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:
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.
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.
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.
In April 2010 a new list of Chronic Pain Guidelines was published by The American Society of Anesthesiologists.
The new recommendations are designed to help clinicians who treat pain. The objectives are to optimize pain control, enhance physical and psychological well-being, and minimize adverse outcomes.
The new guidelines appeared in the April issue of Anesthesiology. The recommendations apply to patients with chronic noncancer,
neuropathic, somatic, or visceral pain. The taskforce focused on interventional diagnostic procedures including diagnostic joint block, nerve block, and neuraxial opioid trials.
The key to chronic pain is creating an individualized treatment plan focused on optimizing the risk-to-benefit ratio. Treatment should progress from a lesser to greater degree of invasiveness.
The new guidelines advocate for multimodal interventions for patients with chronic pain. The taskforce suggests that a long-term approach that includes periodic follow-up evaluations should be developed and implemented as part of the overall treatment strategy. In addition, when available, multidisciplinary programs may be used.
The new guidelines detail
* ablative techniques,
* botulinum toxin,
* electrical nerve stimulation,
* epidural steroids,
* intrathecal drug therapies,
* minimally invasive spinal procedures,
* pharmacologic management,
* physical therapy,
* psychological treatment, and
* trigger point injections.
Drugs for chronic pain include anticonvulsants, antidepressants, benzodiazepines, N-methyl-D-aspartate receptor antagonists,
nonsterioidal anti-inflammatories, opioid therapy, skeletal muscle relaxants, and topical agents. The taskforce discusses each in detail and recommends strategies for monitoring and managing adverse effects and patient compliance.
Dr. Tucker comment: Over the years my practice has evolved to treating chronic pain patients. I work with my clients medical doctors to design personalized programs. My current approach to chronic pain is to use warm laser, physical therapy, breath and body awareness, gentle corrective exercises, natural topical agents, and nutritional therapy. The exercise rehabilitation approach I use is unique in that I blend several techniques to create a treatment plan that gives clients responsibility for participating in recovery. Clients particularly like the detailed nutritional information I provide.