Tag Archive for: inflammation

Posts

opioids

The Problem With Opioids for Chronic Pain

/in /by

Nor shall any man’s entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. – Hippocratic Oath

When it comes to the treatment of chronic pain, the medical profession may be in violation of what can be regarded as the first medical ethic: First do no harm.

In 2015, a report – The Role of Opioids in the Treatment of Chronic Pain – published by an independent panel of experts convened by the National Institutes of Health, stated:

    Together, the prevalence of chronic pain and the increasing use of opioids have created a “silent epidemic” of distress, disability, and danger to a large percentage of Americans. The overriding question is: Are we, as a nation, approaching management of chronic pain in the best possible manner that maximizes effectiveness and minimizes harm?

More recently, the Centers for Disease Control in an attempt to address the massive public health crisis identified by the NIH issued a new set of twelve guidelines aimed at reducing the risk of opioid over-prescription and over-use. Although these recommendations are not yet mandated, they are a necessary first step in rethinking how we look at chronic pain treatment and how narcotics are prescribed.

A Brief History of Opioid Medication Use/Misuse

In 1997, the American Academy of Pain Medicine, in an acknowledgment of 1) the severity of the suffering of patients with chronic pain, and 2) the medical profession’s inability to provide many of these patients with acceptable treatment solutions, issued a consensus paper endorsing the use of opioid medications for the treatment of chronic non-cancerous pain. The Academy openly acknowledged that one of the problems with the long-term use of opioids is addiction. In response, the medical profession began making the distinction between addiction and dependence. Addiction was defined as a craving for opioids with the intention of getting “high” consistent with drug-seeking behavior. Dependence, on the other hand, was defined as any situation in which an opioid medication was prescribed for medical reasons, with a dosage sufficient to control the pain, and a significant improvement in the quality of life of the patient. While the intention was noble, the consequences have been quite disastrous.

Since the release of the AAPM’s paper, the sales of prescription opioid medications measured in grams has skyrocketed. Between 1997 and 2007, sales rose by 866% for oxycodone, 525% for fentanyl, 280% for hydrocodone, and 222% for morphine. As reported in Pain Physician in July 2012, “Gram for gram, people in the United States now consume more narcotic medication than any other nation worldwide.” The report goes on to document that over 90% of patients taking opioid pain medications were prescribed these medications for the treatment of chronic pain.

In 2011, approximately 17,000 drug overdose deaths involved prescription opioid medications. The CDC also reported that “In 2007 there were more opioid analgesic deaths than overdoses involving heroin and cocaine combined.” While a significant number of these drug overdose deaths are associated with diversion of the medication to people who were not originally prescribed the medication, 60% of the deaths occurred in patients that were given prescriptions based on the prescription guidelines by medical boards.

Furthermore, significant side-effects from opioid medications include increased risk of birth defects, falls and fractures, addiction, constipation, heart attacks, a decrease in the production of testosterone, and in some cases, hyperalgesia, an actual worsening of the pain.

Deciphering the Problem

While the NIH report and recent CDC guidelines offer a number of important policy and institutional points to address, I believe that the fundamental basis of our problem comes from a lack of understanding of what we’re treating. Acute pain and chronic pain (not associated with ongoing tissue damage such as in cancer) are two very different phenomena in the body.

1. Chronic pain is not a thing but one manifestation of a complex physiological process that frequently impacts many body systems, including sleep, gastrointestinal, psychological, and endocrine. Thus, we must take a whole-person approach in our diagnosis and treatment, which requires looking at multidisciplinary treatment options.

2. Unquestionably the evidence supporting the use of long-term opioids in the treatment of chronic pain is insufficient. We need better studies to help us understand when long-term use is beneficial.

3. Physicians need to be better educated about the diagnosis and treatment of patients suffering from chronic pain. Ultimately the use of long-term opioid medications is an admission of treatment failure. The recent CDC guidelines are a step in the right direction in this regard.

As a pain specialist, I believe there is an important role for opioid medication, but that role should be limited. Opioids should only be prescribed with close monitoring by the diagnosing physician, for the purpose of relieving pain and improving quality of life when all other medical approaches have been exhausted.

First, do no harm. Opioids should be medications of last resort.


Dr. Kaplan explains how treating the symptoms of chronic pain is contributing to a system of mismanagement in this country. He discusses why we must shift the way chronic pain is treated by addressing its root cause – inflammation of the Central Nervous System.

Low_dose_naltrexone

Low-Dose Naltrexone: Can a Higher Dose Lead to Better Results?

/in /by

Q: I have a question about low-dose naltrexone for chronic pain, I understand you use this in your clinic. The standard dose appears to be 4.5 mg in almost all of the information I can find. There are a few chronic pain MDs in the U.S. that seem to be using higher doses with success — a couple say to go up as high as 10 mg while another one is using it up to 4.5 mgs 3xday with great success for those who do not respond to one dose of 4.5 mgs. Do you have any thoughts on this? What I’ve read is that one should not give up on this medication if not getting benefits at 4.5 mgs. Thank you.

A: LDN, or low-dose naltrexone has recently become popular as a method to boost the immune system for a number of conditions, such as HIV, cancer, Crohn’s disease, multiple sclerosis, neurodegenerative disorders, chronic neuropathic pain, fibromyalgia, and other autoimmune diseases.

How Low-Dose Naltrexone Works

LDN works by temporarily blocking endorphins in the brain which causes a reciprocal boost in natural endorphins, and by down-regulating the inflammatory effect of immune cells called microglia in the brain that get turned on in certain situations. At a low dose, the side effects are minimal. Higher doses can cause sleep disturbances and may cause elevation of liver enzymes. Although I don’t usually go higher than 4.5 mg, most likely the doses you are talking about – 10-14 mg – are far from the 50 mg or higher dose that is used to block opioid overdose, and are therefore are probably safe. I don’t see any research on the efficacy of using higher doses, however.

–Dr. Lisa Lilienfield

 

reading labels, hidden food allergies

Are Hidden Food Allergies Making You Miserable?

/in , /by

How to figure out if food allergies are causing inflammation—and making you hurt

Sure you should eat that?

When it comes to chronic pain and depression, there’s no reason why you “just have to put up with it.” We now know that these states—and a host of conditions that accompany them—are caused by the inflammation of microglia in the brain. The microglia (your brain’s immune cells) turn on inflammation, and when they reach a tipping point, they become hyper-reactive, after which the slightest assault can set them off, triggering system-wide inflammation that can be difficult to stop.

This means that we have more reason than ever to eat well, exercise, meditate and make sure our bodies have the nutrients they need—avoiding the foods that are the likely culprits for allergies and sensitivities.

Here’s how to figure out if your diet is what’s causing your inflammation:

Try a low-inflammation diet

For 6 weeks eat only brown rice, fish, chicken, eggs, fresh fruits, and vegetables. This diet eliminates most of the foods people are allergic or sensitive to, such as wheat, soy, and milk products. Organic, grass-fed beef can be included in the diet as well.

Start an “eating and aftereffects” diary

When you’re trying a low-inflammation diet, it’s important to keep a food diary. In addition to writing down what you eat and when you eat it, you will also check back in with yourself throughout the day to see how the food made you feel. Allergies and food sensitivities may not show up for hours after you eat the offending food or spice, but if you are alert, you’ll increase the odds of making connections between the food and your response. Be sure to write down exactly how you feel at the beginning of the diet, so you can make an accurate comparison in 6 weeks.

Avoid stimulants

This means no caffeinated coffee, tea, or alcohol. It also means no NSAIDS to inflame your gut. If you typically drink more than 2 cups of coffee a day, it might be best to cut your consumption in half every few days until you are coffee-free. If you normally drink 6 cups, cut it down to 3 cups for a few days, then 1.5 cups for a few days. After a week or two easing off caffeine, you should be able to go without coffee and not get a headache.

Questions? Give Us a Call!

703-532-4892 x2

Evaluate your process

Rate the following factors in your diary: Energy Level, Ability to Focus and Concentrate, General Pain Level, and Specific Pain Level. Complete the diary at the same time every day. Feel free to add comments about your sleep, digestion, and any other aspect of your health or mood. Make note of any unusual life events.

Add back foods

After 6 weeks, gradually add back new categories of food, one at a time, one week at a time. A good food to start with is dairy. Pay close attention to whether bringing dairy back causes gas, bloating, or other reactions. The next week, add soy products, such as tofu, soybeans, miso, and soy sauce. The following week, add wheat, such as bread, cereal, pasta, and canned or frozen foods with wheat fillers.

You will be the best judge of whether or not these foods have a negative effect on your energy level, your mood, or your ability to concentrate.

Signs of allergies

If you lose as much as 5 pounds or more the first week, it may be a sign that you’ve been eating foods you’re allergic to and your tissues have been swollen. Other signs of allergies include migraines, numbness in the arms or legs, inability to focus, poor concentration, fatigue, depression, brain fog, headaches, mood fluctuations, itchiness, sneezing, gas, diarrhea, sinus congestion, and skin rashes.

Delayed reactions are not uncommon. You may get a headache in the morning from something you ate the night before. This is why it’s important to add foods back into your diet very slowly.

Prepare for the toughest part

It’s likely that the first 2 weeks will be the hardest. Old habits can be tough to change. The next difficult part comes at the end, after the 6 weeks, when you are feeling better but starting to add in new foods. It can be frustrating to learn that you are having a negative reaction to one of your favorite foods. Maybe you add gluten in for a few days, but soon realize you’re experiencing bloating, congestion, and brain fog. Many people will ask: “Does this mean I can’t eat wheat anymore?!” The truth is: You can eat whatever you want. It depends on whether or not you’re willing to accept the consequences.

Published date: Apr 10, 2014 / This article was first seen on Prevention.com. Read more about the new connection between inflammation and chronic pain — and what scientists are doing about it — with Is Depression Ever Just Depression?

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

 

8 Reasons Your Pain Won’t Go Away

/in , /by

by Julia Westbrook | As first seen on RodaleNews.com.

What you don’t know is hurting you.

Gary Kaplan, DO, author of Total Recovery and founder of The Kaplan Center for Integrative Medicine, recently held “office hours” during a Rodale News Facebook chat. One of only a handful of physicians in the country who is board-certified in Family Medicine and Pain Medicine, Dr. Kaplan was able to apply his pioneering perspective to help answer one of the most difficult questions plaguing our country: What is causing my pain? If you weren’t able to make the chat, we’ve pulled out 8 key takeaways to consider when you’re trying to figure out why your pain just won’t go away.

#1: Inflammation, part of the normal repair process, may have gone awry.

Cytokines are chemical messengers secreted by the body. They have effects ranging from inciting nerve repair to causing inflammation. In the case of chronic pain, we know that the microglia, which are the innate immune system in the central nervous system, are “stuck” in a mode where they continue to excrete predominantly inflammatory cytokines. Under normal circumstances, microglia will shift from producing inflammatory cytokines to making anti-inflammatory cytokines and call in other cells to initiate the normal repair process.

Balance is restored by eliminating all of the factors that caused the microglia to get turned on in the inflammatory state and then doing things such as meditation, exercise, getting adequate sleep, and using things such as low-dose naltrexone (LDN) and turmeric to get the microglia to go back to their resting state.

#2: Allergies can make your pain worse.

Anything that incites an inflammatory response in the body has the potential to spill over into the brain and worsen the inflammation in the central nervous system, as with fibromyalgia. The allergies are not the cause of the fibro, but something that is further aggravating it.

#3: Your diet can cause inflammation.

I would start by thoroughly looking at your diet and make sure there is nothing still in your diet causing inflammation. I saw one woman who is a vegan, and it turned out she was allergic to blueberries. For ongoing inflammation in the brain, turmeric may be helpful.

Questions? Give Us a Call!

703-532-4892 x2

#4: Your fatigue may be a symptom. Don’t ignore it.

Sleep is not a thing, but rather a series of different brain waves divided into stages 2, 3, 4, and REM. People who are deficient in 3 to 4 sleep will present with chronic pain. If you have sleep apnea, where you stop breathing at night, it can cause chronic pain. If you have restless leg syndrome, it can also cause chronic pain. A proper evaluation of the quality and amount of sleep is necessary for anyone suffering from chronic pain and depression.

#5: A migraine problem isn’t just in your head–it’s in your nervous system.

Dehydration, alcohol, bright lights are all triggers that can cause migraines. The underlying cause of the migraine is an irritated nervous system. The nervous system is irritated because of an underlying inflammatory condition in the brain. The key to preventing migraines is to identify what it is that’s causing the inflammation. I would start with an anti-inflammatory diet of rice, fish, chicken, fresh fruits, and vegetables.

#6: Overlapping problems can come from the same source.

  • Migraines and depression: Brain inflammation
    The basis of both migraines and depression is inflammation in the brain. I address this at length in my book, Total Recovery. Yes, the two are related and the cause of the inflammation needs to be identified.
  • Chronic pain and weight loss problems: Gut imbalance
    One of the reasons that you may not be able to lose weight might be related to either food allergies or sensitivities or mold toxicity. We know that the composition of the bacteria in your gut has a very significant effect on your ability to lose or maintain weight. Skinny people have different gut flora than people who are overweight. If you have other symptoms, it’s very likely you have a chronic inflammatory condition but the cause has not been discovered or addressed.

#7: The underlying root cause may still need to be identified.

  • Arthritis (…which isn’t always arthritis)
    Sometimes arthritis in knees and joints can be from Lyme disease, sometimes from rheumatoid arthritis, and sometimes from tendinitis. It can also be associated with food allergies and food sensitivities. The first issue is getting a clear diagnosis.
  • Complex regional pain syndrome
    Also known as CRPS, it is a horrific pain condition. I see a number of patients who suffer from CRPS, and the solution can, unfortunately, be elusive. Again, it’s important to try and understand what it is that has caused the nervous system to be so hyper-reactive. Get evaluated for Lyme disease and its co-infections, celiac disease, gluten intolerance, and neurotoxins associated with mold, along with a number of other conditions that I address in my book. I am familiar with Calmare therapy, and the research on it looks very exciting. While we do not do this therapy in our office, I have referred patients for this therapy. It is certainly worth the trial for anyone suffering from CRPS.
  • Tinnitus
    Tinnitus can be an extremely difficult problem to address and can be a result of multiple issues and not a single problem. Meditation and yoga are extremely effective in reducing inflammation, as is curcumin. You also need to identify the causes of the inflammation, such as the trace mineral imbalances, as well as eliminate anything that may be poisoning your system.

#8: Your body may be more responsive to alternative therapies.

We find that acupuncture can be extremely effective for a large number of pain conditions. But most commonly our treatments are layered, involving a number of therapeutic approaches, which work synergistically for a comprehensive solution. I also recommend meditation or yoga.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Is Your Medication The Root Of Your Chronic Pain?

/in , /by

5 Pills That Might Be Hurting You

By Julia Westbrook

It’s time to stop ignoring the aches and pains and finally live a healthy life.

More Americans are suffering from chronic pain than have diabetes, according to a panel of researchers at the National Institutes of Health. While 29 million people are diagnosed with diabetes, the panel estimated that 100 million Americans live with chronic pain.

While the statistics are staggering, the scary truth is that, despite the apparent universality of pain, there isn’t nearly enough research on safe, effective treatments.

“We learned that sufficient clinical research doesn’t exist to show physicians how best to treat chronic pain in adults, many of whom suffer from multiple health problems,” said panel member and founding director of the Indiana University Center for Aging Research, Christopher Callahan, MD.

Instead, our medical system is heavily reliant on painkillers, both over-the-counter and prescription, despite the fact that, according to the panel, clinicians recognize that pain narcotics aren’t the solution for long-term pain treatment. (Here are 5 reasons over-the-counter painkillers are a bad idea.)

Gary Kaplan, DO, author of Total Recovery: Solving the Mystery of Chronic Pain and Depression, explains that medication—either for treating pains or treating other conditions—can be at the root of chronic pain. “Because of the powerful, short-term effectiveness of many drugs, we’re beginning to experience polypharmaceutical problems, where patients end up taking one drug to treat the side effects of other drugs,” he explains.

“The rough guideline I give my patients about taking medications is this: A drug has to work better than the side effects it creates,” he says. “If it doesn’t, get rid of it.” Of course, it’s important to do so under the supervision of your doctor, he adds.

While it’s easy to tune out the side-effect disclaimer on pharmaceutical ads, you may want to talk to your doctor if you’re experiencing chronic pain and are taking one of these prescriptions:

Statins

Statins are commonly used to lower cholesterol. “They can be the cause of cataracts and unexplained muscle pain. Some studies show they may increase your risk of developing diabetes,” says Dr. Kaplan.

Diet can have a big impact on cholesterol. Consider eating avocados, as research has shown that they’re a food that helps lower cholesterol.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

In the ultimate irony, your painkiller might be causing you more discomfort. “More than 70 percent of people chronically taking NSAIDs—such as ibuprofen (Advil, Motrin), naproxen (Naprosyn), diclofenac (Voltaren), and aspirin (Bayer, Bufferin)—will get ulcers in their small intestines, creating a permeability problem (aka leaky gut syndrome),” says Dr. Kaplan.

Leaky gut is associated with all kinds of painful issues, including food sensitivities, joint pain, headaches, and psoriasis.

Antibiotics

Speaking of your gut, taking antibiotics may be causing more painful inflammation than the infection itself. “Multiple treatments of antibiotics for any reason can profoundly change the gut flora,” says Dr. Kaplan. “Those changes can then damage the intestinal tract enough to create leaky gut syndrome, which will result in inflammation and activate the microglia.”

While he doesn’t dismiss the lifesaving importance of antibiotics, Dr. Kaplan recommends balancing their use with a probiotic supplement. And be sure to support a your gut bacteria with healthy foods.

Opioids

Another counterintuitive finding: Dr. Kaplan says that opioids can heighten your sensitivity to pain. “Additionally, these painkillers—such as codeine, hydrocodone (Vicodin), morphine (Avinza), and oxycodone (Percocet)—can lead to depression, constipation, and sexual dysfunction,” he says.

Instead of popping a pill for your pain, consider meditation as an effective treatment.

Sleeping Pills

Sleep is so important for your health, but popping a pill to get there isn’t the answer. “A chronic reliance on any type of sleeping pill—such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata)—can, in the short term, make it hard to focus and, in the long run, even shorten your life span,” says Dr. Kaplan. Plus, you might be missing key warning signs of sleep apnea.
Article reprinted from www.RodaleNews.com, Jan/2015