing efficiency. Exercise is the most effective way to do this, but breathing exercises can help, too.

There are a variety of breathing exercises designed to help people with COPD and other respiratory illnesses breathe easier and more efficiently. Some of the most common are pursed lips breathing and diaphragmic breathing, which you can read about in more detail here. https://www.copdfoundation.org/What-...niques.aspx%20

Practicing these breathing exercises every day can help you change how you breathe on a daily basis and help you better control other respiratory symptoms like breathlessness and wheezing. Both techniques also reduce the amount of strain that breathing puts on your chest muscles, reducing chest pain and making it easier to breathe

Mucus Clearance Techniques

A chronic cough is a major source of chest pain for people with COPD. If you find yourself sore because of a chronic cough, especially if your cough usually brings up mucus, there are a variety of mucus clearance techniques that can help.

Although it may seem counter-intuitive at first, taking the time to cough intentionally can actually prevent more painful, more exhausting coughing fits later. Controlled coughing and huffing techniques clear the same mucus out of your lungs that is often the culprit behind a chronic cough. This allows you to breathe better and exercise better without worrying about excess phlegm triggering another coughing fit.

Common mucus clearance techniques include huff coughing, chest physiotherapy, and the active cycle of breathing technique. You can also use medical devices like positive expiratory pressure (PEP) devices, high-frequency chest wall oscillation, and lung flutes.

To learn about these and other ways to reduce mucus in your lungs and airways, visit our article on mucus clearance techniques here. https://lifeptmedical.com/blogs/resp...ing-techniques

Heat Therapy

Heat therapy is a favorite home remedy used to treat a variety of aches and pains. It's one of the most simple ways to reduce bone and joint pain, and it works on stiff and sore muscles, too.

Heat therapy works by increasing blood flow to the affected bone or joint, which allows the body to transport extra oxygen and nutrients to the area. This can help the injury heal faster and also provides a soothing, warming sensation that temporarily reduces pain.

To apply this treatment, you'll first need a convenient, portable source of heat, such as a hot water bottle. Then, wrap your heat source in a towel to protect your skin from the extreme temperature. Next, press the hot pack on to the affected muscle, bone, or joint for up to thirty minutes at a time. With any luck, you should experience pain relief after only fifteen or twenty minutes.

What makes heat therapy so great is that it is simple, convenient, and has an immediate soothing effect. And if you don't have a heat pack at home, you can easily make one with items around the house.

Here are some ideas for heat sources you can use to relieve pain in your muscles, bones, and joints:

Electric heating pad
Hot water bottle
Single-use heat packs (e.g. Hot Hands packets)
A hot shower or bath
Fill a sock or other fabric pouch with rice, then microwave for a couple minutes until hot.

Increase Calcium and Vitamin D in Your Diet

A major contributor to osteoporosis is a lack of calcium in your diet. It can also be caused by too little Vitamin D, which your body requires in order to absorb and utilize the calcium your eat.

While extra calcium is not a cure for osteoporosis, it can help prevent osteoporosis and reduce bone density loss. If you have COPD, you are at a very high risk for osteoporosis and you should be especially careful to get the recommended amount of calcium in your diet, which is usually about 500-1000 mg.

Here are some good sources of calcium you can add to your diet to protect against osteoporosis:

Dairy (e.g. milk, cheese, and yogurt)
Collard greens
Kale
Salmon
Sardines
Foods fortified with calcium (e.g. tofu, orange juice, cereal, and almond, rice, or soy milk)

Here are some good sources of vitamin D that you can add to your diet:

Fatty fish (e.g. tuna, salmon, and mackerel)
Cheese
Egg yolks
Beef liver
Foods fortified with vitamin D (e.g. tofu, orange juice, cereal, and almond, rice, or soy milk)

Increase Vitamins and Minerals in Your Diet

Low levels of calcium, potassium, magnesium, and sodium in your body can lead to muscle cramps, soreness, and weakness, especially during and after exercise. Your muscles use up these nutrients as they contract and relax, and they must be replaced to keep your muscles working correctly.

That's why it's important to eat a healthy, balanced diet with plenty of vitamins and nutrients. It's the only way to give your muscles enough fuel to keep going without hurting or cramping up.

People with COPD tend to be especially prone to vitamin and mineral depletion because of poor nutrition and corticosteroid medication use. The same inhaled and oral corticosteroids patients use to treat COPD symptoms and exacerbations can cause deficiencies in vitamins and minerals that their muscles need.

When this happens, you might feel fatigued, weak, and experience frequent cramps and pains in your muscles. This makes it difficult to exercise, and exercising is probably the most important thing you can do to preserve your health and quality of life with COPD.

Magnesium, calcium, potassium, and sodium are all necessary to keep your muscles working efficiently and prevent painful cramps. Long-term corticosteroid medications can reduce your body's stores of all of these nutrients and affect your muscles' function:

Magnesuim: Magnesium is required for muscle contraction and relaxation as well as a number of other important bodily functions. Magnesium is necessary for nerve signaling, energy metabolism, protein synthesis, and moving calcium and potassium in and out of cells.

Potassium: Potassium is also an important nutrient that allows your muscles to contract and relax. It is also important for your heart and regulating the balance of water in your body, among other functions.

Calcium: Calcium plays an integral role in muscle contraction. Both too little calcium or too much calcium can cause muscle cramps, but low calcium levels are the most common culprit.

Sodium: Sodium is an important electrolyte that signals your muscles to contract. It also regulates the amount of fluid in your muscles and the rest of your body. Too little salt in your diet can cause muscle spasms, weakness, and soreness.

If low magnesium, potassium, or calcium is the reason for your cramps, then eating a diet high in these vitamins and minerals can help reduce your pain. It can also make it easier to work out; if your body gets all the vitamins and minerals it needs from your diet, then it can easily replace any that get depleted from your muscles.

Here are some good sources of magnesium, calcium, and potassium that you can add to your diet:

Magnesium: almonds, squash, avocados, spinach, chard, figs, legumes, and dark chocolate

Potassium: bananas, sweet potatoes, beans, carrots, molasses, soybeans, milk, and tomatoes

Calcium: dairy products (e.g. milk, cheese, yogurt), tofu, collard greens, edamame, bok choy, broccoli, figs, salmon, almonds, and citrus fruits (e.g. lemons, limes, oranges)

Sodium: Sodium is in just about everything, and you're more likely to get too much salt in your diet than too little. However, if you're going to be doing any heavy physical activity you should keep a salty sports drink (e.g. Gatorade) nearby to replenish your electrolytes during or after your workout.

Increase Your Carbohydrate Intake

One way that the body gets depleted of the nutrients needed to fuel your muscles is a lack of carbohydrates. Carbs are the main fuel that your muscles use when you exercise, and not getting enough carbohydrates in your diet can cause muscle pain and cramping.

If your muscles don't have enough carbs to use for energy, they have difficulty contracting and relaxing normally. If you continue to exercise without the fuel they need, your muscles can get stuck in a cramped, contracted position.

This is a problem for COPD patients in particular because many people with the disease avoid carbohydrates in order to protect their lungs. Low-carb diets that favor of fats and protein can actually reduce respiratory strain and fatigue and make it easier for people with respiratory diseases to breathe.

However, a certain amount of carbohydrates is always necessary to provide your body with the nutrients and fuel it needs. If you have COPD and experience frequent muscle pain or cramps, you might be in need of some extra carbs in your diet.

However, not all carbohydrates are equally healthy. Simple carbs are like empty calories; they don't provide long-term fuel for your body. Instead, choose complex carbohydrates like those found in vegetables, unprocessed grains, and whole-grain foods.

Here are some good sources of complex carbohydrates to add to your diet:

Whole grain pastas, breads, and crackers (e.g. brown rice and whole-wheat, whole-grain breads)
Starchy vegetables (e.g. sweet potatoes, corn, carrots, beets)
Beans, legumes, and peas (e.g. lentils, navy beans, black beans, and split peas)
Green veggies (e.g. broccoli, brussels sprouts, and parsnips)
Quinoa
Buckwheat
Popcorn
Oatmeal
Blueberries
Apples
Yogurt

If you tend to experience muscle cramps during exercise, it can help to eat carbohydrate-rich foods before you work out. If you are on a low-carb diet and can only eat a limited amount of carbohydrate-rich foods each day, try to time it so you eat them before periods of exercise and other physical activity.

Remember, you should always talk to your doctor before making any significant changes to your diet. If your doctor or dietitian has given you a specific diet to follow, make sure you bring up any concerns or symptoms like cramping with them so they can make any necessary adjustments to your plan.

Treating Leg Cramps

Muscle cramps are involuntary muscle spasms that happen when a muscle or group of muscles suddenly and violently contract, or tighten up. Although harmless for the most part, they can be excruciatingly painful and temporarily hinder your ability to exercise.

Many people with COPD experience muscle cramps, especially in their legs. This can result from a lack of exercise, poor nutrition, and poor circulation, all of which are relatively common for people with COPD.

Leg Cramps During Exercise

Some people experience muscle cramps during or after heavy exercise. This is usually a sign that you need to spend more time stretching and warming up before you work out. It can also be a sign that you're doing too much too fast, and that you need to tone down your exercise intensity and work up to strenuous activities more gradually.

To prevent leg cramps during physical activity, consider this advice:

Always drink plenty of water when you exercise.

Always warm up with light stretches and activities to limber up your muscles before and after you exercise.

Eat carbohydrate-rich foods before you exercise. If your workout lasts longer than 45 minutes, take a short break during exercise to replenish your carbs.

Replace the salt and minerals you use up by drinking sports drinks or having sodium-rich foods or drinks before and during exercise.

Don't exercise in extreme temperatures. You are more likely to experience muscle cramps when it's very hot or very cold outside.

Leg Cramps at Night

Some people tend to get leg cramps at night, which is dreadful to experience when you're trying to sleep. One way to prevent this is to stretch and move your legs before bedtime so they're loose and limber when you lie down.

Here are some techniques you can try to prevent leg cramps at night:

Take a short, leisurely walk shortly before you go to bed.
Take a few minutes to stretch your legs before bed. Calf stretches are very helpful.
If you like to sleep on your back, try placing a pillow under your feet to prop them up.
Make sure you sleep in a position that doesn't cause your feet to flex. Make sure your legs and calves are relaxed and your toes are not pulled backward or forward.
Don't pull your sheets too tight around your body; they can cause the muscles in your feet to flex and cause cramping.
Control the temperature in your bedroom so that it doesn't get too hot or too cold.

Here are two easy calf stretching exercises you can do before bed to prevent cramps.

Leg Stretch 1:

Stand up straight facing a wall, leaving about three feet of space in-between you and the wall.
Keep your feet planted flat on the floor and lean forward, resting your elbows and forearms on the wall.
You should feel the stretch in your calf and the back of your thighs. If you don't feel a stretch, you may need to stand further away from the wall.

Leg Stretch 2:

Sit down on the floor with your legs straight in front of you.
Flex one foot, pulling the toes toward your body until you feel the stretch in your calf.
Lean forward and reach both hands toward your foot, stretching as far as you can and hold for several seconds.
Repeat with your other leg.

How to Get Immediate Relief from Leg Cramps

General leg stretches and exercise can help reduce muscle cramps in the future, but in the short term, you still need a way to cope. When a “charlie horse” leg cramp hits, you'll probably be most concerned with how to stop the cramp right now and make the pain go away.

Here's what you can do to immediately treat a painful leg cramp:

Stretch out your leg:
Straighten out your leg as much as possible.
Flex your foot upward, pulling your toes up toward your body as far as you can and hold for several seconds.
Relax the muscles in your foot and leg. If the cramp has not gone away yet, repeat.
Apply heat to relax the muscle
Apply an ice pack to numb the pain and treat residual soreness

Conclusion

As any COPD patient knows, the disease affects more than just your respiratory system. It can affect your muscles, bones, joints, and cause a myriad of aches and pains throughout your body.

Now that you better understand the relationship between COPD and chronic pain you will be much more equipped to recognize and manage these pains when they come. If you follow the advice on this list, you'll be better able to utilize food, exercise, and medical resources to manage a variety of pains caused by COPD.

Nobody should have to suffer in silence, so don't be afraid to seek help from your doctor or a mental health professional if you need it. There are many different ways to treat and manage chronic pain, and no patient should ever suffer needlessly.