Offering Support for Clients Living with Chronic Pain

(Taken from the Fall 2005 IIPA Newsletter)

by Susie Hale, ND, PhD and Wendy Arthur, MD

Chronic pain is a major health problem in this country as pain is the most common symptom that prompts people to seek medical care. It is the second leading cause of medically related work absenteeism, resulting in more than 50 million lost workdays each year. Employers, concerned about its effect on healthcare costs, have found it is the leading cause of disability in the working-age population, with both private disability plans and the Social security system being significantly affected. Back pain alone produces chronic disability in approximately 1% of the U.S. population, and compensable back pain problem. Chronic pain problems have also become significant for the elderly, and the frequency of these conditions is expected to increase with the aging of the population. Clearly, persistent or chronic pain problems are a significant public health problem (1).

Pain may not receive enough attention from the medical community because it cannot be measured (2). The American Pain Society, or APS, has attempted to elevate the awareness of pain treatment among health care professionals by creating the phrase “Pain: The 5th Vital Sign” tm. Since vital signs are, it would have a much better chance of being treated properly by medical professionals (3). but, feeling pain is, ultimately, a personal experience, and there is no way for a phsician to gauge how much pain the person is experiencing.

Pain is a message intended to alert us to danger. When the message is heard and the body takes appropriate action, the painful symptoms can disappear. (Symptoms are the way the body tries to heal itself or prevent further injury.). The nervous system can be fooled for a while, but over time, pain will break through if there remains what is interpreted as danger. With time, chronic pain can set it. Even though pain is an intensely subjective and personal experience, and even if no physical explanation for it can be found, all pain is real (4).

How does the body experience pain?

The hypothalamic-pituitary-adrenal axis (HPA) axis), a large part of the neuroendocrine system, controls reactions to stress. (The HPA axis is involved in the neurobiology of mood disorders and post-traumatic stress disorder.) It is the mechanism for interactions among glands, hormones and parts of the mid-brain that coordinate the adaptation syndrome. This allows the body’s system to adapt to stress (5).

The HPA axis includes parts of the hypothalamus, the anterior lobe of the pituitary gland, the adrenal cortices, hormones, systems that transport hormones and feedback mechanisms that transport cortisol from adrenal glands back to the hypothalamus and to other parts of the brain. The hypothalamus releases corticotropin-releasing factor (CRF), a hormone that is transported to the anterior lobe of the pituitary through a blod vessel system which descends from the hypothalamus. In the anterior pituitary gland, CRF stimulats release of adrenocorticotropic hormone (ACTH), which is transported by the blood to the adrenal gland, where it quickly atimulates biosynthesis of corticosteroids from cholesterol.

The release of CRF from the hypothalamus is highly influenced by stress, by levels of cortisol in the blood and by the body’s sleep/wake cycle. Anatomical connections between amygdala, hippocampus, and hypothalams facilitate activation of the HPA axis. Sensory information arriving at the amygdala (which is the part of the brain that perceives fear) is processed and conveys messages to other parts of the brain that are involved in responses to fear. Meanwhile, the hypothalamus is activating fear–signaling impulses to the sympathetic nervous system and the HPA axis. Increased production of the cortisol sends alarm reactions to stress, which facilitates an adaptation syndrome which suppresses alarm reactions and the body attempt to incite countermeasures.

Atrophy of the hippocampus part of the brain in humans exposed to severe stress is believed to be caused by the presence of excessive stress-induced glucocorticoids. (Glucocorticoids serve important functions in moderating stress reactions, but in excess, they can be damaging.) Deficiencies of the hippocampus can reduce the memory resources that are equipped to help a body formulate appropriate physiological reactions to stress (6).

Pain affects us biologically, psychologically, cognitively, spiritually, culturally and behavioraly. There is a loss of the normal checks and balances of the internal processes of the central nervous system-spinal cord and brain with chronic pain (7).

“When the pain system is doing its job, it is a warning of danger and harm. When the system is overloaded or has begun reacting indiscriminately, it can be a source of physical and emotional stress. As a result, you may suffer even more symptoms. These additional symptoms are the result of the stress you suffer from chronic pain (p. 19).”

Natural approaches for addressing chronic pain range from bodywork modalities, to emotional/psychological counseling, to nutritional support. For the practicing iridologist, a critical component is the understanding that chronic pain is a multidimensional experience for each client. Assessing the strengths and weakneses of the client’s constitution, then offering counseling for dietary and nutritional supplement support can assist the client in solidifying a stronger foundation on which other modalities can build.

For the chronic pain sufferer, maintaining adequate hydration can decrease the aching and joint pain that occurs with even mild levels of dehydration. Attention should be given to maintaining adequate amounts of magnesium and the B-vitamins in the diet. Magnesium is involved in hundreds of enzymatic reactions to maintain homeostasis in the body, as are the B-vitamins (8). The B-vitamins can increase energy in the body through their effect on the Kres cycle. Individuals who do not consume at least 5 servings of fruits and vegetables a day may be at increased risk for deficiencies of B vitamins except B-12, which requires consumption of meat, poultry, or yeast to maintain adequate levels.

A serotonin precursor, 5-HTP, is an important substance for normal nerve and brain function. This supplement is used for the sufferers of chronic pain. Serotonin appears to play significant roles in sleep, emotional moods, pain control, inflammation, and IBS (9). Less commonly considered by most practitioners is SAM-e (S-adenosylmethionine). S-adenosylmethionine is a naturaly occurring substance that plays a role in the immune system, maintains cell membranes, and helps produce and breaakdown brain chemicals such as serotonin, melatonin, and dopamine as well as vitamin B-12. Numerous scientific studies indicate that SAM-e may be useful in the treatment of depression, osteoarthritis, fibromyalgia, and liver disorders (10).

Adaptogenic herbs, such as rhodiola, have been used for centuries in Russia and Scandinavia. Studies indicate it can fight against fatigue, decrease pain, and restore energy (11). Another herbal supplement, Boswellia, from a tree in India, has been used for centuries for its anti-inflammatory properties and anti-arthritic properties (12). These herbs are two examples of traditional approaches that one may include when working with a client who lives with chronic pain.

There are many approaches to reduce the suffering of individuals with chronic pain including: 1. adequate rest; 2. adequate fluids; 3. stress reduction to quiet the over-stimulation of the HPA axis; 4. whole foods diet with at least 5 servings of fruits and vegetables a day; and 5. possible supplementation with minerals such as magnesium, the B-vitamins, and herbs.

1) Fox, C.D., David Berger, D., Fine, P.G., Gebhart, G.F., Martin Grabois, M.,. Kulich, J.J., Lande, S. D., McCarberg, B., Portenoy, R. A Position Paper of the American Pain Society. Pain Assessment and Treatment in the Managed Care Environment. January, 2000. Retrieved 8/28/04 from http://www.ampainsoc.org/managecare/position.htm. 2)Griffin, R.Morgan. The Price Tag on Pain. Retrieved 9/4/04 from http://my.webmd.com/content/article/57/66051.htm?z=1661_00000_0000_wk_._ Originally published 12/02; medically updated 10/04. 3) Campbell, J. Pain: The Fifth Vital Sign. American Pain Society - presidential addresss. December, 1995. Retrieved 9/19/04 from http://www.ampainsoc.org/advocacy/fifth.htm. 4) Bresler, D and Trubo, R. Free Yourself From Pain. Simon and Schuster, 1979.) 5) Crawford, Leslie. HPA Axis-Important Interactions with Other Central Nervous System Functions, including Modulation of Pain Perception, Mood and Cognitive Function. Retrieved 10/18/05 from http://www.nfra.net/SubCrofford1.htm. 6) NIH. Stress System Malfunction Could Lead to Serious, Life Threatening Illness.Retrieved 10/19/05 http://www.nichd.nih.gov/new/releases/stress.cfm. 7) Caudill, Margaret A. Managing Pain Before It Manages You. Guilford Press, 1995. Tong, GM and Rude, KR. Magnesium deficiency in critical illness. J Intensive Care Med. 2005 Jan-Feb; 20 (1): 3-17. Review. 9) Guyton AC, Hall JE. Textbook of Medical Physiology, 9h ed. Philadelphia:W. B. Saunders, 1996. 10) http://www.uwmm.edu/altmed/ConsSupplements/SAdenosylmethionineSAMecs.html. Retrieved 10/18/05. 11) Brown R, Gerbarg P, and Ramazanov Z. Rhodiola rosea; a Phytomedicinal Overview. HerbalGram. 2002;56:40-52 American Botanical Council. Retrieved 10/19/05. 12) Chevrier MR, et al. Boswellia carterii extract inhibits TH1 cytokines and promotes TH2 cytokines in vitro. Clin Diagn Lab Immunol. 2005 May; 12(5):575-80.