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PAIN MANAGEMENT

By Timothy Schwaiger, MA, NMD

"The mind is seldom quickened to very vigorous operations but by pain, or the dread of pain. We do not disturb ourselves with the detection of fallacies which do us no harm." - Samuel Johnson

Every person experiences some level of physical pain during his or her life. Pain not only has various causes, each person’s response to pain is unique.

During the initial consultation, it is important to establish the type of pain, degree of severity and complexity, and the underlying physiological cause. At times it is necessary to obtain x-rays or other types of imaging of the affected area(s) prior to establishing the best type of treatment. In addition to finding the “cause” it is important to address lifestyle and exercise, psychological and emotional influences and realistic goals of pain relief. Treatment always includes helping the individual achieve maximum pain relief. This may include methods of relaxation, exercise or referral to other clinicians for physical therapy, biofeedback or counseling.

PROLOTHERAPY

What is prolotherapy?

Prolotherapy is the treatment of soft-tissue damage using injections. The injections lead to inflammation in the area, and the body reacts by increasing the blood supply and releasing growth factors to the area, resulting in tissue repair. The term prolotherapy is derived from the word prolo, short for proliferation. The therapy is intended to proliferate tissue growth in the damaged area. This therapy fits well with one of the basic principles of naturopathic medicine: “the healing power of nature”.

The healing power of nature or vis medicatrix naturae is based on the principle that the body has the inherent ability to establish, maintain, and restore health. The healing process is ordered and intelligent; nature heals through the response of the life force. The physician's role is to facilitate and augment this process, to act to identify and remove obstacles to health and recovery, and to support the creation of a healthy internal and external environment.

What are the benefits of prolotherapy?

Prolotherapy is very helpful in chronic pain, especially when tendons and ligaments are involved. Many patients come for treatment when they have exhausted all options and are considering surgery. Adult patients of all ages may benefit. In addition, individuals on drugs can often go without these medications following a series of prolotherapy.

Some pain is caused by the overuse of muscles and tendons. A good example of this is something called tennis elbow. A game such as tennis requires repetitive motions of the arm and wrist. Over a period of time some individuals develop elbow pain. Usually one to two sessions of prolotherapy can resolve the problem.

Other sports can cause similar discomfort to other areas of the body. Shoulders and knees are some of the more common areas. High impact sports such as running or basketball can weaken knee ligaments. Weight lifters can experience problems related to the shoulders or upper back.

I have experienced a great deal of benefit for low back pain regardless of the cause. There have been numerous patient’s suffering from disc herniations that have been helped with prolotherapy.

What does prolotherapy involve?

Prolotherapy involves injection of a solution of dextrose (type of sugar) and Lidocaine or Procaine (anesthetic) directly into damaged ligaments or tendons. These ligaments and/or tendons attach to important bones or muscles. These areas are often weakened or stretched due to overuse or injury. This injection causes a temporary inflammation, which the body tries to heal. In this healing process, the body sends cells called fibroblasts that produce collagen. Collagen makes the ligaments and tendons stronger. This additional strength can often alleviate pain and increase strength to the area.

How many treatments do I need?

The number of injections depends on the area treated and each person’s response. Areas that are more complicated in structure usually require more injections. The back is more complex and usually involves several treatments. On the other hand, the elbow may require less.

I may order diagnostic tests such as x-rays or an MRI if the injury appears complex or if patient does not respond to treatment as expected.

Return visits usually are from three to six weeks apart depending on the severity of the problem and location. Sometimes therapy only involves a visit once every three to six months. The number of sessions and expected results will be discussed at the initial visit.

What can I expect following the treatments?

There might be pain and soreness during and after the injections. Pain usually is temporary lasting for 24 to 48 hours. This is due to the inflammation caused by the therapy. Anti-inflammatory medications are not to be used during the proliferation period. On the third to fifth day patients usually begin to feel positive results.

What other treatments are used for pain management?

ACUPUNCTURE

Traditional Chinese Medicine is based on the principles of meridians and channels. These include pathways in which the blood and Qi (pronounced chee) are circulated. Qi maintains vital activities; blood provides nutrients to bring balance back to the person. Pain syndromes are seen as stagnation or blockage in these pathways. A western or scientific explanation reveals that insertion of needles stimulates release of endorphins, which dulls pain impulses. Acupuncture is safe and carries very few if any side affects.

TRIGGER POINT

In the various types of myalgia (tenderness to a specific muscle area), injections can be made intramuscularly into the most sensitive areas. The use of Sarapin® is very safe and effective. I sometimes combine prolotherapy and trigger point therapy depending on each person’s condition.

BOTANICAL MEDCINE & NUTRITIONAL SUPPLEMENTS

Bromelain

  • Reduces need for corticosteroids; Reduces bruising, edema, healing time
  • Musculoskeletal injuries: decreases fibrin, helps promote circulation and resorption of inflammatory by-products

Cayenne: Capsicum annuum

  • Depletes substance P which is a mediator of pain impulses from periphery and inflammatory mediator in joints
  • Decreases platelet aggregation & blocks small-fiber pain

Ginger: Zingiber officianalis

  • May be the result of inhibiting the release of Analgesic effects in animals is thought to Substance P.

Turmeric: Curcuma longa

  • Depletes nerve endings of substance P
  • Inhibits leukotrienes, neutrophil inflammatory response and platelet aggregation
  • Prevents fibrin deposits, and stabilizes cell membranes

Boswellia serrata

  • Inhibits Human Leukocyte Elastase (HLE) a serine protease that triggers the inflammatory process

Corydalis

  • Anti-inflammatory in acute and chronic models, inhibits increases in vascular permeability
  • Inhibits reticular activating system similar to opioids

Essential Fatty Acids

  • Omega-3 Oils (EPA)
  • Found in cold water fish, flax seed oil
  • Convert to Series-3 Prostaglandins which reduce inflammation
  • EPA and DHA are essential building blocks for the body's anti-inflammatory prostaglandins (e.g., prostaglandin E1) and for turning off Cox-2 and the body's proinflammatory cytokines (IL-1, IL-6, and TNFa).
  • Gamma-linolenic acid, an omega-6 fatty acid, has anti-inflammatory properties.

Glucosamine Sulfate

  • Restores joint cartilage
  • Reduces swelling and pain
  • Shown to reduce arthritic pain better than NSAIDs in longterm use

Chondroitin Sulfate

  • Chondroitin sulfates provide the structural components of joint cartilage, inhibit free radical enzymes that degrade joint cartilage and collagen, and facilitate the entry of glucosamine into inflamed joints.

MSM

  • Methyl-sulfonyl-methane
  • Contains sulfur which aids in maintaining connective tissue
  • Can be helpful in all types of pain

SAMe

  • S-adenosyl-methionine
  • Aids in cartilage and connective tissue
  • Detoxification in liver
  • Enhances mood, works better when depression is a component of pain

ABOUT AUTHOR

Dr. Timothy Schwaiger graduated from Southwest College of Naturopathic Medicine. He holds a Masters' degree in Health Services Management and has more than 17 years health-related experience. His areas of specialty include child and adult health, nutrition, botanical medicine, acupuncture, homeopathy, IV therapy, hormone replacement and pain management. He utilizes prolotherapy and mesotherapy therapy or for the treatment of pain. He completed a two year residency at SCNM in Family Medicine. He is Assistant Professor and Directors of the Division of Clinical Sciences at SCNM. He served as Medical Director for the Medical Center in 2004.

Please call the Southwest Naturopathic Medical Center at 480-970-0000 for more information.

 
 
 
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