Self Care for Your Chronic Pain

The most common cause of chronic pain is the muscles and joints of the musculoskeletal system. According to a study published by the American College of Rheumatology, at any time about 75 million adults in the U.S. are affected by pain and stiffness of the musculoskeletal system. Muscle and joint pain disorders are the leading cause of work related disability among men and women aged 16 to 72 years. Also, chronic back pain is now the most common cause of disability in Americans younger than 45 years old. It is estimated by some that more than 10 million individuals struggle with the horrible pain and fatigue of fibromyalgia and the number diagnosed cases is growing.

Americans are now battling this epidemic of chronic pain by taking exorbitant amounts of Nonsteroidal anti-inflammatory drugs, often referred to as NSAIDS.  More than 70 million NSAIDS prescriptions are written each year plus more than 30 billion over-the counter tablets swallowed annually in the United States alone. If you have been seeing the news lately you know how important it is to find a more natural approach to your recurrent back, neck, extremity or headache symptoms. Research has now shown numerous side effects to the drugs we use to control our muscle and joint pain, everything from rebound headaches, liver damage, heart attacks and especially gastrointestinal bleeding.

According to the American Journal of Medicine "Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated."(1)   Food and Drug Administration suggests even higher figures, estimating NSAID use accounts up to 20,000 deaths per year in arthritis patients.(2)  According to a 2005 FDA government memorandum, between 1999 and 2003 selective COX-2 NSAIDs had injured at least 160,000 patients and killed an estimated 26,000 to 55,000 patients. It is statistics such as these that moves many individuals to pursue safe natural alternatives for their chronic muscle and joint pain disorders.

The good news is that there are now new regimes of self-treatment therapy available that are proving to be long-term solutions without the pitfalls of drug or surgical intervention. To conqueror your chronic muscle and joint pain, it’s important to know how to self treat the causes of these common problems. But first with any muscle and joint pain problem, you must have your doctor rule out all possible pathology’s such as infections, tumors or fractures. Thankfully, more than 90% of all chronic pain problems arise from dysfunction of the muscle and joints, not pathology. This muscle and joint dysfunction arises from physical and nutritional changes in your muscle and joint tissues that must both be addressed for real and lasting recovery. The primary pain-causing changes in muscle tissues are known as myofascial trigger points, but are commonly referred to as “muscle knots.”

These common myofascial trigger points are hyperirritable tissues in muscles that cause three things to happen. First, the tissue becomes locally tender and refers pain to other areas of your body, for example trigger points in the neck can create headaches and in the shoulder they can cause severe arm pains. Second, these trigger points will cause your myofascial tissue to shorten leading to the feeling of stiffness. Third, they can cause the muscle to weaken. These muscle knots causing pain, stiffness and weakness in the muscle group create alterations in your patterns of movement causing even more stress to your muscles, tendons, and ligaments leading to more myofascial trigger points. This can lead to a vicious cycle of more and more recurrent pain in your back, neck, or extremities. The pain, ache and stiffness will continue until you remove all of your active and hidden myofascial trigger points.

These pain-causing muscle knots first start out as taut muscle bands in the tissue. These tight bands are contracted and shortened muscle cells that obstruct good blood flow in the muscle tissue. This lack of blood in the muscle tissue means there is a lack of adequate oxygen and nutrition. A lack of oxygen and nutrients in the taut bands causes the muscle tissue to run low on energy. With this low energy state any added physical, nutritional, chemical or emotional stress to the tissues will cause painful myofascial trigger points to form. These myofascial trigger points are made up of dysfunctional muscle cells and sensitized free nerve endings that create a painful nerve reflex.

Because it actually takes energy to relax contracted muscle cells, this lack of energy in the trigger points means muscle cells can not release on their own. In this way the myofascial trigger points can become a self-sustaining vicious cycle until manually released. To accomplish this you need to apply deep sustained digital pressure to these knotted up trigger points to change the state of the tissue. Research has shown that sustained deep pressure on the point changes the tissue releasing the pain-causing muscle knots. This is called trigger point therapy, myofascial release, pressure therapy or acupressure. By creating these physical changes in these muscle knots utilizing sustained pressure you substantially increase blood flow into the muscle tissue. This brings in much needed oxygen and nutrients to the muscle cells. The muscle tissue can then produce more energy allowing it to relax. You can see why just rubbing the surface with a lotion or a vibrating massager isn’t adequate to fully remove pain-causing trigger points.

As effective as trigger point therapy is, to truly be effective it takes repeated treatments over time with stretching of the myofascial tissue after each treatment. The problem with this is that it can become expensive to have someone properly do this for you over the many treatment sessions that are necessary for real and lasting relief. This is especially true when a doctor or therapist actually spends the time releasing all the active and hidden trigger points involved in a chronic back pain, neck pain, or shoulder-arm pain problem. The answer is to turn this amazingly effective therapy into a home-care program with a self care trigger point tool.

There are many hand held devices in the shape of a large hook to reach around your body and pressure trigger points. With these devices you have to pull with your upper extremities to apply effective pressure on your muscle knots. There are also products that allow you to lie down and apply pressure by using a portion of your body weight if against a therapeutic digit. One of these products utilizes a stable platform with interchangeable soft rubber tipped therapeutic digits of various lengths and sizes to self treat your trigger points. Before starting any self care program please check with your doctor first. There are also many good books in print to assist you in your endeavor in trigger point self-care. One book that I highly recommend is my own titled “Why We Hurt”, which goes into great detail on how to find and treat these pain causing myofascial trigger points.

After checking with your doctor and doing some research, if you're still curious to see if you would respond to this type of self care therapy you can try utilizing either a tennis ball or golf ball to apply pressure to your trigger points. Start by slowly resting the targeted trigger point against a tennis ball or golf ball. Relax into the ball to produce a sustained pressure creating a mild local discomfort with a distinctive pattern of referral pain, which will usually be similar to the symptoms of your complaint. Treatment is useless if you tense the involved muscles in order to protect the trigger point from pressure, as this will cause spasms and aggravate your condition.
If the treatment is properly applied, generally the local discomfort and referral pain will abate within 30 to 60 seconds. As this tolerable discomfort lessens, you may get a sensation of your pain causing trigger point releasing or "melting away." Go easy! Release of the muscle knot can bring you pain relief, increased flexibility and improved performance. Excessive pressure can irritate the tissues and cause increased excitation of nerve receptors, thus increasing spasms and pain. A mild state of discomfort while performing the therapy is ideal. Ideal therapeutic pressure depends upon many factors, your age, health status, level of toxicity and inflammation of your tissues.  

In conjunction with this it is vital to improve your diet by removing junk foods and increasing your intake of fruits and vegetables. Also it’s important to exercise, consider walking 20 to 30 minutes per day. You can spice-up your pain-relief wellness program to assist in overcoming your muscle and joint pain problems by utilizing specific herbal extracts and needed nutrients to improve metabolic function!
  
(1) Singh Gurkirpal, MD, "Recent Considerations in Nonsteroidal Anti-Inflammatory Drug Gastropathy", The American Journal of Medicine, July 27, 1998, p. 31S
(2) Fries James F., "NSAID Gastropathy: The Second Most Deadly Rheumatic Disease? Epidemiology and Risk Appraisal", Journal of Rheumatology, 1991, (Supplement 28), Vol. 18, pp. 6-10

Joint Health

According to the World Health Organization, DJD or degenerative joint disease is one of the top 10 global disease burdens in the world today. Approximately 1 in 3 adults between 25 to 74 years old in the US have radiological evidence of Osteoarthritis (OA) in at least one joint. In the US, 25% of all visits to primary care physicians and half of all NSAIDs prescriptions are for OA. However, degenerative joint disease is not an inevitable consequence of growing older. It develops when trauma, and/or biochemical changes trigger a shift between joint cartilage synthesis and degradation.(1) Primarily, when the cartilage synthesis of any joint cannot keep pace with the background degradation of the cartilage, the joint will degenerate. Two very important factors in the joint play a primary role in joint deterioration. The first factor is the reduction in proteoglycan production in the joint cartilage. The second factor is the rate of production of inflammatory catabolic cytokines in the chondrocytes and synovial cells.(2) The driving force behind these two factors is of course multifactorial, but genetics play a primary role, which is influenced by the quality of the macro and micro nutrient intake of the individual.

Low vitamin D levels are now linked to multiple health problems, including degenerative disc disease of the spine.(3) A 2006 study showed that an inherited polymorphism of a vitamin D receptor in the spinal disc was associated with a high risk of degenerative disc disease and disc bulge developing, especially in individuals younger than 40 years.(4) In a future Clinical Update, I will dedicate an entire issue to the importance of and clinical use of vitamin D3.

Early Assessment of Optimal Joint Health
Even in today's "modern medicine", early diagnosis of degenerative joint disease is still based on keen clinical observation and radiographic changes. However, when you make the diagnosis at this point, your patient has already fully developed the disease. There has always been the hope of finding inexpensive clinical lab tests that would help indicate when a patient is heading for degenerative joint disease. From the previously cited studies, low Vitamin D3 levels may be indicative of spinal degeneration problems in the future. It may be prudent to keep your patients' serum levels of Vitamin D, 25-hydroxycalciferol above the 40 ng per milliliter.

However, exciting work is now being done on the diagnostic relevance of high sensitivity C reactive protein to osteoarthritis. New ultrasensitive methods for C-reactive protein (hsCRP) have improved the usefulness of this marker, especially in the assessment of systemic inflammation. One study found that patients with erosive OA averaged hsCRP levels of 4.7mg/L, and individuals with non-erosive OA averaged 2.2 mg/L.(5) What is important to realize here is that both patient groups were above the threshold for increased risk for systemic inflammation, and the erosive OA group was well above the significant risk profile. What is indicated here is that patients well above ideal levels of hsCRP of 0.5 mg/L may be on the road to the development of osteoarthritis. Fibrinogen is also an inexpensive clinical marker of low-grade systemic inflammation in the tissues and may be helpful in assessing the risk for the development of degenerative joint disease.

Nutritional Support for Healthy Joints
To properly treat the underlying metabolic causes of degenerative joint disease, it is vital to treat the underlying chronic catabolic inflammation, oxidative stress, and poor cartilage repair. For the management of the inflammatory catabolic cytokines of degenerative joint disease, concentrated standardized herbal extracts of Ginger, Curcumin, Nettle leaf, and Boswellia have been shown to help manage this inflammatory cascade. Specifically, standardized extracts of these herbs have been shown to manage the pro-inflammatory cytokines and prostaglandins involved in the pain, swelling, and cartilage destruction of OA. These herbs also reduce oxidative stress and support healthy and muscle joint tissue function. To help improve your management of inflammatory catabolic cytokines it is beneficial to combine these standardized herbal extracts with high levels of EPA/DHA fatty acids.

To help improve proteoglycan production and cartilage synthesis in the joints, supplement 1.5 to 2 g of glucosamine sulfate. Glucosamine sulfate has been found to stimulate the synthesis of GAGs, proteoglycans, and collagen within the joint complex. It has also been shown to support healthy synovial fluid through synthesis of hyaluronic acid, which may increase the mobility of joints and enhance their lubrication. It may also assist in the inhibition of many enzymes that break down the cartilage matrix.

For best results always combine nutraceuticals that manage inflammatory catabolic cytokines and those that promote proteoglycan production and cartilage synthesis. To be successful, make sure these nutraceuticals contain sufficient quantities of quality ingredients. Standardized extracts of ginger should reach 2 g per day and Curcumin a minimum of 1 g per day to reach clinical results. Research studies also show that glucosamine should reach levels of 1 to 2 g daily to be effective and chondroitin should reach approximately 1000 mg. As you can see from these studies, it is vital to get formulations that are highly concentrated. Both products should be supplemented for a minimum of 12 weeks before therapeutic effects can be evaluated.

Copyrighted 2007 by Dr. Greg Fors-Article or portions of this article cannot be used without the authors permission click here to obtain permission
1. Silver FH, Bradica G, Tria A. Relationship among biomechanical, biochemical, and cellular changes associated with osteoarthritis. Crit Rev Biomed
2. Notoya K, Jovanovic DV, Reboul P, Martel-Pelletier J, Mineau F, Pelletier JP. The induction of cell death in human osteoarthritis chondrocytes by nitric oxide is related to the production of prostaglandin E2 via the induction of cyclooxygenase-2. J Immunol. 2000 Sep 15; 165(6):3402-10
3. Videman T, Gibbons LE, Battie MC, et al. The relative roles of intragenic polymorphisms of the vitamin d receptor gene in lumbar spine degeneration and bone density. Spine. 2001 Feb 1;
4. Cheung KM, Chan D, Karppinen J, ET. Al. Association of the Taq I allele in vitamin D receptor with degenerative disc disease and disc bulge in a Chinese population. Spine. 2006 May 1; 31(10):1143-8.
5. Punzi L, Ramonda R, Oliviero F et al. Value of C reactive protein in the assessment of erosive osteoarthritis of the hand Ann Rheum Dis. 2005 Jun; 64(6):955-7

"To Sleep, Perchance To Dream-Ay, There's The Rub."

By Dr. Greg Fors, DC / Board-certified Neurologist

Many Americans no longer enjoy the pleasure of sleep. The National Institute of Health (NIH) estimates more than 70 million Americans are affected by sleep problems, and a new class of sleep drugs called sedative/hypnotics, such as Ambien, Lunesta and Sonata has taken America by storm. These drugs were originally designed for short term use only, no more than 1 to 2 weeks. In just four years (2000 to 2004) the use of sleep medications doubled among adults age 24 to 44 and increased by 85% for children aged 10 to 19.

A recent study financed by the NIH found that sleeping pills like Ambien, Lunesta and Sonata only reduced the time it took to fall asleep by 13 minutes and increased the total sleep time by 11 minutes when compared to a placebo. Individuals in the study thought they had slept 32 minutes longer than they actually had because of a drug induced anterograde amnesia. In other words when people wake up after taking sleeping pills they simply forget they are unable to sleep. Americans now spend more than $5 billion a year on drugs to help them forget they are unable to sleep restfully.

The most commonly reported problems with sleep hypnotics like Ambien include daytime drowsiness, diarrhea, and coordination problems. These medications work as a central nervous system depressant leading to decreased inhibition causing aggressiveness, agitation, bizarre behavior and depolarization in some individuals. Visual and auditory hallucinations have also been reported. There have been numerous reports of people taking these medications and driving their cars, preparing and eating food, making phone calls and having sex while not fully awake and having no memory of the event. Ambien actually now ranks among the top 10 drugs found in the bloodstreams of impaired drivers.

Using these sleep hypnotics like Ambien for more than 7 to 14 days can cause a chronic sleeplessness that is actually worse than the original insomnia. Use of these sleep medications for more than four weeks can damage to the stages of sleep as well as cause addiction, actual physical dependence and withdrawal once you stop taking them. Also these sleep hypnotics like Ambien slow down your brain's activity. When you stop taking Ambien, activity in the brain can rebound out of control and actually cause seizures. This is why it is important to seek medical help when you stop taking drugs like Ambien.

So why do Americans continue to take these addictive damaging drugs, no doubt because everyone treasures a peaceful restful sleep. What is puzzling to me as a doctor is why no one asks the question why am I not sleeping? The simple answer is that it takes a healthy brain to generate a healthy sleep! It is specific areas of your brain that produce the cycles of sleep just like there are areas of the brain that generates a peaceful and happy mood. If the brain is lacking needed nutrients or if something is causing metabolic damage to optimal brain function this will lead to sleep and mood disorders.

To actually have restful sleep again you must look to optimizing your brain health. We can now see that drugs do not heal this problem they simply create more complex health issues. A better choice is to address the underlying nutritional and metabolic issues. There can be food allergies, toxic chemicals and toxic metals in your environment that need to be identified and removed. Usually there are decreased levels and/or genetically an increased need for various nutrients: e.g. vitamins, minerals, anti-oxidants, and essential fatty acids that must be restored, to assist in repair of the metabolic dysfunction related to sleep disorders. It is also vital to test for and treat any hormonal imbalances such as adrenal dysfunction and high nighttime cortisol levels. Added to this proper dosage of melatonin and specific herbal extracts utilized by a knowledgeable doctor can help restore restful sleep, naturally!