Pain Management

Compiled by John G. Connor, M.Ac., L.Ac., Edited by Barbara Connor, M.Ac., L.Ac.

Chinese Medical View of Pain
Useful Foods, Herbs and Nutrients
Relaxation Techniques
Side Effects of NSAIDs and Migraine Drugs

It is known that acupuncture relieves pain by stimulating the production of endorphins, the body’s own painkillers.  For a detailed description on how acupuncture works in relieving pain we refer you to our article entitled How Acupuncture Works on our website.  To find out about all the research that has been done on the health benefits of acupuncture in the treatment of pain we refer you to our article entitled Research on the Health Benefits of Acupuncture on our website. Barbara and I use a combination of acupuncture and craniosacral acupuncture, and sometimes hara visceral work, in the treatment of pain.  When indicated, we may use herbs, nutritional supplements and recommend  therapeutic exercises and/or relaxation techniques.

Pain is intimately connected with the inflammatory process, therefore any approach to pain management must inevitably deal with the complex issues surrounding inflammation.  For a detailed review of the latest research on inflammation we invite you to read our article entitled Inflammation and Its Role in Disease on our website.

· There is a saying in Traditional Chinese Medicine: “If there is free flow, there is no pain. If there is no free flow, there is pain”.  This means that as long as qi (energy) or blood flow freely and smoothly without hindrance or obstruction, there is no pain in the body.  However, if due to any reason, the flow of qi and blood is hindered, blocked, obstructed, or does not flow freely, then there will be pain.

· The flow of qi and blood can become blocked in any part of the body: the organs, muscles, head, back, extremities or joints.  If the pain is due to what is known as Qi Stagnation it will cause a feeling of distention or soreness that fluctuates in intensity and location.  If the pain is due to Blood Stagnation it will be characterized by painful swelling or sharp, stabbing pain at a specific fixed location.  Blood Stasis can also be due to the following: Deficiency of Qi, Heat in the Blood, Blood Deficiency and Interior Cold.  The Liver is the organ most affected by stagnation of Qi.  See our article entitled Liver Qi Constraint for more on this subject.

· When presented with a case in which pain is an important symptom the Chinese Medical practitioner must first diagnose the reason for the non-free flow of qi  and blood, and secondly he must provide treatment which will restore that free flow.

· Angelica and cramp bark – are good for pain related to cramps and muscle spasms.

· Borage oil – is the most potent source (25% of it is GLA) of the omega-6 fatty acid derivative, gamma-linolenic acid (GLA), which has been found to be globally effective in reducing pain and swelling in patients with rheumatoid arthritis.  Other good sources are:  evening primrose oil (10% is GLA) and black currant oil (16% is GLA).  Evening primrose (the most widely studied) has also proven to be effective in the management of diabetes, eczema, PMS, mastalgia, multiple sclerosis, and Sjogren’s syndrome.

· Bromelain – has anti-inflammatory properties that my help to reduce the discomfort caused by rheumatoid arthritis.  Due to its anti-inflammatory properties, it is also used by athletes to prevent the soreness that accompanies a strenuous workout.  It is also believed to facilitate the healing of sports injuries.  A good food source is fresh, raw pineapple.

· Calcium – supplementation for menstrual cramps has been used by women for many years.  Muscles need calcium to maintain their normal muscle tone; if they are deficient in calcium, cramping can more easily occur.

· Capsaicin – is thought to relieve pain by limiting the production of a neural pain transmitter called substance P.  Application of capsaicin to an affected area may cause a burning sensation at first; however, repeated use keeps nerves from replenishing their supply of substance P so that pain is not transmitted to the brain.  In studies, capsaicin has been used to control the pain of shingles (post herpetic neuralgia), diabetic neuropathy, rheumatoid arthritis, osteoarthritis and cluster headaches.  Dosage:  Capsaicin cream applied topically to the affected area four to five times a day provides significant pain relief.

· Corydalis – is the prominent pain-relieving herb of the Chinese Materia Medica.  It is one of the best herbs to use for pain associated with cancer, particularly abdominal pain.  The results of a controlled clinical trial suggest that Corydalis yanhusuo and Angelica dahuricae have potential clinical value for treating mild to moderate pain. (Yuan et al 2004)

· Curcumin – is a powerful anti-inflammatory that works as well as cortisone for some people during acute arthritis flare-ups.

· DL-Phenylalanine – is a natural painkiller for conditions such as whiplash, osteoarthritis, rheumatoid arthritis, back pain, migraines, leg and muscle cramps and neuralgia.  It is a combination of L-phenylalanine, an essential amino acid, and D-phenylalanine, a non-nutrient amino acid.  It works by inhibiting the enzymes that continually destroy endorphins—natural painkillers made in the brain.  Its effect often equals or exceeds that or morphine.  Dosage:  500 mg 1-3 times/day.  Pain usually diminishes within the first week, then dosage can be gradually reduced. Caution:  Do not take if you have high blood pressure or if you are pregnant, and do not use in combination with antidepressant drugs or if you have phenylketonuria.

· Flaxseed oil – is rich in essential fatty acids, particularly ALA (alpha-linolenic acid from the omega-3 group).  Omega-3 fatty acids contain compounds that can inhibit the inflammatory response in the body.  Several studies have confirmed that many people with rheumatoid arthritis have shown improvement after taking supplements of omega-3 fatty acids.  Caution:  According to Earl Mindell, if you are already taking a blood-thinning drug or using aspirin daily, do not take omega-3 fatty acids in doses over 10 grams per day as doing so can decrease the need for blood-thinning drugs.  Please check with your physician to be sure.

· Frankincense – contains boswellin.  Researchers have found that boswellia resin contains boswellic acids, which fight inflammation.  Other research suggests that boswellia may improve the biochemical structure of cartilage by increasing blood supply to joint tissue and inhibiting inflammation.  Dosage:  400 mg three times a day.  Full effects may not be felt for 4-8 weeks.

· Fruits, vegetables and whole grains – contain several phytochemicals such as bioflavonoids, which have demonstrated the ability to stabilize cell membranes and slow the inflammatory cascade.

· Ginger – is one of the best healing herbs that is effective in reducing inflammation of all kinds.

· Glucosamine sulfate – relieves the symptoms of osteoarthritis and in some cases, reverses it.  It plays a role in repairing damaged cartilage.  Dosage:  500 mg 3 times a day, taken between meals.  Full effects may not be felt for 4-6 weeks.

· High fiber diet – may be beneficial in cases of non-pathological, recurrent abdominal pain, perhaps because of its efficacy in irritable bowel syndrome.

· Lipoic acid – reduces the production of lactic and peruvic acids that are generated by cancer cells that cause severe muscular pain.

· Magnesium – can relieve the pain of muscle spasms and often relieves chronic headaches.

· MSM or Methylsufonylmethane – may alleviate the pain associated with arthritis.  People with arthritis report substantial and long-lasting relief while supplementing MSM in their diet.  This beneficial effect is due in part to the ability of MSM to sustain cell flow-through, allowing harmful substances (lactic acid and toxins) to flow out while permitting nutrients to flow in, thereby preventing pressure buildup in cells that causes inflammation in the joints and elsewhere.  MSM may also reduce the incidence of or entirely eliminate muscle soreness and leg and back cramps, particularly in geriatric patients who have such cramps during the night or after long periods of inactivity.  MSM is a bioavailable source of sulfur.  Many of the benefits derived from onions, garlic and the cruciferous vegetables such as cabbage and broccoli may come for the sulfur they supply to the body.

· Myrrh – contains resins that have been shown to have powerful effects on the inflammatory processes.

· Quercetin – is a bioflavonoid that has been shown to block the release of histamines and is an effective treatment for allergies and inflammatory disorders.  Dosage:  250 mg once or two times daily.  Food sources include: yellow and red onions and shallots, broccoli, zucchini, grapes and Italian squash.

· Selenium – is an essential mineral that is necessary for the production of prostaglandins, and it appears to have some anti-inflammatory properties.  Osteoarthritis and rheumatoid arthritis are helped by a combination of selenium and vitamin E.  Food sources of selenium include: brewer’s yeast, organ and muscle meats, fish, shellfish, grains, cereals, Brazil nuts, broccoli, cabbage, cucumbers, radishes, garlic, onions, molasses and dairy products.

· Vitamin B1 or Thiamine – supplementation may be beneficial for pain relief.  Food sources include: brown rice, fish, legumes, peanuts, peas, poultry, rice bran, wheat germ and whole grains.

· Vitamin B3 or Niacin – has been shown in clinical research to be effective in relieving cramps in 87.5% of women.  One side effect is flushing.  Dosage:  100 mg twice daily throughout the month; 100 mg every 2-3 hours during cramps.  Food sources include: avocados, brewer’s yeast, broccoli, carrots, dates, eggs, figs, fish, peanuts, potatoes, prunes, tomatoes, wheat germ and whole wheat products.

· Vitamin B6 or Pyridoxine – may be beneficial especially for patients being taken off all pain medications and for chromic pain associated with TMJ dysfunction.  A dose of 100-150 mg/day appears to improve tolerance to drug withdrawal if started 4 weeks earlier.  Food sources include: brewer’s yeast, carrots, chicken, eggs, fish, peas, spinach, sunflower seeds, walnuts, and wheat germ.

· Vitamin B12 or Cyanocobalamin – may relieve pain in patients with vertebral pain, bursitis, degenerative neuropathy and pain due to cancer.  Food sources include: brewer’s yeast, clams, eggs, herring, mackerel, dairy products, and seafood; also dulse, kelp, kombu, nori, soybeans and soy products.

· Vitamin C or Ascorbic Acid – may be beneficial.  One study showed a significant reduction in pain in severely ill cancer patients who were taking 10 grams of vitamin C per day.  Food sources include: berries, citrus fruits, green vegetables, asparagus, avocados, broccoli, Brussel sprouts, cantaloupe, collards, kale, mangos, onions, papayas, green peas, persimmons, pineapple, spinach, strawberries and tomatoes.

· Vitamin E or Tocopherol – supplementation may reduce pain by activating the endorphin system.  A dosage of 50 mg 3 times daily reduced pain in 68% of women with spasmodic dysmenorrhea.  Vitamin E is also effective in treating ankylosing spondylitis pain and various inflammatory skin diseases.  Food sources include: cold pressed vegetable oils, dark green leafy vegetables, legumes, nuts, seeds and whole grains; also brown rice, cornmeal, dulse, eggs, kelp, flaxseed, milk, oatmeal, soybeans, sweet potatoes, watercress, wheat and wheat germ.

· Vitamin K1 – has demonstrated an analgesic effect nearly as effective as that or morphine in patients with inoperable carcinomas.  Dosage:  5-10 drops two to four times daily.  Food sourcesinclude: kelp, alfalfa, green plants and leafy green vegetables, cow’s milk, yogurt, egg yolks, blackstrap molasses, safflower oil and fish-liver oils.  Vitamin K1 is fat soluble and can be manufactured in the intestinal tract in the presence of certain intestinal flora.  Rancid fats, radiation, X-rays, aspirin, and industrial air pollution all destroy vitamin K.  Antibiotics and sulfa drugs kill intestinal bacteria, which depletes stores of vitamin K.  Caution:  It is important for those who are on blood thinners such as warfarin and coumadin to consult their physician before taking vitamin K supplements.

· White willow bark – contains natural aspirin-like compounds that relieve pain and inflammation without any side effects.  It is especially effective for headaches and arthritis pain.  Dosage:  2 to 4 capsules of extract, three to four times daily.

· Zinc – in physiological concentrations can cause about a 40% inhibition of immunologically-induced histamine and leukotriene release.  In addition, zinc modulates serotonin release from cells.  Food sources include: brewer’s yeast, dulse, egg yolks, fish, kelp, lamb, legumes, lima beans, liver, meats, mushrooms, pecans, oysters, poultry, pumpkin seeds, sardines, seafood, soybeans and whole grains.

Meditation, qi gong, tai chi and yoga, if done regularly for even 20 minutes a day, will help balance your body, mind, heart and spirit, bringing you in touch and in tune with your higher self and generally making you feel healthier and more vibrant.  Exercise is also beneficial, as it stimulates the circulation of Qi and Blood, thereby reducing pain from Qi and Blood Stasis conditions.

Because many of our patients have questions about the safety of NSAIDs (nonsteroidal anti-inflammatory drugs) we have compiled the following list of their side effects:
· Acetaminophen e.g. Tylenol, is notoriously hard on the liver, and for that reason alone should be used with caution.  Other possible side effects include open sores, fever, jaundice, hypoglycemic coma, low white blood cell count, easy bruising and excessive bleeding.

· NSAIDs (e.g. Tylenol, Aspirin, Advil and Aleve) eventually suppress the body’s own anti-inflammatory chemicals.  This process ultimately inhibits repair, leading to degeneration of tissue.  Studies have linked NSAID use with accelerated osteoarthritis and increased joint destruction.

· Aspirin and various steroid drugs block the production of PGE2 (bad prostaglandins) and therefore reduce clotting, pain and fever.  However, aspirin also blocks the production of the beneficial PGE1, so that when it is used for arthritis and heart disease, the inflammation and deterioration of tissue from leukotrienes continues.  (The inflammation of rheumatoid arthritis is considered a direct result of excessive leukotrienes.)

· Other side effects of aspirin are: nausea, upset stomach, massive intestinal bleeding and peptic ulcers.  It can also cause temporary liver dysfunction, hives and rashes, anemia, low white blood cell count, prolonged bleeding, easy bruising, severe allergies, mental confusion, dizziness, headaches and depression.

· Possible side effects of Ibuprofen (Advil, Motrin), Naproxen (Aleve) and similar drugs are: nausea, vomiting, diarrhea, constipation, cramps, gas, as well as serious bleeding and ulcers, particularly in the elderly.  These drugs are hard on both the liver and kidneys.  They can cause hepatitis, jaundice, elevated liver enzymes and urinary tract infections.  Other side effects include dizziness, headaches, drowsiness, fatigue and nervousness.  They can aggravate a wide range of behavioral problems including depression and psychosis.  They can also cause muscle weakness or cramps, numbness, changes in blood pressure, vision disturbances and damage, hearing disturbances, shortness of breath, rashes, blood sugar changes, weight gain or loss, mineral imbalances, menstrual problems, impotence and breast enlargement in men, and anemia.

· Side effects of the migraine drug Imitrex include fatal heart spasms and possibly fatal strokes, eye damage, tingling sensations, dizziness, sensation of tightness or heaviness, numbness, coldness or warmth, drowsiness, weakness, stiff neck and flushing.  Other possible side effects include: allergic reactions, kidney and liver impairment, impotence, jaw or chest tightness, seizures, joint pain, stiffness and swelling, mental confusion, sleep disturbance, depression and suicidal tendencies.

· Avoiding coffee may be beneficial because coffee has powerful opiate receptor binding activity that may increase the degree to which we experience pain.  In a study on patients with fibrocystic breast disease, including breast pain, 61% reported a decrease or absence of breast pain after one year of reducing their caffeine intake.

· Chronic use of ergotamine, opiate analgesics and other medications used for pain relief, such as aspirin, may lead to medication-induced chronic headaches due to depletion of CNS endorphins with down-regulation of receptor sites.  The most successful treatments include an extremely gradual detoxification from the offending agents and concurrent use of vitamin B6(pyridoxine) to increase serotonin levels via pyridoxine-mediated pathways in order to raise pain thresholds.


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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-309-7753.

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