About a decade ago, with roughly one-quarter of all Americans suffering some form of chronic pain, the US government did what it seems to do best, and declared a “War on Pain.”
Unfortunately, the government supplied no real research or training on how to actually win this “war,” so doctors just did what they do best, and increased their prescribing of NSAIDs (like ibuprofen) and narcotics.
The effect? We now have:
- A stunning (and ignored) ~35,000 to 50,000+ preventable US deaths each year from NSAIDs.
- As many as 16,500 bleeding ulcer deaths per year related to NSAIDs.
- A 40-300% increased risk of heart attack and stroke related to NSAIDs, translating into
- 15,000+ overdose deaths per year from prescribed narcotics
- A relentless rise in the number of people living with chronic pain, a figure now estimated to be one out of every three Americans.
The government’s new response? To attack physicians and pharmacists who prescribe narcotics for pain, even if they do so appropriately, and to ensure that people in pain who truly need narcotics get treated like drug addicts.
It’s a very sad situation, reflecting a deeply misguided view of chronic pain and the people who suffer from it.
Fortunately, those of us using the Integrative--or as the late Dr. Hugh Riordan coined it, “Comprehensive Medicine”--toolkit, have many effective options to help turn the tide of the chronic pain epidemic.
I have found that virtually all pain can be effectively treated, and usually without the need for narcotics. What is needed is education! And it can actually be pretty simple.
Let’s start with a few simple paradigm shifts:
Pain is not the enemy. It is also NOT an outside invader. Rather, like the oil light on a car’s dashboard, pain is simply a healthy component of our body’s monitoring system, telling us that something needs attention. If you put oil in the car, the oil light goes out. Similarly, if you give the body what it needs, the pain goes away.
Years ago, we published a randomized controlled trial using fibromyalgia as a model, and showed that 91% of patients improved with an average 90% improvement in quality of life, and an ~50% drop in pain at 3 months (p<.0001 vs placebo), using a comprehensive approach we call the SHINE Protocol.
SHINE stands for Sleep, Hormones, Infections, Nutrition, Exercise as able. (Teitelbaum J, Weiss A, et al. Journal of Chronic Fatigue Syndrome . 2001, 8(2).)
We have enough research to give us a fair idea of what each kind of pain is “asking for.” But sadly, the conventional medical approach has been to cover the oil light, or perhaps even smash it. We’ve seen how that story ends.
Comprehensive Medicine is most effective: This means addressing:
- Biochemistry, with nutrition, herbals, and even judicious use of medications.
- Biophysics, with acupuncture and Frequency Specific Microcurrent. The latter can be very effective, and is a tool easily added to one’s practice.
- Food allergies and other sensitivities. I have found NAET (Nambudripad’s Allergy Elimination Techniques) to be helpful for treatment resistant cases.
- Structural issues, with Chiropractic, Osteopathy, Massage, Exercise and stretching, etc.
- Mind- Body issues. Helping patients say “No” to things that feel bad or are inauthentic to who they really are, helping them express themselves honestly, and avoid being guided by mental chatter and programming received from others, are important aspects of managing chronic pain syndromes.
Collaboration is Key
Few practitioners can do all of this alone. That means you can best serve your chronic pain patients—and also build your practice--by developing healthy, mutually respectful cross referral patterns with practitioners who provide the treatments and services that you do not.
For example, as an internist with expertise in pain relief via biochemistry, I began working with two excellent chiropractors (one a “cruncher,” and the other, a “non-cruncher”) who were expert in addressing the physical and structural aspects of pain.
It was wonderful to have other options when I hit a wall. The patients I referred to my DC colleagues often got better, and told their friends what a wonderful doc I was. One of the chiropractors moved next door to my office, and soon about 20% of each of our practices came from the other’s referrals—a Win-Win for everyone!
I’ve learned a lot about the treatment of pain over the years, and I’ve distilled this information and know-how into a simple online tool. It’s a free iPhone and Android app called, Cures A-Z, and it’s proving to be quite popular with the public and practitioners alike.
The app provides detailed information on how to treat each kind of pain (and numerous other conditions) using Comprehensive Medicine. Here are some practice pearls drawn from Cures A-Z, that will help you help your patients struggling with common pain problems.
This condition represents an “energy crisis,” where a person essentially blows a fuse (the hypothalamic/pituitary axis, which controls sleep, hormones, and autonomic function). Then, the low energy state causes the muscles to get locked in the shortened position (a key point—this is why muscles get tight, not loose, after an aggressive workout!). After months of tightening, the individual experiences chronic muscle (myofascial) pain.
This, like other types of chronic pain, then triggers Central Sensitization, aka “Brain Pain” as well as nerve pain.
The key to resolving fibromyalgia is to address the underlying energy crisis. A free tool called the Energy Analysis Program can analyze a person’s energy dynamics with a 10-minute quiz, and will even assess pertinent lab results, if available. The tool can help you identify the main issues affecting someone’s energy, and then tailor a program to optimize vitality.
The SHINE protocol provides a multifaceted approach to restoring energy. Once that is accomplished, you can add structural therapies to stretch and release the muscles. Frequency Specific Microcurrent can treat any residual nerve or myofascial pain.
Keep the psychosocial and emotional aspects in mind, too: Learning to say “No” to things that feel bad, keeps a person from blowing a fuse again.
Most migraines can be prevented! The Cures A-Z app gives a detailed approach that begins with Riboflavin (Vitamin B2), 400 mg per day, for 6 weeks. There are data showing that this alone can decrease frequency of migraines by 67-69% (Schoenen J, et al. Neurology.1998; 50 (2): 466-70). This has been known for decades!
Add magnesium, 200 mg per day, and Vitamin B12 at 500 mcg per day, and most people will find their migraine frequency decreased by over 80%, after 6 weeks. At that point, I typically put patients on a high potency multivitamin (e.g.- Daily Energy Enfusion vitamin powder by Integrative Therapeutics), which maintains the effect.
Magnesium can be a valuable ally for quick resolution of acute migraines. Roughly 85% can be eliminated within 45 minutes by simply giving 1 g of IV magnesium over 15 minutes. (Demirkaya, S et al. Headache. 2001; 41:171-177). This makes it the most effective acute migraine treatment, short of decapitation!
For the small subset with persistent migraines, think about estrogen/progesterone imbalances, especially for patients who typically get migraines around their menses and ovulation. Also consider food allergies, which can play a triggering role.
Botanical combinations have consistently been found to be more effective than the NSAID, Celexicob, in repeated head-to-head studies, and with fewer side-effects.
The herbal combos indicated below can be safely combined with each other and with any prescription pain med. I typically give each of these botanicals 6 weeks to work:
- Curaphen This formula combines a highly absorbable form of curcumin (BCM-95) with Boswellia (commonly called Frankincense), and DL-phenylalanine. I usually recommend the Extra Strength form and tell patients to take 1-2 tabs, thrice daily. For topical relief, I also recommend EuroMedica’s TraumaPlant comfrey cream.
- EndFatigue Pain Formula (Integrative Therapeutics): This combination, which I helped to formulate, synergizes the effects of three important pain-relieving, anti-inflammatory herbs: Sweet Cherry (Prunus avium), Frankincense (Boswellia serrata), and White Willow (Salix Alba). Typically, patients take one tablet thrice daily, but the dose can safely be increased to two tablets three times per day.
- Glucosamine Sulfate: I usually recommend patients take 750 mg twice daily.
Here are a few general pain management rules I’ve learned over the years:
1) Most pain has a muscle/myofascial component, even if it is secondary. Always look for it.
2) If the pain is chronic, widespread, and associated with insomnia, think “Fibromyalgia.” This is common secondary to other autoimmune conditions (e.g., rheumatoid arthritis and lupus), which are typically treated with escalating and useless doses of toxic steroids and chemotherapeutic drugs. Simply treating the fibromyalgia is often more effective.
3) Chronic pain will usually trigger Brain Pain (Central Sensitization). This can be decreased considerably with Low Dose Naltrexone protocols (www.LowDoseNaltrexone.org ), Minocycline, or ACE Inhibitors. That said, these drug therapies are only part of the equation. It is equally important to identify and address the pain triggers.
Though just a start, these simple tips can help you get most people pain free—now!
Jacob Teitelbaum, MD, is one of the most frequently quoted integrative medical authorities in the world. He is the author of the best-selling, From Fatigued to Fantastic!, Pain Free, 1,2,3!, the Beat Sugar Addiction Now! series, Real Cause Real Cure, The Fatigue and Fibromyalgia Solution, and the popular free Smart Phone app Cures A-Z. He is the lead author of 4 studies on effective treatment for fibromyalgia and chronic fatigue syndrome, and a study on effective treatment of autism using NAET. Learn more at Vitality101.com.