Managing Pain without Drugs Part 3: Physical Management

A significant aspect to physical pain management is improving function. This usually takes the form of physical therapy, massage therapy, or acupuncture to improve the body’s movement and engagement in activities. Opiates have never worked on me so I have always leaned towards natural methods for any chronic pain I have. I know they work based on anecdotal and personal experience.

I hear good things about acupuncture in temporary pain management and a similar process for trigger points called dry needling.   Acupuncture is a ancient eastern medical technique where the practitioner works with the body’s meridians where the energy (chi) flows. Working with various points along the meridians can encourage energy flow, reduce inflammation, and reduce pain.

Movement and the return to exercise will help reset the body’s ability to deal pain and find the new limits of pain. Yoga is particularly good for this. If you can’t find an instructor that does yoga for pain patients try Yoga for Pain Relief or Yoga for Emotional Balance.

 

My personal favorite has become Neuromuscular Massage treatment which focuses on the movement of the body and how the movement aggravates the nerves, causing pain. Change the movement and relax the muscles to reduce the pain. It’s great work and solved my own long term shoulder and leg pain. In Colorado Springs I recommend David at Precision Manual Therapy. He is fabulous. He treats myofascial and neuralgic pain with great success. Three days of one exercise dropped my pain level from a 5 to a 2 and two more weeks eliminated it.

Nutrition is also vital for reducing inflammation and the corresponding pain. Please see my blog entries regarding healing with supplements.

Managing Pain without Drugs Part 2: Mental Aspects of Pain

Pain has a significant mental component to it. Our mental state can increase and decrease our perception of pain and the amount of stress we are in. There have been experiments where people were instructed to push a button to deliver a treatment that would reduce the pain. MRIs showed that indeed there was less pain stimulation but the buttons weren’t hooked up to anything. They had thought their pain away. Pain is often described as 20% physical and 80% emotional. The emotions most often associated with pain include: fear, anxiety, anger, guilt, grief and helplessness.

A psychologist who specializes in pain can help with many of the mental techniques. The psychologist’s focus is to reduce the stress response that contribute to overall tension and affects several types of pain. Cognitive behavioral and Eye Movement Desensitization and Reprocessing (EMDR )programs will change the way you think about pain. Pain tends to be increased when we have negative thoughts associated with it and decrease if we can have a more positive thought pattern. A good pain specialist with teach you a number of techniques to help with pain and overall health support. Self-hypnosis, deep relaxation, and other stress reduction methods are among the most popular.

Cognitive Behavioral Therapy and EMDR help you identify the negative thoughts about your pain and then change them to more functional, positive thoughts. EMDR uses bilateral stimulation to stimulate processing and connect positive thoughts to negative memories and reduce the magnitude of negative emotions. These and other cognitive therapies use the power of the mind to change the way we feel by reducing negative thoughts and worries about the past and future.

Using mindfulness, self-hypnosis and deep muscle relaxation to help you stay in the here and now and create a feeling of well being will reduced the emotional aspects associated with chronic pain.   They reduce your overall stress levels and encourage your body to heal.

New Book on Healthy Eating

One of my favorite health experts is Dr. Mark Hyman. If you haven’t read any of his health information you should. He is a great advocate for natural health solutions and healthy eating.

Check out his blog on drhyman.com.

Or just buy his latest book, Eat Fat Get Thin. He will tell you all the current research on fat and inflammatory issues in our bodies that create pain and weight gain.

Happy reading!

I will get back to my series on pain management shortly.

Managing Pain without Drugs Part 1: Introduction

Chronic pain is an epidemic in this country. So many people have pain from their back, neck, or legs that their activities of daily living are impacted, they can’t work, and they become sedentary leading to a whole other host of diseases. It is common for someone to get opiate pain killers (Vicodin, Percocet, OxyContin, etc) from a doctor’s office to handle the pain but they are not often educated on how these medications work. Since opiates work on the opioid receptors in brain to change the perception of pain, the brain will automatically adjust the opioid receptors in the brain so that more and more of the drug is needed for the same effect. Then viola, you’re addicted.  There is no research that supports the use of opiates for longer than 3 months. Any longer than 3 months and most people report that the more opioid drugs they take the WORSE their pain is.  Often the next step is surgeries that may or may not work.

In my recent study of pain, I was reminded how many different types of pain there are. There is vascular pain, muscular pain (myofascial pain), rheumatic (bone) pain, neuralgic (nerve) pain, and causalgic (autonomic nerves). Each one has a different sensation too. That’s why your doctor asks for detailed description of the pain and things that make it worse and better. The most common cause of chronic pain is myofascial pain which is a dull steady ache. Treatment of chronic pain is essential to maintaining a higher quality of life and preventing depression.

There are also many types of pain treatments that could lessen if not eliminate the use of addictive drugs. From the mental side you have techniques like cognitive behavioral therapy, deep relaxation with or without hypnosis, Eye Movement Desensitization and Reprocessing (EMDR) and other stress reduction techniques. From the physical side you have acupuncture, neuromuscular massage, and transcutaneous electrical nerve stimulation. Not to mention, nutrition can affect your pain levels as well.

An excellent, well rounded resource is Dr. Mel Pohl,’s book, The Pain Antidote. He talks about the causes of pain if you are interested and then many treatment possibilities. Hope this helps in your search for other techniques to manage pain.

Health and Wellness with Supplements Part 7: Turmeric

Turmeric is one of my favorite spices. Now I don’t use it much in cooking but I sure do like it for it’s many health benefits. I have seen Turmeric supplements (or curcumin, the active ingredient) everywhere and have heard of its many benefits. So I decided to dig a little deeper and see what scientific research I could find.

In the little bit of research I read, I found support for fat reduction, improvement of diabetes, mild antidepressant properties, antioxidant and anti-inflammatory. Most people take turmeric for its anti-inflammatory properties. Both my husband and I take it to manage pain associated with exercise and arthritis. I was turned on to turmeric first for my older horse (he’s over 30 now). While he’s retired and hangs out doing nothing but eating, I could tell he was slowing down. He didn’t event chase cats or dogs in the pasture anymore. My friend who is a horse trainer mentioned she put her older horse on turmeric and he started moving around a lot more. So I purchased it in bulk from Missy’s Spice Shop and joined the Turmeric Users Group on Facebook for advice (just search for it and request to join). I started feeding it with a little black pepper and flax seed. The flax and the pepper are supposed to increase bioavailablity of the curcumin. I actually saw the old man running around the field for the first time in a long time! I was sold and we started taking it too.

Turmeric is one of the most researched and widely used spices in the world. A lot of the research is performed in countries like China and India because they spend more time researching natural supplements. In the US, it doesn’t pay to research anything that can’t make you much money or competes with pharmaceuticals.

I found a couple of articles that discussed the health benefits other than anti-inflammatory in turmeric. The most interesting research looked at how turmeric assisted in metabolism support. It was actually shown to prevent adipogenesis (fat development) by increasing fatty acid oxidation. Who can’t use a little help preventing fat accumulation! Another interesting study showed that turmeric supplementation slowed the progression of diabetes with 9 months of treatment by reducing insulin resistance.

Besides helping with metabolic health, there was another study examining the effects of curcumin on the neurotransmitters that affect mental health, especially those involved in depression, serotonin (improves mood) and dopamine (helps motivation and reward response). They found that curcumin increased 5-HTP levels when used with piperine (active ingredient in black pepper). 5-HTP is the precursor to serotonin so the hope is that by increasing the availability of the precursor will improve serotonin levels. Dopamine was less affected by curcumin and only showed minor increases at high doses.

I have found that adding a high quality supplement of curcumin to the diet is extremely helpful.

Resources

Kulkarni, S. Bhutani, M. K., & Bishnoi, M. (2008). Antidepressant activity of curcumin: involvement of serotonin and dopamine system. Psychopharmacology. 435-442. DOI: 10.1007/s00213-008-1300-y

Ejaz, A. Wu, D., Kwan, P., & Meydani, M. (2009). Curcumin inhibits adipogenesis in 3T3-L1 adipocytes and angiogenesis and obesity in C57/BL mice. The Journal of Nutrition. (139). 919-925.

Chuengsmarn, S., Rattanmongkolgul, S., Luechapudiporn, R., Phisalaphong, C. & Jirwatnotai, S. (2012). Curcumin extract for prevention of type 2 diabetes. Diabetes Care (35). 2121-2127.

Health and Wellness with Supplements Part 6: N-acetylcystine

Researching N-acetylcystine (NAC) was the most challenging endeavor yet. I can’t remember where I ran across it as a beneficial supplement but like many others it touts benefits through different possible mechanisms. It is starting to be used in a variety of mental health disorders such as schizophrenia, addiction and bipolar disorder.

Primarily NAC helps maintain and restore glutathione levels. Glutathione is essential for the body to manage oxidative stress. So in this way NAC acts as an antioxidant and anti-inflammatory agent because where you see oxidative stress, you find inflammatory responses.

Some interesting mental health uses include addictions. People with addictions often have glutamatergic abnormalities, which NAC helps with. The exact mechanism is still unknown. In schizophrenia, we see numerous neurotransmitters disrupted, mostly dopamine and glutamate. NAC helps regulate glutamate levels through a glutamate-cystine exchange. If there is inadequate cysteine, not enough glutamate will become available for use. Another interesting use is in Autism. They have found that people with Autism have a deficit in N-acetylcystine and adding this to the diet lowers irritability.

NAC has some challenges as an oral supplement. It is broken down in the digestive tract so it doesn’t get to the brain and it has the potential to cause seizures with overdose. Given these issues, additional research on delivery methods is needed.

Interesting as a supplement but not very promising yet.  Please provide your experiences with this supplement if you have any!

References:

Dean, O. Giorlando, F., Berk, M. (2011). N-acetylcystine in psychiatry: current therapeutic evidence and potential mechanisms of action. Journal of Psychiatry and Neuroscience. 36(2). 78-86. DOI: 10.1503/jpn.100057

Health and Wellness with Supplements Part 5: Coconut Oil

Coconut oil information is everywhere so I won’t repeat of ton of it here. But I have to say that when comparing the common information to the scientific articles, the claims seem well supported.

Coconut oil is a medium chain triglyceride. The medium chain triglycerides are metabolized differently than other fatty acids. They are metabolized differently and immediately head to the liver to be used as energy. This is a benefit because the body will use this as energy along with sugar as the primary energy source. Through this mechanism, coconut oil improves metabolism, reduces appetite, increases ketone production (which reduces siezures), improves cholesterol, and provides brain energy. The brain prefers fat for energy as opposed to sugars, which the muscles love. Combine with conjugated linoleic acid (CLA) for even more fat burning results.

Coconut oil contains 50% lauric acid which when metabolized has multiple health benefits. Lauric acid kills bacteria, viruses, and fungi. It has been show to reduce infections and overgrowth of the fungus, candida. Coconut oil also has shown to provide some anti-inflammatory benefits. Used in combination with other anti-inflammatory agents will produce best results in lowering overall inflammation.

Overall, coconut oil seems to be a great addition to any healthy diet with multiple benefits even if you don’t have any of the problems listed above. Use it for cooking and baking in place of animal or vegetable fats.

References

www.freecoconutrecipies.com

www.authoritynutrition.com

www.organicfacts.net

www.coconutoil.com

Ippagunta, S., Hadnefeldt, TJ., Miner, JL., & Hargrave-Barnes, KM. (2011).           Dietary conjugated linoleic acid induces lipolysis in adipose tissue of coconut oil-fed mice but not soy oil-fed mice. Lipids. 46 (9).

Hargrave, KM. Azain, MJ., Miner, JL. (2005) Dietary coconut oil increases conjugated linoleic acid-induced body fat loss in mice independent of essential fatty acid deficiency. Biochim Biophys Acta. 1737(1). 52-60.

Vysakh, A., Ratheesh, M., … Sibi, PI. (2014). Polyphenolics isolated from virgin coconut oil inhibits adjuvant induced arthritis in rats through antioxidant and anti-inflammatory action. International Immunopharmacology. 20(1). 124-130.

Intahphuak, S., Khonsung, P., Panthong, A. (2010). Anti-inflammatory, analgesic, and antipyretic activities of virgin coconut oil. Pharmacology Biology. 48(2). 151-157.

Health and Wellness with Supplements Series Part 4: Probiotics and Prebiotics

I have been reading a fabulous book about the microbiome by David Perlmutter, MD. He wrote the Grain Brain and his most recent book is The Brain Maker. If you liked my post on gut and psychology then get this book. It is great. He really goes through all the research on how the microbiome that lives in our gut affects our health, mental and otherwise. It was fascinating. It, of course led to more and more things I want to research. Now I want to read the Microbiome Diet and The Gut Balance Revolution by Dr. Mullin.

I put probiotics and prebiotics together since they go hand in hand. These two supplements are essential to a healthy microbiome. Our gut is host to a multitude of bacteria that contribute to our overall health. The gut wall is only one cell thick and not only does it absorb nutrients but it also provides a defense against invading bacteria and toxins. When the microbiome is not in a healthy balance we see a parallel increase in the following issues: inflammatory diseases, overactive allergies, sluggish immune system, Alzheimer’s, changes in pain perception, increases in blood sugar, and increased dementia rates. Reading the Brain Maker will demonstrate a hard to deny connection between the gut microbiome and disease risk.

Besides physical diseases, the gut is responsible for producing several neurotransmitters that affect your overall functioning and brain functioning. GABA (related to anxiety), glutamate, and BDNF (related to depression and anxiety) are produced in the gut. The gut also produces 80-90% of the mood enhancing neurotransmitter, serotonin. Given that the brain and body rely on what goes on in the gut, watching what kind of gas we put in the engine is just part of the over all functioning.

There are two basic categories of microbes in the gut, firmicutes and bacteriodetes. The firmicutes are very efficient microbes and they increase the calories we get from food because they break it down so well. Helpful aren’t they? Well when they are over efficient they contribute to weight gain and blood sugar issues. Making sure you have the right balance in these microbes is the key. Dr. Perlmutter advocates for fermented foods such as yogurt and kefir to help with getting live cultures but you can get good supplements too. They should contain at least 14 different strains of microbes. Most of the beneficial ones are in the lactobacillus and Bifidobacterium families. Several of them have been linked to specific benefits, for example, Bifidobacterium Infantis helps control cortisol, the stress hormone.

So once you get your new microbe pets from either foods or supplements you must keep them happy. Prebiotics do just that by feeding your microbes. Prebiotics are very specific non-digestible fibers that the microbes love. There are studies that show benefits of just taking prebiotics without additional probiotics, feeding what gut bugs you currently have. People that took the prebiotics had better immunity, decreased insulin resistance, better bowel function, anti-inflammatory response, and better absorption of calcium.

Most people need to eat more fiber in general but the type of fiber matters to your microbes. They like soluble fiber such as inulin and oligofructose AKA FOS (found in bananas, onions, garlic, root vegetables, and leeks). You can buy them in supplements as well. Insoluble fiber retains water in the colon and does help digestion but not the way the soluble fiber does.

You can have your microbiome tested to determine what steps you need to take to improve your microbiome health. I have found that a smoothie a day with probiotic kefir and a scoop of soluble fiber supplement are great for the gut. So get yourself some new friends or beef up their party with some new food and experience the health benefits!

References:

Perlmutter, D. (2015) The Brain Maker. Little, Brown, and Company.

Health and Wellness with Supplements Series Part 3: Omega-7

Again I was reading a health magazine or a blog, I can’t remember which. I read so much I forget where I start. They were writing about Omega-7 and how it was better for everyone than Omega-3.

They describe Omega-7 as a fatty acid that works as a hormone with all these health benefits such as weight loss and reduce inflammation. Other claims were that in increases collagen which reduces aging and releases fat, hence the weight loss. Well I had trouble finding human studies that supported these claims but was able to find the animal studies that may show promise. It seems that it does have some health benefits in that it reduces insulin resistance by increasing insulin sensitivity. It increases HDL (good cholesterol) and does not contain any LDL (bad cholesterol). Supposedly there was a Harvard study that demonstrated the fatty acid’s ability to release stored fat in the body but I couldn’t find it.   Michael Roizen, MD has some information about it in his book, This is Your Do Over.

The risks associated with this type of oil are in the production process. If it is unpurified it runs the risk of having too much palmitic acid (bad) instead of being high in palmitoleic acid (good). Natural sources include salmon, anchovies, olive oil, macadamia oil, and sea buckthorn (plant based). You can find it in Barlean’s Heart Remedy and in several other forms. The recommended dose is 210 mg per day in a good quality supplement.

It was rather interesting as I am certainly not an expert on all these fatty acids and their effects on the body. I am looking forward to reading more about it in Michael Smith, MD’s book, The Supplement Pyramid.

Resources

Yang, Z.-H., Miyahara, H., & Hatanaka, A. (2011). Chronic administration of palmitoleic acid reduces insulin resistance and hepatic lipid accumulation in KK-Ay Mice with genetic type 2 diabetes. Lipids in Health and Disease, 10, 120. http://doi.org/10.1186/1476-511X-10-120

Matthan, N. R., Dillard, A., Lecker, J. L., Ip, B., & Lichtenstein, A. H. (2009). Effects of Dietary Palmitoleic Acid on Plasma Lipoprotein Profile and Aortic Cholesterol Accumulation Are Similar to Those of Other Unsaturated Fatty Acids in the F1B Golden Syrian Hamster. The Journal of Nutrition, 139(2), 215–221. http://doi.org/10.3945/jn.108.099804

Health and Wellness with Supplements Part 2: Berberine

I was reading a health magazine and I stumbled across an article on Berberine. Berberine was being touted as the next great thing in weight management so I started a little digging on what it does.

Berberine is an ammonium salt that is derived mostly from plant sources and has been used in Chinese herbal medicines for thousands of years. It claims to be anti-depressant, anti-fungal, anti-biotic, and anti-inflammatory with a positive effect on gut microbes. One article stated that Berberine had the ability to protect against neurodegenerative diseases by decreasing dopamine and increasing noradrenaline and serotonin. Unfortunately, I found little scientific research to back up these claims.

I did find research regarding Berberine’s effect on diabetes. It appears to affect glucose through a number of mechanisms such as reducing the uptake of glucose, lower glucose production in the liver, and prevents insulin resistance by increasing insulin sensitivity.   These effects on glucose levels in the body are presumably how Berberine helps with weight management. It is also supposed to lower the bad LDL cholesterol with a mechanism different than statin drugs.

Sounds like it is pretty beneficial to health, right? Like everything, it does have it’s drawbacks. Side effects include down regulation of necessary enzymes and inhibiting of liver function. It may not be safe to take long term.

Berberine has a ½ life of 3-4 hours, which means it is only effective about that long, necessitating taking it three times per day. The recommended dose is 500 mg, 3 times daily. There are several sources for Berberine. Dr. Julian Whitaker has done a lot of research on Berberine and makes a good product.

References

(2008). Efficacy of Berberine in Patients with type 2 Diabetes. Metabolism. Vol 57 (5). 712-715

Chen, C., Yu, Z., Li, Y, Fincha, J., & Storr, M. (2014). Effects of Berberine in the Gastrointestinal Tract – A Review of Actions and Therapeutic Implications. The American Journal of Chinese Medicine. Vol 42. (5). 1053-1070