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Management of Chronic Pain

by Jurriaan Plesman BA(Psych), Post Grad Dip Clin Nutr.

Always discuss any suggested herbal remedies with your doctor as they may cause side effects to certain medications.

Pain is a natural signal that there is something wrong in the body that needs attention. The first step is a thorough check-up with a doctor to find out the cause of pain. Sometimes it is a group of nerves that has been damaged in the past and that continues to send pain signals to the brain. Medical terms used for pain:

    •    Neuralgia (pain following the course of a nerve as in shingles)
    •    Neuropathic pain
    •    Peripheral Neuropathy (Disease of nerves outside the central nervous system)
    •    Peripheral neuritis (inflammation of nerves)
    •    Sciatica (pain felt down the back and outer side of leg and foot)
    •    Lower back pain
    •    Trigeminal neuralgia (pain emanating from one or more branches of trigeminal nerves in the face)
    •    Facial pain

Causes of pain;

    •    crushing of nerves
    •    severing
    •    burning
    •    blunt trauma
    •    lacerations
    •    amputations
    •    mastectomy (surgical removal of breast)
    •    slipped disc
    •    misaligned vertebra
    •    muscle spasm
    •    cancerous growth

Other causes:

    •    Heavy metals such as mercury, lead can kill nerves
    •    Alcoholism can kill nerves
    •    persistent high blood pressure
    •    persistent high blood sugar levels
    •    “rewiring” of brain following long-term pain

Drug Treatments: Aspirin, ibuprofen, naproxen (Naprosyn, Nycopren, Synflex) ketorofen, (Orudis). indometacen (Imbrilon, Indocid, Indomax, Rimacid), sulindac (Clinoril). Function: decrease production of pain causing chemicals. Side effects: gastrointestinal bleeding, fluid retention, kidney damage. liver damage, allergic reactions. Others: Paracetamol; Function: blocks production of pain causing chemicals

Narcotics: Codeine, codeine and paracetamol (Kapake, Solpadol, Tylex) oxycodone, Endone, morphine, hydromorphone hydrochloride (Palladone), pentazone (Fortral). Functions: bind to receptors in the brain that control pain, turning them off. Side effects: possible dependency and addiction (but see next paragraph), impaired breathing (excessive doses can stop breathing), nausea, constipation. See also new pain killer drugs called Resiniferatoxin or RTX originally derived from a plant called Euphorbia resinefera.

Are Painkillers Addictive?

Painkillers are not necessarily addictive, just as alcohol/marijuana are not necessarily addictive: You need an addictive personality to become addicted to either alcohol or pain killers. When you used them to reduce pain, analgesic drugs are not addictive in themselves. They can improve the quality of life for chronic pain suffers, Prescription Painkiller Addiction: 7 Myths by Miranda Hitti at WebMD

People using painkillers for pain may graduate to addiction if they use these medications for other purposes than pain reduction. Signs of addictive behavior are unauthorized steady increase in dosages over time and taken for emotional purposes not related to pain experiences. People likely to be to become addicted to painkillers may be scoring high on the NBI. (Drug addicts may fake the NBI by scoring noticeably low).

Emotional disturbances may be caused by any form of what is traditionally seen as a mental illness, such as anxiety or depression possibly triggered by a metabolic imbalance, such hypoglycemia or diabetes, nutritional deficiencies or any of the other silent diseases associated with mood disorders.

However, long-term use of pain killers may affect liver function, hence they should be under the strict supervision of the medical profession.  See also Pain at: Research Evidence and here.

Tricyclic Antidepressants Amitriptyline (Domical, Elavil, Lentizol, Tryptizol), nortryptyline (Allegron). doxepin (Sinequan). Function: modify the processing of pain signals in the brain to decrease hypersensitivity to them. Side effects: dry mouth, constipation, lethargy, heart problems.

Anticonvulsants Phenytoin (Epanutin), carbamazepine (Tegretol), gabapentin (Neurontin), clonazepam (Rivotril), Function: stabilize nerve cell membranes to prevent abnormal electrical discharges (seizure-like activity). Side effects: Lethargy, mental grogginess, reduced white blood cell count, liver damage.

HERBAL REMEDIES;

Cayenne (Capsicum annum) Capsaicin, an extract from cayenne can reduce long-term pain in arthritis, shingles, trigeminal neuralgia and diabetic neuropathy. It appears to reduce a Substance P, a chemical that transmit pain signals. It may take several weeks of regular use. It does not produce tolerance. It is available in the form of cream in concentrations of 0.025% to 0.075% to be applied four to six times daily. It can cause burning sensations considered to be harmless. It is best to start with very small amounts and gradually increasing the amount. Some doctors recommend applying lignocaine cream (a prescription topical anaesthetic), and then applying the cayenne cream. See also: Cayenne and PubMed  2.

St John’s Wort (Hypericum perforatum) This is the well-known antidepressant herb. It is not an analgesic, but it helps to relax the nervous system. This increases the threshold for pain sensation. It also relaxes muscle cramps and spasms that accompany pain. Dosage: 900 to 1,200 milligrams of standardized extract per day. Side effects: may increase sensitivity to sun exposure, especially in high doses. Use sunscreen, especially if you are prone to sunburn. Don’t mix with prescribed AD medications or blood thinning medications. See also: St John’s Wort and  Scholarly Articles and for polyneuropathy.

Corydalis (Corydalis yanhusuo) This Chinese herb has been used for its pain-relieving properties as in neuralgia, menstrual cramps, and gastrointestinal spasms. It is comparable to codeine and other drugs in the opium family, by modifying the perception of pain by specific centers in the brain. Dosage: 1/2 teaspoon of powdered herb two to three times a day. Side effects: fatigue, constipation, and occasional headache, it may be addictive, should not be taken during pregnancy, discuss with a doctor. See also: Corydalis and here and here and PubMed 3.

Jamaican Dogwood (Piscidia pisipula) The active ingredients is in the bark of this Central American tree. It acts in a similar fashion as aspirin in that it blocks the enzyme that produces inflammatory and pain-causing chemicals called prostaglandins. It is also mildly relaxing and has anxiety relieving properties. Dosage: one or two 500 milligram capsules of powdered extract every four to six hours as needed. (See: White, Dr L) See also:   Jamaican Dogwood and see Google Scholar.

White Willow Bark:  Containing aspirin-like compounds, this herb was found to be as effective as conventional medicine in lessening pain among people with mild to fairly severe knee and hip problems in a 2008 study. White willow bark may also alleviate acute back pain, joint pain, and osteoarthritis. See:  PubMed 8

Boswellia: Sourced from a resin found in the bark of frankincense trees, Boswellia has been shown to thwart chemical reactions involved in inflammation. Practitioners of Ayurvedic medicine have long used Boswellia to treat arthritis; the herb may also benefit people with inflammatory bowel disease. It can cause heart burn and gastritis. See PubMed 1

Devil’s Claw: Traditionally used to treat rheumatoid arthritis, devil’s claw may also soothe pain resulting from osteoarthritis, tendonitis, and back and neck troubles. In a 2007 study of 259 people with rheumatic conditions, researchers found that 60% of study members either reduced or stopped their pain medication after eight weeks of taking devil’s claw. The herb also appeared to improve the participants’ quality of life. and see PubMed 5

Bromelain: An enzyme extracted from pineapple stems, bromelain reduces levels of prostaglandins, which are hormones that induce inflammation. Bromelain may benefit people with arthritis and conditions marked by musculoskeletal tension (such as TMJ syndrome), as well as those suffering trauma-related inflammation. What’s more, the enzyme may promote healing in muscles and connective tissues and see PubMed 2.

Curcumin: Another ayurvedic remedy known to tame arthritis pain, curcumin is a compound found in the curry spice turmeric. In an animal-based study published in 2007, scientists discovered that curcumin can overpower pro-inflammatory proteins called cytokines. The compound may also help decrease pain associated with autoimmune disorders and tendonitis and see PubMed 4.

Look up an anti-inflammatory  product called AINET containing, Devil’s Claw, Turmeric, and Bromelain.

Also look up Celadrin cream to relieve pain.

Ginger: While sipping ginger tea can help relieve cold-related congestion, supplementing with this warming herb may deliver long-lasting health effects. Research indicates that ginger may calm arthritis pain, possibly by lowering your prostaglandin levels. One 2005 study even suggests that ginger could reduce pain and inflammation more effectively than non-steroidal anti-inflammatory drugs (such as aspirin) and see PubMed 6.

Other remedies:

    •    Try out Acupuncture.
    •    Physical therapy: rehabilitative exercises, deep heat, ultrasound, cold pack, and manipulation
    •    Stress Management techniques: treatment for Anxiety Attacks –> Hypoglycemic diet
    •    Meditation, Yoga, biofeedback
    •    Join classes in the above

DL-Phenylalanine (DLPA); This is a special form of phenylalanine, which is a natural essential amino acid and a neurotransmitter. Phenylalanine is the natural precursor of the neurotransmitters dopamine and norepinephrine, which explains its antidepressant effects. As we age an enzyme – monamine oxidase – degrades these feel-good neurotransmitters, and so we tend to be more depressed. DL-Phenylalanine is a mixture of equal parts of D (synthetic) and L (natural) phenylalanine. By producing morphine-like hormones called endorphins, it prolongs the body’s own pain killing chemicals in response to injury, accident, and disease. Enzymes continually destroy endorphins, but DL-phenylalanine inhibits these enzymes, allowing the pain-killing endorphins to do their job. People with chronic pain appear to have low levels of endorphins in their blood and spinal fluid. The effects of DLPA often equal or exceed that of morphine and other opiate derivatives, but DLPA is non-addictive, pain relief becomes more effective over time without the development of tolerance, and it is also an antidepressant. It is non-toxic and can be combined with other medication or therapy without adverse interaction. Dosage: 100 to 1,500 milligrams per day or as per bottle. Possible side effects: Increased blood pressure. Not recommended during pregnancy, Should be avoided by phenylketonurics, a disease characterised by the absence of phenylalanine hydroxylase, thus accumulating phenylalanine in the body. (Pearson, 185-6) (Mindell, 100-1) PubMed Articles.

Olive leaves; (Olea europaea) (Medical uses: Antipruritic, antiseptic, astringent, cholagogue, demulcent, emollient, febrifuge, hypoglycemic, laxative, sedative). An infusion (a tea made) of the leaves of the olive tree has also been used to relieve pain from Osteoarthritis. Please note that olive leaves are also hypoglycemic and are beneficial to people suffering from diabetes and/or insulin resistance. There are many plants with analgesic properties (about 244) Some of these herbs can be found at Plants For a Future here and  Pain relieving herbs and see PubMed 8.

Resveratrol, a polyphenol found in red wine, also may have an ability to preserve the pain-relieving effect of morphine in rats that are morphine tolerant, a study suggests.  Medscape Nov 20, 2012, and see PubMed 7.

Essential Fatty Acids These consist of omega-3 and omega-6 fatty acids. They are essential because the body MUST obtain them form food such flaxseed oil, walnuts. Omega-6 is ultimately converted to dihomo-gamma linolenic acid (DGLA) and then to prostaglandin series E1 (PGE1), which is anti-inflammatory substances. Omega-3 is converted to ecosapentaenoic (EPA) and docosahexaenoic acid (DHA) which form prostaglandins series E3 (PGE3). These chemicals inhibit inflammatory reactions in such degenerative diseases as arthritis. Because some people (as in hypoglycemia and diabetes) may lack the first enzyme – delta-6-desaturase – they cannot produce the anti-inflammatory substances and they suffer constant pain. To bypass the faulty enzyme people should take Evening Primrose Oil or Fish oil and thus produce their own anti-inflammatory substances. They can replace NSAIDs without any side effects. PubMed Articles.

Anxiety and Obsessive Compulsive Disorder People suffering from anxiety attacks and OCD tend to have a heightened sensitivity to pain. These illnesses can be treated nutritionally as explained at Beating Anxiety and Phobias And OCD and Hypoglycemia

Please discuss this article with your health care worker, doctor or nutritional doctor or therapist.

References Pearson, D. & Shaw,(1982), LIFE EXTENSION; A Practical Approach, Warner Books, NY Earl Mindell (1979), THE VITAMIN BIBLE, Guild Publishing, London

White, Dr Linda & Foster, S (2000), THE HERBAL DRUGSTORE, The Best Natural Alternatives to Over-The-Counter and Prescription Medicines! Rodale Inc. Pp 429-433)

Other references: Index to Specific topics and Research

Pain at Index

GreenInfo on Pain Management

For some herbals or Pain Relief.

References to Mood Disorders and Nutrition

Pain Management at The management of persistent pain by MJA Management Acute Pain – A  Guide for Patients by ANZCoA

Pain Management by Better Health

Chronic Pain Management and anxiety

Easing Pain Rooted in Nervous System at Mercola.com

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