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Taking Control Of Acute Pain

There have been strides made in managing pain naturally, but practitioners must consider a myriad of factors when determining effective treatments.

Pain is a normal part of life: a skinned knee, a tension headache, a bone fracture. Dealing with pain, even on a short-term basis, can require a variety of strategies, which may or may not work for everyone.

“Acute pain ranges from a mild irritation that might last just a moment, or it might be severe and last for weeks or months,” said New Hampshire-based Adam Killpartrick, DC, CNS. “In most cases, acute pain does not last longer than six months, and it disappears when the underlying cause of pain has been treated or has healed. Unresolved acute pain, however, might lead to chronic pain.” 

Chronic pain persists over time despite the fact that the injury has healed, he added. “Pain signals remain active in the nervous system for weeks, months or years,” he said, adding that physical effects include muscle tension, lack of mobility and fatigue. Emotional effects include depression, anger, anxiety and fear of re-injury (these can also be seen in acute pain, especially after a traumatic event such as a car accident). “It’s been my experience that those who endure traumatic events and suffer from emotional involvement can be susceptible to dependency on painkillers and need to be monitored and treated appropriately.”

The differences between acute and chronic pain are not as cut and dry as one would think as there can be some crossover, said Stuart H. Garber, DC, PhD, president of the California-based supplement producer Dr. Garber’s Natural Solutions. “Acute pain is sudden, typically sharp in nature and relatively short lived. It can be situational (stepping barefoot on a sharp rock, the stomachache associated with food poisoning, a bee sting, an eye strain headache from overstudying), or associated with an underlying illness (from the sharp pain in an arthritic joint when overused, to a headache caused by a brain tumor),” he said. “Meanwhile, chronic pain tends to be duller (although can be sharp or can seem duller due to longterm accommodation) and is usually a result of a long-standing underlying condition, physical or mental/emotional. The psychological aspect of chronic pain cannot be underestimated.” 

Talking About Pain 

When discussing pain with patients, to fully understand their needs, Dr. Killpartrick suggested practitioners keep in mind that pain is an indicator, not a condition in itself. “Especially in acute care, the underlying cause can be overlooked while attempting to minimize the pain itself,” he warned. “The ultimate goal is to eliminate pain by addressing the underlying cause. The old analogy of the engine light coming on in a car comes to mind. When the engine light comes on, you don’t want to simply shut off the engine light, you want to make sure the reason the light came on is found and fixed.”

“We must understand how this pain affects basic self-care and activities, and also how it affects the level of functionality patients are accustomed to,” added Amber Lynn Vitse, LMT, CN, founder of AmberLynnVitale.com in Tennessee. “Is it causing the person to self-medicate in any fashion? Is it causing a change in temperament, lack of appetite or inability to focus and concentrate? If pain prevents a person from doing what they have always done or wish to do, then it must be addressed.” 

Natural Treatments 

As a bodyworker, Vitse’s clients are those interested in her services as a primary source of treatment as well as those who view them as a “last hope.” “Hands-on, manual therapy is a well-recognized treatment for both acute And chronic pain,” she said. “Traction, stretching, trigger point therapy, deep tissue, friction/cross-fiber, hot/cold therapy, neuromuscular therapy, myofascial release—all are methods I might use to assess and treat pain to gain measurable relief.” 

As a nutritionist, Vitse said she might recommend anti-inflammatory herbals such as turmeric, boswellia, bromelain and formulas that synergistically combine these ingredients with other herbs and dietary supplements. “Examples might be Inflam-Away by Natura, Zyflamend by New Chapter and Wobenzyme by Garden of Life for musculoskeletal pain. For headaches, I try to assess whether the relief of muscle tension has a positive effect on the pain level. If it does not, the client should seek other medical advice. Other possibilities might be cold laser, various linaments, ultrasound, vibrational therapy, etc.” 

It should be noted that natural treatments never take the place of medical recommendations, especially in a case of acute injury, Dr. Killpartrick cautioned. When appropriate, however, he uses the following treatments:

External approaches: botanicals, nutrients, topicals, homeopathics 

• Manual approaches: chiropractic/osteopathy, cranial work, active release technique (ART), trigger point therapy, contrast hydrotherapy

• Instrumental: electric stim, cold-laser 

“Chiropractic, cranial therapy and cold laser have the potential to provide relief for a variety of ailments and should be considered with any approach to pain, either acute or chronic,” he noted. “My practice utilizes upper cervical chiropractic care. Traditional chiropractic care can be swapped out if needed.” 

More specifically, he noted:

• For muscle cramps

Botanicals: passionflower, valerian

Nutrients: magnesium, malic acid, taurine 

Manual therapies: massage therapy, trigger point therapy, ART, upper cervical specific chiropractic, cranial therapy

• For back pain

Botanicals: cat’s claw, devil’s claw, boswellia, ginger

Nutrients: B12, proteolytic enzymes, vitamin D, glucosamine, chondroitin, MSM, omega-3s Manual therapies: upper cervical specific chiropractic, cranial therapy, massage therapy, trigger point therapy

• For headaches/migraines

Botanicals: butterbur, feverfew 

Nutrients: CoQ10, B2, magnesium, 5-HTP Manual therapies: upper cervical specific chiropractic, cranial therapy, massage therapy

• For abdominal pain 

Botanicals: turmeric, boswellia, chamomile, fennel, peppermint oil 

Nutrients: vitamin U (S-methylmethionine), probiotics, digestive enzymes 

Manual therapies: visceral manipulation, abdominal massage

• For menstrual pain 

Botanicals: chaste tree berry, dong quai, St. John’s wort 

Nutrients: evening primrose oil, omega-3s, magnesium, vitamins B6 and E Manual therapies: upper cervical specific chiropractic, cranial therapy, massage therapy 

Emily Gonzalez, ND and chief medical officer with Washington-based BioGenesis Nutraceuticals, Inc., agreed that anti-inflammatory herbs such as white willow bark, turmeric, boswellia, ginger and rosemary can be effective for acute pain. “These herbs influence a number of different pathways for a synergistic and comprehensive effect. For example, white willow bark extract has a powerful anti-inflammatory in its active constituent, salicin, from which aspirin was synthesized. Fish oil as well as proteolytic enzymes like bromelain and nattokinase will also have pain-relieving effects through their anti-inflammatory actions,” she added. “There has also been research that caffeine paired with any type of pain reliever can increase the alleviation of pain.” 

A more invasive therapy Dr. Killpartrick noted is prolotherapy, also known as “proliferative injection therapy.” “It involves injecting a non-pharmacological irritant solution into the body, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain,” he explained. “The solutions can range from nutrients such as B12 to lidocaine, for its anesthetic properties. This technique can be used in certain states by specific practitioner types based on state laws.” 

In addition, acupuncture has proven highly effective for some types of pain, according to Vitse, in particular the technique of dry needling.

Careful Consideration 

Natural supplements are generally very safe to use for acute pain management, with concerns about side effects being very minimal, according to Dr. Gonzalez. Because botanicals and other nutrients generally work on multiple biochemical pathways, their incidence of side effects is fewer than OTC or prescription drugs, she said.

“If you are caffeine-sensitive or should avoid caffeine due to a health issue, then you should not take any acute pain remedy that Contains caffeine,” she added. “If you are allergic to salicylates, then you should avoid white willow bark, as it contains naturallyoccurring salicylates.” 

However, Dr. Killpartrick warned that in the short term, there are botanicals/nutrients that may interact negatively with any medications. “Every patient should have a drug/nutrient/botanical interaction assessment performed prior to recommending any nutritional support.” For the long term, he noted to be aware of the reliance on chemical solutions to a physical problem—within reason. “This goes back to the discussion practitioners need to have with their patients about pain. This places responsibility on the health care provider to identify the underlying cause (is it physical or chemical?) And determine the most appropriate referral to make if necessary.” 

As for prescription and OTC pain drugs, both can be dangerous, noted Dr. Garber. “From gastrointestinal bleeding to neurological damage, the list of side effects from these drugs is long. I don’t believe that it is necessarily heroic to suffer through pain, but too many people over-rely on these drugs to their detriment. Besides the side effects, use of these drugs allows users to ignore what’s going on, potentially allowing the problem to worsen and for the acute problem to become chronic.” 

He agreed that addiction to pain medication is certainly a concern that practitioners need to be much more aware. “Is this patient someone with a more ‘addictive personality?’” he asked. “Does this patient have a high or low pain threshold or a high or low tolerance to medication? Unfortunately, how medicine is practiced today, few doctors know their patients well enough to ascertain this information.”

Noteworthy Studies 

Dr. Killpartrick said he is interested in the studies that are being done relative to inflammation, pain and whole foods. “I think that one of the most affordable, effective strategies we can educate our patients on is diet,” he said. “If people can ingest more anti-inflammatory foods, it very well may position them to avoid injury and subsequent pain.” 

There are a couple of studies Dr. Killpartrick said he found interesting. The first involves cherries: A study of 58 patients with knee osteoarthritis found WOMAC scores decreased significantly (P<0.01) after cherry juice (8-oz. BID x six weeks); hsCRP declined cherry juice versus placebo (P<0.01).1 The other study featured research on cranberries, which showed it selectively decreases biomarkers of lipid oxidation (oxidized LDL) and inflammation (adhesion molecules) in metabolic syndrome.2 

“New studies on the use of natural products, especially botanicals, are being published quite frequently in peer-reviewed scientific journals and are available for perusal or download from PubMed,” said Dr. Gonzalez. “These studies can help to inform ingredient usage and amounts necessary for acute pain relief when formulating new products.” 

And while a plethora of new research is being done, Dr. Garber said he views it with skeptic’s eyes. “Where is the study coming from and who’s behind it? As Deep Throat admonished Woodward and Bernstein, ‘Follow the money!’ We see time and again that studies, even those coming out of academic institutions, are either funded by the pharmaceutical industry or that the lead researchers have financial ties to pharmaceutical companies. With the continuous demand for more content, the mainstream media is culpable for putting out reports of studies before their time, insinuating cause and effect relationships where only an association has been found.” 

Seeing Results

There have been some great bioavailability improvements, especially with regard to phytosomal turmeric, noted Dr. Gonzalez. “In addition, BioGenesis uses a seaweed-derived system called MakTrek Gastric Bypass Delivery for our proteolytic enzymes in order to ensure intact delivery to the small intestines. This also ensures that no phthalates are used for the enteric coating.” 

Dr. Garber said one of the most significant improvements regarding supplements in general is the implementation and enforcement Of current good manufacturing practices, which help ensure the safety of the products. “As for acute care supplements, the fact that more people are not willing to accept shortterm benefits at the cost of long-term health has stimulated more research into safe and effective alternatives to drugs.” 

In regard to patient recovery times, taking into consideration the myriad of factors, including a patient’s pain tolerance, their response to treatment, the appropriateness of treatment modality to the injury, etc., it is impossible to predict, said Dr. Killpartrick. “Clarity and transparency on this point with the patient does go a long way,” he concluded. “Having a conversation about the expectations will help to solidify a trusting doctor/patient relationship … When it comes to pain, employing a shotgun approach can provide the patient with much needed relief while the underlying cause is assessed and the appropriate long-term strategy is determined.” 

References: 

1 Schumacher HR, et al. Osteoarthritis Cartilage. 2013; S1063-4584(13)00802-9.

2 Basu A, et al. J Agric Food Chem. 2011; Nov 29.

“One of the most affordable, effective strategies we can educate our patients on is diet. If people can ingest more antiinflammatory foods, it very well may position them to avoid injury and subsequent pain.” — Adam Killpartrick, DC, CNS

Seeking Professional Help for Pain

Everyone has a different degree of “pain tolerance.” However, even with “minor” pain the body is indicating a problem and a need for a change. Even if someone chooses to “power through” their pain, there are some key symptoms to be aware of that require immediate medical attention.

Dr. Killpartrick offered a list of key indicators that should not be ignored:

• Headache: The “worst headache of my life” might be a sign of a serious underlying condition such as a hemorrhage. Extreme pain over the temple could be a sign of temporal arteritis and could be extremely damaging if not treated immediately. It typically occurs while one is combing their hair.

• Chest pain: If the patient describes more pressure than pain, and certainly if there is associated shortness of breath.

• Severe abdominal pain (with either rapid or slow onset): Abdominal pain is never something to ignore. There are a number of potential organs that have the ability to transmit pain, i.e. appendix, pancrease, gallbladder, intestines (in the case of diverticulitis, Crohn’s or colitis), none of which should be overlooked.

• Calf pain: This could be a sign of deep vein thrombosis.

• Severe pain in a bone: Especially if it occurs at night can be indicative of an osteosarcoma.

Vitse added that she directs her clients to seek medical help either when they have found no relief in self-help measures, when they are taking excessive amounts of pain medication just to function, or when their musculoskeletal pain appears to be referred from a nerve root. “I also recommend medical help when they are bleeding from an injury, of course, or if considerable swelling is occurring whether related to the musculoskeletal system or to the internal viscera.”

Healthy Take Aways

. In most cases, acute pain does not last longer than six months, and disappears when the underlying cause of pain has been treated or has healed. Unresolved acute pain may lead to chronic pain.

. When discussing pain with patients, practitioners should find how the pain affects basic self-care and activities, and how it affects the level of functionality to which the patient is accustomed.

. Anti-inflammatory herbs such as white willow bark, turmeric, boswellia, ginger and rosemary can be effective for acute pain.

. Practitioners should be aware of the patient’s reliance on chemical solutions to a physical problem.

FOR MORE INFORMATION:

. BioGenesis Nutraceuticals, (425) 487-0788, www.bio-genesis.com 

. Dr. Garber’s Natural Solutions, (310) 396- 7247, www.drgarbers.com 

. Adam Killpartrick, DC, CNS, (603) 505-0941 

. Spine-Health, www.spine-health.com 

. Amber Lynn Vitse, (865) 309-4709, www.Amberlynnvitale.com