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From the Townsend Letter
June 2006

Highly Effective Treatments for Pain and Fatigue
General Principles of Pain Relief—Giving Your Body What It Needs to Heal and Eliminate Pain
by Jacob Teitelbaum MD

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I will begin by briefly reviewing the purpose of pain and general principles of pain relief. By knowing the type of pain that you are treating – nerve, muscle/ligament/tendon, bone/arthritic, inflammatory/infectious, etc. – you can tailor your treatment approach to make it more effective. Once you understand the different types of pain and how to treat them, your ability to make the pain go away will increase dramatically.

What Is Pain?
The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage." Fortunately, most of you don't need such a complex definition. Your patients know pain when they feel it. It is useful to categorize pain. Let's start with two basic categories:

1. Acute pain, which usually results from tissue injury, inflammation, or illness. Acute pain often occurs suddenly after surgery or injury. Usually, doctors can figure out what caused the pain, and the pain goes away on its own or with treatment.

2. Chronic pain can last for many years and is poorly treated medically, which is why it lasts for years. Chronic pain is the main focus of this column.

Pain is Horrible! Why Do We Have Pain?
Although chronic pain can be devastating, it serves a critical function. For example, there is a horrible genetic disease, Congenital Insensitivity to Pain with Anhidrosis (CIPA), that is uniformly fatal and leaves people horribly deformed and disabled. People who suffer from this disease are born without a pain system and therefore without any ability to feel pain. You may think this would be wonderful. It is not. As a child, if a sufferer of this disease falls off a roof and breaks a leg, he or she has no pain and still tries to walk, causing further damage. If his hand is on a hot stove or in a fire, he does not know it until he smells something burning. Pain is a critical warning system for the body. Pain tells us when we need to avoid something so that we do not cause further damage to ourselves. In addition, pain tells us when our bodies are not getting what they need (e.g., sleep, nutrients, oxygen, etc.).

Pain is not the enemy; it is designed as a crucial helper. Yet when pain goes out of balance and becomes chronic, it may end up causing more harm than good.

How Do I Turn Off the Pain Signal?
You turn off the pain by giving your body what it needs and by eliminating what is damaging or toxic to your body. For example, one of the most common types of pain is myofascial or muscle pain. The medical profession in general poorly understands this type of pain. Although we might think that muscles will go limp if they do not have what they need, consider rigor mortis. When someone dies and the muscles are not getting what they need, they do not become loose—in fact, they become stiff as a board. As noted above, if muscles do not have adequate nutrients, optimal hormone levels, or enough sleep for tissue repair, they will get stuck in the shortened position and cause pain. Underlying infections can also cause muscles to get stuck in the shortened position. Pain is the body's way of saying that these problems need to be addressed. You'll be amazed at how pain that has lasted decades can go away quickly when these problems are resolved.

Often, finding the right natural or prescription therapy for pain is like trying on different shoes to see which pair fits best. In the current "medical shoe store," there are one or two pairs to try on – non-steroidal, anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors. If these shoes don't fit, the patient is out of luck. Sadly, when they are used, NSAIDs kill well over 16,500 Americans a year, and many more die from COX-2 inhibitors. Fortunately, dozens of other safer and more effective treatments are available outside conventional medicine, and when one doesn't fit, another often will.

In addition, pain management is a perfect place to combine traditional and complementary therapies. The difficulty that patients have in finding doctors that can effectively treat their pain is driving them to alternative healers in droves. In fact, according to the Journal of the American Medical Association, pain is the number one reason why people use alternative medicine,1 which includes chiropractic medicine, naturopathic medicine, acupuncture, biofeedback, massage, Reiki, meditation, and other techniques. Often, it is difficult to treat chronic pain with a single "magic bullet." It takes a practitioner who is both knowledgeable about many treatment modalities and who is also a compassionate listener.

A number of general principles apply to pain relief and pain management. Many of these have been discussed earlier, but to summarize, the two main principles of pain relief are as follows:

1. Supply your body with what it needs for healing and tissue repair. This includes optimum nutrition (often well beyond RDA levels), eight to ten hours of deep sleep each night, and optimal hormonal levels (simply having a hormonal blood test be "normal" may not be adequate). Each of these three areas is critical. Pain often will not go away until each area is adequately handled—regardless of the cause of the pain.

2. Treat or eliminate things that stress your body and cause pain. These include infections; toxins (e.g., chemical and heavy metal) and inflammation; mechanical stresses on the body; excessive situational, psychological, or physical stresses; and abnormal tissue compression (e.g., cancers). All need to be considered and treated. For example, nutritional and hormonal deficiencies and/or fungal infections (usually secondary to antibiotic use) can aggravate neuropathic or back pain.

A simple way to remember what pain is telling you metabolically is to think of "SHIN":
Sleep: Eight to nine hours a night for tissue repair
Hormonal support, even despite normal labs
Nutritional support

When these four areas have been treated, you will often have eliminated the cause of the pain, and pain will therefore often simply disappear (just as the oil light shuts off after you add oil to the car).

JACOB TEITELBAUM, MD is the Medical Director of the Center for Effective CFS/Fibromyalgia Therapies in Annapolis, Maryland. He is senior author of the landmark studies, "Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia—a Placebo-Controlled Study" and "Effective Treatment of CFS & Fibromyalgia with D-Ribose," author of the best-selling book, From Fatigued to Fantastic! (Avery Penguin Putnam) and two other books, Three Steps to Happiness! Healing through Joy (Deva Press), and the recently released Pain Free 1-2-3: A Proven Program to Get YOU Pain Free Now! (McGraw-Hill, 2006). Dr. Teitelbaum refuses to accept money from any pharmaceutical or natural supplement companies.

1. DM Eisenberg et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. Journal of the American Medical Association. Nov 11, 1998;280:1569-1575.


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