Management of Chronic Pain

Jurriaan Plesman BA(Psych), Post Grad Dip Clin Nutrr

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, morphine, hydromorphone hydrochloride (Palladone), pentazone (Fortral). Functions: bind to receptors in the brain that control pain, turning them off. Side effects: dependency and addiction, impaired breathing (excessive doses can stop breathing), nausea, constipation.

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

St John's Wort (Hypericum perforatum)
This is 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

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 centres 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 doctor.
See also: Corydalis and here and here.

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

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 and L (natural) phenylalanine. By producing morphinelike 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 equals or exceed that of morphine and other opiate derivatives, but DLPA is non-addictive, pain relief becomes more effective over time without 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 chraracterized by absence of phenylalanine hydroxylase, thus accumulating phenylalanine in the body. (Pearson, 185-6) (Mindell, 100-1)

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.

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-gammalinolenic 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 Fishoil and thus produce their own anti-inflammatory substances. They can replace NSAIDs without any side effects.

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

References
Pearson, D. & Shaw,S.(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:
Pain Management at:
http://www.deliciouslivingmag.com/healthnotes/healthnotes.cfm?org=nh&lang=EN&ContentID=1051005

The management of persistent pain by MJA
Managing Acute Pain - A Guide for Patients (PDF -1.12MB)
Pain Management by Better Health
Chronic Pain Management and anxiety
Easing Pain Rooted in Nervous System at Mercola.com

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Last updated 10 Ferbruary 2008