All posts in Chronic Pain

Neuropathy

Dr. Tucker: Will you explain what neuropathy is?

Dr. Fedoryk: Neuropathy is a term for a collection of disorders that occurs when nerves of the peripheral nervous system are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. It is characterized by a numbness or painful tingling in the feet, legs, hands and arms. Neuropathy can affect nerves that control muscle movement and those that detect sensations such as coldness or pain. It can also contribute to dementia. And while neuropathy is a common side effect of diabetes, it’s sometimes caused by other factors, such as thyroid problems, chemotherapy, traumatic injuries, infections and exposure to toxins.

Dr. Tucker: Do most Chiropractors treat neuropathy?

Dr. Fedoryk: Most Chiropractors treat the symptoms of neuropathy. Some of the common treatments include manipulation, mobilization, physical therapy modalities like ultrasound, gentle traction and laser. As a specialist in exercise therapy I like to teach my patients things that they can do at home that include specific exercises to improve muscle and joint function(flexibility and mobility). We can also recommend nutritional supplements and discuss diet. It is especially important for these patients to strictly manage blood sugar levels. Once the blood sugar is under control, supplementation with alpha-lipoic acid may offer considerable support. Alpha-lipoic acid (ALA) can rapidly and significantly reduce sensory symptoms and pain of diabetic neuropathy. It is a potent antioxidant that prevents or improves nerve conduction attributes, endoneurial blood flow and nerve Na+ K+ ATPase activity.

Dr. Tucker: How much alpha-lipoic acid do you recommend?

Dr. Fedoryk: Oral supplements of 600 mg per day is a good dose to start with.

Dr. Tucker: Any other comments for readers?

Dr. Fedoryk: Neuropathy is a serious condition that can lead to grave health problems. Don’t try to go it alone. Look for a health care professional or chiropractor who understands the causes of neuropathy along with the possible treatment options for your condition and uses a holistic approach to your condition.

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Type 2 Diabetes & Omega 3’s

Researchers from Harvard took blood samples from about 3,000 subjects and measured omega-3 levels. When the results were compared to diabetic status, they found that higher levels of omega-3 fatty acids — EPH and DHA — were linked to reduced risk of diabetes. 

Rrisk was lowest in those with the highest omega-3 levels. The is because EPA and DHA help your cell membranes manage insulin. Fat tissue contains an abundance of macrophages — a type of white blood cell that fights viruses, bacteria, and other junk that has to be removed from your cells. The macrophages do their work by producing proteins that burn off the junk with inflammation. Too much body fat creates a flood of those proteins, which happen to promote insulin resistance. Chronic inflammation just makes the situation worse. 

When excessive inflammation is reduced, insulin sensitivity improves. 
EPA and DHA are great natural anti-inflammatories.  For the past year or soI have recommended that patient’s take about  400 IU vitamin E with the omega 3’s (mixed tocopherols).

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Anti-Infammatory Diet Updates

 
Eating right and getting regular exercise is the best way to achieve and/or maintain health. I remember hearing Jack LaLanne say, “Diet is King & exercise is Queen, and when you put them both together you build a Kingdom.” 

Inflammation can be low-grade or it can flare up or progress into chronic or acute disease states, including serious autoimmune problems such as arthritis.  Although inflammation should lead to tissue repair and remodeling, when it becomes chronic, it prevents healing and should be viewed as a disease process. 

Nutritional imbalances  (deficiencies and excesses of various nutrients) can cause inflammation .

The Diet
The most important thing is too  eat fresh food, whatever it may be. Avoid packaged or processed foods—the more a food is processed, the less healthful it will be. Consume lots of plants. Plants have antioxidant properties and phytonutrients that quench inflammation.

Vegetables are always at the top of the list. Foods containing omega-3 fatty acids are also anti-inflammatory, including fish and, to a lesser extent, plant foods like flax seeds and walnuts.

Because plant-based foods are among the richest sources for powerful antioxidants and phenolics (including flavonoids) that reduce inflammation, the Mediterranean diet, which emphasizes fresh plant-based foods and phenolic-rich olive oil, has grown in popularity.

I recommend not eating  grains and enjoy high-fiber foods like beans, peas, lentils, oatmeal, nuts, and avocados. Consume more fish, especially salmon, tuna, and other fatty fish that contain those omega-3 fats.

Processed Foods and Meats

Avoid anything with more than a very small amount of sugar or high-fructose corn syrup, white flour products, sodas and sweet drinks, chips, and fried foods of all types, other than lightly stir-fried vegetables.

White flour increases inflammation.

Red meat isn’t necessarily bad. It is what we do to red meat that makes it bad for us by feeding cattle grains such as corn, instead of allowing them to eat the field grasses that they were intended to eat. An alternative to beef is buffalo or bison—these animals are grass-fed and, interestingly, will not eat corn.

For the carnivores among us, the preferred protein solution is buffalo or bison, grass-fed beef, organic chicken, and wild-caught fish, particularly salmon and tuna.

For those with rheumatoid arthritis: Increase EPA intake from marine sources such as oily fish (salmon, sardines, herring, trout, black cod) and oysters, aiming for consuming these foods several times a week, and to reduce dietary sources of arachidonic acid (meat, high-fat milk and cheese products, eggs) as much as possible. Make sure your diet is low in arachidonic acid and supplement with fish oils.

 

In a recent study at Lund University’s Antidiabetic Food Centre in Sweden, 44 healthy, overweight subjects aged 50 to 75 were fed an anti-inflammatory diet consisting of antioxidants, slow-release carbohydrates, omega fatty acids (oily fish), whole grains, probiotics, and viscous dietary fiber. After only four weeks, the results showed LDL cholesterol had dropped by 33 percent, blood lipids by 14 percent, blood pressure by 8 percent, and a risk marker for blood clots by 26 percent. A marker of inflammation in the body was also greatly reduced.5

A diet free of gluten has positive effects on symptoms and clinical signs of inflammatory diseases. Such a diet would be void of arachidonic acid, free of potentially allergenic wheat, dairy, and egg products, and high in plant-based antioxidants and other potentially anti-inflammatory phytonutrients.

What Sodas Bring to the Table
Soda is the beverage of choice for many Americans, especially children. In addition to the high sugar content, which causes blood sugar levels to spike, soda is loaded with phenylalanine and phosphate, which affect pH and deplete bone density. A 2007 study found that “The caramel content of both regular and diet drinks may be a potential source of advanced glycation end products, which may promote insulin resistance and can be proinflammatory.” In addition, “Consumption of one or more soft drinks per day was associated with increased odds of developing metabolic syndrome, obesity, increased waist circumference, higher blood pressure, hypertriglyceridemia, and low high-density lipoprotein cholesterol.”6

Supplement with anti-oxidants – these will stimulate the immune system, decrease platelet aggregation, modify cholesterol metabolism, reduce blood pressure, and possess anti-bacterial and antiviral activity. One of the most effective supplements I use for inflammation is using the UltraInflamX protein powder by Metagenics. This can be taken as 2 scoops with water or fresh juice twice daily. 

References

1. Seaman DR. Clinical nutrition for pain, inflammation, and tissue healing. Self published. 1998.

2. Seaman DR. The diet-induced pro-inflammatory state: A cause of chronic pain and other degenerative diseases. J Manip Physiol Ther. 2002; 25:168-179.

3. Adam O, et al. Anti-inflammatory effects of a low-arachidonic acid diet and fish oil in patients with rheumatoid arthritis. Rheumatol Int 2003 Jan;23(1):27-36.

4. Salas- Salvadó J, et al. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008;168(22):2449-2458.

5. Hafström I, et al. A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens. Rheumatol 2001;40(10):1175-79.

6.Dhingra R, et al. Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Circulation 2007;116:480-88.

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Karel Lewit, MD, said…

“The first treatment is to teach the patient to avoid what harms him.”

When you come in to see me I will perform an evaluation. My job is to help you manage your painful episode, but to also target & contain the risk factors. The number one risk factor for musculoskeletal injury is a previous injury. That means if you have had one painful low back episode you are more likely to have a second episode. My job is to help you lower that risk. The way I help my clients is by teaching them corrective exercises.

Even very small structural changes, if they occur over time, alter the muscles and joints ability to perform properly. Corrective exercise focuses on fixing the cause of pain, instead of just addressing symptoms, it works where many other remedies fall short.

Weakness and tightness are often attacked with isolated and focused strengthening and stretching protocols that don’t work. The majority of musculoskeletal pain syndromes, both acute and chronic, are the result of cumulative microtrauma from stress induced by repeated movements in a specific direction or from sustained misalignments. We need to teach the body how to develop proper movement so you can get out of pain.

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Should I workout first thing in the morning or at night?

Personally I train in the morning. KNOW THIS: first thing in the morning we are up to 19mm taller in the seated position compared to the evening. This is due to the fact that during the night the disks between the vertebra in our spines become more hydrated with fluids. You literally are taller in the morning than when you go to bed at night. During the day we lose this liquid from or disks, in fact 90% of it is lost 60-90 minutes after getting out of bed.

Here’s how you can decide – if you perform a flexion movement of the torso (lean forward; touch fingers to the floor) as you get out of bed in the morning you will put up to 300% more pressure/compression on your disks. This can be disastrous for someone suffering from back problems. UNLESS you bend over and maintain a neutral spine.

Conclusion:

People suffering from back problems should keep there backs in the “neutral spine” position as much as possible and avoid flexion and flexion with rotation of the torso, especially just after getting out of bed. Wait 60 – 90 minutes if you can’t bend without a neutral spine.

90% of back pain comes from muscle weaknesses and imbalances.

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Chronic groin pain

The ‘big three’ when considering ongoing chronic groin pain are:

  • adductor tendinopathy (disease of the tendon, either inflammation or damage to a tendon)
  • osteitis pubis (injury to the cartilaginous joint of the pubic symphysis), and
  • inguinal (sportsman’s) hernia

It is not uncommon to see two or even all three of these conditions co-existing at the same time. However, there still exists a myriad of other conditions that may be affecting the groin area.

The examination needs to focus on the groin, hip & sacroiliac areas. I’ll teach you the best way to improve strength and inhibition of the adductor muscles.

You’ll need to learn proper stretches and strength training . 

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Natural Pain Treatments That Work Best

 Everyone with chronic pain can safely start the Anti-inflammatory diet – no sugar, alcohol, gluten, dairy, preservatives, & chemicals. The minimum supplements I recommend you should be taking are high amounts of EPA/DHA (EPA-DHA 720, three softgels up to three times daily with food), Vitamin D3 (IsoD3 5,000 i.u. daily) and digestive enzymes (Metazyme, one tablet during each meal). Order from Metagenics 800-692-9400.

Additional Supplements for chronic pain:

Quercetin  (Resveratin Plus 12 capsules daily). Order from XYMOGEN 1-800-647-6100

UltraInflamX Plus 360 medical food is a shake that contains Turmeric, Ginger, Rosemary extract, as well as other vitamins and minerals plus 15 grams of protein. Two scoops in water or juice 1 – 2 times daily. Order from Metagenics 800-692-9400

Kaprex is for joint relief and contains hops, iso-alpha acids, Olive Leaf extract and Rosemary Leaf extract. Dose is two softgels three times daily. Order from Metagenics 800-692-9400.

Chronic pain depletes serotonin, GABA and dopamine and other catecholamines (which in turn amplify pain perception); so nutrients that address serotonin (such as Tryptophan, 5HTP, and vitamin D) and dopamine and catecholamines are useful. Trancor and Symphora (4 each per day). Order from Metagenics 800-692-9400

Acute Trauma: Traumeel tablets – take 1 tablet every 15 minutes for 3 hours then cut back to 1 every hour for day 1; 1 every 2 hours on day 2 and 1 3 per day until you come in for a visit. This is easily purchased in health food stores.

Peripheral neuropathy, including diabetic neuropathy:

Take Insinase  which contains Alpha Lipoic Acid 540 mg BID and  Acetyl-L-Carnitine HCL 400 mg BID. Order from Metagenics 800-692-9400.

 Osteoarthrits & RA:

UltraInflamX 360

Kaprex

EPA-DHA 720

Iso D3

Muscle Pain/Fibromyalgia:

Combinations of Magnesium, Calcium, Valerian root and Hops are essential. See my list for chronic pain and include UltraInflamX 360.

Capsaicin (Capsicum frutescens) cream:

Capsaicin is the main component in hot chili peppers (also known as cayenne). Applied to the surface of the skin, it is believed to deplete stores of a substance that contributes to inflammation and pain in arthritis. Several studies have shown that capsaicin cream provided much better pain relief than a placebo but no improvement in joint swelling, grip strength, or function for people with OA. Pain reduction generally begins 3 to 7 days after applying the capsaicin cream to the skin. Apply the cream 4 times daily.

Biofreeze gel:

This is another topical pain reliever used in pain management. This is especially good for sore or strained muscles; shoulderand arm pain; neck, hip, and leg pain; back pain; arthritis pain; painful joints; diabetic neuropathy; tendonitis; and bursitis. Biofreeze needs to be applied 4 times daily.

KinesioTaping procedures are an invaluable aide in everything from chronic edema (swelling) reduction to reduction of muscle tension/pain.

My two favorite modalities for chronic pain continue to be the Deep Muscle Stimulator (DMS) and warm laser.

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Type 2 Diabetes & Statin Use

Last year, University of Glasgow researchers examined the results of 13 large statin trials that included more than 91,000 subjects.  Results showed that for every 255 patients treated with statins for four years, one would develop type 2 diabetes, apparently as a consequence of statin use.

About 20 million people take statins in the U.S. So, one case of type 2 diabetes for every 255 patients comes to well over 78,000 people who will develop or already have developed diabetes as a statin side effect. (And you can forget about the “four years” business because statin users are users-for-life.) 

For high cholesterol, I advocate therapeutic lifestyle changes – diet, nutrition & exercise. This is my first line of therapy for clients with high cholesterol and/or Type 2 Diabetes. First, lets see if we can control it with medical foods such as UltraMeal by Metagenics along with diet and exercise. I see statins being prescribed with resultant cases of muscle damage, kidney damage, liver damage, and cognition damage. We should put a stop to statin overuse, and prescribe the drug when appropriate and for the right reasons.

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Chronic Pain News

Thinking of events as a catastrophe, fear, and being depressed appear to be major predictors of whether acute pain from surgery or injury will morph into chronic pain, researchers reported at the annual meeting of the American Academy of Pain Medicine. For patients with low back pain, “castastrophizing has been found to be seven times more powerful than any other predictor in predicting the transition from acute to chronic pain,” said Sean Mackey, MD, PhD, chief of the pain management division at Stanford University.

Fear also appears to play a role, Mackey commented. “Those who had more fear during an acute low back pain episode were much more likely to ultimately over-predict the amount of pain they had, which ultimately led to significant increase in fear-avoidance behaviors, with subsequent worsening of symptoms, increase in duration of pain, and increase in disability,” he said.

Depression and anxiety also had similar effects. “About 30% to 65% of patients who have chronic pain also have comorbid depression,” Mackey added. 

Being optimistic was linked to better recovery and higher quality of life (Annals of Surgery 2007; 245: 487-494). 

As part of my chronic pain management strategy, I use therapeutic lifestyle changes including diet, nutrition, attitudinal discussions and gentle exercise. The laser modality is still very, very new to most clients and definitely needs to be tried by chronic pain patients.

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