Pain Doc - Ask Dr. P - The Pain Doc

Inflammation and Pain – The Good and the Bad

by Pain Doc | Jun 2, 2015 | Uncategorized

If you recently injured yourself, or had a sudden onset of low back or neck pain, take note: inflammation is responsible for creating your pain sensations.

I didn’t say this was good or bad– just that inflammation, or the inflammatory response to injury/ tissue damage is maintaining the sensation of pain.

Understand that despite its negative connotation in the media, inflammation is a natural, protective response to injury that is necessary for healing.

Inflammation:

triggers the proliferation of white blood cells that attack microorganisms and remove debris;
dilates local blood vessels and increases their permeability (swelling) to bring more oxygen to the area (more oxygen is needed for the high metabolic activity of damaged tissue);
produces heat which speeds up activity and makes it difficult for germs to thrive;
results in pain to discourage you from using the injured area while it is vulnerable.
quarantines the damaged site from the rest of the body

Normally, after an acute injury such as an ankle sprain, inflammation goes through three phases:

lots of swelling, redness and pain initially for the first 72 hours (acute phase);
followed by a gradual reduction in swelling and pain as debris is cleared and special cells called fibroblasts lay down collagen fibers for repair (sub-acute, repair phase); then
remodeling and strengthening of the new collagen fibers over several weeks (post-acute, remodeling phase).

Eventually, everything gets back to normal.

So for most cases of straight-forward joint sprains/strains R.I.C.E.– Rest, ice, compression and elevation is all you need.

Rest it– don’t splint it unless necessary; just avoid placing a load on the injured joint, or avoid moving it through its full range during the acute phase
Apply ice in the beginning only to keep the swelling from getting excessive/ out of control and to reduce pain; about every two hours for 15-20 minutes a session.
Compress it– this is the least necessary, but some people find it helpful to compress the area to help encourage the swelling to go down.
Elevate it — use gravity to assist the flow of blood back to the heart. If it’s your ankle, lie down and place the injured ankle on a pile of sofa pillows so that it is above your heart.

Let the inflammation take its course and trust in your body’s wisdom to heal; helping it as needed. Unless the pain is so bad that it’s preventing you from doing things you need to do, avoid taking NSAIDs like Tylenol, Motrin or Ipuprofen. Although NSAIDs can reduce pain, they do interrupt the body’s natural attempts to heal a damaged area and may even delay healing.

When inflammation is not so good

Now, if all goes well your injured body part will be back to normal before long. But what if it is six months later, and you still feel pain?

It could mean a number of things.

Perhaps you have a bone fracture. Fractures take longer to heal.
A torn ligament or tendon takes longer to heal, as these tissues are not directly vascularized.
Infection can complicate healing.
The nature of the injury is causing a joint to be abrasive to adjacent tissue during movement.

In these cases, the cause needs to be addressed with a secondary treatment regimen.

But another possibility is that the inflammatory response has gone haywire. It continues at high levels long after the injury has completed its healing. Why this happens is unclear. In rheumatoid arthritis, it’s attributed to the body’s immune system attacking joint surfaces, which creates a continual state of inflammation and pain.

In cases of excessive inflammation, you may need to take NSAIDs to dampen the process and essentially tell your body “it’s time to stop producing inflammation.”

The other possibility is that you have a pre-existing state of systemic inflammation that is driving the process. “Systemic” in this sense generally means “widespread throughout the body.” This can be interfering with the local inflammation of your injury site.

Causes of systemic inflammation include:

allergic reactions
obesity
exposure to pollutants
diet comprised of highly processed food

In most cases it’s difficult to “feel” systemic inflammation because it is usually sub-acute/ chronic. But despite this, systemic inflammation wreaks havoc on your health. It is associated with most chronic, degenerative diseases such as type 2 diabetes, cancer, cardiovascular disease, arthritis, Chron’s disease/ colitis, and Alzheimers disease.

Blood tests that can indicate the presence of systemic inflammation include C-reactive protein (CRP), erythroctye sedimentation rate (ESR), tumor necrosis factor (TNF) and homocysteine. If your levels are high in any one of these, it is prudent to assume you have an inflammatory condition and take the necessary precautions.

First and foremost is to see your doctor to rule out pathologies/ disease processes.

Second, switch to a low calorie diet centered on whole, naturally-occurring plants and protein.

Next, increase intake of the following herbs/ supplements/ superfoods:

Curcumin
Ginger
Fish oil
Dark cherries
Nattokinase
Green leafy vegetable juice

Drink adequate amounts of water throughout the day, reduce your stress and get eight hours of restful sleep. As your inflammation resolves, you will notice faster healing, more energy and strength, clearer mind and a leaner body.

Often it’s the simple things that are within your control that have the most powerful healing effect on your body.

As Hippocrates said, “make food your medicine and medicine your food.”

If you experience chronic pain, check out my book on Amazon, Erase Your Chronic Pain: Unleash Your Body’s Full Healing Potential.

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Is There Anything Besides Drugs for Chronic Pain Treatment?

by Pain Doc | Mar 30, 2015 | Lifestyle Modification

Chronic pain is a complex, physiological process involving specialized sensory cells, nerves, your brain and spinal cord and a multitude of biochemical substances..

Chronic means the injury/damage/disease of the affected body region has gone through the normal stages of healing, but some degree of pain still remains. This can be due to incomplete healing, permanent physical damage to structures, continual re-injury/ aggravation of the area or even “imprinting” into the spinal cord where the central nervous system literally “memorizes” the pain signals, causing them to be ever-present.

Musculoskeletal conditions arising from trauma or gradual wear and tear dominate chronic pain cases (pain originating from bones, joints, muscles, soft tissues). Diseases affecting the nerves such as shingles, advanced diabetes, trigeminal neuralgia and other peripheral nerve diseases often become chronic in nature as well.

Research suggests that one’s conscious reaction to pain (how you respond to it) influences the severity of pain; that is, the perception of it. Someone who embraces his pain and defers to its presence out of excess fear or worry is less likely to improve than someone who resists giving in and “moves into” the pain by not focusing on it too much as he goes about doing what he desires. This strongly suggests that pain has both physiological (body) and psychological (mind) components to it, and therefore, treatment for it should incorporate methodologies that address both.

Options for Treating Chronic Pain

Treatment for chronic pain includes acetaminophen (Tylenol), non-steroidal anti-inflammatories (aspirin, ibuprofen), anti-depressant drugs used “off label” for pain (amitriptyline, Cymbalta), anti-convulsant drugs used off-label for pain (Lyrica), corticosteroids (Prednisone) and opiate drugs (morphine, codeine). They work in different ways to decrease pain; some not fully understood. And, they all come with side effects, which differ from person to person.

TENS units and spinal cord stimulators are instruments used to block or interfere with pain signals as they travel through the central nervous system.

So between strong drugs with unpleasant and often dangerous side effects and devices designed to block pain, the medical options for treatment are disappointing. These interventions are not intended to cure the problem at its source, but rather interfere with its manifestation via chemical and electrical means.

However, two instruments I have come across are in a “gray area” in that the mechanism of action involves stimulating actual, natural healing of injured cells. The first one is red light therapy, which works on human cells very much like how sunlight causes photosynthesis and energy production in plant cells. I recommend red light therapy for joint pain from osteoarthritis and sprains/strains. You can also use it to heal minor cuts and lacerations faster.

The second one is Pulsed Electromagnetic Field Therapy, or PEMF. PEMF uses low frequency, low power magnetic fields in the range of frequencies that is naturally produced by the human body, to normalize cells whose membrane charge, or voltage, has been disrupted by disease processes and strong environmental electromagnetic fields such as those from power cables and electronics. When the cell membran charge is normalized, the cell’s metabolism and respiration is boosted which results in faster healing of disease; especially inflammatory disorders. Pulsed EMF can be used to treat many types of chronic disorders including chronic pain, fibromyalgia, pulmonary disease, heart disease and headaches. Watch the video below where I explain how PEMF works:

If you suffer from chronic pain, I suggest you direct your attention to creating conditions in your body that optimize health. This may not “cure” chronic pain entirely due to its complex nature, but a healthy body is in a much better position to heal and regenerate than one that is not.

Know that:

Your body is a community of interconnected, living cells that affect one another. For example, an intestinal cell and a muscle cell have a functional relationship. This cellular relationship can be influenced via lifestyle changes, primarily through your diet, activities and thoughts/attitudes to reduce pain.
Cells are the basic unit of the human body, and like the human body your cells consume food, breathe oxygen, perform work, burn energy stored in food and produce waste.
What enters your body via your mouth, lungs and skin gets into all of your cells (with the exception of those substances that cannot cross the blood-brain barrier).
Areas of chronic pain are where cells are in a state of distress. They may be producing inflammation, abnormally firing nerves, and/or not getting rid of their waste products properly.
You can greatly influence the functional state of all your cells by what you think, what you eat and drink, and what you do with your body.

When it comes to pain it is better to think in wholistic terms — the whole body, not just where it hurts. This is how your body is designed; how your body functions; and how it heals itself. Your starting point is your mindset and attitude. Use it the create health in your body by all means available to you; and there are many. Use Pulsed EMF for maintenance to enhance energy in your cells and enable efficient cell function and healing. This is your best bet for overcoming chronic pain.

Chronic Neck Pain or Stiffness? Get Your Neck Curvature checked

by Pain Doc | Feb 27, 2015 | Neck Pain

The cervical spine is the thinnest and most flexible part of the human spine. It is tasked with supporting the weight of the head in the upright position while allowing turning in multiple planes — looking left, right, up, down and behind. It also contains structures directly tied to life sustenance, which is why the neck is a logical target when it comes to martial arts/ self-defense and restraint (and unfortunately, murder).

Given all these vital functions, it is wise to take good care of your cervical spine in a proactive way.

The cervical spine is naturally designed to curve, where the apex is at about the level of the Adam’s apple.

This curve behaves much like a spring in a car’s suspension; or the slight upwards curve you see in any bridge design. Long ago, architects discovered that the load capacity of bridges could be dramatically increased simply by integrating curves or arcs into the design. Like a neck curve, a bridge curve or arc distributes weight over a greater area so that gravity cannot concentrate over one small area and cause structural failure.

neck_xr_flat If the neck curve helps distribute the weight of the head in the upright position, what do you suppose might happen if the curve straightened out or started to bend in the opposite direction like the one to the left?

If you lose your cervical curve over time, which could happen from years of poor posture or trauma like multiple rear-end car collisions, you will probably not notice it until several years pass. The change in biomechanics shifts a greater burden of support to your cervical discs and vertebral end plates. This promotes disc degeneration. The once thick and healthy discs lose fluid content, lose strength, allow the center material to bulge out (herniate, protrude or rupture) and cause bony protuberances called osteophytes to form all around the edges of the vertebrae and facet joints.

For some unfortunate people, the bony projections narrow the passageways where the nerve roots and spinal cord pass through (a condition called spinal stenosis) and neck surgery is necessary to prevent nerve tissue from permanent damage, paralysis and severe paresthesias (numbness, tingling) in both the arms and legs.

So the bottom line: be conscientious about the importance of the health of your cervical spine. Don’t get blind-sided by an MRI diagnosis of “multiple-level, severe degenerative disc disease with advanced neural encroachment.”

I’ve seen such cases where patients were oblivious to what was developing inside their necks. They dismissed their neck stiffness and aches to “getting older” or simple muscle strain. When massage and chiropractic provided only temporary relief, they had a cervical MRI done which revealed the formidable origin behind these symptoms, and the next step was neck surgery. Neck surgery of this nature involves removing the damaged disc, shaving off the osteophytes and inserting a bone graft to promote fusion of adjacent vertebrae.

Prevention is the best approach. You don’t have to have neck problems to start preventive measures. In fact, the vast majority of patients who have early to moderate stage degenerative disc disease have no complaints. It’s like a cavity — you don’t feel anything as the pit erodes the tooth enamel, but as soon as it hits a nerve, you will definitely be aware of its presence. But by that time, you’ll need invasive procedures. In the case of a cavity, it means either a filling or tooth extraction; in the case of a cervical disc, it might mean cervical decompression surgery.

Below is a video that summarizes the importance of maintaining a healthy cervical curve (“lordosis”) and exercises to maintain or restore your neck curve so that it can better withstand the physical demands placed on it and hopefully preclude the need to visit an orthopedic surgeon years down the road.

Also, make sure to check out this site’s Self-Care for Neck Pain video, which demonstrates home care procedures for managing musculoskeletal neck pain and/or stiffness.

Do Topical Pain Relieving Creams Work?

by Pain Doc | Feb 25, 2015 | Uncategorized

Icy Hot. Ben Gay. Tiger Balm. These are just a few of the many over-the-counter topical (meaning, applied to the skin) pain relieving products (TPRPs) on the market. They vary by type, and of course active/ therapeutic ingredients.

There are also prescription TPRPs that contain medications like ibuprofen, aspirin or opioid derivatives (Rx TPRPs are not necessarily more effective than OTC ones).

These products generally are OK for aches and pains affecting muscles, tendons, joints and sometimes nerves; not so much for acute injuries involving swelling. And, they are effective only for superficial areas such as elbows and wrists, as depth of penetration is limited.

So far, research shows some benefit in reducing pain, but nothing dramatic. Anecdotal evidence on their effectiveness obviously differs wildly from person to person. This is mostly due to the fact that pain has both physical and mental components to it, and different people perceive pain differently.

Topical pain relief products come in creams, gels, ointments, patches and sometimes sprays. They are usually manufactured with a “delivery agent,” a substance that binds to the active ingredient and penetrates the skin where it diffuses down to the target tissue. The delivery agent, therefore, is critical to the products potency.

There are three basic ways TPRPs work:

(1) analgesia – reducing inflammation

(2) nerve signal inhibition

(3) counter-irritant

The medicinal products use analgesia to reduce pain; this includes those that contain ibuprofen or aspirin (acetylsalicylic acid). Botanicals such as arnica, boswellia serrata, devil’s claw and comfrey are herbs associated with pain relief and are found in many TPRPs. Their mechanism of action is probably via inflammation reduction by acting as a blocking agent in inflammatory reactions.

Capsaicin is the compound that gives hot peppers their perceived heat. Products utilizing this as the active ingredient are more suited for nerve-related pain (neuralgias) like post-herpetic neuralgia, trigeminal neuralgia or a peripheral nerve entrapment condition like carpal tunnel syndrome. What it does is bind to the ends of nerves that send chronic (slow) pain signals which causes them to discharge their neurotransmitter substance P (the substance that transfers the pain signal from nerve cell to nerve cell along the nerve) until it is depleted, effectively deadening the nerve temporarily.

The counter-irritants use menthol and/or camphor, substances that seem to affect cold receptors in the skin. Like ice, it sends a cooling sensation to the brain which may “scramble” or interfere with the pain signal coming from the painful area, thus reducing the perception of pain even though the skin temperature remains the same. Rubbing a sore wrist is basically the same thing — creating more nerve signals (pressure, friction) to compete with the pain signals, thus diluting their impact.

So should you try topical pain relief products? The obvious benefit is that they target only the area of pain. With oral pain relief medications, Rx and OTC, the reach is systemic as the medication is delivered in the blood stream to all body tissues except the brain. This creates a new set of problems (side effects) like nausea, muscle cramps and even renal damage.

On the other hand topical pain relief products don’t reach the target area as well as oral medications. The skin is designed to be impregnable to most external substances, so even if the medicine is able to penetrate, it is at a much lower dosage. This is significant only for the analgesic TPRPs, as they have to reach all the way down to the painful tissue. With the counter-irritants, penetration is not so much an issue as they work on sensory nerve endings that are close to the surface of the skin.

One product that I ran across seems to be effective for a lot of people, at least anecdotally, based on its reviews. It is called Penetrex and contains arnica, boswellia extract, MSM, vitamin B6 and a special delivering agent. If you have chronic pain affecting tendons, muscles and/or superficial joints, it’s worth giving it a try. As a matter of fact, it wouldn’t hurt to try the different TPRPs you find OTC at your nearest drugstore; it’s preferable to oral pain relief products (pills, tablets and liquids) any day, as far as safety is concerned.

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Best Exercise for a Strong and Functional Low Back – Russian Kettlebell Exercises

by Pain Doc | Dec 18, 2014 | Uncategorized

Russian kettlebell exercises are a great way to strengthen and condition your pelvic stabilizers, promoting a strong back that is less prone to movement-caused injury.

The pelvic stabilizers consist of all the muscles connected to the pelvis working in synergy to enable you to lift, push and carry (perform work). They include:

Erector spinae group (quadratus lumborum, multifidi, rotatores, iliocostalis)
Abdominals (rectus abdominus, obliques, transverse)
Gluteal muscles
Quadriceps muscles
Hamstrings
Hip rotator muscles

In this video, I demonstrate the proper form for doing these exercises:

Think of your pelvis as a powerful hinge; a “bio-mechanical hub” that connects your torso to your legs. The pelvis’ engineering enables you to stand upright and bear a load by serving as an anchor/ attachment point (resistance-counter force) for the muscles performing the work. It is truly a biological marvel and should be targeted for exercise so that one can meet the physical demands of life more easily.

Examples of common activities that heavily rely on pelvic stabilizers:

Standing up from a seated position; sitting from a standing position
Bending down and lifting something from the ground
Putting your carry-on luggage in the overhead bin of an airplane
Lifting up a child
Throwing a football
Jumping across a puddle

The exercises involve moving a kettlebell, which resembles a cannon ball with a large hand grip, by using the power generated from pelvic thrusting. The repeated thrusts are created by alternating antagonist-agonist* function of the pelvic stabilizers.

*Muscles work in pairs. The muscle that is undergoing a concentric contraction (getting shorter as it contracts) is called the agonist while its counterpart, referred to as the antagonist offers stabilization and measured control of the movement. Muscles switch from being agonist to antagonist and vice versa, depending on the movement. Examples: biceps-triceps, quadriceps-hamstrings.

Although it looks like the arms are involved due to their obvious swinging motion, they are actually not being exercised. The arms serve to connect the weight to the pelvis structure, like a piece of rope. The kettlebell “drags” your arms with it and moves via inertia after being propelled by the rhythmic pelvic thrusts.

Initiate the thrust with your leg muscles, driving power through your feet and channeling it into your pelvis and core to swing the weight forward. Do not use your arm muscles to swing the weight, and try to keep your lower back straight. The worst thing you can do is put too much load on your lower back muscles in the flexion position– this can cause a severe back injury, so avoid doing this.

The benefit of developing your pelvic stabilizer muscles’ strength and coordination is that it will be much easier to move your body; to make it do work. Going up stairs, getting out of and into your car seat, and lifting and carrying heavy things will be much easier. You’ll be pleasantly surprised!

Kettlebell exercises burn up a lot of calories, so they are also good for weight loss.

Remember to use good form and start out with a light weight, working your way up as you develop muscle strength and coordination. Kettlebells can be as light as 2 pounds and as heavy as 50 pounds. The one I am using in the video is a solid 40 pounds.