Chronic Pain: A Complex Problem Deserves A Comprehensive Solution

Naturopathic medicine offers a holistic solution to address chronic pain.  Because everyone’s experience and condition is different, treatment plans will vary greatly. Below are some of the factors we address to help you live pain-free:

• Nutrition: Eliminate inflammatory foods, identify food sensitivities, replete nutritional deficiencies.

• Sleep: Pain = Difficulty sleeping = Sleep disruption = More pain. Improved sleep is a side effect of some of the techniques that follow.

• Sedentarism: Studies have repeatedly shown that bed rest for back pain makes it worse. The body needs to get comfortable and feel safe at its normal ranges of motion and the only way to do this is to move.

• Exercise: Is neuroregenerative, brings oxygen and nutrients to your muscles, helps rebuild strength and stamina, reduces stiffness and pain. Often even if you're in pain, gentle walking, swimming, yoga, pilates and stretching can help a great deal.

• Habitual movement: work with a professional to help you figure out how to engage in proper movement patterns.

• Medication: Certain medications can actually promote chronic pain. Proton pump inhibitors can interfere with absorption of many micronutrients most notably magnesium. NSAIDs cause an impairment in gut mucosa that can lead to leaky gut, inflammation and malabsorption.

• Chronic infections: Activate inflammatory pathways in the body and microglia. Many examples from SIBO/SIFO in the gut to viruses such as EBV, CMV and HHV-6 are being researched in widespread myofascial pain syndromes.

• Muscle abnormalities: Incredibly common, often misdiagnosed. Muscles have a very rich nerve supply, and they can be full of myofascial trigger points, which are very, very painful when activated. They also produce a referral pattern, which may be confused for nerve pain. Ways to relieve trigger points include: Intramuscular stimulation (IMS), myofascial release massage, stretching, active release technique (ART), injection techniques into trigger points, acupressure, rolling.

• Stress: Puts the body into a state of fight or flight. Studies have shown that people in chronic pain generally have higher cortisol levels then their healthy counterparts, which contribute to a more sensitized nervous system. Many studies have shown that managing stress is an integral part of eliminating chronic pain.

• Hormones: Make sure thyroid and sex hormone function is optimized.

• Emotions: Depression, anxiety, fear and anger all contribute to feeling more pain. Cognitive behavioural therapy (CBT) helps people identify and develop skills to change negative thoughts and negative thought patterns and behaviors.

• Mindfulness: can be defined as a mental state achieved by focusing your awareness on the present moment, while calmly acknowledging and accepting your feelings, thoughts, and bodily sensations, without judgement. Studies have shown that mindfulness meditation is a neuroregenerative process and is a very effective way to manage chronic pain.

• Your biography becomes your biology: Recognizing deeper emotions and significant life events can be a very valuable part of the healing process.  

• Thoughts and subconscious: it is important to pay attention to how we feel and think about our bodies. We often limit ourselves with our thoughts alone.

• Hypnosis: Many studies have demonstrated consistent decreases of pain in regards to chronic pain problems. Most interventions involve instructions in self-hypnosis. The studies looked at cancer pain, low back pain, arthritic pain, fibromyalgia, TMJ pain, disability related pain and several others.

• Acupuncture: A meta-analysis in 2015 in JAMA looked at studies including 18,000 patients, and concluded that acupuncture is effective at treating chronic pain. It triggers the release of endorphins, the body’s natural pain killers; affects part of the brain that regulates mood; it is also neuroregenerative and stimulates the body’s intrinsic healing capabilities.

The Problem of Chronic Pain

Acute Pain:  We’ve all experienced this before. What happens in the body is the nerve fibres in your finger get activated very quickly (alpha fibres). They transmit the signal to another neuron in the spinal cord that crosses over and goes right up to the relay station in the brain. The signal then goes to the somatosensory cortex and we feel pain. As the tissue damage heals the pain decreases and after about a week there's no more tissue damage and there's no more pain.

With chronic pain something different happens. We may have had some tissue injury – a muscle sprain or strain. While the injury will heal in a few weeks, the pain persists. Months pass and we still have pain, yet the tissue has recovered.

This is in part due to a support cell in the spine called microglia, which have recently been discovered to play a very important function in pain perception. In the previous example when the nerve fibre transmits the signal from the thumb to the spinal cord, there are chemical messengers released that transmit the signal. These substances are taken up by the microglia, and they become activated: stimulating the original nerve cell to release more of this painful chemical. This creates a vicious cycle of positive feedback, where pain is being generated in the spinal cord – not from the damaged tissue.  

This pathway within the spinal cord is an example of neuroplasticity: how the nervous system changes in response to stimuli. People with chronic pain may also have central sensitization: The brain is more primed to feel the pain.

The good news is that we rely on this neuroplasticity to resolve the problem. We can re-train the brain and nerves in the spine to respond normally to stimuli. This means that we have to address all the different factors that over-stimulate the nervous system and activate these microglia to create more pain signals.

What about X-rays/MRIs? Studies have repeatedly shown us that disc degeneration is present in most of the adult population, and you can’t tell who is experiencing pain just by looking at an MRI. The most important predictors of chronic disabling pain are not how abnormal an MRI looks, but relate more to how the person responds to their pain. People with the highest risk factors for developing chronic pain typically have many psychological stressors, including depression and anxiety. A leading spine researcher said:

"the development of chronic disabling low back pain is more about psychology then anatomy".

Luckily, there are tools to help address this neuropsychological problem, including cognitive behavioural therapy and hypnosis.

Medical Hypnosis - A Powerful Tool for Healing and Change

When mentioned in conversation, the topic of hypnosis can give rise to many different reactions and opinions.  From stage hypnosis to past-life regression, it is not uncommon to hear of this technique being used for entertainment purposes.  However, the applications of hypnosis in a medical setting are extensive, and as the research indicates, very effective.  Hypnosis can be defined as an altered state of mind that bypasses the critical conscious mind and allows direct access to the subconscious. It can be used to change deeply rooted beliefs or habits, to ease chronic pain and improve physical healing, to prepare for labour or surgery, for weight loss, smoking cessation, stress management, to improve confidence and self esteem, and for many conditions including, but not limited to: anxiety, depression, eating disorders, insomnia, erectile dysfunction, phobias, headaches, IBS and to lessen side effects of chemotherapy. 

Common Questions

What should I expect from a session?

A deep state of physical and mental relaxation is achieved.  The word “sleep” may be used during the session, but it is simply a cue for the subconscious mind. You will not be asleep, your mind will remain aware, the body is deeply relaxed, and you will remember the entire session.  You may feel that you are unaffected by what is being said, but in fact you will be deeply affected because the subconscious mind is listening and making changes at a very deep level. Many people come out of their first session surprised at how relaxed they feel.

I don’t want to say/do something I’ll regret.  Will I lose control of myself?

You are in control at all times.  The mind will only accept that which goes along with established morals and ethics.  The person in a hypnotic state will respond only to suggestions to which he/she is in agreement. In fact, any suggestions that arouse sincere moral indignation immediately cause the client to come out of hypnosis.

What if I can’t be hypnotized?

90-95% of adults can be hypnotized to some degree.  Some will respond more rapidly than others, and will go into deeper depths of trance.  The main requirements for a successful session are: ability to focus, willingness to use your imagination, and your desire to allow yourself to go into deeper states of calmness.

How many sessions will I need?

This depends on the condition being treated and how well you respond.  Some issues, such as simple phobias, can be resolved in 1-2 sessions, while deep-rooted conditions such as depression may take 8-10 sessions.  The average number of sessions required to work on an issue it 4-6.

Dried plums as treatment for osteoporosis

There has been quite a bit of research in the last few years showing that prunes are effective in both preventing and reversing bone loss in osteoporotic and osteopenic women.  One recent study compared dried plums to dried apples and found that in this population of 160 postmenopausal osteopenic women, both dried apple and dried plums had bone-protective effects, but in the plum group, bone density of the spine and ulna was significantly increased compared to the apple group. 

How do plums do this?  It is thought that they slow down the rate at which bones breakdown (bones are living tissue and are contantly being broken down and rebuilt).  The researchers tested several markers of bone turnover, bone resorption and an inflammatory marker and found them all to be significantly lower than the other group at the 3 and 12 month mark. This study follows many animal studies that confirm that dried plum is able to reverse bone loss in several models of osteoporosis in rats and increase markers of bone formation in humans after only 3 months.

So what does this mean for you?  If you’re at risk of osteoporosis – over 65, family history of an osteoporotic fracture, have a low body weight, low calcium intake, experienced menopause early and others you may want to consider eating about 10 prunes every day.  They are also a great source of fibre, potassium, magnesium, boron and antioxidants.  Don’t forget that this is only one piece of the puzzle – it is important to have a complete look at your diet and lifestyle to see what vitamins and minerals may be lacking and how to optimize your exercise program. 

Echinacea – is your product any good?

If you go to a health food store and look for a cold/flu formula or tea, the most prevalent herb in the combinations will likely be Echinacea.  It is so common in these formulas for good reason – it is a powerful immune modulator (helps cells react faster and more appropriately) and increases white blood cell counts, particularly natural killer cells (the ones we need if we catch the virus that’s going around). Sounds good, doesn’t it?  The problem is that according to human and animal studies, the main constituents responsible for this effect, the alkylamides, may not be present in products on the shelf.  Alkylamides are the only part of Echinacea that make it to the bloodstream, and interact directly with the receptors in the spleen and other immune tissues.  This is one reason why there are so many varied studies showing differing outcomes – there is no standardization for how Echinacea is extracted. 

So what do you need to look for? 

• The alkylamides are most concentrated in the root of the plant.  Leaves and flowers are not as good.

• A few species have higher amounts of alkylamides - E. angustifolia and E. purpurea.

• If available, pick one that is standardized to alkylamides (polysaccharides and caffeic acids are no good). 

• The echinacea should be extracted with a high-alcohol solution – this is very important to get the alkylamides (water and glycerin won’t do it).

• The final test can be done with your tongue – alkylamides are the same compounds that make your tongue tingly and numb.  How tingly?  Ask me for a sample next time you come by the clinic

The best part is that it can be used as both prevention – building up a strong immune response to ward off a full-blow infection, and as treatment when the cold is caught very early. Use the right extract, and you will see the benefits over the cold and flu season.

Millions of Antibiotics Prescribed Unnecessarily to Children

A recent study published in the journal Pediatrics showed that antibiotics are being prescribed to children unnecessarily almost 25% of the time.  The study analyzed a nationally representative sample of almost 65,000 doctors visits by children between 2006 and 2008 and showed that one in every five visits ended with an antibiotic prescription, often a broad-spectrum one. Assuming this trend is representative of the population, this means more than 10 million unnecessary antibiotic prescriptions every year. Most antibiotics were given for respiratory infections – but many respiratory infections do not respond to antibiotics as they are viral in origin (ex. the flu, bronchitis, the common cold) or are a result of immune imbalance (asthma, allergies). 

Unnecessary antibiotic use can pose several problems:  it increases the risk of antibiotic-resistant bacterial infections in our children and in society as a whole, and it destroys all of the beneficial bacteria in the body. The beneficial flora have many, many health-promoting effects in the digestive tract, not to mention in the mouth, vagina, and on the skin. They help us digest our food, manufacture vitamins and essential fatty acids, break down bacterial toxins, convert flavonoids into anti-tumor and anti-inflammatory compounds, keep harmful bacteria and yeast from proliferating and communicate extensively with the immune system, enhancing its function.   

So what to do when you have an infection?  There are many herbal and supplement options that are active against certain bacteria, viruses and yeast, but do not kill our good bacteria.  You can also ask your doctor how clear the diagnosis is and if it would be safe to wait a few days before administering the antibiotic.  In those few days and with the right support, the body can often get an infection under control.  I will often give my patients a treatment plan to begin along with an antibiotic prescription that can be used in a few days if absolutely necessary.  And if you need to take an antibiotic, take a high potency probiotic along with it.  Your gut and immune system will thank you.

Kale chips!!

One of my most favorite things!  Quick, easy, packed with nutrients, and a great way to use up your early autumn kale bounty.  They are highly addictive, so make plenty.

Ingredients:

• kale (2 bunches, curly or lacinato)

• 1 tablespoon of olive oil

• salt to taste

Cut or tear kale into pieces, removing the tough inner stalk.  Toss the kale in olive oil and salt in a large bowl. Place on large baking sheet, trying to distribute kale into one layer.  Bake at 250°F for 40 minutes or until dry and crispy, stirring and flipping several times.  If you’re in a hurry, you can also bake at 350°F for 15-20 minutes – you have to be more careful with stirring, because it your kale can go from crispy to black quite easily!  At higher heat you also lose some nutrients.

Very easy to customize… consider adding granulated garlic, chili powder/hot sauce, lime juice, soy sauce/bragg’s, sesame oil, a touch of maple syrup etc.  Play with combinations to make more addictive kale snacks!

YAY KALE!!

Shedding the light on fall/winter blues

Are you one of many Vancouverites that feel great during the summer, but dread the rainy, dark fall and winter?  For many people, decreased light levels mean lower energy, depression, oversleeping, overeating, and carbohydrate cravings.  It is thought that imbalances in melatonin, cortisol, vitamin D, and various neurotransmitters are responsible for this condition, known as seasonal affective disorder (SAD).

One of my favorite treatments for SAD is light therapy, because it can naturally restore proper pineal gland function (the gland that secretes melatonin), which can in turn improve the daily rhythm of other hormones.  There have been many studies showing the benefit of light therapy, however not all light boxes are created equally. Here are several factors to consider when purchasing a light box:

• It is understood that shorter (bluish) wavelengths of light are more effective – this corresponds to the peak wavelengths of the sun. 

• Check that your product does not emit UV rays or has a UV filter (can be a problem with fluorescent lights).

• Are you sensitive to fluorescent light?  They emit higher levels of radio frequency radiation that some people are quite sensitive to.

• Does your light box have any clinical trials supporting its use?

I generally recommend the Litebook because it is small, portable, rechargeable, easy to use, generally requires short exposures, and is supported by research.  It is also considered a medical device and may be reimbursed by insurance companies.  If light is not enough, consider making an appointment to investigate vitamin D levels, thyroid and adrenal function, and how your diet can help.