Managing Chronic Pain, Naturally Wintergreen Botanicals,...

Maria Noël Groves www.WintergreenBotanicals.com

Managing Chronic Pain, Naturally Wintergreen Botanicals, LLC

Maria Noël Groves, Clinical Herbalist Allenstown, NH (Near Bear Brook State Park) 603-340-5161, [email protected] www.WintergreenBotanicals.com

PLEASE READ: The information in this handout has not been approved by the FDA and does not in any way intend to diagnose or prescribe. Always consult with your health practitioner before taking any remedy. Above this, I also recommend that you…

1. Research an herb in at least three good sources before ingesting it (see website for sources), 2. Listen to your body/intuition to determine if an herb resonates or doesn’t resonate with you. 3. Take proper steps to ensure that any wildcrafted or cultivated plant is what you think it is, AND 4. Check with your pharmacist for herb-drug interactions if you take prescriptions.

We should not try to just overcome pain. We should listen to it. Pain is our task-master. It is one of the body’s primary ways of telling us something is out of balance. Unfortunately, in our modern society, pain’s alarms frequently sound off. An astounding 100 million Americans suffer from chronic pain, nearly four times the number of people affected by diabetes, and more than those affected by diabetes, heart disease, and cancer combined. Pain is the fire alarm. It’s not the fire. It might help to shut the fire alarm off (so you can think straight and take action), but for long-term care, you want to put out the fire or new alarms will eventually go off. Whenever we address chronic pain with herbs and natural therapies, we want to look at it holistically. That means, we want to consider the whole person and look for underlying patterns as well as root causes of the inflammation and pain. Blindly taking mega doses of turmeric may be natural (and perhaps even effective), but it’s not necessarily holistic if you’re not taking a closer look at everything going on. Pharmaceutical and OTC drugs often play a major role in managing pain – whether it’s ibuprofen for headaches or steroids for more serious forms of pain. They often work “wonders” quickly, improving your quality of life (at least temporarily). However, as with most superficial band-aids, they often lose their effect, and they have serious cumulative side effects. (They shut off the alarm and ignore the fire.) Studies show that NSAIDs actually worsen injury and recuperation, delay muscle regeneration, and inhibit ligament, tendons, and cartilage healing – both because of inhibition of the body’s natural healing processes and for rebound pain. Stronger pain meds are highly addictive and can directly lead to drug abuse and overdose. Use them minimally, and save them for acute situations. Even though pain can be incredibly responsive to herbs and natural therapies, every person’s pain management will be a little bit different. Your first task is to figure out what is setting off the task master. What patterns are present? WHY are you in pain? WHAT can you do to correct that insult or imbalance? What triggers the headache? Is there something structurally off in the body that is causing joint or muscle pain? Are nutrient deficiencies at play? Inflammation, and, if so, why? What about stress? Have you ruled out underlying conditions like autoimmune disease, nutrient deficiencies, and infections like Lyme? You will need to look hard at the cause of your pain, and you may also need to work with a qualified, sensitive health practitioner to answer all the questions. Getting a proper diagnosis helps target your therapies more effectively.


ABOUT PAIN & INFLAMMATION Essentially, all pain is a nervous system phenomenon because pain travels along the nerves via neurotransmitter signals to the brain to tell it that something hurts. Your body generally sends pain signals because something is damaged or malfunctioning and your body wants you to stop what you’re doing and rest to heal. Damage can occur due to mechanical injury, extreme temperatures, imbalances in the body (ie: blood deficiency – ischemia or oxygen deficiency – hypoxia), infection and illness, inflammation, and at the prodding of chemicals like histamine and acetylcholine. But, pain is often much more than a nervous system phenomenon, and you can further characterize pain by the origin and affected type of tissues: nerve pain, joint pain, muscle tension/pain, immune/autoimmune-related pain, toxicity-related pain... Pain involves multiple body systems and types of tissues, compounds, and transport methods. Compounds Associated with Pain & Inflammation

• Substance P: a neurotransmitter secreted by the nerves and inflammatory/immune cells that sends pain signals to the brain and increases inflammation

• Prostaglandins: hormone-like compounds created from arachidonic acid (AA, a type of fat) that often promote but sometimes resolve inflammation

• COX-2: a pro-inflammatory enzyme that aids the conversion of AA to prostaglandins, which is stimulated by cytokines and other compounds

• Leukotrienes: pro-inflammatory eicosanoids associated with pain and allergy that are made from AA via the enzyme 5-LOX

• Histamine: an inflammatory compound of the immune system associated with allergies that increases your perception of pain

• Cytokines: proteins secreted by the immune system in response to infections, cell injury, and other conditions that affect cell communication, which can often (but not always) be pro-inflammatory. Interleukins and tumor necrosis factors are inflammatory cytokines that increase the production of substance P and prostaglandins.

• Glutamate: an amino acid in food and produced by the body that can increase or decrease the perception of pain in the brain

• Cortisol: a hormone associated chronic stress and blood sugar imbalance that ultimately prevents the body from being able to down-regulate inflammation, leading to increased inflammation throughout the body

• CRP: a protein secreted into the blood by the liver, the levels of which rise in response to inflammation, which has made it a good marker for overall inflammation in the body

So, you can see how complicated and multifaceted pain can be! It also helps you understand some of the mechanisms of various “pain herbs” and protocols. You can see why MSG (a glutamate-based food chemical) in your food might trigger pain for some people. Why chronic stress and resulting high cortisol levels are often underlying factors in chronic pain. Why you might experience pain flare ups during allergy season. How the fats in your diet can affect your tendency for inflammation, and so on. If you like to dig through the scientific research around pain-relieving herbs, you’ll often read of them affecting one or more of these chemicals and pathways. For example, turmeric works via multiple pathways, most notably reducing COX-2. Boswellia appears to reduce leukotrienes. Tart cherry juice reduces CRP. Cayenne, applied topically, depletes substance P. And so on. Inflammation is closely associated with pain. The same injury that causes pain usually causes inflammation, which in turn increases the pain response. The term means literally “to set on fire,” and your body uses acute inflammation to protect itself from the initial cause of cell injury and stimulate the repair process: heat, redness, swelling, and pain. Short blurts of inflammation due to self-limiting issues are normal and healthy, but chronic inflammation can do more damage than good.


Common Systemic Pain & Inflammation Triggers • Stress: Pain makes people miserable, and miserable people are more likely to feel pain. More than half of

chronic pain sufferers feel like they have no control over their pain and that their pain impacts their overall enjoyment of life. Three quarters of chronic pain sufferers experience depression, poor concentration, and poor energy levels. Stress increases the amount of cortisol present in the body, which inhibits the body’s ability to down regulate inflammation. Stress also increases the amount of sugar in the bloodstream, which is another trigger.

Ê Consider herbs that help pain/inflammation and address stress, such as ashwagandha, holy basil, blue vervain.

Ê Adopt diet and lifestyle changes that decrease the stress response, such as eating whole foods, more fruits and vegetables, more fatty fish; regular moderate exercise; meditation, deep breathing, yoga, regular massage, etc.

• Sleep: More than 85% of chronic pain sufferers don’t sleep well, and pain can inhibit your ability to sleep. Inadequate or poor sleep can directly increase stress, pain, inflammation, and muscle tension. One study of female migraine sufferers found that insomnia provoked 79% of attacks.

Ê If sleep issues exist, these should be dealt with first or alongside other pain protocols. Ê Consider herbs that alleviate pain while encouraging sleep, such as valerian, California poppy,

hops, wild lettuce, Jamaican dogwood, skullcap, blue vervain... also magnesium. Ê Practice good sleep hygiene – prioritize sleep, don’t drink a lot of alcohol (even 2 drinks) before

bed, unplug, develop a calming bedtime ritual, etc. • Blood Sugar: Chronic high blood sugar, such as in diabetes and pre-diabetes, encourages high cortisol

levels and chronic low-grade inflammation. This can worsen not only pain but also the risk of inflammation-related diseases such as cancer, heart disease, and Alzheimer’s.

Ê A healthy diet and exercise are crucial! You can start with a general anti-inflammatory diet and daily walks. Sure, herbs help, too, but they don’t replace diet and exercise.

• Inactivity: Just a half day of being sedentary can increase the body’s tendency to have blood sugar issues, which increases inflammation. Exercise allows your body to produce more anti-inflammatory compounds naturally while also lubricating the joints and improving circulation/blood flow to and from inflamed areas of the body to facilitate healing.

Ê Go for a walk. Do yoga or tai chi. Dance...

APPROACHING PAIN NATURALLY We’re about to discuss a wide range of pain remedies. The goal is not to take all of them but to glean which ones to try first in an overall protocol. Pain Protocol Tips • Target to the individual person – the type of pain, underlying factors and triggers, patterns, constitution, etc.

Also consider what is actually do-able for the person. If they hate tea, then no teas, etc. • Incorporate diet and/or lifestyle support. These may provide the best ultimate, long-term pain

management. • Create one or two pain formulas or remedies (ie: a tincture and a tea... a sleep blend and a day blend... a

daily blend and an acute remedy), feel free to integrate in other herbs that may not be about “pain” but other primary concerns for the person. Try to support the whole person.

• Give it 2-3 months. They should ideally see some improvement within the first few days or weeks (this depends on the pain and the remedy), but many won’t really kick in until they have a chance to accumulate. If nothing has improved in 2-3 months, it’s time to try something new.

• Know when to refer. Massage, acupuncture, chiropractic, maybe even conventional medicine (surgery?). Always ask WHY? Keep asking WHY?


The Cascade Theory Pain has many potential underlying causes. However, identifying the one cause may be futile. One theory of pain is that it occurs via a cascade of instigators. For example, you get migraine headaches. Dust or mold buildup in your bedroom initially aggravates your body, which releases histamine and increases inflammation. Your mattress is also old and becoming uncomfortable, which structurally stresses your body, creating muscle tension. One night, you have a glass of red wine with dinner, and a sensitivity to the naturally occurring sulfites throws you into a migraine state. Your magnesium levels are low, platelets sticky, histamine high, serotonin levels low, and you are miserable. In your weakened state, you may also become more susceptible to a cold, sleep more poorly, get moody, etc. How do you get off this crazy train? You may need strong remedies or conventional medicine to stop the cascade. But, once this has calmed, consider a broad, preventative approach. Natural Anti-Inflammatory Support Inflammation is one of our most basic responses to injury or imbalance in the body, and it is the main target for pain-relieving drugs, remedies, and lifestyle techniques. Even if you can’t get to the root cause of your pain (ie: chronic fatigue syndrome), you can still reduce inflammation. Identify Triggers: Stress, food allergies and sensitivities, environmental allergens and pollutants, poor diet, and a

sedentary lifestyle are the most common. Anti-Inflammatory Diet: This is huge and helpful for almost anyone with pain. • Eliminate the most common food allergens – wheat/gluten, dairy, eggs, soy, corn, nuts, nightshade family

plants – to see if they are an underlying cause of inflammation. If you determine that a food is not the cause, feel free to add it back into your diet – most of these foods can be very healthy as long as you’re not reacting to them. If eliminating all potential allergens seems overwhelming, consider an IgG food sensitivity test or only eliminate the most suspicious foods.

• Eliminate or at least drastically reduce foods known to aggravate or cause inflammation including refined carbohydrates, processed food, artificial anything (especially MSG and fake sugar), sugar, alcohol, coffee, trans fats, fried food, excess vegetable oils, and factory farmed animal products (meat, dairy, eggs). This may seem daunting; however, anti-inflammatory foods are plentiful, incredibly delicious, and you will feel so much better once you switch!

• Focus on anti-inflammatory foods including tons of vegetables and moderate fruit (especially greens, broccoli family plants, onion/garlic family, orange vegetables, mushrooms, berries, and vividly hued fruits). Raw, cooked, juiced, in smoothies, dehydrated kale chips, you name it – aim for at least half a plate at each meal. (A full plate of veggies is even better! Then a half plate of protein/carbs.) Also focus on protein from plant sources like legumes and nuts and quality animal protein like eggs, poultry, meat, game, and fish that are wild or raised in a free-moving, grass/sunshine environment with good feed. They are sources of quality protein and important omega 3 fatty acids, but still keep your animal protein portion sizes small. Be sure to get healthy fats in your diet, which are important for lining your nerve tissue and decreasing inflammation: nuts, seeds, olive oil, avocado, unrefined coconut, flax, fatty fish and fish oil, and those quality animal proteins. Use plenty of herbs and spices, green tea, and moderate amounts of dark chocolate, all of which are potent antioxidants (and delicious). Consume dairy in moderation and opt for pastured animals and forms like yogurt, cheese, butter, and perhaps raw dairy from a careful farm. Consume grains and high-glycemic foods in moderation, opting for the whole form when you do eat them, including organic purple potatoes, sweet potatoes, winter squash, quinoa, steel-cut oats, and wild whole-grain rice blends. Looking for recipe ideas? Check out traditional Asian, Indian, Mediterranean and similar ethnic cuisine as well as the book Recipes for Repair by Gail and Laura Piazza. Raw and healthy vegan cuisines also offer a variety of tasty anti-inflammatory recipes.

Movement: A sedentary lifestyle increases your blood sugar and cortisol levels in as little as half a day, but extreme exercise is also tough on your body. Aim for mild to moderate exercise, which will systemically reduce inflammation and also lubricate the joints. Ultimately aim for 30-60 minutes 5-7 days a week of movement, but starting anywhere is better than nothing. Start slow if you’re new, and consider seeking the support of a trainer to help prevent injuries. Walking, hiking, biking, xc skiing, kayaking, swimming, dancing, yoga, and tai chi are just a few of the options. Studies show that moving outdoors amplifies the benefits and makes the experience more pleasurable for you.


Mind-Body Balance: Stress directly increases inflammation throughout the body through a variety of biochemical reactions. On the flip side, bringing yourself to better mind-body balance can have a phenomenal ability to reduce pain over time. Regular mindfulness meditation, yoga, tai chi, journaling, art, gentle movement, and time spent in nature are just a few methods of achieving mind-body balance. Herbal assistants include calming herbs (lemon balm, skullcap, passionflower, California poppy…), adaptogenic/stress-relieving herbs (holy basil, gotu kola, codonopsis, rhodiola, eleuthero, ashwagandha…), pleasing natural scents (lavender, citrus, vanilla, incense, herbal smudges…), and flower essences (Rescue Remedy/Five Flower Formula, aspen, lavender…).

Sleep: Besides the obvious connection with mind-body balance, a good night’s sleep allows your body to relax, repair, relax muscles, and detoxify. Just one night’s bad sleep will begin to increase inflammation in the body. Prioritize sleep by devoting 7 to 9 hours to it each night and developing good sleep hygiene including not eating, watching TV, or doing anything overly stimulating during the last hour or two before bedtime. Wind down with soothing music, a mellow book, dimming the lights, a bath, relaxing aromas, meditation, calming herbs, etc. Herbal allies for sleep include valerian (great for some, not for others), passionflower, skullcap, California poppy, hops, chamomile, motherwort, kava, and lemon balm.

Reduce Environmental Allergens & Pollutants: Although it’s more subtle, the chemicals you come in contact with can do a lot of damage on your nervous and endocrine systems and also increase inflammation. We can’t avoid all pollutants, but try to limit your exposure to EMFs from cell phones and electronic equipment (especially in the bedroom), pesticides/herbicides, chemical/conventional cleaning products, conventional/outgassing household and construction products (paint, fire- and stain-proof fabric, carpeting, plastic), plastic, conventional personal care products (especially ingredients like phthalates, parabens, artificial fragrances, and anything that smells toxic). Visit www.ewg.org for ratings on EMFs and cell phones, mercury in fish, pesticides in produce, chemicals in personal care products, and cleaning products. There are alternatives for all these things. They may cost more, so slowly switch over and find DIY recipes to save money. Also, consider an indoor air filter and good ventilation, and remove your shoes when you enter your house.

Anti-Inflammatory Herbs Seek out an anti-inflammatory herb or blend that works for you. They generally need to be taken regularly as their effects are subtler and cumulative for chronic pain than pharmaceuticals. However, they’re also usually a lot safer and may have a variety of beneficial “side effects.” Always double-check for herb-drug reactions, especially with blood thinning medications. Turmeric (Curcuma longa): This famous anti-inflammatory herb is a good place to start in chronic pain conditions because it works via multiple inflammatory pathways (a notable COX-2 inhibitor) and has been shown to benefit a range of types of pain including rheumatoid and osteoarthritis and pain from over-exertion. Clinical studies have found that turmeric and/or its constituent curcumin useful for pain and inflammation associated with colitis, arthritis, cancer, and chronic neurodegenerative diseases. In a four-week study of 367 sufferers of knee osteoarthritis pain, 1,500 mg of turmeric extract performed just as well for pain relief as 1,200 mg of ibuprofen with fewer side effects. Turmeric boasts a long list of other health benefits: cardiovascular tonic, anti-depressant, antioxidant, alterative, cholagogue, choleretic, hepatoprotective, anticancer. Clinical indications include mental dullness, poor digestion (especially fat digestion), rheumatoid arthritis, irritable bowel, and high cholesterol. Turmeric – especially curcumin – is not very easily absorbed in the gut. Heating it, adding it with oil (curcumin is a fat-soluble carotenoid), and adding black pepper (just 1 percent of piperine in black pepper boosts curcumin’s bioavailability 2,000 times!) all enhance its activity. You’ll find all sorts of lovely and tasty variations of golden milk recipes, which are great for daily use, and you can also take it as a capsule or use it in meals. Aim for 1/4 to 1/2 teaspoon daily, which equates to 2 to 4 homemade capsules. For commercial extracts, follow the label recommendations. I sometimes use turmeric tincture in formula (made fresh 1:2 in 95% alcohol or dry 1:5 in 70% alcohol – the brighter it stains, the stronger it is), but I prefer other forms when really focusing on turmeric as the main remedy. Be patient: you may notice immediate improvement, but most likely the full effects won’t be obvious for at least two to four weeks. Even though turmeric can protect against ulcers, it may aggravate active ulcers and overly acidic digestive systems. It also has mild blood thinning properties. It blends well with ginger (a hotter anti-inflammatory with noted benefits for muscle pain), ashwagandha and/or holy basil (two anti-


inflammatory calm-energy adaptogens), rosemary (a potent anti-inflammatory and circulation enhancing herb), and boswellia (a general anti-inflammatory with benefits for arthritis as well as pain associated with allergies and autoimmune disease). Ginger (Zingiber officinale): Think of this close relative of turmeric when dealing with muscular and “cold,” stagnant pain. It’s also a COX-2 inhibitor, inhibiting inflammatory prostaglandins, yet it is more specific for muscle aches and spasms. A one-month study of 100 migraine sufferers found that one 250 mg ginger capsule taken at the onset of a migraine performed as well as a triptan medication, decreasing the severity of pain by 44% within two hours. Another clinical study found that taking 500 mg capsules three times daily starting two days before menses and continuing through day three of menses reduces menstrual cramp pain and duration... although, being an emmenogogue, it can increase bleeding. (Cinnamon caps have also been studied for dysmenorrhea and lessen bleeding.) Ginger is often used in formula for stiff joints, arthritis, and as a muscle rub or bath. Other benefits of ginger include reduced nausea, improved digestion, gas relief, better circulation, and reduced blood sugar. Dry ginger is better for nausea control, fresh is better for immune support. For pain and inflammation, it doesn’t really matter. It can have slightly greater blood thinning properties than turmeric and is too spicy for some. Be cautious in reflux or ulcers. It’s a fabulous synergist in pain blends for cold folks. Tart Cherries (Prunus cerasus): Several studies support the ability of cherries, especially tart cherries, to reduce inflammation and pain. One study found that a cherry-rich diet reduced inflammatory markers by 50 percent. In two studies on runners, drinking two glasses of juice daily in the week prior to and day of an event significantly reduced muscle pain and recovery. It works via various inflammatory pathways, counteracts the damage of overexertion, and rivals NSAIDs without the side effects. Cherry juice also improves the kidneys’ elimination of uric acid, reducing the risk of painful gout attacks. And it boosts melatonin levels and improves sleep quality. Its benefits in arthritis have been mixed. Drinking 100 percent cherry juice (read the ingredients carefully!) or taking concentrated cherry supplements likely work best. Buy organic if you can; cherries tend to have a lot of pesticide residue. I like using 100% certified organic tart cherry juice concentrate in seltzer, smoothies, popsicles, etc. Boswellia (Boswellia serrata, B. carteri): Boswellia, a specific species or two of frankincense, comes from Ayurvedic medicine as a potent anti-inflammatory resin. It appears to inhibit inflammation through a variety of chemicals/pathways including prostaglandins, 5-lipoxygenase (5-LOX), leukotrienes, and cytokines. It’s really a tremendous herb for inflammation where the immune system is also a factor, such as allergies and autoimmune disease. Study highlights include asthma, ulcerative colitis, arthritis, and general inflammation. In a month-long, double-blind, placebo-controlled study of boswellia combined with ashwagandha and turmeric, the formula was as effective as anti-inflammatory medication for osteoarthritis in the knee. It took longer to work but produced longer-lasting results. In another study, ulcerative colitis patients achieved 82% remission with boswellia. Resins literally repel water, so it’s usually taken as capsules. You can only tincture it effectively in high-proof (190 proof, 95%) alcohol, which can be taken internally or applied externally (ie: stir it into cream). In tincture blends, it easily precipitates out into a resinous glob in the presence of other herbs and water present in those other tinctures its blended with. It’s generally safe but may (rarely) cause stomach upset, nausea, diarrhea, rash. Ashwagandha (Withania somnifera): Think of this Ayurvedic tonic adaptogen when inflammation and pain coincide with stress and/or autoimmune disease. It has performed well in studies for arthritis in combination with turmeric and boswellia. It’s a superb anti-inflammatory adaptogen as well as a nerve and immune tonic with studies supporting its ability to boost mood and improve mental function. I use it as a powder in milk, in tea and broth blends, turmeric-ashwagandha-honey electuary in hot milk, and as a tincture (1:5 dry roots in 50-60% alcohol), and capsules work, too. Using a hot fatty base like milk (cow, almond, coconut) or ghee is believed improve absorption and send ashwagandha’s healing activity to the fat-lined nervous system. It makes a nice addition to herbal “coffee” blends in a base of chicory, chaga, dandelion, and/or burdock, potentially with extras like turmeric, codonopsis, nutmeg, ginger, cardamom – specific herbs chosen based on taste preferences and client needs. Be aware that ashwagandha is a nightshade, and some people with nightshade sensitivity may react to it (but not everyone).


Holy Basil (Ocimum sanctum syn O. tenuiflorum): Decent studies are sadly lacking, but holy basil (aka tulsi) is a favorite of mine for a range of issues including for calm energy, improved mood, released grief, reduced anxiety, blood sugar and cortisol balance, and as an anti-inflammatory (inhibits COX-2, 5-LOX). I often use it as a tea or tincture (1:2 fresh flowering plant in 95% alcohol), but pretty much any form of it works well. A 50/50 blend of ashwagandha and holy basil tinctures is a good start for those with a lot of stress, exhaustion, and pain. You can stick with that or build a broader formula from there. Carbon dioxide capsules are pricey but potent. I grow a nonspecific variety from High Mowing seeds with good success. Horizon Herbs sells various species. Krishna is considered stronger, kapoor more productive. A nice clove-y scent and flavor (eugenol) indicates potency, and unfortunately a lot of the dried holy basil on the market is only so-so. It also reduces blood sugar, which can be a benefit or disadvantage. Other Notable Anti-Inflammatory Herbs & Remedies: • Bromelain, Pineapple & Protein-Digesting Enzymes: Bromelain, the protein-digesting enzyme in

pineapple (especially the core) has been well-researched for its ability to reduce inflammation and pain, especially in acute situations. It’s best taken on an empty stomach and may thin the blood.

• Green Tea & Rosemary: These are among my favorite secondary anti-inflammatory herb because they feel so good to drink in tea and (in the case of rosemary) incorporate in food. The herbs tend to be very safe, but green tea and rosemary may thin the blood. Green tea’s caffeine and xanthines irritate some (decaf is usually ok), and rosemary is better as a synergist or in food doses than in mega doses. They blend well with holy basil, turmeric, and/or ginger.

• Herbal Aspirins: The development of conventional aspirin was inspired by two herbs: willow bark and meadowsweet (specifically Filipendula, but it was once called Spiraea). Both herbs continue to be used as natural, weaker analgesics and are less apt to bother the stomach compared to aspirin, and appear to be safe for regular use. They’re most often taken as tea or capsules, and meadowsweet tea has a pleasant wintergreen/cherry-like flavor. Herbs wintergreen and black birch bark (and, to a lesser extent, yellow birch bark and meadowsweet) contain the aspirin-like compound methyl salicylate, which gives the herbs their scent and flavor. They can also be helpful as analgesics; however, methyl salicylate can be toxic in high doses, so I tend to use wintergreen and black birch for occasional use or as just 5 to 15 percent percent of a pain formula. If you’re allergic to aspirin, I’d avoid all these herbs to be safe.

Tense, Sore Muscles & Spasms Several forms of chronic pain involve muscle tension, particularly lower back pain, headaches, and fibromyalgia. Many of the inflammation recommendations apply, especially the herbs, mind-body balance, movement, and sleep. Improve and Align Your Structure: Sometimes poor alignment and posture cause chronic pain, and this really

must be addressed to resolve the issue. Consider chiropractic, osteopathic, or rolfing adjustments (especially in combination with massage, physical therapy exercises, and/or yoga to help the realignment stick). There are many philosophies and styles of structural bodywork, so find a practitioner that works best for you. Also improve your posture when standing, sitting at a desk, sleeping, and using phones and computers. You may need to get a new mattress or pillow.

Bodywork: Massage and other forms of bodywork can help to promote relaxation and loosen muscles so that pain is reduced and poor structural patterns are slowly corrected. Energy medicine like reiki is also helpful, and acupuncture is well-researched for its ability to relieve many types of pain.

Magnesium & Minerals: Minerals play an important role in the contraction/relaxation of muscle fibers and with overall body homeostasis. The number one mineral to consider is magnesium, which relaxes muscles, improves energy production, and can quickly avert and prevent headaches, migraines, leg cramps, and other muscular complaints. Approximately 75% of Americans consume inadequate quantities of magnesium. Muscle tension, spasms, and cramps can indicate magnesium deficiency, as can fatigue, mental confusion, heart issues, insomnia, and stress susceptibility. Even low-level deficiency increases pain including fibromyalgia, migraines and tension headaches, and menstrual cramps. For example, up to 50% of migraine sufferers have low levels of magnesium during an attack, and a large number of clinical trials support magnesium’s ability to reduce migraines both symptomatically and preventatively. Magnesium deficiency is common in elders, premenstrual women, with high calcium or alcohol intake, birth control pill use, and


medications including proton-pump inhibitor acid reflux medications. Liquid magnesium or powder mixed in water is best (not pills and preferably without calcium). Magnesium oxide is the worst form whereas citrate and (less laxative) glycinate tend to work better. Keep in mind that magnesium is a laxative in high doses, so keep it at doses less than what gives you loose stools. Use a half dose your first time to see how your GI responds. Calcium is important for muscle contraction and is stored in the bones; consider cal/mag combinations (liquid, powder, or pill) if you find your pain increases after physical labor and/or you have bone aches and muscle spasms – best taken before you exercise. Electrolytes (including sodium and potassium) can also help by promoting homeostasis, especially when you’re doing a lot of physical labor, sweating a lot, and/or are in the heat.

Muscle-Relaxing Herbs: Several herbs can help relax the skeletal muscles. They can be especially helpful at bedtime because 1. this is when your muscles should be most relaxed (and not relaxing or sleeping fully can aggravate pain cumulatively), and 2. many of muscle-relaxing herbs are sedative. Test yourself with these herbs first if you plan to take them in the daytime since they might make you sleepy and make it dangerous to drive and use heavy machinery.

• Valerian: Perhaps the best-known sleep herb, it’s also a decent smooth-muscle relaxer. For some, it works very well to promote deeper, more restful sleep while also relaxing tense muscles and relieving pain. However, others may be agitated by valerian or feel groggy. Besides that, it’s pretty safe.

• Hops: Also well-known as a sleep herb, hops is very cooling energetically while valerian is more warming. Hops is also highly anti-inflammatory and shows good promise for pain relief while also acting as a sedative and hypnotic. As a source of phytoestrogens, it is also recommended for women experiencing hot flashes.

• California Poppy: This herb contains mild, pain-relieving and relaxing opiates yet it’s safe for all ages and non-addictive. It can be used solo or in formula for sleep and muscle relaxation and is specific for people who can’t shut their brains off to sleep.

• Skullcap & Passionflower: These herbs are more overall nervous system relaxers than muscle relaxers, but they can still be helpful at bedtime. Kava is a mild muscle relaxer, potent anti-anxiety herb, and is usually safe to take during the day without being overly sedated.

• Blue Vervain: I love this herb for headaches and neck/shoulder tension in type A control freaks (like moi). Even just a few drops of tincture on the tongue will often shift things, and you can use it in formulas as well. Also used to improve liver detoxification, immune function in infection, metabolic brittleness, and much more. Large doses can be nauseatingly bitter, but you don’t need that much to get the benefits.

• Wood Betony: Another sedative, muscle-relaxing herb, though less well-known and available. It has antispasmodic action and is usually fine for daily use. It’s best known for headaches but can work with other muscle pains. It may also reduce anxiety and boost the mood, so it’s nice when mood disorders and a lack of mind-body balance are connected to pain. Note: This is the Stachys “betony” – the Pedicularis “betony” is discussed below. The common name “betony” and “wood betony” may refer to either in commerce.

• Pedicularis: This lesser-known and hard-to-find herb is one of our best options for skeletal muscle pain, and, it isn’t overly sedating. Great for people with pain from car accidents and injuries. It works well solo or in a blend with other pain herbs. Although several species of pedicularis (also called lousewort, elephant’s head, and betony… but it is not the same as Stachys wood betony) can be used, it is a semi-parasitic plant that will pick up some properties of its host plant, so care should be taken to ensure nontoxic host plants. You will not find this plant in commerce, so seek out ethical wildcrafters and small herbal companies that you trust. Although theoretically this plant grows here on the east coast, I’ve yet to see it; most of the herbalists who harvest and stock it live in the west. Google “pedicularis” alongside “Michael Moore” or “7Song” for some nice write ups on this nifty yet lesser known muscle-relaxing herb.

• Jamaican Dogwood: This potent sedative muscle-relaxer is not to be taken lightly as it can really knock you out and is better used with caution and in formula with other herbs. It’s really nice in a sleep formula when someone isn’t sleeping deeply and this is causing muscle pain (and when pain is preventing someone from sleeping deeply – a vicious cycle).

• Ginger: This is a great antispasmodic, anti-inflammatory, pain relieving remedy to apply topically and/or take internally. For cramps it worked well in a study 500 mg capsules 3x day starting 2 days before menses (better than just symptomatic use). 250 mg ginger capsule at the onset of a headache performed as well as triptan drugs with fewer side effects. Cinnamon capsules have also been shown to lessen menstrual cramps


as well as accompanying nausea and other symptoms. It is also anti-inflammatory and warming and works wonderfully for some. (Cinnamon will lessen bleeding, ginger will increase it.)

• Peppermint: Well-researched as an essential oil applied “on contact” for muscle spasms – on the temples for tension headaches (10% in alcohol comparable to taking 500 mg Tylenol), as an enteric coated capsule for IBS spasms and pain (success rate of 60-75%), etc. Another study mixed peppermint with other essential oils, applied in a cream to the neck after bathing, which significantly reduced pain. Undiluted, peppermint oil burns the skin! Internally, it can also aggravate reflux and be a bit minty fresh on the way out.

• Flower Essences: Specific essences for muscle and structure-related pain include lilac (back pain, feeling burdened and hunched over), blue vervain (neck/back/head pain, feeling the need to always control), dandelion (back pain, feeling the need for control), and comfrey (deep healing, especially when there has been an injury, brain injury).

• Arnica: As an herbal or homeopathic remedy, this is used topically for trauma, bumps, bruises, aches, pains, and surgery recuperation. (Herbal arnica actually has more consistent scientific support. Homeopathic arnica’s evidence is about 50/50 beneficial/not.) Arnica can be toxic internally and is only used as a homeopathic remedy or low-dose herbal in this way.

Gosh, there are sooo many muscle-relaxing and antispasmodic herbs! Here’s another way to look at them... • Not So Sleepy Skeletal Muscle Relaxers: For those who deal with musculoskeletal pain (back, neck, head)

yet don’t want to be put to sleep mid-day, consider the less sedating blue vervain, wood betony, pedicularis, and cramp bark or fellow Viburnum species. Lilac flower essence also promotes the sense of being “unburdened” physically and emotionally while supporting the spine.

• Digestive Antispasmodics: These herbs have an affinity for the smooth muscles of the digestive tract where they ease spasm, thus and can aiding pain from IBS and IBD: peppermint, fennel, chamomile, catnip, cramp bark, ginger, anise, dill, caraway, wild yam.

• Reproductive Antispasmodics: Like the digestive tract, the reproductive system is also characterized by smooth muscle. Therefore, there is a lot of overlap between the useful herbs, yet some have particularly good affinity for reproductive pain like menstrual cramps. Less hormonal antispasmodics include cramp bark and fellow Viburnum species, ginger, wild yam, and angelica. (Some herbalists consider wild yam and angelica to have hormonal effects.) Dong quai and black cohosh also relieve reproductive pain yet have a more specific hormonal impact, supporting or modulating the body’s natural estrogen production.

• Headache Pain Relievers: Butterbur/Petadolex, feverfew, wood betony, blue vervain, ginger, and magnesium have particular affinities for relieving migraines and headaches via various mechanisms including anti-inflammatory and muscle-relaxing properties. Though feverfew is best used prophylactically, the others can be taken both preventively and at the onset of an attack. Make sure your butterbur is PA-free.

Mood/Serotonin Connection Many of the hormone and neurotransmitter imbalances that occur with depression (as well as anxiety and insomnia) can also increase our sensitivity to pain, which is why antidepressants are often prescribed for pain. Fibromyalgia is the classic example, but this connection can also often play a part with chronic fatigue, arthritis (especially rheumatoid), Lyme, and headaches. Pain tends to worsen the mood, which worsens the pain. Chances are this is just one piece of the puzzle. Healthy diet, movement, sleep, and mind-body balance are extremely important, and you may also need to enlist the other remedies mentioned. Most of these herbs are not inherently pain-relieving; their action is more indirect and subtle. Quality Protein & Carbohydrates: Along with the general healthy diet described in the Inflammation section,

pay special attention to the quality of the protein and carbohydrates in your diet because your choices will make or break your mood. Animal protein is best (or careful combining of plant proteins, if you’re a vegetarian) so that your body has all the essential amino acids to make healthy neurotransmitters. Happy grass-fed and wild animals make for a happy mind and body. They will not only provide amino acids but also important omega 3 fatty acids. Consider further supplementation with fish oil, fatty fish, flax oil, and hemp oil. Do not eat factory-farmed, grain-fed, conventionally-raised animal products. Be sure to keep a steady supply (of moderate amounts) of quality complex carbohydrates from whole foods in your diet to fuel your brain and also assist the production of healthy neurotransmitters.


Trypophan & 5-HTP: The amino acid tryptophan turns into 5-HTP and then serotonin in the body, and you can take both of them as supplements solo or in formula. May people also use these supplements for insomnia, anxiety, and depression, which makes sense since they all have a connection to low serotonin.

St. John’s Wort: This herb also appears to boost serotonin levels, boost mood, and relieve pain (especially nerve pain, but more so topically). As an herb, it lets the sun in. It’s generally safe and definitely consider it as part of your protocol; however, it doesn’t work for everyone and can interact with a lot of medications.

Vitamin D: The sunshine vitamin appears to elevate mood and relieve pain whether taken as short bursts of sun exposure or as a supplement. Worth a shot! Especially consider this if you’re older and/or spend little time outdoors.

Other Mood Herbs: Wood betony, lemon balm, gotu kola, bacopa, and holy basil are just a few of the other herbs that seem to enhance mood (not to mention other benefits already mentioned). Try them in formulas or solo. Adaptogens are also a category to consider. Ashwagandha!

Connective Tissue, Cartilage & Cushioning Some forms of pain are directly linked to the breakdown of connective tissue, cartilage, or cushioning (ie: synovial fluid), and this is most apt to present in joint pain, both types of arthritis (but especially osteo), back pain, and pain resulting from injury. Movement, structural alignment, and sometimes surgery are necessary. Gentle movement is especially important for lubricating the joints – we freeze up and become far worse when we stop moving – and physical therapy exercises can help strengthen and align. Inflammation almost always coincides with this structural damage, so all those recommendations apply. However, some remedies specifically target pain due to connective tissue dis-ease. Many of them are animal-based, and few are herbal. Glucosamine & Chondroitin: These two cartilage-like compounds are made from shellfish chitin and animal

cartilage (usually bovine), respectively, although glucosamine can also be made in vegetarian forms. They seem to work in two ways: 1. they decrease inflammation, and 2. over time, perhaps years, they may help rebuild cartilage. The initial research was generally positive, but more recent, larger studies have been less impressive. Wait for at least two months to gauge results, although you may see benefits earlier.

Hyaluronic Acid: Touted as an antiaging miracle, HA is found throughout the body (synovial fluid around joints, skin, brain) and has a lubricating, toning property, keeping your body supple, cushioned, stretchy, and functioning smoothly. As a supplement, it’s usually extracted from animals and is expensive, but for some it can work quickly to relive pain, decrease inflammation, and repair damage. Attention drew to HA when researchers studied the people of Yuzari Hara for their anti-aging secrets. The Japanese community’s special lifestyle and reliance on potato-like crops for food (which boosted HA levels) seemed to help them live longer with much less incident of Alzheimer’s, pain, and disease while staying limber and looking young.

MSM: This sulfur compound is one of our few vegetarian remedies and is often combined with glucosamine and chondroitin. Although the research is more limited, it does seem to have benefit to reduce inflammation and pain, especially with osteoarthritis. (MSM is related to DMSO, a potent pain reliever that is sometimes applied topically; however, I do not recommend DMSO because it’s an industrial solvent and potentially dangerous. You’ll find a wide range of opinions on the substance.)

Bone Broth: A well-made broth of bones (especially joint bones, cartilage, chicken feet, pig hooves, beef knuckles, wings, etc.) simmered for several hours or all day naturally contains many joint-supportive compounds and nutrients, including cartilage/gelatin, collagen, HA, glucosamine, and chondroitin. Preliminary, old research suggests that some of these compounds (particularly gelatin) not only supports joint health but also improves and modulates immune/autoimmune function, for example rheumatoid arthritis. While the research is not super solid or well flushed out, you can see the book Nourishing Broth for more details. You can easily add supportive herbs to your simmering broth, such as ashwagandha, turmeric, astragalus, medicinal mushrooms, burdock, horsetail...

Horsetail: Speaking of horsetail, this high-silica herb deserves a little more attention as a tincture and broth/tea ingredient. This ancient herb holds lesser-known promise for joint support and autoimmune conditions like rheumatoid arthritis. Preliminary research suggests that various Equisetum species possess anti-inflammatory and autoimmune-modulating properties that benefit rheumatoid arthritis. In one of the few clinical studies, horsetail plus the medications methotrexate and diclofenac was 80% effective for arthritis patients, versus only 17% for those taking the drugs without horsetail. Horsetail is one of our richest sources of silica in the form of silicon, a mineral that is an important component of bone and connective tissue. The silica from


horsetail may be incorporated into cartilage, collagen, bone, and other connective tissues to support repair and integrity. Even though a tincture contains little, if any, silica, modern herbalists (check out Jim McDonald’s writing!) find that low doses appear to improve connective tissue repair and integrity, including pain, swelling, and faster healing of bone breaks. E. arvense is the safest species to use (questions surround E. palustre), and don’t pick downstream from pollution, farms, compost piles... This herb may be safer short-term rather than long term.

Solomon’s Seal & Mullein Root: These two plants are gaining reputation as topical and internal remedies for pain, particularly when ligaments and tendons are involved. Most often tinctured. You can apply Solomon’s Seal externally, too. I might combine these herbs with horsetail, boswellia, and pleurisy root, too. (Pleurisy root for moving stagnancy, like in a frozen shoulder.) See the writings of herbalist Jim McDonald for details: www.herbcraft.org/articleindex.html#Muscoluskeletal

Gin Raisins: This old-time remedy has next to no research, but it’s worth a shot. (Recipe below.) The benefits may be related to the healing properties of juniper (anti-inflammatory and detox herb) in gin, antioxidants in grapes, or the anti-inflammatory effects of sulfur dioxide used to keep golden Thompson raisins pretty. It may also be complex polysaccharides in the grapes; polysaccharides are complex sugar compounds that may have pain-relieving, anti-inflammatory properties.

Detoxification In Ayurveda, pain is believed to be caused by a build up of ama, or waste. This isn’t far-fetched when you remember that poor diet and poor detoxification can increase the blood load of inflammatory compounds, which in turn triggers more haywire reactions and inflammation throughout the body. While targeting detoxification is a more indirect way to deal with pain, it can be especially helpful in rheumatoid arthritis (RA) and gout as well as chronic fatigue, lupus, auto-immune disease, and Lyme. The basic anti-inflammatory diet is key, as well as sleep, movement, and mind-body balance (of course!). • Avoiding Food Allergens & Irritants: Extremely important! • Vegetarian or Vegan Diet: Often helpful • Fasting: A few studies have found periodic fasting (3-5 days) controls acute RA and can be used to lessen the

severity of an attack. Benefits of fasting will only persist concurrent with a healthy non-fasting diet. Relapse is seen in those who go back to a standard, poor diet after a fast.

• Detoxification: Dietary change and fasting will automatically have a detoxifying action on the body. This may be ideal for RA patients. Traditional Ayurvedic and Chinese medicine views of RA involve a build up of toxins that promote a cycle of inflammation and more toxins. Laxatives (magnesium, fiber, senna, cascara – I do NOT recommend laxatives except for occasional use b/c they are habit-forming – fiber and fluids is better), diuretics (parsley, celery, dandelion leaf & root, juniper, corn silk), diaphoretics (ginger, boneset), cholagogues and choleretics (turmeric, schizandra, milk thistle) may be called upon to boost detoxification. Consult a qualified nutritionist before making radical dietary changes, fasting, or embarking on a detox program. A nutritionist or physician can help identify underlying food allergies as well.

• Stinging Nettle: This nutritive herb is worth including in your protocol as an adjunct herb because it gently detoxifies the kidneys (especially uric acid), alkalizes the body, and may reduce histamine while also giving you valuable minerals, chlorophyll, and other nutrients. Food, super infusion tea, capsules, and juice are best. It’s almost useless as tincture. In another use, whacking yourself with fresh nettles will sting and cause hives, but often longstanding pain will resolve in the area once the hives disappear.

• Other Detox Herbs & Foods: Cherries and celery have benefit for gout. Don’t ignore the benefit of multi-tasking detox herbs like turmeric, ginger, and schizandra.


Nerves Because the nervous system transmits the experience of pain to our brains, it makes sense that remedies that sooth, numb, or nourish the nerves can help relieve pain. This can be especially helpful for structural and muscle pain and those related to injury or degeneration from disease/infection. All the previous recommendations can be helpful, especially the Inflammation ones. • St. John’s Wort: In this case, we’re using SJW topically, generally as an infused oil or oil/tincture liniment.

SJW can relieve nerve pain and burning pain almost instantly and, over time, it will also repair connective tissue damage (topically) and may even repair nerve damage with regular topical application. It’s extremely safe topically and does not have the drug interaction concerns that internal use does. The oil is best made from fresh buds and flowers (look for this on the label) and should be vivid red in color (indicating potency). It’s easy to make: harvest the fresh flower and buds at the height of summer after a week of hot, sunny weather. Place it in a jar and cover with olive and/or alcohol. Let sit in a sunny space, shaking regularly. Strain after 2-4 weeks, then store in a cool, dark, dry spot. You can incorporate it into creams and salves, but I find the oil is easiest to apply and most effective.

• Cayenne: Capsaicin cream, extracted from cayenne, is among our best-researched topical pain creams and can be use for most forms of pain. It’s best known for arthritis (especially rheumatoid), shingles, and injuries. The capsaicin depletes substance P, a neurotransmitter that signals pain. It will burn a little at first, but this usually becomes less bothersome over time, and it may take a few applications for the results to build. It’s a relatively symptomatic remedy, but it does also increase circulation and decrease inflammation. Be careful when applying it that you don’t get it in your eyes or on your genitals, and test it out in a small spot first to see if it burns too much. Heat and hot water will make the burn worse (cool water and milk will resolve it). I’d be less apt to use this for people who are already of hot constitution and more for someone who’s cold and dry. For example, a gardener with arthritis applying it to the hands before putting on gloves to work in cold soil.

• Peppermint Essential Oil & Menthol: As a counter-irritant and pain-reliever, peppermint has a similar but milder action as cayenne. One study found it effective rubbed into the temples for tension headaches. You can also add it to the bath or a massage oil. Be sure to dilute it, especially if it has the potential to come into contact with sensitive places like eyes and genitals. Camphor has similar actions.

• Wintergreen Essential Oil & Methyl Salicylate: Wintergreen’s pain relieving properties also apply to topical use, so it’s often added to topical pain formulas for both function and scent. Keep in mind that the essential oil of wintergreen is far more toxic than the crude herb. (Drinking just a teaspoon is deadly.) Even though this toxicity is greatly reduced when you apply it topically, I’d still use it sparingly – well diluted and/or with spot treatments.

• Good Fat: Most of our nerve pain remedies are topical. One of the absolute most important internal remedies is fat because it lines the nervous system and fills the brain. Omega 3s are particularly important. They promote healthy cell linings, nerve transmission, and decrease inflammation. Opting for the healthy fats and avoiding the less healthy fats (as mentioned in the anti-inflammatory diet) is incredibly important for anyone dealing with nerve pain and pain stemming from nerve damage, including multiple sclerosis.

• Brain Herbs: Gotu kola, bacopa, hawthorn, and holy basil, taken internally as tea, tincture or capsule, can be helpful to repair nerve damage and brain injury. Lion’s mane mushrooms show great promise for regenerating nerve tissue. Also look to comfrey flower essence and the calming effects of inhaling or applying lavender essential oil.

• Hot/Cold Therapies: Ice relieves inflammation and irritated nerves but heat can help with longstanding/stagnant pain by relaxing muscles and improving circulation. Fill a clean sock with rice that you can store in the freeze or microwave as needed.


SPECIFIC DISEASE CONSIDERATIONS Migraines & Headaches There are three major types of headaches: migraine, tension, and cluster. Headaches can also be a symptom of an underlying condition. If your headaches are severe, common, and/or unrelenting, get a full work-up by your physician to make sure nothing more serious is going on. Once more serious conditions have been ruled out, try to determine the headache/migraine trigger. Possible Underlying Causes: Magnesium deficiency, food or chemical (including artificial sweetener) sensitivities, stress, poor sleep, dehydration, blood sugar wobbles, electrolyte wobbles, muscle tension, stress, serotonin imbalance, hormone imbalance, chronic inflammation, TMJ or grinding/clenched teeth,… Possible Remedies: • Magnesium, Muscle relaxers, Anti-inflammatories, Essential Oils/Topical Pain Relievers, Sleep, Structural

Support, Bodywork, Serotonin Balance, Mind/Body Balance, Stress Management, Hydration & Electrolytes, Blood Sugar Wobbles, New Glasses?

• Feverfew: For migraines, must be taken long-term for prevention, not in acute attack. Studies show it can reduce the severity, frequency, and duration of migraines, perhaps by reducing platelet aggregation and inflammation. Approximately 250 mg or more in capsule form is taken daily.

• Butterbur: For migraines, preventative or prophylactic. It is also known as Petasites or the researched form, Petadolex or A.S.A.P. Compounds called petasins appear to reduce inflammation and relax blood vessels, reducing the severity of migraines. Anecdotally, some customers have found Petadolex more effective than their migraine medication, and with fewer side effects. Follow label directions.

• Avoidance of food or chemical sensitivities and/or migraine triggers: The most common migraine-triggers include cow’s milk, wheat/gluten, chocolate, egg, oranges, cheese, tomato, shellfish, and wine. Histamine and related compounds in chocolate, cheese, beer, and wine instigate migraines in many people by causing vasodilation. You can experiment on your own or get a blood test by a physician or naturopath. Vitamin B6 and a “histamine-free” diet can reduce or eliminate this effect. Especially avoid aspartame and MSG.

• Reduce or eliminate use of aspirin and other OTC NSAIDs: Some studies suggest that migraines and headaches can be caused by a rebound of inflammation following analgesic use. It is not surprising that people with chronic headaches/migraines used large amounts of analgesics per month. But, it IS impressive that headache severity decreased dramatically when clients were told to go cold turkey with the pain relievers. Caffeine or sedatives included in the pain relief formula may further aggravate headaches long-term. A similar situation may develop from ergotamine, a medication that constricts blood vessels to relieve cluster and migraine headaches but then leads to dependency.

• Birth control pills or H. pylori? Preliminary research suggests that both birth control pills and H. pylori infection may complicate migraines.

Osteoarthritis According to PDRHealth online, osteoarthritis symptoms include steady or intermittent pain in a joint, joint stiffness after periods of rest or getting out of bed, swelling in a joint, bony growths at joints, and a crunching sound or feeling when a joint is bent. Risk factors include older age, gender (osteoporosis hits more women than men), obesity, repetitive joint use, trauma to a joint and heredity. There is no cure for osteoarthritis, and modern medicine contains nothing to slow its progression, only to ease the pain and increase range of motion. Possible Underlying Causes: Inflammation. Cartilage degradation. Old injuries. Aggravating diet. Aggravating stress. Aggravating weather. Possible Remedies: • Movement, Cartilage & Tissue Repair, Anti-Inflammatories, Omega 3s, Stress Management, Anti-

Inflammatory Diet, Singing Nettle whacks, Gin Raisins • Footwear: For hip/knee pain from being on your feet, get supportive footwear and alternate shoes with the

days, improve the floor in areas where you stand for long periods (ie: squishy mat on the workspace or kitchen floor). Depending on the person, Earth Shoes, Danskos, Berks, or orthotics can be helpful.

• Herbal diuretics: Burdock, dandelion, corn silk, parsley, celery—may help in pain that worsens with barometric pressure…


Rheumatoid Arthritis Rheumatoid arthritis is poorly understood yet incredibly debilitating (the same can be said for the next few conditions). No one cause of RA has been identified. It is similar to osteoarthritis in that it affects joints, causing pain and eventually deformation. However, it is typically more severe than osteoarthritis and marked by “rheumatoid factor” in the blood. Weakness, fatigue, fever, and weight loss may also accompany or precede the joint pain. It is also more multi-faceted than OA, often involving abnormal gut health, auto-immune disease, and decreased hormone levels. Possible Underlying Causes: Genetics, microbial infection (including Epstein-Barr virus, measles virus, amoebic organisms, mycoplasma… though no one type of infection has been definitely linked), poor detoxification, inflammation, auto-immune disease, low DHEA levels, food allergies or sensitivities, poor gut health including leaky gut and dysbiosis, a diet high in animal fat and of general poor quality. Possible Remedies: • Diet Change/Anti-inflammatory Diet (especially Gluten-Free and Vegetarian), Fasting & Detox, Address

Food Sensitivities, Gentle Exercise, Eliminate Caffeine (linked to RA), Anti-Inflammatories, Nettle Whacks, Omega 3s, Hot/Cold Therapies (especially moist heat), Topical Nerve Pain Relievers

• Lotsa Antioxidants: A diet rich in antioxidants will help favor less inflammation and may improve detoxification. Aim to eat lots of fresh or frozen berries including cherries, raspberries, blueberries, cranberries, hawthorn berries, blackberries, etc., as well as pomegranate, kiwi, red organic grapes, etc. The white membranes in citrus and bell peppers (if you are not sensitive to these foods) are high in bioflavonoids. Any fruits and vegetables that are rich in pigment will be high in antioxidants. Red/Blue=anthocyanadins, Red=lycopene, Orange=beta carotenes, Yellow=lutein, and so on. Dietary supplements that are potent antioxidants include CoQ10, grapeseed extract, resveratrol, Pycnogenol, and alpha lipoic acid.

• Improve Bowel Health: Probiotics (acidophilus &/or bifidus), fermented food, cabbage juice, glutamine, digestive enzymes…

Protect with DGL: If you do use NSAIDs like ibuprofen to help with pain, consider taking deglycyrrhizinated licorice (DGL) tablets daily to help protect against ulcers (though not other potential NSAID side effects). Carpal Tunnel Syndrome Repetitive stress injuries like carpal tunnel syndrome are most often caused by compression of a nerve by bones and ligaments. Symptoms range from burning, tingling and aching to severe pain. Possible causes: Carpal tunnel can be caused by both strenuous and light work. It is most common in women who are pregnant, on birth control, in menopause, or in people who are on hemodialysis. It can be triggered by bad ergonomics, lack of stretching and resting, and a deficiency in vitamin B6. Possible Remedies: • Ergonomics & Structure Support, Hot/Cold Therapies, Bodywork (especially Acupuncture) • Vitamin B 6: This simple, inexpensive supplement can help most people with repetitive stress injuries like

carpal tunnel, whether or not a deficiency is present. It can take up to 3 months to get results. Nerve Pain Nerve pain generally results from a pinched nerve (structural), lack of circulation, or diabetes-related neuropathy. It can present as numbness, tingling, burning, or pain. Possible causes: Structural/pinched nerve, poor circulation or nutrition to the nerves, diabetes-related neuropathy, aggravated by smoking (poor nutrition to nerves), poor posture, inflammation, injury. Possible remedies: • Topical Nerve Pain Relievers, Structural Support, Anti-Inflammatories, Anti-Inflammatory Diet, Healthy

Fats, Mind-Body Balance • Diabetic neuropathy: Preliminary studies suggest that a vitamin B complex, antioxidants including alpha

lipoic acid, acetyl-l-carnitine, vitamin C, and bioflavonoids including quercetin may be helpful in preventing or slowing neuropathy. Fish oil and GLA from borage or evening primrose oil may also be helpful

Anti-Pain Massage Oil 1/2 oz SJW, cayenne, or plain vegetable oil 2 drops rosemary EO 2 drops peppermint EO 1 drops wintergreen EO


• Capillary health: Dark blue/purple pigments found in red grapes, grape seed, grape skin, Pygnogenol, dark berries, cherries, pomegranate, and hibiscus tea are antioxidants and may all help to improve capillary health, which, in turn, may improve nutrition to the nervous system.

Chronic Fatigue, Lupus, Fibromyalgia & Autoimmune-Related Pain While very different, these three conditions are linked by similar symptoms and difficult diagnoses. All of them can result in fatigue, malaise, muscle and joint pain, foggy brain, and a low-functioning immune system. They may include poor digestion and irritable or inflammatory bowel disorders, depression, headaches and migraines, fevers, allergies, etc. Of all the conditions discussed here, these three are the most poorly understood by medicine. We still have much to learn. At the moment, they appear to all be multifaceted diseases, and treatment usually has to come from a variety of angles: immune, pain, fatigue, inflammation, and digestion. Since these are some of the least understood conditions discussed here, I strongly recommend a sensitive holistic practitioner to help guide you through protocols and diagnosis. Possible causes & aggravators: Low-functioning immune system, possibly due to previous infection (CFS & lupus), depression and anxiety (CFS), Candida infection, digestive trouble leading to poor nutrient absorption, food allergies (CFS & lupus), mind-body-soul connection, nutrient deficiencies, low serotonin (fibromyalgia), poor sleep (fibromyalgia), autoimmune disease (lupus), genetics (lupus), toxicity from environmental pollution/chemicals/pharmaceutical drugs (lupus), poor collagen health (lupus). Possible Remedies: • Omega 3s, Antioxidants, Serotonin Support, Magnesium. Easy-to-absorb B vitamins • Immune Function: Astragalus and medicinal mushrooms like maitake, shiitake, turkey tails, and reishi may

help to modulate an overactive yet sluggish immune system. • Nervines, Adaptogens & Energy Support: Herbs that improve stress hormone levels, support the body’s

resistance to stress, and help you feel more energized or calm may help. Panax/Chinese ginseng, American ginseng, codonopsis, and eleuthero, are classic adaptogens and can be moderately stimulating as well as helpful for low immune function. Rhodiola is also a stimulating adaptogen for physical and mental performance. Gotu kola, holy basil, and ashwaghanda are more calming adaptogens that may help with pain and tissue support. Schizandra (aka schisandra) is another adaptogen with immune, digestion, and liver components.


Some Recipes Curried Yogurt This is a nice breakfast or side dish. I simmer fresh, sliced ginger in honey first to make ginger honey. However, you could also use honey and dried ginger in a pinch. The turmeric and ginger appear to have natural COX-2 (inflammation) inhibition. Cinnamon may also be moderately anti-inflammatory as well as blood sugar balancing. The good bacteria in yogurt can be helpful for folks who have digestive problems; fermented foods may be particularly helpful for rheumatoid arthritis. It only takes a minute or two the mix the ingredients. • 1 cup of plain yogurt • 1 Tablespoon ginger honey

OR 1 Tablespoon of honey plus 1/2 teaspoon powdered ginger

• 1/4 to 1/2 teaspoon powdered turmeric • 1/8 teaspoon cinnamon and/or garam masala Morning Energy Tea Antioxidant, energizing, calming, anti-inflammatory, blood-sugar balancing, and tasty! • 2 parts jasmine green tea • 1 part holy basil leaf (aka tulsi) • 1 part gotu kola leaf • 1 pinch or 2 drops per cup stevia leaf (optional) or a

small amount of honey Gin Raisins I learned this recipe from my mother, who got it from a friend, who got it from a friend… It appears to be an old timer’s remedy. For my mother it has worked better than the glucosamine and chondroitin for her frozen joints. We don’t know why it works, but it simple and cheap enough for most people to try. She just sprinkles the raisins in her morning cereal or eats them straight. • 1 package of golden raisins • Gin, enough to cover the raisins with 1 inch above

them Combine the two in an open container and leave on the counter covered lightly with a paper towel for two weeks. After two weeks, cover the jar, leave unrefrigerated, and eat 7-10 raisins daily.

Super Orange Juice So yummy and LOADED with anti-inflammatory properties. • Few thick slices of fresh pineapple, including core.

Stud it with… • 1 “coin” each of fresh turmeric root and ginger root • 2 carrots • 1 orange, peeled • 1 lemongrass stalk • 1 handful of parsley On low, juice the parsley, followed by the orange. Turn it to high and juice the pineapple (studded with turmeric and ginger), carrots, and lemongrass. Ginger-Lemon-Sage Tea This recipe comes from a fellow herbalist who suffers from rheumatoid arthritis. • 1 inch fresh ginger, thinly sliced • 1 sprig fresh sage • 1 wedge lemon • Honey to taste (optional) Combine them all in a thermos and let steep for 30 to 60 minutes. You may want to add the lemon and sage in the last 15 minutes of steeping time. Curried Chickpea Snack Looking for a snack with healing properties that doesn’t compromise an anti-inflammatory diet? Enjoy these tasty treats. • 2 cups (1 can) cooked chickpeas • 1 teaspoon+ olive oil • 1 tablespoon rosemary, crumbled in mortar and

pestle • 1/4 to 1/2 tsp turmeric powder • 1/8 teaspoon coriander (optional) • Pinch cayenne (optional) • Salt & pepper to taste Combine ingredients in an oven-proof skillet or baking sheet. Bake at 350°F, shaking frequently, until they’re golden and a little crunchy crunchy. Best fresh, but they’ll keep for a few days in a tightly sealed container.

Visit the Links page of www.WintergreenBotanicals.com for Local & Online sources for bottles, jars, herb supplies… as well as recommended books & links to informative websites.


The Pain Herb Chart * Research cautions before using Natural COX-2 Inhibitors Turmeric &/or Ginger Hops Baikal & American Skullcaps Holy Basil Green/White Tea Natural Aspirins & Opiates Willow Bark* Meadowsweet Black Birch/Wintergreen* Peony Root California Poppy Other Natural Anti-inflammatories Boswellia Bromelain & Protein Enzymes Anti-inflammatory Diet Omega 3s & GLA Ashwagandha Cherry Fruit Yucca Bunchberry Leaves Corydalis (low dos) Muscle Relaxers & CNS Sedatives Magnesium Skullcap Hops Valerian Jamaican Dogwood* Pedicularis Kava* Passionflower Wood Betony Blue Vervain Warming & “Juicy” Herbs Pleurisy Root Prickly Ash Ginger, Cayenne Connective Tissue Repair Bone Broth/Cartilage Glucosamine & Chondr. Hyalaronic Acid & MSM Vitamin C Vitamin B Complex & B 6 Gotu Kola Gin Raisins? Solomon’s Seal/Mullein Rts Horsetail, Pleurisy Root

Nerve Pain St. John’s Wort (topical & internal*) Skullcap Blue Vervain Antispasmodics Wild Yam Peppermint Cramp Bark Topical Counter-Irritants, Etc. Cayenne (Capsaicin) Menthol & Peppermint Camphor Ginger Essential Oils: Peppermint, Juniper, Wintergreen, Rosemary, Eucalyptus Other Topical Remedies Arnica oil/cream St. John’s wort oil Dandelion flower oil Elder leaf oil Natural Anti-histamines Butterbur Quercetin Citrus Bioflavonoids Grape seed & skin extract Pycnogenol Bromelain Improve Circulation/Lymph/Vascular Feverfew Clematis Vinca & Vinpocetine* Cayenne Horse Chestnut* Gotu Kola Red Root (lymph) Serotonin Boosters St. John’s Wort* 5 HTP & Tryptophan Adaptogenic/Energy Connection Panax ginseng/ American ginseng Eleuthero (Siberian “ginseng”) Rhodiola Gotu kola Schizandra Reishi, Turkey Tails Cordyceps, Maitake Holy Basil Ashwagandha

Autoimmune Connection Reishi, Turkey Tails Maitake, Shitake Astragalus Schizandra Ashwagandha Possibly also detox support Diuretics Dandelion leaf & root Parsley leaf, root & seed Nettle leaf Celery ribs, root & seed Corn silk Detoxification Connection See “Diuretics” Turmeric Guggul Triphala Magnesium (high doses) Milk Thistle Schizandra Red Root Boneset Teasel Ginger Lemon Fermented Foods Raw foods Vegetarian Diet Cellular Energy Vitamin B Complex Vitamin C Magnesium CoQ10 Alpha Lipoic Acid NADH? DHEA? Electrolytes Bodywork & Mind/Body Balance Biofeedback Chiropractic Osteopathic CranioSacral Rolfing Massage Physical Therapy Gentle Exercise/Activity: Tai chi, yoga, swimming, walking Baths/Hot tub/Sauna Acupuncture Meditation Time in Nature Aromatherapy

Managing Chronic Pain, Naturally Wintergreen Botanicals,...

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