CHRONIC PAIN

Dr. Jon Repole, D.C., N.C., H.H.P., C.P.T.

There is another way of looking at chronic “full body” pains rather than settling on a “diagnosis” or “symptom” such as: fibromyalgia, cervicalgia (neck pain), lumbalgia (low back pain), etc.


This new approach looks at all the mechanisms (THE CAUSE) within the body. Once identified, treatment can be custom tailored to provide significant decreases in pain, and any associated depression and stress that often accompanies chronic pains.



The major mechanisms that cause pain in the body include the following:

  1. Cardiovascular Health and Poor Diet 
  2. Inflammation
  3. Hormones: Cortisol and Insulin 
  4. Nerve Facilitation 
  5. Structural issues


CARDIOVASCULAR HEALTH AND POOR DIET  

Generally speaking, dysfunctional cardiovascular health and poor diet creates decreased blood supply and occlusion of the arteries supplying the joints and tissues of the body. In turn, this deprives the tissues of oxygen and nutrients resulting in degeneration and pain. The research article below demonstrates this phenomenon with the example of lower back pain. This can, of course, be correlated with all areas of the body.


Article: Atherosclerosis and Disc Degeneration/Low-Back Pain - A Systematic Review

Eur J Vasc Endovasc Surg (2009) 37, 661e670

Results: One hundred and seventy-nine papers were identified. After exclusion of case reports, letters, editorials, papers not related to the lumbar spine, and animal studies, 25 papers were included. Post-mortem studies showed an association between atheromatous lesions in the aorta and DD (Degenerative Disk), as well as between occluded lumbar arteries and life-time LBP (Low Back Pain). In clinical studies, aortic calcification was associated with LBP, and stenosis of lumbar arteries was associated with both DD and LBP. In epidemiological studies, smoking and high serum cholesterol levels were found to have the most consistent associations with DD and LBP.

Conclusion: Aortic atherosclerosis and stenosis of the feeding arteries of the lumbar spine were associated with DD and LBP.

INFLAMMATION

Inflammation has been linked to ALL disease processes from chronic pain, autoimmune diseases, depression, diabetes all the way to more severe life-threatening problems such as cancer and heart disease.


Simply put, inflammation=pain.


Food is the #1 contributor to inflammation in the body. All foods contain alive/dead micro-organisms. All processed foods contain chemicals and additives. Foods that contain the largest amount of micro-organisms will induce the largest inflammatory response by the body (see below). 70% of the body’s immune system is housed in the Gastro-intestinal tract. The role of the immune system is to distinguish friend (nutrients that are allowed to go into the blood stream) from foe (harmful chemicals, and bugs that need to be eliminated through the feces and urine).  Foods that contain the largest amount of micro-organisms will induce the largest inflammatory response by the body (see below). For example, a meal containing poultry will induce a 300 million fold increase in inflammation compared to the typical plant-based meal. Whereas, the typical average American meal will induce a billion-fold increase.


TYPICAL MEAL                               # OF MICRO-ORGANISMS              

Average American Meal                1 billion per meal

Beef, Poultry, & Fish                      336 million/serving

Ice Cream                                      225 million/serving

Cheese                                          100 million/serving

Eggs                                               37 million per egg

Plant Based Meal                          500 TOTAL!                                                  

HORMONES 

Ever wonder why cortisone injections and drugs such as codeine help with pain control?  These substances are derivatives of a hormone called cortisol which is naturally produced by the body in a gland that sits above the kidneys called the adrenals. Cortisol, in fact, is the number 1 anti-inflammatory hormone/chemical in the body. When it is not being produced appropriately such as in a condition called adrenal fatigue, there will be an increase in the amount of systemic (full body) inflammation. In turn, this increased inflammatory cascade will lead directly to pain-associated symptoms. Causes of adrenal dysfunction are many but include: stress, poor diet, under/over exercise, poor sleep hygiene, use of stimulants such as coffee and nicotine, etc. Uncontrolled sugar levels (such as insulin resistance, pre-diabetes, diabetes, syndrome X, etc.) in the blood also directly contribute to inflammation. Thus, the hormone insulin plays a critical role in pain management, as well.


NERVE FACILITATION  

If your body has been firing pain sensations over the same nerve pathways for years, it will begin to find it easier and easier to deliver these “pain messages” to the brain. This is analogous to thousands of people walking on a pathway curbed out in the woods. The more people walking on the pathway will make it easier for others to walk on.


Thus, if the cause of the original pain is not dealt with or treated, the pathway will require LESS stimuli (i.e. external trigger) in order to elicit firing of the same pain pathway that at an earlier time required MORE stimuli to fire. For example, you are doing your normal chores and are now finding that these simple tasks are eliciting an increased pain response.   


STRUCTURAL 

Structural issues will, of course, cause damage to the muscles, tissues, and joints leading to inflammatory cascade that causes pain. The most common structural issues include: spinal subluxations, sprains/strains, herniated disks, etc. These, in turn, have multiple causes including: poor work and home ergonomics, sports-related activities, yard work, etc. 


A MORE COMPREHENSIVE TREATMENT APPROACH 

There is no MAGIC bullet in the treatment of chronic pain. The best approach, however, is to apply a multi-dimensional treatment approach that compounds the effects of each treatment listed below. With a one dimensional treatment plan your success is limited in that oftentimes only ONE mechanism is being addressed.

A multi-dimensional and holistic treatment plan would include the following:

- Individualized plant-based diet

- Exercise Program (Aerobics, Strength training, Flexibility, Lymphatic, Balance and Proprioception)

- Guidance of work/ergonomics and Activities of Daily Living

- Stress Reduction targeting the Adrenal Glands and Cortisol

- Breaking the patterns of Nerve Facilitation

- Body Work (i.e. Massage) and Chiropractic Care


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