New approach can help patients with chronic pain

New approach can help patients with chronic pain

By Dr. Martin Gleixner, MSc, ND

 

Chronic pain is reaching epidemic proportions.

 

Back pain, shoulder pain, elbow tendinitis, fibromyalgia, carpal tunnel syndrome, plantar fasciitis, sciatica, repetitive stress injuries, 'pinched' nerves are common.

 

Despite our best attempt to explain health conditions with modern science and medical research, the cause of many chronic pain conditions remains elusive while their treatments are often unsuccessful. Where has our standard of care for musculoskeletal conditions gone wrong?

 

How often has it occurred that we give the diagnosis of a "pulled muscle" when no physical changes were documented and no sign of injury can be seen. The involved area is not bruised, bleeding, swollen or warmer to the touch. Often, the only findings on physical exam include tender areas in muscles and tendons, as well as restricted movements resulting from the pain. These findings however, rarely explain the debilitating degree of pain many patients feel.

 

It also confuses me how a patient could essentially have normal radiographic evaluation and a normal physical exam but have excruciating symptoms. Blood tests in these cases can be completely normal, showing no evidence of chronic disease.

 

Likewise, how is it that a patient's X-ray can show significant arthritic and vertebral disc changes, although the patient has no present pain and never had a history of pain associated with the affected joint? Furthermore, does it make sense that we attribute mild age-related osteoarthritic changes shown on X-rays to explain a patient's chronic pain? Does this mean that we should all expect pain in our later years of life? In reality, many people are pain-free and live very active lives despite living with the so-called "degenerative" joint changes related to the normal aging process.

 

It is therefore evident, that changes in anatomy and structure often cannot predict pain. Based on a review of medical literature, researcher Richard Deyo M.D. (2002) indicated that up to 85 per cent of low back pain as being of unclear cause. The medical literature is either lacking or shows that many of the structurally based treatments (eg surgery) have not provided long-term relief of pain conditions, while surgical complications are common.

 

It is clear that the accepted "gold standards" in how we diagnose and treat most chronic musculoskeletal pain conditions are in fact not based on sound science.

 

Medicine has done well on the other hand diagnosing musculoskeletal disease defined by clear underlying causes. The autoimmune destruction of joints as in rheumatoid arthritis, lupus, and psoriatic arthritis for example, can be diagnosed by abnormal lab tests and physical examination. The autoimmune reactions and subsequent joint inflammation underlying these conditions provide a clear direction for treatment considerations.

 

In contrast, chronic pain in the back, neck, shoulders, and limbs (commonly diagnosed as strained/pulled muscles), fibromyalgia, carpal tunnel syndrome and bulging/herniating disc are common conditions with a poor track record of treatment. Many patients with these conditions live in chronic pain with little hope of a cure. This track record has never sat well with me. My physiological understanding of the human body is that it is designed to heal and is in fact quite resilient.

 

In my earlier column titled "Guiding principles form a new health-care paradigm" (see www.monctonnaturopathic.com for previous columns), I discussed how the body has a tremendous capacity to heal and that it is our job as doctors to encourage this process. A broken bone or acute injuries to muscles and tendons, for example, has shown to heal within a couple of months. For many people, however, their condition becomes chronic despite having healed from the initial injury. Our failures in treating chronic pain conditions should tell us that it is time to think "outside the box". For the last five years, I have been fortunate enough to experience the professional satisfaction of helping patients heal from chronic pain. I have developed a chronic pain program that is based on a three-step approach:

 

1) Rule out pathological conditions that may explain chronic pain

Examples include (but not limited to) noticeable inflammation or autoimmune disease affecting joints, tendons, nerves and/or muscles (eg gout, rheumatoid arthritis, lupus, psoriatic arthritis, and multiple sclerosis), traumatic injury, infections, cancer, and fractures from thinning bone (as in advanced osteoporosis). Blood test results, physical examinations and imaging studies help rule out these conditions. They are treated accordingly using naturopathic modalities often in combination with conventional medicine.

 

2) Integrate concepts of mind-body medicine

For all other chronic pain conditions, patients are treated based on a unique approach developed by Dr. John Sarno, M.D. who coined the condition Tension Myositis Syndrome (TMS). His three books Healing Back Pain (1991), The Mindbody Prescription (1998), and The Divided Mind (2007) are invaluable references. Although, mainstream medicine has rejected the diagnosis of TMS because it is based on the theory that physical symptoms are initiated by emotional phenomena. Based on my experience (and many MDs practicing in North America), I have consistently seen patients heal through TMS concepts. For this reason, I encourage the medical community to avoid waiting until science catches up to explain how and why TMS works. After all, the medicinal ingredients of Aspirin for example, were used for many years before science could explain that it inhibited the production of prostaglandins thereby decreasing blood clotting and pain.

 

TMS is a disorder in which unconscious, repressed emotions initiates physical pain and other symptoms. TMS is a painful but harmless change in muscles, nerves, joints, tendons and organs. It is said to be harmless because there is no destruction of the tissue (ie pathological changes). Rather, TMS develops when the autonomic nervous system decreases blood flow to muscles, nerves, joints, tendons and/or organs, resulting in oxygen deprivation. Low oxygen is experienced as pain, numbness, tingling, weakness, tension and/or dysfunction in the affected tissues. The pain is real and can be excruciating for many people.

 

This physiological process occurs in everyone, only the intensity and way that it can manifest in the body can vary between each individuals. The underlying cause of the pain is the mind's defence mechanism against unconscious mental stress and threatening feelings such as anger, guilt, etc... In other words, the purpose of physical symptoms is to prevent repressed feelings from becoming conscious by diverting attention from the realm of the emotional to that of the physical. It is strategy of avoidance. It is important to understand that the patient is not to blame for manifesting the physical symptoms because it is an entirely unconscious process. A complete discussion of TMS is beyond the scope of this column, but stay tuned for more upcoming columns on this subject.

 

Once I have determined that a patient fits the TMS diagnosis and other conditions are ruled-out, a patient must be psychologically open to the diagnosis of TMS to improve. As Dr. Sarno states "we don't need to have a leap of faith, merely a leap of understanding". Getting better occurs by understanding what TMS is all about and by acknowledging that TMS is the main cause of the pain.

 

3) Apply naturopathic principles and treatments

An integrative approach also includes some or all of the following:

  1. An individualized anti-inflammatory eating plan clinically designed to decrease inflammation and increase the intake of nutrients that facilitates healing.
  2. Encourage sleep and deep breathing, which promote healing.
  3. Encourage exercise to increase the circulation of oxygen and nutrients to tissues.
  4. Decreasing exposure to chemicals that may cause inflammation in the body. In the case that toxins are already present in the body, appropriate detoxification methods may be indicated.
  5. Help patients obtain their ideal weight, as fat cells are pro-inflammatory in the body, and excess weight can promote wear and tear of the joints.
  6. Address co-existing chronic inflammatory conditions such as diabetes, etc...
  7. Encourage the healing of TMS, using various naturopathic treatments that aim to: a) increase and maintain blood flow to nerves, tendons, muscles and other tissues lacking sufficient oxygen; and b) restore communication between the anatomic nervous system and tissues/organs so that the brain is less able to produce symptoms in the body. Working in tandem with a psychologist may also be helpful.
  8. Promote healing using specific vitamins or minerals in medicinal doses and individualized herbal combinations.

As always a combination of naturopathic approaches tailored to each individual provide the best clinical results. Incorporating groundbreaking concepts such as TMS helps patients heal faster, can result in a true cure, and provides an important tool that patients can use during their entire lifetime. The treatment allows people to resume full physical activity and emerge with a profound awareness of their emotional selves.

 

Published by Dr. Gleixner on Wednesday March 2nd, 2011 in Times & Transcript.

 

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