Pain and Catastrophizing Leads to more Pain!

I am often asked by my patients why their pain feels so much worse when they are stressed out or feeling in the dumps. Today, I found a review of the best reason I've ever heard, and the new explaination I'll give to my patients. Believe me, in the field of healthcare there is something new to learn every day. As a take home point from this article, I'd say that it is to do whatever you can to increase your positive outlook on the world, especially if you have a new injury or suffer from chronic pain. Your good health depends on it. Here's the entire review from the fantastic group at the Neuro Orthopaedic Institute Australasia (noigroup.com):

"The article (Edwards RR et al 2008 Association of catastrophising with interleukin-6 responses to acute pain. Pain 140: 135-144 ) really struck home. In essence, these authors demonstrated a link between catastrophisation and elevated levels of the pro-inflammatory cytokine interleukin-6. Interleukin-6 (IL-6) is one of a number of pro-inflammatory molecules produced by immune organs and cells (eg bone marrow, macrophages, glial cells) and is known to be involved in hypersensitivity, such as the aching you get when you get the flu, but also related to the severity of pain in back pain, fibromyalgia, OA and RA and neuropathic pains. This study basically says that the more you catastrophise, the higher the levels of and influence of IL-6 (and surely other cytokines such as TNF alpha). Cognitions and emotional responses are translated into known chemistry. It harks back to Candice Pert's "Molecules of Emotion."

The research adds to the growing literature that proinflammatory cytokines play a role in the development and maintenance of persistent pain syndromes. (Watkins and Maier 2002; Marchand, Perretti et al. 2005; Thacker, Clark et al. 2007)

The author's suggestion is that a range of ongoing pain states such as Type II diabetes and cardiovascular disease, known to be associated with IL-6 levels, may be influenced by catastrophisation and therapy could be directed to it. Said in another way - catastrophisation can lead to tissue inflammation and damage. It is not too much of an extrapolation to add low back pain, whiplash and neuropathic pains to the list - indeed any persistent pain state. By the way, as the authors remind us, catastrophisation is a complex response to varied stimuli and the influences on immune cells and inflammation and pain may be just one of a number of influential pathways. For example, IL-6 can also blunt the endogenous opioid system." (NOI group newsletter - www.noigroup.com)

Independance Valley Reconnoitre

Here's the view from 6 feet 6 inches off the ground:

Total Ride Time: 3:59:16
Total Distance: 75.09
Ave Speed: 18.90 (for real?)
APR Ave HR: 146 (middle top of Zone 2)
APR Max HR: 168 (Zone 5a... oops)

Today's ride was probably my best personal ride with the team. About this time last year, I could hold similar effort but only for about 35 miles then I'd have my SLOW rides back home. On this 70+ mile ride I spent a lot of time hanging at the back, though I did take turns through on the rotations. I found that I was really feeling it after my week, and couldn't stay more than about 45-60 sec. At least I know the feeling and what to do now. Bail. My 168 max for this ride is about 10 beats below my MAX hr, so I was burning pretty hot on the climbing in Independance Valley. It was great to see this course, though, because last time I was here was when I raced here last year. I never made it up the first hill with the group and ended up riding three laps by myself or with other stragglers (who all told me that they had just gotten on their bikes for the first time after months of being off. Whatever.) I ended up finishing with the group which made all the work feel very good. Not sure if I'll see this course again before racing on it in the spring.

Tour Down Under (and Lance) is rolling!

Well, there it is. The first race in the world has started the 2009 year off with a bang! I watched the Tour Down Under online this morning and remembered how exciting it is to watch everything that happens in a race. According to VeloNews, there were about 140,000 spectators there to watch. To tell you the truth, I would have wanted to be there myself. I am a Lance Armstrong fan and to see him race again is very exciting for me. Watching him dominate in the TDF for years is one of the inspirations that got me back on my bike after many years of ignoring it.

Hearing Phil Liggett announcing the racing was very reminiscent of staying up late on summer nights watching the TDF and trying not to doze off until everyone started getting "twitchy" which would keep me awake.

No matter what Lance does in these first races, one of my main interests is watching what happens to him through the year. He is doing a very interesting experiment with his body. I hate to say it, but his birthday is September 18, 1971, and that sort of rhymes with December 18, 1971, which is mine... So, in a way, I'm interested in what he's doing because it inspires me and gives me something to think about that is bigger than me.

In his commentary during the pre-Tour Down Under criterium, Phil Liggett made a statement that Lance Armstrong has been training like a "madman." (Referencing Lance Armstrongs unprescedented January form. This leads me to smile a bit because I know from my studies and interactions with his doctor (Jeff Spencer), that while he is indeed training hard, he's resting even more. I smile because Phil Liggett has inspired me to set the tone and focus of my writing in this blog to the topic of maximizing RECOVERY in cycling.

G'day, Andy

My First 100 Mile Weekend in a While

Not that I had really set it as a goal or anything, but after a 70 mile ride on Saturday with the team and the opportunity to ride again on Sunday, 100 miles seemed like the obvious choice as a stopping place. The best news of the year so far is that compared to last year, I'm feeling like a different (read: better) rider.

About twelve months ago, I braved my first team rides and would end up being wiped out from a 40 or 50 mile weekend. Many of those rides I ended up coming home alone because I couldn't keep up without
feeling like I was going to throw up or pass out. Going in to work on Monday, feeling "less than fresh" made me wonder what I was doing to myself, but kept at it anyway. A year of solid riding, good mentoring, and a season of racing looks like it may have paid off for this beginner. But, really, folks, I think that's quite enough jinxing for one post...


Saturday's ride was 28 or so strong as it left from the Valley. I didn't count, but I think the group was half men, half women. The route patched together a few rides that I've done many times, but never all at once. As always, I'm totally impressed by the route leaders who seem to know every rural turn that exists and can work through course options on the fly. My inability to find my way around is one of my biggest motivations for building my fitness, truth be known.

I almost couldn't remember what it felt like to ride my carbon bike after riding my cyclocross bike for months and months now. It felt cushy after all the road miles on my fendered cross bike this year! Still, by the end of it, going up French Loop, I did have nasty little cramps in my quads when I tried to stand up. Guess that's show biz! Oh, I also didn't mind the pauses in intensity as we had to stop for several flats along the way.
Day 2 of my weekend was riding down past Millersylvania State Park for about an hour out and an hour back. I rode with the CBC Fitness ride from The Bike Stand. Besides feeling my legs from the day before, I felt good and was perfectly happy to sit in the back of this group and let them muscle forward so I could just cruise along. I think they went on to Tenino and back

Johnson Creek and Home via Delphi... Almost

Johnson Creek Loop returning on Delphi Rd

Total Time: 3hrs 17min
Total Distance: 59.25miles
Ave Speed: 18.10mph

Today I was able to get out for the team ride starting from The Valley. A large group assembled with a good mix of riders, some of whom I hadn't seen since October for our Meet the Team ride. Most of them, however, are part of the core of the team that make the rides every time. So far, I've had a flakey start. (Kinda like a lawn mower that doesn't start for the first time in the spring and blows out a little too much black smoke when it does.)



Our ride worked a bit like a caterpillar for a while as the group tried to find a decent pace for all, which is nearly an impossible task, given that the group does have varying levels of fitness and ranges of what constitutes Zone 1-2. My favorite part of the ride was when a small group of us stopped for a minor mechanical. Suddenly I looked around and discovered that I was surrounded by Cat 1-2s and another rider who has quads as big as both of mine put together. Hmm, I thought, where's my bungie cord. There were 5 of us to bridge back up to the main group. Since this was less than halfway through the ride, I sure wasn't looking forward to breaking the bank too early. As it turned out, though, our trip back up was speedy and lots of fun, even though I wasn't exactly planning on pushing my heartrate up so high. Oh, well. Good times!



Not long after, we came up through Millersylvania St. Park and the choice to go straight up Tilly to Olympia or take the turn towards Delphi/Black Lake. Well, I chose the left turn, slowed down to about 10mph up the hill and finally made it over only to suffer a flat within about a minute of coming down the hill. Robbed by destiny? Nope, the flat was a welcomed reason to stop watching the rest of the group vanishing in the distance. I came up Little Rock Rd. and am now warm at home, already looking forward to riding with the group again next week.

Cheers, Andy

January 1 Ride: More Base Needed

Today, the team held a ride to Centralia via the Steam Plant. I'd never tried this ride before, so I thought it would be a great day to do it given the time available for the holiday. I've also been very excited about getting my training plan started for the year.

My goal was to stay low in my heart rate zones (Zones 1 & 2) for the entire ride. And all went well for the first half of the ride, but I really started feeling tiredness in my legs when I stopped in Centralia to get something to drink. I went through two large bottles during the first 30 miles of the ride.

On the way back out of Centralia and heading for home, I started to feel my legs a lot and it felt very much like my road racing experience. The feeling of hanging with the peloton followed by rapid fizzling of the legs and then a long lonely ride by myself. This happened today, after discussion with the group, and I shooed them along. I'd ultimately make my way home, but not after a lot of pain in my legs. Guess I should have ridden about half the mileage I did today, in retrospect.

There is a P.S. to the story: I had a flat right after being dropped and broke my pump in the process of pumping up the tire... "Epic" is all that comes to mind, but not in a good way!

Cheers! Andy