Chronic Pain Chronic Pain SolutionsSolutions

Dr. Richard BurgDr. Richard BurgChiropractor, Nutrition Consultant, Certified ART® Chiropractor, Nutrition Consultant, Certified ART® ProviderProvider

DisclaimerDisclaimer

Acute & chronic pain may be a Acute & chronic pain may be a sign of a serious underlying sign of a serious underlying disease or condition.disease or condition.

It is imperative that you see your It is imperative that you see your physician or health care provider physician or health care provider to determine the cause of your to determine the cause of your pain.pain.

This lecture is not intended to This lecture is not intended to diagnose or treat any condition.diagnose or treat any condition.

The Silent EpidemicThe Silent Epidemic

Estimates are that 50 million Estimates are that 50 million Americans live with chronic pain Americans live with chronic pain caused by disease, disorder or caused by disease, disorder or accidentaccident

25 million people suffer from acute 25 million people suffer from acute pain from surgery or accidentpain from surgery or accident

2/3 of these people have had their 2/3 of these people have had their pain for more than five yearspain for more than five years

The Silent EpidemicThe Silent Epidemic

The most common types of pain are The most common types of pain are arthritic, lower back, bone/joint pain, arthritic, lower back, bone/joint pain, muscle pain and fibromyalgia.muscle pain and fibromyalgia.

Estimates are that 20% of adult Estimates are that 20% of adult Americans experienced chronic pain Americans experienced chronic pain in 1994 and approximately 4.9 in 1994 and approximately 4.9 million individuals saw their million individuals saw their physician for chronic pain treatment physician for chronic pain treatment in 1999.in 1999.11

Pain perceptionPain perception

Pain receptors in the body send Pain receptors in the body send signals through nerves to the spinal signals through nerves to the spinal cord and then up to the brain where cord and then up to the brain where pain is “perceived”.pain is “perceived”.

In the brain there are areas that In the brain there are areas that bring awareness to the pain and bring awareness to the pain and areas (limbic system) that areas (limbic system) that determine our “experience” of pain.determine our “experience” of pain.

The Gate Control The Gate Control TheoryTheory Melzack & Wall’s theory from the Melzack & Wall’s theory from the

1960’s states that in the spinal cord 1960’s states that in the spinal cord there is a neuronal “gate” that signals there is a neuronal “gate” that signals must pass through and the gate can must pass through and the gate can be open or closed. be open or closed.

The gate is controlled by movement The gate is controlled by movement and other sensory information that and other sensory information that over-rides pain signals and is specific over-rides pain signals and is specific to the area of painto the area of pain

The Brain Controls The Brain Controls PainPain The brain has pathways that The brain has pathways that

inhibit or modulate pain signalsinhibit or modulate pain signals These pathways rely on These pathways rely on

neurotransmitters such as neurotransmitters such as serotonin, endorphins and serotonin, endorphins and enkephalins to transmits signals enkephalins to transmits signals that block pain signals to the that block pain signals to the brainbrain

Underlying CausesUnderlying Causes

Chronic low grade inflammationChronic low grade inflammation– Prostaglandin imbalance causes systemic Prostaglandin imbalance causes systemic

inflammation which chemically stimulates pain inflammation which chemically stimulates pain receptorsreceptors2 2 Injured pain receptors give off substance P Injured pain receptors give off substance P which causes the release of histamine which leads to which causes the release of histamine which leads to inflammatory prostaglandin production and sustained inflammatory prostaglandin production and sustained activation of the pain receptors.activation of the pain receptors.

Metabolic Syndrome is linked to inflammationMetabolic Syndrome is linked to inflammation– 2/3 of the Adult US population are overweight or obese2/3 of the Adult US population are overweight or obese– 25% of Americans have Metabolic Syndrome (insulin 25% of Americans have Metabolic Syndrome (insulin

resistance)resistance)– Chronic subclinical inflammation is part of this Chronic subclinical inflammation is part of this

syndromesyndrome

Underlying CausesUnderlying Causes

Lack of proper motion Lack of proper motion – ↓ ↓ frequency of firing of mechanoreceptorsfrequency of firing of mechanoreceptors– ↓ ↓ input into the cerebellum & cortex allows input into the cerebellum & cortex allows

increased pain signals to be perceived.increased pain signals to be perceived.– Pain fibers grow into scar tissue and lead to Pain fibers grow into scar tissue and lead to

increased or chronic painincreased or chronic pain Neurotransmitter deficiency or Neurotransmitter deficiency or

imbalanceimbalance– Deficiencies in Serotonin, Endorphins, Deficiencies in Serotonin, Endorphins,

EnkephalinsEnkephalins

Nutritional SolutionsNutritional Solutions

Anti-inflammatory dietAnti-inflammatory diet– Low Glycemic Diet, high blood sugar leads to increased Low Glycemic Diet, high blood sugar leads to increased

inflammation inflammation – High Omega 3 diet, fish and flax, decrease fatty meats and High Omega 3 diet, fish and flax, decrease fatty meats and

poultry (2.7 g of EPA/DHA 2:1 daily)poultry (2.7 g of EPA/DHA 2:1 daily) Adequate protein intakeAdequate protein intake

– Your body needs adequate protein over 60 grams per day Your body needs adequate protein over 60 grams per day to synthesize neurotransmitters and repair muscles and to synthesize neurotransmitters and repair muscles and tissuestissues

– Protein with each meal keeps your blood sugar levels Protein with each meal keeps your blood sugar levels normalnormal

Adequate water intakeAdequate water intake– Most all metabolism in your body takes place in waterMost all metabolism in your body takes place in water– You need to drink half your body weight in ounces of water You need to drink half your body weight in ounces of water

per dayper day– Adequate water turns off histamine which reduces Adequate water turns off histamine which reduces

inflammation and paininflammation and pain

Neurological SolutionsNeurological Solutions

Better Brain ChemistryBetter Brain Chemistry– Increase your body’s reserves of Endorphins and Enkephalins Increase your body’s reserves of Endorphins and Enkephalins

with DLPAwith DLPA– DLPA 500 mg (50:50) 1-2 tabs 3x daily before 3 PM orDLPA 500 mg (50:50) 1-2 tabs 3x daily before 3 PM or– DPA 500 mg 1 tab 3x daily before 3 PMDPA 500 mg 1 tab 3x daily before 3 PM– B complex vitamin daily B6 is required for neurotransmitter B complex vitamin daily B6 is required for neurotransmitter

synthesis (serotonin and dopamine)synthesis (serotonin and dopamine)33

– Magnesium 200 mg to 400mg daily, helps prevent over-Magnesium 200 mg to 400mg daily, helps prevent over-excitation of neuronsexcitation of neurons

– Vitamin D 1,000 IU daily (or as recommended from blood test)Vitamin D 1,000 IU daily (or as recommended from blood test)44

Chiropractic CareChiropractic Care– Improve frequency of firing of mechanoreceptors to the brainImprove frequency of firing of mechanoreceptors to the brain– Improve your function so you can be more active which uses the Improve your function so you can be more active which uses the

Gate Control Theory to reduce pain signalsGate Control Theory to reduce pain signals– Improved posture reduces chronic painImproved posture reduces chronic pain

Manual Therapy Manual Therapy SolutionsSolutions Specialized myofascial therapiesSpecialized myofascial therapies

– Active Release Techniques® effectively Active Release Techniques® effectively restores motion and removes interference restores motion and removes interference to normal tissue function which contributes to normal tissue function which contributes to painto pain

– Adhesions trap nerves that travel through Adhesions trap nerves that travel through muscle and fascia and can cause chronic muscle and fascia and can cause chronic pain and disabilitypain and disability

– Movement therapies such as this retrain the Movement therapies such as this retrain the body to move and function correctly to body to move and function correctly to make everyday activities and exercise make everyday activities and exercise easier and more enjoyableeasier and more enjoyable

Functional Functional improvementsimprovements ExercisesExercises

– Studies indicate that exercise may be the only reliable approach Studies indicate that exercise may be the only reliable approach to resolving the disability of chronic back painto resolving the disability of chronic back pain

– Motion is Life and increased motion reduces pain, stabilizes Motion is Life and increased motion reduces pain, stabilizes blood sugar, elevates mood and keeps your weight normalblood sugar, elevates mood and keeps your weight normal

Postural awareness and improvementPostural awareness and improvement– Chronic postural distortions result in chronic pain patternsChronic postural distortions result in chronic pain patterns– Muscles become too tight and short and pull on the body Muscles become too tight and short and pull on the body

causing the antagonist muscles to become too long and tight causing the antagonist muscles to become too long and tight and lead to chronic painand lead to chronic pain

– Learn how to correct your posture using specialized exercises to Learn how to correct your posture using specialized exercises to change a chronic patternchange a chronic pattern

Cerebellar trainingCerebellar training– Cerebellar exercises improve coordination and increase Cerebellar exercises improve coordination and increase

frequency of firing to the brain which then inhibits excessive frequency of firing to the brain which then inhibits excessive pain signalspain signals

REFERENCESREFERENCES

11http://www.aapainmanage.org/http://www.aapainmanage.org/literature/Articles/PainAnEpidemic.pdfliterature/Articles/PainAnEpidemic.pdf

22http://www.jci.org/articles/view/6749http://www.jci.org/articles/view/6749 33http://ods.od.nih.gov/factsheets/http://ods.od.nih.gov/factsheets/

vitaminb6.aspvitaminb6.asp 44Ross, J. Ross, J. The Mood CureThe Mood Cure (New York: (New York:

Penguin Books, 2002) pp. 106-117.Penguin Books, 2002) pp. 106-117.