Chronic pain causes many people to become addicted to pain medication.
The addiction may occur via the analgesic pathway or the euphoric pathway (or both). In the analgesic pathway, pain medication offers tremendous relief from chronic pain, so that the medication becomes strongly associated with relief.
Over time, however, tolerance to the analgesic effect of pain medication develops and escalating doses are required. Typically, there is a decrease in benefit with each rise in dosage.
Despite realizing that the pain relief is not as effective as it once was, the user is still obtaining marginal benefits.
Even if he or she wants to discontinue the medication, it can be difficult because of a rebound in pain as well as physiological withdrawal.
The euphoric pathway is mediated by the reward center of the brain (the nucleus accumbens). As a chiropractor, you can address the analgesic pathway of addiction more readily.
Source of the trouble
Chronic pain almost always has a significant underlying component of inflammation, and so inflammation plays a starring role in the analgesic pathway. Because of this, if one can reduce or eliminate inflammation, the associated pain can be reduced.
Inflammation is classically defined as a local tissue response, which occurs in reaction to injury or destruction of tissues. These triggers can be infections, chemicals, physical injury, radiation, or burns.
The inflammatory process aims to contain, destroy, or dilute the injurious trigger, repair the injured tissue, and restore it to normal function. Acute inflammation is a self-limiting process in which the inflammatory mechanisms restore homeostasis (normal function). Chronic inflammation is a state of prolonged activation of the immune response, leading to chronic tissue and organ damage that causes symptoms and diseases to develop.
Chronic inflammation is a major underlying mechanism in the chronic illnesses affecting western societies.
These illnesses include “-itis” disorders (e.g., arthritis, sinusitis, and prostatitis); chronic skin conditions such as acne vulgaris, cystic acne, and folliculitis; and chronic pain syndromes such as sciatica and fibromyalgia. It is also a factor in diabetes, cardiovascular disease, cognitive disorders, and auto- immune disorders. It is also a component of chronic infectious diseases and cancers.
As a person ages two things happen: First, stress accumulates, and second, the reserve (or buffering) capacity gradually diminishes.
With time and trauma, there is a gradual slide into a state of long-term inflammation. This wears down biological systems, and the decline is felt in specific ways as with arthritis, or in general ways such as chronic fatigue. As people age further, they have increasing trouble controlling inflammation, and often end up in a vicious cycle where the effects of inflammation cause more inflammation.
Mainstream approaches to inflammation
Current mainstream medicine approaches inflammation by identifying and treating its cause; and when no obvious cause can be found, treating it with medication. Commonly used anti-inflammatory medications are often inadequate and potentially have serious side effects. They fall primarily into two broad categories: steroidal and nonsteroidal.
Steroidal medications are associated with long-term dangers including diabetes, osteoporosis, and glaucoma. Nonsteroidal approaches include narcotics, prostaglandin inhibitors (acetaminophen), and COX 1 and 2 inhibitors (ibuprofen and celecoxib).
The chronic use of virtually any anti-inflammatory medication is associated with side effects such as hepatic injury, renal dysfunction, ulcers, and hemorrhage. Nonsteroidal anti-inflammatories such as codeine, medical marijuana, and narcotics also pose the risk of addiction and cognitive dysfunction.
Alternative approaches to inflammation
As a replacement for the above approaches (or in addition to them), natural and herbal interventions can be employed to good effect. There are scores of substances that have been shown in clinical and research studies to reduce pain and inflammation.
Omega-3 fatty acids. EPA and DHA are two related essential fatty acids, commonly found in cold water fish.
They enhance the conversion of inflammatory COX molecules to prostaglandin E3 (PG-E3), which is a natural anti-inflammatory. These two fish oils also inhibit the precursors of inflammatories and protect cartilage.
Frankincense (Boswellia serrata). This herb has been used for millennia and it was likely also valued for its anti- inflammatory pain-relieving effects. We now know that this herb has anti- inflammatory actions, suppressing metalloproteinase (MMP), which breaks down intercellular tissue, and sparing glycosoaminoglycans (GAGs), which protect connective tissue.
Stinging Nettle (Urtica dioica). This ubiquitous herb is considered a weed yet it has potent anti-inflammatory properties. One action stabilizes the two molecules that drive inflammation: TNF-alpha and NF-kappa B. Additionally, it has effects on the synthesis of other molecules of inflammation such as the leukotrienes and prostaglandins.
Turmeric (curcumin). This is a Cox 1 and 2 inhibitors, and an NF-kappa B inhibitor. However, absorption in significant quantities is a challenge. When used continuously in cooked foods, it likely results in an anti- inflammatory benefit.
Green tea (Camellia sinensis). This contains polyphenolic compounds called catechins. A component of this plant, epigallocatechin-3-galate (E3G), inhibits interleukin 1b and reduces the activation of NF-kappa B. NF-kappa B–mediated signal transduction affects the regulation of viral replication, auto- immune diseases, the inflammatory response, development of tumors, and cell death (apoptosis).
Pycnogenol (pine bark). This tree product contains polyphenols, which inhibit TNF-alpha activation caused by bacteria, and also MMP activity. It should not be used by those taking immuno-suppressants or steroids and it can cause diarrhea and nausea.
Resveratrol. This phytochemical contains polyphenolic compounds. It is found in plant skins like red wine grapes. These polyphenols are potent inhibitors of TNF-alpha and inter- leukin 1-B–induced NF-kappa-B activation. Resveratrol should not be taken if blood clotting is an issue; the use of any herb should be screened before use if one has a clotting problem or is on anti-coagulant medication.
Horsetail (Equisetium arvensae). Horsetail, like other herbs in this category, inhibits TNF-alpha-based inflammatory response.
Celery (Apium graveolens). This inhibits the production of COX-2, which is blocked by over-the-counter and prescription anti-inflammatories (e.g., Advil). It also is a weak diuretic, thereby reducing swelling and excess blood flow in tissues.
Garlic (Allium sativum). This familiar plant enhances white blood-cell production (white blood cells fight infections that create inflammation), increases the ability of white blood cells to consume bacteria, and increases natural killer cells, which are a first line of defense against viruses and bacteria.
Put it into practice
Pain medications and the relief they give may activate an addictive response in those who are vulnerable. For people addicted to pain medication due to chronic pain (as opposed to those addicted due to euphoria), treating inflammation can lead to achieving and maintaining sobriety and improving many areas of health.
To normalize inflammation, you must use natural substances in a synergistic manner, along with other approaches. The following protocol illustrates how a combination approach can attack several points in the inflammatory cascade, working upstream in a domino-like process to support normal levels of inflammation.
- A well-balanced, minimally processed diet, low in grains and high in small fish (e.g., sardines, mackerel, herring), colorful vegetables, and fruits is a fabulous start.
- Use a couple of probiotics. This will help reduce inflammation coming from the gut.
- Use a broad-spectrum herbal anti- inflammatory blend on a regular basis.
- Life is stressful—this cannot be avoided. But one can engage in some form of meditation, music, or art— anything to slow down worrying and calm the body. Five minutes of stretching daily and exercise three or four times per week is also helpful.
- Get involved and stay involved in a service-oriented community organization. This has been shown to improve long-term health, if done before illness starts.
Work on identifying your patients’ sources of inflammatory stress: diet, psychological stress, chronic infections, etc. Once you have identified the sources of inflammation, a prescription for reducing it emerges.
Robert J. Hedaya, MD, DLFAPA, has been practicing medicine since 1979 and is a pioneer in the Functional Medicine field. He is the founder of the National Center for Whole Psychiatry in Chevy Chase, Maryland, as well as the founder of Functional Herbals LLC. He can be contacted through drhedaya.com or drhrejoint.com.