Good morning, this is Jim Fricton, and I'm presenting today on the lifestyle module, to continue our series on the risk factors and protective factors in the seven realms of our lives. And I'm speaking from the University of Minnesota here, although it is not summertime, as it shows on the slide here, it is the dead of winter right now. And we have about zero degrees outside so it's very brisk. You don't need a cup of caffeine to wake up this morning. anyways, the lifestyle realm is one of the most important things and one of the easiest to change, at least from my perspective and it focuses on a number of different issues. One is to understand the treadmill that we find ourselves on, everyday. It's those daily routines, those little things we do everyday repeatedly. And then with regard to sleep, it has a big impact on chronic pain. We'll talk about diet, nutrition, weight and eating disorders and it's relationship to chronic pain. We'll also talk about activity levels inactivity. Sitting a lot, as well as the opposite of pacing, and the need for variation in lifestyle. We'll talk about chemicals, that you use everyday, the medications, the smoking, alcohol, and illicit drugs. And then we'll talk a little bit out experiential learning we have a relaxation recording that we did. As well as to, help you, guide you, in, in, identifying, what are your lifestyle patterns? And what are the little things that you really enjoy everyday, or little things that, that create risk, for chronic pain. And then there's a quiz. So we're hopefully, by the end of the module you will be able to identify lifestyle factors. Both the risk and protective factors. In each of the areas that I explained, particularly sleep, diet, activity levels, medication, smoking and chemical use, and the experiential learning. So, the first one, is on Lifestyle Treadmill. Now, we all know that we are, have our daily routine. You know we get up in the morning. We have breakfast. We have coffee, whatever we have and we go about our daily activities. We need to know, that we are what we repeatedly do. So if we have risk factors that we repeatedly do, those risk factors are going to have an impact on our health. On the other hand, if we have a daily routine that has lots of protective factors, eating well, exercising, relaxing as we need to do. And have a variation in lifestyle. Those things will also protect us from developing illness and the most common illness, chronic illness is chronic pain. So you need to decide and we need to decide for our patients, is, is our lifestyle a risk factor or is it a protective factor in each of these different areas? So let's just quickly summarize, what are the protective factors. And risk factors in each of the lifestyle realms. Well, protective factors, as you would expect, is a sound, restful sleep. Seven to eight hours. It's a healthy diet, particularly of protein, and, and vegetables. As much as you want to eat of those. Normal weight, positive routines, that are active, balanced, and we'll, talk, a little bit about that later. Pacing, timing, variation in lifestyle. And avoid risky lifestyles also. So with regard to risk factors then on the other hand we have poor disturbed sleep, we have a poor diet of high fat, high sugar, high processed foods, high caffeine, and a variety of other foods. If we are over bait, overweight or obese, it's a risk factor for chronic pain. And then negative routines, like being inactive sitting around a lot, laying around, imbalanced lifestyle, feeling hurried, irregular, those types of lifestyle fed routines. And then high risk behaviors. smoking, alcohol, drugs, mainly chemical use but sexual practices also. So let's kind of review the fact that these, occur in the cybernetic cycles that I talked about in a previous lecture. So these are the positive and negative feedback cycles that we do every day. And one factor in the cycle contributes to another, which contributes to another, and contributes to another, and we get into this cycle that just continues on and on, an illness may be part of that cycle, and particularly, chronic pain. So here's an example of some of the cycles that we see ourselves in. When you have a disrupted sleep pattern for whatever reason. I was just talking to my colleague about being waken up in the middle of the night by a baby. A four month old baby. There are many different factors that can contribute to disrupted sleep and I'll get into that. But what that does in increase your fatigue in the morning of course. During the day then, with that increased fatigue. You have a lot of daily tension just to go, get through the day. You're yawning, you're tired, you know, you, you tense up. And you have a decreased ability to cope. With both of those, increased tension, whether it's from clenching, holding your shoulders tense, moving too fast through the day, or drinking too much caffeine to wake yourself up. It contributes to more pain. And that pain-sleep cycle, disrupts sleep. And with that you will develop more pain. That disrupts your sleep. An increase of fatigue, and this cycle continues on. Now let's kind of, review another cycle one with diet and obesity, overweight, and pain they're all linked. Now here, if you have an excessive, a frequent, or a poor quality diet, it leads to obesity. Well, what that does, is increase your weight on your muscles, your joint, and it increases your inactivity level. That, of course creates a poor body image more pain, because of the strain on the muscles and joints, and the possibility of depression. Which decreases your ability to cope, and depression and pain are correlated together. And with more pain, you have a tendency to eat more. And with that, perhaps even eat a poorer quality diet. So, this is all linked within a cycle. The same thing is true about caffeine. Now, caffeine can be both a protective factor in some cases. As well as a risk factor. But what happens when you have an increase in tension strain or poor sleep, there is a tendency to be more fatigued during the day. And with that, you'll have an increase in pain and you'll drink more caffeine. Or you'll take energy pills, drugs, for more energy. And this of course increases more tension, increases central sensitization. And interferes with your sleep. And then you go down that cycle again. So caffeine and pain may be linked. And the same thing is true about pacing and pain. Now you find yourself that pain often leads to inactivity and you get less done. With that of course getting less done and that end you have to feel rushed or hurried in order to get whatever you need done, and the quality of work suffers. This does increase your tension level. It increases some anxiety, stress, and of course more pain with that tension. And then the pain leads to further inactivity, getting less done, and that cycle just continues on and on and on. In addition, our risky lifestyle and pain are linked. So there's a tendency to when you have risky behaviors whether it's high smoking alcohol, frequent alcohol use, sexual practices, you have the potential for increasing injuries, illness and pain. With that you also characterized by lower self-esteem, some tendency towards self-abuse. So you smoke more. Oh, I don't really care, about myself. I'm going to smoke more, I'm going to do whatever I want. I don't care about the consequences. You have increase in risky behaviors, this leads to more illness, injuries, pain and that cycle continues and so, each of these cycles are something that are repeated over and over again. Particularly by those people who are high risk, with chronic pain and, and other illnesses. And these cycles al, also, most importantly, can be reversed. By changing sometimes one factor in the cycle, it begins to reverse that cycle. And you really begin to feel better. But it's not something that occurs overnight. It's about that daily routine. It's those little things, that you do everyday that's most critically important.