A board-certified internist and expert in pain and sleep explains 4 health domains for pain alleviation, as well as 7 common causes of pain (and how to get rid of each).
We’ve all seen how pain can disrupt sleep. But did you know that poor sleep also significantly worsens pain?
An excellent large review article showed the effect to be bidirectional. “Sleep complaints are present in 67-88% of chronic pain disorders and at least 50% of individuals with insomnia…suffer from chronic pain,” the authors state in The Journal of Pain. “A key trend emerging from population-based longitudinal studies is that sleep impairments reliably predict new incidents and exacerbations of chronic pain.…Recent experimental studies suggest that sleep disturbance may impair key processes that contribute to the development and maintenance of chronic pain, including endogenous pain inhibition and joint pain.”
Deep sleep is when growth hormone release and tissue repair occurs. Numerous other mechanisms have also been implicated.
Sadly, physician education on treating chronic pain is minimal, leaving a third of Americans suffering with chronic pain. The good news? This is where sleep specialists can dramatically help their patients.
Understanding Pain: A Paradigm Shift
Pain is not an outside invader. It is a normal, healthy part of our body’s monitoring system, telling us when something needs attention. Pain is like a warning light on our body’s dashboard. To extend this analogy, when you put oil in the car, the oil warning light turns off.
Using fibromyalgia as a model, our research shows that if you give the body what it needs, the pain goes away. The question is how to tell what the body is asking for. Unlike our cars, we don’t come with an owner’s manual.
This article will help you understand what each pain is asking for, so you can effectively treat it. (The free Cures A-Z smartphone app that I developed also does this for hundreds of health conditions.) I find the vast majority of pain, even when severe and chronic, can be effectively treated using a comprehensive approach.
4 Key Health Domains for Eliminating Pain
Most illnesses do best when these 4 key domains of health are addressed.
- Biochemistry. This includes medications, nutrition, and herbals.
- Biophysics. This includes acupuncture and an especially excellent treatment for pain called frequency-specific-microcurrent, which delivers low-level electrical current to reduce swelling, repair tissue, and lessen pain. (I recommend www.frequencyspecific.com to learn more).
- Structural. This includes ergonomics, manipulation techniques, surgery, massage, and myofascial release.
- Mind-body. Unexpressed feelings can get trapped in muscles. Emotional and physical trauma can also cause the fascia to get stuck in “frozen” mode. Put simply, there is a reason why some people are called a “pain in the back” (or even lower)!
Standard medicine uses only medications and surgery—a very small part of the healthcare toolkit. People do best when the entire healthcare toolkit is available, instead of just the standard medical “hammer” of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs).
Let’s look at the most common types of pain and how to approach them. Though each of these would take more than one article to fully understand, the information below will dramatically improve your ability to help people with pain.
7 Most Common Causes of Pain—and How to Eliminate Them
1. Muscle pain. Called myofascial pain, this is associated with decreased energy in the muscles. Muscles are like a spring; although it may seem counterintuitive, they take more energy to stretch than to contract. (This is why after a heavy workout, your muscles are tight instead of loose and limp.) Muscle pain is extremely common, accounting for 30% of pain visits in a primary practice. Yet it is routinely missed by physicians. Most back pain comes from muscle pain.
Optimizing energy production with the S.H.I.N.E. Protocol (the initials stand for: Sleep, Hormones, Infections, Nutrition, and Exercise as able) is dramatically effective at decreasing muscle pain, according to our research. Improved energy conditions in the muscles allow them to relax. A free 10-minute “Energy Analysis Program” quiz on my website www.vitality101.com (see step 3) can determine the causes of the patient’s low energy and tailor a protocol for reducing the pain. It can be done by the patient at home.
2. Arthritis results from excessive inflammation. Repeated double-blind studies have shown that the herbal mix Terry Naturally Curamin is more effective than celexicob (known commonly as the brand name Celebrex) for arthritis. It can be taken along with NSAIDs. It takes 6 weeks to see the full effect.
3. Migraine headaches. Triptans can be very effective if used early in migraines. But once sensitivity around the eyes sets in, the gut goes to sleep, and the effectiveness of these medications decrease markedly, according to a fascinating Harvard study. Another study shows that Excedrin Migraine was as effective as triptans. I find they can be synergistic.
Interestingly, Vitamin B2 (400 mg a day) has been shown to decrease migraine frequency by approximately 69%. Vitamin B12 (200 – 500 µg) and magnesium (200 mg a day) also markedly decrease migraine frequency. Give these 6 weeks to see the full effect.
4. Nerve pain. This generally results from decreased energy in the nerves resulting in uncontrolled repetitive firing. Numerous medications can help this and are discussed more in depth in other places including my book Pain Free 1-2-3 (email me at fatiguedoc[at]gmail.com for the relevant chapter). Supplements such as lipoic acid (300-600 mg twice a day) and acetyl-L-carnitine (1,000 mg 2 to 3 times daily) have been shown to help nerve pain over time as well.
5. Central sensitization or brain pain. When pain becomes chronic, the brain starts to amplify it. This can occur in many (if not most) kinds of chronic pain via a mechanism of “microglial activation.” Although many medications are now geared toward masking the pain of central sensitization, a few exist that can actually help to turn it off. Low-dose naltrexone (LDN) (3-4.5 mg at bedtime) has been shown in numerous studies to be very helpful for fibromyalgia, autoimmune illnesses, and a host of other conditions. If it initially disrupts sleep, LDN can be given in the morning until this phase passes. It takes 2 months to see the benefits. LDN cannot be used if the patient is on narcotics, and the effectiveness is lost at doses over 4.5 mg daily.
6. Allodynia. This describes when light touch on the skin is painful. It results from an increase in the brain neurotransmitter chemical N-methyl-D-aspartate (NMDA) and can improve with NMDA receptor antagonist medications such as Namenda (memantine).
7. Complex regional pain syndrome (CRPS) comes from difficulty in regulating the sympathetic nervous system. Its treatment is indeed complex. Fortunately, effective treatments are now available even for this. For information on treating CRPS effectively, you can email me at fatiguedoc[at]gmail.com.
A Few Other Tips
Several medications are highly effective at both maintaining sleep and decreasing pain. My favorites include:
- Gabapentin: 100 – 600 mg at bedtime. When pelvic pain is present, adding 10 – 25 mg of amitriptyline can make a very effective combination.
- Cyclobenzaprine (Flexeril): 2.5 – 5 mg. Higher doses add more side effects with modest benefit.
- Tizanidine (Zanaflex): 2 – 4 mg. Effectively treating pain can optimize sleep and decrease pain.
Optimizing sleep is also critical for effective pain relief. This puts sleep specialists on the frontlines of pain management, where a few simple steps can dramatically improve our patients’ quality of life.
Integrative medical authority Jacob Teitelbaum, MD, is the author of the best-selling From Fatigued to Fantastic!, Pain Free1-2-3!, The Fatigue and Fibromyalgia Solution, and the free smart phone app Cures A-Z. He is the lead author of 4 studies on effective treatment for fibromyalgia. Teitelbaum frequently lectures to physicians, is the author of several textbook chapters, appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah Radio, CNN, and Fox News (Health). Learn more at www.vitality101.com.