Complementary Treatments for Pain. Paula J. Ceh, PharmD, PA-C Live Optimally, Vitally, Energetically

Transcription

1 Complementary Treatments for Pain Paula J. Ceh, PharmD, PA-C Live Optimally, Vitally, Energetically

2 The Many Faces of Pain Fever, headache and sinus congestion Muscle soreness from exercise Pain of anguish Gut pain from allergy / dyspepsia Joint pain from osteoarthritis or injury Pain of cancer Chest pain Pain associated with loss Limb (phantom pain) or a loved one

3 Pain Definition An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage The International Association for the Study of Pain An unpleasant sensation, occurring in varying degrees of severity as a consequence of injury, disease, or emotional disorder dictionary Whatever the patient says hurts International pain expert- Margo McCaffrey

4 My Description of Pain Any experience that filters one s perception into response How we see our experience translates to pain or pleasure In any 1 minute, our cognition processes 50,000 bits of information but our CNS can only process a few hundred at a time

5 My Description of Pain The lens through which we translate information is psychosomatic The connection of the conscious (stimulus) to the unconscious (response) to the ADAPTIVE unconscious (filtering perception into response) Our realities are framed by what we allow to come through Affects body, mind and spirit

6 Pain is a Web of Interfacing and Networking It is the only experience that crosses almost all disciplines and specialties Psychology Neurology Immunology Endocrinology Infectious Disease Sports Medicine Surgery

7 Disciplines and Specialties Crossed Radiology Genetics Physical Therapy Massage Chiropractic Osteopathic manipulation Reiki Therapeutic Touch

8 Disciplines and Specialties Crossed Cranial sacral therapy Rolfing Tai Chi Acupuncture Cupping Moxibustion Esoteric Healing Meditation

9 Disciplines and Specialties Crossed Prayer Distance Healing Chakra Balancing Hospice Care Spirituality Religion / Religious services Chaplain Services

10 Allopathic Principles in Pain Treatment Determine the inflammatory profile Inhibit or suppress the inflammatory mediators Inhibit or suppress afferent and efferent motor transmission Modulate the neuronal transmission Restore function of bodily part affected Manual therapies, physical therapy, nonpharmaceutical modalities

11 Common Allopathic Treatments of Pain Pharmacologic Non-steroidal Anti-Inflammatory Drugs (NSAIDs) Steroids COX-2 inhibitors Acetaminophen Opioids Antidepressants Anti-psychotic medications Anti-epileptic medications

12 Problems With This Model Human pain is comprised of a network that crosses multiple organ systems as well as psychological and spiritual systems Using medication therapy alone results in unwanted central side effects Requires a team approach of disciplines some of which are considered soft and little evidence to support their value

13 Problems With This Model Neuropathic pain is comprised of neurons, immune cells and glial cells Peripheral blood neutrophils express the neuropeptide nociception which has been linked with the transmission of pain signals Proinflammatory cytokines signal the CNS thereby creating pain as well as physiological, behavioral and hormonal changes The gut is the second brain

14 The Pain Model Endocrine Neurons Immune System Psychology

15 Neurons Central nervous system Brain and the spinal cord Interventional radiology, nerve blocks Use of anti-epileptic medications Peripheral nervous system Use of anti-epileptic medications Neurotransmitters Serotonin, norepinephrine, epinephrine, dopamine and gamma amino butyric acid (GABA) Antidepressant use Enteric nervous system 70% of neurotransmitters are formed in the gut

16 Psychology Depression Alter the neurotransmitters by using antidepressants Anxiety Anti-anxiety medications Psychotherapy and counseling treatment options

17 Immune System Inflammation 70% of our immune system is found in the gut Comprised mostly of amino acids strategically placed together to form proteins that also form antibodies and antigens

18 Endocrine System Hormones Estrogen, progesterone, testosterone, pregnenolone, and DHEA Thyroid Pancreas Insulin, glucose Adrenal Glands Cortisol, adrenaline, stress hormones

19 The Pain Model Endocrine Neurons Immune System Psychology

20 Immune System and Inflammation 70% of the immune system is found within the gut Decreasing the inflammatory load in the gut will decrease all inflammation throughout the body, not just in the gut

21 Decreasing Intestinal Permeability Improves Inflammation Using supplements that maintain intestinal structure and function reduces the chances for leaky gut Increased intestinal permeability allow substance such as toxins, microbes, undigested food, or waste leak into the body which results in an autoimmune reaction and/or chronic inflammation

22 Leaky Gut Syndrome

23 Pain and Probiotics Probiotics are live bacteria that coexist with us and share our bodies We have a symbiotic relationship with them They live in our mouths, lungs, digestive tract, vaginal tract, and skin There are over 400 species living within us at this very moment

24 What do probiotics do for us? Maintain an intestinal barrier and protect us from the outside world Regulate inflammation Inhibit toxic substances secreted by bacteria Serve as a communicator for our immune system Protect us from pathogens or bad bacteria Prevent the formation of biofilms Actively compete for food sources of bad bacteria

25 What do probiotics do for us? Help us absorb some of the minerals that we eat from our digestive tract Help keep us regular (prevent constipation) Maintain a healthy balance of our hormones Neutralize toxins and help us metabolize bad substance that could be damaging to the body Matrix metalloproteinases (MMP) breakdown tissue so new cells can regenerate but during chronic pain, the enzyme does not get turned off

26 Probiotics

27 Pain and Probiotics They enhances the expression of the muopioid and the endocannabinoid receptors in the intestinal epithelial cells thus reducing gut pain Improves pelvic pain associated with IBS and pelvic inflammatory disease

28 L-Glutamine Amino acid that is the preferred source of fuel for the small intestinal mucosa Plays a key role in small intestinal structure and function Fuel for the immune system and may have immunostimulatory effects Prevents muscle wasting also by transporting circulating amino nitrogens

29 L- Glutamine Mainly used in the past for preventing or treating AIDs, alcohol addiction, burns, critical illnesses, gastroenteritis, pancreatitis and peptic ulcers Provides a major fuel source for the brain Important precursor for GABA (an inhibitory neurotransmitter) calming effects and assist in decision making

30 L- Glutamine Glutamine is widely available Relatively non-toxic even at high doses (60gm/day) Because it affects nitrogen balance, should not be used in impaired hepatic function

31 Other Methods used to Decrease Inflammation in the Gut Brushing your teeth will decrease gingivitis thus reducing the inflammatory load within your body Test for food allergies and celiac disease Avoid sugars and alcohol High fiber diet Helps support probiotics Prevents constipation

32 Other Anti-Inflammatory Agents Bromelain Proteolytic enzyme found in pineapples Cat s Claw Inhibits prostaglandins E2 and TNF-alpha Devil s Claw Inhibits the cyclooxygenase and lipooxigenase pathways

33 Other Anti-Inflammatory Agents Stinging Nettle Mainly used to treat allergies Tumeric Inhibits COX-2 prostaglandins and leukotrienes Willow Bark Similar reactions to aspirin

34 Other Anti-Inflammatory Agents Fish Oils or EPA/DHA Block the formation of arachidonic acid Ginger Localized effects especially in the intestine S-adenosylmethionine (SAMe) Assists in synthesis and metabolism of hormones, neurotransmitters and phospholipids Possess the ability to assist in regrowth of cartilage

35 The Pain Model Endocrine Neurons Immune System Psychology

36 Endocrine System and Pain Estrogen Estrogen may suppress stress-induced analgesia Women report higher pain on pain scales Protects neurons and improves their function Stimulates nerve growth Increases serotonin in the brain Increases dopamine and dopamine receptor sensitivity Increases GABA

37 Endocrine System and Pain Progesterone Inhibits arachidonic acid in the body Improves mood Improves sleep Calms the body less irritability and mood swings Enhances energy levels

38 Endocrine System and Pain Testosterone Prevents muscle wasting Promotes stamina and sustained energy Low levels known to worsen peripheral neuropathies

39 Endocrine System and Pain Cortisol and Adrenaline Released by the adrenal glands Assists in the stress response induced by pain Provides the energy and stamina necessary to make it through the day The fight or flight chemical for adaptation to the surroundings

40 Endocrine System and Pain Thyroid Considered the master gland Helps regulate and keep all the hormones balanced Responsible for digestive enzymes and substances Supports neurotransmitters and immune system

41 Pain and the Stress Response The adrenal glands are the emergency back up system in the body The adrenals respond to perceived or real dangers in the body Pain is a symptoms of a danger to the body therefore the adrenal glands are activated Chronic pain can lead to adrenal fatigue

42 Adrenal Fatigue Adrenal stress causes the sympathetic nervous system to overreact The parasympathetic nervous system is turned off Responsible for relaxation of the body The neurotransmitters responsible for relaxation are depleted and turned off Causes irritability, agitation, increased pain perception

43 Sympathetic and Parasympathetic Nervous Systems

44 Adrenal Fatigue Prolonged stress causes the body to prioritize cortisol over the sex hormones and the thyroid hormones Results in the cortisol steal Excessive cortisol release requires an enormous amount of energy thus leading to extreme fatigue Also leads to insulin resistance and diabetes Adds peripheral neuropathy to the pain syndrome

45 Cortisol Steal

46 Support for the Adrenal Glands Rhodiola Ashwaganda Licorice Root unless hypertensive Vitamin C Vitamin B5 Vitamin B6

47 Support for the Adrenal Glands Progesterone cream Pregnenolone Testosterone replacement Dehydroepiandrosterone (DHEA) Glutamine

48 Help the Body Relax Improve sleep Melatonin GABA Valerian root Passion Flower Inositol Theanine 5-HTP

49 Help the Body Relax Magnesium Muscle relaxer, relieves constipation and is involved in over 350 reactions in the body Calcium Supports the nervous system and muscle contractions

50 The Pain Model Endocrine Neurons Immune System Psychology

51 L- Tryptophan Amino acid Improves pain induced by several causes Increases serotonin in the brain Serotonin decreases sensitivity to pain Improves depression and mood Can reduce pain by 50% when used alone Can reverse opioid tolerance Dose of 3 to 4 gms per day

52 5-HTP Precursor to the formation of serotonin Serotonin responsible for relaxing the body Tells the mind that everything is ok with the world Dosage range of 100 to 300 mg Adverse Effects GI irritability, sedation, excitability

53 Vitamins B1 (Thiamine), B6, & B12 The combination of the three produced a pain response There is activity against inflammation also Related to serotonin Supports hormone metabolism

54 D-Phenylalanine Inhibits the breakdown of enkephalins (endogenous opioid peptides) Mechanism is suggested that it potentiates the endogenous opioids thus relieving pain Dose = 250mg 3 to 4 times per day

55 L-Tyrosine Essential amino acid synthesized from L-phenylalanine Serves as a precursor for the major catecholamines (dopamine, norepinephrine and epinephrine) The need for these increases with stress Precursor for thyroid hormone synthesis Dose = 500mg to 1000mg twice a day

56 GABA Gamma amino butyric acid Neuro-inhibitory Enhances the parasympathetic nervous system Similar reaction to Valium, Xanax, Ativan

57 Treating Peripheral Neuropathy Acetyl-L Carnitine Slows the nuerodegeneration and decreases excessive neuronal excitability and firing Dose = 1000mg 2 to 3 times a day Alpha-lipoic acid Antioxidant that increases neuronal blood flow, neuronal glucose uptake and improves neuronal conduction velocity Dose = 600 to 1200mg daily

58 Summary Appreciate the complexity of pain and its treatment Identify the failings of the allopathic model for treating pain Rationalize the treatment of the gut in assisting in pain management Understand the role of the endocrine system in managing pain

59 Summary Provide examples of amino acids, supplements and vitamins that can complement the efficacy of pain medications Improve the quality of life for a patient who is in pain

60 Questions???