Book Notes: Pain Free 1-2-3

Appendix A: Summary and Flowcharts for Quickly Evaluating Your Pain and Determining How to Treat It

In this section:

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Section 2: Neuropathic Pain

1. Neuropathies are characterized by pain that is burning, shooting (often to distant areas), or stabbing. It also has an “electric” quality about it. “Tingling or numbness” (paresthesias) and increased sensitivity, with normal touch being painful (allodynia), are also commonly seen.

2. Neuropathic pain can come from malfunction of nerves or the brain (e.g. diabetes, low thyroid, etc.), infections (e.g. shingles), pinched nerves, nutritional deficiencies (e.g. vitamins B6 and B12), injury (e.g. stroke, tumors, spinal cord injury, and multiple sclerosis), and medication/treatment side effects.

3. Do blood testing to check for diabetes, low thyroid, or vitamin B12 deficiency.

4. Nutritional support is critical! This can be done simply by taking the Energy Revitalization System vitamin powder/B complex plus lipoic acid, 300 mg, 3 times a day.

Types and Causes of Neuropathic Pain

1. Diabetic Nerve Pain. Be sure to take the vitamin powder and B complex capsule because vitamins B6 and B12, as well inositol, can be very important for nutritional support. Take lipoic acid, 300 mg, 3 times a day. Then follow the directions below for nerve pain as needed.

2. Did the pain follow an attack of shingles/herpes zoster (a linear painful rash on one side of your body)?

If yes, consider Postherpetic Neuralgia and treat with Lidoderm® patches and a gel containing a combination of Neurontin® and Ketamine®. If pain persists, take Neurontin® and Elavil® orally with the other medications below as needed.

3. Nerve Compression. This is often a muscular problem with the tight muscles pinching the nerves. See Chapter 9 for the treatment of muscle tightness. If the pain is from disc disease, intravenous colchicine, 1 mg once or twice weekly for a total of 6 to 8 doses will usually eliminate this pain .

4. Does your pain manifest as horribly severe pain in one hand or foot (often following trauma to that extremity or the associated hip/shoulder) so that you make sure no one touches it?

If yes, consider Reflex sympathetic dystrophy (CRPS). Treat this with Neurontin® (at least 2400 mg daily), Elavil® (25 mg at bedtime), topical gels containing high levels of Ketamine®, and Lidoderm® patches. For refractory cases consider intravenous Ketamine®.

5. Is the pain excruciating, consisting of attacks of pain in the lips, gums, cheek, or jaw, usually lasting no more than a few seconds or minutes? Do the painful attacks also recur frequently throughout the day and night for several weeks at a time (usually occurring in the middle-aged and elderly)?

If yes, consider trigeminal neuralgia (tic douloureux). Begin treatment with Tegretol®, 100 mg a day (taken with food), and increasing slowly up to 200 mg 4 times a day as needed. This eliminates the pain in 75 percent of patients. Nutritional therapies can also be helpful and I recommend beginning with the vitamin powder and lipoic acid, 300 mg 3 times a day. Several studies have shown that giving niacin (nicotinic acid 100 to 200 mg IV daily for several days) and vitamin B1 intravenously can also help. The other treatments listed below can also be helpful. If these treatments fail, surgical options are available.

General Principles for Treating Neuropathies/Nerve Pain

Many medications can be helpful for nerve pain. Allow them each 2 to 6 weeks to start working. If pain is severe, you may want to begin with Ultram® or narcotics immediately, as well as topical treatments, which will let you be more comfortable while waiting for these other therapies to work. For small areas, begin with the Lidocaine® patch (Lidoderm®). Up to 4 patches can be used at a time, and they can be left on for 12 to 18 hours a day (leave the patch off for at least 6 hours daily). You can add topical gels or use them instead of the patch. Consider putting the patch over the gels. It can take 2 weeks for these to work. For large areas, or if topical/local treatments are not effective, use the oral medications below. They can be tried in the order listed. Appendix B: Treatment Protocol gives directions for using each medication. It may take 2 to 6 weeks to see the effect of a given treatment.

If pain is severe, you can try 2 medications at a time so that you can get relief more quickly. This is especially true if you’re combining a topical and an oral medication. It may take a higher dose of medicine to eliminate nerve pain than for other types of pain. Side effects are less likely if you start with a lower dose and work your way up as is comfortable. If the first treatment for any given family (number) is helpful but poorly tolerated, try the next one in the same group. If the medication does not help significantly, skip down to the next numbered treatment (i.e. if medications for level 1A help but have too many side effects, try level 1B. If 1A simply does not help, go to treatment group 2).

Treatment Order for Neuropathies

Begin with the vitamin powder and lipoic acid, 300 mg, 3 times a day. For localized areas add the Lidoderm® patch and pain gels (effects seen in 2 weeks). Begin all these simultaneously as well as:

1A. Neurontin®—may take 2400 to 3600 mg daily for nerve pain
1B. Gabatril®—average effective dose for nerve pain is 16 mg a day

2. Tricyclic anti-depressants, 10 to 50 mg at bedtime
2A. Elavil®

2B. Tofranil®

2C. Nortriptyline®

2D. Doxepin®

3A. Effexor®, 75 mg 3 times a day

3B. Paxil®, 20 to 80 mg per day

4. Ultram®, 50 mg, 1 to 2 tablets up to 4 times a day. Four tablets a day works very well. Above this dose sometimes causes nausea. It can start to work immediately.

5. Topamax® (Topiramate®), 200 to 300 mg a day. Side effects are less if you start with a low dose and work up.

6. Lamictal® (Lamotrigine®), 300 to 400 mg a day. Lower doses are less likely to be effective.

7. Zanaflex®, although more likely to be helpful for muscle pain at a dose of 4 to 8 mg daily, it can help nerve pain in doses of approximately 24 mg a day.

8. Keppra®, 1000 to 1500 mg, 2 times a day

9. Trileptal® (oxcarbazepine), usually requires approximately 150 to 300 mg twice daily

10. Dilantin®, 100 mg, 3 to 4 times day

11. Narcotics

12. Benadryl®, 25+ mg, 3 to 4 times a day

As you can see, there are many treatments that can eliminate nerve pain.

Section 3: Fibromyalgia and Myofascial Pain Syndrome

See Section 1 The Basics.

1. Fibromyalgia and myofascial (muscle) pain syndrome are associated with shortened, tight muscles. In fibromyalgia, the pain is widespread, with pain being present in both the upper and lower and left and right portions of the body. It is also usually associated with fatigue and insomnia. Myofascial/muscle pain is more likely to be localized in one or two areas. In these situations, pain often comes from a structural problem (i.e. an uneven leg length or repetitive stress injuries). Pushing deeply on the area reproduces the pain.

2. To release the muscles and eliminate pain, four key areas need to be treated. These are sleep, hormonal support, nutritional support, and the treatment of underlying infections. For localized pain, structural or other triggers should also be looked for and eliminated. If you do this, you have a 91 percent chance of improving (see the study at www.vitality101.com).

3. For nutritional support take the vitamin powder long-term. Add NAC, 500 to 650 mg, coenzyme Q10 (use the Vitaline® form) 200 mg, and acetyl l-carnitine 1000 mg a day for 3 to 4 months if you have fibromyalgia.

4. For sleep, take the Revitalizing Sleep Formula combined with medications, as needed, to get at least eight hours of sleep a night. Excellent medications for sleep include Ambien®, Klonopin®, Trazodone®, Soma®, Zanaflex®, doxepin, and Elavil®.

5. Most patients with fibromyalgia benefit from a trial of thyroid hormone. If you have low blood pressure, irritability that goes away with eating, crash with stress, or have an elevated sedimentation rate blood test, I recommend adrenal support with Adrenal Stress End and Cortef®.

6. Treat the underlying infections—especially yeast. If you have bowel symptoms or nasal congestion/sinusitis, yeast overgrowth is especially likely (although controversial). Treat yeast by avoiding sugar (except for chocolate), taking Acidophilus Pearls, Phytostan®, and Citricidal®. You can also take nystatin and Diflucan®. If you have a recurrent low-grade fever or lung congestion, consider the antibiotics doxycycline or Cipro®. If you have bowel symptoms, perform a stool test for parasites at the Great Smokey Mountain Labs.

7. For symptomatic relief while waiting for the underlying problems to be eliminated, a number of medications can be helpful. These do not include Tylenol® (which can deplete a critical nutrient called glutathione) or NSAIDs (like Motrin®), which are only effective approximately 10 percent of the time. Instead, Celebrex® is much more likely to be helpful, even though it has similar mechanisms of action. Other medications that are very helpful include Ultram®, Skelaxin®, Neurontin®, Baclofen®, Zanaflex®, Permax®, and a not yet released medication called Pregabalin®.

Section 4: Arthritis

1. Do not presume that joint pain is arthritis. Joint pain can also come from the muscles, tendons, and ligaments around the joint. This is so even if x-rays are abnormal.

2. The most common type of arthritis is osteoarthritis, known as “wear and tear arthritis.” The joints mainly affected by osteoarthritis are the finger, knee, and hip joints. There may be joint deformities, but there should not be inflammation.

3. If inflammation is present, consider rheumatoid or infectious arthritis. In these situations, in addition to standard treatments, I recommend adding the antibiotic doxycycline, 100 mg twice daily, and an anti-inflammatory diet low in meat and high in fish oil. It is a good idea to take fish oil (1 to 2 Tbsp daily) as well. Many other nutrients are also critical, so be sure to take the vitamin powder.

4. If you have psoriasis or “pitting” in the fingernails, which looks like someone stuck a needle tip into several places in the nails (even without the skin changes/rash), your arthritis may be from the psoriasis.

5. If you have an elevated uric acid blood test and sudden pain and swelling in the joints (especially the big toe), consider gout. The NSAID medications plus colchicine can work well for the acute phase. Allopurinol® can be used to prevent further attacks. Your doctor is likely to be familiar with the treatment for gout.

6. I recommend you begin with a natural treatment program, which will decrease inflammation and help to repair the joints. This treatment has four main components:

A. Repair. The joint cartilage can be repaired using a combination of glucosamine sulfate (most important, 500 mg 3 times a day for at least 6 weeks), MSM (3 to 6 grams a day), and Condroitin® (less important). It is also critical that you get the other nutrients present in the vitamin powder to promote wound healing. The powder naturally increases your SAMe levels. Increasing these levels has been shown to help arthritis. After 6 weeks, this combination decreases pain.

B. Use other anti-inflammatories to prevent damage and decrease or eliminate pain. I recommend a combination of several natural remedies, many of which can be found in combination. The mix I like the most combines boswellia, willow bark, and cherry (all present in the End Pain formula). It takes 6 weeks to see the full effect. Begin with two capsules three times a day for 2-6 weeks until your pain is controlled. You can then lower the dose.

C. Restore function with stretching, exercise, weight loss, and heat. Exercise at least twenty minutes a day. Swimming, walking, and yoga are good choices. Use a heating pad or moist heat for up to 20 minutes at a time to give relief.

D. Rule out and treat infections and food allergies that can aggravate arthritis. Most blood tests (except the ones from Elisa Act Technologies) are not reliable. NAET (see http://www.naet.com/) is a wonderful way to test for and eliminate food sensitivities. A related technique called JMT (see www.jmt-jafmeltechnique.com) is also an excellent way to treat rheumatoid and osteoarthritis naturally using energy medicine.

7. For symptomatic relief, prescription therapies, including NSAIDS such as Motrin®, COX 2 inhibitors like Celebrex®, Tylenol®, Lidoderm® patches and Ultram® can all be helpful.

Section 5: Inflammatory Pain

1. Inflammation is a common cause of pain and many other medical problems that we experience in Western society. For example, anything that ends in the letters “-itis” means that the problem is inflammatory. This includes things like arthritis, tendonitis, bursitis, spondylitis, appendicitis, etc.

2. Many inflammatory problems cause a secondary fibromyalgia, which may be causing most of the symptoms. If you have widespread pain, fatigue, and insomnia, look for and treat the associated fibromyalgia.

3. Much of our increased tendency to inflammation occurs because of the high amounts of animal fats relative to fish and vegetable oils in our diets. Increasing fish, nuts and seeds, berries, free range chicken and grass fed meats, spices and herbs, and green leafy vegetables (not potatoes and grains) can be a helpful start if you want to decrease inflammation.

4. For acute injury, remember the old standbys. These have the initials R.I.C.E., which stand for Rest, Ice, Compression, and Elevation.

5. In addition to dietary changes, natural remedies can be helpful in settling down inflammation. These include antioxidants, which are abundantly present in the vitamin powder. In addition, fish oil can be helpful. Begin with 1 to 2 tbsp daily. You can then lower the dose to 1 tsp a day after 2 to 6 months as the inflammation settles. Many herbals such as willow bark, boswellia, and tart cherry are also excellent. These three herbals are all present in the End Pain formula – see Appendix C).

6. Anti-inflammatories like Motrin® and Celebrex® can be helpful but are more likely to cause side effects and long-term problems. Natural therapies are safer and more likely to help heal the body over time, while also decreasing pain.

Section 6: Osteoporosis and Bone Pain/Fractures

1. Taking calcium plays only a modest role in improving bone strength. Take 1000 to 1500 mg per day (with evening meals or at bedtime, and not within 6 hours of taking thyroid hormone).

2. Also take the vitamin powder, which contains magnesium, boron, folic acid, copper, manganese, zinc, and vitamins B6, B12, D, and C, all of which are important in treating osteoporosis.

3. Take strontium, 680 mg per day as well. This nutrient can markedly increase bone density by 4 to 7 percent a year safely and inexpensively. It can also help osteoarthritis. Take it on an empty stomach in the morning at a different time than the calcium.

4. DHEA, testosterone, and estrogen replacement (use the safer, natural forms—the problems reported on in the media are predominantly with synthetic forms) can also help.

5. Fosamax® (Rx), 70 mg once a week can also help.

Section 7: Cancer Pain

1. It is unacceptable for cancer patients to be in pain, and the treatments discussed in this book can also be helpful in eliminating cancer pain. Most pain is coming from tissue/nerve invasion or muscle spasm. Treat these pains as discussed elsewhere in the book (see Chapter 22 on prescription therapies).

2. It takes much less medication to prevent pain than to make it go away once it occurs. Because of this, if you have chronic pain, take the medication before you expect the pain to hit (or at first sign of it coming back) instead of waiting for it to be severe. You’ll need less pain medicine and have fewer side effects.

3. I recommend that any patient with a significant cancer order a search of medical studies done on their specific type and stage of cancer from Health Resources (Call Jan Guthrie at 800-949-0090 for more information). I have seen “incurable cancers” go away when the patient combines the best of standard and complementary therapies.

4. For uncontrollable nausea, use ABHR cream (applied to an area of soft skin, such as the wrist). This prescription cream can be made by compounding pharmacists, who can also guide you in its proper use. It contains lorazepam, Benadryl®, Haldol®, and metoclopramide.

5. Treatments that improve bone density (see osteoporosis above) may decrease bone pain as well.

Section 8: Headaches

1. Tension Headaches cause moderate pain on both sides of and across the forehead, tend to both start and fade away gradually, and are the result of muscle tightness in the sterno-cleidomastoid muscles of the neck. If the pain is coming from the suboccipital muscles at the base of the skull, the pain is often behind the eyes and/or on top of the head.

2. Because tension headaches are muscular, the same treatments discussed in Chapter 9 that cause your muscles to relax will often eliminate the recurrence of these headaches. Paying attention to structural factors can also help.

3. Many medications can be used to prevent chronic tension headaches. These include anti-depressants such as Remeron®, 15 to 30 mg, or Elavil®, 10 to 50 mg at bedtime.

4. To treat the acute pain of headaches, begin with herbal remedies such as the End Pain formula, which contains willow bark, boswellia, and cherry. This can be helpful for acute attacks, but it takes 2 to 6 weeks to fully kick in. A physical therapy technique called stretch and spray, which approximately 10 percent of physical therapists are familiar with, is also an excellent and pain-free way to release your muscles and eliminate a tension headache. In addition, there are the old standbys of Tylenol® and Motrin®/Advil®. Other medications that can be quite helpful include Midrin® and Ultram®. I would begin with the natural therapies first, however, as I think these are both more effective and safer.

Migraine Headaches

1. These headaches can be very severe and usually last for several days. Migraines are often preceded by an “aura,” which may consist of visual disturbances such as flashing lights. And the headaches are often associated with nausea, sweats, dizziness, and light and sound sensitivity.

2. In the U. S., medications in the Imitrex® family still remain the first choice for the treatment of acute migraines. A combination of indomethacin (a “super-aspirin”), prochlorperazine (for nausea and to enhance absorption), and caffeine in suppository form is commonly used in Italy (it can be made up by compounding pharmacies). Midrin®, which is a mix of three medications, can also be effective. Take two capsules immediately followed by 1 capsule every hour until the headache is relieved (to a maximum of 5 capsules within a 12 hour period).

3. A fascinating study can guide you on when to use Imitrex® family medications vs. when to go with other therapies. Seventy-five percent of migraine patients get painful sensitivity to normal touch (e.g. from eyeglasses) around their eyes. Studies showed that when participants used Imitrex before the tenderness/pain around the eyes began, it knocked out the migraine 93 percent of the time. If the pain/tenderness around the eyes had already set in, Imitrex only eliminated the migraine 13 percent of the time, although it still helped the throbbing. In other words, if you are one of the lucky ones who does not get pain around the eyes, the Imitrex can knock out your migraine at any time. If you are one of those who do get pain/tenderness around the eyes, it is a race against the clock to take the Imitrex before the pain starts. This means take the Imitrex early in the attack (the first 5 to 20 minutes) before the skin hypersensitivity gets established. For example, use it at the earliest warning signs, like painful scalp or discomfort from your wearing glasses or earrings or from shaving. If pain has already fully set in before you take the Imitrex, consider using one of the other treatments.

4. Anti-nausea medications can also be helpful. Phenergan® or Compazine® suppositories can be helpful. Another excellent anti-nausea alternative is ABHR cream, which is applied to an area of soft skin, such as the wrist. This prescription cream can be made by compounding pharmacists, who can also guide you in its proper use. It contains lorazepam, Benadryl®, Haldol®, and metoclopramide.

5. Butterbur is an herb that can both prevent and eliminate migraines. Take 50 mg 3 times a day for 1 month and then 1 50 mg dose twice a day to prevent migraines. You can take 100 mg every 3 hours to eliminate an acute migraine. In the hospital emergency room or doctor’s office, intravenous magnesium can very effectively and quickly eliminate an acute migraine.

6. For patients with severe migraines who often need to go to the hospital emergency room, and if the above treatments are not adequate, it is helpful to have a “rescue medication” that can be used at home. ACTIQ (fentanyl lollipops) can be used at home and are as effective as intravenous morphine. The average dose needed is 800 mcg.

Migraine Prevention

1. Natural therapies can prevent many, if not most, migraines. I would begin by taking the Energy Revitalization System vitamin powder plus 300 mg of Vitamin B2 in the morning, plus 200 mg of magnesium at night. If the cost is not prohibitive, add butterbur, 75 mg 2 times day (you can use 100 mg once a day but it is not as effective). Natural approaches can help eliminate even frequent and horribly severe migraine problems, but remember that it usually takes 2 to 3 months to see the effect. So give them time to work.

2. Avoiding hidden food allergies can reduce or eliminate migraines in as many as 85 percent of patients. The most common reactive foods are: wheat in 78 percent of patients; oranges in 65 percent; eggs in 45 percent; tea and coffee in 40 percent each; chocolate and milk in 37 percent each; beef in 35 percent; and corn, cane sugar, and yeast in 33 percent each. Clinical experience also suggests that the artificial sweetener aspartame (NutraSweet®) can trigger migraines and other headaches, although this is controversial. You may find that instead of avoiding foods that trigger your migraines for the rest of your life, you can eliminate the sensitivities/allergies using a powerfully effective acupressure technique called NAET (see http://www.naet.com/).

3. If the migraines are predominately around your periods or associated with taking estrogen.

4. Prescription therapies for prevention can reduce the number of headache days per month by an average of 50 percent. These include Neurontin®, beta-blockers (Inderal®—avoid this if you have asthma or fatigue), calcium channel blockers, Depakote®, Topamax®, Elavil®, and Doxepin®.

Other Headaches

1. Sinusitis is another common cause of headaches. It is usually associated with pain and tenderness over the sinuses, by the cheeks, or above the eyes. Nasal congestion, often with yellow/green nasal mucus, is also common. Interestingly, we have found that most cases of chronic sinusitis are caused by fungal overgrowth in your body, especially your bowels, which can then cause gas, bloating, diarrhea, or constipation. Chronic sinusitis routinely resolves when we treat it with Diflucan® and the other yeast/anti-fungal therapies. It is also helpful to use a special prescription nose spray that contains anti-bacterials and anti-fungals. Your doctor can order it by calling Cape Apothecary at 410-757-3522. Use 1 to 2 sprays in each nostril twice a day. Silver spray taken with it can also be effective.

2. Caffeine withdrawal headaches are common in people who drink a lot of coffee. It is especially common in the morning before people get their coffee “fix” and often occurs approximately 18 hours after the last cup of coffee. Weaning off excess caffeine is the solution.

3. Cluster headaches occur as a repeating series of headaches that can each last 30 to 90 minutes and are very severe. They cause excruciating, piercing pain on one side of the head (often centered around one eye) and are much more common in men. Many medications can help. These include anti-seizure medications like Valproic Acid, 500 to 1000 mg a day, or Topamax®, 50 to 100 mg a day. These often start to work in 1 to 2 weeks.

4. Trigeminal Neuralgia is characterized by excruciating attacks of stabbing, shooting pain in the lips, gums, cheek, or chin that last for a few seconds to minutes. It occurs almost exclusively in the middle-aged and elderly. It often responds well to treatment with the medications Tegretol® and/or Neurontin®.

5. Temporo Mandibular (Jaw) Joint Dysfunction (TMJ/TMD) is a common cause of facial pain and headaches. Although classically considered to come from the jaw joint (the area just in front of your ears), in many cases the pain is actually coming from tightness of the Masseter muscles. Following the principles discussed above for myofascial/muscle pain (and information in Chapter 13) will often make this pain go away.

Section 9: Back Pain

1. By eliminating the tissue swelling using intravenous colchicine, disc pain can be eliminated approximately 70 percent of the time without surgery. Sciatica, or back pain in which the pain goes down the leg, is often a form of disc disease.

2. Sleep on a medium firm mattress instead of a firm mattress.

3. Add glucosamine sulfate, 1500 mg a day and Chondroitin® sulfate, 2500 mg per day. Give it a 6 to 12 week trial.

4. Lamictal® and/or Lidoderm® patches can also be helpful in reducing back pain.

5. Most other back pain, unless it is coming from your chest or abdominal organs (which is rare and usually can be found by your internist) is muscular, arthritic, or from ligaments. Using the treatments in Chapters 9 and 10 on myofascial pain and arthritis, and also taking care of any underlying structural/ergonomic problems, can routinely eliminate this pain. In addition, chiropractic (see Chapter 21), Prolotherapy (see Chapter 23) and mind-body approaches developed by Dr. Sarno (see Chapter 24) can also be helpful, as can many forms of bodywork.

Section 10: Indigestion and Digestive Enzymes

1. Indigestion is usually not caused by excess stomach acid. Due to poor digestion or stomach infections, any stomach acid can hurt. Although it helps you feel better in the short-term, turning off stomach acid long-term can markedly worsen digestion and overall health. Food processing (used to prolong grocery store shelf life) destroys the digestive enzymes present in food. This contributes dramatically to indigestion. Coffee, alcohol, and aspirin/Motrin® products can also cause indigestion and ulcers.

2. To get off of acid blocker medications comfortably do the following for 4 to 8 weeks:

A. Use plant-based digestive enzymes (e.g. Complete Gest by Enzymatic Therapy). Taking 2 capsules with each meal will help you digest your food properly. In addition, drink warm liquids with meals, because cold liquids inactivate your digestive enzymes. If the enzymes are irritating to the stomach, switch to a brand called GS Similase until your stomach feels better.

B. Take mastic gum (any brand), 1000 mg twice a day for 2 months, then as needed.

C. Take DGL Licorice, 380 mg (not the sugar-free type) from Enzymatic Therapy or Rhizinate from PhytoPharmica. Chew 2 tablets 20 minutes before meals.

D. Take Heartburn Free. After your stomach is feeling better, take 1 capsule every other day for 20 days. It may initially aggravate reflux, but 10 capsules can give long term-relief by eliminating the stomach infection.

E. In 4-8 weeks, when your stomach is better, you can wean off the antacids (with your doctor is OK).

Section 11: Spastic Colon

1. The most effective way to eliminate spastic colon is to treat the underlying cause, which is usually infection. In my experience most patients’ spastic colon resolves when underlying bowel infections are treated. What is most important is to treat the Candida/fungal overgrowth in the gut (see Chapter 16 for recommended treatment). In addition, many patients have parasitic infections. Unfortunately, many, if not most, labs are clueless about how to do a proper stool parasite exam and will miss the vast majority of these infections. Because of this, I would do the parasitology testing by mail at the Great Smokey Mountain Labs or the Parasitology Center (see Appendic C: Resources). In addition, I recommend a stool test for Clostridium Difficile. This is a toxin-producing bacteria and testing for it can be done at any laboratory.

2. For symptomatic relief while treating the underlying problems, consider taking peppermint oil. This must be in an enteric-coated capsule, or it could be quite irritating. Take 1 to 2 capsules 3 times a day between meals (not with food) for spastic colon.

3. Prescription medications that can be helpful include anti-spasmodics such as Hyoscyamine®, and Valium® family medications such as Librax®. These can be used on an “as needed” basis. If constipation is a predominant symptom, adding fiber and water plus the magnesium contained in the vitamin powder can be helpful. If these are not adequate, you can take the prescription Miralax®. In addition, you can add Zelnorm®, 6 mg twice a day for both constipation and pain.

Section 12: Non Cardiac Chest Pain

1. Once your doctor has ruled out heart or lung problems as a source of your chest pain, it most often turns out to be muscle/cartilage pain (Costochondritis) or indigestion/acid reflux.

2. Costochondritis pain tends to be aggravated by movement, deep breathing, or position change. It tends to be sharp, nagging, aching, or pressure-like, and it is usually well-localized, although the pain may radiate. It is usually along the sides of the sternum (the chest bone in the center of the chest), 2 inches below the left nipple, or in the Pectoral muscles in the upper chest. Reproducing the chest pain by pushing on the area suggests that the pain is coming from the muscles or ligaments of the chest wall. Hot compresses and relaxing the muscles with your mind can be helpful, as can the rest of the treatments for muscle pain. For severe cases, Lidocaine® patches can be helpful, as well as the pain creams recommended earlier for muscle pain.

3. If the pain is in your solar plexus and mid-chest and relieved by taking a few ounces of Maalox® or Mylanta® or other antacids, or is affected by eating, it is likely indigestion. See Chapter 15 for information on treating indigestion.

4. The most worrisome causes of chest pain, are ,of course, angina and heart attacks. These pains are usually associated with tightness and pain that radiates down the left arm, shortness of breath, and sweats, and is made worse with walking or exercise. Everyone is different, however, and sometimes these pains can be atypical. It is always best be on the safe side and have a family doctor check out the source of the pain to be sure it is not coming from something dangerous.

Section 13: Pelvic Pain

1. For menstrual pain, begin with over-the-counter Advil® or Aleve®. For severe menstrual cramps, the prescription Bextra®, 20 mg twice a day can be even more effective.

2. Interstitial Cystitis(IC) is a bladder problem characterized by severe urinary urgency, frequency, burning, and pain. Once bacterial infections have been ruled out, I prescribe Elavil®, 25 mg at bedtime plus Neurontin®, 300 to 900 mg at bedtime and perhaps during the day as well. If these are ineffective after 6 weeks, a trial of Sinequan® and the other anti-seizure medications is worthwhile. The medication pyridium, which numbs the bladder (and turns the urine and sweat light orange) and Urispaz®, an anti-spasmodic, can be helpful as well. I also treat the patient for presumptive Candida with oral Diflucan® for 3 months.

3. It is important to avoid certain foods that aggravate symptoms and to recognize that any vitamins, especially the B vitamins and any nutrients that are acidic (including the vitamin powder), can dramatically irritate the bladder in some patients with IC.

4. Conversely, some practitioners have found that patients with interstitial cystitis often have chronic alkaline urine. This can be aggravated by excessive coffee and cola intake. PH strip paper can be obtained cheaply at most pharmacies and one can test multiple urine samples at home to see if the pH is regularly over 7.0. Also take the enzyme product URT (enzyme product No. 24), 4 capsules 5 times a day between meals. During flares, add the enzyme product called “Kidney,” 2 capsules every 20 minutes as needed. In 2 to 4 weeks the symptoms may subside and the products can then be taken as needed (Products are available by phoning 410-573-5389).

5. If the above products do not work, try Elmiron®, a 100 mg capsule 3 times a day with water at least 1 hour before, or 2 hours after, eating. In addition, consider adding MSM (Methyl Sulfonyl Methane) at a dose of 6 to 18 grams a day, L-Arginine®, 500 mg 3 times day, and the herbal “saw palmetto,” 160 mg twice a day. These may all take 3 months to work.

6. Vulvodynia is defined as chronic vulvar itching, burning, and/or pain that is significantly uncomfortable. In this condition, vulvar/vaginal pain can either occur only during intercourse, or be constantly present. I put almost all women with pelvic pain on tricyclics such as Elavil® or nortriptyline combined with Neurontin®. In my experience, vulvodynia seems to occur as 3 main types:

A. Neuropathic—this pain appears to be caused by nerve irritation and is sharp, burning, and/or shooting (like nerve pain). In this case, apply the treatment principles in Chapter 8 on neuropathic pain. Begin with tricyclic anti-depressants (nortriptyline, desipramine, imipramine, doxepin, or Elavil®) at 25 to 150 mg each night and/or Neurontin®, 100 mg to 3600 mg daily, and proceed from there.

B. Inflammatory—this pain type is associated with local inflammation/irritation. In this situation, I would avoid topical creams. I routinely give at least a 3 month trial of oral Diflucan®, 200 mg a day.

C. Muscle pain—if the pain is deep seated and not triggered by touching the outer vagina, it may be coming from spasm of the deep pelvic muscles. In this situation, the pain may occur or be accentuated during the deep thrusting of intercourse. For this pain, the general principles for treating muscle pain apply.

7. Prostate pain—this pain is fairly common in men. When no infection is found, it is called prostadynia. I suspect that prostadynia often occurs because of subtle infections, and it usually improves when I treat these. Interestingly, the bioflavonoid vitamin Quercetin, 500 mg twice a day, decreases prostate symptoms in both prostadynia and prostatitis.

8. Endometriosis—if you have pelvic and/or abdominal pain that is much worse around your periods (and not simply muscle cramps), consider endometriosis. See the book “Endometriosis” by Mary Lou Ballweg and the Endometriosis Association for more information.

Section 14: Wrist, Hand, Shoulder, Leg, and Foot Pains

1. Carpal tunnel syndrome is characterized by pain, numbness, and tingling that occurs in one or both hands. It often wakes people from their sleep, leaving them feeling like they have to “shake their hands out” to make the pain and symptoms go away. In almost all of my patients, their carpal tunnel syndromes have resolved by using vitamin B6 (250 mg daily), Armour Thyroid hormone (see Appendix B: Pain Treatment Protocol for information on how to adjust the dose) and a “cock up” wrist splint at night for 6 weeks.

2. Thumb tendonitis is characterized by pain along the side of the hand going from the thumb joint towards the wrist. The pain gels/creams can work very well for this. Give them several weeks to work.

3. If you get a shoulder injury or pain, be sure to maintain range of motion to prevent frozen shoulder.

4. Nighttime leg cramps—Take magnesium 150-250 mg and calcium 500 to 1000 mg at bedtime and increase the potassium in your diet (e.g. bananas, V8®, or tomato juice). Stretch your calf muscles before you go to sleep. This can be done by pulling your toes towards you when you’re sitting on your bed. Wearing socks at night can also help, since cold feet will sometimes be a trigger. Quinine can be helpful for nighttime leg cramps as well.

Section 15: Natural Therapies

1. Natural remedies can be very powerful tools. Unfortunately, most medical doctors have a strong bias against natural remedies due to a lack of awareness of the scientific data.

2. Many natural therapies can be very helpful for pain. My three favorite pain relieving herbals are willow bark, boswellia, and tart cherry. All three can be found in combination in the End Pain formula by Integrative Therapeutics. Begin with 2 tablets 2 to 3 times a day, as needed, until maximum benefit is achieved (approximately 4 to 6 weeks) and then you can use the lowest effective dose.

3. Take the vitamin powder, which has many nutrients that help pain, and add sleep herbals if needed for 8 hours sleep a night (see Section 1 The Basics above). The sleep herbals in the Revitalizing Sleep Formula decrease pain as well.

4. If you have arthritis, or back pain from arthritis of the spine bones (vertebrae), take Glucosamine Sulfate (500 mg 3 times a day—takes 6 weeks to work), and consider MSM (3 grams a day for 2 to 5 months).

5. If you have nerve pain, take lipoic acid, 200 to 300 mg, 3 times a day (takes weeks to months to help).

6. Joint Gel® by NF Formulas is an over-the-counter, natural pain reliever that is applied directly on the skin. Joint Gel contains many different natural products that provide relief from aches and pains. It can be used for pain of backaches, muscle sprains, and strains. Massage Joint Gel into your skin over the painful area until it is absorbed. You can use Joint Gel every day as needed, up to 3 to 4 times daily.

7. Digestive enzymes can actually digest away inflammation. Ultrazyme and MegaZyme can be helpful in aiding digestion of your food when taken with meals. I recommend that you take them on an empty stomach, however, because enzymes are most effective at reducing pain and inflammation when you take them between meals. For acute pain, enzymes can be taken for a few days as needed. For chronic pain, begin by taking either of the above regularly (2 to 3 tablets, 3 times a day) between meals for 6 to 12 weeks to see how much it helps, or until the pain and inflammation are gone. Then you can take the enzymes as needed.

8. A major problem in chronic pain is that the areas that hurt often have decreased blood flow. This is one reason why using the intravenous “Myers Cocktails” nutritional therapies can be so effective. A less expensive way to get the blood vessels to open wide is to take a B vitamin called niacin (not niacinamide, which does not cause flushing). Take 100 to 500 mg of niacin 3 to 4 times a day as needed to cause a “flushing” feeling, which will occur within approximately 10 to 20 minutes. This can significantly help pain and is inexpensive. Try to keep the dose at 1000 mg a day or less, if this is enough to cause flushing, because higher doses can sometimes (but rarely) cause liver inflammation or unmask diabetes. The flushing may be intense. Do not worry—it is not dangerous and it can help your muscles to heal while decreasing pain. It also lowers cholesterol levels at doses at or over 1000 mg per day.

9. Treat food allergies and sensitivities. As discussed earlier, the best approach I have found for the elimination of food and other sensitivities/allergies is a technique called NAET (see http://www.naet.com/).

10. Homeopathics can be helpful (see discussion in Chapter 20).

11. Consider home remedies like “Purple Pectin for Pain” (especially arthritis): Purchase Certo® in the canning section of your local grocery. It is the thickening agent used to make jams and jellies. Certo contains pectin, a natural ingredient found in the cell walls of plants. Use 1 to 3 tbs of Certo in 8 ounces of grape juice 1 to 2 times daily. If it’s going to help, you’ll likely know in 7 to 14 days. You can lower the dose as you feel better.

12. Consider hypnosis and/or magnets. Acupuncture and structural therapies such as chiropractic, osteopathy, and numerous types of bodywork can also be powerfully effective.

Section 16: Prescription Therapies

1. The use of topical delivery systems for pain medications is a major leap forward in pain management. It allows high doses of multiple medications to get right to your area of pain—usually with no side effects!

2. Begin by going after the perpetuating factors (i.e. nutritional, hormonal, sleep deficiencies, and underlying infections discussed above in Section 1 The Basics), followed by adding in natural remedies. Then use the prescription pain creams. The oral followed by IV medications below can (and should) be added if needed because it is unhealthy to be in pain. On the other hand, it is also reasonable to begin immediately with prescription pain medications like Ultram®, and sometimes even narcotics, for immediate pain relief while you’re waiting for the other treatments to take effect.

3. Give the creams at least 1 to 2 weeks to work, and be willing to continue adjusting the mix until you find what works. This is a list of just some of the medications that can be added to the creams: Ketoprofen®, piroxicam, diclofenac, or ibuprofen (these four are NSAID anti-inflammatories); Neurontin®, clonidine, amitriptyline, Cyclobenzaprine®, Baclofen®, Ketamine®, Lidocaine®, guaifenesin, capsaicin, cortisone, and/or Sarapin®.

4. Because your physician may not be familiar with compounded pain creams, the pharmacist at Cape Apothecary (phone 410-757-3522) can help guide your doctor and can mail you the cream if prescribed.

5. The chapters in which we discussed the different kinds of pain (e.g. neuropathic, muscular, arthritic, etc.) and the summary sections on these chapters (see above) give the order in which to try the medications for pain. If you are not clear on the source/type of your pain, there are many orders, or sequences, in which to try the medications. One order I recommend is listed below. When there are several medications on the same line, if the first medication helped but was not tolerated because of side effects, go to the next medication on the same line. If it did not help significantly, go to the next line. If you get partial benefit from a medication, continue it and add the next medication, as needed, to get pain free. Here is the order:

A. Lidocaine® patches or gels for localized area of pain
B. Tylenol®
C. Motrin®, Voltaren®, or Daypro® (your insurance company prefers that these be tried before Celebrex® because of cost)
D. Celebrex®
E. Skelaxin® (for muscle pain/achiness)
F. Ultram®
G. Neurontin®, Gabitril®, and/or Pregabalin®
H. Flexeril® (for muscle pain/achiness)
I. Elavil®, Doxepin®, Desipramine® (norpramin), or nortriptyline (Pamelor®)
J. Zanaflex®
K. Effexor®
L. Baclofen® (for muscle pain/achiness)
M. Klonopin® (for muscle pain/achiness)
N. Topamax®
O. Lamictal®
P. Keppra®
Q. Narcotics®
R. Benadryl®
Appendix B: Pain Treatment Protocol gives the directions on how to use each of these medications. Other medications are also discussed in Appendix B.

6. For refractory pain consider IV nutrients (see Appendix F: Myers Cocktails), IV Lidocaine®, Ketamine®, or Prolotherapy.

Section 17: Prolotherapy

1. Prolotherapy is a series of injections of a natural solution (something as simple as a sugar or salt solution, cod liver oil (known as sodium morrhuate), or herbal extract) into the area where the ligaments have either been weakened or damaged through injury or strain. This stimulates proliferation of normal tissue, which helps the body to repair painful areas.

2. Its effectiveness for pain is wide-ranging and includes pain associated with the back, the neck, all joints throughout the body, arthritis, migraine headaches, fibromyalgia, sciatica, herniated discs, and Temporo Mandibular Joint Dysfunction (TMJ).

3. Chronic musculoskeletal pain is often due to weakness of ligaments and tendons. The injection is given at the point where the ligament or tendon connects to the bone. Many points may require injection. The injection causes the body to heal itself through the process of controlled inflammation and production of growth factors.

Section 18: Sexual Dysfunction, Depression, Mind-Body Aspects of Pain

1. Sexual dysfunction and loss of libido is common in chronic pain. Pain can cause a low testosterone level, as can treatment with codeine/narcotics. Check a free testosterone level and take natural testosterone supplements if the level is in the lowest 25th percentile of the normal range. For men, use Androgel®, 25 to 50 mg, 1 to 2 times a day rubbed onto your skin. For women, 2 to 6 mg a day of natural testosterone is usually adequate and can help pain, as well as loss of libido. Keep the free testosterone blood test in ~ the upper 30th percentile of the normal range (lower if you get acne).

2. Depression is also common in chronic pain, and it is important to be able to talk about your feelings with your doctor and family. Usually, depression can be reversed naturally by taking the vitamin powder, taking fish oil (1 Tbsp daily), getting exercise (if able), taking the herb St. John’s Wort (1000 to 2000 mg a day of a standardized product), taking 5-HTP (200 to 400 mg a day (use the lower dose if on anti-depressants), and natural hormones including Armour Thyroid and testosterone as needed. If depression persists, use anti-depressants, which can also decrease pain. The mineral Rubidium, 500 mg daily with food, can help even resistant depression. It takes 1 month to work and is available from compounding pharmacies without a prescription.

3. Anti-depressants can also cause sexual dysfunction. The herb ginkgo biloba, 120 mg twice a day can often reverse this after 6 weeks.

4. Work by Dr. John Sarno, M.D., has shown that emotional stress can also contribute to pain. He found that the mind often decreases the blood flow to areas of the body because of repressed anger/rage and/or an attempt to distract us from uncomfortable emotions by causing pain. To overcome this, learn to “feel” and express your feelings. In addition, when you feel pain, tell your mind that you will repeatedly use the pain as a signal to look for and feel those uncomfortable emotions for 10 to 15 minutes—then do so. The pain will often leave within 6 weeks.

5. Read my book Three Steps to Happiness: Healing through Joy! It will help you get from where you are to feeling great in 144 pages.

6. By treating the things that your pain is pointing out, the pain signal decreases and often stops. In addition, the filtering system of your mind now knows that it is okay to ignore any residual pain signal.

Section 19: Eliminating the Weight Gain

1. The average weight gain in fibromyalgia/chronic pain is 32 pounds.

2. Several factors contribute to the weight gain. These include inadequate thyroid and adrenal function, poor sleep, yeast overgrowth, and sometimes decreased ability to exercise because of the pain.

3. Treating these problems can result in marked weight loss. See Section 1 The Basics, for details on how to do this.

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