teitelbaum, jacob (2005). pain free. 1-2-3. new york, mcgraw-hill

A Proven Program for Eliminating

CHRONIC PAIN NOW

PAIN FREE

1–2–3

JACOB TEITELBAUM, M.D.

http://dx.doi.org/10.1036/0071464573

Copyright © 2006 by Jacob Teitelbaum. All rights reserved. Manufactured in the United States of America.Except as permitted under the United States Copyright Act of 1976, no part of this publication may be repro-duced or distributed in any form or by any means, or stored in a database or retrieval system, without theprior written permission of the publisher.

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DOI: 10.1036/0071464573

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http://dx.doi.org/10.1036/0071464573

To Laurie, my wife, my special lady,

and the love of my life;

My children, David, Amy, Shannon,

Brittany, and Kelly;

My mother, Sabina, and father, David,

whose unconditional love made

this book possible;

Drs. Janet Travell, Billie Crook, and

David Simons, who laid the foundation

for this work;

And to my patients, who have taught me

more than I can ever hope to teach them.

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Contents

Acknowledgments ix

Introduction xi

P A R T I 1

General Pr inciples of Pain Relief

C H A P T E R 1 3

Why We Have Pain What Is Pain? 3

The Critical Function of Pain 4

How Do I Turn Off the Pain Signal? 4

C H A P T E R 2 7

Giving Your Body What It Needs to Heal Your Pain Optimizing Nutritional Support 7

Sleep: The Foundation of Pain Relief 18

Treating Hormonal Deficiencies 23

C H A P T E R 3 39

Eliminating the Causes and Triggers of Your Pain Managing Infections 40

Reducing Stress (by Bren Jacobson) 51

Considering Ergonomics (by Bren Jacobson) 61

Dealing with Trauma 70

v

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CONTENTS

vi

P A R T I I 73

Evaluat ing and Treat ing Common Types of Pain

C H A P T E R 4 75

Focusing on Nerve Pain Types and Causes of Neuropathic (Nerve) Pain 76

Treating Neuropathic Pain 79

Reflex Sympathetic Dystrophy (RSD) 84

C H A P T E R 5 89

When Inflammation Leads to Pain When Inflammation Is Unhealthy 90

The Link Between Diet and Inflammation 91

Treating Inflammation 92

Treating Arthritis: Inflammation of the Joints 96

C H A P T E R 6 105

Focusing on Muscle and Bone Pain Myofascial and Fibromyalgia Pain 106

Treating Osteoporosis and Bone Pain 108

Easing Cancer Pain and Discomfort 111

C H A P T E R 7 115

It’s Not All in Your Head: Treating Headaches and Facial Pain

Finding Relief from Tension Headaches 115

Getting Rid of Migraines 117

Other Common Severe Headaches 127

C H A P T E R 8 133

A Pain in the Gut Resolving Chronic Acid Reflux and Indigestion Naturally 133

The Importance of Enzymes for Digestive Health 136

Eliminating Spastic Colon by Treating the Underlying Causes 138

CONTENTS

CONTENTS

vii

C H A P T E R 9 141

Dealing with Pelvic Pain Syndromes Interstitial Cystitis (IC) 141

Painful Menstrual Cramps and Vulvodynia 145

Endometriosis 147

Prostatitis and Prostadynia 148

C H A P T E R 1 0 151

Treating Other Common Pains Based on Their Locations

Chronic Back Pain 151

Noncardiac Chest Pain 155

Carpal Tunnel Syndrome and Thumb Tendonitis 156

Shoulder Problems 158

Leg and Foot Pain 159

P A R T I I I 161

Effect ive Therapies for Chronic Pain and Related Problems

C H A P T E R 1 1 163

Natural Therapies Why Does a Bias Against Natural Remedies Exist? 164

Three Effective Natural Pain Therapies 167

Other Important Natural Healing Ingredients 171

Natural Remedies for Sleep 172

Additional Safe and Inexpensive Natural Remedies for Pain 175

C H A P T E R 1 2 183

Alternative TreatmentsOsteopathy 183

Chiropractic Medicine 184

Hypnosis and Magnets 186

Prolotherapy 186

Acupuncture (by Peter Marinakis, Ph.D.) 187

CONTENTS

C H A P T E R 1 3 193

Prescription Therapies: We’re Way Past Aspirin! Things to Consider Before Beginning Pain Medications 194

Topical Medications (Gels) 197

Treating with Patches 199

Oral Pain Medications 200

When to Consider Narcotics 217

Intravenous Pain Medications 222

Prescription Sleep Medications 224

Why One Medication Doesn’t Fit All 230

C H A P T E R 1 4 233

Sexual Dysfunction, Depression, and Mind-Body Aspects of Pain

Dealing with Loss of Libido and/or Sexual Function 233

Pain, Anxiety, and Depression 236

Pain: The Mind-Body Connection 239

C H A P T E R 1 5 243

Eliminating Weight Gain Why Chronic Pain Makes It So Difficult to Lose Weight and Keep It Off 244

How to Lose Weight and Feel Better 247

Managing Medications That Affect Weight Gain and Loss 248

Conclusion 251

Appendix A: Useful Information on My Website 253

Appendix B: Resources for Finding Physicians and Supplies 255

Appendix C: Selected References 263

Index 287

CONTENTS

viii

Acknowledgments

So many special people helped make this book possible that I can-not possibly list them all.

I would like to extend my sincerest thanks to the army ofhardworking and courageous physicians and healers, who createdthe foundation for my work, and to my staff. Their hard work,compassion, and dedication are what made my work possible.

Special thanks to my wonderful research partner, Birdie (Bar-bara Bird). Her dedication to quality shows in every facet of herwork. Thanks to my office manager and “right-hand person”Cheryl Alberto (the real boss), who makes sure that everythingworks as it should—no matter how much chaos I create; and AmyPodd, Mary Groom, Angela Borlik, and Denise Haire, who makeeverything run smoothly. Thanks to Bren Jacobson and AlanWeiss, who love me enough to call me on my “stuff ” and keep meintellectually honest, and the Anne Arundel Medical Centerlibrarian, Joyce Miller. Over the last twenty years, I have oftenwondered when she would politely tell me to stop asking for somany studies. So far, she has not. In fact, she always smiles whenI ask her for more.

Thanks to my many teachers, the real heroes and heroines intheir fields, whose names could fill this book. They includeWilliam Crook, Max Boverman, Brugh Joy, Janet Travell, DavidSimons, Jerry and Esther Hicks and the Abraham team, HughRiordan, Hal Blatman, William Jefferies, Jay Goldstein, LeonardJason, Michael Rosenbaum, Murray Susser, Charles Lapp, andAlan Gaby. I would like to thank my sweet and gifted editors,Natasha Graf and Charlie Fisher, for their dedication, help, and ix

Copyright © 2006 by Jacob Teitelbaum. Click here for terms of use.

patience. And I would especially like to thank my loving wife,Laurie, for her incredible and devoted dedication and help in mak-ing sure this book was the best possible guide it could be for help-ing people get their lives back.

I would also like to thank the many chronic pain, chronicfatigue syndrome, and fibromyalgia support groups. These are eas-ily the best patient support groups I have ever seen.

And finally, I would like to thank God for the guidance andinfinite blessings I have been given and for using me lovingly asan instrument for healing.

ACKNOWLEDGMENTS

x

Introduction

Nineteen seventy-five was a very difficult year for me. After hav-ing several very stressful years that made medical school look easy,I came down with fibromyalgia, myofascial pain syndrome, andchronic fatigue syndrome (CFS). This gave me firsthand experiencewith widespread muscle pain. It also gave me an enormous incen-tive to learn how to overcome these problems. Having widespreadachiness was difficult, but it taught me an enormous amount. Ilearned how a tight muscular knot (trigger point) in one area cancause pain and tenderness elsewhere in the body. I also found thattight muscles can cause other apparently unrelated symptoms likenausea, acid reflux, and diarrhea. It was quite an education!

Several other experiences broadened my “pain horizon” dra-matically. During my medical residency in 1979, I was workingin the outpatient clinic. We would all cringe when one of thepatients, an ornery, hunched-over elderly woman, came in. Shewas always in severe back pain, and no one could help her. Dur-ing one of her visits, she told me that when she pushed on a lumpon her back that was about a foot away from her discomfort ittriggered her pain. I mentioned this to my instructor, Dr. JohnStuckey, and his eyes lit up. He said, “Watch this,” and with asmile he injected the lump with a little lidocaine (Novocain). Thewoman was able to stand up straight, pain free for the first time inyears. Without the chronic pain, she was the sweetest person youcould imagine!

At that time I had no idea why this had worked, but I rapidlylearned about doing trigger point injections. Several years later,after reviewing thousands of research studies and attempting many xi


experiments to ease my own discomfort, I had developed an effec-tive metabolic approach to treating muscle pain. Despite being aninternist I had, by default, become the pain specialist in town.

I soon found out that other doctors had also discovered simi-lar principles of pain management. Two of these spectacular physi-cians, Dr. Janet Travell and Dr. David Simons, had written a book,which a patient of mine gave me, called The Trigger Point Manual.In it, the authors had long before documented the concepts that Ihad thought I had discovered. Dr. Travell was a professor atGeorge Washington Medical School and the White House physi-cian for Presidents Kennedy and Johnson. She has since passed on.Dr. Travell and Dr. Simons are the “grandparents” of modernpain management. Their book expanded the understanding oftreatment dramatically for pain specialists. They also laid the foun-dation for your getting well!

You Are Not Alone in Your Pain

Chronic pain is a very common problem affecting millions ofAmericans. In a 1999 American Pain Society survey, 9 percent ofthe American adult population was found to suffer from moder-ate to severe non–cancer-related chronic pain. Fifty-six percentof these had suffered for over five years. When the researchersreviewed 805 chronic pain patients, they found that over half ofthem had changed doctors because their physicians were unwill-ing or unable to adequately and appropriately treat their pain.

In addition to the ways in which it devastates people’s lives,chronic pain is one of the most expensive medical conditions inthe United States. The price tag, including loss of productivity,loss of income, and medical costs, exceeds $100 billion annually.Over $61 billion is lost in productive work time because of pain,even if the person is able to work. Our track record for treatingcancer-related pain is equally devastating. The American CancerSociety estimates that an enormous number of advanced cancerpatients suffer from inadequately treated chronic pain.

INTRODUCTION

xii

However, the financial costs pale in comparison to the suffer-ing and loss of personal relationships, functional ability, and evenlength of life, as well as the depression and anxiety caused bychronic pain. The good news is that most chronic pain can now beeffectively treated. Unfortunately, most doctors have not yet beentrained in proper pain management. However, this does not meanthat you have to wait to get relief. This book has been written togive you and your physician the information you need so that youcan be pain free now and get your life back.

Good News for Chronic Pain Sufferers

I can summarize most of what I was taught about pain in medicalschool in one paragraph. Use Tylenol and/or Advil family medica-tions. If the patient has cancer, you can use narcotics if you haveto. Were I a surgeon, surgical options might be added. I was giventhe impression that chiropractors, and anyone else who offeredsomething that wasn’t taught in medical school, were quacks try-ing to steal people’s money and that physicians needed to protectgullible patients from them. Although this may seem like a sadassessment, I suspect that most of you who have chronic pain willagree with it. Many physicians reading this book will also find thatthis mirrors their experience.

The good news is that you don’t have to be in pain anymore!The use of both natural and allopathic (prescription) medicine dra-matically increases our ability to help you get well. Although bothallopathic and natural medicines have their weaknesses, when youcombine them, almost all pain can be effectively treated. It’s thedifference between having only one tool—say a hammer, whichis like allopathic medicine—or a whole tool kit that includes thedozens of other healing arts available in natural medicine. A ham-mer can be a very useful tool, but unfortunately when all you haveis a hammer, everything starts to look like a nail! It’s much easierto get the job done safely and effectively when you are using allthe tools available to you.

INTRODUCTION

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Doctors are usually better at treating acute, short-lasting painsuch as that from injuries or surgery because they are better ableto find the source of the pain and are more comfortable usingavailable treatments on a short-term basis. Treating chronic painproblems such as fibromyalgia and myofascial/muscle pain, can-cer pain, arthritis, headaches, back pain, and nerve pain is more ofa challenge for physicians.

Closing the Gap Between Allopathic and Natural Medicine

There seems to be much confusion and conflict over whether nat-ural or prescription medicines are the best. On one hand, thereare those who claim that pharmaceuticals are the new panacea foreverything, while natural remedies are unregulated, unproven,and ineffective forms of snake oil. On the other hand, there arethose who say that surgery and prescription medications arehighly toxic and too expensive. They claim that we should onlyuse natural medicines and point out their safety record. How arewe to make sense of all this confusion?

I choose to keep the best of both systems. Over the decades,I’ve often had to struggle with the perceived conflict betweenthese two wonderful and powerful branches of the healing arts.When we examine these systems closely, however, there is noconflict between them. Complementary and alternative medicine(CAM), or natural therapies, offer the vast variety and power thatnature brings to healing through herbs, nutrition, and energy/spirit. Using a mix of intuition, experience, and science—like amother taking care of her child—it is most interested simply inwhat works and what is safe. This results in it being very open-minded and accounts for its current rapid growth.

Allopathic medicine focuses largely on that which is patentable.It mainly deals with prescriptions and can sometimes use the pow-erful tools of science to develop effective new remedies. Scientificdebate within the medical community can be very useful for sort-ing out what works and dealing with things that the scientists

INTRODUCTION

xiv

believe in, such as prescriptions. Allopathic medicine, however, ismuch too biased to be objective when it comes to evaluating nat-ural remedies. For example, if given the power to regulate naturalmedicines, the FDA would likely regulate them out of existence.Because of this, Congress appropriately protects natural products.

Although natural therapies have their strengths, they also havetheir shortcomings. One of these is quality control. Where anallopathic medication has to go through stringent testing forpotency and purity, natural remedies are viewed as foods and donot have adequate regulation. Because of this, many products havelittle or none of the potency they claim to have and therefore,although cheap, do nothing. Because this is a major problem, I amvery picky about which products and companies I recommend.For example, two natural products companies, Enzymatic Ther-apy and Integrative Therapeutics/ITI, have voluntarily registeredwith the FDA as pharmaceutical companies, which means theirproducts have the same quality control as prescriptions. In time,Congress will recognize that quality control regulation is neededfor all natural products, but hopefully will put it in the hands ofpeople who are knowledgeable and open-minded about them.

I simply propose that you use the best of both systems. Tomake this easier for you, and to maintain objectivity, I have a pol-icy of not taking money from any companies (natural or pharma-ceutical) whose products I recommend. In addition, for theproducts I make, 100 percent of my royalties go to charity. There’snothing wrong with money. I simply don’t want it to get in theway of your getting well!

How This Book Can Help You

In Part I, I will begin by briefly reviewing the purpose of pain andthe general principles of pain relief. I will then discuss the differ-ent types of pain in Part II. By knowing the type of pain that youhave—nerve, muscle/ligament/tendon/bone, arthritic/inflamma-tory, and so on—you can tailor your treatment approach to makeit more effective, and your ability to make the pain go away

INTRODUCTION

xv

increases dramatically. I will also discuss the most common causesof pain—such as headache, back pain, pelvic pain, and so on—andhow to effectively treat them. For some readers, the pain is wide-spread. For others, it is localized. For most kinds of pain there aregeneral principles that are helpful for healing. These are especiallyimportant for myofascial (muscle and tendon) pain, but are impor-tant for most other pain conditions as well. In Part III, I teach youboth natural and prescription approaches that can help the pain goaway and discuss the pros and cons of each, enabling you to makethe best use of all available treatments. Mind-body issues are alsoreviewed, as well as related problems that can be associated withand caused by pain such as sexual dysfunction, depression, andweight gain.

Appendix A describes additional useful information found onmy website, vitality101.com. This includes more detailed discus-sions of the topics covered in each chapter. Appendix B offershelpful resources for finding a physician, supplies and services, andtools and products that can help you get well. To help your doc-tor become more comfortable with the treatments in this book,Appendix C gives reference information that supports thesetreatments.

INTRODUCTION

xvi

P A R T I

General Principles of Pain Relief

Basically, there are two main principles of pain relief. First, you wantto supply your body with what it needs for healing and tissue repair.These critical areas include optimum nutrition (often well beyondRDA levels), eight to ten hours of deep sleep each night, and opti-mal hormonal levels (simply having a hormonal blood test be “nor-mal” may not be adequate). The second principle is that you wantto treat or eliminate things that stress your body and cause pain(which include infections; toxins such as chemicals and heavy met-als; inflammation; mechanical stresses on the body; excessive situa-tional, psychological, or physical stresses; and abnormal tissuecompression such as that caused by cancers). In these next few chap-ters, I will outline these critical areas and triggers so you can getstarted on the right path toward pain relief.

1


Why We Have Pain

I know that you are tired of being in pain and are ready to havethe pain go away. You may have received little relief from currentmedical approaches. In fact, you may not even know what is caus-ing your pain.

Pain Free 1-2-3 will teach you how to determine the cause ofyour pain and how to make it go away. Although an enormousamount of new research is emerging on the complex biochemistryof pain—and this information helps when creating new approachesfor pain relief—dazzling you with this difficult biochemistry is notmy goal. My purpose is to give you the information that you needto give your body what it needs and help you move forward so youcan get a life that you love.

While I won’t give all of the thousands of research studies andreports that this book is based on, I will give some references thatI think your doctor (or you if you have a scientific interest) will findhelpful (see Appendix C). For areas of special interest to you, moredetailed technical information can be found on my website underthe Pain Free 1-2-3 “Notes.” For now, let’s start with the basics.

What Is Pain?

The International Association for the Study of Pain defines painas “an unpleasant sensory and emotional experience associated 3

C H A P T E R 1


with actual or potential tissue damage or described in terms ofsuch damage.” You don’t need such a complex definition, how-ever. You know pain when you feel it.

Pain can be divided into two basic categories: acute pain andchronic pain. Acute pain, which usually results from tissue injury,inflammation, or illness, often occurs suddenly after surgery orinjury. Usually doctors can figure out what caused it, and it goesaway on its own or with treatment. Chronic pain, on the otherhand, can last for many years and is poorly treated medically.Chronic pain is the main focus of this book, although acute painwill also be addressed.

The Critical Function of Pain

Although chronic pain can be devastating, pain serves a criticalfunction. It is a warning system for your body. Pain tells you whenyou need to avoid something so you do not cause damage to your-self. In addition, pain tells you when your body is not gettingwhat it needs—sleep, nutrients, oxygen, and so on. For example,there is a genetic disease called hereditary sensory and autonomicneuropathy, or HSAN. People who suffer from this disease areborn without any ability to feel pain. You may think this wouldbe wonderful, but it is not. These people die very young and crip-pled. If a sufferer of this disease breaks a leg, he has no pain andstill tries to walk, causing further damage. If his hand is on a hotstove, he does not know it until he smells something burning.

Pain is not the enemy. It is an important warning system. Butwhen pain goes out of balance and becomes chronic, it may end upcausing more harm than good. Therefore, in addition to teachingyou how to turn off the pain signal, I will also help you understandwhat pain is trying to tell you about what your body needs.

How Do I Turn Off the Pain Signal?

You turn off the pain by giving your body what it needs and byeliminating what is damaging or toxic to your body. For example,

GENERAL PRINCIPLES OF PAIN RELIEF

4

one of the most common types of pain is muscle or myofascialpain. The medical profession very poorly understands this type ofpain. Although we might think that muscles will go limp if theydo not have what they need, consider rigor mortis. When some-one dies and the muscles are not getting what they need, they donot become loose—in fact they become stiff as a board. If yourliving muscles do not have adequate nutrients, optimal hormonelevels, or enough sleep for tissue repair, they will get stuck in theshortened position and cause pain. Underlying infections can alsocause your muscles to get stuck in the shortened position. Pain isyour body’s way of saying that these problems need to beaddressed. You’ll be amazed at how pain that has lasted decadescan go away quickly when these problems are taken care of. Wewill discuss this in more depth in Chapters 2 and 3.

Often, finding the right medication for pain is like trying ondifferent shoes to see which fits the best. In the current medical“shoe store” there are one or two pairs to try on. If these few“shoes” don’t fit, you are out of luck. Fortunately, there are actu-ally many dozens of treatments to try, and when one doesn’t fitanother often will.

In addition, pain management is a perfect place to combine tra-ditional and complementary therapies. The difficulty that patientshave in finding doctors that can effectively treat their pain is driv-ing them to alternative healers in droves. In fact, according to theJournal of the American Medical Association, pain is the number onereason why people use alternative medicine, which includes chi-ropractic, naturopathic medicine, acupuncture, biofeedback, mas-sage, Reiki, meditation, and other techniques. Often, it is difficultto treat chronic pain with a single “magic bullet.” It takes a prac-titioner who is knowledgeable about many treatment modalitiesand who is also a compassionate listener.

WHY WE HAVE PAIN

5

Giving Your Body What It Needs to

Heal Your Pain

This chapter explains how to optimize nutritional support, getadequate sleep, and address hormonal deficiencies. Pain often willnot go away until each area of the body’s need is adequately han-dled. For example, it may surprise you to know that nutritionaland hormonal deficiencies and/or fungal infections (usually sec-ondary to antibiotic use) can aggravate neuropathic or back pain.Because of this, it is a good idea for you to read this entire chap-ter, as I outline a simplified approach for making sure that all ofthe key principles for treating your pain are addressed.

It is important not to forget that some simple general princi-ples and lifestyle issues are critical to the treatment of chronicpain. For example, exercise daily for at least twenty minutes ifyou’re able. Swimming, walking, and yoga are good choices.

Optimizing Nutritional Support

The American diet is awful. In fact, it is often called the “standardAmerican diet,” or SAD, and the initials are appropriate. The aver-age American’s diet includes 150 pounds of added sugar per year,

C H A P T E R 2

7


accounting for approximately 18 percent of caloric intake. Sugarsuppresses your immune system and stimulates yeast overgrowth inyour bowel. Yeast grows by fermenting sugar and says thank youfor all this added sugar by making billions of baby yeasts.

Another dietary stress is white flour. Vitamins were discoveredby a settler who went on sailing expeditions with Dutch explor-ers. He found that the colonists were becoming ill, yet thecolony’s chickens were looking unusually healthy. Finding this tobe curious, he began feeding the chickens’ food to the people.Over a period of several weeks, the people became stronger andhealthier. He (incorrectly) named the chicken feed vital amines,meaning “vital proteins,” and began selling it. The name was latershortened to vitamins.

Today, scientists understand what happened to those colonists.Polishing off the brown outer coat, or bran, from rice hadbecome fashionable. The rice bran was then used as chicken feed.The bran, however, contains most of the vitamins and minerals.The colonists therefore quickly became nutritionally deficient,while the chickens flourished. In the United States, approximately18 percent of calories come from white flour. However, whiteflour, just like white rice, has had the bran removed and thereforeis also significantly depleted of vitamins and minerals.

As you can see, from just the use of white flour and addedsugar, Americans often reduce their vitamin and mineral intake byaround 35 percent. Adding to this problem are the nutrients thatare lost in the canning of vegetables and in the processing offoods, which can cause vitamin losses of up to 80 percent.

The Link Between Nutrient Deficiency, Diseases, andChronic PainAs Dr. S. B. Eaton noted in his study in the prestigious NewEngland Journal of Medicine, “Physicians and nutritionists areincreasingly convinced that the dietary habits adopted by West-ern society over the past one hundred years make an importantetiologic [causative] contribution to coronary heart diseases


8

[angina], hypertension, diabetes, and some types of cancer.” Thisis the same conclusion that was reached by the authors of WesternDiseases: Their Emergence and Prevention by the Harvard Univer-sity Press.

Just as nutritional deficiencies can cause these medical prob-lems, not having adequate nutrients can cause pain and keep thepain from going away. The late Dr. Janet Travell, White Housephysician for Presidents John F. Kennedy and Lyndon B. Johnsonand professor emeritus of internal medicine at George Washing-ton University, cowrote Myofascial Pain and Dysfunction: The Trig-ger Point Manual, which is acknowledged as the authoritative workon muscle pain. In one chapter alone, Dr. Travell and coauthor Dr.David Simons referenced 317 studies showing that problems suchas hormonal, vitamin, and mineral deficiencies can contribute tomuscle disorders. Dr. Travell strongly encouraged me in my work,and my landmark study on effective pain management was dedi-cated to her memory.

Numerous other studies have shown that adequate amounts ofvitamins and minerals, especially folic acid, zinc (found to be verylow in people with fibromyalgia), and selenium, are critical forproper immune function—that is, for defense against infections.Vitamin A, beta-carotene, vitamin B₆, vitamin C, vitamin E, iron,and many other nutrients also have been found to be very impor-tant in keeping the body’s defenses strong.

Addressing SkepticsI sometimes hear doctors express skepticism about the importanceof nutritional supplements. A typical comment is, “Five hundredyears ago, there were no vitamin tablets, and people seemed to dojust fine.” These doctors forget that five hundred years ago sugarwas expensive and not readily available. The king of Englandmight have sprinkled a teaspoon of sugar on his food as a sign ofpower, but he had to send someone to the West Indies to get it!People ate whole-grain bread and fresh locally grown produce,and only the wealthiest had refined flour or much fatty meat.

GIVING YOUR BODY WHAT IT NEEDS TO HEAL YOUR PAIN

9

The argument about people not needing vitamin tablets fivehundred years ago simply does not apply to the average modernAmerican. A study reported in the American Journal of ClinicalNutrition showed that fewer than 5 percent of the study partici-pants consumed the recommended daily amounts (RDAs) of alltheir needed vitamins and minerals. What is frightening is thatthis study was conducted in Beltsville, Maryland, on employees ofthe U.S. Department of Agriculture (USDA) research center.

Despite this, some cynics still like to say that the vitamins goout in your urine, so all you’re doing by taking vitamin supple-ments is making expensive urine. Using this line of reasoning,these cynics can stop drinking water (it just goes out in theirurine). That way, they’ll soon stop annoying people who are inthe process of getting themselves well.

Vitamin and Mineral SupplementationEvery vitamin and nutritional mineral, amino acid, and nutritionalcofactor is very important in some way to health. The bodydepends on receiving vitamins and minerals from the diet becauseit cannot make them itself. If you are low in vitamins, minerals, andother nutrients, your pain simply will not go away! Because of this, anexcellent nutritional supplement is critical to your becoming painfree.

For example, inositol; vitamins B₁, B₆, and B₁₂; zinc; andantioxidants are critical for healing neuropathies (nerve pain). Formuscle pain, magnesium, B vitamins, antioxidants, zinc, iodine,selenium, and malic acid are critical. In fact, each kind of pain hasdifferent nutrients that are important for its relief.

As there are literally dozens of different nutrients that are crit-ical for tissue repair, I recommend that you use a powdered nutri-tional supplement called the Energy Revitalization System byEnzymatic Therapy. I developed this product so that my patientscould easily get the nutritional support they need without takinghandfuls of tablets. One hundred percent of my royalties go tocharity, and the product is available in most health food stores (or


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online at vitality101.com). One good-tasting drink and one cap-sule replace over thirty-five tablets of supplements a day. TheEnergy Revitalization System, which consists of a vitamin pow-der and a B-complex drink, contains over fifty nutrients includ-ing almost all the key nutrients recommended in this chapterexcept for iron (which is toxic to take unless you are iron defi-cient), calcium (which blocks thyroid hormone absorption andshould be taken at nighttime), and essential fatty acids (oil andwater don’t mix). Many people find that simply taking this prod-uct for optimal nutritional support can help them feel much bet-ter while decreasing and sometimes eliminating their pain after sixweeks. It can replace the multivitamin and almost all of the nutri-tional supplements that most people take. (To make it easy, whenI recommend specific nutrients I will often note whether or notthey are in the vitamin powder and B-complex drink, althoughmost are.) Alternatively, the individual nutrients I recommend canbe obtained separately or in other forms.

Some people will develop diarrhea from products containingmagnesium. Most people, however, find that the vitamin powdersimply makes them wonderfully regular. If diarrhea is a problem,you can cut the dose of the powder in half or take it with milk,and this will usually take care of it. In addition, any supplementcontaining B vitamins can turn your urine bright yellow. This isnormal.

Although many excellent physicians use them, I do not rec-ommend checking blood levels for most nutrients because the testsare often inaccurate, expensive, and/or unnecessary. I feel it is bet-ter and less expensive to simply use the vitamin powder. Theexceptions would be iron and vitamin B12 levels. Let’s discusssome key nutrients in a bit more depth.

Iron. Iron is important because an iron level that is too low cancause pain, fatigue, poor immune function, cold intolerance,decreased thyroid function, and poor memory. Too high an ironlevel can cause arthritis, diabetes, inflammation, and even death.


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I routinely recommend that all of my chronic pain patients havetheir iron level, total iron binding capacity (TIBC), and ferritinlevels checked. Even if a person’s iron level is suboptimal but stillnormal, that person will often feel fatigue and pain, despite testresults saying that the person is not anemic. Significant iron defi-ciency symptoms can often occur with a low “normal” iron level.Because of this, anyone whose ferritin level is below 40, or whosepercentage iron saturation (TIBC) is less than 22 percent, shouldbe given a trial treatment of iron therapy.

Vitamin B12. Vitamin B12 is another key nutrient. Technically, theB₁₂ level is normal if it is over 208 picograms per deciliter (pg/dL)of blood. However, studies have shown that people can suffersevere and sometimes long-term nerve and brain dysfunctionfrom B₁₂ deficiency, even if their levels are as high as 300 pg/dL.Why are the “normal” levels set so low? In part, the normal val-ues were initially set according to what prevents anemia. How-ever, the needs of brains and nervous systems for vitamin B₁₂ areoften much higher than those of the bone marrow. Also, as muchas I hate to admit it, medical schools have greatly enjoyed pokingfun at the old-time doctors who gave vitamin B₁₂ shots for fatigue.The use of B₁₂ shots despite “normal” blood levels is consideredalmost a symbol of unscientific, archaic medicine. As noted in aneditorial in the New England Journal of Medicine, however, currentfindings suggest that those old-time doctors may have been right.In addition, a recent study using the respected Framingham data-base showed that evidence of B₁₂ deficiency occurs even with lev-els over 500 pg/dL. I suspect, though, that the modern medicalestablishment will be a little slow to eat crow.

It is no surprise, then, when their other problems are alsotreated, many people respond dramatically to B₁₂ injections. Inaddition to fatigue, it can be very helpful for nerve pain,migraines, and other problems. If a patient’s B₁₂ level is under540 pg/mL, I treat that person with a 1 cc (1,000 to 3,000 mcg)injection of vitamin B₁₂ one to five times a week, for fifteen injec-


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tions. These shots are very safe and fairly inexpensive. Usually, ifa patient is going to benefit from the shots, I see improvement byten weeks. But if a patient feels worse when the injections arestopped, I resume giving the shots, usually giving one every oneto five weeks (but as often as three to four times a week in somecases) for an extended period of time. Most people can maintainexcellent B₁₂ levels by taking the 500 micrograms of B₁₂ in theEnergy Revitalization System.

Other B Vitamins. Vitamins B₁, B₂, B₆, and B₁₂ have been foundto be clinically effective in helping a number of chronic pain con-ditions, including low back pain, migraines, sciatica, trigeminalneuralgia, and diabetic neuropathy. Now researchers at the ParkerInstitute in Dallas have conducted a study suggesting that thesevitamins may also help treat painful sprains, old fractures, burns,and bruises. The study suggests that B vitamins may possess theability to block a certain type of pain receptor, especially inpatients with neuropathic pain.

Magnesium. Magnesium is probably the single most importantnutrient for pain relief. It is involved in hundreds of differentfunctions and is routinely low in the American diet as a result offood processing. The average American diet supplies less than 300milligrams (mg) of magnesium per day, while the average Asiandiet supplies over 600 mg per day. I generally recommend taking900 mg of malic acid and 150 to 200 mg of magnesium glycinatea day (both present in the vitamin powder). If diarrhea andcramps are not a problem, you can take up to 500 mg of magne-sium daily. If you get uncomfortable diarrhea from the magne-sium, cut the dosage back and then slowly increase the dose as iscomfortable.

If your body’s magnesium stores are low, your muscles will stayin spasm and your pain will not resolve. This is one of the reasonsthat taking magnesium is so critical. In addition, magnesium isimportant for your muscle and body strength and energy. Most of


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your magnesium is inside your cells, and the blood tests only mea-sure the magnesium in your blood, making blood tests an unreli-able measure. Almost everyone with pain should take magnesium,but if you have kidney failure discuss your dosage and regimenwith your physician. Magnesium absorption is very difficult,which is why I like to use the glycinate form. Plain magnesiumoxide is also available and is the most inexpensive form of mag-nesium, but your body may not absorb it well. If you choose totake magnesium oxide, take 500 mg per day.

In addition to helping muscle pain when taken by mouth orintravenously, intravenous (and often oral) magnesium has otherbenefits as well. Two grams of intravenous magnesium given overa few minutes will routinely knock out an acute migraine. Inaddition, it is very good for esophageal spasms and for preventingkidney stones.

Calcium. Most people do not need calcium supplementation, and(as is the case with iron) taking it at the same time as a thyroidhormone will block the thyroid hormone’s absorption. Some peo-ple’s pain improves with taking calcium, and others get worse. Inaddition, calcium is best taken with meals to enhance absorption,and at night as it also helps sleep.

Most calcium tablets are made of calcium carbonate (chalk)and often will not dissolve in the stomach. They then go out inthe stool, having done no good along the way. It is better to usechewable calcium or other forms of calcium such as calcium cit-rate or chelates, taking 500 to 600 mg at bedtime and perhaps thesame amount at dinner. This is most important, however, inwomen over forty years old. Although calcium gets much atten-tion in the treatment of osteoporosis, other nutrients are as, ormore, important (see Chapter 6). In fact, countries with the high-est calcium intakes often have the highest rates of osteoporosis.

Vitamin C and Vitamin D. In a study of 324 patients with arthritisof the knee, those taking over 200 mg a day of vitamin C had lesspain than those taking smaller amounts. One epidemiologic study


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also suggested that taking vitamin C may prevent the developmentof pain and worsening of the arthritis as seen on x-ray.

Another problem is that people tend to get most of their vita-min D from exposure to sunlight, and, unfortunately, Americanshave been misled into thinking that sunshine is bad for them.Most of the skin cancers that are caused by excess sun exposureare not especially dangerous and are easy to treat. Some doctorsalso think that the rise in dangerous skin cancers (melanomas) isalso associated with excess sun exposure. I do not believe this isthe case, as most melanomas occur in clothed areas that are notexposed to the sun. As time goes on, I think we’ll find that theincrease in this single type of dangerous skin cancer is largelycaused by other factors besides sunshine. Dr. Michael Holick,director of the vitamin D research lab at Boston University Med-ical Center, thinks that “the current message that all unprotectedsun exposure is bad for you is too extreme . . . the original mes-sage was that people should limit their sun exposure, not that theyshould avoid the sun entirely. I do believe that some unprotectedexposure to the sun is important for health.” This is supported byevidence that vitamin D deficiency can contribute to many can-cers including prostate, colon, and breast cancer. Dr. Holick feelsthat vitamin D may also help protect against heart disease, autoim-mune disease, and even type 1 diabetes. For example, multiplesclerosis is mostly seen in northern latitudes where people get lesssunshine. Now we are also finding that vitamin D deficiency maycontribute to unexplained muscle and bone pain. In a study of 150children and adults with unexplained muscle and bone pain,almost all were found to be vitamin D deficient—with manybeing severely deficient with very low vitamin D levels.

The RDA (which I feel is often inadequate) for vitamin D is200 to 400 IU/day for most people. One glass of fortified milk ororange juice has approximately 100 units of vitamin D, and mostmultivitamins have 400 units or less. To put it in perspective, alight-skinned person wearing a swimsuit at the beach will getabout 20,000 units of vitamin D in the time it takes his or her skinto get lightly pink.


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Copper. This nutrient is a double-edged sword. Because copperis pro-inflammatory, it can aggravate arthritis and many otherinflammatory and autoimmune processes. On the other hand,copper deficiency can contribute to deficiencies of a criticalantioxidant called superoxide dismutase. The bottom line is thatit’s good to get just a tiny bit of copper. To be on the safe side, Irecommend approximately 0.5 mg a day.

Essential Fatty Acids. Although we get excessive fat in the Ameri-can diet, most of it is not the type that our bodies need. Your bodyneeds specific fats for proper hormonal and cell function. For exam-ple, the omega-3 fatty acids found in fish oils are anti-inflammatoryand can be helpful in rheumatoid arthritis and other types of pain.As a fringe benefit, high intakes of fish oil are associated with adecreased risk of Alzheimer’s disease and cognitive impairment.

Because of the cost, I do not routinely recommend essentialfatty acid supplementation for everyone. If you have dry eyes ordry mouth, however, this suggests essential fatty acid deficiencies,especially of the oils found in fish. For years I would only useflaxseed oil (which is poorly converted to the type of omega-3fatty acids found in fish) because most fish oils contain toxins suchas mercury and lead and are also rancid. Fortunately, there arenow a few brands of fish oil that have no mercury or toxins andare not rancid. Two brands of fish oil that I recommend areEskimo 3 and Nordic Naturals. Take one to three teaspoons (orthree to nine capsules) a day for nine months if you have dry eyesor dry mouth—symptoms that are suggestive of this deficiency.

Nutrients That Help Both Pain and EnergyThere are a number of nutrients that can be very helpful for bothpain and energy, but which are not in my vitamin powder. Theseoften are only needed for four to eight months, but can be veryhelpful. I recommend you take all three of these for at least threemonths.


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D-Ribose. This excellent nutrient is a key building block for mak-ing energy and can be very helpful in decreasing both pain andfatigue. The early results that I have seen have been so impressivethat we are now in the process of doing a study on it in ourresearch center. Ribose comes as a sweet-tasting powder that canbe used like sugar and is available in a product called Corvalen byValen Labs. I recommend taking one scoop (5 grams) three timesa day for three weeks, and then one scoop twice a day. After threemonths, you can stop it to see if it is still needed. Results are usu-ally seen within a month.

Acetyl-L-Carnitine. Acetyl-L-carnitine is critical for both energyproduction and the ability to lose weight, and I suspect that thisdeficiency is an important cause of the average thirty-two-poundweight gain that is seen with CFS and fibromyalgia. Take one 500mg capsule twice a day for three months; then reduce to 250 to500 mg once a day or stop it.

Coenzyme Q10. This nutrient is especially important for anyonewho is taking cholesterol-lowering prescriptions (such as Meva-cor), which can often cause or aggravate muscle pain. Take 200mg (I use the Vitaline brand) once a day with a meal that has fat,with oil supplements, or in an oil-based form to improve absorp-tion. This supplement helps your body produce energy.

The Importance of a Healthy DietAlthough I strongly recommend taking nutritional supplements toensure obtaining the necessary nutrients, I also want to stress thateating a good healthy diet is important. Eat a lot of whole grains,fresh fruits (whole fruit, not fruit juice), and fresh vegetables. Manyraw vegetables have enzymes that improve digestion and help todecrease pain. You do not have to cut out all foods that might be“bad” or eat a diet that is impossible to follow. All you need to dois eat a diet that is reasonably healthy and low in added sugar.


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When I tell people to cut out sugar, I like to add the three magicwords “except for chocolate”! I consider chocolate to be a healthyfood. To have your cake and eat it too (so to speak), consider sugar-free chocolates. Some are awful but others are spectacular. RussellStover has a whole line of sugar-free chocolates that are outstand-ing. There are many healthy sugar substitutes. Stevia is excellent,healthy, and easy to use. The best tasting brands of stevia I’ve foundare from Body Ecology and Stevita (see Appendix B or vitality101.com). Many others are bitter. Inositol (which helps anxiety andnerve pain) and xylitol (which decreases osteoporosis) look and tastejust like sugar. Saccharin (which comes in the pink packets) is alsoOK, but because of safety concerns I do not recommend aspartame(NutraSweet). Some sugar substitutes (although not stevia, saccha-rin, or Splenda) can cause gas or diarrhea.

In addition, most Americans are chronically dehydrated, andthis can make you feel worse as well. I do not recommend thatyou count glasses of water; this is an annoying way to spend a day.Simply check in with your mouth and lips every so often. If theyare dry, you are dehydrated and need to drink more water.

The more unprocessed your diet is, the healthier you will be.On the other hand, things that give you pleasure and make youfeel good are generally good for you (contrary to popular belief ).Your body will tell you what’s good for you by making you feelgood.

Sleep: The Foundation of Pain Relief

To eliminate muscle and many other sources of pain, it is criticalto get eight to nine hours of solid, deep sleep each night on aregular basis. Disordered sleep is, in my opinion, a major under-lying process that perpetuates pain. Inadequate sleep can occur fora number of reasons. Many Americans simply do not makeenough time for adequate sleep. A hundred years ago, the averageAmerican was getting nine hours of sleep a night. Anthropolo-gists tell us that five thousand years ago, the average night’s sleepwas eleven to twelve hours a night. When the sun went down, it


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was dark, boring, and dangerous outside, so people went to bed.When the sun came up, they woke up. The use of candles initiallyshortened sleep time. Then light bulbs were developed, followedby radio, TV, computers, and so on. We are now down to an aver-age of six and a half to seven hours of sleep a night, and this issimply not adequate to allow proper tissue repair.

Some people get inadequate sleep because of poor sleephygiene, often occurring because pain keeps them awake. Othershave insomnia because the sleep center in the brain (called thehypothalamus) is suppressed by the same process that is causingthe pain. A poll conducted by the National Sleep Foundationfound that 58 percent of Americans had sleep difficulties. This hadincreased from 51 percent the year before. In addition, 15 percentof Americans use a prescription or over-the-counter sleep aid, andthose who slept less than six hours a night felt more stressed,angry, sad, and tired than the people who got more sleep. The sur-vey also found that only 30 percent of people reported getting therecommended eight hours of sleep a night, down from 38 percentthe year before.

Key Stages of Sleep for Pain ReliefSleep has a distinct architecture with key stages. Stages 1 and 2sleep are fairly light, while stages 3 and 4 sleep (also called deltawave sleep) are the deeper stages of sleep. My experience, and thatof many other clinicians, suggests that what is deficient infibromyalgia and likely in many pain patients are the deeper,restorative stages of sleep (stages 3 and 4). These are the stages inwhich you produce growth hormone, which results in tissuerepair and healing. Unfortunately, most sleeping pills in commonuse keep people in light stage 2 sleep, which can actually maketheir problem worse. The good news is that there are a number ofexceptions.

Several studies have shown that if you continually wake peo-ple up whenever they go into deep sleep, or even shake themlightly so that they go from deep sleep into light sleep, they willdevelop pain within one to two weeks and often within one


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night. In fact, inadequate sleep has repeatedly been shown to con-tribute to pain. In a study of fibromyalgia patients, it was foundthat increased pain sensitivity is associated with greater sleep dis-turbance. Another study of female office employees in one largecompany showed that women who suffer from frequent musclepain also have insufficient sleep.

I find that when my patients get eight to nine hours of solidsleep regularly each night for six to nine months, their pain and,interestingly, their inability to fall asleep both resolve. They arethen able to markedly reduce the amount of sleep and pain med-ications that they need. Breaking the cycle of poor sleep andmaintaining quality sleep for at least six to nine months is criticalto breaking the cycle of pain. Eight to nine hours of solid sleepeach night without waking or hangover is the goal and, hard asthis may be to believe, it is very attainable using the suggestionsthat I will give you in this chapter.

Natural Sleep AidsIn general, I think it is a good idea to begin with natural reme-dies and good sleep hygiene. You may, however, have a problemwith your sleep center (the hypothalamus) not working or withthe pain simply keeping you awake at night. Because of this, inlight of how critical it is that you get eight to nine hours of solidsleep a night, I would strongly encourage you to add prescriptiontherapies if the natural approaches are not adequate. This willmake a big difference in making your pain go away, and you canusually decrease or come off the prescriptions about six monthsafter you are feeling better.

I recommend the following natural sleep aids:

• Revitalizing Sleep Formula—a mix of six sleep herbals• Hydroxy L-tryptophan (5-HTP)—aids the body in making

serotonin• Melatonin—a natural hormone• Calcium and magnesium


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Chapter 11 gives complete information on these aids and how touse them. Most of these remedies are not sedating, yet they willhelp you fall asleep and stay in deep sleep.

Another natural way to help yourself fall asleep is to play deep-sleep–inducing tapes or CDs. If you wake up during the night,you can push your sound system’s replay button. Better yet, get aCD or tape player that can replay continuously throughout thenight. Delta-wave-sleep–inducing tapes and CDs (and the naturalsleep aids) are available online at my website, vitality101.com.

Good Sleep HygieneThese are some important things to consider that enhance goodsleep hygiene:

• Do not consume alcohol near bedtime.• Do not consume any caffeine after 4:00 p.m.• Do not use your bed for problem solving or doing work.• Take a hot bath before bed.• Keep your bedroom cool.• If your partner snores, sleep in a separate bedroom (after

tucking in or being tucked in by your partner) or get a goodpair of earplugs and use them. The wax plugs that mold tothe shape of the ear are often the best ones.

• Put the bedroom clock out of arm’s reach and facing awayfrom you so you can’t see it. Looking at the clock frequentlyaggravates sleep problems and is frustrating.

• Have a light snack before bedtime. Hunger andhypoglycemia cause insomnia in all animals, and humans areno exception. For your snack, eat foods high in the aminoacid tryptophan, such as milk and turkey, which contributeto sleep.

If you frequently wake up to urinate during the night, do notdrink a lot of fluids near bedtime. Most pain patients wake duringthe night because their sleep center is not working properly or


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because of the pain. Since they also have a full bladder, they thinkthey are waking up because they have to urinate. This is usuallynot the case. They are waking up because of their pain syndrome.There is a simple way to remedy this problem. If and when youwake up during the night and you notice your bladder is full, justtalk to it (in your mind, so your spouse doesn’t think you’re crazy)and tell it to go back to sleep—you’ll pee in the morning. If youstill have to urinate five minutes later, go to the bathroom. Youwill most likely find that your bladder will happily go back tosleep, and when you wake up in the morning, you won’t evenhave to urinate as badly as you did when you woke up in the mid-dle of the night.

Sleep MedicationsAlthough I much prefer natural remedies to prescription medica-tions, natural remedies do not solve sleep problems for everyone,and it may be necessary to use a prescription sleep medication.(See Chapter 13 for a detailed discussion of prescription sleepmedications.) Unfortunately, most sleeping pills in common use(for example, Dalmane, Halcion, and Valium) may actually worsenthe quality of sleep by increasing the amount of light stage (espe-cially stage 2) sleep and decreasing the deep stages of sleep evenfurther. You want to be certain that the treatments and medica-tions you use leave you feeling better the next day, not worse.

Even if you are someone who needs prescription sleep aids,adding natural remedies can be very helpful and usually decreasesthe amount of medication that you will need, resulting in fewerside effects. By using a combination of the treatments discussed,almost all people, even those with chronic pain, can get eight tonine hours of solid sleep a night. It usually takes trial and error tofind out exactly what is best for you, but it is worth being persis-tent. In addition, once you come off the sleep medications (usu-ally after nine to eighteen months, although they can be usedindefinitely if needed) you may find that all you require are thenatural remedies. Whatever treatments you use, though, it is


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important that they not only increase the duration of sleep butalso maintain or improve the deep stages (stages 3 and 4) of sleep.

It is not uncommon to see your sleep worsen again (even ifyou’ve been feeling better) during periods of increased stress—whether physical or emotional—and the flaring of your illness.During these times, increase the treatments for as long as you needso that you get eight hours of solid sleep a night, and then taperthem or stop them when the problem is resolved. The best way toneed less medication in the long run is to use as much as it takesto get eight to nine hours of solid sleep each night without wak-ing or feeling hungover for six to eighteen months.

Many people, because of fear of addiction and concern abouthaving to use constantly escalating doses of sleeping pills, areafraid to take enough medication to get adequate sleep. If I havea patient who has been feeling better and then finds that his or herpain is coming back, one of the first things I ask is, “How is yoursleep?” The usual answer is, “Not good.” However, they are sograteful to get five hours of sleep a night that they settle for it.That’s a bad idea! I recommend taking whatever you need to geteight to nine hours of solid sleep. You’ll be very happy you did.

Treating Hormonal Deficiencies

Our hormonal system regulates our body’s metabolism. Althoughmost hormonal deficiencies (and sometimes excesses) can causepain, the key players are hypothyroidism, inadequate adrenalfunction, and low growth hormone. In addition, if your painbegan from ages forty to sixty, it is worth considering low testos-terone in men and low estrogen or testosterone in women. Recentpress reports about problems with Premarin (an estrogen productextracted from pregnant horses’ urine) were no surprise. Manydoctors have been saying for over a decade that it is insane for peo-ple to take Premarin as these estrogens are markedly differentfrom the ones your body makes. We will discuss ways to giveestrogen therapy that can be much safer and may actually decrease


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the risk of developing cancer. For now, however, let’s begin withhypothyroidism—a condition in which the thyroid gland fails toproduce enough thyroid hormone and the most important hor-monal trigger for chronic pain.

HypothyroidismThe thyroid gland, located in the neck area, is the body’s gaspedal, regulating the body’s metabolic speed. If the thyroid glandproduces insufficient amounts of thyroid hormones, metabolismdecreases and the person will be in pain. As I mentioned earlier,it is not uncommon for chronic pain patients to put on twenty tofifty pounds during the first years of their illness. In addition tonerve, muscle, ligament/tendon, and other pains, other symptomsof hypothyroidism include fatigue, infertility, weight gain, “brainfog,” constipation, and intolerance to cold.

Why Hypothyroidism May Go Undiagnosed. Modern medicine hasgone through many generations of thyroid tests, and with each newtest, we found that we missed an enormous number of cases ofhypothyroidism. To make matters more difficult, if the thyroid isunderactive because the hypothalamus is suppressed (as is commonin chronic pain), the TSH test, which is the test most often used,may appear to be normal, or even suggest an overactive thyroid.

Unfortunately, our current thyroid testing will miss mostpatients with an underactive thyroid. Once again, doctors ofdecades ago were on target when they knew that one has to treatthe patient and not the blood test. In fact, in November 2002 theAmerican Academy of Clinical Endocrinologists again changedthe normal range on the TSH thyroid blood test (so that a TSHover 3 warranted treatment), increasing the number of patientswith hypothyroidism in the United States from 13 to 26 million.Less than a quarter of these patients have been properly diagnosedand treated.

I have found—either through blood testing or according tosymptoms—that over 47 percent of my fibromyalgia patients have


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a low thyroid and that 83 percent of these patients have improvedby taking a low dose of thyroid hormone. However, years afterthe new directives have been given, doctors are still largelyunaware of these new lab guidelines for diagnosis and treatment.Even the major labs doing thyroid testing have not bothered tochange the now incorrect normal ranges for both diagnosis andtreatment of thyroid disorders.

The Problem with Thyroid Tests. The normal range for most bloodtests, including thyroid hormone levels, are based on statisticalnorms (called 2 standard deviations). This means that out of everyone hundred people, those with the 2 highest and lowest scoresare defined as abnormal and everyone else is arbitrarily consideredto be normal. That means if a problem affects over 2 percent ofthe population (as many as 24 percent of women over sixty arehypothyroid and 12 percent of the population have abnormalantibodies attacking their thyroid), then our testing system willmiss most of them. In addition, our testing system does not takebiological individuality into account. To translate how poorly this“2 percent equals abnormal” system works, consider this: if weapplied this approach to getting you a pair of shoes, any sizebetween a 4 and 13 would be “medically normal.” If a man wasaccidentally given a size 5 shoe or a woman a size 12, the doctorwould say that the shoe sizes they were given are “normal,” andthere is no problem!

Simply changing the normal range for the TSH test to less than3 increased the number of Americans with thyroid illness from13 million to 26 million. Unfortunately, over 13 million Ameri-cans with thyroid disease remain undiagnosed, and the majorityof those receiving treatment are not being dosed appropriately.Doctors do not know that they have not been adequately trainedin the proper diagnosis or treatment of hypothyroidism, and thecost in human life and devastating illness is enormous. Whatmakes this especially tragic is how easy treatment is if doctors aregiven and use the correct information.


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The Potential Cost of Missing Hypothyroidism. A study in theprestigious Annals of Internal Medicine noted that hypothyroidism“contributed to 60 percent of cases of myocardial infarction [heartattacks] among women affected by subclinical [even mild] hypo-thyroidism.” It contributed more to causing heart attacks in thesepatients than smoking, elevated cholesterol, high blood pressure,or diabetes. As a result, there may be over thirty thousand pre-ventable deaths per year from heart attacks as women withuntreated hypothyroidism are more than twice as likely to have aheart attack.

In addition, 6 percent of miscarriages are associated withhypothyroidism with 4,600 miscarriages per year after fifteenweeks of pregnancy and countless more before. Undiagnosedhypothyroidism is also associated with infertility. In moderate toseverely hypothyroid mothers, the baby was also over six times aslikely to die soon after being born. In addition, children born tohypothyroid mothers have a lower IQ by an average of 7 points.They are almost four times as likely to have an IQ under 85 andover twice as likely to have learning difficulties resulting in theirhaving to repeat a grade.

Over six million Americans have fibromyalgia, and tens ofmillions more have chronic muscle pain. Undiagnosed or inade-quately treated thyroid disorders contribute to these unnecessar-ily disabling conditions.

As I mentioned earlier, hypothyroidism is a major cause ofgaining and being unable to lose weight. It also causes fatigue, dryhair, coarse skin, depression, and “brain fog” as well. As a result,hypothyroidism is often confused with depression and can be mis-takenly treated with Prozac. This is an even bigger problem in theelderly who are being misdiagnosed with depression or Alz-heimer’s/senility when what they have is hypothyroidism.

Fortunately, given the proper information, hypothyroidismcan be incredibly easy and inexpensive to diagnose and treat.Sadly, because of lack of awareness and open-mindedness on the


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part of our medical community, Americans still unnecessarily suf-fer from a major public health disaster.

Treating an Underactive Thyroid. If you have chronic pain and suf-fer from even two of the following symptoms, you should con-sider asking your doctor to prescribe a low dose of thyroidhormone.

• Chronic fatigue• Heavy periods• Constipation• Easy weight gain• Cold intolerance• Dry skin• Thin hair• A body temperature that tends to be under 98.6°

In addition, family members of those with a low thyroid have abouta 50 percent chance of also getting it. If your doctor won’t prescribethyroid hormone, you may wish to consult one who is open to theidea (see Appendix B). Before seeing a new doctor, call and ask ifhe or she sometimes treats people with thyroid hormone despite theblood tests being normal if their symptoms show they need it. Aslong as you do not have underlying angina/heart disease and youfollow up with a blood test to make sure that your free T4 bloodtest (do not use TSH) thyroid levels are in a safe range (going abovethe upper limit of normal may aggravate osteoporosis), a trial oflow-dose thyroid hormone treatment is usually safe and may be dra-matically beneficial.

Some patients have found desiccated thyroid (Armour Thy-roid) to be helpful and the synthetic thyroid (Synthroid) not tobe. Some have found the opposite. What is important to know isthat if you have muscle or nerve pain and an underactive thyroidthat is not treated (even if your blood tests come back normal),


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these pains simply will not resolve. Many experts on chronic painagree.

Thyroid treatment despite normal tests is very controversial,even though it’s usually very safe. All treatments (even aspirin) cancause problems in some people. Thyroid treatment can triggercaffeine-like anxiety or palpitations. If this happens, cut back thedose and increase by one-half to one 30 mg or 50 mcg tablet eachtwo to eight weeks as is comfortable. Sometimes taking 500 mgof vitamin B₁ (thiamine) one to three times a day (as in the Calm-ing Balance Formula) will also help prevent the anxiety afterabout two weeks. If you have severe, persistent racing heart, callyour family doctor and/or go to a hospital emergency room.

Like exercise (such as climbing steps), if one is on the edge ofhaving a heart attack or severe “racing heart” (atrial fibrillation),thyroid hormone can trigger these occurrences. However,research suggests that thyroid hormone treatments may actuallydecrease the risk of heart disease. If you have chest pain, go to thehospital emergency room and/or call your family doctor. It willlikely be chest muscle pain (not dangerous), but better safe thansorry. To put it in perspective, I’ve never seen this happen in mydecades of treating thousands of patients with thyroid hormone.

Increasing your thyroid hormone dose to levels above the upperlimit of the normal range may accelerate osteoporosis, which isalready common in those with chronic pain. Because of this, youneed to check your thyroid (free T4, not TSH) blood levels afterfour to eight weeks on your optimum dose of thyroid hormone. Ifind treatments with thyroid hormone safer than aspirin andMotrin. If you have chest pain or risk factors for angina, do anexercise stress test to make sure your heart is healthy before begin-ning thyroid hormone treatment. Risk factors for angina includediabetes, elevated cholesterol, hypertension, smoking, personal orfamily history of angina, gout, and age over fifty years old.

We are constantly learning powerful new tricks for treat-ing hypothyroidism, and there are many reasonable treatment


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approaches. I would recommend starting with a trial of ArmourThyroid. (More information is available at my website, vitality101.com.)

Adrenal InsufficiencyThe adrenal glands, which sit on top of the kidneys, are actuallytwo different glands in one. Both parts are critical to your stressresponse system. The center of the gland makes adrenaline (epi-nephrine). The outer part of the adrenal gland, called the cor-tex, also makes many important hormones (including cortisol,DHEA-S, and testosterone).

• Cortisol. The adrenal glands increase their production ofcortisol in response to stress. Cortisol raises the blood sugarand blood pressure levels and moderates immune function,in addition to playing numerous other roles. If your cortisollevel is low, you may have fatigue, low blood pressure,hypoglycemia, poor immune function, an increasedtendency to allergies and environmental sensitivity, and aninability to deal with stress. Inadequate cortisol canmarkedly increase pain by hindering your body’s ability todeal with inflammation. In addition, recurrent drops inblood sugar (hypoglycemia) can constantly throw yourmuscles into spasm.

• Dehydroepiandrosterone sulfate (DHEA-S). Althoughits mechanism of action is not clear, DHEA is the mostabundant hormone produced by the adrenal cortex. If it islow, you will often feel unwell. Patients often feeldramatically better when their DHEA-S levels are broughtto the midnormal range for a twenty-nine-year-old.DHEA-S levels normally decline with age and often dropprematurely in fibromyalgia patients. DHEA has been calledthe “fountain of youth” hormone. This is because gray hairsometimes returns to its original color when one takes


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DHEA. In fact, I didn’t realize that my nephews thought Iwas dying my hair for years (I would never dye my hair—Ilike the salt-and-pepper look) because my normal hair colorwould return when I took DHEA!

• Testosterone. This hormone is produced in small butsignificant amounts by the adrenals as well as by the ovariesand testicles.

Causes of Adrenal Insufficiency. I suspect that many people haveadrenal burnout. Dr. Hans Selye, one of the first doctors toresearch stress reactions, found that if an animal becomes severelyoverstressed, its adrenal glands bleed and develop signs of adrenaldestruction before the animal finally dies from the stress.

If you think back to your biology classes in high school, youmay remember something called the “fight-or-flight response.”This is a physical reaction that occurs during times of stress. Dur-ing the Stone Age, when a caveman met an animal that wanted toeat him, the caveman’s adrenal glands activated multiple systemsin his body that prompted him to either fight or run. This reac-tion helped the caveman survive. In those days, however, peopleprobably had a couple of weeks or months to recover before fac-ing the next major stress. That is no longer the case. In today’ssociety, especially with chronic pain, people often experiencestress reactions every few minutes.

I suspect that many people suffer exhaustion of their adrenalglands. With the kinds of stresses common in modern society, aperson’s adrenal test may initially show hormonal levels that areactually higher than usual, since the adrenal gland tends to over-compensate to deal with stress. Over time, this may exhaust theadrenal reserve, that is, the adrenal’s ability to increase hormoneproduction in response to stress. Both high and low cortisol cancontribute to weight gain. In endocrinologist Dr. William Jef-feries’ experience (and in mine as well), people with either lowhormone production or a low reserve often respond dramaticallyto treatment with low doses of adrenal hormones.


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Symptoms of Adrenal Insufficiency. If your adrenal glands areunderactive, what symptoms might you experience? Low adrenalfunction can cause, among other symptoms:

• Pain and fatigue• Recurrent infections• “Crashing” during stress• Hypoglycemia (irritability when hungry)• Low blood pressure and dizziness upon first standing

Hypoglycemia deserves special mention. Many people becomeshaky and nervous, then dizzy, irritable, and fatigued when theyget hungry. They then often feel better after they eat sweets,which improve their energy and mood for a short period of time.Because of this, these people often crave sugar, not realizing thatit makes their blood sugar level initially shoot back up to normal,which is what makes them feel better, but then continue to soarbeyond normal. The body responds to this by driving the sugarlevel back down below normal again. The effect, energy-wise, islike a roller coaster.

Dr. Jefferies has noted—and again, my experience confirmshis finding—that most people with hypoglycemia have underac-tive adrenal glands. This makes sense because the adrenal glands’responsibilities include maintaining blood sugar at an adequatelevel. Sugar is the only fuel that the brain can use. When people’sblood sugar level drops, they can feel poorly and it can flare theirpain. I recommend diagnosing hypoglycemia based on symptoms.Like other tests of hormonal function, I consider glucose toler-ance tests to be incredibly unreliable.

Treating Adrenal Insufficiency. People with hypoglycemia can treatlow blood sugar symptoms by cutting sugar and caffeine out oftheir diets; having frequent, small meals; and increasing theirintake of proteins and vegetables. Fruit—not fruit juices, whichcontain concentrated sugar—can be taken in moderation, about


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one to two pieces a day, depending on the amount of sugar in thefruit. Taking 250 micrograms of chromium a day (present in thevitamin powder) for six months often helps smooth out hypo-glycemic symptoms.

Treating the underactive adrenal problem usually banishes thesymptoms of low blood sugar. You can begin with adrenal glan-dulars combined with licorice and key nutrients (all present inAdrenal Stress End, which I helped to formulate). In addition yourdoctor may consider using prescription hydrocortisone, such asCortef. (See vitality101.com for further information.) When usedin doses of 20 mg or less a day, Cortef is usually quite safe and canresult in a dramatic decrease in many types of pain. Interestingly,some doctors are using microdose Cortef therapy for arthritis.Although some doctors may charge four thousand dollars to pre-scribe this simple and inexpensive treatment, your doctor couldprescribe it for free!

Cortisone Treatment and ToxicityAdrenal hormones are essential for life. Without them, a persondies. But, as with any hormone, too much can be dangerous. Inthe early studies using adrenal hormones, the researchers had noidea what dose was normal and what was toxic. When they gaveinjections of the hormone to patients, the patients’ arthritis wentaway and they felt better. However, because they gave patientsmany times more than the normal amount, the patients becametoxic and died. Because of this, the researchers became frightenedand avoided using adrenal hormones whenever possible. Medicalstudents were taught to avoid adrenal hormones unless no othertreatment choices existed.

The use of adrenal hormones needs to be put into perspective,however. Imagine if the early thyroid researchers had given theirpatients fifty times the usual dose of thyroid hormone. Thyroidpatients would have routinely died of heart attacks. The thyroidresearchers, however, were fortunate enough to stumble upon the


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body’s healthy dose early on and to skip these negative outcomes.If they had not, people today would not be treated for an under-active thyroid until they displayed symptoms of very advancedthyroid disease (myxedema) and were nearly comatose. Medicalscience is just beginning to learn that a person can feel horribleand function poorly even with a minimal to moderate hormonedeficiency. Waiting for the person to go “off the deep end” of thetest’s normal scale is not healthy.

Dr. Jefferies has found that as long as the adrenal hormone levelis kept within the normal range, the main toxicity that a patientmight experience is a slight upset stomach due to the body notbeing used to having the hormone come in through the stomach.Taking the hormone with food usually helps this. In addition,some patients gain a few pounds. This is because a low adrenal levelcan cause a person’s weight to drop below the body’s normal setpoint, even if that set point is high because of pain or fibromyal-gia. (The average weight gain in fibromyalgia is thirty-twopounds.) However, any weight gain often is more than offset bythe weight loss resulting from being able to exercise once again.

Many physicians do not like to prescribe even low doses ofadrenal hormone. If your physician is uncomfortable with Cortef,invite him or her to read Dr. Jefferies’ material on the safety oflow-dose cortisone as well as our recent study. Most patients onlyneed 5 to 12.5 mg of Cortef a day, equivalent to 1 to 3 mg a dayof prednisone (a more dangerous and less effective synthetic formof cortisol that your doctor is aware of ), which is a dose so lowthat most doctors have never prescribed it. After feeling well forsix to eighteen months, most people begin to slowly decrease theiradrenal hormone dosage, eventually discontinuing the treatmententirely.

If your symptoms started suddenly after a viral infection, ifyou suffer from hypoglycemia or crash with stress, or if you haverecurrent sore throat or respiratory infections that take a long timeto resolve, you probably have underactive adrenal glands.


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Treating Dehydroepiandrosterone (DHEA) DeficiencyThe adrenal gland makes many hormones in addition to hydro-cortisone. One of these previously mentioned is DHEA, which isoften very low in chronic pain patients. Although DHEA’s func-tion is not yet fully understood, it appears to be important forgood health, which makes a low DHEA level worth treating.Some studies suggest that the higher a person’s DHEA level is, thelonger that person will live and the healthier he or she will be. I’mconcerned that pushing the blood level above the upper limit ofnormal may slightly increase the risk of breast cancer, so keep itin the normal range. For many patients, when a low DHEA levelis treated, the result is a dramatic boost in well-being and adecrease in pain.

If your DHEA-S (not DHEA) blood level is low—under 120micrograms per deciliter (mcg/dL) for females or 325 mcg/dLfor males—I recommend beginning treatment with 5 to 25 mgof DHEA per day and slowly working up to what feels like anoptimal level to you. For women, I suggest keeping the DHEA-Slevel at around 150 to 180 mcg/dL, which is the middle of thenormal range for a twenty-nine-year-old female. For men, I keepthe DHEA-S level between 350 and 500 mcg/dL, which is thenormal range for a twenty-nine-year-old male. The low ends ofthe normal ranges are normal only for people over eighty. If youhave side effects, such as facial hair or acne, which are uncom-mon, check your blood level of DHEA-S and decrease your dose.I have found that many brands of DHEA are not reliable. I rec-ommend you use DHEA made by compounding pharmacists (seeAppendix B) or by General Nutrition Center or other reputablecompanies.

Treating Low Testosterone: Not Only a Male ProblemMany people going through midlife develop pain, fatigue, poorlibido, or depression. This includes men and women alike. Anunderactive adrenal gland can aggravate this problem. Although


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the ovaries make most of a woman’s estrogen and the testiclesmake most of a man’s testosterone, in women the adrenals makesignificant amounts of testosterone.

Inadequate testosterone is a major problem in 70 percent of mymale patients with fibromyalgia and/or chronic pain. It is impor-tant (again, in both men and women) to check the free or unboundblood testosterone level. This measures the active form of the hor-mone. If your result is below normal, or even in the lowest 25 per-cent of the normal range, I would consider a trial of naturaltestosterone therapy.

Low testosterone is associated with many problems also causedby pain, including fatigue, depression, poor stamina, muscle-wasting, osteoporosis, and poor libido. Chronic pain is routinelyassociated with low testosterone, further aggravating these prob-lems. In addition, taking narcotic pain medications also lowerstestosterone. Treating both men and women who have a low tes-tosterone can help all of these conditions.

A recent study by Dr. Hillary White, an associate professor atDartmouth Medical School, found that testosterone replacementtherapy is helpful in the treatment of women with fibromyalgiapain. Because the study is still awaiting publication, more detailsare not yet available. Dr. White became interested in this problemwhen testosterone helped relieve her own fibromyalgia pain. Shealso notes that it is important to use natural testosterone and notthe synthetic methyl testosterone form.

Most studies show that low testosterone in men is associatedwith an increased risk of angina and that using natural testos-terone to bring low testosterone up to the midnormal leveldecreases angina and leg artery blockages, improves cholesterol,and may decrease diabetic tendencies. It is not clear if takingtestosterone increases the risk of prostate enlargement or cancerbeyond that of any other healthy male. While I don’t feel beingtestosterone deficient is a good way to prevent these illnesses, ifyou are a man over fifty who is taking testosterone, it is reason-


35

able to do a prostate exam and prostate-specific antigen (PSA) testyearly. For many, improvements in overall sense of wellness havebeen dramatic, and treating the low testosterone has been critical.

Treating Low Estrogen and Progesterone in WomenAlthough not likely to be a problem with men, deficiencies ofestrogen and/or progesterone can be major problems in womenwith CFIDS/FMS. In a book by Dr. Elizabeth Lee Vliet, Scream-ing to Be Heard: Hormonal Connections Women Suspect . . . and Doc-tors Ignore, the role of estrogen deficiency in causing pain, fatigue,brain fog, disordered sleep, fibromyalgia, poor libido, PMS, lowlevels of serotonin and other neurotransmitters, and interstitialcystitis, as well as other problems, is reviewed in detail. She notes,appropriately, that the perimenopausal period (the period as youapproach menopause) has a gradual onset, and symptoms of estro-gen deficiency can occur five to twelve years before your bloodtests and periods become abnormal.

If your pain is worse when your estrogen levels are dropping(during ovulation, which occurs about fifteen days after the firstday of your period, and around your period), a trial of naturalestrogen supplementation is warranted. Other symptoms of inad-equate estrogen include inadequate vaginal lubrication, nightsweats, and/or hot flashes.

Most of the media attention and research about estrogen beingdangerous relate to the use of conjugated estrogens (made usingpregnant horse urine) like Premarin, mentioned at the beginningof this chapter. I prefer to use natural biestrogen (1.25 to 2.5 mga day) from a compounding pharmacy. This contains estradiol plusestriol, a weaker form of estrogen that may actually decrease therisk of developing breast cancer. Patients with estrogen-inducedmigraines usually get them not from the estrogen itself but fromfluctuating blood levels of estrogen. They will often get relief byusing estrogen patches that last for the week around their period.These give steady estrogen levels.


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Unless you have had a hysterectomy, if you take supplementalestrogen you must also take progesterone. I prefer natural proges-terone—for example, 200 mg of Prometrium a day for the firstten days of each month, or 30 to 100 mg every day. Taking bothestrogen and progesterone every day will often result in your peri-ods going away after six to nine months, and most women overforty-eight years of age prefer this approach.

Now that you understand what your body needs to get and stayhealthy, you can take a look at the next chapter, where I discussthe outside triggers that you must address to heal and repair. Forthose of you who would like a brief summation of what to do toget well, I invite you to visit the summary section of the Pain Free1-2-3 “Notes” at vitality101.com. This gives a quick review foreach chapter.


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Eliminating the Causes and Triggers

of Your Pain

In addition to pain coming from not having the basic things yourbody needs for health, it can also come from outside triggers.Infections, including subtle ones that are often hidden (especiallyyeast infections), are a common trigger. Tissue compression fromcancer or disc disease and structural problems also frequently causepain. Some other causes, such as burn injuries, are obvious, whiletoxin exposures may be more subtle. This chapter examines someof the more important triggers. (See Appendix A for informationon my online program that can analyze your medical history andlab tests to determine the most important underlying metabolicproblems in your case.)

Bren Jacobson, a gifted Rolfer and minister who practices inAnnapolis, Maryland, contributed the sections in this chapter onreducing stress and ergonomics. Being very knowledgeable aboutboth standard medical issues and a very wide array of comple-mentary therapies, he is very gifted at guiding people through themyriad options available in complementary and holistic medicineand also does both this and psychological counseling by phone (seeAppendix B for contact information).

C H A P T E R 3

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Managing Infections

Many different kinds of infections can trigger pain. Pain can becaused by direct irritation caused by the infection, but can also becaused by the inflammation or immune activation your body cre-ates as it attempts to fight the infection—like feeling achiness withthe flu. In some cases, such as Lyme disease, the role of infectionin causing the pain is fairly well accepted. In many, if not mostcases, however, the role of infections is still controversial as asource of pain. Although it is possible for numerous infections tobe the source of pain, we will focus on the most important ones.

Fungal Infections and OvergrowthAlthough many doctors still believe there is no such thing as fun-gal overgrowth, the increase in antibiotic and sugar use in oursociety has made this problem more common. When it affects theskin in athlete’s foot or causes obvious vaginal infections, it can bereadily seen and is therefore accepted by the medical community.Unfortunately, when it affects the bowels and sinuses there is noreliable way to test for it, and many physicians still make believethat fungal overgrowth cannot occur in these areas. It can, how-ever, and it is very important to treat it.

There are no definitive tests for yeast overgrowth that will dis-tinguish it from normal yeast growth in the body. Nonetheless,fungal/yeast overgrowth should be considered in any of the fol-lowing situations:

• Chronic sinusitis and nasal congestion• Spastic colon, gas, bloating, constipation, and/or diarrhea• A history of frequent antibiotic use• Recurrent or ongoing skin, nail, or vaginal fungal infections• Itchy ears or anus, recurrent aphthous ulcers (painful ulcers

in the mouth where the lips meet your gums that last for fiveto ten days), and/or sugar cravings

• The presence of widespread achiness without inflammation(fibromyalgia/chronic fatigue syndrome)


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Although people most often speak of Candida as the main typeof fungal infection, I suspect that these infections can be causedby many different fungi. Although many tests are recommendedto look for these infections, I do not consider them to be morereliable than simply looking for the six things that I noted above.If any of these are present, I believe that an empiric trial of anti-fungal therapy is warranted. Your body’s response to therapy is thebest indicator of whether fungal overgrowth was a problem. Ifyour symptoms initially worsen with antifungals and/or improvesignificantly by the end of six weeks of treatment (shorter coursesare unlikely to eradicate the problem), this suggests that fungalovergrowth is playing a role in your pain (and perhaps many othersymptoms). A number of very effective methods can be used toeliminate a yeast problem. My preference is to treat with a mix ofnatural and prescription therapies (described later in this section).If your doctor is unwilling to use prescription antifungals, eitherbegin with the natural therapies or look for a doctor who willprescribe them.

Many physicians feel that yeast overgrowth causes a general-ized suppression of the immune system. In other words, once theyeast gets the upper hand, it sets up a cycle that further suppressesthe body’s defenses. Interestingly, a recent Mayo Clinic studyshowed that most cases of chronic sinusitis seem to be associatedwith a reaction to yeast in the sinuses—something I proposedyears ago. Nonetheless, as I have already noted, this theory is con-troversial. Yeast are normal members of the body’s “zoo.” Theylive in balance with bacteria—some of which are helpful andhealthy and some of which are detrimental and unhealthy. Theproblems begin when this harmonious balance shifts and the yeastbegins to overgrow.

Causes of Fungal Infections. Many things can prompt yeast toovergrow. One of the most common causes is frequent antibioticuse. Antibiotics kill off the good bacteria in the bowel along withthe bad bacteria. When this happens, the yeast no longer havecompetition and begin to overgrow. The body is often able to

ELIMINATING THE CAUSES AND TRIGGERS OF YOUR PAIN

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rebalance itself after one or several courses of antibiotics, but afterrepeated or long-term courses—and especially if the body has anunderlying immune dysfunction—the yeast can get the upperhand.

Other factors are also important. Studies have shown that ani-mals that are sleep-deprived and/or have increased sugar intakedevelop bowel yeast overgrowth. Many physicians feel that eatingsugar stimulates yeast overgrowth in people as well. Sugar is foodfor yeast. Yeast ferment sugar in order to grow and multiply. Yeastovergrowth due to the overuse of sugar also seems to causeimmune suppression, which facilitates bacterial infections such aschronic sinusitis, requiring even more antibiotic use. Poor sleepalso results in marked suppression of your immune function.

Treating Suspected Fungal Overgrowth Naturally. The first thingyou need to do is to stop feeding the yeast. Yeast grow by eatingsugar and other sweets. You can enjoy one or two pieces of fruita day, but you should not consume concentrated sugar sources suchas juices, corn syrup, jellies, pastry, candy, or honey. Stay far awayfrom soft drinks, which often have ten to twelve teaspoons ofsugar in every twelve ounces. This amount of sugar has beenshown to markedly suppress immune function for several hours.

Using stevia as a sweetener is a wonderful substitute for sugar.Stevia is safe and natural, and you can use all you want. There areeven cookbooks available for using stevia. Most brands are bitter,and I don’t recommend them. Two brands taste great, however.These are the ones made by Body Ecology or the Stevita Com-pany (see Appendix B or vitality101.com).

Other healthy natural sweeteners include maltitol (used inmany sugar-free chocolates), inositol, and xylitol. The yeast do notappear to be able to ferment these. In addition, inositol candecrease nerve pain and anxiety, and xylitol also appears todecrease osteoporosis. Be prepared to have withdrawal symptomsfor about one week when you cut sugar out of your diet. Severalexcellent books have been written on the yeast controversy andoffer additional dietary methods to try. One of the best is The


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Yeast Connection and the Woman by Dr. William Crook, a physi-cian who did a spectacular job of advancing our understanding ofthe problems caused by fungal overgrowth.

Acidophilus—milk bacteria, a healthy type of bacteria for thebowel—helps restore balance in the bowel. Acidophilus is foundin yogurt with live and active yogurt cultures. Indeed, eating onecup of yogurt a day can markedly diminish the frequency ofrecurrent vaginal yeast infections. Acidophilus is also available inmany forms. Unfortunately, recent tests of many brands showedthat the quality control is very poor. The only forms of aci-dophilus that I currently recommend are those that have a pearlcoating to protect the bacteria and keep them alive such as Aci-dophilus Pearls, Probiotic Pearls, or a product called PrimalDefense. Take two pearls or two Primal Defense tablets twice aday for five months. This will help to restore the healthy bacteriain your colon that were destroyed by antibiotic use. Some peoplelike to continue on one pearl or tablet a day long term to helpmaintain healthy bowel function. If you are on antibiotics (notantifungals), take the acidophilus at least three to six hours awayfrom the antibiotic dose.

Another effective natural antifungal is Citricidal. Derived fromgrapefruit and grapefruit seeds, it can be quite powerful at inhibit-ing fungal growth and the growth of other infections. Take oneor two 100 mg tablets twice a day. Do not use the liquid form, asit tastes vile. Many natural antifungals are available, but using astrong enough dose often causes stomach irritation and reflux. Bycombining several antifungals at lower doses, one can increasetheir effectiveness with fewer side effects. Phytostan by NF For-mulas is an excellent mix of natural antifungals. These includegrapefruit seed extract, Pau d’arco, caprylic acid, undecylenic acid,rosemary, and thyme. The recommended dose is one tablet, threetimes a day or two tablets, twice a day.

Medical Treatments for Yeast Overgrowth. Nystatin, an antifun-gal medication, has been helpful in the treatment of yeast over-growth. Unfortunately, some fungi seem to be developing


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resistance to nystatin. In addition, nystatin is poorly absorbed,which means that it has little impact on the yeast outside of thebowel. Other antifungal medications, such as Diflucan and Spo-ranox, seem to be effective systemically (throughout the body),but they have two main drawbacks. First, they are expensive, cost-ing more than $450 to $900 for a two-month course. Happily,Diflucan just went generic and can now be found for $40 permonth. Second, any effective antifungal can initially make thesymptoms of yeast infection worse. If you get this reaction, startyour treatment with Acidophilus, a sugar-free diet, plus Phytostanfor a few weeks before beginning the Nystatin and Diflucan.

Although it is uncommon, Diflucan and Sporanox can alsocause liver inflammation. If you are taking Diflucan or Sporanoxfor more than six to twelve weeks, I would consider intermittentblood tests to check liver function—specifically checking bloodlevels of ALT and AST, two inexpensive tests and good indicatorsof injury to the liver. If you have preexisting active liver disease,you should be cautious about using Diflucan or Sporanox—or donot use them at all.

I recommend taking 200 to 300 mg of lipoic acid a day when-ever you take Sporanox or Diflucan. This is a natural supplementthat helps to protect and heal the liver (and can also be helpful fornerve pain). I also recommend lipoic acid for anyone with nervepain (200 to 300 mg two to three times a day) or active liver dis-ease such as hepatitis (at doses up to 1,000 to 3,000 mg a day) asit may prevent and/or help treat hepatitis and cirrhosis. (Furtherinformation is available at vitality101.com.)

Avoiding Yeast Overgrowth. The best thing you can do to com-bat yeast overgrowth is to avoid it in the first place. When you geta viral infection, immediately begin treating it naturally. (See thesidebar “Treating Respiratory Infections Without Antibiotics.”)Hopefully, you will be able to prevent it from turning into a bac-terial infection that might require an antibiotic. Ask your doctorwhat other measures you can take before resorting to antibiotics.


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Many people do not realize how many things they can do before

resorting to using an antibiotic to clear an infection. If you feel you

are coming down with a respiratory infection such as a sore throat,

a cold, sinusitis, or the flu, I recommend that you try the following:

• Take a natural thymic hormone mimic. This is available as a

product called ProBoost, which is a very effective immune

stimulant (see Appendix B). At the first sign of any infection,

dissolve the contents of one packet under your tongue three

times a day and let it absorb there (any that is swallowed is

destroyed). I have found that using it for two or three days at

the onset of any infection can shorten the length of the

infection dramatically and often stops it on the first day.

• Take 1,000 to 8,000 mg of vitamin C a day. Take enough to get

diarrhea; then cut back to a comfortable level.

• If you have a sore throat, suck on a zinc lozenge five to eight

times a day. Make sure that the lozenges have at least 10 to

20 mg of zinc per lozenge. Less than this will not be effective.

Zinc lozenges have been known to speed the time it takes to

recover from a cold by about 40 percent. The Vitamin Shoppe

and General Nutrition Center brands are excellent.

• Drink plenty of water and hot caffeine-free tea (or hot water

with lemon) and rest.

• Take Oscillococcinum. If you have flulike symptoms such as

chills, fever, achiness, and/or malaise, take Oscillococcinum, a

homeopathic remedy available at most health food stores and

some supermarkets. It speeds healing and eases discomfort. It

is best taken early in the infection—as soon as you have any

symptoms.

• If you have a sinus infection, try nasal rinses. Dissolve a half

teaspoon of salt in a cup of lukewarm water. Inhale some of the

Treating Respiratory Infections Without Antibiotics

(continued)

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solution about one inch up into your nose, one nostril at a time.

Do this either by using a baby nose bulb or an eyedropper

while lying down, or by sniffing the solution out of the palm of

your hand while standing by a sink. Then gently blow your

nose, being careful not to hurt your ears. Repeat the same

process with the other nostril. Continue to repeat with each

nostril until the nose is clear. Rinse your nasal passages at least

twice a day until the infection improves. Each rinsing will wash

away about 90 percent of the infection and make it much easier

for your body to heal. Colloidal silver nose sprays can also help.

Also ask your doctor to prescribe the sinusitis nose spray from

Cape Pharmacy (listed in Appendix B). In addition, see the

section later in this chapter on treating sinusitis.

• Try using a humidifier or vaporizer in your bedroom. You can

also make a steam room by running a hot shower in your

bathroom and then breathing in the steam. Or try using a

steam inhaler, such as the one available from Bernhard

Industries. This is also wonderful for alleviating chronic and

acute sinusitis.

If, in spite of these measures, nasal and lung mucus is yellow

after seven to fourteen days, or if you are feeling worse after three

to four days, you may have to consider taking a course of

antibiotics. If you do, you should take nystatin while on the

antibiotic. Erythromycin antibiotics such as azithromycin (Zithromax)

and clarithromycin (Biaxin) are usually preferable to penicillin

antibiotics. Interestingly, my patients have sometimes found that

pain and many other symptoms (not just the cold) improve while

they are taking an erythromycin or tetracycline antibiotic. If that

happens, I recommend a six- to twenty-four-month course of

Zithromax 250 mg per day, or 100 mg of doxycycline twice a day. If

you feel better on the antibiotic (take thymic hormone/ProBoost,

Treating Respiratory Infections Without Antibiotics, continued

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and the antifungal nystatin in conjunction with it), keep repeating

twelve-week courses until the symptoms stay gone. I would also

check for Lyme disease, although the tests are not reliable. For

most of my patients who repeatedly get respiratory infections that

seem to take forever to go away, I consider an empiric trial of

prescription hydrocortisone (Cortef) at a dosage of 7.5 mg in the

morning and 5 mg at noon for two to three months (see the earlier

section on adrenal insufficiency).

To treat or prevent bladder infections caused by E. coli (the

most common cause), use the natural supplement D-Mannose.

If you find that you must take an antibiotic, all is not lost. You

can still lessen the severity of yeast overgrowth by avoiding sweets

and by taking nystatin or Phytostan plus Acidophilus Pearls (again,

not within three to six hours of an antibiotic).

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What if the Yeast Come Back? It is normal for yeast symptoms toresolve after treatment. After six weeks on Sporanox or Diflucanmany people feel a lot better. However, symptoms may recur soonafter stopping the antifungal. If this happens, I would continuethe Sporanox or Diflucan for another six weeks or for as long as isneeded to keep the symptoms at bay. More frequently, people feelbetter after treatment and stay feeling fairly well for a period ofsix to twenty-four months. At that time, we sometimes see arecurrence of symptoms, especially if the person is eating toomuch sugar or is taking antibiotics.

The best marker that I have found for recurrent yeast over-growth is a return of sinusitis or bowel symptoms, with gas, bloat-ing, diarrhea, and/or constipation. If these symptoms persist formore than two weeks, especially if there is even a mild worsen-ing of pain, fatigue, or mental cloudiness, it is reasonable to re-treat yourself with six weeks of acidophilus, nystatin or Phytostan,

and Sporanox or Diflucan. In addition, I would also resume treat-ment if there is a recurrence of vaginal yeast or other fungal infec-tions. You may repeat this regimen as needed. By using some ofthe natural remedies listed earlier in this chapter, however, youmay be able to avoid repeated use of antifungals and the possiblerisk of becoming resistant to them.

Antibiotic-Sensitive InfectionsIn traditional medicine, physicians like to look for things that areeasy to test for. If we have no test for an infection, we makebelieve it does not exist. This was the case with polio, Lyme dis-ease, and numerous other infections until tests were developed.Physicians also like to look for infections that can be cultured.These include bacteria such as staph, strep, and E. coli. For theseinfections, a few bacteria put on a culture dish will grow into mil-lions overnight, and these can then be seen with the naked eye. Isuspect that many kinds of inflammatory arthritis (for example,rheumatoid arthritis) and autoimmune diseases are triggered bythe body’s response to infections that we cannot yet culture.

When to Treat with Antibiotics. Having just talked about the prob-lems of fungal overgrowth that occur with long-term or frequentantibiotic use, it may seem odd that we will now talk about thebenefits of ongoing antibiotic use in some pain patients. This sim-ply helps to remind us that things are neither all good nor all bad.What is important is to use the right tool in the right situation.

As mentioned previously, pain may be a signal from your bodythat there is an underlying infection that is problematic. In othercases, the pain is not caused by the infection but by your body’sreaction as it attempts to fight the infection. Unfortunately, themore commonly used antibiotics (penicillin, Keflex, sulfa) may beineffective against slow-growing infections. Research suggeststhat a trial of tetracycline-family antibiotics (and occasionallyantiparasitics) is warranted in the treatment of inflammatoryarthritic conditions. I am most likely to consider a trial of six to


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twelve months (or more) of these antibiotics in the followingsituations:

• If you have recurrent low-grade fevers (which I define asanything over 98.6°) and/or chronic lung congestionwithout your doctor finding an underlying cause

• If your pain or other chronic symptoms improved (evenbriefly) while you were taking antibiotics for something else

• If you have rheumatoid arthritis or other inflammatoryarthritis (where your joints are red, hot, and swollen) ofunknown cause

• If you have persistent sinusitis, skin/scalp pustules, or otherchronic infections that persist after six weeks of antifungaltherapy

People with these symptoms seem to be more likely to have bac-terial, mycoplasma, or chlamydia, or other infections that respondto special antibiotics.

Bowel Parasite InfectionsThe symptoms of parasitic infections can include pain. Asimmune dysfunction may be present in chronic pain patients, Ibelieve that all parasites should be treated.

I am most likely to test for parasites in patients who have gas,bloating, diarrhea, and/or constipation—especially if the symp-toms do not resolve with antifungal therapy, or if the person trav-eled overseas, or developed the bowel symptoms, in the weeks tomonths before the chronic pain began.

Diagnosing and Treating Bowel Parasites. Most laboratories missparasites when they do stool testing. The only labs that I use forstool testing (by mail) are the Parasitology Center and the GreatSmokies Diagnostic Laboratory (listed in Appendix B). The appro-priate treatment for many bowel parasites depends on which organ-ism is causing the problem. (Further information is available at


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vitality101.com.) Prevent parasitic infection by filtering your waterwith an effective filtration unit (most are not effective). I recom-mend the Multi-Pure filter from Pure Water (see Appendix B).

Other InfectionsWe will discuss specific infections such as sinusitis, bladder infec-tions, and prostatitis in the chapters on localized pain in Part II.In addition, many things determine how likely your body is toreact with a severe inflammatory response and how much damagethis response is likely to do. Nutritional factors such as essentialfatty acids and antioxidants and hormonal factors such as inade-quate cortisol levels can dramatically modify your body’s inflam-matory response.

DetoxificationAlthough an extensive discussion of detoxification is beyond thescope of this book, there are several simple things you can do thatcan be very helpful. Sweating can remove toxins, especially if youshower immediately after. Because of this, saunas can be very help-ful for health. With many of the newer far-infrared saunas, a half-hour sauna three to seven times a week may dramatically helpdetoxification. My wife and I use an excellent one made by HighTech Health (800-794-5355). Hot baths can also help. The follow-ing detox bath recipe was given to me by a wonderful osteopathicpractitioner, Anette Mnabhi, D.O., who practices in Montgomery,Illinois. Dr. Mnabhi’s patients love it. She has seen one or twoinstances of nausea, vomiting, and diarrhea after the bath. In thesecases, however, the patient felt much better the next day.

This detox bath recipe helps with general muscle aches andpains.

Detox Bath Recipe

2 cups Epsom salts

1 cup baking soda1⁄3 cup hydrogen peroxide


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Fill the tub with hot water and add the above ingredients. Soakfor twenty to thirty minutes. You will sweat in the tub and losetoxins. This causes you to lose some water as well, so it is impor-tant to drink plenty of water while you soak. Some people like toadd fresh lemon juice to their drinking water. If you have a ten-dency to get light-headed easily, be cautious when getting out ofthe tub, or have someone nearby the first time you take a detoxbath. Take a lukewarm to cool shower after getting out of the tubto rinse off the salts or you may itch. Rest for thirty minutes afterthe bath.

Reducing Stress (by Bren Jacobson)

Most pain is part of a cycle that originates with stress that can bephysical, emotional, psychological, spiritual, or any combinationof these. Any kind of stress causes muscle tension and stiffness,which ultimately leads to permanent muscle tightness and even-tually immobility. This state of chronic contraction of the mus-cles and connective tissue leads to reduced blood flow andoxygenation, along with an inability to get rid of toxic wasteproducts. All of these factors put strain on the body, causing it towork harder with less efficiency. This strain on the body causespain that interferes with sound, deep sleep. A lack of sleep lowersone’s stress threshold, and this can become a downward spiral withpain levels increasing exponentially.

To reverse this cycle of stress, muscle tightness, pain, loss ofsleep, and further stress, it is good to interrupt the cycle in asmany places as possible. I have found that prayer, meditation,counseling, lifestyle coaching, exercise, lovemaking, and doingthose activities that one enjoys are all effective ways of reducingstress. As discussed in the previous chapter, poor sleep can becounteracted by herbs, medicine, hot baths, soothing music, alight snack or warm milk. Muscle tightness as well as stressand pain can all be alleviated with bodywork, stretching, andexercise.


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BodyworkThe term bodywork generally refers to various types of massageand therapies performed on one’s body. I will use it in a muchbroader sense and incorporate anything that affects and improvesthe body including various exercises. Before getting into the var-ious types, here are a few general suggestions that apply to allforms of bodywork.

• If it’s not working, try something else. If you try anyform of bodywork and find that you feel worse after a fairtrial, or it causes you continuing discomfort, or you simplydon’t like it, stop and find something you enjoy more andhelps your situation. By a fair trial, I mean that if after oneyoga lesson you feel sore and stiff the next day, don’t give up.Try it regularly, more slowly, for shorter periods of time, andmore gently for a month, and then if you don’t feel that it ishelping, stop and try something else.

• Always start gradually. Don’t start with three or fourhours of exercise a day. Twenty minutes of yoga every day isbetter than five hours on the weekend. A daily walk aroundthe block is better than running a marathon once a year. Doonly what feels good and do it only as long as it is enjoyable.

• Get references. To find a good therapist or teacher, askfriends for references, check the person’s credentials, and talkto the person to see if you are compatible with them.

• Check with your doctor. If you have any sort of medicalcondition, check with your doctor to see if the type ofbodywork you are considering is appropriate and has nopotential to do harm.

• Always listen to the messages that your body andintuition give you. Pay attention to what your body istelling you. You live in your body and have a very intimateknowledge of what is good or bad for it. People often getinto trouble when they ignore what their bodies are tryingto tell them. When one doesn’t listen to one’s body, it often


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gives louder, more insistent, and harder to ignore messagesin the form of pain or disabilities that prevent one fromdoing further damage (like a fuse blowing to prevent a firein an electrical system). The Chinese have a saying that isapplicable, “A stumble very often prevents a fall.”

• Never push yourself, never show off, and never, evercompete with anyone while exercising. If you are in ayoga class and the person on the mat next to you is doing aforward bend with her hands flat on the floor and her headtouching her knees, and you can barely touch your toes, itdoesn’t matter at all. The purpose of the exercise is not totouch the floor or your toes but to stretch the muscles ofyour back. Forcing yourself can cause severe injury.

• Forget the adage “no pain, no gain.” It has no truth and often causes painful injuries. “Slow, gradual, andcomfortable” is a much better and safer approach.

• Always warm up before exercise or athletics withslow, gentle movements and stretches. This is one ofthe best ways to avoid injury. It is equally important to cooldown after exercise. Some form of complete relaxation is agood way to end your workout.

• Natural activity is good. Any natural activity that usesyour entire body, does not involve extreme exertion, doesnot involve high impact, and which is fun is probably goodfor you. Some examples of this are walking (one of the best,easiest, cheapest, and most readily available activities foralmost everyone), swimming, dancing, making love,gardening, and bicycling. It is a good practice to alternatethese activities so as to achieve a good balance in your body.Some of the activities that I have found to cause pain andinjury are lifting heavy weights, running, and ballet.Running often causes lower back pain, disc compression,and damage (the impact on the spine when running is threetimes the body weight). It also causes stress fractures, tornligaments, and knee damage (knees incur five times the


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amount of force when running as they do when walking). Ihave worked with numerous ballet dancers and weight liftersand have seen many who are totally disabled and many whoare in constant, unbearable, and intractable pain.

Movement, Exercise, and Bodywork. In this section I will give abasic overview of a few types of bodywork that can be effectivein relieving pain, and I will recommend some books as I go.Movement and exercise include such disciplines as yoga, tai chichuan, chi gong, Pilates, and others.

The most complete and time-tested system of exercise is yoga.It combines balance, stretching, resistance, breathing, and focus.Today, yoga has gone from being an esoteric spiritual practice tobeing commonplace. There are many different types of yoga, andmost of them have benefit. A good type of yoga for anyone start-ing out is a gentle form of hatha yoga. Sivananda yoga, a popularand comprehensive form of hatha yoga, is described in SwamiVishnu Devananda’s Complete Illustrated Book of Yoga and in TheSivananda Companion to Yoga. The Sivananda organization hascenters throughout the world that give classes, train teachers, andoffer yoga vacations and retreats. More information can be foundonline at sivananda.org. The advanced student can go on to tryBikram yoga, Iyengar yoga (explained in the book Light on Yoga),astanga yoga, Kundalini yoga, and Anusara yoga.

Ideally, the student will not just use yoga as a series of exer-cises, but will also become acquainted with the yoga diet, philos-ophy, lifestyle, breathing exercises, and meditation. All of thesecomprise a system that is extremely effective in relieving, as wellas preventing, pain. It is possible to begin practicing yoga from abook, but it is much better to start by taking a class from a certi-fied teacher. It is important to begin gently, to never compete, tonever force a posture to the point of pain, and to do all of theexercises mindfully. Done properly, yoga will be enjoyable.

In yoga as well as all forms of exercise, correct breathing is ofthe utmost importance. Breath is a link between the mind and


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body. When the body is in pain or the mind is frightened, breath-ing is short, rapid, and irregular. If a person is relaxed and in a stateof enjoyment, breathing is long, slow, deep, and regular. It is pos-sible to change one’s state of being by simply focusing on andchanging one’s breathing. Practitioners of zazen, one of the mosteffective forms of meditation, as well as vipassana meditation usethis concentration on their breath as a major part of their practice.A powerful way of dealing with pain is to visualize the breath asa colored healing stream of energy and to concentrate on direct-ing the breath to the part of the body where the pain is. Imaginethe healing energy of the breath dissolving the pain and carryingit out of the body with each exhalation.

Another breathing practice that can be useful and which is anessential part of a complete yoga practice is called pranayama. Thisconsists of a series of powerful breathing exercises that arouse andcontrol the flow of energy in the body. In any exercise, it isimportant when bending forward to exhale and to inhale whenbending backward. It is also good to coordinate the breath withthe motion so that when you begin to bend forward, you beginto exhale, ending the exhalation when you reach the limit of yourforward bend.

Another wonderful system of bodywork is tai chi chuan. It is,all at the same time, an exercise, a dance, a moving meditation, asystem of energy generation and regulation, breath control, and amartial art. It was developed over thousands of years by Chinesemonks and is practiced throughout China by millions of people.It consists of a series of many “hands” or postures and movementslinked together in a very slow, harmonious, and graceful dance.Today there are numerous books and videos that teach variousforms of tai chi, but it is very difficult to learn it that way. Myadvice is to join a class that proceeds slowly and rigorously. Forhealth and pain relief purposes, it is better to avoid schools thatteach tai chi as a martial art.

Similar to tai chi is another Chinese practice called chi gong.This is a type of healing that can be performed by a practitioner


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and is also a system of exercise, with more emphasis on healingand controlling the flow of energy in the body. An excellentintroduction to the philosophy, history, and practice of chi gongcan be found in books by Ken Cohen.

Pilates is a system of bodywork that is enjoying increasingpopularity in the United States. It complements the other systemsof bodywork that I have mentioned and is taught in many gymsand spas. Pilates is somewhat vigorous and should be done bysomeone who is already fairly healthy. As with other forms ofbodywork, it is of the utmost importance to work with a prop-erly trained and experienced teacher.

There are various other forms of bodywork that focus onproper and efficient ways to move and use one’s body. Theseinclude Feldenkrais work, Alexander technique, Rolf movementwork, Trager Mentastics, and Aston patterning. Some types ofbodywork performed by a practitioner focus primarily on thephysical body and others concentrate on the body’s energy sys-tem. In all cases, however, there is an overlap. For example, acu-puncture is primarily a way of enhancing the proper flow ofenergy in the body, but it also effects physical change. Likewise,structural integration/Rolfing, which works only on the physicalbody, always affects the energy system.

Furthermore, anything that changes the body physically notonly changes a person’s structure and physiology, but also changesthe person emotionally and psychologically. We are all familiarwith the term psychosomatic, meaning bodily symptoms caused bymental or emotional disturbance. The reverse phenomenon ofphysical improvement causing a corresponding psychologicalimprovement, or somatopsychic, is not as universally recognized. Ananalogy I use to illustrate this phenomenon is that the body and themind are like the back and the palm of the hand. Both are sepa-rate, distinct, different, and distinguishable, but it is impossible tomove or in any way change one without a corresponding changein the other. They are inextricably linked. Just think about the lasttime you hit your finger with a hammer or stubbed your toe.


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Massage Therapies That Involve Bodywork. Before discussing var-ious types of bodywork and massage, I would like to give a fewcautionary notes. Anyone with open sores, an infectious disease,severe psychological imbalance, a fracture or other serious injury,an acute illness, or a pain or other symptom that is increasing infrequency or severity should see a physician before trying any ofthe following therapies. If you have acute appendicitis or hepati-tis, for example, an acupuncturist, chiropractor, or reflexologistwould not be the appropriate therapist to go to.

Over a period of thirty-five years I have studied and practicedmany forms of bodywork worldwide, and I now work with myown fusion of all of them. If, however, I were to be asked whichsingle form of bodywork I find most profoundly effective inrelieving pain as well as enhancing well-being and vitality, Iwould recommend structural integration. This is a holistic systemof balancing and integrating the body that was developed by Dr.Ida P. Rolf and which has been called Rolfing by many of itspractitioners to honor her.

I had the great honor of studying advanced Rolfing with Dr.Rolf and have practiced it for more than thirty years. I find it tobe the most holistic, long lasting, and transformative form ofbodywork available. An excellent source of information aboutstructural integration is available online at rolfguild.org. Excellentbooks on the subject are available. Two of the best are Rolfing:Reestablishing the Natural Alignment and Structural Integration of theHuman Body for Vitality and Well-Being and Rolfing and PhysicalReality, both by Dr. Ida P. Rolf.

Structural integration involves ten sessions of work with mostof the work being done with connective tissue to straighten andbalance the body so that it gets support from gravity, rather thanbeing torn down by it. The results that most people get arereduced pain, more energy, better posture, and less anxiety, as wellas easier, more efficient, and more graceful movement. A fairlycommon remark by people who have had this work done is thatthey feel more attractive, have more energy, and feel healthier.


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Because so much pain and dysfunction is caused by imbalance andstructural problems, such as one leg being shorter than the other,uneven hip heights, the head being forward, the pelvis tilted, orthe shoulders rotated, this is an extremely effective approach foralleviating these problems and the pain caused by them.

Massage is a broad category of bodywork that involves hands-on manipulation. It is one of the oldest forms of healing and hasbeen used from time immemorial. Today there are scores of dif-ferent schools of massage. One of the best introductions to thevarious types is the book Hands on Healing by Jack Angelo.

One wide group of massage techniques uses stroking, friction,kneading, and vibration. This relaxes muscles and increases bloodand lymph flow, while increasing oxygenation of the tissues of thebody. This type of work generally relieves muscular tension andleaves the person feeling relaxed and energized at the same time.This category includes Swedish massage, sports massage, Esalenmassage, tuina (a type of Chinese massage), and lymphaticdrainage massage.

Additional Bodywork Therapies. Other forms of bodywork focuson regulating and directing the flow of energy in the body. Theseinclude acupuncture, reflexology, shiatsu, polarity work, do-in,and applied kinesiology. Thai massage is explained well in thebook Thai Massage: Sacred Bodywork by Ananda Apfelbaum.

Various types of bodywork mobilize joints and release muscles,while straightening and balancing the spine. These include chiro-practic work, osteopathy, Trager, and cranial-sacral work. Thefirst two are very complementary to the therapies mentionedabove. A Canadian study recommended chiropractic treatment asan effective first-line treatment for acute back pain. The latter twoare both very gentle and powerful.

How to Use Bodywork for Optimum Effect. Any and all of thesesystems and techniques will help to relieve pain but obviously no


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person has the time, money, or energy to do them all. Nor are alltypes of work suited to all people. It is best to talk to other peo-ple and health practitioners as well as read more about these heal-ing modalities and then try one. If it helps, keep doing it, and ifnot, try another. Never get discouraged. Each type of bodyworkwill help in some way and each will teach you something aboutyourself.

I would like to note that many of the things I have mentionedare synergistic. This means that they work together and enhanceeach other so that the total effect is greater than each done sepa-rately. In other words the total effect is greater than the sum ofthe parts. A combination that I have found to be particularlyeffective is yoga, structural integration, meditation, and tai chi.

The Benefits of Meditation for Stress ReductionMany associate meditation with someone who shaves his or herhead and bangs a tambourine in an airport or someone who sits ina cave contemplating his navel. The truth is that every religiousand spiritual tradition worldwide advocates some form of medi-tation. There are also many individuals with no religious or spir-itual aspirations who meditate for reasons that are as varied aslowering their blood pressure to improving their golf game. Manyrecent studies have shown the benefits of meditation to be as far-ranging as increasing life expectancy, stress and pain control, bet-ter immune function, lower blood pressure, increased fertility, lessPMS, and fewer headaches.

What I mean by meditation is one-pointed, focused mindful-ness and awareness. This can be visual concentration on a candleflame or religious icon or an auditory input, such as wholeheart-edly listening to a Gregorian chant or the waves on a beach. Theverbal or silent repetition of a mantra is another form of medita-tion. Some people find the repetition of a word like “peace” help-ful. This is talked about in Dr. Herb Benson’s book The RelaxationResponse. Others recite the rosary or a syllable such as “Om,” or


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they repeat their name over and over as did Alfred Lord Tennyson.Mindful meditation can involve a kinesthetic experience such aswalking or doing an everyday task such as gardening or washingdishes with full attention and awareness. The secret is to “do onething.” In other words, when you are washing dishes, focus onlyon doing the dishes. Be aware of the sound of the water, the feelof the dishes, the way your muscles work to accomplish the task,the smell of the soap, and the appearance of the soap bubbles. Ifyour back becomes tired, be aware of that in an observant ratherthan a judgmental way. When you are doing the dishes think, “Iam doing the dishes.” Try not to let the usual useless mind chat-ter take over, such as, “Boy, I wish I didn’t have to do the dishes;I wonder what’s on television; I wish I had said such and such toso and so earlier today; wouldn’t it be great if I had a dishwasher;maybe I should use paper plates.” If these thoughts intrude, justlet them go without judging yourself for losing focus and get backto “washing the dishes.”

Observing, concentrating, and becoming one with one’sbreathing are all part of another form of meditation. One of thebest practical manuals for this form of meditation, called zazen, isPhilip Kapleau’s The Three Pillars of Zen. Another very goodintroduction to meditation is Mindfulness Meditation: Cultivatingthe Wisdom of Your Body and Mind by Jon Kabat Zinn.

The Benefits of Sex for Stress ReductionLast but not least, I have alluded to the benefits of sex. I wouldlike to expand on what I mean by this. To begin with, I am talk-ing about more than a simple orgasmic release. I am speakingabout all forms of physical give-and-take in a loving relationship.This can range from wild sex to a simple foot massage. There havebeen an increasing number of studies from such conservative bas-tions as Johns Hopkins and Dartmouth as to the physical and emo-tional health benefits of this kind of relationship and its ability tomaintain well-being and reduce pain. Part of this has to do with


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the release of neurotransmitters such as endorphins and oxytocin,but the cardiovascular benefits, not to mention the pleasurederived, cause a cascade of health-promoting effects from bettersleep to improved immune function. There is even proof that fre-quent sex increases growth hormone levels, resulting in less pain,weight loss, a more youthful appearance, and even an increase inlife expectancy!

Considering Ergonomics (by Bren Jacobson)

Ergonomics refers to the science of engineering, adapting, anddesigning machines, tools, and furniture to suit people andincrease efficiency. I will use the term here in its broader sense toinclude the ways in which individuals adapt themselves to theirenvironment and work.

Even very subtle imbalances in our bodies or in the way weuse them can cause severe pain. Dr. Rolf taught that the con-nective tissue in the body forms a continuous web so that anyinjury, strain, or inflammation is instantly and lastingly commu-nicated to the entire body. She often used the analogy of tryingto straighten out a wrinkled bedsheet; as soon as one tugs on onecorner of the sheet to get rid of a crease, it causes another creasesomewhere else.

A more practical example of this principle is illustrated in whathappens to a woman’s body when she wears high-heeled shoes.The most energy efficient and comfortable way to stand is verti-cally. When high-heeled shoes are worn, the woman’s weight isshifted forward to a fairly small area on the ball of the foot. Tomake matters worse, the toes are jammed into the front of theshoe, causing bunions that are both painful and unattractive. Inaddition, there is excess tension in the ankle, which causes immo-bility in the joint. Because of the elevation of the heel, the calfmuscle and Achilles tendon shorten, causing increased stress onthe knee. With the weight and therefore the pelvis being shifted


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forward, the shoulders come back and the head goes forward tocompensate. The pelvis also tilts forward creating a lordosis (sway-back) and causing the abdomen to protrude, making the personlook many pounds heavier than she actually is. The long-termeffects of simply elevating the heels a few inches are almost invari-ably lower back, upper back, and neck pain, as these are the partsof the body that have to constantly do extra work to compensatefor the imbalance created by the shoes. A whole constellation ofsecondary pains and other symptoms can arise from this appar-ently simple cause, including headaches, knee pain, imbalance,pain in the jaw, poor digestion, and fatigue.

The feet are the only interface that we have with the earth.They are, in other words, our sole foundation and support for theentire body. If we do not have proper weight distribution, flexi-bility, contact, and support from our feet, our entire body will suf-fer. We will become “ungrounded.”

As an interesting example of synchronicity, just after finishingthe paragraphs above I stopped writing to read the New YorkTimes’s science section and came across the article “In the Relent-less Pursuit of Fashion, the Feet Pay the Price.” The article quotedthe president of the Podiatric Medical Association as saying, “thecurrent trend in fashion is very bad for women’s feet.” He andother medical experts said that poorly designed and fitting shoesthat included not only high heels, but flip-flops, some runningshoes, and platform shoes, cause the problems that I have alreadymentioned as well as causing nerve damage. These shoes make thewearer more prone to accidents and ankle sprains. They upset thestabilizing mechanics of the foot, contributing to arthritis, inhibit-ing range of motion, causing loss of toe strength, shin splints, andfoot deformities such as bunions and hammer toes as well as plan-tar fascial tears and fasciitis (pain along the soles of the feet).

Another example of an ergonomic problem is that of a manwho came to see me in Holland. For over twelve years he had suf-fered from extreme and constant pains in his neck, in his shoul-


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ders, and between his shoulder blades, as well as unbearablemigraine headaches. He had gone to over forty healers, includingneurologists, surgeons, shamans, and hypnotists. No one hadhelped him. As I took his history, I asked what kind of work hedid. He replied that he played cello for the Amsterdam Concerte-bau Orchestra and he practiced four to six hours a day. I thenasked him to pretend that he was playing his cello so that I couldsee how he was using his body. When he did this, I observed thathe bent forward at the waist, hunched his shoulders, and broughthis head forward. All of this was obviously the cause of his prob-lems, and I asked him why he didn’t sit erect. He replied that thecello was low and he was tall, and hence he had always playedhunched over. I suggested that he was intelligent enough to fig-ure out a way to raise the cello. As it turned out there is a pegunder the cello that adjusts its height. He went home and adjustedthe height of his cello. He called me a week later and said that bysimply sitting erect while playing, his pain had gone from beingtortuous to only a mild annoyance, his headaches had disappeared,and his teacher had remarked that his playing was much improved(because he was no longer “wrapped” around the instrument andhad more freedom in his arms and shoulders).

I could go on with endless examples of people that I havecounseled who have suffered years of torment because of a poorlyplaced computer monitor, a piece of furniture that didn’t suitthem, an activity they performed in the wrong way, or trying todo a job with an inappropriate or poorly designed tool. I suggestthe following guidelines to help you avoid these problems.

Keep a Daily Ergonomics JournalRate whatever pain or discomfort you have on a scale of 1 to 10,with 1 being no pain and 10 being excruciating pain. This can bedone at any time of the day, but the end of the day is a good timeand it is preferable to do it at the same time each day if possible. Onany day that your pain level is low (1 to 3) or high (7 to 10) try to


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examine and record any variables that might make that day differ-ent from others. Some things you might consider are the following:

• Is it a workday or a holiday? Do you have a new job,different work, or increased responsibilities?

• Are you on vacation or just returning from one?• Have you been doing a different activity than usual, or are

you doing a normal activity in a different way or with adifferent tool?

• Did you have a deadline that you had to rush to meet, or didyou have sufficient time to complete your tasks?

• Were you juggling too many different jobs?• What have your interpersonal relationships been like that day?• Have you been using a different piece of furniture than

usual? It is particularly important, if you have pain, to noticeif you are better or worse when sleeping away from homeon a different bed.

• What types of stress have you been subjected to that day?Are any of them new or different? If you have encounteredyour usual stresses, have you dealt with them differently?

• Is the weather (barometric pressure, temperature, wind, orhumidity) particularly different?

• Has your diet changed in either type of food, quantity, orquality?

• Has anything in your work or home environment changed?This could be anything from more noise to new furniture,lighting, carpeting, or paint.

• Are you using a different car, bike, golf clubs, tennis racket,telephone, shoes, and so on?

When you are able to identify any variable that affects your levelof pain, vitality, wellness, and sense of well-being, avoid it, changeit, or do more of it as is appropriate.

You may think that the previously mentioned points are obvi-ous and not worth wasting time on, but I can assure you that this


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is not the case. I have counseled thousands of people and can tellhundreds of stories like the one above about the Dutch cellist whorelieved years of pain by playing detective and finding the factorsthat caused his pain. It is particularly important to keep a writtenjournal on a daily basis, because on the days that the pain is severeit can be so distracting that you wouldn’t think of trying to trackdown the cause of your pain. On days when you feel good, it iscommon to forget that you ever had pain and you don’t want toexpend the energy to think about it.

Vary Your Work and PlayOne of my teachers said that “the best vacation is a change ofwork.” There is much truth in the saying. Instead of spending awhole day cleaning the house and another day gardening and yetanother day doing paperwork, it is far preferable to spend a shortertime doing each and then switching. This enables you to not onlyuse different muscle groups, but different mind functions. It alsocreates a relaxing change of pace and prevents ennui.

Even if you are doing everything right, one risk that comes ofnot varying activities is the possibility of straining muscles andtendons through the excessive repetition of a movement—knownas repetitive use syndrome. If you are doing anything that is repet-itive, try to switch, at least temporarily, to a different activity atthe first indication of any physical strain or discomfort.

Equally important is to intersperse work periods with timespent in play, relaxation, exercise, entertainment, and meditationor reverie. One of the most invigorating and healing practices is atwenty-minute afternoon siesta or nap. Not everyone has the lux-ury to indulge in this, but even having lunch in a park or quietplace instead of a busy restaurant can be beneficial.

Become Aware of What Your Body Is Telling YouAt the risk of sounding repetitive, I will say that one of the mostimportant things you can do is to listen to your body. Our bod-ies communicate with us through aches, pains, pleasures, resist-


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ances to certain activities, or reactions to different conditions. Thebody has its own wisdom and very often, even though it doesn’thave warning lights like your car, it will through various meansattempt to communicate with you. To expand on this car analogy,if you race your engine constantly or subject it to long periods ofdisuse, use the wrong fuel, or neglect preventative maintenance,you will eventually have a breakdown. If this seems a silly anal-ogy, consider that many of the people that I work with routinelychecked their car’s tire pressure but have never had their bloodpressure checked. Others wouldn’t think of using low-test gaso-line but regularly eat junk food. Still others never go more thansix months without having their automobile serviced but haven’thad a physical checkup in years.

I have learned over the years that when the body gives a sub-tle hint or message that is ignored by its owner, it will continueto give the same message in a different way or at increased vol-ume. If it is still ignored it will continuously try to make its mes-sage clear. If the person still does not pay attention, it will try tomake it impossible for the person to persist in the activity that maybe endangering him or her. One example is the person who isoverexerting himself on a constant basis. The body’s first messagemight be lethargy, discomfort, or mild digestive upset. When thatperson ignores these conditions and continues to work too long,too hard, or too constantly, the pain, tiredness, and indigestionwill most certainly grow worse. If these indications are ignored,the body in its wisdom realizes that the path that the person ispersisting on may lead to severe repercussions such as a nervousbreakdown, loss of job or relationship, or even a life-threateningoccurrence such as a heart attack. At that point the body puts intoplay some form of circuit breaker that forces the person to stopwhat he is doing. This can take the form of headaches, back pain,chronic fatigue, fibromyalgia, or irritable bowel syndrome. It ismuch better to heed the early warning signals we get from ourbodies and moderate our behavior than it is to deal with thesemore serious conditions.


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You are your body and, if you pay close attention to it, youwill often become aware of problems long before a diagnostic test,x-ray, or doctor’s exam will. This doesn’t mean that you shouldnot talk to your doctor about your concerns. As many spiritualtraditions have held, the body is the temple of the soul. It shouldnever be disregarded, and anyone who does, does so at his or herown risk.

Use Your Body and Enjoy ItThe same goes for your mind and spirit. Don’t become a couchpotato. One of the best ways to stay healthy and young is to con-stantly try new activities, meet new people, explore new places,try new foods, keep in touch with old friends and family, read newbooks, and be of service to those who are less fortunate or capa-ble than you. Use it or lose it. I would not be so presumptuous asto believe that I know what the true meaning of life is or what theideal way to live is, but I am absolutely sure that it is not aboutdoing as little as possible while accumulating as much as possible.I am sure that service, knowledge, home, family, friends, com-munity, and relationships in general are much more importantthan most other things that people strive for. They are also morehealing and bring more happiness. Many spend their lives strivingfor wealth, thinking that money will bring happiness. Truewealth, however, is not getting what you want but wanting whatyou have.

After thirty-five years as a healer I can say with great convic-tion that the four best medicines for pain are laughter, sleep, tears,and loving, although not necessarily in that order. They also arenecessary to create true health, wholeness, and happiness.

Find a Better Way to Do Things That Cause You PainIf doing any activity causes pain, and you must do it, find a bet-ter way to do it. Today there are many devices that make variousactivities, from opening a bottle to digging in the garden, easier.These devices can be found in various catalogs or on the Internet.


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One good example of this is the Jar Key. It is a simple device thatbreaks the vacuum seal on food jars. This enables one to removethe lid with minimal effort and no torquing force on the wrist.Sometimes a little bit of ingenuity goes a long way. Very often byusing a lever, wedge, or pulley, you can reduce the effort neces-sary to do a job to a fraction of what it might have been.

Also, when lifting, keep your back straight and your feet apartto give yourself a broad, stable foundation. When lifting things,turn your entire body, using your legs rather than twisting yourspine. If you can push or pull or slide an object instead of lifting,do that. If you can put something under the object to be movedto reduce friction, do so.

Find the Most Comfortable Furniture for YouRemember the adage that “one man’s meat is another’s poison.”There is not any one shoe, mattress, diet, therapy, exercise pro-gram, climate, career, or lifestyle that is perfect or right for every-one, despite advertising claims to the contrary. I remember a manI Rolfed in Spain. He suffered severe burning and pain on gettingup in the morning. I suspected a bad mattress and suggested tohim that this might be the source of his problem. He was positivethe mattress could not possibly be the problem because it had costsix thousand dollars, had been designed by Germany’s mostfamous orthopedic surgeon, and had been prescribed by Spain’stop back specialist. He even brought me to his home to examineit and try it out. I laid down on it and it was a very comfortable,supportive, firm mattress, and I had to agree with him that it wasprobably not the cause of his pain. I Rolfed him, which was ben-eficial for his general well-being and his back, but he still had theburning sensation when he woke up. He later tried chiropractic,acupuncture, Mezier work, and physical therapy with the sameresults. I ran into him a year and a half later and he told me thatthe burning sensation had disappeared. I immediately thought thatthe Rolfing, which usually takes a full year after the work is fin-ished to manifest its full benefit, had finally done the trick. He told


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me that what had really made the most difference was going to ahotel that had cheap, soft, sagging mattresses, which evidentlysuited him better then the super expensive one that he hadimported from Germany.

Always buy for comfort, adjustability, and functionality ratherthan cost, an expert’s opinion, a brand name, appearance, or fash-ion. Much of the furniture that is available today is overstuffedand too soft to give proper support, or it is of an extreme shapethat would look good in an art museum but is not suited to thehuman body. Very often the best chair is a simple old-fashioned,straight-backed chair. Instead of buying the fanciest sports car,buy one that you can drive without getting back pain. A simplerule of thumb is to “try before you buy” (or be sure that you cantake it back if it turns out to be unsuitable). If you are buying acar, try renting that model first and drive five hundred miles, andsee how your back feels at the end of the trip. When buying achair that you might spend 20 percent of the rest of your life in,go to the store and sit in every chair until you find the one thatis most comfortable. Sit in that one for an hour or so and read amagazine and see how you feel at the end of that period. Shoes,which I have already spoken of at length, can cause more prob-lems than any other item people use. They should always be cho-sen for comfort before any other consideration. The thing youare using should not only be appropriate for you but also theactivity it is being used for. For instance, running shoes are notappropriate for hiking.

Another good general rule is to buy the item that is the mostadjustable and customizable. If you buy a computer desk, forinstance, buy one on which the height of the monitor and thekeyboard can be adjusted independently. When shopping for anoffice chair, look for one that can be adjusted for the height of theseat, the height of the arms, the height and amount of lumbar sup-port, and the amount of tilt as well as the force needed to changethe tilt. Likewise, the more separate adjustments an automobileseat has, the easier it is to make it comfortable for your body. The


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more customizable anything is, the easier it is to get it to workefficiently with your body.

Bilaterally Balance Physical ActivitiesFor example, if you are carrying something like a shopping bag,switch hands frequently (the tendency is always to use your dom-inant or strong side, which increases imbalance), divide the loadinto two bags, use a backpack, or, ideally, use a wheeled cart.

One of the most common problems I see is neck and back paincaused by office workers holding their telephone receiver withtheir shoulder while using a keyboard. This is very easily dealtwith by getting a headset from a store like Radio Shack, Best Buy,or Circuit City. Almost all cordless and cellular phones have jacksfor a headset, and Radio Shack has regular phones with headsets.Another solution is using a speaker phone, and GE makes onewith good sound quality that I bought for twelve dollars.

Lose the Extra WeightFinally, one stress factor that is frequently overlooked is that ofexcessive weight, which can sap one’s energy and cause harmfulwear and tear in the joints. Every extra pound of weight a personcarries causes four pounds of pressure in the knee. This in itselfcan cause extreme pain.

Getting HelpAs we’ve seen in the last two sections, it is important to addressboth stress and structural issues. I have found Bren Jacobson to bean extraordinarily gifted counselor who can help with both psy-chological counseling and guiding people through the myriadhealth-care options that are available (see Appendix B).

Dealing with Trauma

Trauma can also cause pain by many mechanisms, so I want tobriefly touch on it here. Initially it can cause inflammation ordirect tissue injury. If bleeding occurs into the area, the iron in


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the blood can actually continually trigger inflammation (iron is“pro oxidative”). This ongoing inflammation can be shut downby using antioxidants. Nutritional and sleep remedies also supportthe healing of injuries. Often, an injured muscle can get stuck ina shortened position, causing years or decades of pain.

Using some simple physical therapy techniques such as stretchand spray (where a special, cold spray administered by a therapistto the painful area temporarily blocks the pain), the shortenedmuscles can often be released in a matter of seconds or minutes—often with instantaneous relief of what had been chronic pain.Sometimes this is all that is needed for permanent pain relief.Other times, the muscle again contracts to the shortened position,causing pain. This problem (of recurrent pain) often respondsbeautifully to nutritional, sleep, and hormonal support, and toeliminating underlying infections as discussed earlier. It is alsoimportant, of course, to treat any structural abnormalities.

Ice and heat can both be helpful for a trauma injury. Ice worksbest for the first twenty-four to thirty-six hours after acuteinjuries or for problems where inflammation plays a role becauseof its anti-inflammatory effect. Heat works best for chronic painor for injuries that are over twenty-four hours old because itincreases blood flow (and therefore healing) in the area. Only usethe ice or heat for twenty minutes at a time so you don’t freeze oroverheat the affected area and cause further injury. Ice and heatcan also be alternated for injuries over twenty-four hours old orfor chronic pain. Use the ice first for twenty minutes (this acts asan anti-inflammatory) followed by a heating pad or moist heat fortwenty minutes. You can use either of these as often as you like,as long as you wait at least thirty minutes after the treatmentbefore repeating the cycle.

In these last few chapters, you have read about a number of gen-eral principles that apply to pain relief and pain management. InPart II, you will find specific details of when and how to applythese principles to specific types of pain.


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P A R T I I

Evaluating and TreatingCommon Types of Pain

New research suggests that pain affects men and women differently.This likely occurs in part because of hormonal differences related toestrogen and testosterone. For example, male animals injected withestrogen appear to have a lower pain threshold, while giving testos-terone to female animals increases pain tolerance. How pain is trans-mitted in our bodies also contributes to the differences in how painis felt by men and women. Both sexes have a natural ability to sup-press pain, but the mechanisms are different.

Societal factors may also play a role. Women are quicker to seekmedical help and less likely to allow pain to control their lives. Theyare also more likely to ask for help from their friends. A person’s agealso plays a role in pain. One out of five older Americans takes apainkiller on a regular basis. Because they are prone to medications’side effects, such as bleeding ulcers from nonsteroidal anti-inflammatory drugs (NSAIDs), finding alternative and safer remediesis especially helpful for older patients.

In these next few chapters, I will explain the basic types of pain(nerve, muscle/myofascial, arthritis, inflammatory, and so on) and thetreatments that are most effective for eliminating them.

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Focusing on Nerve Pain

Everyone has pain. As I mentioned in Chapter 1, pain serves acritical function, and we would be in serious trouble if wecouldn’t feel what is happening in our bodies. However, pain thatdoesn’t quit is worrisome. Chronic pain can result from diseases,infections, or trauma. However, there is a different type of painthat affects the nerves and can be unbearable. The term neuropathicpain, or nerve pain, refers to a wide range of problems that causediseases of, or injury to, the nervous system. It is a category ofpain syndromes and not a single problem. Neuropathic pain cancome from malfunction of nerves or the brain associated with ill-ness (diabetes, low thyroid), infections (shingles), pinched nerves,nutritional deficiencies (vitamins B₆ and B₁₂), injury (stroke,tumors, spinal cord injury, and multiple sclerosis), and medica-tion/treatment side effects (radiation and chemotherapy, AIDSdrugs, Flagyl). It is estimated that 50 to 80 percent of diabeticswill develop some nerve injury, with 30 to 40 percent of thesehaving painful diabetic neuropathy unless preventive measures aretaken such as nutritional support. Neuropathic pain affectsapproximately 0.6 to 1.5 percent of the U.S. population (roughlytwo million Americans) and 25 to 40 percent of cancer patients.

C H A P T E R 4

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Types and Causes of Neuropathic (Nerve) Pain

Neuropathies are characterized by pain that is burning, shooting(often to distant areas), or stabbing. It also has an “electric” qual-ity about it. Tingling or numbness (paresthesias) and increased sen-sitivity with normal touch being painful (allodynia) are alsocommonly seen. Continual pain is often present regardless ofwhat the patient does or does not do. In some cases, pain comesin sudden attacks without any apparent trigger. Diagnosis is madepredominantly by history and physical examination, as testingoften offers little benefit clinically unless the testing is looking fora treatable cause.

As with other pain problems, neuropathies are both expensiveand poorly treated. In one study of 55,686 patients with neuro-pathic pain, health-care charges were threefold higher than theywere in the overall population ($17,355 versus $5,715 per year,respectively). Use of relatively ineffective therapies such asNSAIDs (like Motrin) and opioids was widespread, while rela-tively few received anti-epileptic drugs, tricyclic antidepressants,or any of the many other medications that are often much moreeffective in relieving neuropathic pain.

In the presence of nerve pain, it is especially important to lookfor treatable causes. Lab testing should include:

• A blood count (CBC) and an inflammation/sedimentationrate (ESR)

• Thyroid testing with a free T4 and TSH• Vitamin B12 level• Screening for diabetes with a morning fasting blood sugar

and a glycosylated hemoglobin (HgBA1C)

The medical history should be assessed for excess alcohol use,vitamin deficiencies, hereditary factors, or treatment with med-ications that can cause nerve injury. A neurological examinationmay also give an indication of the cause.

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Nerve pain is often associated with a process known as pain-sensitization. The nerves and brain are like wires that carry infor-mation. When they become overstimulated with chronic pain, itmay make the whole system overexcitable. In these situations nor-mal touch and other usually comfortable contact can be painful.Medications that stimulate the calming (GABA) receptors in thebrain, such as a number of antiseizure medications, can help set-tle the system and decrease pain.

Postherpetic Neuralgia (PHN)Postherpetic neuralgia follows a rash called herpes zoster. Oftencalled shingles, it is caused by the same virus that causes chickenpox. The first time you get chicken pox, the virus remains in yournerve endings even after the chicken pox is gone. This usuallycauses no problems. If the virus reactivates in one of the nerveendings, however, it causes a rash all along the distribution of thenerve. The rash of herpes zoster is characterized by being painfuland being in a line totally on one side of the body. If it extendspast the midline of your body, the rash is probably coming fromsomething else. If the pain persists after the rash is gone, contin-uing for weeks to years (over one year in half of elderly patients),it is called postherpetic neuralgia (PHN). The pain tends to be burn-ing, electric, or deep and aching. PHN affects between five hun-dred thousand and one million Americans, most of whom areelderly. It can severely disrupt one’s life, but fortunately can nowbe effectively treated in most cases.

Painful Diabetic Neuropathy (PDN)PDN is the most common cause of neuropathy in the UnitedStates. Alterations in sensation are common, and the feet, whichare most often affected, may feel both numb and painful at thesame time. Many factors contribute to nerve injury in diabetes,including decreased circulation, damage from elevated sugars,accumulation of toxic by-products, and nutritional deficiencies.There are also changes in pain receptors.

FOCUSING ON NERVE PAIN

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Research has shown that many people who are labeled as hav-ing diabetic neuropathy actually experience neuropathic paincaused by vitamin B₆ or B₁₂ deficiency. In addition, the nutrientinositol has been shown to improve nerve function. The nutrientlipoic acid has also been shown to be very helpful for diabeticnerve pain.

Nutritional DeficienciesNeuropathic pain can also be caused by deficiencies of vitaminsB₁, B₆, B₁₂, and E and zinc. A number of studies have shown thatdifferent kinds of nerve pain can improve by supplementationwith high-dose B vitamins. Excess vitamin B₆ (over 500 mg a dayfor years), however, can also cause neuropathy.

In patients with long-standing shingles pain, one study showedthat taking 1,600 units of vitamin E (use the natural form) dailybefore a meal for six months was markedly helpful in eliminatingthe pain. Another study showed that taking lower doses for lessthan six months was not effective.

Hormonal DeficienciesHormonal deficiencies, especially an underactive thyroid, can alsocause neuropathic as well as muscular pain. A therapeutic trial ofthyroid hormone is reasonable for anybody who has the symptomsof low thyroid including fatigue, cold intolerance, achiness, havinglow body temperatures, or unexplained inappropriate weight gain.

Nerve EntrapmentsA pinched nerve can cause nerve pain in many places in the body.Two of the more common ones are low back pain from sciaticaand pains in the hand and sometimes wrist from carpal tunnel syn-drome. Sciatica usually goes away without surgery by using intra-venous colchicine, and carpal tunnel syndrome usually resolvesafter six to twelve weeks with vitamin B₆ (250 mg a day), thyroidhormone, and wrist splints (see Chapter 10).


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Trigeminal NeuralgiaAlso known as tic douloureux, trigeminal neuralgia causes excruci-ating attacks of pain in the lips, gums, cheek, or jaw. It usuallyoccurs in the middle-aged and elderly and seldom lasts more thana few seconds or minutes. The painful attacks recur frequentlythroughout the day and night for several weeks at a time. They canbe triggered by stimulating certain areas on the face. Tegretol elim-inates the pain in 75 percent of patients. Begin with 100 mg a day(taken with food), increasing slowly up to 200 mg four times a dayas needed. Other treatments listed in the next section can also behelpful. If these treatments fail, surgical options are available.

Treating Neuropathic Pain

Neuropathic pain occurs biochemically, making it a very fluid sys-tem that can often be quickly modified, resulting in pain relief.Many different chemicals (neurotransmitters) in your body maybe involved in your pain, and therefore it is worth trying differ-ent types of medications to see which ones work best in your case.For many, treating the nutritional and thyroid deficiencies andeliminating the muscle spasms that are compressing the nervesmay be enough to eliminate the pain. Others may need to takemedications to suppress the pain while looking for ways to elim-inate the underlying cause. The best way to tell which chemicalsare involved in your nerve pain is to simply try different medica-tions (individually and, if needed, in combination) to see whateases your pain. Basically, it is like trying on different shoes to seewhat fits best. The good news is that we have a large assortmentof “shoes” that you can try on and that are likely to help you.

It is, of course, critical to begin by eliminating the underlyingcauses of neuropathy and giving the nerves what they need toheal. This includes the nutritional support I’ve discussed in Chap-ter 2. In addition, the involvement of free radicals in nerve exci-tation was found in 1995, supporting the use of antioxidants in


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nerve pain. Since that time, the antioxidant lipoic acid (300 mgthree times a day) has been shown to be helpful in diabetic neu-ropathy and should be tried in other neuropathies as well. Youwill be amazed at how much benefit you may get over time sim-ply from optimizing nutritional support.

In addition, if you are tired, are cold intolerant, experienceachiness, have low body temperature, or have gained weight, Ithink it is reasonable to consider a therapeutic trial of natural thy-roid hormone regardless of your blood levels. It may take three tosix months for the thyroid and/or nutritional therapies to beginworking, but regardless of the cause of your neuropathy, thistreatment may result in nerve healing. It is reasonable to beginmedications along with the nutritional support so that you can getpain relief as quickly as possible. If only a small area is involved,it makes sense to begin with a Lidocaine patch. Otherwise, I pre-fer to begin with Neurontin and/or tricyclic antidepressants. Allof the recommended oral nutrients discussed in this chapter,except lipoic acid and the 1,600 unit megadose of vitamin E, arecontained in the Energy Revitalization System vitamin powderand B-complex. For carpal tunnel syndrome, add 200 mg of B6 tothe powder.

Let’s look at each of the different categories of treatments thatcan be helpful for nerve pain. Begin with the nutritional and thy-roid support, and then you can add the following medications inthe order that they’re listed.

Lidocaine PatchThis Novocain-like patch (5 percent) is applied directly over thearea of maximum pain. It can be cut to fit the area, and up to fourpatches can be used at a time (although the package insert saysonly three). It is left on for twelve hours and then removed fortwelve hours each day, although recent reports have suggested thatthe patch can be left on up to eighteen hours and still be safe andeffective. Results will usually be seen within two weeks. Because


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the effect is local, side effects are minimal. The most common sideeffect is a mild skin rash from the patch. It should not be used ifyou have an allergy to Novocain/lidocaine.

The patches are most likely to be helpful if the pain is local-ized to a moderately sized area. Even in a large area, however,patches can be used on the most uncomfortable spots. The maindownside of the patches is that they are expensive. If you haveprescription insurance, however, they will usually be covered.

Neurontin and Other Seizure MedicationsNewer antiseizure medications, and some of the older ones, canalso be very helpful for neuropathic pain. Neurontin has beenshown to be helpful for both shingles and diabetes pain. Commonside effects include sedation, dizziness, and sometimes mildswelling in the ankles when first starting therapy. These sideeffects can often be avoided by starting with a low dose and rais-ing the dose slowly. A common total dose for Neurontin is 600mg, three to four times a day.

Tricyclic AntidepressantsTricyclic antidepressants include medications such as Elavil,Tofranil, nortriptyline, or doxepin. Tofranil may be more effec-tive than Elavil. Sedation, constipation, dry mouth, and weightgain are the most common side effects, although dizziness can alsooccur. Other side effects include urinary retention, sweating, andabnormal heart rhythms. As most of the benefit occurs with thefirst 10 to 50 mg, and most of the toxicity occurs with higherdoses, if adequate relief is not attained at a low dose, beforeuncomfortable side effects occur, I then add the next treatment orswitch to another tricyclic instead of pushing the dose to higherlevels. If it gave no benefit, I would, of course, stop the tricyclicswhen I began the next treatment. These can be very helpful fornerve pain and have the added benefit of being inexpensive (if youbuy the generic form of the drug).


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Although antidepressants can be helpful for pain, even if nodepression is present, they seem more likely to help nerve painwhen they also raise adrenaline (norepinephrine) and not justserotonin. For example, the medication Effexor reduced diabeticnerve pain by 75 to 100 percent in one open study of elevenpatients. I recommend use of Effexor early in your treatment ifyou have depression associated with your pain. Higher doses(225 mg a day) seem more effective for nerve pain than the lowerdoses used for depression.

Topical Gels or CreamsA wonderful new addition to the treatment of pain in general, andespecially nerve pain, is the use of prescription topical gels orcreams. New gels have been developed that markedly increase theabsorption of medications through the skin. By using a low doseof many different medications in the cream, one can get a pow-erful effect locally with minimal side effects. It is best to have aknowledgeable compounding pharmacist guide you and yourphysician in the prescribing of these creams and gels. (See Appen-dix B for help in finding a compounding pharmacy.)

For example, studies have shown that for long-standing, per-sistent nerve pain (average thirty-one months) that occurs aftershingles (postherpetic neuralgia, or PHN), using a 5 percent Ket-amine gel applied two to three times daily over the painful skinareas decreased pain significantly in 65 percent of cases—usuallywithin days and without side effects, except for occasional mildskin irritation. Other studies have also found topical Neurontin,opioids, and capsaicin to be effective. Lidocaine patches resultedin a highly significant decrease in pain, which was seen withinone week. I find the Lidocaine patches to be more effective thanthe Lidocaine topical gels.

To explore an example of how to treat with these creams com-bined with nutritional support, let’s use the example of diabeticneuropathy. One must, of course, begin with proper control of


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the elevated blood sugar. Nutritional support with high levels ofvitamin B₆, vitamin B₁₂, and inositol are important in diabeticnerve pain as are many other nutrients, such as vitamins C and E,magnesium, antioxidants, and bioflavonoids. In addition, lipoicacid 300 mg three times a day has been shown to be helpful fordiabetic neuropathy. A compounded gel containing Ketamine 10percent, Neurontin 6 percent, clonidine 2 percent, and nifedipineshould be added to painful areas (apply 1 gram three times a dayas needed). The nutritional support can actually make the pain goaway over time, while the cream/gel can add symptomatic relief.Other medications discussed in this chapter can then be added asneeded to assist in the neuropathic pain.

Another excellent cream for neuropathic pain is a combinationof lidocaine 10 percent, amitriptyline 7 percent, Ketamine 5 per-cent, and Tegretol 7 percent used two to four times a day asneeded. If results are not seen within fourteen days, speak withthe compounding pharmacist (or your physician if he or she isfamiliar with pain creams) about modifying what is in the cream.Start with having the pharmacist make up relatively small amountsof the cream until you find a mix that works well for you.

Although it is generally not recommended that the gels beused under occlusion (putting plastic wrap or a patch over the gelto force it into the skin) because this may raise blood levels of themedications causing side effects, I think the benefit of increasedeffectiveness may outweigh the risks. I feel it is reasonable to putthe Lidocaine patch over an area where you have applied the paingels once the gel has dried. If you get unacceptable side effects,remove the patch and use the patch and creams/gels separately.

Ultram (Tramadol)Ultram is an interesting medication that works on many areas ofpain and in many different types of pain. It has been shown to beeffective for nerve pain in a placebo-controlled study after fourweeks. It blocks both norepinephrine and serotonin reuptake and


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also stimulates the narcotic receptors. Main side effects includedizziness, nausea, constipation, sedation, and light-headedness onstanding. These are more likely to occur when the dose is raisedrapidly. Lower doses should be used with antidepressants andother medications that can raise your serotonin levels.

Begin with a dose of 50 mg one to two times daily andincrease to a maximum of 100 mg four times a day. Most peoplefind that 100 mg twice daily is wonderful and higher doses causeuncomfortable side effects.

Additional Drug Treatments for Nerve PainAlthough the medications previously listed are the ones that I usemost commonly for nerve pain, there are many other treatmentsthat can also be helpful (see Chapter 13). These include Topamax,Cymbalta, Lamictal, Zanaflex, Gabitril, Keppra, Trileptal, Dilan-tin, capsaicin, narcotics, amantadine, Zonegran, and Benadryl.

Saint-John’s-Wort for Nerve PainSaint-John’s-wort is best known for its effectiveness in the treat-ment of depression. It has, however, also been found to be help-ful for some people in treating neuropathic pain. In one studyusing approximately 1,000 mg a day of Saint-John’s-wort for fiveweeks, approximately 20 percent of the subjects had a goodresponse. For treating neuropathies, I would recommend taking600 mg three times a day for six weeks. At that time you candecide whether the benefits justify staying on it.

Reflex Sympathetic Dystrophy (RSD)

Reflex sympathetic dystrophy (RSD) is a nasty and chronic paindisorder affecting as many as 1.5 million Americans. It oftenbegins with severe pain in one hand or foot. It is also referred toas complex regional pain syndrome (CRPS). It usually manifestsas horribly severe pain in one hand or foot but can certainly spreadelsewhere. When I first meet a patient, and I see that he or she


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immediately moves her hand or foot out of the way to be sure thatit is not touched, I quickly inquire about symptoms suggestingRSD.

The Reflex Sympathetic Dystrophy Association of Americadefines the disorder as a multisystem, multisymptom syndromethat usually affects one or more extremities and can affect theentire body. There are many pain patterns, but the pain is oftenvery severe and much greater than one would expect from theprecipitating injury. Any number of traumas, including accidents,fractures, surgery, or even mild injuries such as IV insertions, cantrigger RSD in one’s hands or feet. Interestingly, injury of the hipcan cause foot pain, and injury in the shoulder can cause handpain. A heart attack can also trigger RSD in the hand. Pain is usu-ally burning or stinging, and the skin has exquisite sensitivity toeven the lightest touch. It is sometimes associated with swelling,color and temperature changes in that hand or foot, and unusualsweating. Muscle spasms, tremor, and/or weakness may also bepresent. Although it is classically considered to affect just oneextremity, according to one survey as many as 70 percent of peo-ple with RSD had noted spreading of pain beyond the hand orfoot to other parts of the body.

The most common pattern of spread is for pain to move overthe same extremity. It may continue to spread or move to theopposite extremity or other distant sites. Early diagnosis withprompt treatment may result in the problem being more easilyreversed.

Combining Treatments for EffectivenessMany pain specialists use a combination of treatments, includingphysical therapy, medication, electrical nerve stimulation, nerveblocks, and/or emotional support with counseling. It is best toavoid surgery or further injury to the area, if at all possible, as itwill usually result in worsening of the symptoms. Casting andimmobilization can also worsen symptoms and should be avoidedas well. Unfortunately, there’s no definitive test for the illness as


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nerve pain does not show up on x-rays or standard diagnostic tests.Because of this, most people with RSD have not been properlydiagnosed, resulting in further psychological trauma. The level ofpain can be anywhere from mild to devastating. Patients some-times choose to have the extremity amputated because of thepain, only to find that the pain still persists! In addition, it is sus-pected that people who have had RSD once are at greater risk ofdeveloping it again with future injury.

The good news is that in addition to new treatments, there isalso a simple preventive measure. In one study of 123 adults withwrist fractures, half of the patients were given 500 mg of vitaminC daily and the other half were given placebo for fifty days. RSDoccurred in 22 percent of the patients in the placebo group, butonly 7 percent of the vitamin C group.

For more information on RSD, visit the website of the RSDSyndrome Association of America at rsd.org.

An Exciting New Treatment Approach for RSDAlthough the treatments discussed for neuropathic pain can alsobe helpful in RSD, because of the severity of this illness and thefact that it often does not respond to other treatments, I am veryexcited about a new treatment approach. This involves the use ofKetamine, an anesthetic. Unfortunately, many patients experiencethe side effect of intoxication, including hallucinations, whichmay be uncomfortable. This problem can be avoided in most casesby giving the Ketamine as a topical gel. In one study of fivepatients with refractory reflex sympathetic dystrophy, pain wastemporarily relieved by 65 to 100 percent within three minutesof applying Ketamine gel (1 to 9 mg Ketamine per kilogram ofbody weight) to the painful area without significant side effects.All patients chose to continue treatment. The dose needed tomaintain the benefit ranged from 50 to 600 mg, three to six timesdaily.

Since this study was conducted, reports have been publishedof permanent elimination of severe RSD using an IV infusion of


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Ketamine continuously for six days. The IV Ketamine was startedin one patient at 10 mg per hour and increased by 10 mg per hourevery two hours as tolerated, with the maximum infusion rate of30 mg per hour. A higher dose was not used, as the patient wishedto remain “in control” without being overly intoxicated from themedication. By day three her pain was decreasing, and by day fiveit was gone. Cessation of the pain continued after the treatmentwas stopped. This medication holds great promise for the treat-ment of this devastating problem.

Dr. Argo, a pain specialist at the Pain Management Center atColumbia Rose Medical Center, Denver, has found that Paxil canbe helpful for reflex sympathetic dystrophy where other SSRIs arenot. In another clinic, a combination of Neurontin and clonidinecreams decreased RSD pain by one-third.


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When InflammationLeads to Pain

Inflammation is your body’s response to what it perceives to be anoutside invader or irritant (for example in gout). When caused byinfections, the inflammation can sometimes be rather obvious, asoccurs with pneumonia. Other times, it can be very subtle. Keepin mind the following key points regarding inflammation and pain:

• Treat the underlying infections or irritants when possible.• Often the inflammation causes more harm than good. It is

often worthwhile to simply decrease the inflammation usingnatural remedies, nutrients, ultra low-dose cortisol, and anti-inflammatories such as aspirin and Motrin familymedications.

• Sometimes the inflammation is obvious because it causesredness, heat, and swelling. At other times, it can be quitesubtle and needs to be looked for.

There are many different autoimmune and inflammatory ill-nesses. Lupus (systemic lupus erythematosus, or SLE) is a commonautoimmune disease that often results in significant fatigue andpain. What most rheumatologists don’t realize is that the second-ary fibromyalgia caused by lupus and many other rheumatologic

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diseases (including rheumatoid arthritis) may be a source of many,if not most, of the symptoms and much of the disability in thesepatients. Flaring fibromyalgia may also be misinterpreted as a flar-ing of lupus or other inflammatory disease activity. In addition,both of these illnesses can be associated with marked vitamin Ddeficiencies. Vitamin D deficiency has also been associated withmuscle pain.

When one treats the associated fibromyalgia, patients oftenfind that their lupus is actually a minimal problem. In addition,several studies have shown that taking DHEA, 200 mg a day, sig-nificantly improves the outcome of lupus and allows the patientto get by with a lower dose of prednisone. The main side effectsof a too-high DHEA level are darkening of facial hair and acne.If either of these occurs, lower the dose. It is unnecessary to fol-low blood levels of DHEA at this dose because this is a very highdose and you can assume the blood level will be high. Lowerdoses, however, are not as effective as 200 mg a day. As many, ifnot most, inflammatory and/or autoimmune illnesses can cause asecondary fibromyalgia, and fibromyalgia is now treatable, it isimportant to keep this possibility in mind. If you have widespreadpain, fatigue, and insomnia, look for and treat the associatedfibromyalgia!

When Inflammation Is Unhealthy

Inflammation is part of our natural healing process. Wheneverthere is injury, our body puts out cytokines in the injured area tobring in white blood cells to knock out any infections and bringin other cells to begin the healing process. Because of this, healthyinflammation is a very beneficial tool that our body uses to heal.The cells come in, eliminate any infections, fix the problem, andthen dissipate. When healthy, inflammation is almost always local-ized and short-term.

Inflammation can become unhealthy, however. In these situa-tions it is often generalized throughout the body. In addition to


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causing pain and disability, it can also cause premature aging. Asmentioned earlier, anytime you see the suffix -itis at the end of theword, it tells you that unhealthy inflammation is present. Excessinflammation is very common. For example:

• Over 40 million Americans have arthritis. The inflammationcan then damage the joints, causing deformity.

• Allergic rhinitis, which causes swelling of the nasal passages,is also common, affecting approximately 40 millionAmericans.

• Gastritis and colitis cause abdominal pain.• Dermatitis, including psoriasis and eczema, are inflammatory

illnesses of the skin.• Alzheimer’s disease and heart disease have been associated

with increased inflammation.• Asthma, with its associated bronchitis, is an inflammatory

condition—and one that has doubled in frequency duringour lifetime. In treating allergies and asthma, we sometimesmistakenly focus on the trigger. But the trigger is not themain problem because most people don’t have problemswhen they come in contact with that trigger. It is moreimportant to look at the cause of the overall reactivity ineach individual.

The Link Between Diet and Inflammation

We are now beginning to understand why we are so much moreprone to inflammation these days than we were in the past. Cluesfor understanding this can be found by looking at how the mod-ern diet has changed over the last several thousand years.

Our body’s armies of inflammation are often on high-alertwhen they don’t have to be. Much of this occurs because of thehigh amounts of animal fats relative to fish and vegetable oils in ourdiets. Land animal fats tend to contain arachadonic acid (in theomega-6 fatty acids family), which stimulates inflammation. Fish

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oils and some vegetable oils, such as flaxseed, contain what arecalled omega-3 fatty acids. These decrease inflammation. Over thelast few hundred years, we have markedly decreased anti-inflammatory omega-3 fatty acids and increased pro-inflammatoryomega-6 fats in our diet. This often results in our bodies being oninflammatory overdrive.

Research shows that prehistoric hunter-gatherers were muchless likely to have degenerative diseases; their main problems wereinfection and trauma. They had a high-protein, high–complex-carbohydrate, and high-fiber diet. Most important, their diet washigh in omega-3 fatty acids and low in inflammation-stimulatingomega-6 fatty acids (fats from meat, saturated and trans fats, short-ening, margarines, and grains). Their diet was also high in antiox-idants, nutrients that put out the inflammatory “fires.” Foods werealso unprocessed and low in refined sugar.

As society became more farming-based, our diet included moregrains, and cattle were more likely to be grain fed. All this resultedin higher levels of the omega-6 pro-inflammatory fats. Theseomega-6 fats stimulated cytokines and inflammation. At this time,inflammation began to increase. This problem has been seen oncebefore in recorded history in ancient Egypt. This civilization alsohad the osteoporosis and inflammatory diseases seen today.

Our current diet has continued to degenerate to where we aregetting as much as twelve to twenty times as many inflammatoryfats in the diet as we used to! In addition, we have a massiveamount of sugar, potatoes, and white flour in our diet. This stim-ulates insulin resistance and release, further increasing the pro-duction of pro-inflammatory hormones (arachadonic acid) fromthese omega-6 fats. At the same time, our intake of antioxidantsto put out these fires has markedly decreased.

Treating Inflammation

Excess inflammation has been associated not just with anincreased tendency to pain, but at times with increases in heart


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attacks and other diseases as well. You can sometimes see this ten-dency to over-inflammation in yourself when you get a paper cut.Sometimes the paper cut heals so quickly that you barely noticeit’s there. At other times, the same type of cut will be red andinflamed and will continue to hurt beyond the initial few secondsof the cut.

For acute injury, remember the old standbys. These go by theacronym RICE, which stands for rest, ice, compression, and ele-vation. These are the standard treatments recommended bycoaches, trainers, and other professionals to treat muscle or jointinjuries such as sprains or strains. When combined with enzymessuch as Megazyme or Ultrazyme and homeopathic creams such asTraumeel (one of several wonderful products for traumatic injuriesthat contains arnica), acute injuries heal much more quickly.Adding another supplement called MSM can help when tissuehealing is necessary (for example with sprains or broken bones).The vitamin powder can give overall support for healing as well.

Medical ApproachesMedically, anti-inflammatories like Motrin and Celebrex can beused to block conversion of the omega-6 fats to the pro-inflammatory cytokines by blocking the enzyme cyclooxygenase(COX). You can decrease your tendency to excess inflammationby using steroids such as prednisone or the nonsteroidal anti-inflammatory drugs (NSAIDs). Unfortunately, both of these canbe fairly toxic, and they also block your body’s ability to makeanti-inflammatory messengers. This is one reason why over16,000 Americans a year die from NSAIDs and approximately139,000 have had heart attacks or strokes from Vioxx. High-dosesteroids can be used as anti-inflammatories, but used long term,they can be highly toxic. Other treatments include new tumornecrosis factor blocking medicines for rheumatoid arthritis thatcost thousands of dollars a year. We focus on prescription med-ications because that’s where the money is—so the pharmaceuti-cal industry makes sure that we learn about them!


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Natural Alternatives That Are Safe and EffectiveIn the long run, using diet and nutrition is a much safer and moreeffective way to get your inflammatory system into balance. Arecent study, for example, showed that taking a multivitamin canreduce inflammation with vitamins C and B6 seeming to play thelargest role. Many other natural therapies are also helpful indecreasing inflammation.

Substituting olive oil for other oils can also be very helpful.When you’re shopping for meat, go to Whole Foods Market, WildOats, Sprouts, or a similar store where you can get free-rangechicken and grass-fed beef. Although it is a bit more expensive, ittastes much better, may not make you put on as much weight, andwill save you a fortune on doctor bills. Olive oil is also tasty andcan be used for frying and cooking as well as a substitute for but-ter on your bread.

In addition, increasing fish, nuts and seeds, berries, free-rangechicken and grass-fed meats, spices and herbs, and green leafy veg-etables (not potatoes and grains) can be a very helpful start. Formore information on this, there is an excellent book you can read,The Inflammation Syndrome: The Complete Nutritional Program toPrevent and Reverse Heart Disease, Arthritis, Diabetes, Allergies, andAsthma by Jack Challem. In addition to this book, an excellent setof two cassette tapes will help you understand excess inflammationin more detail. Inflammation and Aging (tapes 1 and 2) by RonaldE. Hunninghake, M.D., are available by calling 1-800-447-7276.

Does that mean you should only eat things that you hate? Ofcourse not. You may find that substituting a wide variety of nutssuch as peanuts, cashews, or walnuts for chips and sugary snacksactually tastes better. Eating more salmon and tuna is not a bigdeal if you like these. If you don’t like them, don’t eat them. Youcan always add fish oil instead. Take one-half to two tablespoonsdaily. When you feel better you may be able to drop to one tea-spoon a day.

Substitute stevia or saccharin for sugar. Use sugar-free choco-lates (Russell Stover makes a delicious line, and there are now an


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enormous number of yummy sugar-free options for those on theAtkins diet). They taste just as good as foods with sugar but willnot make you sick. In addition, as a general rule of thumb, themore colorful a vegetable the healthier it is. For example, sweetpotatoes or carrots are a lot healthier than white potatoes. Thevitamin powder will also supply extensive antioxidant support,simplifying the process dramatically.

The effects of treatment with diet are not subtle. In a studydone at the University of Washington, it was found that womenwho ate one or two servings of fish a week were 22 percent lesslikely to have rheumatoid arthritis. Those who had more thantwo servings a week were 43 percent less likely. Those who haddeep-fried fish (usually fried in omega-6 fats), however, weremore likely to have rheumatoid arthritis. In another study donein Scotland, sixty-four men and women with rheumatoid arthri-tis were given fish oil. They began to feel better in three months.By one year, they had decreased NSAID medicine use by 40 per-cent. There is also evidence suggesting that fish oil helps heal thejoints and may decrease osteoporosis as well.

Unlike prescription medications, which can result in quickresults (but some such as steroids and NSAIDs cause long-termtoxicity), natural and dietary therapies take longer to see the fulleffect. They are more likely, however, to build up and heal yoursystem. I find that benefits usually start to be seen by six to twelveweeks and continue to build over years as the person gets health-ier and healthier. Because of this, I tend to use medications as aninitial “Band-Aid,” while the natural therapies heal the underly-ing problem over time.

In addition to using fish oil, it can be very helpful to use theEnd Pain formula, which contains willow bark, boswellia, andcherry. These natural elements can wonderfully decrease bothpain and inflammation (see Chapter 11).

Just remember that if you have excess inflammation, your bodycan often repair the damage over time. This means decreasingsugar and simple carbohydrates (keep chocolate, but make it sugar


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free), increasing protein and healthy oils (fish, olive, nuts), andgetting optimal nutritional support (such as the vitamin powder).Your dietary changes can actually be simple (similar to the Atkinsdiet but using healthy fats) and will leave you younger-looking,thinner, healthier, and feeling great!

Treating Arthritis: Inflammation of the Joints

As we just discussed, inflammation is a common cause of pain andmany other medical problems that we experience in Western soci-ety. For example, anything that ends in the suffix -itis means thatthe problem is inflammatory. This includes things like arthritis,tendonitis, bursitis, spondylitis, appendicitis, and so on. Manyinflammatory problems cause a secondary fibromyalgia, whichmay be causing most of the symptoms. If you have widespreadpain, fatigue, and insomnia, look for and treat the associatedfibromyalgia (see Chapter 6). Joint pain can also come from themuscles, tendons, and ligaments around the joint, even if x-raysare abnormal.

One type of joint pain, known as arthritis, comes in manyforms. The most common type is osteoarthritis, known as “wearand tear arthritis.” The joints mainly affected by osteoarthritis arethe finger, knee, and hip joints. This section will help you get ahandle on inflammatory pain and other types of arthritic pain.

A more severe form of arthritis is rheumatoid arthritis, whichis inflammatory and results in hot, swollen joints. It is an autoim-mune disorder that causes the body’s immune system to attack thejoints. I suspect that infections are common triggers for thisattack. The American College of Rheumatology has defined thefollowing criteria for rheumatoid arthritis:

• Morning stiffness lasting more than one hour• Arthritis and soft-tissue swelling in more than three of the

fourteen joints or joint groups• Arthritis of hand joints


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• Symmetric arthritis• Subcutaneous nodules• Rheumatoid factor at a level above the 95th percentile• Radiological changes suggestive of joint erosion

At least four of these criteria need to be met, although patients aresometimes treated despite not meeting these criteria. The child-hood form of this disease is called juvenile rheumatoid arthritis.Other types of arthritis include psoriatic arthritis, gouty arthritisand pseudo gout, systemic lupus erythematosus and other autoim-mune diseases, and hemochromatosis (excess iron).

As baby boomers begin reaching the age of retirement, thenumber of Americans developing arthritis-type disorders isexpected to soar. This increase will add to already significantarthritis rates. According to the Centers for Disease Control(CDC), one out of four American adults has been diagnosed witharthritis and another 17 percent may be suffering from it withouthaving been diagnosed. In 2002, the percentage of those diag-nosed with one or more forms of arthritis (including rheumatoidarthritis and gout), lupus, or fibromyalgia ranged from a low of17.8 percent in Hawaii to a high of 35.8 percent in Alabama.Thirty-six million workdays are lost each year because of osteo-arthritis. A Centers for Disease Control arthritis expert stated thatthe number of cases of arthritis in America is huge compared tomost other diseases. Fortunately, there are many natural and pre-scription therapies that can be effective.

How Diet Can Help with Inflammatory ArthritisIn addition to using long-term antibiotic therapy with minocy-cline in rheumatoid arthritis, it is worth considering dietarychanges as well. Diet can play a major role in inflammatory arthri-tis. A recent study tested the role of diet in sixty patients withrheumatoid arthritis. Thirty patients were given a standard Amer-ican diet and the other thirty an anti-inflammatory diet low inmeat and high in fish oil—with supplements given to supply


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approximately 2 grams of omega-3 fish oils daily—for eightmonths. The patients on an anti-inflammatory diet had a 28 per-cent decrease in the number of tender joints. In addition, decreas-ing inflammation by giving borage seed oil (supplying 1.4 g ofGLA—gamma linolenic acid) decreased the swollen joint scoreby 41 percent in the active group versus a 40 percent worseningin the placebo group. No patients had to withdraw because of sideeffects. Many other nutrients, including pantothenic acid, vitaminA, vitamin C, vitamin E, boron, copper, zinc, and selenium, havebeen found to be deficient and/or helpful in the treatment ofrheumatoid arthritis. High doses of fish oil (for example, one totwo tablespoons a day for at least three months) have been shownto be especially helpful in over six studies. As always, use fish oilthat is mercury and lead free (see Appendix B).

Natural Therapies for Treating ArthritisI prefer using natural rather than prescription therapies for osteo-arthritis. The most common prescription medications in use(NSAIDs like Motrin) kill over sixteen thousand Americansyearly and do not slow, and may actually hasten, the progressionof the arthritis. I recommend you begin with a natural treatmentprogram that will decrease inflammation and help repair thejoints.

This natural treatment program has four main components:

1. Repair2. Prevent damage3. Restore function4. Rule out and treat infections and food allergies

Repair. The joint cartilage can be repaired using a combination ofglucosamine sulfate, condroitin, and MSM. It is also critical thatyou get comprehensive nutritional support, as discussed earlier, topromote wound healing. Glucosamine, a cartilage compound thathas been shown to actually heal your joints, is as effective as


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NSAIDs (Motrin and other anti-inflammatory drugs). In addi-tion, a recent animal study showed that glucosamine and the anti-inflammatory drugs work synergistically. This means that whenthe two are taken together, it is much more effective than simplytaking either one alone. Using glucosamine can therefore allowyou to stop the anti-inflammatory drugs, or at least lower theneeded dose. This can improve the safety, effectiveness, and costof treatment dramatically.

Because of this, for tissue repair I recommend glucosaminesulfate, 500 mg, three times per day. Also consider MSM, 1.5 to3 grams a day for two to five months, and chondroitin, althoughthese last two are less important. MSM supplies the sulfur aminoacids needed for healing in general. Although most of the researchon MSM and arthritis has not been placebo-controlled, two stud-ies were. One showed an 80 percent decrease in arthritis pain aftersix weeks using 1,500 mg in the morning and 750 mg at lunch-time. Another showed that glucosamine and MSM are synergis-tic for reducing pain and swelling in arthritic joints. One hundredand eighteen patients with mild to moderate osteoarthritis weretreated three times daily with either 500 mg of glucosamine, 500mg of MSM, a combination of both, or placebo. After twelveweeks, the researchers found that the combination treatment hada faster effect on decreasing pain and inflammation compared toglucosamine or MSM alone.

Glucosamine sulfate is a cartilage-building compound that hasbeen found to be helpful in arthritis in many studies. Although itsexact mechanism of action is not yet fully understood, it is a majorcomponent of the cartilage that is damaged in arthritic joints. Glu-cosamine taken by mouth is incorporated in the molecules thatmake up this cartilage, likely contributing to the healing of arthri-tis. I recommend the sulfate form (as opposed to glucosaminehydrochloride) because the sulfate can also help with wound/jointhealing.

Unlike aspirin/NSAIDs that do not slow down destruction ofjoints in arthritis, glucosamine has been shown to actually help


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stabilize, and often heal, the joints as shown on x-ray. Doses of lessthan 1000 mg a day do not affect symptoms, and the standard doseis 500 mg three times a day. It can also be taken as 1,500 mg oncea day. It can be taken with or without food, and has no more sideeffects than placebo. Chondroitin sulfate is sometimes added toglucosamine or taken by itself. Its benefits are modest because lessthan 10 percent of it is absorbed, as opposed to 90 percent for glu-cosamine sulfate. Because of this, I rarely use chondroitin. On theother hand, certain forms (low molecular weight brands such asthe ones made by Integrative Therapeutics and Enzymatic Ther-apy) are better absorbed and are more effective (and more expen-sive). A dose of 1,200 mg a day can be helpful in slowing downarthritis and is worth trying if you do not get adequate relief withthe other treatments. It can be taken all at once or 400 mg threetimes a day with equal effectiveness.

Overall nutritional support is also critical. For example, lowconcentrations and low intake of vitamin D seem to be associatedwith an increased risk of progression of osteoarthritis of the knee.In addition, SAM-e can be helpful. This nutrient is produced frommethionine (an amino acid) in combination with multiple nutri-ents, including B vitamins, folate, and inositol. It was initiallytested and found to be effective in treating depression. Research-ers also noted that it improved patients’ arthritis as effectively asanti-inflammatory medications (NSAIDs). A number of studieswere done, including one that gave 600 mg a day for two weeksfollowed by 400 mg daily for two years. Pain and stiffnessdecreased within one week, and the improvement continuedthroughout the two-year trial. A study that reviewed seven otherstudies was inconclusive. A major problem with SAM-e productsis that they are not stable and break down easily, with many prod-ucts not really delivering what they claim. In addition, it is quiteexpensive. A better alternative is to take the nutrients your bodyneeds to make SAM-e. Combining the nutrients found in the vita-min powder and B complex resulted in increased blood levels ofSAM-e similar to those found in people taking 400 to 800 mg ofSAM-e daily.


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These are only a few of many examples of the importance ofoverall nutritional support in treating arthritis. Dozens of otherimportant nutrients can help arthritis, including niacin, pan-tothenic acid, B complex, vitamin C, vitamin E, boron, selenium,and zinc. As you can tell, it is important to get optimal nutritionalsupport. The vitamin powder makes this easy to do.

Prevent Damage. I recommend a mix of several natural remedies,many of which can be found in combination. The formulationthat I like the most combines boswellia, willow bark, and cherry.These are combined in an excellent new product called End Pain(see Appendix B). Using these three together can powerfullydecrease many kinds of pain while preventing damaging inflam-mation. Take two to four tablets three times a day until your painsubsides (approximately two to six weeks), and then you can oftenlower the dose to one tablet two to three times a day, or as needed.Curcumin can also be a healthful anti-inflammatory but requiresthe addition of piperine from black pepper for the curcumin to beadequately absorbed. I do not generally recommend that you usethese if you take any prescriptions, however, because piperine maypotentially also increase the absorption of other medications,causing them to reach toxic levels. Fish oil, one-half to one table-spoon daily, also has strong anti-inflammatory properties.

Restore Function. Restore function with stretching, exercise, andheat. Exercise at least twenty minutes a day. Swimming, walking,and yoga are good choices. Use a heating pad or moist heat for upto twenty minutes at a time to give relief.

Diet, exercise, and lifestyle can be important in the treatmentand prevention of osteoarthritis. For example, losing elevenpounds will reduce a woman’s risk of developing arthritis of theknee by 50 percent over a ten-year period. Adding exercise mayfurther decrease arthritis pain.

Rule Out and Treat Infections and Food Allergies. Food allergiescan aggravate arthritis. The best approach I have found for the


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elimination of food and other sensitivities or allergies is a tech-nique called NAET. This technique combines acupressure withapplied kinesiology in a special way and is powerfully effective. Itcan eliminate one allergy per twenty-minute treatment. It got myattention when it knocked out my lifelong hay fever in a singletwenty-minute visit. (See the website naet.com.) I recommendthat you read Dr. Devi Nambudripad’s book on pain and NAETfor more information.

If you also have osteoarthritis or rheumatoid arthritis, I rec-ommend using a spin-off of this technique called JMT (see jmt-jafmeltechnique.com for more information). For rheumatoidarthritis, I also use long-term antibiotics (minocycline) because Ifeel this is an infectious disease in many cases, and research hasshown antibiotics to be effective.

Another food sensitivity issue to consider is that a small per-centage of people with arthritis suffer aggravation of their arthri-tis from foods in the nightshade family. These include tomatoes,potatoes, eggplant, peppers, paprika, cayenne, and tobacco. I rarelyneed to have people consider this, but it is worth considering ifarthritis pain persists despite other treatments. Eliminate the abovefoods from your diet for one month. If you do not experiencerelief, reintroduce these foods to see if they affect your symptoms.Also avoid the artificial sweetener aspartame (NutraSweet).

In addition to these four treatment areas, although it may seemsilly, copper bracelets have actually been shown in a blindedcrossover study to be helpful in relieving arthritis, and I have alsoseen patients get better using them.

Additional Natural Therapies. As noted earlier, I recommend thatyou begin with the End Pain formula and glucosamine/MSM/chondroitin. You may also want to try another popular homeremedy made with pectin and grape juice, Purple Pectin for Pain.(See directions for use under “An Easy-to-Make Home Remedy”in Chapter 11.)

Although I prefer nutritional and herbal therapies, manyhomeopathic treatments can also be helpful for arthritis—espe-


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cially if given by a well-trained homeopath. The concept ofhomeopathy is that an extraordinarily diluted amount of a sub-stance does the opposite of a high dosage of the same substancewhen prepared properly. There have been a number of studiesshowing that this approach can be very helpful.

Prescription TherapiesPrescription therapies include NSAIDs such as Motrin, COX 2inhibitors (such as Celebrex), and Ultram. Because you and yourphysician are probably well aware of these, and they are discussedin Chapter 13, we will not go into more depth about them. Arecent study also showed that the Lidoderm patches were helpfulin decreasing pain by approximately 30 percent in two weeks,with many patients experiencing over a 50 percent drop in pain.Except for headache and an occasional skin rash where the patchwas applied, treatment was well tolerated.

Although I have been using natural cortisol (Cortef—by pre-scription) in doses of up to 20 mg daily for decades, some recentlytouted techniques adapt the protocol to use low-dose pulse thera-pies. The main concern with cortisol is that too high a dose can betoxic, and it also suppresses the adrenal glands. Doses of up to20 mg daily (approximately equal to 4 to 5 mg of prednisone butsafer) have been shown to be safe even when used for extendedperiods. If the arthritis persists despite natural therapies, it is worthtrying to give the Cortef in seven- to nine-day cycles as follows:

• On days one and two, give 20 mg twice a day.• On days three and four, give 10 mg twice a day.• On day five, give 5 mg twice a day.• Take no Cortef for the next two to four days.

Keep repeating the cycles, looking for benefit to occur withinthree months. At that time, you can try lowering the dose. Ifinflammatory arthritis is present (and in severe cases even if it isnot), consider minocycline (an antibiotic), 100 mg twice a daylong term as discussed earlier.


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Focusing on Muscle and Bone Pain

While pain from fibromyalgia, myofascial pain syndrome, osteo-pororis, and cancer may seem quite different, they do share com-mon treatment options. Focusing on one or all of four key areas ofgeneral pain management can be crucial to treating these pain syn-dromes that occur in the muscles and bones. For example, infibromyalgia and myofascial pain, my double-blind, placebo-controlled study showed a 91 percent improvement rate whenthese four areas (getting seven to eight hours of sleep, taking nutri-tional supplementation, treating hormonal deficiencies, and treat-ing infections) were addressed. (The full text of the study can alsobe seen on my website at vitality101.com.) For both treating andpreventing osteoporosis and bone loss, incorporating the rightnutrients and hormonal support is essential. Another thing to con-sider is that in addition to causing pain, cancer that has spread tobone can also make the bones weak and susceptible to fracture.Because of this, treatments that improve bone density (and preventosteoporosis) may decrease bone pain from cancer as well. In addi-tion, cancer often triggers muscle/myofascial pain, and using thetreatments for muscle pain can result in more comfort, the patientneeding less pain medicine, and, therefore, fewer side effects.

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Myofascial and Fibromyalgia Pain

Fibromyalgia (FMS) and myofascial pain syndrome (MPS) occurwhen your muscles get stuck in the shortened position. Infibromyalgia, this also results in reversible changes in how yourbrain processes pain. In addition, fibromyalgia patients have sup-pression of a major control center in the brain called the hypo-thalamus. This is basically like blowing a fuse in your brain. As Imentioned earlier, the good news is that our research has shownthat 91 percent of patients can turn the hypothalamic “circuitbreaker” back on by treating four key areas. Doing this can makeboth fibromyalgia and myofascial pain go away.

The four areas are discussed at length earlier in this book inChapters 2 and 3. (For an in-depth look at how to eliminatefibromyalgia and myofascial pain, I invite you to read my best-selling book From Fatigued to Fantastic! )

The Importance of Sleep When Treating FMS and MPSMost patients with these illnesses find that they are unable to getseven to eight hours of deep sleep a night without taking med-ications. In part, this occurs because hypothalamic function is crit-ical to deep sleep. For patients to get well, it is critical that theytake enough of the correct sleep medications to get eight to ninehours of sleep at night! These medications include Ambien,Desyrel, Klonopin, Xanax, Soma, and if you don’t have restless legsyndrome, Flexeril and/or Elavil. In addition, natural remedies canhelp sleep. An excellent natural compound is the RevitalizingSleep Formula. In the first six months of treatment, it is notuncommon to require six to eight different products simultane-ously to get eight hours of sleep at night. After six to eighteenmonths of feeling well, most people can come off most sleep (andother) medications. (See Chapters 11 and 13 for more informa-tion on natural and prescription sleep aids.)

I’m starting to believe that, to offer a margin of safety duringperiods of stress, it may be wise to stay on one-half to one tabletof a sleep medication or herbal for the rest of your life. Your doc-


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tor may initially be uncomfortable with this. Nonetheless, myexperience with more than two thousand patients and tworesearch studies has found this approach to be safe and critical topeople getting well. When one recognizes that fibromyalgia andits disabling cousin chronic fatigue syndrome (CFS/FMS) arehypothalamic sleep disorders—not poor sleep hygiene—thisapproach makes sense. Otherwise, it is as if your doctor wouldimmediately try to stop blood pressure or diabetes medicinesevery time the patient was doing better!

Nutritional Supplementation for FMS and MPSNutritional deficiencies are widespread in fibromyalgia. I recom-mend taking the vitamin powder long term. I also recommendadding D-Ribose (Corvalen) 5 grams two to three times a day;NAC, 500 to 650 mg; coenzyme Q10 (use the Vitaline form),200 mg; and acetyl l-carnitine, 1,000 mg a day for three to fourmonths if you have fibromyalgia. These are all readily available.

FMS, MPS, and Hormonal DeficienciesThe hypothalamus is the main control center for most of theglands in the body. Most of the normal ranges for blood tests werenot developed in the context of hypothalamic suppression.Because of this, and for a number of other reasons, it is usuallynecessary, albeit controversial, to treat with thyroid, adrenal (verylow dose Cortef, DHEA), and ovarian and testicular hormonesdespite normal blood tests. These hormones have been found tobe reasonably safe when used in low doses.

FMS, MPS, and Unusual InfectionsMany studies have shown immune system dysfunction infibromyalgia/CFS. Although there are many causes of this, I sus-pect that poor sleep is a major contributor. The immune dysfunc-tion can result in many unusual infections. These include viralinfections (HHV-6, CMV, and EBV), parasites and other bowelinfections, infections sensitive to long-term treatment with the

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antibiotics Cipro and Doxycycline (mycoplasma, chlamydia,Lyme, and others), and fungal infections. Although controversial,both my study and another recent placebo-controlled study foundtreating with an antifungal to be very helpful with the symptomsseen in these syndromes. Avoiding sweets (stevia is OK) and tak-ing Acidophilus Pearls (a healthy milk bacteria), two pearls twicea day for five months, can be helpful. I often also add prescriptionantifungals as well.

Other Helpful Fibromyalgia TreatmentsWhile treating the underlying causes of muscle pain that we dis-cussed previously, it is also helpful to have other treatments tokeep you comfortable. NSAIDs like Motrin are minimally effec-tive, only helping about 10 percent of fibromyalgia patients. Inter-estingly, Celebrex is more likely to be helpful—despite havingsimilar mechanisms of action. Safety concerns have been raisedabout this family of medications as well, however. Other medica-tions that are very helpful include Ultram, Skelaxin, Neurontin,and Baclofen. Zanaflex has also been helpful in many patients, andmost only need a 4 mg tablet at bedtime. Another helpful nondrugpain treatment that is currently being studied is Flexyx. This ther-apy is a brainwave biofeedback and treatment system. (See flexyx.com for more information.)

Treating Osteoporosis and Bone Pain

Osteoporosis, or decreased bone density/strength, can worsenwith age, inactivity, and hormonal deficiencies (estrogen, testos-terone, and DHEA). Currently, the rate of osteoporosis amongolder women is estimated to be about 29 percent, yet only 13 per-cent of older women have been diagnosed with the disease.Osteoporosis can be easily diagnosed by performing a test calleda DEXA scan. Fortunately, many treatments can be effective atrestoring bone strength and eliminating osteoporosis pain.

Although using calcium to increase bone density has receivedmost of the media attention, it is actually a rather small player


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when it comes to improving bone strength. In addition to weight-bearing exercise and natural estrogen, many other nutrients andtreatments can dramatically improve bone density and decreasebone pain. Sadly, except for calcium, most doctors only hear aboutexpensive prescriptions such as Fosamax and calcitonin (200 unitstwice a day—used only in severe cases). Although these can behelpful, I would certainly start first by adding the nutrients thatyour body needs to make strong bones.

When You Already Have OsteoporosisIf you already have osteoporosis, I would recommend Fosamax ora related medication in addition to the other treatments men-tioned in this section. The usual dose is 70 mg once a week on anempty stomach taken with a full glass of water. It is best to take itimmediately on waking and then stay upright for thirty minutesso gravity helps it get past the stomach quickly (it can irritate thestomach). If you are on the 35 mg a week prevention dose, youshould be aware that the 35 and 70 mg tablets cost exactly thesame amount; you can save half the cost by buying 70 mg tabletsand breaking them in two. The same price for both low- andhigh-dose tablets is commonly seen with many medications.

Additional Nutrients for Prevention and TreatmentThere are many other nutrients that are critical for bone produc-tion. These include magnesium, boron, folic acid, copper, man-ganese, zinc, and vitamins B₆, B₁₂, D, and C. All of these arepresent in the Energy Revitalization System vitamin powder (pre-viously discussed and included in Appendix B). In addition I rec-ommend adding the following important nutrients.

Calcium. Take 1,000 to 1,500 mg of calcium daily. Be sure you geta form of calcium that dissolves in your stomach. Unfortunately,most calcium tablets are chalk (calcium carbonate) and do not dis-solve. Because of this, they go in your mouth and out the otherend, doing no good along the way. If you get one that is a chew-able, powder, or liquid, this is not a problem. If you get a tablet,


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put it in some vinegar for an hour and see if it dissolves. If it doesnot, it will not dissolve in your stomach either, and I recommendthat brand not be used.

If you are taking thyroid hormone supplements, do not takethe calcium within two to four hours of the thyroid hormone oryou will not absorb the thyroid hormone. In addition, make surethat your free T4 thyroid blood test (not the TSH test) is notabove the upper limit of normal because too high a thyroid dosecan cause osteoporosis. You may choose to take your calcium atmeals and bedtime (500 mg at lunch, dinner, and bedtime)because it is better absorbed with food, and calcium taken at nightcan help you to sleep.

Strontium. This mineral is highly effective at improving bonedensity. I am not speaking about strontium-90, the very danger-ous radioactive compound released during nuclear testing. Thestrontium available in health food stores and at vitality101.com isnonradioactive and very safe—even in high doses. Studies usingstrontium in the treatment of 353 osteoporosis patients showed adramatic 15 percent increase in lumbar spine bone mineral den-sity (BMD) over two years in patients using 680 mg of strontium(2,000 mg of strontium ranelate) a day. They then repeated theplacebo-controlled study with 1,649 osteoporotic women. Newfractures decreased by 49 percent in the first year of treatment,and bone mineral density in the lumbar spine increased by anaverage of 14.4 percent after three years. There was an 8.3 per-cent increase in hip bone density as well. Overall, strontiumappears to be approximately 150 percent as effective as Fosamax.Other forms of strontium have shown similar benefits, and680 mg of elemental strontium daily appears to be a good dose.Strontium gluconate is better absorbed than strontium carbonate.

If possible, take the strontium on an empty stomach and at adifferent time of day than the calcium, as calcium can blockstrontium’s absorption. Early data also suggest that the strontiummay also be helpful in the treatment of osteoarthritis. Although it


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took three to thirty-six months of therapy, taking strontium wasassociated with a marked reduction in bone pain in osteoporosispatients. After three years, drop the dose of strontium to 340 mga day or take it as needed.

Fish Oil. Fish oil also may decrease osteoporosis. You can eitherincrease your intake of salmon and tuna or take one to two tea-spoons of fish oil a day. (Sources of fish oil are listed in Appen-dix B.)

Hormonal Support for OsteoporosisMake sure that your DHEA and testosterone levels are optimizedsince these hormones also can improve bone density considerably.These are discussed in Chapter 2 in the section on hormonal defi-ciencies. Even very low dose transdermal (by patch) estrogenreplacement therapy improves bone density in menopausal women.

Easing Cancer Pain and Discomfort

It is unacceptable for cancer patients to be in pain, and the treat-ments discussed in this book can be very helpful in eliminatingcancer pain. Most cancer pain comes from muscles, bones, ornerves. Treat these pains as discussed in earlier chapters. In addi-tion, nutritional deficiencies are rampant in cancer patients andcan contribute markedly to the pain and disability. I strongly rec-ommend that most cancer patients take the vitamin powder (dis-cussed in Appendix B; lower the dose if diarrhea is present).

As an aside, there are many treatments that can help cancer thatyour oncologist may not be aware of. I recommend that anypatient with a significant cancer order a search of medical studiesdone on their specific type and stage of cancer from HealthResources, as they do a spectacular job. (Call Jan Guthrie at 800-949-0090 for more information.) This report routinely turns upvaluable treatment options that most doctors are not aware of. Ihave seen “incurable” cancers go away when the patient combines


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the best of the standard and complementary therapies that arefound in the printout’s studies. As an example, my research asso-ciate has now been cancer-free for over five years despite havinghad an ovarian cancer metastasize to her neck!

In addition, here are a few thoughts for easing nausea, a com-mon discomfort of cancer treatment. For uncontrollable nausea,use ABHR cream applied to an area of soft skin, such as the wrist.This prescription cream contains lorazepam, Benadryl, Haldol,and metoclopramide and can be made by a compounding phar-macist (who can also guide you in its proper use). Nausea oftensettles within fifteen to thirty minutes after applying the medica-tion. The cream can be reapplied every six hours as needed.Promethazine 25 mg per 0.5 cc of cream is also helpful for nausea.

How Bone, Muscle, and Nerve Pain Treatment Can Helpwith Cancer PainAs I mentioned at the beginning of the chapter, cancer that hasspread to the bones can make them susceptible to fracture. In onestudy of patients with bone metastases from breast or prostatecancer, strontium gluconate (the healthy form—not the radioac-tive one), 274 mg daily, increased bone regrowth in areas oftumor and often resulted in patients feeling better and gainingweight. I would use the 680 mg a day dose of strontiumgluconate.

In addition, a study by Dr. Neoh Choo Aun, a wonderfulacupuncturist and friend in Taiwan, showed that using acupunc-ture to treat the trigger points (used to treat muscle pain) in can-cer patients was very beneficial.

In another study of twelve patients with very severe neuro-pathic pain due to the cancer pushing on major nerve centers, IVmagnesium was given. Half the patients received 500 mg and theother half 1,000 mg given over ten minutes. Aside from produc-ing a mild feeling of warmth at the time of the injection, the IVwas well tolerated. Ten of the twelve patients experienced signif-icant relief that lasted approximately four hours. I would give 2


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grams of magnesium over thirty to sixty minutes. Most patientswith neuropathic pain will not need this, although it can easily begiven if they have an IV in place, if they simply use the medica-tions we discuss in Chapter 4 on neuropathies.

The rest of the chapters in this section focus on pain based in spe-cific locations in the body, such as headaches and back, chest,abdominal, and pelvic pains.


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It’s Not All in Your Head:Treating Headaches

and Facial Pain

Headaches are a major source of chronic pain. Although mostpeople get an occasional headache, as many as 45 million Ameri-cans get them on a regular basis. Headache-related lost work timeand medical expenses cost $50 billion per year in the United Statesalone. Over $4 billion a year is spent on over-the-counter head-ache relievers. Headaches are problematic in about 10 to 18 per-cent of the general population, and 10 percent of patientsidentified headache as the reason for their doctor visits. This chap-ter provides the effective prescription and natural remedies thatcan help you eliminate both mild and severe chronic headaches.

Finding Relief from Tension Headaches

Tension headaches account for about three-quarters of all head-aches. They cause moderate pain on both sides of, and across, theforehead, tend to both start and fade away gradually, and are theresult of muscle tightness coming from the sternocleidomastoid(SCM) muscles in the neck. These muscles begin behind the bot-

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C H A P T E R 7


tom of the ear and come around the neck to the top of the collarbone (clavicle). They are the muscles that turn your head fromside to side. With tension headaches you can often find a tenderknot right in the middle of the muscle. This knot, called a triggerpoint, refers pain and tenderness to the sides of your forehead (thetemple area) and then sends the pain across your forehead.Although putting a hot compress or one of the pain creams on thetemples and across the forehead may help temporarily, they aremore effective when placed over the tender knots in the muscleson both sides of the neck.

Occasionally, tension headaches are felt at the base of the skull,on the top of the head, and/or behind the eyes. For these headaches,the pain is often coming from the muscles where they attach to thebase of the skull at the top of the back of your neck. If you push onthose muscles (called the suboccipital muscles) where they attach atthe base of the skull during a headache, they will be very tender,and pressure on them can make the headache better or worse.When the pain is reproduced by pushing on the area, you knowthat these muscles are part of the source of that headache. If this isthe case, use heat and the pain creams over those tender areas.

Because tension headaches are muscular, the treatments (dis-cussed previously in Chapter 6 on myofascial and fibromyalgiapain) that cause your muscles to relax will often eliminate therecurrence of these headaches. These are nutritional support, hor-monal support, getting at least eight hours of sleep at night, andtreating underlying infections. Paying attention to structural fac-tors (discussed in Chapter 3) can also help.

Natural and Prescription RemediesHerbal remedies such as the End Pain formula (see Appendix B),which contains willow bark, boswellia, and cherry, can be veryhelpful for acute attacks as can natural and prescription pain gels(discussed in Chapters 11 and 13). Although the End Pain direc-tions say to take one or two tablets, for acute pains three or four


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tablets at a time can be more helpful. Using two to four capsules ofthe Revitalizing Sleep Formula with the End Pain formula (or byitself ) can also be very effective, as these herbs are also muscle relax-ants (see Chapter 11). A physical therapy technique called stretchand spray (in which the muscles are stretched while using a coolantspray to block pain), which approximately 10 percent of physicaltherapists are familiar with, is also an excellent and pain-free wayto release your muscles and eliminate a tension headache. When theunderlying metabolic and structural factors have been treated,stretch and spray may result in permanent relief of the pain.

In addition, there are, of course, the old standbys of chiro-practic and bodywork as well as Tylenol and Motrin/Advil. Othermedications that can be quite helpful include Midrin and Ultram.I would begin with the natural therapies first, however, as I thinkthese are both more effective and much safer.

Preventing Tension HeadachesWhile you are treating the underlying causes of your muscle pain,many medications can also be used to prevent chronic tensionheadaches. Antidepressants can help headache and other pains aswell as depression. In one study comparing Elavil 25 mg at bed-time with Remeron 30 mg at bedtime, both groups had fewerheadaches but the Remeron group had fewer side effects. Both ofthese medications are likely to be more effective for tension head-aches than Paxil 40 mg daily, which had only a mild effect.

Getting Rid of Migraines

Migraine headaches can be very severe and often leave peoplecrippled for days. They may afflict as many as 28 million Ameri-cans. Migraines are often preceded by an aura, which may consistof visual disturbances such as flashing lights. The headaches areoften associated with nausea, sweats, dizziness, and slurred speech.Light and sound sensitivity can be severe.

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There is still marked debate over the cause of migraines. Fordecades, researchers thought that migraines occurred because ofexcessive contraction and expansion of the blood vessels in thebrain. Others thought this blood vessel problem occurred becauseof inadequate serotonin, the neurotransmitter that controls sleepand mood, which also plays a role in how blood vessels expand.Low serotonin also amplifies pain by increasing the pain neuro-transmitter called substance P. Muscle spasm and nutritionalimbalances and deficiencies can also contribute to migraines, ascan food sensitivities. Most likely, migraines are a common end-point for many different underlying problems.

Effective migraine treatment is important. Not only aremigraines horribly painful for many people, but they are expen-sive as well. The average amount of work missed by those withmigraines is 19.6 days a year, costing employers three thousanddollars per year per employee. It is also under-treated, with 31percent of migraine patients never having sought treatment.

Migraine-Busting MedicationsIn the United States, medications in the Imitrex family stillremain the first choice for treating migraines. This new family ofmedications, called triptans, has dramatically increased our abil-ity to treat migraine headaches effectively. Imitrex comes in 25,50, and 100 mg tablets, and up to 100 mg may be taken at a time.If pain persists at two hours, another dose of up to 100 mg can betaken. In addition, it is also available by nasal spray, using a doseof up to 20 mg initially, followed by one more spray of up to20 mg two hours later if needed. Another alternative is a 6 mgsubcutaneous injection, which can also be repeated one hour laterif needed. It is reasonable to try these different forms to see whatworks best for your migraines.

Imitrex has been found to be effective in eliminating an acutemigraine attack in 34 to 70 percent of patients within two hours.Unfortunately, at least 30 to 40 percent of patients remainedunsuccessfully treated.


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You may also want to try a newer cousin called Amerge. Use2.5 mg initially. This dose may be repeated four hours later ifneeded. Your physician may also use other related medicationssuch as Zomig or Relpax. Axert (almotriptan 6.5 to 12.5 mg,which can be repeated in two hours) is similar in effectiveness toImitrex but less expensive.

Other treatments may be effective for acute migraines whenImitrex is not. Aspirin-family medications do not work well inmigraines because the absorption of aspirin is delayed during themigraine attack. To combat this problem, medications that enhanceabsorption can be added to the aspirin and/or it can be given bysuppository. For example, a combination of indomethacin (a “super-aspirin”), prochlorperazine (for nausea and to enhance absorption),and caffeine in suppository form were compared with sumatriptanrectal suppositories for acute migraines. Forty-nine percent ofpatients given the indomethacin combination were pain-free at twohours on the first treatment as compared to 34 percent with theSumatriptan.

Another study using a similar approach had the same result.Aspirin (lysine acetyl salicylates, 1,620 mg—equivalent to 900 mgof aspirin) was combined with metoclopramide, 10 mg. The lat-ter medication returns the absorption of aspirin to normal duringmigraine attacks and also combats nausea and vomiting. In thetwo placebo-controlled studies, this combination was more effec-tive than 100 mg of Imitrex by mouth and was better tolerated.These combinations can be made by compounding pharmacists(see Appendix B). It is quite likely that regular aspirin, especiallyif chewed, would be as effective as the form used in the study.Metoclopramide is readily available.

Other medications can also be helpful for acute migraines.Many patients get relief with Midrin, which is a mix of threemedications. Take two capsules immediately followed by one cap-sule every hour until the headache is relieved (to a maximum offive capsules within a twelve-hour period). It can also be helpfulfor tension headaches in a dose of two capsules up to four times a


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day, as needed. Many patients find this to be quite helpful, and itis not addictive. Fiorinal can also be effective but is addictive, andI prefer not to use this medication.

A fascinating study can guide you as to when to use Imitrex-family medications versus when to use other therapies. At a recentAmerican Academy of Neurology meeting, Dr. Burstein of Har-vard Medical School noted that 75 percent of migraine patientsget painful sensitivity to normal touch (such as that from eye-glasses) around their eyes. This pain is created in a different partof the brain than the throbbing pain that gets worse with move-ment or coughing. The study found that if these patients useImitrex before they get the tenderness/pain around the eyes, itwill knock out the migraine 93 percent of the time. If the pain/tenderness around the eyes had already set in, Imitrex only elim-inated the migraine 13 percent of the time (although it still helpedthe throbbing). In other words, if you are one of the lucky oneswho does not get pain around the eyes, the Imitrex can knock outyour migraine at any time. If you are one of those who getspain/tenderness around the eyes, it is a race against the clock totake the Imitrex before that pain starts. This means that you needto take the Imitrex early in the attack (within the first five totwenty minutes), before the skin hypersensitivity gets established.For example, use it at the earliest warning signs like painful scalpor discomfort from wearing your glasses, shaving, or wearing ear-rings. If the pain has already fully set in before you take theImitrex, consider using one of the other acute treatments we’vediscussed.

Because of the nausea and light/sound sensitivity, antinauseamedications can also be helpful. Phenergan or Compazine sup-positories are two such medications.

Natural Remedies That Can Knock Out MigrainesTwo natural treatments can knock out an acute migraine: butter-bur and magnesium. You can take butterbur at home on yourown. This herb can both prevent and eliminate migraines. Take


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50 mg three times a day for one month and then 50 to 75 mgtwice a day to prevent migraines. You can take 100 mg everythree hours to eliminate an acute migraine. Use only high-qualitybrands (see Appendix B). Many others that were tested had impu-rities and did not contain the amount of butterbur the labelclaimed (in other words, they don’t work).

The development of standardized extracts of butterbur has ledto a powerful new natural tool in both the prevention and treat-ment of migraine headaches. Two randomized placebo-controlleddouble-blind studies have found it to be effective. In the firststudy, sixty migraine patients received 50 mg of butterbur twicea day. By the twelfth week, there was a 60 percent decrease in thenumber of migraine attacks compared to the placebo group. Asecond study of 202 migraine patients, who were given 75 mg ofbutterbur twice a day, showed a 58 percent decrease at threemonths. The 100 mg a day group had a 42 percent decrease atthree months. About 20 percent of people taking the butterburnoted increased burping.

Magnesium has also been found effective for migraines. In ahospital emergency room or a doctor’s office, 1 to 2 grams ofintravenous magnesium over fifteen to thirty minutes can effec-tively eliminate an acute migraine 86 percent of the time withinfifteen minutes!

When Nothing Else Works: Rescue MedicationsUnfortunately, sometimes the treatments discussed above are noteffective. Because of this, and largely because most people are notaware of all the treatment options, over eight hundred thousandAmericans per year visit hospital emergency rooms for treatmentof their migraines. This is an expensive proposition; it often runsmore than five hundred dollars per emergency room visit. Inaddition, the average time spent in the emergency room is fourhours. Because the person usually needs to have somebody drivehim or her, this can be multiplied by two. Therefore, it is helpfulfor people to have “rescue medication” that they can use instead


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of having to go to the emergency room. A number of options areavailable to serve this purpose.

One such remedy is the use of fentanyl lollipops, known asoral transmucosal fentanyl citrate (OTFC, Actiq). Fentanyl lol-lipops (Actiq) should be intermittently sucked on, not chewed orswallowed. In between being sucked on, the lollipop should beleft between the cheek and lower gum. Time the sucking so thatit takes approximately fifteen minutes for the medication to beabsorbed into your cheek. This makes it more effective. Actiqcomes in six strengths (200 to 1,600 mcg). It begins to workwithin five to ten minutes, with pain relief lasting approximatelythree hours. Its effectiveness is similar to 2 to 16 mg of intra-venous morphine. The most commonly used doses are 400 and800 mcg.

Because these medications are only approved by the FDA foruse in patients who are on chronic narcotics, it is reasonable (if youare not already on chronic narcotic pain medications) to take thefirst dose in a doctor’s office to make sure that it does not cause adangerous level of sedation. Like other narcotics, this medicationcan be highly habituating. Because of this, it should only be usedas a rescue medication when other medications have failed. Onceyou have tried the 200 and 400 mcg doses and know that they arenot too sedating, begin with a 400 mcg dose over fifteen minutes.If adequate pain relief is not achieved ten minutes later (that is,twenty-five minutes after beginning the first lollipop), use another200 or 400 mcg unit every twenty-five minutes until adequatepain control is achieved or you reach 1,200 mcg. The average doseneeded is 800 mcg.

In one study using this approach, all twenty-eight of thepatients in the study were able to avoid having to go to the emer-gency room, with twenty-seven of the twenty-eight patientsroutinely getting significant relief from pain (decreasing to a mildlevel). The medication was well tolerated with the main sideeffect being nausea in 18 percent of patients. A few patients haditching that was easily relieved by Benadryl. Side effects were


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much less than normally experienced with the usual rescue med-ication, Demerol.

Preventing MigrainesIn addition to being able to treat acute migraines more effectively,many medications can prevent them. Together, these medicationsreduce the number of headache days per month by an average of50 percent. These medications include beta-blockers (Inderal),calcium channel blockers, Neurontin, Depakote, Topamax, Elavil,and doxepin. Although Inderal XL can be helpful, it may aggra-vate fatigue, asthma, or depression. Another medication that canbe helpful is Zonegran (an antiseizure medication). Begin with100 mg a day for two weeks and then increase to two tablets a day.The maximum dose is 400 mg daily, although most of the bene-fit occurs at the first 200 mg. Because there have been rare occur-rences of a life-threatening rash (most rashes caused by themedication are not dangerous, however), stop the medicationimmediately if you get a rash. Do not use this medication if youare allergic to sulfa drugs.

Fortunately, natural remedies are even more effective in pre-venting migraines. They may take up to three months to startworking, however, so the above medications can be used whileyou’re waiting for the natural preventives to take effect. Magne-sium by mouth has been found to be effective for migraine pre-vention and is as effective as Elavil. Magnesium serves in anenormous number of functions in the body, including the relax-ation of muscles and arteries. Most Americans get nowhere nearthe optimum amount of magnesium in their diet, getting lessthan 250 mg a day as opposed to the 650 mg that the averageChinese diet supplies. Blood testing to check magnesium levels ishorribly unreliable and may not detect magnesium deficiencyuntil it is severe.

Dr. Alexander Mauskop, a leading authority on natural pre-vention of migraine headaches and the author of What Your Doc-tor May Not Tell You About Migraines, published a study in 1995


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showing that intravenous magnesium could abort a migraineheadache. He also found that intravenous magnesium could knockout other types of headaches as well. Such powerful data spurredresearchers to discover that magnesium could also preventmigraines. In one German placebo-controlled study, patients weregiven 600 mg of magnesium or a placebo daily for twelve weeks;there was a significant drop in migraine frequency in the magne-sium group. Another study shows similar effects in women withmenstrual migraines. Thus, it is a good idea for most migrainepatients to take 150 to 200 mg of magnesium in the morning(present in the vitamin powder) and again with dinner or at bed-time (less if diarrhea is a problem).

Riboflavin (vitamin B₂) assists in the production of energy. Inone study, migraine patients were given riboflavin 400 mg withbreakfast every day for at least three months. By the end of thestudy they had a 67 percent decrease in migraine attacks as wellas a decrease in attack severity. This was later repeated in aplacebo-controlled study. Note that it can take three months forthe riboflavin to start working.

Vitamin B₁₂ can also decrease migraine frequency. In onestudy in which patients received 1,000 micrograms a day as a nasalspray, migraine frequencies decreased by an average of 43 percentafter three months (the vitamin powder/B-complex contains 500micrograms a day).

Feverfew is another helpful herb for migraine prevention.Using feverfew was found to be very safe and has resulted in a sig-nificant reduction in migraines in one-third of patients.

Butterbur is a shrub that grows in Europe, Asia, and Africa. Astandardized extract called Petadolex was used in two double-blind studies. By the third month, those receiving active treatmentwith 100 mg a day had 60 percent fewer migraine attacks than thecontrol group. Although 100 mg a day is effective, 75 mg twice aday with food may be the optimal dose.

Fish oil has also been found to decrease the frequency ofmigraines. In two placebo-controlled studies of patients with fre-


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quent severe migraines that did not respond to medication, fish oilwas found to be effective. Use one to two tablespoons a day forsix weeks to see the effect. Then you can decrease it to the low-est dose that maintains the benefit.

Other natural compounds that may be helpful include glu-cosamine 1,500 to 2,000 mg a day (this compound was found tobe helpful in a small study of ten patients over four to six weeks).Coenzyme Q10, 150 to 200 mg daily, decreased the average num-ber of migraine attacks from 4.8 to 2.8 per month.

All this suggests that many, if not most, migraines can be pre-vented naturally. I would begin by taking the vitamin powder plus300 mg of vitamin B2 in the morning, plus 200 mg of magnesiumat night. If the cost is not prohibitive, I would add butterbur aswell. Also check for food allergies, as noted in the following sec-tion, and follow the advice for hormones in Chapter 2 if themigraines are predominately around your periods or associatedwith taking estrogen. I have seen this approach commonly elim-inate frequent and horribly severe migraine problems, but remem-ber that it may take three months to see the effect.

Eliminating Migraine TriggersAcupuncture is another option to consider for chronic migraineand tension headaches. It results in reduced pain, reduced fre-quency of headaches, and improved function, energy, and health.In two studies conducted in New York City and London, acu-puncture was found to be cost-effective. In a randomized con-trolled study of 401 patients with chronic headaches (the majorityhaving migraines), patients received up to twelve acupuncturetreatments over a three-month period versus a control group thatreceived standard care. The acupuncture patients had 22 fewerheadache days per year, 15 percent fewer sick days, and 25 percentfewer visits to the doctor.

Food allergies are also very important to consider. Approxi-mately 30 to 50 percent of migraine patients get marked improve-ment by avoiding certain foods, and most people with migraines


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are not aware of what foods are triggering their headaches. Thishas now been demonstrated in at least four placebo-controlledstudies. Food sensitivities are an even bigger problem in childrenwith migraines. To determine if foods are playing a role in caus-ing your headache, it is helpful to do an elimination diet, whichrequires that you eat a very limited diet for five days. Eat onlypears and lamb, and drink only bottled spring or distilled water.This kind of strict elimination diet will make it easier to tell iffood allergies or sensitivities are present and triggering yourmigraines when you reintroduce foods into your diet. In onestudy, by avoiding the ten most common food triggers, subjectsexhibited a dramatic reduction in the number of headaches permonth, with 85 percent becoming headache-free. Twenty-fivepercent of the patients with high blood pressure also had theirblood pressure reduce to normal. The most common reactivefoods were wheat in 78 percent of patients, oranges in 65 percent,eggs in 45 percent, tea and coffee in 40 percent each, chocolateand milk in 37 percent each, beef in 35 percent, and corn, canesugar, and yeast in 33 percent each. Some studies also suggest thatthe artificial sweetener aspartame (NutraSweet) can triggermigraines and other headaches, although this is controversial.

If you have severe and frequent migraines, it is definitelyworth exploring food sensitivities. You may find that instead ofavoiding foods that trigger your migraines for the rest of your life,you can eliminate the sensitivities/allergies by using a powerfullyeffective acupressure technique called NAET (see NAET.com).

Reducing Estrogen-Induced MigrainesIn many women, migraines are triggered by a sudden drop inestrogen level. Because of this, migraines are often worse on thetwo days before or after the day the period starts. For those tak-ing estrogen replacement or the birth control pill, the headachesmay occur in the hours before the next dose of therapy is due (asthe estrogen level is dropping). In these situations, the key is toprevent the dropping estrogen level. One way to do this is to use


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an estrogen patch for one week beginning a few days before yourperiod is expected (for example a Climara .025 patch). For thosetaking the pill, switch to a different form of birth control if youget the headaches throughout your cycle. If you only get the head-ache for the week that you stop the pill, consider taking the pillevery day and stopping it only one week every five months. Forthat week, use the estrogen patch noted above. Anti-inflammatoryaspirin-family medications like Motrin and Aleve may be helpfulin combination with Imitrex-related medications in estrogen-associated headaches.

Other Common Severe Headaches

A surprising number of people with chronic headaches haveunderlying medical problems that are often treatable—and thatshould be treated before the problem escalates any further.

Sinus HeadachesSinusitis is a common cause of headaches. It is usually associatedwith pain and tenderness over the sinuses by the cheeks or abovethe eyes. Nasal congestion, often with yellow-green nasal mucus,is also common. Interestingly, I have found that most cases ofchronic sinusitis are associated with yeast overgrowth. These fun-gal infections (similar to vaginal yeast infections but occurringpredominantly in the bowels) cause an allergic-type reactionresulting in swelling of the nasal passages. This swelling blocks thesinuses, resulting in a secondary bacterial infection (when themucous turns yellow-green), which is very painful. You then getantibiotics from your doctor that knock out the bacterial infec-tion but worsen the yeast/fungal infection and the nasal conges-tion. Things then get blocked up again and reinfected, and youare off to the doctor for another antibiotic (and more yeast prob-lems). This is why sinusitis usually becomes chronic.

I have found that when you treat the yeast overgrowth by tak-ing Diflucan for six weeks and avoiding sugar (as discussed previ-


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ously in Chapter 3 in the section on infections), most chronicsinusitis will go away. Adding a colloidal silver nose spray (listedin Appendix B) is also worthwhile. It is also helpful to use a spe-cial prescription nose spray that contains antibacterials and anti-fungals. Your doctor can order it by calling Cape Apothecary at410-757-3522 and asking for the “sinusitis nose spray.”

Use one to two sprays in each nostril twice a day. If it is irri-tating, then it is too concentrated for you, and you can simply adda small amount of salt water. Patients find this to be enormouslyhelpful. If fungal overgrowth is causing your chronic sinusitis, itmay also be causing spastic colon, which also often resolves whenyou treat the yeast. Unfortunately, many doctors still consider thepossibility of yeast overgrowth to be nonsense—just as occurredin medicine when we first began to understand about bacterialinfections. Because of this, you may have to go to a holistic/com-plementary physician to get the treatment you need. (Resourcesfor finding a holistic physician are listed in Appendix B.)

Caffeine Withdrawal HeadachesAlthough caffeine can sometimes decrease headache pain (and canbe found combined with aspirin in some headache products), toomuch caffeine can become problematic. Common in people whodrink too much coffee, caffeine withdrawal headaches are espe-cially frequent in the morning before people get their coffee “fix”and may occur approximately eighteen hours after their last cupof coffee. They often begin with a feeling of fullness in one’s headand may be aggravated by exercise. Slowly decreasing your caf-feine intake by about one cup daily each week, and perhaps mix-ing decaf with regular coffee as part of your weaning process, canhelp. Other people prefer to simply go cold turkey, tough out theheadache, and be done with it.

Cluster HeadachesThese headaches occur as a repeating series of headaches that caneach last thirty to ninety minutes and are very severe. They cause


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excruciating, piercing pain on one side of the head (often centeredaround one eye) and are much more common in men. Many med-ications can help, including antiseizure medications like Depakote(valproic acid) 500 to 1,000 mg a day or Topamax 50 to 100 mga day. These often start to work in one to two weeks. Lithium300 mg three times a day can also prevent cluster headaches.High-dose lithium must be monitored with blood level testsbecause it can cause an underactive thyroid, tremors, and othertoxicity. The tremors and neurologic toxicity can be decreased bytaking a few teaspoons of expeller-pressed safflower oil each day(from your local health food store).

Trigeminal NeuralgiaTrigeminal neuralgia affects a large cranial nerve and is charac-terized by excruciating attacks of stabbing, shooting pain in thelips, gums, cheek, or chin that last for a few seconds to minutes.It occurs almost exclusively in the middle-aged and elderly.Trigeminal neuralgia often responds well to treatment with themedications Tegretol and/or Neurontin.

Other HeadachesIn some headaches, there may actually be increased pressure in thebrain. Some practitioners have found that using Diamox (a diuretic)125 to 500 mg once or twice daily decreases these headaches. Car-bonated beverages will taste funny while you’re on this medication.

Jaw Joint Dysfunction (TMJ/TMD)Temporomandibular joint dysfunction (TMJ/TMD) is a commoncause of facial pain and headaches. Although classically consideredto come from the jaw joint (the area just in front of your ears), inmany cases the pain is actually coming from tightness of the mas-seter muscles, which can pull the jaw out of alignment. The mas-seter is the very powerful muscle we use to chew our food, andI’ve been told it can generate 1,000 pounds of pressure per squareinch. TMJ can occur when this muscle goes into spasm/shorten-


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ing. This can be caused by a poor bite, but also by all the otherfactors we discuss in Chapters 2 and 3 and under fibromyalgia andmyofascial pain in Chapter 6. By treating these same issues (sleep,hormonal deficiencies, infections, and nutritional support) themasseter muscles often release and the pain goes away. Because ofthis, dentists often come to my pain workshops and use thesetreatments.

A simple way to tell if the masseter muscle is contributing toyour pain is to put your thumb into your mouth and put itbetween your molars (back teeth) while also placing your secondand third fingers about two inches in front of your earlobe. Youwill feel a muscle between your thumb and fingers. Squeeze themuscle between your thumb and fingers and see if it producesmuch pain/tenderness. If so, your TMJ pain may be coming fromthe muscle and not the joint.

Zanaflex, like other treatments for muscle pain, can be veryhelpful. In one study, 2 mg of Zanaflex was taken two times a dayfor two weeks by seventy-eight people with jaw muscle pain. Bythe end of the treatment period, all of the patients had improved;forty-two patients (53.8 percent) showed absence of clinicalsymptoms; eighteen (23.1 percent) showed a good improvementwhile still presenting a low number of painful sites; and eighteen(23.1 percent) showed only a slight improvement.

It is also important to be aware that pain and hot/cold sensi-tivity in your teeth can come from tight muscles in the face—despite your teeth being totally healthy. It is frightening to seehow many people have had unnecessary root canals because theirdoctor/dentist is not familiar with these pain referral patterns. Fortooth pain in the lower jaw, push on the muscles right below thoseteeth to see if they are tender. Pain in the upper teeth can bereferred from the masseter muscles ( just in front of the ears) orthe pterygoid muscles (a large area by the temples). If these aretender and you do not have obvious tooth problems on yourx-ray/exam, try the pain creams and/or Lidoderm patches and agentle massage over those tender muscles three times a day for a


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few weeks to see if you can eliminate the dental pain. These den-tal pain referral patterns are described at length (along with treat-ment) in The Trigger Point Manual by Dr. Janet Travell and Dr.David Simons, which is the best pain book for doctors ever writ-ten. Treating these muscles first is a lot more fun than having rootcanals or having your teeth pulled unnecessarily!

In some cases of jaw joint pain, the discomfort is coming fromthe jaw joint itself. Often, the bite is not in alignment, and thisaggravates the pain. Treating the bite can help. In addition, it ishelpful to be sure that you do not grind your teeth at night (brux-ism) and to have your dentist give you a mouth guard if you do.Often the x-ray will show arthritis or cartilage slipping or loss inthe jaw joint. Some dentists recommend surgery in these situa-tions. I usually recommend that other measures be tried first.


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A Pain in the Gut

Indigestion, ulcers, acid reflux, gastritis, and spastic colon arecommon causes of abdominal and chest pains (discussed in Chap-ter 10). If the pain is coming from indigestion or acid reflux,drinking a few ounces of Maalox or Mylanta will usually causethe pain to ease up within a few seconds. When this happens,there’s a high probability that your pain is coming from stomachacid. In this situation, it is OK to use Tagamet or other acid block-ers short term to ease your symptoms. I do not feel that it ishealthy to use these medications long term, however, becausestomach acid is necessary for healthy digestion. When you aredealing with spastic colon, treating the underlying infections(especially yeast) can help to alleviate pain.

Resolving Chronic Acid Reflux andIndigestion Naturally

When you’re having indigestion/reflux, it is important to avoidcoffee (including decaf ), aspirin/Motrin-related products, andalcohol as all of these can aggravate indigestion. In addition, fol-lowing the directions in this chapter can help you to effectivelytreat and often eliminate indigestion, reflux, and gastritis naturally.

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If you still think your problem is too much acid, keep this inmind. The older people get, the more likely they are to useantacids. This is interesting as stomach acid production decreasesdramatically as people get older. However, we seem to forget thathaving stomach acid is both necessary and normal. In fact, thebody has gone to great lengths to be able to produce stomach acidwithout digesting the stomach itself ! Your body needs to haveproper nutrition to make the mucous lining that protects thestomach. Instead of giving our body what it needs to heal, wesometimes make the mistake of turning off our stomach acid tosolve the problem.

Most indigestion symptoms occur when stomach acid refluxes(squirts) back up into the food pipe (the esophagus). Your foodpipe is not made to resist stomach acid, and even a little bit willcause it to burn. Because of this, we take medications that turnoff all the stomach acid. Because there is no stomach acid, theburning stops, and we get deluded into thinking the problem istoo much stomach acid.

Unfortunately, using antacid medications for an extendedperiod causes two problems. First, with no stomach acid yourbody is not able to optimally digest food and you become nutri-tionally deficient. This makes it even harder for your stomach tomake the mucous lining it needs to protect itself and can set youup for even more reflux. Second, in your body’s attempt to makethe stomach acid it desperately needs (when you take antacidmedications), it makes huge amounts of a hormone called gastrin,which stimulates stomach acid. Because of this, as soon as youstop your antacids the stomach makes massive amounts of acid,which it cannot protect itself against. In essence, you becomeaddicted to the antacids. It is no surprise that Prilosec, Nexium,Zantac, and other antacids are some of the biggest moneymakingpharmaceuticals!

In mild or occasional cases of acid reflux, DGL licorice for afew days may be all you need. For more severe cases, follow these


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directions for a wonderfully effective way to resolve your refluxand indigestion.

• Drink sips of warm liquids instead of cold whileeating. Cold temperatures inhibit digestive enzymefunction.

• Improve your digestion by taking the properenzymes. Long-term use of digestive enzymes can alsodramatically improve your overall health and well-being!Take two capsules of Similase (by Tyler) or Complete GESTEnzymes with each meal to help digest your food properly. Ifthe enzymes are irritating to the stomach, switch to GSSimilase until your stomach feels better.

• Avoid coffee, aspirin products, colas, and alcohol.Avoid these products until your stomach heals, and then usethem in limited amounts. Iced tea is OK but stimulates acidreflux in some people.

• Take measures to heal your stomach lining using DGL licorice. This can be powerfully effective in resolvingyour symptoms. It must be the DGL form, which has thecomponent that stimulates your adrenal gland removed,because others can cause blood pressure problems. Researchshows that DGL licorice is as effective as Tagamet, but ishealthy for you! Take 380 mg (not the awful tasting sugar-free one), and chew two tablets twenty minutes before meals.Mastic gum (available online at vitality101.com) 500 to1,000 mg twice a day for two months is also highly effective.These can be used separately or together. Because they helpto heal the stomach instead of just masking symptoms, theymay take three to six weeks to work in severe cases. You canuse your antacids during that time if you want.

• Add Limonene (Heartburn Free by EnzymaticTherapy) once your indigestion has settled down a bitwith the licorice and mastic gum. In many patients,

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stomach infections (H. pylori) can be a major cause of long-term indigestion. Most doctors treat this with Priloseccombined with two to three antibiotics used simultaneously.However, while the suggested natural remedies may initiallyaggravate reflux symptoms, by killing the infection they maygive long-term relief after only one ten-capsule course! Takeone capsule of Heartburn Free every other day for twentydays. Mastic gum can also eliminate H. pylori infections.

Coming off Prescription Antacids SafelyAfter you have been on this treatment regimen for one to twomonths and are feeling much better, ask your doctor if you canstop your prescription antacids and switch to Tagamet (or stay onthe DGL licorice/mastic gum). This will decrease your stomachacid instead of totally turning it off. By doing this, your body canslowly ease back to a normal production of acid. Decrease thedose of Tagamet or DGL licorice until you are able to come offof it. After two months, most people can stop the licorice/masticgum. They can be used as long as you want, however. If symp-toms recur down the line, simply use the mastic gum or DGLlicorice for a few days. If needed, you can repeat the course ofDGL licorice/mastic gum (and even the Heartburn Free if thestomach infection recurs) whenever you like. Meanwhile, you’llhave broken your addiction to antacids and allowed your body tohave the stomach acid it needs for proper digestion!

The Importance of Enzymes for Digestive Health

Unfortunately, medical schools do not give physicians much infor-mation on proper nutrition or digestive health. Yet how can yourbody stay healthy if it can’t get the nutrition that it needs from food?Enzyme deficiencies can contribute to many conditions, including:

• Indigestion, gas, bloating, diarrhea, and constipation• Arthritis and inflammatory disorders• Fatigue and muscle aches


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Proper nutrition is important for all your body’s functions. Theability to properly digest your food is critical for proper nutritionand the avoidance of toxicity.

In medical school, I was taught that the pancreas and salivaryglands made all of the enzymes you needed to digest your food. Ifthere was a problem with the pancreas, we could always givedigestive enzyme tablets made from an animal pancreas to take careof the problem. This information seems to be woefully deficient!

What goes on in real life is that most of the enzymes we needto digest the foods we eat are naturally present in the foods. Thisoccurs because fruits and vegetables use enzymes to ripen. As theripening process continues, the food breaks down to where weconsider it to be rotten. From the perspective of an apple or grain,however, this is a perfect stage for the seed to use its food sourceso it can grow into an adult plant. These same plant enzymes workin the acid environment of your stomach, where approximately40 percent of digestion can take place, while animal enzymes can’twork until after they get past the stomach.

Decades ago, food processors realized that they could prolongthe shelf life of food from days to years by destroying the enzymespresent in the food. They also discovered that heat or salicylates (theactive component of aspirin) are very effective ways to destroyenzymes. Over the last thirty years, the processing of foods hasessentially eliminated most of the enzymes present in our food.This corresponds to the period of time in which we have seen adramatic increase in degenerative diseases and indigestion. Mean-while, your poor pancreas has had to pick up the slack and makealmost all the enzymes needed for digestion. Many people realized,however, that if they juiced or ate a raw food diet (cooking can alsodestroy enzymes) they felt dramatically better. Food processors arelearning new tricks, though. By gassing fresh fruits and vegetables,they can destroy the enzymes present even in these fresh foods.This way these foods can look appealing on the grocery shelf forweeks instead of developing those little brown spots that we don’tlike to see. Unfortunately, although the food looks good when youdestroy the enzymes, it has lost much of its nutritional value.

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What Happens When You Don’t Have Enough EnzymesWhen you don’t have enough enzymes to adequately digest yourfood, several things happen. First, you become deficient in pro-teins, carbohydrates, and/or fats—depending on which enzymesyou are missing—and you then crave the missing nutrient. By eat-ing excessive amounts of the nutrient you can’t digest, it can buildup in your colon and become toxic. You absorb large chunks ofproteins into your bloodstream before they are broken down totheir component amino acids, and then your immune system hasto treat them as outside invaders, using up its energy completingthe digestion of those foods. This process can exhaust yourimmune system while contributing to food sensitivities. (If youcheck you may find that your temperature goes up around fortyminutes after eating because your immune system has had to makeup for a weak digestive system.)

Thus, your body works poorly because of the nutritional defi-ciencies, and you have digestive disturbances. All in all, you feellousy. Your stomach hurts, and you may have specific food crav-ings. Sound familiar?

Why Which Enzymes You Use MattersAs noted earlier, it is critical that the enzymes be from plant sources,as animal enzymes do not work in the acid environment of thestomach. Enzymes can also easily be destroyed in processing, soquality is critical. I recommend taking Similase or CompleteGest,two with each meal. If the enzymes irritate your stomach in thebeginning, as protein-digesting enzymes might, begin with GSSimilase first because this form is gentler on the stomach.

Eliminating Spastic Colon by Treating theUnderlying Causes

Another painful abdominal problem is spastic colon (also knownas irritable bowel syndrome), which can occur when you have gas,bloating, abdominal cramps, diarrhea, and/or constipation with anegative medical workup. When physicians do not know what is


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causing your symptoms, we give you the label of “spastic colon,”instead of more effectively searching for the source of thesymptoms.

The most effective way to eliminate spastic colon is to treat theunderlying cause. This is usually infection, and in my experiencemost patients’ spastic colon resolves when the underlying bowelinfections are treated. What is most important is to treat the can-dida/fungal overgrowth in the gut. Unfortunately, most physi-cians still make believe that fungal or yeast overgrowth isnonexistent. This is reminiscent of our early days in medicinewhen we first learned about, but still ridiculed, the possibility ofbacterial infections. Although the research needs to be completedto demonstrate the role of fungal infections in chronic illness, alarge body of clinical experience has shown this to be a majorproblem. Many people with yeast overgrowth also find that theyhave chronic sinusitis and/or nasal congestion that go away whenthe fungal infection is treated.

In addition, many patients have parasitic infections. For exam-ple, in my study on the effective treatment of chronic fatigue syn-drome, one out of six of the study patients had a parasite present.Unfortunately, many if not most labs are clueless about how to con-duct a proper stool parasite exam and will miss the vast majority ofthese infections. Because of this, I would only do the parasitologytesting by mail at the Great Smokies Diagnostic Laboratory or theParasitology Center (see Appendix B). If your doctor will not giveyou a lab requisition for this test at these labs, or for any other testsyou may need, you can obtain a lab requisition on my website at nocharge (vitality101.com—click on “Do the Program” and then on“Get a lab requisition”).

I would also recommend a stool test for Clostridium difficiletoxin. Clostridium difficile is a toxin-producing bacteria, and thistest can be done at any laboratory. For more information on treat-ing these infections, see Chapter 3 in this book and my book FromFatigued to Fantastic!

While you’re going after the underlying cause of a spasticcolon, there are many treatments you can take for symptomatic

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relief. One natural therapy is peppermint oil. This must be in anenteric-coated capsule or it could be quite irritating. Take one totwo capsules three times a day between meals (not with food) forspastic colon. I recommend Peppermint Plus or Mentharil. Othernatural remedies that can be helpful are Iberogast (digestive sys-tem herbal), twenty drops three times a day in warm water withmeals (takes four to eight weeks to work), or artichoke extract,two 160 mg capsules three times a day. Artichoke extract stimu-lates bile acid release and may help decrease the risk of gallstones.Over-the-counter simethicone (Mylicon) can also be helpful.When chewed, this breaks big gas bubbles into little ones,decreasing the sense of bloating.

Prescription medications that can be helpful include antispas-modics such as hyoscyamine and Valium family medications suchas Librax. These can be used on an as-needed basis. If constipa-tion is a predominant symptom, adding fiber and water plus theEnergy Revitalization System vitamin powder can be very help-ful. If these are not adequate, you can take the prescription med-ication MiraLax. In addition, you can add Zelnorm 6 mg twice aday for both constipation and pain.


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Dealing with Pelvic PainSyndromes

Pelvic pain can be caused by menstrual cramps, vulvodynia, inter-stitial cystitis, endometriosis, or prostadynia. In this chapter, we’llreview each of these.

Interstitial Cystitis (IC)

Interstitial cystitis is a bladder problem that causes severe discom-fort in approximately five hundred thousand Americans. Ninetypercent of people affected are women, and the condition oftenoccurs in association with other illnesses such as fibromyalgia.Onset of symptoms is often between the ages of forty and sixty.On average, people see five doctors before they find one who isable to make the diagnosis. IC is characterized by severe urinaryurgency, frequency, burning, and pain. These symptoms in mildform are common in chronic fatigue syndrome (CFS), fibromyal-gia, and chronic pain, and are not what I am discussing here. ICis when these symptoms are the predominant problem and areoften so severe that people want to have their bladder removed.

The more common category of IC is nonulcerative and is mostoften seen in young to middle-aged women. It is associated withnormal or increased bladder capacity. The cause of IC is not

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known, but there are many theories. In all likelihood, it is causedby a number of different problems. One possibility is that thereare infectious triggers, which either irritate the bladder directlyor cause an autoimmune reaction in which the body attacks itself.The autoimmune theory has recently been getting more support.For whatever reason, the protective inner lining of the bladder(called the glycosaminoglycan, or GAG) gets damaged, resultingin severe bladder irritation and pain, urinary urgency and fre-quency, and decreased bladder capacity. Again, it is important topoint out that the symptoms in mild form are very common andare not IC. IC is often associated with vulvar pain and painfulintercourse (discussed later in this chapter). There is no definitivetest for IC, and the diagnosis is based on clinical symptoms andbladder cystoscopy (looking in the bladder with a tube). Otherinfections need to be ruled out, as does cancer.

How to Relieve Symptoms with MedicationsAlthough there is currently no cure for interstitial cystitis, thereis much that can be done to relieve the symptoms. Surgery shouldbe a very rare and final resort. Even after the bladder has beenremoved, half of the IC patients will continue to suffer from pain.

Once bacterial infections have been ruled out, I add Elavil25 mg at bedtime plus Neurontin. If these are ineffective, a trialof Sinequan and the other antiseizure medications are worth-while. The medications Pyridium, which numbs the bladder andturns the urine and sweat light orange, and Urispas, an antispas-modic, can be helpful as well.

I would also treat the patient for presumptive candida with oralDiflucan for three months, which may help as well. (See the anti-fungal/antiyeast protocol discussed in Chapter 3.) Although it hasnot been well studied, many physicians suspect that yeast over-growth, like some other infections, may contribute to IC. A crit-ical part of the antiyeast/antifungal protocol is avoiding sugar,which feeds yeast. Interestingly, Dr. Ward Dean had noted thatone person’s IC cleared up when she used xylitol, which looks and


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tastes like sugar, as a sugar substitute. It is not clear whether thexylitol helped, or simply avoiding the sugar was the reason for thepatient’s relief. Either way, xylitol is a good sugar substitute withmultiple health benefits, including preventing cavities and osteo-porosis, and is worth trying.

Urologists can also put different medications in the bladder,such as DMSO and heparin, both of which can be helpful. I rec-ommend the medication Elmiron, which may take three monthsto work. Take a 100 mg capsule three times a day with water atleast one hour before, or two hours after, eating.

Natural Ways to Relieve SymptomsIt is also important to avoid certain foods that may aggravatesymptoms and to recognize that vitamins, especially the B vita-mins and any that are acidic, can dramatically irritate the bladderin some patients with IC. Because of this, supplements, especiallyone as powerful as the Energy Revitalization System vitaminpowder, should be tried in extraordinarily tiny doses (stick a fin-ger in the powder and lick it) first to make sure they are tolerated.Then slowly increase the dose if you are able. Take any B vitaminswith a large amount of water. Otherwise, they can achieve highconcentrations in the bladder. In most people this causes no prob-lem, but can be irritating in those with IC or bladder spasm. Bvitamins are bright yellow and you can tell when they are con-centrated in the urine.

Dr. Stanley Jacob, M.D., the physician who helped to get FDAapproval for the use of DMSO (instilled into the bladder) for IC,has also explored the use of methylsulfonylmethane (MSM) totreat IC patients. Although MSM takes longer to work (severalmonths), it is better tolerated than the DMSO, which is irritatingand results in a garlicky body smell. Dr. Jacob estimates that 80percent of his IC patients improve with MSM. He has his patientsmake a formula of 15 percent MSM in deionized sterile water anduse a catheter to put the solution in their bladders (two to fivetimes a week), holding it in their bladder as long as is comfortable.

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He gives the MSM intravenously and by mouth (starting with 1 ga day and increasing to 18 g daily). For more information, see Dr.Jacob’s book MSM—the Definitive Guide.

Lower morning cortisol levels have also been associated withincreased symptoms of IC. Many fibromyalgia patients getmarked improvement in their IC as part of the overall improve-ment of their fibromyalgia. One of the treatments I often give iscortisol in very low doses.

Another natural remedy that has been shown to be helpful inIC is the amino acid L-arginine 500 mg three times a day for threemonths. In one study of fifty-three patients with IC, half weregiven the L-arginine and the other half a placebo. At the end ofthree months, 29 percent of the patients on arginine were feelingbetter with less pain and urgency as compared to 8 percent in theplacebo group. L-arginine helps to make nitric oxide, which canrelax the bladder muscle. The enzyme that makes nitric oxide hasbeen shown to be low in interstitial cystitis patients. In anotheropen study using 1,500 mg of L-arginine daily a similar effect wasseen. Another study using higher amounts did not show benefit,so more is not better.

Some health practitioners have found that patients with inter-stitial cystitis often have chronic extremely alkaline urine. Thiscan be aggravated by excessive coffee and cola intake. PH strippaper can be obtained cheaply at most pharmacies, and one cantest multiple urine samples at home to see if the pH is regularlyover 7.0.

In addition, certain enzyme therapies by Thera-zyme havebeen found to be very helpful. They can be obtained from myoffice at 410-573-5389 or from the Thera-zyme company. Forinterstitial cystitis use the enzyme URT. Take four capsules fivetimes a day between meals; and add the enzyme product calledKDY, two capsules every twenty minutes, as needed during flares.In two to four weeks the symptoms may subside and the productscan then be taken just as needed.

Although I have not yet used it for interstitial cystitis, it wouldbe worth trying the herbal saw palmetto, 160 mg twice a day for


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six weeks as this relaxes the bladder muscle in those with urinaryretention and an enlarged prostate. Research shows that this safeherb promotes smooth muscle (the bladder muscle) cell relaxationby a number of different mechanisms. It takes six weeks to work.

The good news is that most patients I have seen with IC havereceived significant relief using some combination of thesetreatments.

Painful Menstrual Cramps and Vulvodynia

For menstrual pain, NSAIDs can be very helpful. You can beginwith over-the-counter pain relievers such as Advil or Aleve.

Vulvodynia is defined as chronic vulvar itching, burning, and/or pain that is significantly uncomfortable. In this condition, vul-var/vaginal pain can either occur only during intercourse or beconstantly present. It used to be thought that it was fairly rare.Recently, the National Institutes of Health (NIH) funded a studyto see how common vulvodynia is. According to Dr. Harlow,associate professor of gynecology at Harvard Medical School,“The preliminary data suggest that possibly millions of womenmay be affected at some point during their lifetime.” The Inter-national Society for the Study of Vulvovaginal Disease has pro-posed several names to describe the different types of vulvodyniawhich include:

• Generalized vulvar dysesthesia (VDY)—characterized bypain that can occur anywhere on the vulva

• Localized vulvar dysesthesia—characterized by pain that canbe consistently localized by pushing on certain area(s) of thevulva

• Mixed dysesthesia—a combination of both of the above

Symptoms can occur anywhere from the pubic bone to theanus. It may be present all of the time, sporadically, or only withintercourse. Many women feel like they have a chronic yeastinfection. In others, it feels raw, swollen, or like they are sitting


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on a hard knot. Burning, electric shocks, and tingling are alsooften felt. If the area around the urethra (where the urine comesout) is involved, the woman may feel like she has a chronic blad-der infection. She may have recurrent urinary urgency, frequency,and burning despite having negative urine cultures. Painful inter-course (dyspareunia) is common, and pain may even occur fromtight slacks or panties.

Some patients have found that for painful intercourse, topical0.2 percent nitroglycerine cream can give temporary relief (madeby a compounding pharmacist in a base without any irritatingadditives). In my experience, vulvodynia seems to occur as threemain types: neuropathic, inflammatory, or as muscle pain.

When It’s NeuropathicNeuropathic vulvodynia appears to be caused by nerve irritationand is sharp, burning, and/or shooting (like nerve pain). In thiscase, apply the treatment principles in Chapter 4 on neuropathicpain. Begin with tricyclic antidepressants (nortriptyline, desipra-mine, imipramine, doxepin, or Elavil) at 25 to 150 mg each nightand/or Neurontin (100 mg to 3,600 mg daily), and proceed fromthere. Be sure to use a high enough dose of the medications andgive them enough time to work, which may take three months.In addition, topical lidocaine (Novocain) gel can be helpful (forexample, EMLA cream). In severe cases, opiates may be necessary.

When It’s InflammatoryWhen vulvodynia pain is associated with local inflammation/irri-tation, I would avoid topical creams, especially if they containparabens, propylene glycol, fragrance, or sorbic acid. Also, do notuse topical antifungals or over-the-counter creams. Instead, I rou-tinely give at least a three-month trial of oral Diflucan 200 mg aday to be sure any chronic vaginal yeast is eliminated. Occasion-ally, long-term Diflucan treatment is needed. In this case, checkliver blood tests occasionall, because this medicine can cause liverinflammation. Some patients find that avoiding oxalates can helpdecrease symptoms. In a small subset of patients, one can see a


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narrow ring of tissue that is inflamed and which reproduces thepain when touched (with a cotton swab). In these patients, surgi-cally removing that small area of tissue is reasonable.

When It’s Muscle PainIf the pain is deep-seated and not triggered by touching the outervagina, it may be coming from spasm of the deep pelvic muscles.In this situation, the pain may occur or be accentuated during thedeep thrusting of intercourse. For this pain, the general principlesfor treating muscle pain apply (see Chapter 6). In addition, EMGbiofeedback of the pelvic floor muscles may help vulvodyniacaused by muscle pain. Muscles that are often involved include theobturator internus and pubococcygeus. The sacroiliac joint anddisc/spine disease (see “Treating Disc Disease” in Chapter 10) alsorefer pain to the pelvic and rectal areas. Any injury or conditionaffecting these can trigger pelvic pain.

Important Precautions to Take with VulvodyniaAs noted earlier, precautions include avoiding any direct chemi-cal contacts that can irritate the vulva such as sprays, creams, orminipads. In addition, it is a good idea to wear loose, comfortableclothes and to avoid thong underwear and biking. Sitz baths canalso be helpful. Menopausal women should use topical naturalestrogen (estradiol) to prevent atrophy.

Many of my patients with fibromyalgia also have vulvodynia.As with IC, it seems that symptoms of vulvodynia often resolveas their fibromyalgia resolves. I put almost all women with pelvicpain on tricyclics such as Elavil or nortriptyline combined withNeurontin.

Endometriosis

Endometriosis is a complex disorder affecting females during theirreproductive years. In this disorder, the tissue that lines the insideof the uterus and sheds each month during the menstrual cycle(called the endometrium) escapes the uterus and attaches to inap-


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propriate areas within the pelvis and abdomen. These growthsthen respond to changes in estrogen just like tissue within theuterus. Because of this, women will often get pelvic and abdomi-nal pains that are worse around their period. These pains are usu-ally worse than menstrual cramps. In addition to pain, womenwith endometriosis often experience myriad other symptoms sim-ilar to fibromyalgia (fatigue, insomnia, widespread achiness) thatimprove with treatment (see Chapter 6) as well as allergies, asthma,and autoimmune problems. Although the cause of endometriosisis unknown, there are many theories.

Most doctors forget to consider this diagnosis in evaluatingabdominal and pelvic pain. The diagnosis is made by laparoscopy.During this surgical procedure, the surgeon makes a small inci-sion and inserts a tube through which he can see the internalorgans to evaluate for endometrial implants. If these implants areseen, the diagnosis is made and treatment is given with hormonaltherapies that attempt to stop ovulation. Pain medications aregiven as well. Pregnancy often causes a temporary remission ofsymptoms. Many alternative therapies are also available.

Although this condition is too complex to be dealt with thor-oughly in this book, I recommend a book called Endometriosis byMary Lou Ballweg and the Endometriosis Association. This orga-nization is located in Milwaukee, Wisconsin, and is dedicated tohelping women with endometriosis.

Prostatitis and Prostadynia

Even in the absence of a full-blown attack of prostatitis, which isusually not subtle and is easily diagnosed and treated, prostate painis fairly common in men. When no infection is found, it is calledprostadynia. It is also known as chronic nonbacterial prostatitis orchronic pelvic pain syndrome (CPPS). Unfortunately, when doctorsdo not know what is causing a problem, we often presume it mustbe psychological (“I don’t know what’s wrong with you, so youmust be crazy!”). This is what has occurred with prostadynia.


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I suspect that prostadynia often occurs because of subtle infec-tions that do not grow on our culture media. These commonlyinclude fungal infections and/or other slow-growing antibiotic-sensitive infections. In the latter case, the prostate is mildly boggy(indents like a ripe fruit) instead of firm and is tender on exami-nation. Unfortunately, most doctors consider such an exam nor-mal despite your having prostate symptoms. These symptomsinclude urinary urgency without there necessarily being muchurine present and burning on urination. The discomfort is oftenfelt on the tip of the penis. Because the infection is not overt,most doctors offer no treatment.

My suspicion is that this is indeed an infectious problem inmany cases. This suspicion is bolstered by a recent study showingthat mepartricin (40 mg per day for two months), an antibioticwith antifungal and antiparasitic properties, decreased symptomsby 60 percent in these patients. The study does not totally supportinfection as the cause, however, because the medication also low-ers estrogen levels in the prostate and can work in that way as well.In the study, the authors theorized that lowering estrogen causedthe improvement. My experience, however, shows that patientsalso improve with antibiotics and antifungals that do not lowerestrogen. Treatment needs to be given for many months, sinceanti-infectious agents have difficulty getting into the prostate.

The bioflavonoid vitamin quercetin (500 mg twice a day) alsodecreases prostate symptoms in both prostadynia and prostatitis.In one study, thirty men with severe prostadynia lasting an aver-age of eleven years were treated with either quercetin 500 mgtwice a day or a placebo for one month. There was an average 37percent decrease in symptoms with over two-thirds of patientsfeeling they gained a meaningful benefit. Quercetin 500 mg ispresent in the Energy Revitalization System vitamin powder (seeAppendix B).


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Treating OtherCommon Pains

Based on Their Locations

In this chapter, I focus on other common pains that are based ona specific location in the body. I cover treatments for back pain,one of the most common chronic pain conditions, as well as fornoncardiac chest pain, which is also fairly common and present inabout 10 percent of the population. Pain in the arms and legs isalso discussed in this chapter, including carpal tunnel syndrome,tendonitis, frozen shoulder, leg cramps, plantar fasciitis, and Mor-ton’s neuroma.

Chronic Back Pain

Chronic back pain affects an estimated 36 million Americans. Itis the price we pay for being an upright species. Fortunately, it isalso very treatable. In understanding back pain, it is helpful tounderstand the anatomy of the spine. The spine is made up of a

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column of bones called the vertebrae. From top to bottom, theseare divided into four sections:

• The seven cervical (neck) vertebrae (C1–C7)• The twelve thoracic (upper back) vertebrae (T1–T12)• The five lumbar (lower back) vertebrae (L1–L5)• The sacrum plus the tailbone (coccyx) at the bottom of the

spine

The bones/vertebrae of the spinal column are held together bytendons, ligaments, and muscles. Between the vertebrae are shockabsorbers called discs. These flexible pads of cartilage contain liq-uid. If this liquid leaks out, it can trigger inflammation andswelling, which pinches on the nerve roots, causing pain. Byeliminating the tissue swelling using intravenous colchicine (dis-cussed later), disc pain can be eliminated approximately 70 per-cent of the time without surgery!

The spinal cord itself is a critical bundle of nerve cells that areinside the spinal column and protected by it. At each of the ver-tebrae, nerve roots come out of the front of the spinal columncarrying information from the brain to the body and nerve rootsenter the back of the spinal column bringing information fromthe body to the brain. Compression of, or damage to, these nerveroots causes pain and loss of sensation and function.

It’s always good to start with the basics when considering treat-ment for back pain. For example, in one study people with lowback pain who slept on a medium firm mattress had less back painthan those who slept on a firm mattress. Distraction and relax-ation, such as listening to relaxing music for one half-hour dailyfor three weeks, also reduced back pain by 40 percent.

Treating Disc DiseaseIn disc disease, the nerve is being pinched as it comes out of thespine. As the vertebrae and discs (the building blocks that makeup the spine) develop wear and tear, the discs, which act as shock


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absorbers between the vertebrae, sometimes rupture, and the fluidinside of the disc leaks out. As noted earlier, this disc fluid cancause inflammation and swelling that can compress the nerve as itenters the spine, causing pain. MRIs and x-rays are poor indica-tors of whether the pain is coming from disc disease (rather thanfrom tight muscles or muscle spasm pinching the nerve) as almosteveryone shows normal “wear and tear” in back x-rays.

Fortunately, over 70 percent of back pain from disc disease canbe eliminated without surgery by simply giving six intravenousinjections of an old gout medicine called colchicine. Given intra-venously, this medicine gets into the disc space and turns off theinflammation and swelling. Relief usually occurs by the fifth tosixth dose. It is fairly safe, with the main risk being rare and severeallergic reactions (similar to the risk with penicillin) and a nastyskin burn if it leaks out of the IV (the medication has to stay inthe vein, not anywhere else). This can usually be easily avoidedby making sure the IV is flowing well. I usually recommend thatas long as the IV is in, you also get the IV nutrients in Myers cock-tails (see Chapter 11) because this helps associated muscle pain.Two studies with more than one thousand patients (one studybeing placebo controlled) have shown the same 70 percent reliefrate that I and others who use it in practice have found. Only onestudy (conducted with fourteen long-term workman’s compensa-tion patients who had failed all other treatments, where no treat-ment was likely to help) did not show benefit.

The main problem with the use of IV colchicine in disc dis-ease is that it is too inexpensive. It costs three dollars per dose forsix doses, with the main cost being that of starting the IV. Becausethere is no money to be made, and it would eliminate most backsurgeons’ business, surgeons are understandably hesitant to look atthe research. One excellent local orthopedist had a staffer whohad disc disease for many years but refused surgery. When shecame to our office, we treated her with the IV colchicine and thedisc pain, as usual, went away. One night, my partner and I wereout for dinner when the orthopedist entered the restaurant. When

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he came over to say hello, my partner asked the orthopedist whathe thought about his staffer’s pain going away without needingsurgery. The orthopedist ignored the comment and kept on talk-ing as if we had never asked the question.

Treating Sciatica. Sciatica, or back pain in which the pain goesdown the leg, is very common. Sciatica is simply disc disease fromcompression or irritation of the nerve from the foot as it entersthe spine (although a tight muscle can also pinch the nerve). If youlie on the floor and lift the painful leg straight up without bend-ing it (while keeping the other leg flat on the floor), it can stretchthe nerve and worsen the pain. This is called the straight leg rais-ing test. Sciatica also usually goes away by treatment with intra-venous colchicine.

Additional Treatments for Disc Disease. It is reasonable to add glu-cosamine sulfate, 1,500 mg a day; MSM, 3,000 mg per day; andchondroitin sulfate, 2,500 mg per day. Give this combination asix- to twelve-week trial. In one Russian study, 73 percent ofthose who took the chondroitin had less back pain and moremobility. As noted above, use only low molecular weight chon-droitin (such as the one made by Enzymatic Therapy) as mostothers are poorly absorbed. These compounds may help to rebuildthe cartilage tissue worn away by wear and tear.

Lamictal (lamotrigine, a seizure medicine that acts as a sodiumchannel blocker with some calcium channel blockade) can also behelpful. In one study with patients who had severe refractory neu-ropathic pain (especially disc pain) and had failed at least twoother treatments, there was an average 70 percent drop in pain infourteen of twenty-one patients using this medication.

What If It Is Not Disc Disease?Most other back pain, unless it is coming from your chest orabdominal organs (which is rare and can be found by yourinternist) is muscular. Using the treatments in the chapter onmyofascial pain (Chapter 6) and also taking care of any underly-


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ing structural/ergonomic problems (see Chapters 3 and 12) canroutinely eliminate this pain. In addition, chiropractic (see Chap-ter 12) and mind-body approaches such as those developed by Dr.Sarno (see Chapter 14) can also be very helpful, as can manyforms of bodywork.

Noncardiac Chest Pain

Once your doctor has ruled out heart or lung problems as a sourceof your chest pain, it most often turns out to be muscle/cartilagepain or indigestion/acid reflux. A diagnosis of costochondritis—pain in the chest wall muscles and cartilage—is made by exami-nation and ruling out other problems since lab and other studiesprovide little information about muscle pain. Interestingly, mus-cle pain over the lower half of the chest bone (sternum) is involvedin a reflex arc that can both cause and be caused by acid reflux.Treating this muscle pain can decrease reflux problems as well.

Costochondritis pain tends to be aggravated by movement,deep breathing, or position change. It tends to be sharp, nagging,aching, or pressure-like, and it is usually fairly well localized,although the pain may radiate. It is usually along the sides of thesternum (the chest bone in the center of the chest), two inchesbelow the left nipple, or in the pectoral muscles in the upper chest.Reproducing the chest pain by pushing on the area suggests thatthe pain is coming from the muscles or ligaments of the chest walland is not dangerous. Nonetheless, it is best to be on the safe sideand have a physician make sure that the pain is not coming fromthe heart.

Hot compresses and relaxing the muscles with your mind canbe helpful, as can the treatments for muscle pain discussed inChapter 6. For severe cases, Lidocaine patches can be very help-ful, as can the pain creams. Aspirin family medications such asMotrin can be helpful but can cause indigestion or stomach ulcersand bleeding, which can worsen the chest pain.

If the pain is in your solar plexus and midchest and is relievedby taking a few ounces of Maalox, Mylanta, or other antacids, or


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is affected by eating, it is likely indigestion. (See Chapter 8 forinformation on treating pain from indigestion.)

When to WorryThe most worrisome causes of chest pain, however, are anginaand heart attacks. These pains are usually associated with tightnessand pain that radiates down the left arm, shortness of breath, andsweats and is made worse with walking or exercise. Everyone isdifferent, however, and sometimes these pains can be atypical. Itis always best to be on the safe side and have a family doctor checkout the source of chest pain to be sure it is not coming from some-thing dangerous. Most doctors are very good at diagnosing andtreating angina and other dangerous causes of chest pain. Oncethese have been ruled out, I would go ahead and apply the treat-ments described in this chapter to help eliminate your chest pain.

Carpal Tunnel Syndrome and Thumb Tendonitis

Carpal tunnel syndrome is characterized by pain, numbness, andtingling that occurs in one or both hands. It often wakes peoplefrom their sleep, leaving them feeling like they have to “shaketheir hands out” to make the pain and symptoms go away. Thissyndrome is caused by compression of the median nerve as it goesthrough a narrow tunnel in the wrist formed by the carpal bone,hence the name carpal tunnel syndrome. According to the Amer-ican Academy of Neurology, 10 percent of the population suffersfrom the syndrome. It also affects up to 50 percent of industrialworkers.

All too often the syndrome is treated by surgery. Although thiscan be effective, it is also expensive and can leave people withresidual problems due to the formation of scar tissue that canoccur after surgery.

Nonsurgical Treatment Options for Wrist PainFortunately, unless people are continuing to stress the wrist withrepetitive stress injuries (such as handling heavy equipment or


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doing large amounts of typing), carpal tunnel syndrome canalmost always be relieved without surgery. In almost all of mypatients, their carpal tunnel syndromes have resolved by simplyusing vitamin B6 (250 mg daily), Armour thyroid hormone (seeChapter 2), and a wrist splint for six weeks. When your hand getsinto funny positions while you are sleeping, it stretches and strainsthe nerve as it goes through your wrist. This is why you wake upin the night with numbness or tingling. The type of wrist splintto use is called a “cock up” wrist splint. It keeps your hand in theneutral position (the position your hand is in while holding a glassof water), which takes the stress off the nerve. Be sure to wear thesplint for at least six weeks while you’re sleeping. During thatperiod, also wear it during the day when you can.

Although the treatment I mentioned generally takes care ofcarpal tunnel syndrome, it is worth being aware of a new treat-ment as well. A portable wrist traction device combines neutralwrist position and stretching to decompress the carpal tunnel. Itis used ten minutes twice a day for one month, followed by tenminutes once a day for a second month. It can be used at home orat work, making it very convenient. At the end of a study ofthirty patients, most had normalization or near normalization ofthe nerve function.

Other conservative measures can also be effective, includingacupuncture, osteopathic manipulation, chiropractic manipula-tion, and myofascial release. Unfortunately, your doctor may betotally unfamiliar with these conservative therapies; in today’smedicine only expensive treatments tend to get attention. If sur-gery is recommended, ask your physician if you can try these con-servative measures instead for six to twelve weeks.

Thumb TendonitisThumb tendonitis is characterized by pain along the side of yourhand going from the thumb joint toward the wrist. If you feelaround, you may find a “ropy” cord (the tendon) that hurts, withthe pain worsening when you push on it. The pain gels/creams(see Chapters 3, 4, and 13, and see Appendix B for sources) can


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work very well for this; but you need to give these medicationsseveral weeks to work. Steroid injections locally are also reason-able, but should not be injected into the tendon.

Shoulder Problems

Frozen shoulder has many causes, including tendon inflammation,bursitis, and injury. Anything that causes pain on motion can trig-ger it. This occurs as the patient stops moving the shoulderbecause of the pain. The shoulder gradually loses mobility, andscar tissue can form around the shoulder joint causing it tobecome frozen. Rotator cuff tears are a common cause. If youhave shoulder pain and find that you can only lift your arm up toshoulder level to the side (a 90-degree angle), a rotator cuff tear islikely.

The usual treatments include NSAIDs (discussed in Chapter13) and physical therapy (heat, ultrasound, and range of motionexercises). Cortisone injections can also be given. If these treat-ments fail after six to twelve months, surgery to repair the jointmay sometimes be necessary.

When doing range of motion exercises, increase the jointmovement up to the point where it causes mild pain, but do notpush through pain as this can further injure the joint. Severalgood stretches for the shoulder include:

• Using your other hand to lift your hand up to the top of adoor (so that your hand holds on to the top of the door),gently squat down to stretch the shoulder.

• Putting your arm behind your back and using your otherhand to gently pull on it and stretch it. (This can also bedone with your arm over your head.)

It is good to be sure that you maintain range of motion of yourshoulder anytime you have shoulder pain to prevent a frozenshoulder.


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Leg and Foot Pain

In some people, the calf and other leg muscles go into spasm whilethey are sleeping. A number of treatments can prevent this.

• Begin by taking the Energy Revitalization System vitaminpowder (take the vitamin B-complex capsule in the morningand the powder at night).

• In addition, take calcium 500 to 1,000 mg at bedtime andincrease the potassium in your diet (bananas, V8, andtomato juice are good sources of potassium).

• Stretch your calf muscles before you go to sleep. This can bedone by pulling your toes toward you when you’re sitting onyour bed.

• Wearing socks at night can also help because cold feet willsometimes be a trigger.

• Quinine can be helpful for nighttime leg cramps as well.

For most of my patients, the nutritional support I recommendplus quinine has done an excellent job in relieving pain from legcramps. Interestingly, several readers of Dr. Peter Gott’s medicalcolumn have noted that leaving a bar of soap (but not Dove orDial soap) under their bed sheet stopped their leg cramps. It seemsodd, but it is cheap, safe, and easy to try.

Foot ProblemsPlantar fasciitis is the most common cause of pain along the entirebottom of the foot. It occurs when you have a tightness/irritationof the muscles and tissues that form the “suspension bridge” onthe bottom of the foot. This is very common in my fibromyalgiapatients and routinely goes away with the overall treatment pro-tocol (see Chapter 6). In addition, a podiatrist or chiropractorfamiliar with the technique can tape the bottom of the foot. Thiswas another wonderful trick that Dr. Ron Huse taught me. Thistape then takes over the role of the suspension support and mayease the pain immediately.


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Morton’s neuroma is an irritated nerve bundle in the webbetween two toes. It hurts when one squeezes that area, repro-ducing the pain. This is best treated by a podiatrist.

Now that we have examined the various types of pain, the nextpart of this book goes into dozens of different alternative and pre-scription therapies for alleviating common pain problems, includ-ing those that were briefly touched on in earlier chapters.


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P A R T I I I

Effective Therapies forChronic Pain andRelated Problems

As discussed throughout this book, natural remedies can be power-ful tools in relieving pain. Because of this, there is often much to begained from working with naturopaths—practitioners trained in nat-ural medicine. These next few chapters cover various herbal andother alternative treatments for chronic pain. We will also review pre-scription pain medications that include topical therapies (creams andgels that can be rubbed directly on the painful areas), oral pain med-ications, and intravenous medications. Finally, we’ll discuss how totackle some common problems that arise from chronic pain includ-ing depression, sexual dysfunction, and weight gain.

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Natural Therapies

Unfortunately, most medical doctors have a strong bias againstnatural remedies. As one goes into academic centers, this onlyincreases. Although many physicians think that their bias is basedon lack of scientific evidence supporting natural therapies (whatthey like to call “evidence-based medicine”), it is actually simplybased on a lack of awareness of the scientific data.

Many physicians refuse to objectively look at studies that sup-port natural medicine. The people in charge of grants will rarelygive money to study natural therapies. All too often, journalreviewers look for any excuse they can not to publish findings,and many doctors refuse to look at a positive study on naturaltherapies once it is published. Thus physicians can honestly saythey have not seen any data supporting natural remedies. On theother hand, any data against natural remedies seem to get pub-lished—no matter how poorly done the study was and how unre-liable the data are.

I have repeatedly seen this in action, and this is not just myown impression. A study was conducted in which two identicalstudy reports were submitted for publication. The only differencewas that in one study the treatment was an “unconventional”therapy while the other was a “conventional” treatment. A totalof 398 reviewers were recruited and did not know they were part

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of a study. They simply thought they were reviewing the studyreports to see whether they should be published. Although thestudy reports were exactly the same (except for using a “conven-tional” or “unconventional” treatment), the studies using con-ventional therapies were much more likely to be recommendedfor publication, suggesting that a strong prejudice exists againstalternative interventions. This makes it much harder for such stud-ies to get published and also suggests that it would be more diffi-cult to get research funding for studies supporting naturaltherapies.

Why Does a Bias Against Natural Remedies Exist?

A curious thing happened during the rigorous process I wentthrough to become a physician. By the time I completed my for-mal training, I presumed that if an important treatment existed foran illness, I would have been taught about it. I understood thatphysicians need to keep reading to stay abreast of new informa-tion. But I knew that if someone claimed he or she could effec-tively treat a nontreatable disease, that person was a quack. If sucha treatment existed, I would surely have been taught about it inmedical school. I was wrong.

Dr. Werner Barth, my rheumatology instructor, taught memany things. The most important thing he taught me, though,was to spend an hour a day reading the scientific literature. Thispractice has gotten me into all kinds of trouble.

When I first started my medical practice, patients would askme if I knew about certain herbal or nutritional treatments for ill-nesses. One patient asked me if I had ever heard about using vita-min B₆ for carpal tunnel syndrome. “That’s nonsense,” I answered.“If B₆ cures carpal tunnel syndrome, don’t you think I would havebeen taught to use that instead of surgery?” However, I said thatI would look into it.

Joyce Miller, the Anne Arundel Medical Center librarian, hasalways been happy to obtain studies for me (and she has obtained

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many thousands over the years). When she did a literature searchfor vitamin B₆ and carpal tunnel syndrome, she found a numberof studies showing that 250 mg of the vitamin per day for threemonths, combined with wrist splints, often cures carpal tunnelsyndrome. I thought that was curious. Over the months, this scenewas played out again and again. I decided to keep notes on theserare “pearls” in a thirty-page spiral notebook. My notes are nowover one thousand pages long.

After a while, I began to comprehend that, indeed, my pro-fessors had not taught me everything in medical school. As Icontinued my research, I realized that although our modernallopathic medical system might be the best in the world, it hasits weaknesses.

Money: A Critical IssueMoney strongly colors drug research; there is much more moneyto be made on patentable drugs than on nonpatentable naturalremedies. In fact, research done by Cary Gross at Yale shows thatstudies funded by a drug company are 3.6 times as likely to havea result favorable to the sponsor. A quarter of biomedical research-ers have financial ties to the companies whose products they arestudying. Drug companies fund approximately 60 percent of thebiomedical research done in the United States, spending over $30billion yearly on research and development. In addition, becauseuniversities can patent and license the results of positive research,there is a further incentive to skew the data on drug therapies overnatural, nonpatentable treatments.

In addition, these days, it is rare (albeit wonderful) for a majormedical development to come out of a doctor’s office instead of aresearch center. This stems from a critical drawback in our eco-nomic system (and all systems have their drawbacks). In our cur-rent system, a treatment must be very profitable to be promoted.Experts estimate that it costs more than $400 million on averageto develop a single new treatment and get it through the Food andDrug Administration (FDA) approval process. Unless a medica-

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tion or supplement is put through the FDA approval process, itsmanufacturer is banned from making any medical claims for theproduct. However, if a product is inexpensive and nonpatentable(as is the case with most natural therapies), its manufacturer can-not afford to pay $400 million to put it through the FDA process.

Vitamin B₆, when used for carpal tunnel syndrome, is an excel-lent example. Treating carpal tunnel syndrome with B₆ costs aboutnine dollars for the whole course of treatment. Vitamin B₆ man-ufacturers would, therefore, find it impossible to recoup the costof getting FDA approval for this treatment. Because of this, mostpatients instead spend between two thousand and four thousanddollars to have surgery. This situation is the same for hundreds ofother nonpatentable, effective, inexpensive, and relatively safetreatments.

Not Knowing the Scientific ResearchThe treatment approaches that we discuss in Pain Free 1-2-3 arewell-grounded in the scientific literature. Dr. Janet Travell, pro-fessor emeritus of internal medicine at George Washington Uni-versity Medical School, was considered the world’s leading experton muscle disorders. She served as the White House physician forPresidents John F. Kennedy and Lyndon B. Johnson and, alongwith Dr. David Simons (who is also superb), authored the overeight-hundred-page bible on treating muscle disorders entitledMyofascial Pain and Dysfunction: The Trigger Point Manual. Dr.Travell and Dr. Simons investigated the perpetuating factors thatkeep muscles from appropriately relaxing. A large percentage ofthese perpetuating factors are the things that we discuss in thisbook. In one chapter alone, Dr. Simons and Dr. Travell referenced317 scientific studies that showed how important it is to treat theseperpetuating factors. There is no lack of scientific basis for treat-ment, just a lack of awareness of the treatments due to their rela-tive low cost and nonpatentability.

Unfortunately, your doctor is likely to be unfamiliar with theresearch on effective treatment of myofascial pain and fibromyal-


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gia. It is possible that your doctor may even be hostile to theinformation presented in this book, considering it to be quackerybecause it was not covered in medical school. I can understand hisor her feeling this way, because I felt the same way before I exten-sively reviewed the medical literature. Because of this, I have ref-erenced many of the sources of the information given so that yourdoctor can have the scientific basis needed to be comfortable withthe recommendations I make.

It is possible that your doctor may choose to disregard theinformation, and that is OK. It simply says that he or she is notinterested in this area of pain management. On the other hand,your doctor might be open-minded (though reasonably skeptical)and interested in effective treatment of pain and, therefore, maychoose to explore the subject in more depth. If this last possibil-ity is the case, the information and references in this book willgive your doctor the scientific basis necessary to manage and opti-mize your treatment.

Three Effective Natural Pain Therapies

Many natural therapies can be very helpful for pain. My threefavorite pain-relieving herbals are willow bark, boswellia, andcherry. All three can be found in combination in the End Painformula by Enzymatic Therapy (see Appendix B). Begin with twoto four tablets three times a day, as needed, until maximum ben-efit is achieved (approximately four to six weeks), and then youcan use the lowest effective dose. For acute pain three or fourtablets at a time is best. Let’s look more closely at these threeherbals.

Willow BarkWillow bark is the original source of aspirin, but when used as theentire herb it has been found to be much safer than aspirin andmore effective. The active ingredient is salicin, and willow barkhas been shown to be effective in both osteoarthritis and back

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pain. People who are severely allergic to aspirin (those withaspirin-induced asthma or anaphylaxes, which are very unusual)should not use willow bark. Like aspirin and Celebrex, willowbark acts as a cyclooxygenase enzyme (COX) inhibitor, decreas-ing inflammation.

There is clearly a combination of other elements in willowbark that markedly enhances its effectiveness and safety—whichcan be a major benefit over aspirin and NSAIDs such as Motrin.Unfortunately aspirin and NSAIDs cause an enormous amount ofgastritis and ulcer bleeding to the extent of killing fifteen thou-sand to twenty thousand Americans yearly! The studies on wil-low bark are quite consistent in showing its effectiveness andsafety in reducing pain. Let’s look at some of the research.

In one study, 210 patients with severe chronic low back painwere randomly assigned to receive an oral willow bark extract,with either 120 mg (low dose) or 240 mg (high dose) of salicin,or placebo, in a four-week blinded trial. In the last week of treat-ment, 39 percent of the group receiving high-dose extract werepain free; 21 percent of the group receiving low-dose extractwere pain free; and only 6 percent of the placebo group were painfree. The response in the high-dose group was evident after onlyone week of treatment. Researchers then studied 451 patientswho came in with low back pain in an open study, using salicin240 mg, 120 mg, or standard orthopedic/NSAID care for fourweeks. Forty percent of the patients in the 240 mg group and 19percent in the 120 mg group were pain free after four weeks. Inthe standard treatment group, using standard medications, only 18percent were pain free. The study showed that willow bark wasnot only far more effective and safer than standard prescriptiontherapies, it also decreased the cost of care by approximately 40percent!

Another review found that willow bark extract has anti-inflammatory activities comparable to much higher doses ofacetylsalicylic acid/aspirin, and it reduces pain and fever as well.In pharmacologically active doses, no adverse effects on the stom-


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ach lining (indigestion, ulcers) were observed, in contrast toaspirin.

A daily dose of willow bark extract standardized to 240 mgsalicin per day was also significantly superior to placebo in patientswith osteoarthritis of the hip and the knee. In two open studiesagainst standard active treatments as controls, willow bark extractexhibited advantages compared to NSAIDs and was about aseffective as Vioxx (but much safer). Another study found that wil-low bark (salicin 240 mg/day) was much more effective thanplacebo in treating arthritis (the normal wear-and-tear type calledosteoarthritis) after only two weeks of therapy.

All of this information makes willow bark a wonderful natu-ral pain medicine. It is safe and effective for arthritis, back pain,and likely many other types of pain. I recommend beginning withenough to get 240 mg of salicin a day (six tablets of the End Painformula) until maximum benefit is seen. At that point, you maybe able to lower the dose to 120 mg or less a day, or take it asneeded.

BoswelliaBoswellia serrata, also known as frankincense, has been used in tra-ditional Ayurvedic medicine for centuries. Boswellia has beenfound to be quite helpful in treating inflammation and pain, andit does this without causing ulcers like aspirin family medications.It has been shown in studies to be helpful for both rheumatoidarthritis and osteoarthritis.

In one study, thirty patients with osteoarthritis of the kneewere given 1,000 mg of either an extract of boswellia or a placebofor eight weeks; the groups were then switched for the next eightweeks. All of the patients on the boswellia showed significantlydecreased pain and improved ability to walk. In fact, the improve-ment was quite remarkable, with the pain index falling by 90 per-cent after eight weeks and a similarly dramatic increase infunction! This was recently discussed in more length in an articlewritten by Kerry Bone for the wonderful patient-oriented news-

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letter Nutrition and Healing by Jonathan Wright, M.D.—a physi-cian that I have great respect for. (See wrightnewsletter.com.)

Boswellia has also been demonstrated to have significant anti-inflammatory properties. Unique to boswellia is that it blocks twoinflammatory chemicals that are increased simultaneously in avariety of human diseases. This results in its being helpful inasthma and colitis, as well as pain. In one study of asthmatics,forty patients were treated with 300 mg three times day for sixweeks. Seventy percent of the asthma patients showed improve-ment in symptoms and lung function and a decrease in allergicblood cells (eosinophils).

Boswellia also helped in the treatment of ulcerative colitis. Inone study of twenty patients in which boswellia, 300 mg threetimes a day, was given for six weeks, fourteen went into remis-sion, while with sulfasalazine (the standard prescription treat-ment), the remission rate was four out of ten. Test tube studiessuggest that Boswellia also markedly inhibits cancer.

Boswellia does not appear to have any major side effects thatresulted in people withdrawing from the studies, and it rarelycauses minor gastrointestinal disturbances or rash. A commondose is 150 to 350 mg three times a day.

Cherry (Prunus Cerasus)Although there are not as many human studies on the use of cher-ries, they also contain compounds that inhibit COX (inflamma-tion) as effectively as ibuprofen. Cherries also possess bothantioxidant and anti-inflammatory properties. In addition,research suggests that cherries may also inhibit colon and perhapsother cancers. Cherries and other colored berries are very high inmany antioxidants. As with eating cherries, taking cherry fruitextract is quite safe. Many people find that eating ten to twentycherries a day helps their arthritis considerably. Taking 2,000 mgof cherry fruit extract (present in six tablets of the End Pain for-mula) contains the active components present in ten cherries orthirty-two ounces of cherry juice. Early research, as well as how


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many people come back for more after they have tried it, whichto me is a significant indicator of effectiveness, suggests thatcherry fruit extract holds a lot of promise!

Other Important Natural Healing Ingredients

As we discussed earlier, pain is often your body’s way of tellingyou that it desperately needs something—and what it needs is usu-ally natural and not chemical. Let’s review the key things yourbody needs and how you can give it what it needs naturally.

Nutritional SupportFirst you need to give your body the nutritional building blocksit needs to heal. Otherwise, your body cannot even begin to getwell (see Chapter 2). As you’ve noticed, I’ve talked about theEnergy Revitalization System vitamin powder and B-complexcapsule at length. This is because this formula has over fifty keynutrients that serve an enormous number of needs. Many peoplehave told me that using the formula by itself eliminated theirchronic pain!

Glucosamine Sulfate and ChondroitinNext, although the vitamin powder has most of what your bodyneeds, joints require other specific nutrients for healing. So if youhave arthritis or back pain from arthritis of the spine, considertaking glucosamine sulfate, MSM (methylsulfonylmethane), andchondroitin (see Chapter 5).

Lipoic Acid and SAM-eOther nutrients are also critical for nerve healing. One such ele-ment is lipoic acid, 300 to 1,000 mg per day. Alpha lipoic acid isan antioxidant that has been shown to be especially beneficial fordiabetic neuropathy. The fact that lipoic acid helps in several kindsof neuropathies suggests it is worth trying in others as well, espe-cially since it is quite benign and not very expensive.

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SAM-e is a nutrient produced from trimethylglycine (betaine)in combination with multiple nutrients, including B vitamins,folate, and inositol. It was initially tested and found to be effectivein treating depression. Researchers also noted, as an aside, that itimproved patients’ arthritis as effectively as anti-inflammatorymedications (NSAIDs) (see Chapter 5).

Natural Remedies for Sleep

As previously discussed in Chapter 2, your repair cycle occursduring sleep and your body needs eight to nine hours of sleep anight for optimal healing. Unfortunately, insomnia often accom-panies pain. The good news is that many natural remedies that arevery effective for sleep also directly help pain. Most of the natu-ral sleep remedies discussed here are not sedating, yet they willhelp you fall asleep and stay in deep sleep. Some are available incombination formulas as well.

Wild Lettuce and Jamaican DogwoodTraditionally, wild lettuce has been found to be wonderful foranxiety and insomnia, as well as for headaches, muscles, and jointpain. Wild lettuce also helps to calm restlessness and reduceanxiety.

In addition, the extract from Jamaican dogwood acts as a mus-cle relaxant and also helps people to fall asleep while calmingthem. According to tradition, Jamaican dogwood was used byJamaican fishermen. Large amounts were thrown in the water.The fish would then be sedated and easy to net.

Hops and TheanineHops are a member of the hemp family, and the female flowers areused in beer making. Hops stimulate some hormonal activity; cansuppress breast, colon, and ovarian cancer in test tube studies; andhave been reported to reduce hot flashes in menopausal women.Hops are also associated with antibiotic and antifungal activity.


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They have a long history of being used as a mild sedative for anx-iety and insomnia. They also inhibit inflammation. A study using120 mg of hops combined with 500 mg of valerian showed animprovement in insomnia with effectiveness similar to Valiumfamily medications. Hops are considered to be very safe.

Theanine comes from green tea and has been shown toimprove deep sleep and to help people maintain calm alertnessduring the day. Green tea also is helpful as an immune stimulantand has many other benefits.

Passionflower (Passiflora)Passionflower is an excellent herb used throughout South Amer-ica as a calming agent and is even present in sodas. In fact, it is notuncommon for friends to tell an anxious person, “Why don’t yougo get a passionflower drink.” The active component is in theleaves. Herbalists use passionflower to treat muscle spasms, colic,dysentery, diarrhea, anxiety, and menstrual pain. A number ofstudies support its having a calming effect. Early data also suggestthat it may increase men’s libido. Passionflower has other painmanagement benefits as well. In one animal study, it was shownto decrease morphine tolerance and withdrawal, thereby improv-ing morphine’s effectiveness and safety.

ValerianValerian is commonly used as a remedy for insomnia. Oneplacebo-controlled study showed that people taking valerian(400 mg of extract each night for two weeks) fell asleep morequickly and had better sleep quality without next-day sedation.Another placebo-controlled study using 450 and 900 mg doses forjust one night also showed improved sleep, but there was somehangover with the higher dose. A number of other studies alsoshow benefit, including an improvement in deep sleep. The ben-efits were most pronounced when people used valerian forextended periods as opposed to simply taking it for one night.Another study showed it to be as effective as a Valium family

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medication (oxazepam). A review of multiple studies concluded,“Valerian is a safe herbal choice for the treatment of mild insom-nia and has good tolerance.” Most studies suggest that it is moreeffective when used continuously rather than as an acute sleep aid.

Combining Remedies for Fuller EffectBecause I have found all six of these herbals to be dramaticallyhelpful in patients with disordered sleep, anxiety, and/or chronicpain, I had them all combined in the Revitalizing Sleep Formula(see Appendix B). One to four capsules can be taken at bedtimeto help sleep, or an hour before bedtime if the main problem isfalling asleep. You’ll see the effect of a given dose on sleep the firstnight you take it, although the effectiveness increases with con-tinued use. It can also be used during the day for anxiety and mus-cle pain. Although the bottle says to take up to four capsules a day,one could take up to three or four capsules two or three timeseach day, as it is very safe. If you’re still not getting eight to ninehours of sleep a night, magnesium (75 to 250 mg) and calcium(600 mg) at bedtime also help sleep. It can also be used togetherwith the End Pain formula for more powerful pain relief.

Besides these herbs, I recommend the natural sleep aids in thefollowing sections.

Hydroxy L-Tryptophan (5-HTP)Take 200 to 400 mg at night. When used for six weeks, a 300 to400 mg dose has been shown to decrease fibromyalgia pain andoften helps people to lose weight. Your body uses 5-HTP to makeserotonin, a neurotransmitter that helps improve the quality ofsleep while also decreasing levels of substance P, your body’s painmessenger. The one caution I give is that if you are taking othertreatments that increase serotonin (these include antidepressantssuch as Prozac, Saint-John’s-wort, Ultram, Desyrel, and others),limit the 5-HTP to 200 mg at night. It takes six to twelve weeksto see the full effect of 5-HTP, and it is more expensive than the


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other remedies. Nonetheless, it may be worthwhile in treatingchronic pain.

MelatoninThis is a hormone produced by the pineal gland. Although mela-tonin is natural and available over the counter, this does not meanthat it is without risk. My concern with any hormone is thatalthough it might be quite safe when used within the body’s nor-mal range, I worry about toxicity when people take more than thebody would normally make. For most people, all it takes to restoremelatonin to normal levels is 0.5 mg. The usual dose you find instores, however, is 3 mg, which is six to ten times the dose thatmost people need. Except for a small subset of people, who likelyhave trouble absorbing it properly, the 0.5 mg dose is every bit aseffective for sleep as higher doses. I would use a dose higher than0.5 mg only if it clearly helps you sleep better than the lower dose.

Additional Safe and Inexpensive NaturalRemedies for Pain

Many other natural therapies can be powerfully effective in thetreatment of pain while also being safe and relatively inexpensive.Although we do not have space to review all of them, let’s look ata few that are worth being aware of.

Topical Gels for Muscle and Arthritis PainI am a big fan of using topical therapies (see Chapter 13). Byapplying these gels directly to a targeted area of pain, you get ahigh dose to where it’s needed without saturating your wholebody as you do with tablets.

A promising product for the relief of muscle and arthritis paindoes just that. Joint Gel by NF Formulas is an over-the-counternatural pain reliever that is applied directly on the skin. It containsmenthol, MSM (methylsulfonylmethane), white willow, pine

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bark, and botanical oils that provide relief of aches and pains. JointGel also can relieve the pain of backaches, muscle sprains, andstrains. Its roll-on design delivers the gel directly onto the skinand does not leave an oily or sticky feeling. As you massage theJoint Gel over the painful joint or muscle until absorbed, you’llinitially feel the menthol. The active ingredient in peppermint ismenthol, which serves as a counterirritant, stimulating the nervesthat perceive cold while simultaneously depressing those for pain.Joint Gel’s aloe leaf, white willow bark, and MSM (discussed ear-lier in this chapter) are also well known for their natural pain-relieving properties. Pine bark also provides unique antioxidantsknown to play a role in the stabilization of joints and muscles.Because it contains eucalyptus, rosemary, and ginger botanicaloils, Joint Gel smells good. You can use Joint Gel three to fourtimes daily.

Oral Enzymes That Treat InflammationAnother wonderful treatment for inflammation is the use of oralenzymes. For those looking for a gentle, natural, and fairly sideeffect free method of reducing inflammation, digestive enzymescan be very helpful. When taken with food, enzymes help digestfats, proteins, and carbohydrates. When taken in between meals,digestive enzymes are absorbed into the bloodstream and areactive throughout the body, not just in the digestive tract. Thisallows them to perform other functions such as combating inflam-mation. My favorite enzyme supplements for pain and inflamma-tion are MegaZyme and Ultrazyme. They contain pancreaticenzymes (protease, amylase, and lipase), trypsin, papain, brome-lain, lysozyme, and chymotrypsin.

Enzymes in high doses may “digest” inflammation by remov-ing fibrin from inflamed areas, thereby restoring drainage andreducing swelling. This speeds wound healing. For example, onestudy used bromelain, an enzyme derived from the stem of thepineapple plant, in 146 boxers with multiple face bruises and blackand blue marks after a boxing match. Half the boxers received the


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real thing and half received placebo. All signs of bruising disap-peared within four days in 78 percent of the boxers receivingbromelain as compared to only 14 percent of those on a placebo.By working with your body, bromelain is able to reduce pain andinflammation caused by numerous health problems. It can alsoimprove circulation. Bromelain helps the body make its ownenzymes to dissolve and clean up dead tissue and debris from thesite of inflammation.

Some physicians are under the misconception that enzymestaken by mouth would simply be digested and not absorbed intothe body. This is not the case when they are taken on an emptystomach. In this situation enzymes are well absorbed, raising theirlevels in the blood.

In addition to decreasing inflammation, taking enzymes mayhelp improve function in other ways. Enzymes are necessary formany reactions to take place within your body’s cells, such asassisting with rejuvenation and healing. For example, studiesshowed that taking large doses of pancreatic enzymes could helppeople with pancreatic cancer to live longer. Research by Dr.Gonzalez has shown this to be the case, and a larger scale studyusing this enzyme treatment in pancreatic cancer is now beingfunded by the National Cancer Institute. Many people have foundthat taking enzymes can markedly help decrease inflammatorypain. For example, in one study of muscle soreness after downhillrunning, subjects were given either enzymes or a placebo. In theenzyme group, muscle soreness was much less than in the placebogroup.

Although I strongly recommend that people use plant-basedenzymes for digestion, pancreatic enzymes are better for inflam-mation. The pancreatic enzymes in Ultrazyme and MegaZymeare very high potency. The other enzymes present are also pow-erfully effective. Papain is often used to relieve the inflammationand pain in sports injuries because athletes have discovered that itspeeds up the healing process. Papain has also been used to reduceinflammation from wisdom tooth extractions, root canals, and

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other oral surgeries. Unlike prescription anti-inflammatories suchas Prednisone (a powerful, prescription-only corticosteroid med-ication with a long list of health risks), enzymes treat inflamma-tion safely.

To summarize, although enzymes such as Ultrazyme andMegaZyme may be helpful in aiding digestion of your food whentaken with meals, I recommend that you take them on an emptystomach because enzymes are most effective at reducing pain andinflammation when you take them between meals. For acute pain,enzymes can simply be taken for a few days as needed. For chronicpain, begin by taking either of them regularly (two to threetablets three times a day) between meals for six to twelve weeksto see how much it helps or until the pain and inflammation aregone. Then you can take the enzymes as needed.

Intravenous “Myers Cocktails” Nutritional TherapiesA major problem in chronic pain is that the areas that hurt oftenhave decreased blood flow. That means that even when you feedyour body, the areas in pain may still be starved. This is one rea-son why using the intravenous “Myers cocktails” nutritional ther-apies can be so effective. (More information is available atvitality101.com.) The magnesium in the IV causes the closed-down blood vessels in your muscles and brain to open, floodingthe starved areas with nutrients and washing away toxins. Unfor-tunately, although very worthwhile, these IV treatments requirerepeat visits by a nurse and cost approximately eighty to one hun-dred dollars per dose.

Another way to get the blood vessels to open wide is to take aB vitamin called niacin (not niacinamide, which does not causeflushing). This trick was taught to me by a brilliant chiropractorand pain specialist, Ron Huse, D.C. (phone 281-996-8100), inHouston, Texas. Take 100 to 500 mg of niacin three to four timesa day, as needed, to cause a “flushing” feeling, which occurswithin approximately ten to twenty minutes. This can signifi-cantly help pain and is inexpensive. Try to keep the dose at


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1,000 mg a day or less, if this is enough to cause flushing, becausehigher doses can sometimes (but rarely) cause liver inflammationor unmask diabetes. This treatment also helps to lower cholesteroland is often used for this purpose. The flushing will make you feellike you are in the Florida sun for about fifteen to forty-five min-utes and will often be intense. Do not worry; it is not dangerousand can help your muscles to heal while decreasing pain.

Arnica: A Powerful HomeopathicThe classic homeopathic for acute tissue injuries is arnica. Thiscan be highly effective and is available as a cream (Traumeel bythe Heel Company). This is a product that should be in every-body’s medicine cabinet.

Turmeric (Curcumin Longa)Turmeric is an ingredient in curry powder and a relative of gin-ger. Turmeric contains curcumin, which has been shown to be aneffective antioxidant. A study of forty-five days of supplementa-tion with curcumin showed marked decreases (60 percent) in thelevel of serum lipid peroxide. It is suspected that the curcuminmight therefore reduce the risk of heart disease, cancer, andinflammatory conditions, and it may also help asthma. A reviewof several studies suggests that curcumin has anti-inflammatory,antioxidant, anticarcinogenic, antiviral, and anti-infectious activ-ities. A common dose would be 500 to 1000 mg three times a day.

Unfortunately, curcumin is poorly absorbed in the absence ofpiperine—a compound that comes from black pepper. Piperinecan increase the absorption of many different substances and med-ications, potentially leading to toxic blood levels, however, andshould therefore be used with caution—preferably with their usebeing guided by a health practitioner. When used in combinationwith boswellia, turmeric has been shown to improve bothosteoarthritis and rheumatoid arthritis.

In traditional Indian medicine, curcumin has been used totreat arthritis, inflammation, skin disease, and infections for many

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centuries. It contains at least 133 active compounds, and approx-imately four hundred studies have been published on curcumin inthe last several years. It has also been found to be effective intreating gastric ulcers and indigestion as well as lowering serumcholesterol.

Ginger and ButterburGinger acts to decrease inflammation by inhibiting two keyenzymes (cyclooxygenase and lipooxygenase, with secondaryleukotriene inhibition). Although studies suggest some benefitwith arthritis, I consider the effect to be modest compared to theEnd Pain formula. Butterbur has been found effective in the pre-vention and treatment of migraine headaches (see Chapter 7).

Saint-John’s-WortSaint-John’s-wort has been found to be helpful in treating neuro-pathic pain for some people (see Chapter 4). This treatment is safeand inexpensive and helps depression, so it is worth a try—espe-cially if other treatments have failed.

MarijuanaAlthough it may seem odd to include marijuana as an herbal, it isan herb, and it is my job to give you medical information regard-less of the politics involved. Studies suggest that the receptors thatmarijuana binds to can also decrease pain. In addition, it candecrease the suffering associated with pain, improve appetite insituations where weight loss is associated with pain (as in cancer),and is likely much safer than many other medications. The activeingredient in marijuana, THC, is available by prescription in amedication called Marinol. It is, of course, much more expensivein this form and probably not as effective, but it can be helpful.

CapsaicinCapsaicin is another cream that comes from hot chili peppers. Itworks by depleting the substance P pain transmitter in nerve end-ings, interfering with the ability to send pain signals to the brain.


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It can be very helpful in some situations, but I tend to avoid usingit. I am uncomfortable with irritating the body so much that itdepletes the pain-sending chemicals. In addition, capsaicin canmake the problem worse by stimulating pain when it is first used,and it has to be taken regularly or the pain-sending chemicals havea chance to recover.

An Easy-to-Make Home RemedyThe following home remedy, Purple Pectin for Pain, is inexpen-sive and easy to try. It is especially geared to work for arthritis.(Please let me know how it works for you! You can send me mes-sages or questions at vitality101.com.)

Purchase Certo, the thickening agent used to make jams andjellies, in the canning section of your local grocery. Certo con-tains pectin, a natural ingredient found in the cell walls of plants.Take one to three tablespoons of Certo in eight ounces of grapejuice one to two times daily (you can try more if you wish). If it’sgoing to help, you’ll likely know in seven to fourteen days. Youcan lower the dose as you feel better.

As you can hopefully tell by this chapter, there are many naturaland prescription treatments available that can be helpful. You donot have to be in pain. There are other excellent natural therapiesto consider, and these are simply a sampling of my favorite natu-ral remedies.

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AlternativeTreatments

There are many alternative therapies that can be very effective fortreating chronic pain. These include structural therapies such asosteopathic and chiropractic medicine and other techniques suchas hypnosis, magnets, and prolotherapy, which are described inthis chapter. In addition, Peter Marinakis, Ph.D., director of FullCircle Healing Arts in Annapolis, Maryland, provides valuableinformation on how acupuncture—one of the oldest, most com-monly used medical procedures in the world—can help treat pain.Many forms of body and energy work can also be powerfullyeffective in treating pain. Some, such as Rolfing (see Chapter 3),we discussed in earlier chapters. These are simply some examplesout of dozens of different forms of body/structural/energy workthat can be powerfully effective.

Osteopathy

Osteopathy combines both pharmacologic/surgical medicine andan emphasis on the interrelationship between structure and func-tion in the body. It also has an appreciation of the body’s ability

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C H A P T E R 12


to heal itself. There are fourteen principles of osteopathic philos-ophy. Here are a few of them:

• The body is a single system that includes mind and spirit aswell as muscles, bones, and organs.

• The body is capable of self-healing, self-regulation, and self-maintenance.

• The structure of parts of the body will affect thefunctioning of those body parts.

• Treatment should consider the unity of the body, as well asthe interactions of specific treatments, and should harness thebody’s self-regulatory ability to heal as much as possible.

Where in the past, osteopathy was viewed as providing morenatural therapies, some osteopathic physicians are becoming moreand more like M.D.s. Others are taking full advantage of thestrength of combining osteopathic manipulation and naturalremedies with prescription and surgical therapies. Pain is the mostcommon reason why patients seek osteopathic manipulation.Although this is a marked oversimplification, osteopathic manip-ulative treatment (OMT) is the manual application of forces to thebody to restore maximal pain-free movement of the muscu-loskeletal system. Osteopathy looks at restrictions in movementand asymmetry of body parts. Manipulative therapy is then usedto restore balance and range of motion. A trained osteopathic canwork wonders in ways that are both safe and cost effective.

Chiropractic Medicine

Chiropractic medicine is a health-care discipline that focuses onthe relationship between the spine and body function, coordi-nated via the nervous system. Chiropractic practitioners feel thatthis relationship is critical in maintaining and restoring health.Spinal manipulation was used as early as 2700 b.c. in Chinesemedicine, and manipulation techniques were also used by Hip-pocrates and Galen.


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A bit over one hundred years ago, David Palmer developed theprinciples upon which modern chiropractic is based. He believedthat abnormal nerve function was a primary cause of medical prob-lems, and he recommended adjustments to the spine to treat this.Although some physicians accepted his principles, others objectedto anybody who proposed any treatments besides their own. Thisresulted in Palmer and other early chiropractors being arrested. Thisrift between chiropractors and medical doctors persisted with theAmerican Medical Association (AMA) even saying that it wasunethical for any physician to work with a chiropractor and that anydoctor who did so could lose his or her license. This continueduntil the AMA lost an antitrust suit brought by the chiropractors.

As is the case in many fields, growth occurred in many differ-ent directions in chiropractic. The more conservative chiroprac-tors believed that poor alignment in the spine (subluxation) wasthe only problem that needed to be treated. Other chiropractorsrecognize that multiple causes could be at play, and they workalongside physicians and other practitioners.

Chiropractors are the most commonly used health practition-ers after physicians and dentists. There are more than sixty thou-sand licensed chiropractors in the United States. Almost 80percent of chiropractic visits are for musculoskeletal complaints,and more than 40 percent are for back pain. In 1999, 11 percentof adults and more than 30 percent of patients with low back painvisited a chiropractor.

As chiropractic medicine has continued to grow, more thanone hundred different approaches have been developed. Most fallunder the following categories:

• Manipulation to decrease joint restriction, increase range ofmotion, and restore vertebrae to their normal position

• Traction• Massage/soft tissue mobilization directed at muscle, tendon,

and other nonbony tissues• Electrical muscle stimulation• Diathermy—using electrical currents to produce heat

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• Ultrasound• Ice therapy• Heat• Exercise-based programs• Nutritional and metabolic support• Energy medicine

Because body manipulation requires hands-on therapy, it isvery difficult to do a double-blind study. This has been used bysome traditional physicians as an excuse to ignore and put downchiropractic while conveniently forgetting that surgery faces thesame scientific problem. Also, because the types of chiropractictreatment vary so widely, it is difficult to compare the results ofdifferent studies. Nonetheless, chiropractic treatment has survivedbecause people find it to be helpful and often safer than usingmedications.

Hypnosis and Magnets

Although a detailed discussion of these therapies is outside thescope of this book, hypnosis and magnets can both be very help-ful in the treatment of chronic pain. I have seen hypnosis decreasethe intensity of pain, change its location, decrease the sufferingassociated with pain, and change the sensation so that it feels likewarmth or softness instead of pain. When using magnets, the typeof magnet used is important because the strength and field con-figuration can be critical. Nikkan Company magnets seem to befairly reliable.

Prolotherapy

Prolotherapy is a series of injections of a natural solution (some-thing as simple as a sugar or salt solution; cod liver oil, known assodium morrhuate; or an herbal extract) into the area where theligaments have been weakened or damaged through injury or


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strain. This stimulates proliferation of normal tissue, which helpsthe body to repair painful areas.

Chronic musculoskeletal pain is often due to weakness of liga-ments and tendons. The injection is given at the point where theligament or tendon connects to the bone. Many points may requireinjection. The injection causes the body to heal itself through theprocesses of controlled inflammation and production of growthfactors.

The effectiveness of prolotherapy is wide ranging and includespain associated with the back, the neck, all joints throughout thebody, arthritis, migraine headaches, fibromyalgia, sciatica, herni-ated discs, and temporomandibular joint dysfunction (TMJ).Many chronic pain patients who did not get relief with othertreatments have improved markedly with prolotherapy. For anexcellent article on the subject by Dr. Brad Fullerton and Dr.David Harris, see the vitality101.com website under the Pain Free1-2-3 “Notes.” See Appendix B for information on how to findqualified physicians who have been trained in prolotherapy.

Acupuncture (by Peter Marinakis, Ph.D.)

This section on acupuncture was written by Peter Marinakis,Ph.D., M.Ac., director of Full Circle Healing Arts, a multidisci-plinary well care clinic in Annapolis, Maryland, and providesdetails on how you can best use this ancient form of Chinesemedicine to treat pain.

Acupuncture is one of the oldest, most commonly used medicalprocedures in the world. Originating in China more than threethousand years ago, acupuncture began to become better known inthe United States in 1971, when New York Times reporter JamesReston wrote about how doctors in China had used needles to easehis abdominal pain after surgery. Research shows that acupunctureis beneficial in treating a variety of health conditions.

The term acupuncture describes a family of procedures involv-ing stimulation of anatomical points on the body by a variety of


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techniques. American practices of acupuncture incorporate med-ical traditions from China, Japan, Korea, and other countries. Theacupuncture technique that has been most studied scientificallyinvolves penetrating the skin with thin metallic needles that aremanipulated by the hands or by electrical stimulation.

Increasingly, acupuncture is being used to complement con-ventional therapies. For example, doctors may combine acupunc-ture and drugs to control surgery-related pain in their patients. Byproviding both acupuncture and conventional anesthetic drugs,doctors have found it possible to achieve a state of complete painrelief for some patients. They also have found that using acupunc-ture lowers the need for conventional painkilling drugs and thusreduces the risk of side effects for patients who take the drugs.

Currently, one of the main reasons Americans seek acupunc-ture treatment is to relieve chronic pain, especially from conditionssuch as arthritis or lower back disorders, but a more complete rangeof medical conditions is listed by the World Health Organization(WHO). Some clinical studies show that acupuncture is effectivein relieving both chronic (long-lasting) and acute or sudden pain,but other research indicates that it provides no relief from chronicpain. Additional research is needed to provide definitive answers.

The U.S. Food and Drug Administration (FDA) approved acu-puncture needles for use by licensed practitioners in 1996. TheFDA requires manufacturers of acupuncture needles to label themfor single use only. Relatively few complications from the use ofacupuncture have been reported to the FDA when one considersthe millions of people treated each year and the number of acu-puncture needles used.

What the Research SaysThe National Certification Commission for Acupuncture andOriental Medicine (NCCAOM) and the Office of AlternativeMedicine (OAM) have supported scientific research to find outmore about acupuncture. Researchers at the University of Mary-


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land in Baltimore, with the support of OAM, conducted a ran-domized controlled clinical trial and found that patients treatedwith acupuncture after dental surgery had less intense pain thanpatients who received a placebo. Scientists at the university alsofound that older people with osteoarthritis who used conventionaldrugs and acupuncture together experienced significantly morepain relief than those using conventional therapy alone.

What People Who Use Acupuncture SayThe use of acupuncture, like the use of many other complemen-tary and alternative medicine (CAM) treatments, is supported bya good deal of anecdotal evidence. Much of this evidence comesfrom people who report their own successful use of the treatment.If a treatment appears to be safe and patients report recovery fromtheir illness or condition after using it, others may decide to usethe treatment. However, scientific research may not support theanecdotal reports. Patient outcomes continue to be one of the bestforms of feedback to the practitioner, patient, and the health-careindustry at large. In a patient survey done by the Maryland Acu-puncture Society in January 2000, for example, 71 percent of thepatients reporting in had a “very satisfied experience with acu-puncture and had excellent results.” (See maryland-acupuncture.org for the full report.)

Lifestyle, age, physiology, and other factors combine to makeevery person different. A treatment that works for one personmay not work for another who has the same condition. You as ahealth-care consumer (especially if you have a preexisting med-ical condition) should discuss any CAM treatment, including acu-puncture, with your health-care practitioner. Do not rely on adiagnosis of disease by an acupuncture practitioner who does nothave substantial conventional medical training. If you havereceived a diagnosis from a doctor and have had little or no suc-cess using conventional medicine, however, you may wish to askyour doctor whether acupuncture might help.


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How to Find a Licensed Acupuncture PractitionerHealth-care practitioners can be a resource for referral to practi-tioners of acupuncture, as more are becoming aware of this CAMtherapy. More medical doctors, including neurologists, anesthesi-ologists, and specialists in physical medicine, are becoming famil-iar with acupuncture, traditional Chinese medicine, and otherCAM therapies.

Check Credentials. A practitioner who is licensed and credentialedmay provide better care than one who is not. About forty-sevenstates have established training standards for acupuncture certifi-cation. Although proper credentials do not ensure competency,they do indicate that the practitioner has met certain standards totreat patients through the use of acupuncture.

Check Treatment Cost and Insurance Coverage. A practitionershould inform you about the estimated number of treatmentsneeded and how much each will cost. If this information is notprovided, ask for it. Treatment may take place over a few days orfor several weeks or more. Physician acupuncturists may chargemore than nonphysician practitioners. For federal employees,physician acupuncturists are more likely to be covered. Checkwith your insurer before you start treatment as to whether acu-puncture will be covered for your condition, and if so, to whatextent. Some plans require preauthorization for acupuncture.

Check Treatment Procedures. Ask about the treatment proceduresthat will be used and their likelihood of success for your condi-tion or disease. You also should make certain that the practitioneruses a new set of disposable needles in a sealed package every time.The FDA requires the use of sterile, nontoxic needles that bear alabeling statement restricting their use to qualified practitioners.The practitioner also should swab the puncture site with alcoholor another disinfectant before inserting the needle.


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During your first office visit, the practitioner may ask you atlength about your health condition, lifestyle, and behavior. Thepractitioner will want to obtain a complete picture of your treat-ment needs and any behaviors that may contribute to the condi-tion. Inform the acupuncturist about all treatments or medicationsyou are taking and all medical conditions you have.

Acupuncture needles are metallic, solid, and hair-thin. Peopleexperience acupuncture differently, but most feel no or minimalpain as the needles are inserted. Some people are energized bytreatment, while others feel relaxed. Improper needle placement,movement of the patient, or a defect in the needle can cause sore-ness and pain during treatment. This is why it is important to seektreatment from a qualified acupuncture practitioner.

For a complete list of national and international acupunctureand oriental medicine organizations see the websites aomalliance.org or who.org. Click “Health Topics,” “Acupuncture” to see alist of health issues treatable with acupuncture.


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Prescription Therapies:We’re Way Past Aspirin!

Today we have dozens of tools that can be used to eliminate yourpain. It can, however, be overwhelming to have so many options.This is why I provide the pain algorithms in this chapter and onmy website, under “Notes.” Eliminating pain is like buying shoes.You don’t want to go into a shoe store that sells only one pair oryou’re likely to be out of luck. With so many options available toeliminate pain, it’s nice to know where to start. This chapter willtell you exactly what to try and the order in which to try themuntil you (with your doctor’s help) become pain free.

As a reminder, although these medications can be helpful, it isalways best to go after the underlying causes of the pain first, sothat you can make it go away permanently. This is discussed in thechapters in Part I of this book. In most cases, medications simplygive symptomatic relief without eliminating the underlying causeof the pain. We began this section by discussing the natural ther-apies, as these remedies are likely to be safer, less expensive (unlessyou have prescription coverage), and have fewer side effects. Iwould begin treatment by going after the perpetuating factorsinvolved in pain (nutritional, hormonal, and sleep deficiencies andunderlying infections), followed by natural remedies (discussed inChapter 11). Then use the prescription pain creams. The oral and 193

C H A P T E R 13


IV medications described in this chapter can (and should) beadded if needed, because it is unhealthy to be in pain. It is alsoreasonable to begin with prescription pain medications such asUltram for immediate pain relief while you’re waiting for theother treatments to take effect.

Things to Consider Before BeginningPain Medications

Some medications are expensive. Most often, a generic medica-tion is as effective as a brand name but much less expensive. Somepatients like to get ten to thirty tablets of the brand-name med-ication first, so they can see what it does, and then switch to thegeneric. If there is a difference between the brand-name andgeneric medications, you would be able to tell. Unfortunately,some pharmacies are drastically marking up the cost of generics,keeping the savings for themselves. To see what a generic med-ication really should cost, go to Costco pharmacies (or visit themonline at costco.com). They have a policy of marking up the priceto a set amount over their cost, passing the savings on to the cus-tomer. You do not have to be a Costco member to use the phar-macy. If you go to one of their stores, simply tell the person at thedoor that you are going to the pharmacy.

In addition, most medications are much less expensive inhigher-dose tablets. For example, a 40 mg tablet may cost the sameas a 20 mg tablet. You can save 50 percent by getting a higher-strength tablet and breaking it in half. The price of the same med-ication can also vary dramatically from pharmacy to pharmacy. Itpays to call around and check prices. An excellent mail-orderpharmacy is Consumers Discount Drug Company (phone 323-461-3606). If you can find a reliable Canadian pharmacy that isless expensive, you may also consider ordering from them directly.

While medications are less expensive in higher-dose tablets, forsome medications you are likely to get more benefit relative to theside effects at a lower dose. As you push the higher doses, you get


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more side effects for less benefit. In addition, people sometimesget the full benefit without side effects at a small fraction of the“standard” starting dose. Because of this, if you have a medica-tion that helps but causes side effects, try lowering the dose toeven a fraction of the starting dose. Find the dose that gives themost benefit relative to side effects. On the other hand, somemedications do require a high dose before you see the effect.

Doctors are often taught to give one medication, raise it to themaximum tolerated dose, and then switch to another medicationif an adequate effect is not seen. They avoid combining medica-tions because of the risk of drug interactions. In treating chronicpain or insomnia, however, I have found that patients are morelikely to get excellent results with fewer side effects if they mixlow doses of several medications instead of taking a high dose ofa single medicine. As noted previously, this is because most peo-ple get more benefit and fewer side effects at lower doses of amedication. This is especially true with medications that can besedating. Mixing medications from different categories (asdescribed later in this chapter) is more likely to help than com-bining medicines within a category. The exception is if a medica-tion greatly helps, but you cannot get an adequate dose withoutunacceptable side effects. In that situation, trying other medica-tions within the same category is a good idea.

Other helpful things to keep in mind when taking medicationinclude:

• Do not get pregnant while on any medication.• Do not drive while on any medication that is sedating

because you may not always be aware of the sedation.• Some of these medications interact poorly with alcohol.

Some people will (I think reasonably) try having a drink athome when on a steady dose of the medications to see if itcauses any reactions. Legally, I must tell you not to take anyalcohol with these medications, and check with yourphysician regarding any possible risks.

PRESCRIPTION THERAPIES: WE’RE WAY PAST ASPIRIN!

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Why People Worry About Taking What They Needfor PainMany people hesitate to take the amount of pain medication theyneed because they fear side effects or addiction or because theyconsider it a sign of weakness to take medication. For those of youwho have these concerns, I would like to make several points.

First, I’d like to touch on an important issue regarding treat-ment and prevention. It takes much less medication to preventpain than to make it go away once it occurs. Because of this, ifyou have chronic pain, take the medication before you expect thepain to occur, or at the first sign of it coming back, instead ofwaiting for the pain to be severe. You’ll need less pain medicineand have fewer side effects. This means that if the pain comes backevery six hours after you take the pain medicine, taking the med-icine every five hours—even if you’re not in pain when you takethe medicine—may enable you to control the pain with less med-ication overall.

The stress of pain takes a toll on your body that is not healthy.Pain is simply meant to tell you that there’s something wrong thatyou need to pay attention to. Once you do this, the pain is nolonger healthy and should be eliminated. I suspect that you get nobonus points in heaven for having suffered through the paininstead of taking the medications needed to be comfortable. Ioften tell my patients the story about the pious man who lived inJohnstown during the Johnstown flood. The National Guardcame into the city and told everyone to evacuate. This manrefused to leave, saying that he had faith in God and that Godwould protect him. The floodwaters came, and soon the CoastGuard boat arrived, floating by his second story window. Theybeseeched him to climb in the boat and be saved but he refused,once again saying that he had faith in God to protect him. Prettysoon he was up on the top of his roof, and a helicopter came byand the pilot yelled at him to get in. Once again he refused—andthe man drowned. He went to heaven, and God came by. Theman was very angry at God and said, “I had full faith in you and


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you let me drown!” God said, “What are you talking about? I sentthe National Guard, the Coast Guard, and a helicopter!” Themedications are like the National Guard, the Coast Guard, and thehelicopter. It’s OK to use them!

Topical Medications (Gels)

The use of topical delivery systems for pain medications is a majorleap forward in pain management. It allows high doses of multi-ple medications that get right to your area of pain—usually withno side effects. One of the many common “recipes” for the paingel is the following combined in a PLO gel:

Ketamine (10 percent)

Lidocaine (15 percent)

Baclofen (4 percent)

Amitriptyline (2 percent)

Clonidine (0.2 percent)

Ketoprofen (10 percent)

Ibuprofen (10 percent)

Rub a large pea–sized amount into a silver dollar–sized area at thecenter of a painful area three times a day. Give it two weeks towork.

There are over a dozen medications that can be combined inthese topical gels. Although they are administered by prescription,compounding pharmacists ( listed in Appendix B) are usuallyhappy to guide your physician in their use.

Some gels and creams can markedly enhance the penetrationof medications through your skin. Medications go directly to thearea of pain in high concentrations while the rest of your body(which does not need the medication) receives very low levels.This is why side effects are usually nonexistent despite the creamsbeing highly effective. These creams need to be put together bycompounding pharmacists, who can sometimes tailor the dosing


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to your case. Because of the time and work involved in mixingthese medications, most drug companies and pharmacists are notwilling to mix them.

Although the creams require a prescription, many prescriptionplans will not cover them. I recommend paying for the first tubeof the cream yourself (approximately fifty to one hundred dollarsfor a one- to three-month supply). If it helps you and allows youto lower your dose of other pain medications, or keeps your doc-tor from having to prescribe the new very expensive medications,you’ll often find that you can talk your insurance company intocovering the cost.

If you are getting benefit from a NSAID (such as Motrin) fortreating a small area of pain, at least four studies have now shownthat NSAIDs can also be effective (and much safer) when used ina topical cream. In one double-blind study using a topical creamfor knee arthritis without swelling, patients rubbed a 5 percentibuprofen (Motrin) cream (containing 200 mg of ibuprofen) intothe knee three times a day. The cream started to work by thefourth day, and by the eighth day there was an average 45 per-cent decrease in pain. All patients were helped, and 40 percentconsidered the treatment to be “very good.” No side effects wereseen.

To get an even more powerful, yet safe, effect from thesecreams and gels, there are many medications that can be com-bined, and selecting the correct combination is an art. Some phar-macists and physicians prefer to begin with just a few medications;for example, ketoprofen (10 percent) and Flexeril (2 percent)applied three times a day locally for trigger point pain. Otherswould begin with ketoprofen (15 percent), Flexeril (3 percent),and lidocaine (5 percent). I often begin with a mixture of five ormore medications as this can enhance the effectiveness—usuallywithout any side effects. Give the creams at least one to two weeksto work, and be willing to continue adjusting the mix until youfind what works. The following list is just some of the medica-tions that can be added to the creams:


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Ketoprofen, piroxicam, diclofenac, or ibuprofen

(these four are NSAID anti-inflammatories)

Neurontin

Clonidine

Amitriptyline

Cyclobenzaprine

Baclofen

Ketamine (using with clonidine 0.2 percent reduces side effects)

Lidocaine

Guaifenesin

Capsaicin

Cortisone and/or Sarapin

Fortunately, even though topical medications are in the “babystages” of development, researchers and pharmaceutical compa-nies are beginning to recognize their power. Stephen Hersh,M.D., clinical professor at George Washington University Schoolof Medicine and a member of the American Pain Society, hasfound compounded pain creams to be very helpful. For his RSD(reflex sympathetic dystrophy) patients, he uses a combination ofgabapentin and clonidine cream, which is applied to the affectedarea two to three times a day. He notes, “instant relief [using paincreams] has not been my goal nor has it been my experience . . .unless a patient is allergic to one of the compounds in the topicalmedication, these are interventions that, unlike many in the treat-ment of chronic pain, truly do no harm.” If your physician is notfamiliar with compounded pain creams, the pharmacist at CapeApothecary (Tom at 410-757-3522) can help guide your physi-cian and can mail you the cream if prescribed.

Treating with Patches

If you have a prescription plan, you may want to begin with thelidocaine patch. This Novocain-like patch, called Lidoderm, isapplied directly over the area of maximum pain. It can be cut to


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fit the area, and up to four patches can be used at a time (althoughthe package insert says to use only three). It is left on for twelvehours and then removed for twelve hours each twenty-four-hourperiod, although recent reports have suggested that patches can beleft on for eighteen hours and still be safe and effective. Resultswill usually be seen within two weeks. Because the effect is local,side effects are minimal. The most common side effect is a mildskin rash from the patch. It should not be used if you have anallergy to Novocain/lidocaine.

The patches are most likely to be helpful if the pain is local-ized to a moderately sized area. Even in a large area, however,patches can be used on the most uncomfortable spots. The maindownside of the patches is that they are expensive. If you haveprescription insurance, however, they will usually be covered. Isuspect that, overall, patches will be more effective than thecreams by themselves, because putting a medication “under occlu-sion” (with the patch over it) drives the medication through theskin more effectively.

Oral Pain Medications

Although I have organized the medications by category, it is notat all important that you understand what these categories mean.The chapters in which we discussed the different kinds of pain(neuropathic, muscular, arthritic, and so on) give the order inwhich to try the pain medications. If you are not clear on thesource or type of your pain, there are many reasonable sequencesin which to try the medications. One way to try them is in theorder of the following list. When there are several medications onthe same line, if the first medication helped but was not toleratedbecause of side effects, go to the next medication on the sameline. If that medication does not help significantly, go to the nextline. If you get partial benefit from a medication, continue it andadd another medication as needed to get pain free. (The medica-


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tions discussed in this chapter are not a complete list of possiblemedications, but they are the ones I have found most helpful.)

The main cause of side effects with many of these medicationsis raising the dose too quickly. Start with a low dose and work upslowly as is tolerated. For more information, visit the vital-ity101.com website under “Treatment Protocol” and the website’sPain Free 1-2-3 “Notes.”

Here is the order:

1. Lidocaine patches and/or gels (for a localized area of pain)2. Tylenol3. Ultram (Like narcotics, Ultram is good for overall pain

relief and is a reasonable medication to begin with as well.)4. Motrin, Voltaren, or Daypro (Your insurance company

prefers that these be tried before Celebrex because of cost;however, long-term use is also associated with significantrisks and side effects, and other medications may be betterfor nonarthritis pain.)

5. Skelaxin (for muscle pain/achiness)6. Neurontin, Gabitril, and/or pregabalin (Lyrica)7. Flexeril (for muscle pain/achiness)8. Celebrex (Long-term use is associated with significant

risks and side effects, and other medications may be betterfor nonarthritis pain.)

9. Elavil, doxepin, desipramine (Norpramin), or nortriptyline(Pamelor)

10. Zanaflex11. Effexor12. Baclofen (for muscle pain/achiness)13. Klonopin (for muscle pain/achiness)14. Topamax15. Lamictal16. Keppra17. Narcotics


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Ultram (Tramadol)Ultram is an excellent medication for almost any kind of pain. Itworks on the codeine receptors and also raises serotonin and nor-epinephrine levels. Although Ultram can be taken up to 100 mgfour times a day, many people find they get nausea and sedation atdoses over 200 mg a day. Rarely is this a problem at a low dose,so only take 50 mg for the first dose. If four to six hours later nau-sea is not a problem, feel free to increase the dose to a maximumof 100 mg twice a day the first day. If nausea is still not a problemat this dose, you can continue to increase the dose to the maxi-mum above. The medication can also be taken on an “as needed”basis.

Aspirin and NSAIDs (NonsteroidalAnti-Inflammatory Drugs)NSAIDs block inflammation by inhibiting hormones calledprostaglandins (PGE). This family of hormones comes from spe-cial fats/oils in our diet (essential fatty acids). The prostaglandinthat causes inflammation is called PGE2. This hormone is madefrom animal fats (arachadonic acid). Other oils (especially fish oil,flaxseed oil, and borage oil) make different prostaglandin hor-mones (PGE1 and PGE3) that inhibit inflammation. In addition,these prostaglandins protect your stomach from developing ulcers.Aspirin/NSAID family medications block all of these prostaglan-dins, resulting in approximately 1 percent of chronic users peryear developing ulcers or other serious gastrointestinal complica-tions. This is why approximately fifteen thousand to twenty thou-sand Americans die each year from these medications (mostly frombleeding ulcers).

In fact, NSAIDs are one of the most common causes of pre-scription drug adverse reactions, accounting for over 107,000 hos-pitalizations and over 16,500 deaths annually in the United States.More than $2.5 billion a year is spent on the purchase of thesedrugs with another 4 billion dollars being spent to manage theirside effects. Using fish oil and cutting down on animal fats is a


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safer way to get much of these medications’ benefits. In addition,willow bark and other natural remedies (discussed in Chapter 11)have been shown to be as effective and are much safer thanNSAIDs.

NSAIDs are rarely beneficial in fibromyalgia (a muscle paindisorder). In one study, NSAIDs were no more effective than aplacebo. There are many different categories of NSAIDs. As yourphysician is likely familiar with this family of medications, and asI am not thrilled with their being used for long-term treatmentbecause of side effects, I’m not going to talk about them at greatdepth. However, let’s review the key points.

It is important to be aware that NSAIDs can belong to differ-ent families or chemical structures (as seen in Table 13.1), andtherefore all NSAIDs do not behave the same. If you do not getbetter with an NSAID in one family, do not try another in thesame family. Instead go to one in a different family.

As you can see in Table 13.1, you may not respond to ibupro-fen, but may respond well to Voltaren. The important thing is thatif you try ibuprofen, don’t try naproxen next because you’re justadding a chemically similar agent. If you use one type of NSAID


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Family/Chemical Structure NSAID

Propionic Ibuprofen (Motrin and Advil)

Naproxen (Naprosyn and Aleve)

Oxaprozin (Daypro)

Ketoprofen

Acetic Diclofenac (Voltaren)

Indomethacin (Indocin)

Tolmetin

Sulindac (Clinoral)

Salicylic (carboxylic) Aspirin

Diflunisal (Dolobid)

Anthranilic (enolic) Piroxicam (Feldene)

Pyrrolopyrroles Etodolac

Ketorolac (Toradol)

TABLE 13.1 Families of NSAIDs

and it does not work, change to another family altogether if you’regoing to try another NSAID. This applies not just to effectiveness,but also to tolerability.

I recommend beginning with Motrin (Advil, ibuprofen) orDaypro, followed by Voltaren (which seems to be easier on thestomach). Although NSAIDs can be very good for inflammatorypain, they usually work poorly for muscle/myofascial pain. Basedon its mechanism of action, one would expect that Celebrexwould not work for muscle pain either. Nonetheless, my patientshave taught me that this medication can be highly effective formuscle pain that is not helped by NSAIDs. We still have a lot tolearn.

Selective COX-2 InhibitorsThese medications inhibit certain inflammatory pathways morespecifically than the NSAIDs, inhibiting those COX enzymesinvolved in inflammation, while not affecting those prostaglandinsthat protect the stomach lining. Because of this, they’re consid-ered by some to be less likely to cause stomach bleeding and irri-tation. In my experience, patients have found Celebrex (100 to200 mg one to two times a day) to be far more effective forfibromyalgia and muscle pain than the NSAIDs, which only seemto help in 10 to 15 percent of patients. They are also easier on thestomach.

In one study conducted over a period of twelve weeks, stom-ach ulcers were seen in 7 percent of patients given a placebo,approximately 7 percent of patients on a COX-2 medication, and29 percent of patients on Motrin (800 mg three times a day).

Unfortunately, recent research suggests that this family ofmedications may markedly increase the risk of heart attacks andstrokes, and because of this Vioxx and Bextra have been removedfrom the market (although in a controversial way, Vioxx was ini-tially allowed back on). In addition, they may result in high bloodpressure. Researchers at the Arthritis Research Center Founda-


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tion in Wichita, Kansas, examined data on 8,538 patients whowere taking rofecoxib (Vioxx), celecoxib (Celebrex), or otherNSAIDs. They determined that taking Vioxx also increased therisk of lower leg swelling (a symptom often linked to hyperten-sion and other cardiac diseases) by 23 percent and increased bloodpressure by 21 percent compared to other NSAID use. Patientswho are allergic to sulfa antibiotics cannot take Celebrex.

Acetaminophen/TylenolFor many people, acetaminophen can be a safe and effective painmedication. Simply be aware that chronic use at too high a dosecan cause liver and sometimes kidney problems. Do not take morethan 4,000 mg a day, and for chronic use it is best to stay under2,000 to 3,000 mg daily. If you are taking more than 1,000 mg aday on a regular basis, you are probably depleting a critical antiox-idant called glutathione. This can result in many other problems.Taking the Energy Revitalization System vitamin powder canhelp restore your glutathione levels by supplying vitamin C, NAC(N-acetyl-cysteine), and other key amino acids. Unfortunatelytaking glutathione itself by mouth is not effective as it getsdigested. If you are taking over 1,500 mg of acetaminophen a dayon a regular basis, take an extra 500 to 650 mg of NAC each dayalong with the vitamin powder.

A common problem is that people often take several differentmedications that contain acetaminophen. In addition to Tylenol,it can also be found in many prescription and over-the-countercold, sleep, pain (including most narcotics), and other remedies.Please check to see how much acetaminophen is in each medica-tion you are taking so that you can be sure that you’re not gettingtoxic amounts. This has become a significant concern with analarming number of patients suffering from serious side effectsassociated with accidental overdosing of acetaminophen. Thisresults in over fifty-six thousand hospital emergency room visitsand one hundred deaths a year according to the FDA. This risk is


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especially alarming when you realize that acetaminophen is onlymodestly superior to a placebo for treating arthritis. At higherdoses of acetaminophen (over 2,000 mg a day), the risk of gas-trointestinal bleeding increases 3.6 fold. At doses of over3,600 mg, the risk was equivalent to that of aspirin and NSAIDs.In addition, kidney failure and death from liver failure was morecommon in people taking acetaminophen for pain than in thosewho overdosed.

Although I consider acetaminophen to be an excellent drug forshort-term or intermittent use, especially at doses under 2,000 mga day, other medications may be safer for long-term and chronicuse—and will likely be more effective.

Muscle RelaxantsSome muscle relaxants work directly on the brain, causing lessmuscle weakness. One excellent medication is Skelaxin (800 mgthree to four times a day), which is low in side effects. In somepeople it works wonderfully, and in others it does nothing. Formuscle pain, give Skelaxin a few weeks to see the effect. This is amedication I use frequently because it is not sedating.

Other medications work directly on the muscles to causerelaxation instead of working at the level of brain or nerve func-tion. Because of this, they are also not likely to cause sedation orconfusion, but they are more likely to cause muscle weakness.

One such medication is dantrolene (Dantrium), which worksdirectly on the muscle causing it to relax. The usual dose is 25 to100 mg given three to four times daily. The main problem withusing this medication is that it can cause liver damage in about1 percent of patients who use it, and liver blood tests may need tobe monitored.

GABA-Augmenting MedicationsGABA is a chemical compound in the brain that tends to settledown excess stimulation. Historically, GABA-augmenting med-ications have been used to treat muscle spasm. The medication


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Baclofen has been used for almost forty years and has been foundto be safe and effective and is considered a key first-line therapyfor spasticity.

Unlike some medications, Baclofen can be used over a widerange of dosing. Although a common dose is 10 to 20 mg two tofour times a day, doses as low as 5 mg or as high as 200 mg a daycan be used. Its main limiting side effects are sedation and, athigher doses, muscle weakness. In addition, withdrawal spasmsand other side effects can be seen if the medication is stoppedabruptly. Because of this, if you have been on Baclofen for anextended time and you want to stop, you should be weaned offthe medication slowly. This medication may also be helpful forpost-traumatic stress disorder. In addition, I found that newermedications that affect GABA are more effective than Baclofenand work on many different kinds of pain

Neurontin (Gabapentin). This seizure medication can help a widevariety of pain patients. Although Neurontin is related to theGABA neurotransmitters, how it works is unclear. It does stimu-late GABA receptors in ways that are different from Baclofen.Although it causes sedation and other neurologic side effects insome patients, overall it is very safe and well-tolerated. It has beenproven to be effective in both diabetic neuropathy and posther-petic neuralgia (shingles pain).

Begin with 300 mg at bedtime. Patients who are very sensitiveto medications should begin with only 100 mg. If tolerated, youcan increase the dose to 600 mg the second night and 900 mg thethird night. You can then increase the Neurontin dose by 300 mgonce or twice weekly (or more quickly if side effects are not aproblem). When taking over 900 mg a day, divide the totalamount into three daily doses. If there is no effect at 2,400 mg aday, the medication is not likely to help. If you have been on themedication for more than a few months, it should be tapered offover several weeks. Although it is rare, withdrawal can occur ifthis medication is stopped suddenly. If only partial relief is seen at


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2,400 mg a day, the dose can be raised as high as 4,800 mg ormore daily. The medication may not be absorbed as effectively iftaken within a few hours of magnesium (or aluminum antacids).Therefore, if it’s convenient, take the vitamin powder, whichcontains magnesium, a few hours away from the Neurontin dose.

Gabitril. As noted in Chapter 4, Gabitril (tiagabine) is an anti-seizure medication that has also been shown to increase GABA byinhibiting reuptake (the same way that Prozac raises serotonin).Although not FDA approved for sleep, studies have found that, inaddition to decreasing pain, the medication can also improve deepsleep. The main side effects are sedation, dizziness, irritability, andgastric upset. It is best to take Gabitril with food. The most com-mon effective dose of Gabitril is 16 mg a day (ranging from 5 to24 mg a day).

In one study, Gabitril was given at a dose of 2 mg twice a dayand increased by up to 4 mg daily each week to a maximum of24 mg a day. Other patients received Neurontin, beginning at100 mg twice daily and increasing by 300 mg a day each week toa maximum of 2,400 mg a day. The ninety-one patients partici-pating all had chronic pain of different types. Gabitril decreasedpain by approximately 30 percent and decreased sleep problemsby approximately 40 percent. Similar albeit smaller improvementswere seen with Neurontin. Especially important is the findingthat the amount of time spent in deep, restorative sleep wasincreased. Five mg at bedtime is a good sleep dose.

Lyrica (Pregabalin). This drug is related to Neurontin and is thefirst drug that may eventually have FDA approval for use infibromyalgia, so insurers will more likely pay for it. It may alsobe approved for epilepsy, neuropathic pain, and anxiety. A mul-ticenter drug study showed that pregabalin was helpful with bothcontrolling pain and increasing deep sleep in patients with fibro-myalgia. It also reduced restless leg syndrome, a very common


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problem in fibromyalgia. The main side effects are dizziness anddrowsiness, which tend to decrease over time. Initial experiencewith it has been very encouraging. The dosing range is 50 to150 mg three times a day. A dose of 100 mg three times a daymay be as effective as the higher dose.

Topamax (Topiramate). This is another antiseizure medication thatcan be very helpful for pain. Although I use Topamax infre-quently, this is a medication that I have seen work wonderfully inpatients for whom numerous other treatments have failed, and itsometimes starts working in less than one week. Begin with 25 to50 mg daily and increase by 25 to 50 mg a week until you get thedesired effect. This medication is usually given twice a day at atotal daily dose of 50 to 100 mg per day for migraines and 200 to300 mg a day for nerve pain, although lower doses can be effec-tive. If you get side effects, decrease the dose and perhaps laterincrease it more slowly until you get the desired effect.

The most common side effects are diarrhea (11 percent), lossof appetite (11 percent), sedation (10 percent), and nausea (10 per-cent). The side effects often go away after two to three months.Along with pain relief, Topamax also has the benefit of causingweight loss. Besides sedation, its most worrisome, albeit unusual,side effect is that it can make your body very acidic—to the pointwhere it is dangerous. Because of this, it is reasonable to check ablood bicarbonate level every so often (especially if you startdeveloping symptoms such as fatigue) and make sure that the levelis over 17.

AntidepressantsAntidepressants can be very helpful in alleviating pain even if theperson is not depressed. Do not presume that your pain specialistthinks that you have a psychological problem if you’re offered anantidepressant for pain. The following types of antidepressantshave been found useful in alleviating pain.


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Tricyclic Antidepressants. These medications (including Elavil/amitriptyline, doxepin, and others) can be dramatically beneficial,even at very low doses, for neuropathic pain. They also improvethe sleep problems caused by the pain. Where the antidepressantdose of Elavil is approximately 200 to 250 mg a day, the neuro-pathic dose is usually about 10 to 50 mg at bedtime. In additionto neuropathic pain, tricyclic antidepressants have also been foundto be effective for fibromyalgia. Tricyclics have also been foundto be effective for headaches and vulvodynia/pelvic pain syn-dromes. They also can markedly enhance the effect of narcoticpain medications.

Their main side effects include dry mouth, sedation, weightgain, constipation, low blood pressure, and palpitations. In addi-tion, these medications can cause a worsening of glaucoma, uri-nary retention, and restless leg syndrome.

Desipramine (Norpramin), 25 to 150 mg at bedtime, or nor-triptyline (Pamelor), 10 to 25 mg at bedtime, cause less sedationand fewer side effects than Elavil and may be as effective. If seda-tion is still a problem, consider switching to doxepin (10 to 40 mgat bedtime).

Flexeril (Cyclobenzaprine). While Flexeril is a muscle relaxant, itis in the tricyclic family. Unlike Elavil, which is more effective fornerve pain, Flexeril is mostly effective for muscle pain and sleepproblems. In my experience, it is better tolerated than Elavil andis worth trying even if the other tricyclics were ineffective orpoorly tolerated. In one fibromyalgia study, Flexeril was far moreeffective than a placebo.

Flexeril can be sedating, and many people choose only to takeit at night, using 10 to 20 mg at bedtime. It can also be taken at adose of 5 to 10 mg three times a day instead. Recent studies havefound, however, that a 5 mg dose is almost as effective as 10 mgwith much less drowsiness. In one study of patients with musclespasm, most patients experienced moderate to complete symptomrelief within forty-eight hours of starting Flexeril (5 mg three


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times a day). Only 29 percent were sedated at the lower dose, andin most cases sedation was mild, with only 2 percent of patientsreporting severe sedation. As an aside, the generic form is muchless expensive. If it is not available in the 5 mg generic size, sim-ply get the 10 mg tablet and break it in half.

SSRI Antidepressants. SSRIs include medications such as Prozac,Effexor, and Celexa and can also be highly effective for pain.These medications raise serotonin, which lowers levels of sub-stance P, a major pain messenger. Substance P levels can beincreased by 300 percent in the brains of patients with fibromyal-gia, and it is elevated in other pain states as well. One-third offibromyalgia patients find that SSRIs help their pain significantly.Interestingly, people may feel horrible with one SSRI and won-derful with another, so it is worth trying several sequentially tofind one that “fits.”

Being off-patent, Prozac has the benefit of being less expensive.Celexa causes fewer side effects than other antidepressants. In myexperience however, Effexor is the most effective antidepressantfor decreasing the pain and other symptoms of fibromyalgiapatients, so it is a reasonable medication to try first. This may occurbecause the medication raises both serotonin and norepineph-rine—an excellent combination in pain management. Effexor canbe helpful in neuropathic pain and headache as well, especially inpatients with associated depression and/or anxiety.

Dr. Argo, a pain specialist at the pain management center atColumbia Rose Medical Center, Denver, has found that Paxil canbe very helpful for reflex sympathetic dystrophy where otherSSRIs are not.

A new family of antidepressant medications is promising.Cymbalta (duloxetine) is a norepinephrine and serotonin reuptakeinhibitor. At lower doses (20 to 60 mg a day), it has fewer sideeffects and does not cause weight gain.

If sleep is a problem, consider adding trazodone (Desyrel) atbedtime. This novel antidepressant is very good for sleep (use a


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low dose such as 25 to 75 mg at bedtime) and anxiety. As notedin previous chapters, good sleep is critical for pain relief !

One of the most troublesome side effects of the Prozac family(SSRI) antidepressants is sexual dysfunction (discussed in moredetail in Chapter 14). This especially manifests as delayed orgasm.As one of my female patients said, “An orgasm delayed is anorgasm lost.” Many treatments are available to help with this typeof sexual dysfunction. I recommend beginning with the herbginkgo biloba, 120 mg two times daily. This higher dose is nec-essary to counteract the loss of libido from antidepressants, as theusual dose (60 mg twice daily) was not effective in a recent study.It takes six weeks to see the effect on the libido.

Medications that can be helpful for antidepressant-induced sex-ual dysfunction include cyproheptadine (Periactin), 2 to 16 mgdaily, average dose 8 mg. It can be taken one to two hours beforeintercourse on an “as needed” basis, or it can be taken every day.Its main side effect is sedation, and it will sometimes reverse theeffectiveness of the antidepressant, so taking it on an “as needed”basis may be the best approach. BuSpar (buspirone), a medicationused to treat anxiety, has also been shown to help. It is best takenevery day when used for sexual dysfunction. Stimulants such asDexedrine and Ritalin, 5 to 25 mg daily, are also effective. Othermedications that raise dopamine, such as amantadine (Symmetrel),100 mg twice daily, or the antidepressant Wellbutrin, have alsobeen shown to be effective. Although most of the studies on thesemedications were conducted in a small number of patients (exceptfor ginkgo biloba, which was a larger trial), there are plenty ofoptions available so that you can have your Prozac and your sexlife too!

Alpha-2-Adrenergic Agonists (Enhancers)Zanaflex (tizanidine) and Catapres are two key medications in thecategory of alpha-2-adrenergic enhancers. The former appears tobe more effective for pain management and has fewer side effects.Like GABA agents, these medications tend to settle things down.


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Unlike Baclofen, however, Catapres has the benefit of not caus-ing muscle weakness.

The main side effect of Zanaflex is sedation, but this can alsobe a benefit. In most patients, I recommend that they take 2 to8 mg at bedtime. This helps sleep and also helps both nighttimeand next-day pain. Dry mouth is sometimes seen with this med-ication. If sedation is not a problem, Zanaflex can be taken threeto four times a day as needed, with a maximum dose of 36 mg aday. Most patients find that 4 mg at bedtime works just fine. IfZanaflex is too expensive, try Catapres instead.

NMDA Receptor AntagonistsNMDA receptors are highly involved in triggering pain and cancause irritation that results in the persistence of pain. Because ofthis, medications that settle down this NMDA irritation can bevery helpful.

Ketamine. Ketamine is a general anesthetic that has traditionallybeen given intravenously. Because ketamine works by blocking acritical pain mechanism (the NMDA receptor) that is missed byother therapies, it holds promise in the treatment of refractorypain, especially neuropathic, myofascial, postamputation, andreflex sympathetic dystrophy. Ketamine has been used clinicallyfor over twenty-five years for anesthesia. In addition, pain reliefoften persists long after the medication has worn off. This sug-gests that ketamine may actually be breaking the pain cycle (whenthe pain itself triggers more pain) in some conditions.

In the later section on IV therapies, I briefly discuss the role ofIV ketamine, an anesthetic that can cause hallucinations and a feel-ing of unreality, limiting its use on a regular basis. Nonetheless, itcan be very helpful in certain refractory cases—especially withnerve/neuropathic pain and reflex sympathetic dystrophy. Sideeffects tend to decrease with continued use and can be decreasedby adding other medications such as Haldol or midazolam (or byadding 0.2 percent Catapres to ketamine creams when needed).


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Because of IV and oral ketamine’s psychological side effects,these forms of ketamine are best prescribed by those physicianswho have more experience with pain management. Ketamine canbe very helpful (and usually side effect free) in gel form applied tothe painful area, taking one to two weeks to see the effect.

Klonopin (Clonazepam). Klonopin is in the Valium family, but Ifind it to be much more effective and safer than Valium for a num-ber of reasons. Klonopin acts as an NMDA receptor antagonist. Italso acts as a muscle relaxant and can be very helpful for sleep(unlike Valium, which actually interferes with restorative sleep,keeping people in light stage 2 sleep). However, like Valium,Klonopin can be addictive. In my experience, addiction has beenrare at doses under 1.5 mg a day. Its main side effect is sedation,so I mostly have patients take it at nighttime. It can also be veryhelpful for anxiety and restless leg syndrome (where your legs arerhythmically moving all night—and your sleep is not very restfulif you’re running a marathon all night).

Patients often come to my office who have been on benzodi-azepines (Valium family medications) for many years and are oftenaddicted. If the medication is not interfering with their life and ishelping their symptoms, I do not consider getting them off themedication to be a high priority. For those who want to wean offValium family medications, it must be done under a physician’ssupervision as withdrawal is common. Neurontin (200 mg threetimes a day) can help make it easier to wean off Valium and otherrelated medications.

Dextromethorphan. Dextromethorphan is not usually very effec-tive on its own in treating pain, but when added to narcotics ithelps to keep the narcotics effective. Only a small percentage offibromyalgia patients (less than 18 percent), however, received sig-nificant benefit from the dextromethorphan (a 51 percentdecrease in pain at an average dose of 50 mg, three times a day).


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For most patients, the side effects—dizziness, mental fog, nausea,and fatigue—at these doses are prohibitive. But if you have per-sistent pain, dextromethorphan is worth trying by starting at 25to 50 mg a day and slowly increasing the dose as tolerated.Although this medication is available over the counter, it is usu-ally found mixed with other medications. It can be obtained inpure form from compounding pharmacists.

Sodium Channel BlockersExcept for lidocaine, this family of medications tends to be highin side effects. Because of this, I usually use other medicationsfirst. Nonetheless, in some patients these medications can be agodsend. (Lidocaine is discussed in the later section on IV painmedications.)

Dilantin (Phenytoin). Dilantin is one of the oldest seizure medica-tions and is underused. I was amazed about twenty years agowhen I received a book on the uses of Dilantin in the mail. A mil-lionaire was given Dilantin for a severe chronic problem withalmost miraculous results. He researched the little-publicized ben-efits of Dilantin use, put them in a book, and sent a free copy ofthe book to every physician in the country. Since he derived nobenefit except helping others from this expensive action, I wasimpressed enough to explore the use of this medication further.Although it is old and fairly inexpensive, Dilantin can be veryhelpful. It is useful for nerve pain of several types, including timeswhen cancer is infiltrating into nerve bundles. The recommendeddose is 300 to 400 mg daily.

Dilantin does have more side effects than most of the othermedications we’ve discussed, and, therefore, I rarely use it as afirst-line treatment, saving it for cases that do not respond to othertherapies.

Dilantin can also cause birth defects if one gets pregnant whiletaking it. Otherwise, its main side effects include dizziness, seda-


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tion, and nausea. It can also cause unwanted hair growth (some-times on the ears in females) and overgrowth of gum tissue. (Thelatter side effect can actually be beneficial in those who havereceding gums. Dilantin can be given as a topical cream appliedto the gums for this purpose.)

Tegretol (Carbamazepine). This antiseizure medication is mostoften used for trigeminal neuralgia, peripheral neuropathy, andpostherpetic neuralgia (post shingles pain). The main side effectsinclude sedation, tremor, and difficulty with speech. A drop inwhite blood cell count can occur in 10 percent of patients, butthis sometimes resolves after four months. If blood counts go toolow or there is lymph node enlargement, stop the medication.This medication can also cause birth defects if one gets pregnantwhile taking it. It has many more side effects than most of theothers that I use, and therefore I rarely use it.

Additional Oral MedicationsLamictal ( lamotrigine) can also be effective for many kinds ofpain, including nerve pain from AIDS and central brain pain fromstrokes. In early studies where lower doses of 200 mg a day or lesswere used, the effects were marginal. Doses of 200 to 400 mg aday, divided through the day, are more effective for some kinds ofpain. You can start with a low dose and increase by 25 mg a weekto decrease the probability of side effects. The most worrisomeside effect is a rare rash (called Stevens-Johnson syndrome), whichcan be fatal. If you develop a rash, stop the medication immedi-ately and let your doctor know. The vast majority of the time itwill not be this dangerous type of rash, but better safe than sorry.

Keppra (levetiracetam) is another new antiseizure medicationthat we are just starting to explore. It has been effective whenother treatments have not helped. The recommended dose is 500to 1,500 mg twice daily.

Trileptal (oxcarbazepine) is a cousin to the medication Tegre-tol, and both of these medications are helpful for trigeminal neu-


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ralgia. The dose is 150 mg two times a day, although one can goas high as 600 mg two times a day. The side effects (sedation,blurred vision) decrease after the initial three weeks of treatment.

Lithium is a natural mineral that is available by prescription forthe treatment of bipolar disorder (manic-depressive illness). It hasmany other properties including being antiviral. Interestingly, sev-eral case reports have noted that debilitating chronic pain that hasbeen refractory to other treatments will sometimes improve dra-matically with lithium. Sometimes this can be achieved withdoses as low as 300 mg one to two times daily.

When to Consider Narcotics

Some physicians consider narcotics to be a pain reliever of lastresort—only to be used with terminally ill cancer patients. Theuse of narcotics for chronic pain continues to be controversial andhas become highly politicized. Fortunately, the vast majority ofchronic pain cases can now be treated effectively without nar-cotics. Nonetheless, there are cases in which they are necessary.Sometimes the toxicity of the pain dramatically outweighs thetoxicity of the medication.

If narcotic side effects are problematic, ask your doctor to usethe other pain medications we discuss in the book as well so youcan find a combination that is more comfortable. (Using fentanylpatches can be very helpful because they give steady release ofpain medication, are powerful, and can be taken even if nausea orconfusion is present.)

Data suggest that longer-acting narcotics are less likely to causeaddictive behavior than short-acting narcotics. In addition, as pre-viously mentioned, for severe chronic pain, giving the medicationon a regular basis (two to three times a day) to prevent pain ismore effective than waiting for the pain to occur before takingthe medication—with the result that less medication is needed.

When treating with narcotics, it is helpful to be aware that dif-ferent narcotics can work on several different types of opioid


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receptors. This means that combining different narcotics mayresult in their having a synergistic effect (a lower dose of two dif-ferent types such as oxycodone and morphine may work muchbetter than a higher dose of one of them). In addition, if one isdeveloping resistance to one narcotic, rotating to others may resultin improved effectiveness. Some narcotics also have multipleeffects. For example, methadone affects the opioids receptorswhile also blocking NMDA receptors.

Dealing with the Side EffectsThe main side effects of narcotics are constipation and sedation.The magnesium in the vitamin powder can be very helpful for theconstipation, and other treatments can also help. I recommendusing the following list as many other constipation treatments canbe addictive. Adjust as needed for one soft bowel movement a day.

• Increase water, fiber (for example, eat one bowl of wholegrain cereal in the morning), and magnesium intake.

• Try other natural over-the-counter treatments forconstipation that include high-dose vitamin C (see thearticle “Vitamin C Flush” under “Useful Articles” atvitality101.com), prunes, and/or prune juice. Although weoften forget about prunes, they have been used for centuriesand can be quite helpful.

• Prescription treatments can also help and include MiraLax—take one heaping tablespoon a day in eight ounces of water;sorbitol (70 percent)—take one to three teaspoons threetimes a day as needed; and lactulose liquid as needed.

A new medication called Provigil can be very helpful fornarcotic-induced fatigue. Aricept (donepezil), a medication forAlzheimer’s disease that increases acetylcholine levels, has alsobeen found to be helpful for this problem.

I would note that there is also a small subset (approximately 2to 5 percent) of fibromyalgia patients who experience dramaticclearing of exhaustion and fatigue (associated with their pain)


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with narcotic pain medications. They state (and I’ve heard thisstatement many times) that they “feel like healthy normal humanbeings” when they are taking the narcotic medication. AlthoughI have not yet figured out the biochemistry of this effect, in thefuture I hope to have nonnarcotic alternatives that will give thesame benefit.

Another important side effect of using opioids in men is thatthe narcotics will routinely drop the patients’ testosterone levels(often by elevating a hormone called prolactin), resulting in lossof libido and sometimes difficulty with erections. Because of this,it is reasonable to have a patient’s testosterone level checked beforebeginning chronic opioids. If symptoms of low testosteroneoccur, and the testosterone level has decreased on treatment withopioids, it is reasonable to treat with natural testosterone cream orAndroGel as well.

Long-Acting Narcotic Pain MedicationsThere are a number of different long-acting narcotic pain med-ications. These include methadone (Dolophine), sustained-releasemorphine (such as MS Contin), and sustained-release oxycodone(OxyContin), which may be preferable to short-acting combina-tions of codeine with acetaminophen, oxycodone, or hydroco-done. The longer-acting medications maintain a steady blood levelso there is less of a euphoric effect (and therefore less drug crav-ing) and more consistent relief of pain. In addition, not combin-ing the medication with acetaminophen allows one to safely usehigher doses, as needed. Using more than 3,000 to 4,000 mg ofacetaminophen (Tylenol) daily can be toxic to the liver andimmune system (as explained previously).

Methadone is one of the oldest narcotics and has many bene-fits. It is inexpensive, long-acting, effective, and usually well-tolerated. It also may have some activity as an NMDA receptorantagonist, making the medication useful in neuropathic pain aswell. Unfortunately, I do not use methadone in my practicedespite its being an excellent pain medication. The regulatory andbureaucratic risks and hassles associated with its use are simply


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too great. This has also been the experience of many other painspecialists.

Fortunately, there are other longer-acting narcotics available.One of the best known is OxyContin (timed-release oxycodone),which can be very safe and effective when used orally as directed.Sadly, it can be illegally diverted and used illicitly. Therefore, ithas also become dangerous for physicians to prescribe Oxycontin,even appropriately, because the federal government will some-times put a physician in jail for doing so. OxyContin also has beenassociated with vitamin B2 (riboflavin) deficiency, which willsometimes cause the corners of the mouth to crack. This is calledangular stomatitis, cheilitis, or perleche. In one study of twenty-twopatients receiving OxyContin, twenty of them were found tohave this problem. High-dose vitamin B2 (present in the EnergyRevitalization System) eliminated the problem in almost allpatients within a few days.

An alternative is the use of timed-release morphine. This canbe given every twelve hours, although in some patients it needs tobe given three times a day. Another alternative is non–timed-release oxycodone (Percocet and Roxicet), which is stronger andless sedating than morphine. Although not as safe (they are moreaddictive) as the timed-release form (Oxycontin), they’re stillhighly effective, and physicians are less likely to be arrested or losetheir licenses for prescribing them. Again, be aware that many ofthese medications are combined with acetaminophen (Tylenol)and that many pain patients are getting acetaminophen from manysources. It is worth repeating that chronic use of more than 3,000to 4,000 mg of acetaminophen a day can cause severe liver dam-age. It is very important to check everything that you are takingto make sure that you do not take more than this amount of acet-aminophen daily.

Narcotics and AddictionExperience and the scientific literature have shown that opioidsare very unlikely to cause addiction when used properly for treat-


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The medical components found in marijuana (discussed in Chapter

11) can be helpful in a number of painful conditions, especially

when anxiety and/or loss of appetite (for example due to cancer)

are also problematic. In most studies, pharmaceutical fractions are

studied (such as THC in the medication Marinol) instead of whole

marijuana. Studies have found marijuana to be effective for cancer,

neuropathic, and spasticity pain. Unfortunately, as discussed earlier,

the more expensive synthetic pharmaceutical forms of marijuana

may not be as effective as smoking marijuana.

Current evidence suggests that there are brain receptors for

cannabis just as there are receptors for opioids, and that migraine

headaches, fibromyalgia, and irritable bowel syndrome may all

display an underlying deficiency of the body’s own “cannabis-like”

chemical production. Especially in cases where the brain has been

sensitized to pain (called a central sensitization state with

secondary hyperalgesia) such as occurs in fibromyalgia, the data

suggest that cannabis therapies could be helpful. Unfortunately,

the politics surrounding drug policy precludes these treatments

from currently being used—despite their being safer, more

effective, and certainly less expensive than many other treatments.

Cannabinoids

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ment of pain. Addiction needs to be contrasted to a physicaldependence and tolerance. Addiction is an uncontrolled compul-sive use of the drug even though it is harming the user. Clinicalexperience and medical literature suggest that this is a veryuncommon situation when opioids are used for chronic pain innon–drug addicts. Habituation and physical dependence, however,are common with this family of medication as well as with anti-depressants, antiseizure medications, and many other medications.All this means is that you do not want to stop the medication sud-denly, as you might go through withdrawal. Instead, the medica-tion should be tapered off over time. Physical dependence does

not usually become a problem in the clinical setting unless themedication is stopped suddenly or the dose is reduced substantiallywithout tapering it.

In addition and as noted previously, Dr. Argo, a pain specialistat the pain management center at Columbia Rose Medical Cen-ter, Denver, has found that adding low-dose Elavil can markedlyenhance the effect of narcotic pain medications. In addition, tak-ing dextromethorphan (25 mg two times a day) can decrease thetolerance that people develop to a narcotic’s effectiveness. Becauseof this, it is reasonable that anyone on narcotic pain medicationsshould also take dextromethorphan.

Intravenous Pain Medications

In severe cases of persistent pain, the use of intravenous pain ther-apies can be powerfully effective. Anytime IV pain medicationsare used, it is worth giving intravenous nutritional support at thesame time. This can contribute powerfully to healing the under-lying problem, and a series of these treatments can help you feelbetter and may actually eliminate the source of the pain. These IVnutritional therapies are called Myers cocktails and are currentlybeing studied in a placebo-controlled trial.

MagnesiumIn a study of eighty-six patients with chronic muscle pain, includ-ing myofascial pain and fibromyalgia, a series of injections with IVor IM (intramuscular) magnesium with other nutrients, includingB vitamins, calcium, and vitamin C, was given. Seventy-four per-cent of the patients improved, with 64 percent requiring four orless injections to see optimal results. Some patients required long-term treatments to maintain the effect. Side effects leading to dis-continuation of therapy occurred in 4 percent of the patients. Theneed for prescriptions for anti-inflammatory medications and mus-cle relaxants was decreased markedly. In addition (as noted in


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Chapter 7), intravenous magnesium has also been shown to bevery helpful for acute migraine headaches.

LidocaineA second highly effective intravenous pain therapy is the use oflidocaine. I have found this to be very effective in a large numberof patients with widespread pain. In my practice, I give a 60 mgtest dose during a time period of approximately forty-five min-utes. This is to screen for patients whose blood pressure tends todrop or who have other side effects. If the initial treatment iswell-tolerated, an additional 40 to 60 mg can be given the first day(this low dose is unlikely to result in much pain relief ). Forfollow-up treatments, I usually give 75 mg of lidocaine over atime period of approximately twenty minutes, followed by 2 mgper minute (120 mg per hour) for a total of 200 to 300 mg. Thiscan be repeated once or twice a week as needed, and pain relieftends to be more sustained after the first three to six treatments.

Using this treatment approach without heart monitoring iscontroversial because there’s a possible risk of abnormal heartrhythms with lidocaine use. These abnormal rhythms occur pre-dominantly in patients who are in intensive care units for acuteheart attacks. I have never seen heart rhythm problems and do notuse monitoring because this can increase the patient’s cost fromeighty to seven hundred dollars per dose. One study using high-dose lidocaine (up to approximately 500 mg per day over six hoursfor six days) showed marked pain improvement, but two of thepatients did have cardiac side effects that were transient but sig-nificant. This suggests that caution be used when administeringlidocaine in patients with heart problems.

KetamineOther studies have also found IV ketamine (at a dose of 0.3 mgper kilogram over one half hour) to be helpful. Because of thesometimes uncomfortable spaciness/mental changes that can occur


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during the IV infusion, IV ketamine is used less often than lido-caine. Its main promise may be in the treatment of those withreflex sympathetic dystrophy/regional complex pain syndromeand others with severe refractory pain (discussed in Chapter 4).Despite the intoxicated/dissociative feelings that can routinelyoccur with ketamine in higher dosing, it can be powerfully effec-tive in very difficult pain syndromes. Any uncomfortable (mostoften they are not) psychological side effects of ketamine can bedecreased by giving the patient Klonopin and having the patientsleep right after the injection.

Prescription Sleep Medications

Although I much prefer natural remedies to prescription medica-tions, the sleep disorder in some pain patients may be too severeto be dealt with by natural remedies alone. The medicationsdescribed in this section can help you get a full night’s sleep.

Prescription Sleep AidsFor all of the medications discussed here, most of the side effectsthat you may notice will occur the first day that you take the med-ication. Do not drive or operate hazardous equipment if you aresedated from the medications. As with almost everything, do nottake these medications if you are or are trying to get pregnant.Although in my experience it is very uncommon, it is possible toget unusual reactions from combining these medications. If amedication causes recurring nightmares, change the dose or themedication.

Ambien (Zolpidem). I like Ambien because it is short-acting (thatis, less likely to leave you hungover) and less likely to cause sideeffects than many other medications. Because it is short-acting, itmay not keep you asleep all through the night, but it will likelygive you four to six hours of good, solid sleep as a foundation. The


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normal dosage is one-half to one 10 mg tablet, taken at bedtime.If you wake up in the middle of the night you can take an extrahalf to one tablet, and any sedation is usually gone by the time youare ready to wake up in the morning. One-half tablet is usuallyenough for the middle of the night. If you find that taking an addi-tional dose in the middle of the night leaves you hungover, switchto the new, sustained-release form, or use Sonata (described a fewsections later) when you wake instead.

Studies have not shown a wearing-off effect with Ambien inmost people, nor have they found addiction with long-term use.What does occur, though, is rebound insomnia when you stopusing this medication—that is, the need to use something else toassist your sleep for a week. Because of this, if you have takenAmbien for more than four months, use one of the other med-ications or natural sleep remedies discussed in this chapter for aweek or so to assist sleep during the time when you stop theAmbien. In my experience, Ambien can be helpful for restless legsyndrome as well.

Although the use of Ambien is only FDA recommended forless than a month, a two-year study of four thousand patients withchronic insomnia showed that people were able to use it long termwhenever they needed it without developing any significant prob-lems. Regardless of the package insert saying to only use Ambienfor a maximum of one month, both research studies and the expe-rience of many clinicians show that it can be used safely longterm. Rarely, I have seen patients develop depression after beingon Ambien for over a year. In these cases, the depression hasalways lifted quickly within a few days of stopping the Ambien.

Klonopin (Clonazepam). Although in the Valium family, andtherefore potentially habit-forming, Klonopin can be very help-ful for people with pain and is excellent for patients with restlessleg syndrome. When used at doses of less than 2 mg a night, I havenot seen significant problems with addiction. The main side effect


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is next-day sedation, which is fairly common. If this occurs, takea lower dose or take it several hours before bedtime. Because it ispotentially habituating (for example, it may cause withdrawal ifstopped abruptly), do not suddenly stop taking Klonopin if youhave been on it for over six weeks. Instead, taper off by decreas-ing the dosage by 0.25 to 0.5 mg a day every one to eight weeks.

Sonata (Zaleplon). Sonata (in 10 mg capsules) generally wears offwithin three to four hours, so it is best used in the middle of thenight (for example, at 4:00 a.m.) if you wake up and need some-thing to help you fall back to sleep, or if you have trouble fallingasleep but not staying asleep.

Lunesta (Eszopiclone). Taking 1 to 3 mg at bedtime can be mod-estly effective with few side effects. Oddly though, a third of peo-ple taking it get a funny taste.

Muscle Relaxants That Help with SleepFlexeril (cyclobenzaprine) is a muscle relaxant that can be a veryhelpful medication for many people, especially if the pain issevere. The usual dose is one-half to one 10 mg tablet at bedtime,but some people need to take two tablets at bedtime. The mainside effects are sedation and dry mouth and eyes.

Soma (carisprodol) is predominantly a muscle relaxant, and Iwould use this earlier in treatment if you are being kept awake bysevere pain. The usual dose is one-half to two 350 mg tablets atbedtime. Soma is potentially addictive, although I have almostnever seen withdrawal in patients who are only using one to twotablets at bedtime (as opposed to people taking it four times a dayfor pain). The main side effect is sedation.

Medications That Help Both Pain and SleepNeurontin (gabapentin) taken at bedtime can markedly help withboth sleep and pain in many patients. You can take one to three


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capsules of 300 mg (though it also comes in 100 to 800 mg doses).Its main problem is next-day sedation, which often wears off withtime. It can also be taken during the day for pain relief at doses ofup to 4,800 mg daily.

Zanaflex (tizanidine) taken at bedtime can also be helpful forboth pain and sleep; the usual dosage is one-half to two 4 mgtablets. However, it rarely causes nightmares, so if this occursrepeatedly, stop the Zanaflex.

Gabitril (tiagabine) helps both pain and deep sleep. For sleep,2 to 8 mg at bedtime is a reasonable dose. In one study, Gabitrildecreased pain by approximately 30 percent and decreased sleepproblems by approximately 40 percent. Another benefit is that theamount of time spent in deep, restorative sleep is increased.

Antidepressants That Can Help with SleepIn addition to the prescription medications previously mentioned,the serotonin-raising antidepressants known as SSRIs can helpimprove sleep. They also have many other benefits in treatingpain—even if there is no depression present. These medicationsinclude Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (ser-traline) and can improve sleep after six weeks.

Elavil (amitriptyline), technically an antidepressant, was oneof the first medications to be studied for fibromyalgia and foundto be effective. It is also the only medication that many doctorshave heard of for treating fibromyalgia. Although Elavil can bevery helpful, it has significant side effects and therefore is oftenone of the last treatments I try. These side effects include weightgain, dry mouth, sedation, aggravation of restless leg syndrome,neurally mediated hypotension, and abnormal heart rhythms. Itis, however, especially good for nerve pain, vulvadynia (pain inthe vulvar area), and, perhaps, interstitial cystitis characterized bysevere urinary frequency and burning without infection (seeChapter 9). If these are present, it is reasonable to start withElavil or a related medication. You can take one-half to eight


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10 mg tablets at bedtime. If you take more than two tablets, itshould be tapered off and not stopped suddenly. I would not usemore than 80 mg at bedtime (unless you have to) because of theside effects.

Desyrel (trazodone) in high doses is marketed as an antide-pressant, but at a low dose it is excellent for sleep and anxiety.Desyrel comes in 50 to 450 mg tablets, and the usual recommen-dation is to take one-half to six of the 50 mg tablets at bedtime(most patients need no more than two tablets). The main sideeffect of Desyrel is next-day sedation, and priapism can occur inmales. Priapism is a condition characterized by a painful erectionthat does not go away. This is unusual. Most men find that whileit causes an improvement in the strength of their erections, it doesso at a comfortable level, as opposed to an erection that will notgo away after a normal amount of time. If you develop an erec-tion that does not go away after an hour (despite a cold bath), stoptaking the medication and go to a hospital emergency room. Iferections are lasting longer than normal, you should stop theDesyrel and switch to the other medications.

Additional Medications for SleepXanax (alprazolam) is a short-acting cousin of Valium that givesa good three to five hours of sleep with less hangover in themorning. I was pleasantly surprised to find that Xanax improvessleep quality because Valium usually seems to worsen this in mostpeople. Xanax is very good for anxiety as well and tends to bevery well tolerated; however, it can be addictive. The usualdosage is one-half to four 0.5 mg tablets at bedtime or during thenight.

GHB (Xyrem) is an excellent (and possibly the best) sleepmedication for pain and fibromyalgia. However, because the DEAclaimed (many suspect mistakenly) that it was being used as a daterape drug, it has gone from being inexpensive and available overthe counter to being tightly regulated and costing approximately


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five hundred dollars a month. If all else fails, Xyrem often worksvery well. It comes as a liquid that can dissolve your enamel anddamage your teeth, however, so be sure to rinse your mouth welland swallow after taking the liquid to prevent this. Physiciansmust fill out special forms when prescribing Xyrem.

Benadryl (or doxylamine) is a common antihistamine that mayalso help pain. The usual dose is 25 mg at night.

Combining Sleep Aids for an Optimal EffectThere are several approaches to sleep when treating pain patients.Some doctors prefer to use a single medication or treatment andpush it up to its maximum level. If that works, great; if not, theystop it and switch to another medication. Other doctors prefer touse low doses of many different treatments together until thepatient is getting good, solid sleep regularly. I strongly prefer thelatter approach. Most of a medication’s benefits occur at low doses,and most of the side effects at high doses. In addition, if you com-bine low doses of a few different sleep aids, each of them will becleared out of your body by morning—so you won’t be hungover.Meanwhile, the effective blood levels that you have during themiddle of the night from each treatment are cumulative and willkeep you asleep for eight to nine hours of solid sleep each nightwithout waking or hangover. If you’re not sleeping eight to ninehours a night without waking, let your physician know so yourmedications can be adjusted.

As I mentioned earlier and depending on your preference, youmay want to start with the natural aids (for example, taking theRevitalizing Sleep Formula herbal remedy plus calcium and mag-nesium at bedtime), see how those work, and then use the pre-scription ones as needed. My preference is to start with at leastone of the sleep medications (Ambien and/or Klonopin) com-bined with some of the natural remedies. Ambien, Klonopin,Xanax, and Soma are considered potentially addictive, but in thedose and form that I use, this is rarely a problem. If you have


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next-day sedation, try taking the medications (except for Sonataand Ambien) a few hours before bedtime. However you chooseto do it, on the first night begin with one of the remedies at a lowdose.

For most of the treatments recommended, by the next morn-ing you will know the effects that it is going to have. It may, how-ever, take six to twelve weeks to see the full effect of 5-HTP andvalerian. In rare cases, some of these treatments have the oppositeof their normal effect, activating you instead of putting you tosleep. If this happens, don’t use that treatment.

Once you have tried a low dose of a single treatment, increasethe dosage each night until you either get eight to nine hours ofsolid sleep without waking or feeling hungover, you get sideeffects (for example, next-day sedation), or you are at the maxi-mum dose recommended. Use the lowest dose that gives you themost benefit. In other words, you may find that 50 mg of Desyrelis just as effective as 150 mg, in which case there is no need totake the higher dose. Once you have tried one treatment, you cango ahead and add in a second one in the way I just discussed, andthen a third one, and so on. You may choose to initially try eachof them separately so you can see what each one does by itself, oryou may choose to simply add one treatment to the next. Basically,you are trying the treatments on to see what “fits,” in the sameway you would try on shoes to see which pair feels the best. Onceyou have found the combination of treatments that feels the best,you can simply stay on that combination.

Why One Medication Doesn’t Fit All

It is interesting to note that patients with fibromyalgia and otherpain syndromes often respond well to one medication but notanother that works by a different mechanism. Which treatmentswork varies from person to person. This demonstrates that thereis not a single cause to many pain problems. This is why looking


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for the single “magic bullet” approach to pain management doesnot work as well as the “try a combination of therapies until yousee what works” approach (known as integrative or comprehen-sive medicine). Of course, this approach works better if you havemore options to choose from than only Tylenol or Motrin/aspirinfamily medications!


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Sexual Dysfunction,Depression, and

Mind-Body Aspectsof Pain

There are many additional problems that result from chronic painand often can be interrelated. For example, depression, pain, andanxiety may cause loss of self-esteem and associated loss of libidoin both men and women. In addition, narcotic therapies and thechronic stress of pain itself can lead to decreased production ofmany hormones including testosterone.

Dealing with Loss of Libido and/orSexual Function

Loss of libido and/or sexual function can occur from any of themultiple problems that are common in chronic pain. In our studyof patients with fibromyalgia, 73 percent had loss of libido. Lossof sexual function in fibromyalgia was also found in a study con-ducted in Brazil. Sexual dissatisfaction was present in 55 percentof patients, with 74 percent of women having pain with inter-

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course. This is also a very common problem in chronic pain aswell.

Chronic opioid use has also been shown to significantly lowertestosterone levels. Because of this, checking testosterone levels isappropriate in anyone, male or female, with sexual dysfunction—especially in the presence of chronic pain. When treating for lowtestosterone, I strongly recommend that natural testosterone be usedinstead of synthetics. In men, testosterone 1 percent (Androgel) canbe applied to the skin over the shoulders and abdomen twice dailyfor a total daily dose of 25 to 100 mg. Testosterone cream can alsobe made less expensively by compounding pharmacists. Testos-terone tablets should not be used in men because the high dose canresult in elevated cholesterol levels when taken by mouth.

In men with low or low-normal testosterone who also hadangina, high cholesterol, and/or diabetes, repeated studies haveshown decreased angina, cholesterol, and diabetes with the addi-tion of natural testosterone. Sadly, these data have been largelyignored. I bring my patients’ testosterone blood levels up to themid to upper part of the normal range.

Testosterone can also help loss of libido in women. For exam-ple, a recent study has demonstrated that small doses of testos-terone may improve the sex lives of women who have hadhysterectomies. Delivered transdermally (via the skin) by a patchapplied twice a week, the testosterone raised desire and improvedfunction in 74 percent of the study participants. Even if you havenot had a hysterectomy, a trial of testosterone is reasonable if yourfree testosterone level (use the results of the free testosteroneblood test, not the total testosterone) is in the lowest quarter ofthe normal range. In women, 2 to 6 mg of testosterone in creamor tablet form daily is usually adequate and can help pain, libido,and overall well-being.

Other factors also contribute to sexual dysfunction. Theseinclude pain caused from assuming sexual positions or marital stressfrom chronic pain. Antidepressants such as Prozac commonly cause


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difficulties with erections, decreased libido, and difficulty withachieving orgasm (the latter being especially important in women).

If you need to continue the antidepressants, the associated sex-ual dysfunction is treatable. One study showed that taking the herbginkgo biloba 120 mg twice daily often eliminated the sexual dys-function caused by antidepressants after six weeks (a lower dose wasnot as effective). Wellbutrin, trazodone, or Remeron do not seemto cause the sexual dysfunction caused by other antidepressants.

Medications for Sexual DysfunctionI recommend using Viagra or Cialis for erectile dysfunction. Via-gra can be taken in doses of 25, 50, or 100 mg tablets. It is mosteffective when taken on an empty stomach, and the higher doseis often effective if the lower dose is not. In addition, it is gener-ally cheaper to buy a 100 mg tablet and break it in half than to buytwo 50 mg tablets. Cialis is a newer medication for erectile dys-function. It may work faster than Viagra (within ten to fifteenminutes), and the effects last for more than twenty-four hours. Itcomes in 10 and 20 mg strengths and can be taken with food.Neither medication should be used in conjunction with nitro-glycerin, and they may cause problems in patients with heart dis-ease. A newer medication that may not have this problem (calledvardenafil) is being developed.

Natural Remedies for Treating Sexual DysfunctionAt the 2004 meeting of the American Psychiatric Association,researchers from Columbia University reported on the growinguse of complementary medicines to boost sexual function anddesire. The herb rhodiola, for example, may reduce prematureejaculation and boost sexual desire in both men and women. Rho-diola also seems to revive sexual energy, provide increased pleas-ure, improve erections, and intensify orgasms, allowing for moresatisfying sex. The presentation also discussed the effectiveness of

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the herbs ginseng, ginkgo, maca, and horny goat weed in restor-ing sexual desire and function in both men and women.

Pain, Anxiety, and Depression

Chronic pain, anxiety, and depression have long been linked, andpatients with chronic pain suffer a high incidence of majordepressive disorders (MDD). Thomas Elliott of St. Mary’s DuluthClinic Health System set out to further characterize this link bylooking for correlations among age, sex, chronic pain, and depres-sion. He found that the prevalence of MDD was significantlyhigher in younger patients with chronic pain—59 percent in theeighteen to forty-four years age group. Furthermore, 70 percentof women with chronic pain also suffered MDD, a significantlyhigher percentage than the men in this sample. It is understand-able that anyone with a severe illness, especially one that is treatedas poorly as pain, would go through periods of depression. Youare not alone. With new treatments, however, you finally have theopportunity to become pain free—which is a great start at treat-ing depression!

It is OK to acknowledge that chronic pain devastates people’slives in many ways. It can dramatically worsen the quality of yourlife on many levels, including physical, social, emotional, and spir-itual. It can trigger depression, anxiety, and loss of independence.It also can severely interfere with your ability to work and main-tain friendships and relationships. All of these issues need to beaddressed and supported.

People with chronic pain, however, are often afraid to bring upthese problems with their family, friends, and physicians. Althoughit may be appropriate not to continually bring up one’s pain in per-sonal relationships, since you may find yourself getting tuned outand avoided, it is important that your doctor be made aware of per-sistent pain at each visit. Research has shown that patients are oftenhesitant to bring up their pain during doctor visits for the follow-ing reasons: they’re afraid of being viewed as complainers, they are


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concerned about distracting the doctor from other medical issues,or they have a fatalistic view that nothing can be done.

It is important to recognize that it is not OK to be left inchronic pain. You need to make your doctor aware of your situa-tion if the pain is persistent and not adequately controlled. If yourphysician is not able or willing to take further measures to help,ask for a referral to a pain specialist (or another one if you arealready seeing one). If your doctor does not believe that anotherphysician may have any other options for you, let him or herknow about the options discussed in this book, or go ahead andget a second opinion on your own.

Natural Remedies for Depression and AnxietyDepression can often be effectively treated using natural therapies.I recommend beginning by making sure that you have adequatelevels of most nutrients, particularly B vitamins (especially B₁₂ andfolate). The easiest way to do this is with the Energy Revitaliza-tion System powder, which also dramatically raises levels ofSAM-e—another nutrient highly effective against depression.Many studies show that SAM-e is as (or more) effective at treat-ing depression than tricyclics, without the side effects. Unfortu-nately, SAM-e tablets are not very stable, are very expensive, andrequire a high dose. Because of this, the vitamin powder is likelythe best approach. I recommend also adding fish oil (one-half toone tablespoon per day) to your regimen. Several studies haveshown fish oil to be very helpful in treating depression.

Saint-John’s-wort, 1,000 to 2,000 mg daily, is the next thing Iwould add. Dozens of studies have found it to be as effective asprescription antidepressants for treating moderate depression. Likemost prescriptions, it is unlikely to be effective by itself for severedepression, although limited data suggest that higher doses mightbe effective. Do not combine it with prescription antidepressantsunless cleared by your doctor because the combination can (very,very rarely) drive serotonin levels dangerously high. In my prac-tice, I may combine Saint-John’s-wort with prescription antide-


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pressants, because this allows for a lower dose of the antidepressantmedication and therefore fewer side effects.

5-HTP, the nutrient that your body uses to make serotonin,can also be helpful for both depression and pain. It also has thebenefit of improving sleep and causing weight loss. The usual doseis 200 to 400 mg at bedtime. As with Saint-John’s-wort, it raisesserotonin levels, so limit the dose to 200 mg a day if taking it withantidepressants. Combining 5-HTP with the amino acid tyrosinecan make it even more effective.

The mineral rubidium, 500 mg daily with food, can also helpeven resistant depression. It takes one month to work and is avail-able without a prescription from compounding pharmacies. Instudies of the mineral, participants used between 180 to 720 mgdaily. Some minor side effects include constipation, diarrhea,insomnia, or agitation (do not use it if you have manic-depressiveillness/bipolar disorder). It is a good idea to eat a banana a day ortake a glass of V8 juice each day along with the rubidium.

Magnolia delivers a double whammy. The herb magnolia isrich in honokiol and magnolol, which have numerous health ben-efits, especially their ability to alleviate both depression andstress—without making you sleepy! See the website smart-publications.com/articles/040331magnolia.htm for more informationon this excellent herb.

For anxiety, high-dose vitamin B₁ (thiamine) at 250 to 500 mgthree times a day and/or theanine, 50 to 300 mg a day, can have awonderfully calming effect, which continues to dramaticallyincrease over time when it is used regularly for two to six weeks.

There are two excellent products that contain many of theabove natural therapies and much more. For anxiety, I would takethe Calming Balance Formula, and for depression I recommendHappiness 1-2-3. Take one to three capsules of either (or both)three times a day. Although some benefit is seen immediately, theeffectiveness increases markedly over two to six weeks, and mypatients love these products (see Appendix B).


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Lifestyle Changes That Can Help with DepressionOther commonsense approaches to treating depression are alsovery important. Walking, for example, has been shown to be aseffective as Prozac in treating depression. Bright light exposureduring the wintertime, yoga and tai chi, spiritual healing, andother similar modalities can also be very helpful. Most important,it is essential that you get in touch with, and express, your feel-ings. My book Three Steps to Happiness: Healing Through Joy! is ashort book that will teach you how to do this (available online atvitality101.com).

Pain: The Mind-Body Connection

Emotional stress can also contribute to pain. John Sarno, M.D., isa professor of clinical rehabilitation medicine at New York Uni-versity School of Medicine and an attending physician at the RuskInstitute of Rehabilitation Medicine at New York UniversityMedical Center. He found that the mind often decreases the bloodflow to areas of the body in an attempt to distract us from uncom-fortable emotions by causing pain. This occurs even though thepain is often hundreds of times more uncomfortable than the feel-ing our mind is trying to protect us from. Fortunately, although thepain caused by decreased blood flow is real and can be severe, itgenerally does no permanent harm.

This concept may seem odd at first, but it gives us a powerful,simple, safe, natural, and inexpensive way to eliminate many kindsof pains—especially when we combine this knowledge with thephysical treatments. This approach is quite simple, and I find thatit works best for localized pain such as back pain, tendonitis, andlocalized nerve pain.

As noted, your mind may be decreasing blood flow to musclesand other areas to distract you from uncomfortable emotional feel-ings or at other times because you are “burying” these feelings inyour muscles. When you feel pain, tell your mind that you will


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repeatedly use the pain as a signal to look for and feel those uncom-fortable emotions for ten to fifteen minutes—then do so. The painwill often leave within six weeks. Interestingly, this works welleven for pain that began after an injury. For more informationabout this approach, read Dr. Sarno’s books Healing Back Pain: TheMind Body Connection and The Mind Body Prescription.

Dr. Sarno theorizes that what is actually causing pain is not theherniated disc, or some other structural condition, but a conditionof mild oxygen deprivation that is brought about by the brain sim-ply altering the blood flow to a particular area. This mild oxygendeprivation is what causes pain in muscles, nerves, and tendonsanywhere in the body. He calls this tension myositis syndrome(TMS). He feels the problem is not based on inflammation butrather a decreased oxygen supply. He theorizes that this is whytreatments that increase local circulation, such as deep heat in theform of ultrasound, deep massage, and active exercise can tem-porarily decrease pain.

Dr. Sarno explains that x-ray and MRI studies find normalchanges in the area of the pain that are unrelated to the pain. Hegives an example published in a 1994 research paper by MaureenJensen and colleagues in the New England Journal of Medicine.They performed MRIs on about ninety-eight people who had nohistory of back pain. The researchers found normal discs in only36 percent of the people. Everyone else had bulges (herniations)of various kinds and yet no pain. That’s the kind of informationthat doctors in this country totally ignore.

Emotional Factors Associated with PainDr. Sarno came to many of the same conclusions about the psy-chodynamic of pain that I discuss in my book From Fatigued toFantastic! The difference is that he feels that the pains comeentirely from the psyche without a physical cause (other than theself-induced decreased blood flow). In my experience, pain, muchlike other illnesses including heart attacks, cancer, and others, has


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both a physical and a psychospiritual component, and I find thataddressing both simultaneously results in the best outcome.

Other Important Mind-Body IssuesThe bottom line is that if you are repressing emotions, not lettinggo of your feelings, and you feel like a victim (which leaves youpowerless), and you are not keeping your attention on what feelsgood when you can, you are likely to not stay healthy. This cycleof repression and lack of focus on what feels good can result inmany illnesses, including pain.

In addition to pain coming from decreased blood flow to themuscles, pain can also come from muscles being stuck in the short-ened position. In addition to the biochemical triggers that we havediscussed earlier in this book, this can occur in response to emo-tional stresses where we tighten our muscles as a form of “emo-tional armor.” It can also occur in response to other physicalinjuries. The body will often tighten the muscles in the area ofinjury to form a kind of a splint. This helps to decrease pain ini-tially, but can then add to pain in the long run.

Another critical point to remember is that we are only awareof less than 3 to 5 percent of the sensory input that comes into ourbrains at any given time. The rest is filtered out. For example, takea moment to notice the sounds of your heating/cooling system,the buzzing of the lights, the feeling of the air on your skin, andthe numerous other sensations that you do not notice until some-body points them out. Pain is a fairly loud sensory input becauseit is meant to get our attention. It does so to tell us many things.We are familiar with the messages to avoid something traumatic,like our hand being on a hot stove, or to pay attention to and takecare of, an injury—and we heed these messages fairly well. Weare now also aware of some of the less overt but equally impor-tant needs of our bodies that pain informs us of. These include thephysical needs of nutritional support, sleep, hormonal support, andeliminating infections. But the root causes of pain also include the


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psychological, and perhaps even the spiritual, needs to be true toourselves, acknowledge our feelings, and to do what feels best tous. This may not always be what other people are expecting of usor telling us to do. Simply attending to these issues will eliminatemany pains.

In other situations, there may be a malfunction in the pain sys-tem itself. Once your psyche knows that you have finally attendedto those things you needed to pay attention to, a remarkable thingcan happen. Your brain’s “filtering system” is now able to recog-nize that the pain signal is no longer important, and it can start tofilter the signal out as it does other sensory input presented to it.This process of muting your pain signal can be helped by themany pain treatments we’ve discussed in this book. At this pointa fairly remarkable thing occurs. You’ll find that your chronic painbecomes intermittent, then mild, then gone!


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EliminatingWeight Gain

This chapter is derived from an article on weight gain in pain-related illnesses that I wrote for a magazine. I think you will findit interesting, and it will also serve as a helpful overview of manyof the things we have discussed in the book.

Weight gain can be a major problem in chronic pain and chronicstress states. For example, our study of fibromyalgia patients showedan average weight gain of thirty-two pounds. It’s bad enough to feelawful and be in chronic pain, and the blow that many people feel totheir physical self-image from the weight gain can add further suf-fering. Why is weight gain such a problem? For starters, we live ina society where being overweight is epidemic. It is much easier tolose weight and keep it off, however, when you understand thatthere are many things that contribute to this problem. Most of usare familiar with the more common ones.

• The standard American diet (SAD). Our standard dietcontains excessive sugar and fat. In addition, food processingcauses the loss of many vitamins and minerals, resulting in“high calorie malnutrition.” It is quite possible that this isthe first time in the history of the human race that this has

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occurred! Being nutritionally deficient in numerous vitaminsand minerals is one of many causes of excessive foodcravings. Unfortunately, it is hard to get adequate nutritionout of the American diet, even if one’s diet is relativelyhealthy.

• Lack of exercise. During most of human history, peoplehad to walk if they wanted to get somewhere. In addition,work often consisted of physical labor. This is no longer thecase. In fact, we often even get upset if we can’t get aparking space right near the entrance of the mall!

For many people, simply altering their diet and increasing theirexercise is enough to let them lose weight. A large percentage ofchronic pain sufferers, however, have found that it is impossibleto lose weight and keep it off no matter what they do.

Why Chronic Pain Makes It So Difficult to Lose Weight and Keep It Off

There are a number of ways that stress, fibromyalgia, and/orchronic pain can contribute to your inability to lose weight. For-tunately, understanding these can help you overcome this problem.Both physical stresses (pain, infections, nutritional deficiencies,toxic chemical exposures) and emotional/situational stresses (hav-ing a toxic boss, working too hard without enough sleep, worry-ing) can result in a metabolic chain reaction that results in weightgain. Chronic fatigue syndrome and fibromyalgia (CFS/FMS) aregood models for the occurrence of weight gain during stress andchronic pain.

How CFS/FMS Causes Weight GainAs noted in Chapter 6, I do not view these syndromes as theenemy. Rather, I see them as attempts by the body to protect itselffrom further harm and damage in the face of excess energy


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demands. A simple way to look at fibromyalgia and CFS is to viewthem as circuit breakers. In a house, when certain systems areoverstressed, some of the circuit breakers will go off to preventdamage to the home’s wiring. In CFS and fibromyalgia, the hypo-thalamus acts as a “circuit breaker” going into hibernation in theface of excess stress. In the body, under normal circumstances, bysupplying proper rest and nutrition, the circuit breakers can comeback on and systems can return to healthy functioning. In CFS/FMS, however, it is as if the main circuit breaker (in this situationit’s the hypothalamus—a master gland in the brain) has “blown.”When this occurs, rest is no longer enough to restore properfunctioning.

Despite the many diverse stresses that can cause these syn-dromes, most patients’ symptoms seem to come from a commonendpoint—dysfunction or suppression of the hypothalamus. Thisgland controls sleep, hormonal function, temperature regulation,and the autonomic nervous system (including blood pressure,blood flow, and movement of food through the bowel). This iswhy these patients can’t sleep, have low body temperatures, andbecause poor sleep causes immune dysfunction, are prone to mul-tiple and recurrent infections. The hypothalamic dysfunction byitself can cause most of these symptoms. In addition, I suspect thatproblems with the mitochondria (the “energy furnaces” in thecells) are also present and are what cause hypothalamic suppression.

This process contributes to weight gain in several ways. Theexpression “getting your beauty sleep” has a basis in fact. Deepsleep is a major trigger for growth hormone production. Growthhormone stimulates production of muscle (which burns fat) andimproves insulin sensitivity (which decreases the tendency tomake fat). Getting the eight to nine hours of sleep a night that thehuman body is meant to have can powerfully contribute to yourstaying young and trim!

The other two main triggers for growth hormone productionare exercise and sex. In fact, one study showed that people who

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have sex at least three times a week look ten years younger thanthose who don’t. The study notes that this was because of theincrease in growth hormone release.

How Stress and Hormones Contribute to Weight GainAs noted in Chapter 2, the hypothalamic “circuit breaker” thatgets suppressed with stress also controls the hormone system. Thisresults in inadequate levels of thyroid hormone (which acts as ourbody’s gas pedal and burns calories) and adrenal hormone. Thesymptoms of hypothyroidism include weight gain as well asfatigue, cold intolerance, achiness, and poor mental function.

The adrenal gland is the body’s stress handler. As discussed inChapter 2, when we are under stress our “fight or flight reaction,”may be set off many times a day with little time in between torecover. This can result in exhaustion of the adrenal gland. As itis the job of the adrenal gland to maintain blood sugar levels intime of stress by making cortisol, people initially have elevatedcortisol levels, which results in weight gain.

Over time, adrenal exhaustion occurs that can result in epi-sodes of hypoglycemia (low blood sugar). Unfortunately, peoplecrave sugar and eat more than they normally would when they gethypoglycemic. This leads to further weight gain, which can occurparadoxically whether your cortisol levels are too high or too low.Whether your cortisol is high or low, treating the overall processthat is causing your pain lowers the stress on your body and canhelp you lose weight.

Additional Factors That Lead to Weight GainClinical experience has shown that fungal (also known as candidaor yeast) overgrowth (see Chapter 3) contributes powerfully toboth sugar cravings and weight gain. Although doctors do notknow the mechanism for this, we have repeatedly seen excessweight drop off once this overgrowth is treated and eliminated.The good news is that treating yeast overgrowth will not just help


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you to lose weight but can also help eliminate your spastic colonand sinusitis.

How to Lose Weight and Feel Better

To lose weight, cut down on sugar and simple carbohydrates (suchas potatoes, bread, and pasta) and increase your water intake. Wesometimes confuse thirst with hunger, and this leaves us eatingmore than we really want.

Not to sound like a broken record here, but getting optimumnutritional support helps pain and also helps prevent weight gain.When you are deficient in vitamins or minerals your body cravesmore food than you need, and your metabolism will be sluggish.To keep it simple and avoid the need to take tablets all day, I rec-ommend that you use the Energy Revitalization System (see Chap-ter 2 and Appendix B). In addition, acetyl-L-carnitine 500 mgtwice a day can be very helpful as well.

Again, not to keep repeating myself, but to keep weight down,it’s essential to get eight to nine hours of solid sleep a night. If youhave insomnia, herbals can help. I recommend Revitalizing SleepFormula, one to four capsules, one hour before bedtime. This is amix of six herbals and is the most effective natural sleep aid avail-able. (See Chapter 11 and Appendix B.)

Getting exercise is also a key. Find something that is fun andfeels good. It also helps to have a regularly scheduled exercise timethree to four times a week in which you meet a friend to exercisewith. Otherwise, human nature is to make excuses not to show up!

Having even a few of the symptoms of hypothyroidism isenough to justify a therapeutic trial of thyroid hormone, whichmay help to counteract weight gain. If you are overweight, tired,and have cold intolerance or achiness, ask your holistic doctor fora prescription of Armour Thyroid. Adjust it to the dose that feelsbest while keeping the free T4 blood test in the normal range (seeChapter 2).


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Pay attention to adrenal stress support, as both elevated and lowadrenal cortisol levels can cause weight gain. Start by making anattitude change. Whenever you notice that you’re getting anxiousor worried, ask yourself the simple question, “Am I in imminentdanger?” The answer is almost always no, and you’ll find that youradrenal glands relax as you realize this. If you have problems withrelaxing or letting go of worry, my new book Three Steps to Hap-piness: Healing Through Joy can help you get from where you are toa life that you love (available online at vitality101.com). If you areexperiencing hypoglycemic episodes, consider taking an adrenalglandular. I recommend Adrenal Stress End, one to two capsuleseach morning as needed (available online at vitality101.com).

If you have chronic sinusitis or spastic colon, there is a goodchance you have fungal/yeast overgrowth in your bowels. Avoidsugar (stevia is a great substitute—the best tasting one is by BodyEcology). Take Acidophilus Pearls (healthy milk bacteria to com-bat yeast), two pearls twice a day (see vitality101.com for sources).If you have a holistic physician, ask for a prescription for nystatinand Diflucan antifungals (see Chapter 3).

It is no longer necessary to be on an extreme, unsustainable, orunhealthy diet to lose weight and keep it off. The preceding rec-ommendations will not just help you stay trim, but they will leaveyou healthy and full of vitality as well.

Managing Medications That Affect Weight Gainand Loss

Many medications contribute to weight gain. Lithium, for exam-ple, has been associated with average weight gains of eight to thir-teen pounds. This is similar to the amount of weight gainassociated with taking Depakote (valproic acid). Antipsychoticmedications are also associated with gaining an average of four tonine pounds.

In the treatment of pain, however, the biggest culprits forweight gain are tricyclic antidepressants (such as Elavil). Other


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antidepressants such as those related to Prozac can cause eitherweight gain or weight loss depending on the individual. Medica-tions that increase norepinephrine such as Wellbutrin and Effexorare less likely to cause weight gain. In most studies, Lamictal pro-duced little or no weight gain.

Although some medications used for pain management causeweight gain, others have the side effect of causing weight loss. Forexample, Topamax (topiramate) causes appetite suppression, withpeople on average losing 9 percent of their body weight. In stud-ies, the average weight loss was fourteen pounds; people whowere taking high doses (138 mg per day) lost more weight thanthose using low doses (70 mg a day, who experienced no weightloss). Zonegran (zonisamide), another antiseizure/pain medica-tion, is also associated with weight loss.


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Conclusion

One of the nice side effects of treating pain, fibromyalgia, andchronic fatigue syndrome is that in addition to feeling great youcan also look great. One patient that I recently treated had lostfifty pounds by her four-month follow-up visit—in addition shehad great energy and no pain. She was thrilled.

It is time for you to also be treated properly so that you can geta life you love, look great, feel great, and be thrilled. I know thisis possible. I had chronic fatigue syndrome and fibromyalgia pain,so I understand what you have been through. I have made it tothe other side and feel fantastic. I have helped thousands ofpatients make the same journey to health and taught hundreds ofdoctors to help tens of thousands more. It’s time for you to makethe journey back to health.

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Appendix AUseful Information on My Website

Some of you would like more detail, and others simply want the“bottom line.” Because of this, I have focused largely on the mostimportant points in this book. For those who want more depth, Ihave placed a large amount of additional, more technical ordetailed information on my website. For this added information oneach chapter, go to vitality101.com and click on “Pain Free 1-2-3Notes.”

The Web notes also include a very useful item called “Summaryand Flowcharts for Quickly Evaluating Your Pain and Determin-ing How to Treat It.” It starts with the basics (nutritional support,sleep, hormonal support, and treating underlying infections thatmay be triggering your pain) as pain is often your body’s way ofsaying that it needs something. It then includes quick evaluationsand treatments for neuropathic pain; arthritis and inflammatorypain; muscle and bone pain; headaches; indigestion and spasticcolon; pelvic pain; back pain; noncardiac chest pain; and wrist,shoulder, foot, and leg pain. I also provide an easy list of naturaland prescription therapies in addition to summarizing treatmentsfor related problems (i.e., sexual dysfunction and weight gain).

One important tool available on the website is a comprehen-sive pain treatment protocol form that lists over 280 treatmentoptions, including most of the treatments covered in this book,that can be helpful with pain and associated problems. It will giveyou and your doctor directions on how to use each of the recom-mended treatments. I recommend that you use this form as arecord of your treatments and have it with you for your doctor

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visits. Occasionally you may see a “blank” provided for your doc-tor to fill in a dose.

The website also provides access to a computerized educationalprogram that, for a fee, can analyze your medical history (and lab-oratory test results, if available) to determine the most importantunderlying metabolic problems in your case. It will create a treat-ment protocol tailored to your case that you can institute on yourown and will assist and support your doctor in giving you the bestpossible care. The long form can also create a complete medicalrecord of your case. To use this program, go to vitality101.com.

The website also has a referral list of practitioners who havedone my workshop(s) and a second list of those who have not butwould like to see CFS and fibromyalgia patients (a good start). Italso has contact information for finding holistic physicians.

Along with the information in this book, these additionalitems should help you and your doctor take you step-by-step tobeing pain free. I can tell you firsthand that pain is treatable. Mypain is gone!

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Appendix BResources for Finding Physicians

and Supplies

Finding a Physician

Physicians Specializing in Pain and FibromyalgiaFor physicians specializing in pain (who may or may not be famil-iar with these metabolic therapies) go to the American Acad-emy of Pain Management website at aapainmanage.org (click on“Patients”).

I see patients from all over the world in consultation at myoffice at the following address:

Jacob Teitelbaum, M.D.466 Forelands RoadAnnapolis, MD 21401Phone: 410-266-6958Fax: 410-266-6104

Other Physician OrganizationsPhysicians who can treat the underlying nutritional, sleep, andhormonal deficiencies as well as the infections that drive your painusing metabolic therapies are often called holistic or comprehen-sive physicians. They are often familiar with effective pain andfibromyalgia therapies. The following are two of many organiza-tions of physicians who take a comprehensive/holistic approachto medicine:

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American College for the Advancement of Medicine

P.O. Box 3427Laguna Hills, CA 92654apma.net

American Holistic Medical Association (AHMA)

4101 Lake Boone Trail, Suite 201Raleigh, NC 27607Phone: 919-787-5146

AHMA also provides speakers through its speakers bureau.

Physicians Trained in Prolotherapy

David K. Harris, M.D.The Lakewood Clinic7307 Creekbluff DriveAustin, Texas 78750Phone: 512-454-1234Fax: 512-476-0850lakewoodclinic.com

Brad Fullerton, M.D.The Patient-Physician Partnership2714 Bee Cave Road, Suite 106Austin, TX 78746Phone: 512-347-7246Fax: 512-347-7245proloaustin.com

To find additional physicians who have been trained in prolother-apy, refer to the American Association of Orthopedic Medicinewebsite at aaomed.org or see getprolo.com.

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Psychological and Health Counseling by Phone

Bren Jacobson is an excellent Rolfer who has spent decades work-ing with people in pain. In addition, if you have a medical prob-lem your doctor says is not treatable, Bren can act as a consultantto guide you to resources in alternative medicine that can oftenoffer hope and relief. He is also a minister and does personal pas-toral and health counseling in person or by phone. He can bereached at 410-224-4877.

Stool Culture and Sensitivity Tests

The following laboratories do an excellent job with stool testingfor ova and parasites, yeast, and bacterial infections:

Great Smokies Diagnostic Laboratory63 Zillicoa StreetAsheville, NC 28801Phone: 800-522-4762Fax: 828-252-9303gsdl.com

Parasitology Center, Inc.903 South Rural Road, Suite 101-318Tempe, AZ 85281Phone: 480-777-1078

(call Urokeep at 602-545-9236 to get the stool test kit)

Fax: 480-777-1223

Compounding Pharmacies

To find a compounding pharmacy near you, call the Pharmaceu-tical Compounding Association at 800-221-8768 or the Interna-

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tional Academy of Compounding Pharmacies at 800-927-4227(iacprx.org).

My favorite compounding pharmacy is Cape Apothecary, aholistic compounding pharmacy that fulfills mail orders (they shipanywhere in the world). Among other products, they can supplypain gels and creams, a sinusitis nose spray, natural testosteronecream, pure dextromethorphan (DM), sustained-release T3 (thy-roid hormone), high-dose injectable vitamin B12, natural biestro-gen, testosterone, and natural progesterone. Tom, the pharmacist,lectures at Johns Hopkins School of Pharmacy and will work withyou to adjust pain cream and hormonal formulations to providethe optimum dosage and combination of medications for yourcase. Cape Apothecary can also supply ingredients for Myerscocktails (see Chapter 13).

Cape Apothecary1384 Cape St. Claire RoadAnnapolis, MD 21401Phone: 800-248-5978 or 410-757-3522 or 410-974-1788Fax: 410-626-7226rxstat.com/capedrug

Water Filters

Pure WaterBren Jacobson103 Second StreetAnnapolis, MD 21401Phone: 410-224-4877purewatermd.tripod.com

(do not type in www. before the Web address)

Consultant on health and environmental concerns, especiallywater, and distributor of Multi-Pure water filters.

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Saunas

Far infrared saunas are excellent for detoxification and relievingmuscle pain. My wife and I use the one made by High TechHealth. They can be contacted at 800-794-5355 or 303-413-8500.

Natural Products and Prescription Pain Creams

Most of the nonprescription supplements I recommend are read-ily available in most health food stores, and most are also availableon my website at vitality101.com (see the next section). You maynotice that I often recommend products by Enzymatic Therapy(which sells to health food stores) and Integrative Therapeutics(which sells predominately to practitioners). This is because in mytwenty-eight years of practice I have found them to be an incred-ibly reliable source for natural products. I was amazed to find thatthey both voluntarily registered with the FDA as pharmaceuticalcompanies, even though they only make natural products. Becauseof this, their products are subject to an incredibly high level oftesting so you can be sure that what you are getting is the bestquality supplement possible. (I do not take money from any com-pany whose products I recommend.)

Supplements and Other Products Available atVitality101.com

I developed these products to meet the needs of my patients andothers suffering from pain, fibromyalgia, and chronic fatigue. Iknow that when I see a “Dr. Smith’s Formula,” I worry that Dr.Smith might have “sold out.” Because of this, I direct any com-pany making my formulas to donate all of my royalties to charity.

To order recommended products online, go to vitality101.com, or call 410-573-5389 (my website and office number). You


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can also go to enzy.com to find stores near you that carry many ofthese products.These are just a few of the products available at vitality101.com.

Energy Revitalization System Vitamin Powder withB-ComplexI developed this product so that my patients could easily get thenutritional support they need without taking handfuls of tablets. Asnoted previously, 100 percent of my royalties go to charity, and theproduct is available in most health food stores or at vitality101.com.

One good-tasting drink and one capsule replace over thirty-five tablets of supplements a day (including, of course, your mul-tivitamin). The Energy Revitalization System contains over fiftynutrients, almost all the key nutrients that you need to get fromyour diet. Many people find that this product can help them feelmuch better while decreasing and sometimes eliminating theirpain. This is the single most important supplement for helpingyour body to heal!

Fatigued to Fantastic! Revitalizing Sleep FormulaThis formula helps you get to sleep faster and maintain a healthysleep cycle through the night so you wake up energized and withless pain. Lack of sleep at night can lead to daytime sleepiness andpain and negatively impact your daily activities. These herbs alsodecrease pain directly by acting as muscle relaxants, and theydecrease stress and anxiety. For optimum results, use one to fourcapsules taken one-half to one and a half hours before bedtime.

Adrenal Stress EndThis provides excellent adrenal support for those who crash withstress or get irritable when hungry (sign of low adrenal function).It helps you maintain calm, stable energy throuhout the day.

End Pain FormulaThis natural formula contains willow bark, boswelliea, and cherry,wonderful ingredients for relief of inflammation and pain. For

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chronic pain, it can take two to six weeks to see the full effect.Begin with two to four capsules, three times a day. After sixweeks, you can often lower the dose to one capsule three times aday or take it as needed.

Corvalen (D-Ribose)This energy metabolite can have a dramatic effect on decreasingpain and increasing energy in many pain patients. Try one con-tainer to see what it will do for you.

Fish OilsFish oil deficiencies can contribute to pain and many other prob-lems. I have seen people come off of chronic morphine by takingfish oil. I strongly recommend using the Eskimo 3 or Nordic Nat-urals brands because they do not contain mercury, lead, or othertoxins. The usual dose is one-half to two tablespoons daily forthree to nine months. Dry eyes, dry mouth, and inflammation areindicators of inadequate fish oil in the body.

Sugar SubstitutesThere are many healthy sugar substitutes. Stevia is excellent,healthy, and easy to use. I recommend the Body Ecology brand(many others are bitter).

Inositol (which helps anxiety and nerve pain) and xylitol(which decreases osteoporosis) look and taste just like sugar.Outside of occasionally causing loose stools, these are healthyand you can use all you want. These products are available atvitality101.com. Saccharin (comes in the pink packets) is alsoOK, and I suspect Splenda will also turn out to be OK. RussellStover has a whole line of sugar-free chocolates that areoutstanding.

Supplements for Anxiety and DepressionThere are two excellent products for these. For anxiety, I woulduse the Calming Balance Formula. For Depression, I recommendHappiness 1-2-3!


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Enzymes for Pain Relief and InflammationMy favorite enzyme supplements for pain and inflammation areMegaZyme by Enzymatic Therapy and Ultrazyme by IntegrativeTherapeutics. I recommend that you take them on an emptystomach because enzymes are most effective at reducing pain andinflammation when you take them between meals so they getabsorbed into your body instead of being used for digestion. (UseCompleteGest if your purpose is to aid digestion.) All of theseproducts are available at vitality101.com.

For acute pain, enzymes can be taken for a few days as needed.For chronic pain, begin by taking either MegaZyme or Ultrazymeregularly (two to three tablets three times a day) between meals forsix to twelve weeks to see how much it helps or until the pain andinflammation are gone. Then you can take the enzymes as needed.

Wholesalers of Recommended Products

The following companies also sell the recommended productswholesale directly to health practitioners:

• Integrative Therapeutics carries many of the naturalproducts discussed in this book. Ask for the End Fatigueproduct line. Phone: 800-931-1709.

• Klabin Marketing makes ProBoost, the best immunestimulant on the market. Phone: 800-933-9440.

• Corvalen (D-Ribose) is available from Valen Labs(valenlabs.com). Phone: 866-267-8253.

• Calming Balance (outstanding for treating anxiety) andHappiness 1-2-3 (excellent for treating depression) areavailable from Health Freedom Nutrition. Phone:800-980-8780.

• Body Ecology carries stevia. Phone: 1-800-4Stevia.• I recommend the companies Boiron and Heel (the makers of

Traumeel Cream) for homeopathics.• Natural Immunogenics provides Colloidal Silver-Argentyn

23. Phone: 888-328-8840.

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Appendix CSelected References

Introduction

Caraway, D. L. “Highlights of the American Academy of PainMedicine CME.” Medscape—American Academy of PainMedicine, medscape.com/viewarticle/472404.

Sipkoff, M. “Training Needed for Pain Treatment.” The QualityIndicator (November 2003): 8–12.

Stewart, W. F., et al. “Lost Productive Time and Cost Due toCommon Pain Conditions in the U.S. Workforce.” Journal ofthe American Medical Association 290 (2003): 2443–54.

Chapter 2

Agargun, M. Y., et al. “Sleep Quality and Pain Threshold inPatients with Fibromyalgia.” Comprehensive Psychiatry 40, no.3 (1999): 226–28.

Allan, W. C., et al. “Maternal Thyroid Deficiency and PregnancyComplications: Implications for Population Screening.” Jour-nal of Medical Screening (2000): 127–30.

Anderson, R. A., et al. “Chromium and Hypoglycemia.” Abstract.American Journal of Clinical Nutrition 41, no. 4 (April 1985):841.

Beck, W. S. “Cobalamin and the Nervous System.” Editorial. NewEngland Journal of Medicine 318 (1988): 1752–54.

Boyles, Salynn. “Lack of Vitamin D Linked to Pain.” Web MDMedical News, December 10, 2003, http://my.webmd.com/content/article/78/95751.htm.

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http://my.webmd.com/content/article/78/95751.htm

http://my.webmd.com/content/article/78/95751.htm

Braunwald, E., ed. Harrison’s Principles of Internal Medicine. 11thed. New York: McGraw Hill, 1987, 1496.

Canaris, G. J., et al. “The Colorado Thyroid Disease PrevalenceStudy.” Archives of Internal Medicine (February 28, 2000):526–34.

Chandra, R. K. “Effect of Macro and Micro Nutrient Deficien-cies and Excess on Immune Response.” Food Technology (Feb-ruary 1985): 91–93.

Chandra, R. K., et al. “NIH Workshop on Trace Element Regu-lation of Immunity and Infection.” Nutrition Research 2 (1982):721–33.

Chandra, S., et al. “Undernutrition Impairs Immunity.” InternalMedicine 5 (December 1984): 85–99.

Drewes, A. M., et al. “Slow Wave Sleep in FMS.” Abstract. Jour-nal of Musculoskeletal Pain 3, suppl. no. 1 (1995): 29.

Eaton, S. B., and N. Konner. “Paleolithic Nutrition. A Consider-ation of Its Nature and Current Implications.” New EnglandJournal of Medicine 312, no. 5 (January 31, 1985): 283–89.

Edwards E., et al. “Testosterone Propionate as a TherapeuticAgent in Patients with Organic Disease of the Peripheral Ves-sels.” New England Journal of Medicine 220 (1939): 865.

Everson, C. A. “Sustained Sleep Deprivation Impairs HostDefense.” American Journal of Physiology 265, no. 5, part 2(November 1993): R1148–54.

Guthrie, J. Health Resource Newsletter 20, no. 1 (2004): 2.Haddow, J. E., et al. “Maternal Thyroid Deficiency During Preg-

nancy and Subsequent Neuropsychological Development ofthe Child.” New England Journal of Medicine (1999): 549–55.

Hak, A. S. “Subclinical Hypothyroidism Is an Independent RiskFactor for Atherosclerosis and MI in Elderly Women.” Annalsof Internal Medicine 132 (2000): 270–78.

Harvard School of Public Health. “High Intake of Vitamin DLinked to Reduced Risk of Multiple Sclerosis.” InteliHealth(January 12, 2004).

Jaffee, M. “Effect of Testosterone Cypionate on Post Exercise STSegment Depression.” British Heart Journal 39 (1977): 1217–22.

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Jefferies, M. Safe Uses of Cortisol. 2nd ed. Monograph. Springfield,IL: Charles C. Thomas, 1996.

Jefferies, W. M. “Low-Dosage Glucocorticoid Therapy: AnAppraisal of Its Safety and Mode of Action in Clinical Disor-ders, Including Rheumatoid Arthritis.” Archives of InternalMedicine 119, no. 3 (March 1967): 265–78.

Kalmijn, S., et al. “Dietary Intake of Fatty Acids and Fish in Rela-tion to Cognitive Performance at Middle Age.” Neurology 62(2004): 275–80.

Kennes, B., et al. “Effect of Vitamin C Supplements on Cell-Mediated Immunity in Old People.” Gerontology 29 (1983):305–310.

Kirn, T. F. “Do Low Levels of Iron Affect Body’s Ability to Reg-ulate Temperature, Experience Cold?” Journal of the AmericanMedical Association 260 (August 5, 1988): 607.

Lakshmanad, L., et al. “Magnesium Intakes and Balances.” Amer-ican Journal of Clinical Nutrition 60, suppl. 6 (December 1984):1380–89.

Lesser, M. “Testosterone Propionate Therapy in 100 Cases ofAngina Pectoris.” Journal of Clinical Endocrinology 6 (1946):549–57.

Lindenbaum, J., et al. “Neuropsychiatric Disorders Caused byCobalamin Deficiency in the Absence of Anemia or Macro-cytosis.” New England Journal of Medicine 318, no. 26 (June 30,1988): 1720–28.

Lindenbaum, J., et al. “Prevalence of Cobalamin Deficiency in theFramingham Elderly Population.” American Journal of ClinicalNutrition 60, no. 1 (July 1994): 2–11.

“LMPG: Laboratory Support for the Diagnosis and Monitoringof Thyroid Disease.” National Association of Clinical Bio-chemistry, nacb.org/lmpg/thyroid_LMPG_PDF.stm.

Lowe, J. C., et al. “Effectiveness and Safety of T3 Therapy forEuthyroid Fibromyalgia: A Double-Blind, Placebo-ControlledResponse Driven Crossover Study.” Clinical Bulletin of Myofas-cial Therapy 2, no. 2/3 (1997): 31–58.

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Lowe, J. C., A. J. Reichman, and J. Yellin. “The Process ofChange During T3 Treatment for Euthyroid Fibromyalgia: ADouble-Blind, Placebo-Controlled, Crossover Study.” Clini-cal Bulletin of Myofascial Therapy 2, no. 2/3 (1997): 91–124.

Marston, R. M., and B. B. Peterkin. “Nutrient Content of theNational Food Supply.” National Food Review (Winter 1980):21–25.

McLean, R. “Thyroid Hormone Therapy Reduces Chronic Painand Fatigue.” Pain Medicine News (December 2003): 20–21.Based on a presentation at the 2003 Annual Meeting of theAmerican College of Obstetricians and Gynecologists.

Mertz, W., ed. “Beltsville 1 Year Dietary Intake Survey.” Ameri-can Journal of Clinical Nutrition 40, suppl. (December 1984):1323–1403.

Meydani, S. N., et al. “Vitamin E Supplementation EnhancesCell-Mediated Immunity in Healthy Elderly Subjects.” Amer-ican Journal of Clinical Nutrition 52, no. 3 (September 1990):557–63.

Moldofsky, H., and P. Scarisbrick. “Induction of NeuresthenicMusculoskeletal Pain Syndrome by Selective Sleep StageDeprivation.” Psychosomatic Medicine 38, no. 1 (January–February 1976): 35–44.

Nelson, J. H. “Wheat: Its Processing and Utilization.” AmericanJournal of Clinical Nutrition 41, suppl. (May 1985): 1070–76.

Plotnikoff, G. A., and J. M. Quigley. “Prevalence of SevereHypovitaminosis D in Patients with Persistent, NonspecificMusculoskeletal Pain.” Mayo Clinic Proceedings 78 (December2003): 1463–70.

Prien, E. L., et al. “Magnesium Oxide-Pyridoxine Therapy forRecurring Calcium Oxalate Urinary Calculi.” Journal of Urol-ogy 112 (1974): 509–512.

Reuters Medical News. “Testosterone Patches Improve ExerciseCapacity in Men with Angina.” Professional Medical News (June22, 2000).

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Schroeder, H. A. “Losses of Vitamins and Trace Minerals Result-ing from Processing and Preservation of Foods.” AmericanJournal of Clinical Nutrition 24, no. 5 (May 1971): 562–73.

Seelig, M. S. “The Requirement of Magnesium by the NormalAdult.” American Journal of Clinical Nutrition 14 (June 1964):342–90.

Simons, D. G. “Myofascial Pain Syndrome Due to Trigger Points.”International Rehabilitation Medicine Association Monograph Series1 (November 1987).

Talbott, M. C., L. T. Miller, and N. I. Kerkvliet. “Pyridoxine Sup-plementation: Effect on Lymphocyte Responses in Elderly Per-sons.” American Journal of Clinical Nutrition 46, no. 4 (October1987): 659–64.

Teitelbaum, J., and B. Bird. “Effective Treatment of SevereChronic Fatigue: A Report of a Series of 64 Patients.” Journalof Musculoskeletal Pain 3, no. 4 (1995): 91–110.

Teitelbaum, J. E., et al. “Effective Treatment of CFS and FMS: ARandomized, Double-Blind Placebo Controlled Study.” Jour-nal of Chronic Fatigue Syndrome 8, no. 2 (2001): 3–25.

Tennant, F. “From Research to Practical Application.” PracticalPain Management (July/August 2004): 60.

Travell, J. G. “Identification of Myofascial Trigger Point Syn-dromes: A Case of Atypical Facial Neuralgia.” Archives of Phys-ical Medicine and Rehabilitation 62 (1981): 100–106.

Travell, J. G., and D. G. Simons. Myofascial Pain and Dysfunction:The Trigger Point Manual. Vol. 1, 103–164. Baltimore, MD:Williams & Wilkins, 1983.

Trowell, H. C. ed. Western Diseases: Their Emergence and Preven-tion. Cambridge, MA: Harvard University Press, 1981.

Ursin, R., et al. “Relations Among Muscle Pain, Sleep Variables,and Depression.” Journal of Musculoskeletal Pain 7, no. 3 (1999):59–72.

Walter, T., et al. “Effect of Iron Therapy on Phagocytosis and Bac-tericidal Activity in Neutrophils of Iron-Deficient Infants.”

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Winkler, U. “Effects of Androgens on Hemostasis.” Maturitas 24(1996): 147–55.

Wright, J. V. “Given IV, Magnesium Can Help Acute KidneyStones to Pass.” Nutrition and Healing 10, no. 5 (May 2003).

Wright, J. V., and L. Lenard. Maximize Your Vitality and Potency,for Men over 40. Petaluma, CA: Smart Publications, 1999.

Chapter 3

Crook, William G. The Yeast Connection and the Woman. Jackson,TN: Professional Books, 1995.

Galland, L., et al. “Giardia as a Cause of Chronic Fatigue.” Jour-nal of Nutritional Medicine 1 (1990): 27–32.

Gittleman, Ann Louise. Guess What Came to Dinner: Parasites andYour Health. Garden City Park, NY: Avery Publishing Group,1993.

Holmes, G. P., et al. “Chronic Fatigue Syndrome: A WorkingCase Definition.” Annals of Internal Medicine 108 (1988):387–89.

Reid, G., K. Millsap, and A. P. Bruce. “Implantation of Lacto-bacillus Casei Var. Rhamnosus into Vagina.” Lancet 344 (1994):1229.

Simons, D. G. “Myofascial Pain Syndrome Due to Trigger Points.”International Rehabilitation Medicine Association Monograph Series1 (November 1987): 1–39.

Chapter 4

American Geriatrics Society. “The Management of Chronic Painin Older Persons.” Journal of the American Geriatrics Society 46(1998): 635–51.

Ayres, S., et al. “Post Herpes Zoster Neuralgia: Response to Vita-min E Therapy.” Archives of Dermatology 108 (1973): 855–56.

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Backonja, M. “Pathogenesis and Treatment of Neuropathic Painin Older Adults.” American Journal of Pain Management 14, no.2 (April 2004): 9S–18S.

Backonja, M. M. “Anticonvulsants for Neuropathic Pain Syn-dromes.” Clinical Journal of Pain 16, suppl. 2 (2000): s67–s72.

Backonja, M. M. “Gabapentin Monotherapy for SymptomaticTreatment of Painful Neuropathy: A Multicenter, Double-Blind, Placebo-Controlled Trial in Patients with DiabetesMellitus.” Epilepsia 40, suppl. (1999): s57–s59.

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Harbut, R. E., et al. “Successful Treatment of a Nine-Year Caseof Reflex Sympathetic Dystrophy with IV Ketamine Infusionin a Warfarin Anti-Coagulated Adult Female Patient.” PainMedicine 3, no. 2 (2002): 147–55.

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Meier, T., et al. “Efficacy of Lidocaine Patch 5 Percent in theTreatment of Focal Peripheral Neuropathic Pain Syndromes:A Randomized Double-Blind, Placebo-Controlled Study.”Pain 106 (2003): 151–58.

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Sindrup, S. H., et al. “Tramadol Relieves Pain and Allodynia inPolyneuropathy: A Randomized, Double-Blind, ControlledTrial.” Pain 1 (1999): 85–90.

Chapter 5

Adam, O., C. Beringer, et al. “Anti-Inflammatory Effects of aLow Arachidonic Acid Diet and Fish Oil in Patients withRheumatoid Arthritis.” Rheumatology International 23 (2003):27–36.

Buskila, D., et al. “Fibromyalgia and Systemic Lupus Erythe-matosus: Prevalence and Clinical Implications.” Clinical Reviewof Allergy and Immunology 25, no. 1 (August 2003): 25–28.

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Leventhal, L. J., et al. “Treatment of Rheumatoid Arthritis withGamma Linolenic Acid.” Annals of Internal Medicine 119(1993): 867–73.

McAlindon, T., et al. “Nutrition: Risk Factors for Osteo Arthri-tis.” Annals of Rheumatic Disease 56 (1997): 397–402.

McLean, R. Pain Medicine News (January/February 2004): 14.Based on the study presented at 2003 American Academy ofPhysical Medicine and Rehabilitation.

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Petri, M. A., et al. “Effects of Prasterone on CorticosteroidRequirements of Women with Systemic Lupus Erythemato-sus: A Double-Blind, Randomized, Placebo-ControlledTrial.” Arthritis and Rheumatism 46, no. 7 (2002): 1820–29.

Reginister, J., et al. “Glucosamine Sulfate Slows DownOsteoarthritis Progression in Postmenopausal Woman: PooledAnalysis of Two Large Independent, Randomized, Placebo-Controlled, Double-Blind, Prospective, Three-Year Trials.”Abstract 196. ULAR 2002 European Congress of Rheuma-tology, June 12–15, 2002, Stockholm, Sweden.

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Chapter 7

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Schoenen, J., et al. “Effectiveness of High-Dose Riboflavin inMigraine Prophylaxis. A Randomized Controlled Trial.” Neu-rology 50, no. 2 (February 1998): 466–70.

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Singer, R. S., et al. “Oral Transmucosal Fentanyl Citrate in theOutpatient Treatment of Severe Pain from Migraine Head-ache.” The Pain Clinic (January/February 2004): 10–13.

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Chapter 8

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Chapter 9

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Chapter 10

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Chapter 11

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Bullock, M. L., et al. “Characteristics and Complaints of PatientsSeeking Therapy at a Hospital-Based Alternative MedicineClinic.” Journal of Alternative and Complementary Medicine 3,no. 1 (1997): 31–37.

Deihl, D. L., et al. “Use of Acupuncture by American Physicians.”Journal of Alternative and Complementary Medicine 3, no. 2(1997): 119–26.

Han, J. S. “Acupuncture Activates Endogenous Systems of Anal-gesia.” Acupuncture. NIH Consensus Statement, November 3–5,1997 15, no. 5 (1997): 1–34.

Lao, L. “Safety Issues in Acupuncture.” Journal of Alternative andComplementary Medicine 2, no. 1 (1996): 27–29.

Lao, L., et al. “Efficacy of Chinese Acupuncture on PostoperativeOral Surgery Pain.” Oral Surgery, Oral Medicine, Oral Pathol-ogy 79, no. 4 (1995): 423–28.

Lewith, G. T., and C. Vincent. “On the Evaluation of the Clini-cal Effects of Acupuncture: A Problem Reassessed and aFramework for Future Research.” Journal of Alternative andComplementary Medicine 2, no. 1 (1996): 79–90.

Lytle, C. D. An Overview of Acupuncture. Washington, DC: U.S.Department of Health and Human Services, Health SciencesBranch, Division of Life Sciences, Office of Science and Tech-nology, Center for Devices and Radiological Health, Food andDrug Administration, 1993.

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Jancin, B. “Adjunctive Therapies in Difficult Pain Patients.” Inter-nal Medicine News (May 1, 1999): 16.

Jung, A. C., et al. “Selective Serotonin Reuptake Inhibitors AreEffective for Mixed Chronic Pain.” The Journal of GeneralInternal Medicine (June 1997): 384–89.

Karst, M., et al. “Analgesic Effect of the Synthetic CannabinoidCT-3 on Chronic Neuropathic Pain: A Randomized ControlTrial.” Journal of the American Medical Association 290 (2003):1757–62.

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Mathias, S., et al. “The GABA Uptake Inhibitor Gabitril Pro-motes Slow Wave Sleep in Normal Elderly Subjects.” Neurobi-ology of Aging 22 (2001): 247–53.

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Pembrook, L. “NSAIDs Superior to Acetaminophen in TreatingOsteoarthritis Pain.” Pain Medicine News (March/April 2004):13. Based on a presentation at the 2003 annual meeting of theAmerican College of Rheumatology.

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APPENDIX C

286

287

Index

Abdominal pain, 133–40ABHR cream, 112Acetominophen, 205–6Acetyl 1-carnitine, 107Acid reflux, 133–36, 155Acidophilus, 43, 44, 47Acidophilus Pearls, 43, 47, 108, 248Actiq, 122Acupressure, 102, 126Acupuncture, 56, 112, 125, 187–91Acute pain, 4Addiction, 220–22Adjustability, 69Adrenal burnout, 30Adrenal glands, 29, 103, 246. See also Adrenal

insufficiencyAdrenal glandular, 248Adrenal insufficiency, 29–33Adrenal Stress End, 32, 248, 260Advil, 117, 145Age factors, 73AHMA (American Holistic Medical

Association), 256Alcohol, 135, 195Alexander technique, 56Alkaline urine, 144Allodynia, 76Allopathic medicine, xiv–xvAlpha-2-adrenergic agonists, 212–13Alprazolam, 228ALT levels, 44Alternative medicine, 5Alternative treatments, 183–91

acupuncture as, 187–91chiropractic medicine as, 184–86hypnosis/magnets as, 186osteopathy as, 183–84prolotherapy as, 186–87

AMA (American Medical Association), 185Amantadine, 84, 212Ambien, 106, 224–25American Academy of Clinical

Endocrinologists, 24American Academy of Neurology, 120, 156American Academy of Pain Management, 255American Association of Orthopedic Medicine,

256American Cancer Society, xiiAmerican College for the Advancement of

Medicine, 256American College of Rheumatology, 96American Holistic Medical Association

(AHMA), 256American Medical Association (AMA), 185American Pain Society, xiiAmerican Psychiatric Association, 235Ancient Egypt, 92Angelo, Jack, 58

Angina, 156Angular stomatitis, 220Annals of Internal Medicine, 26Antacid medications, 134Antibiotics, 40–42, 44, 47–49, 102Antibiotic-sensitive infections, 48–49Antidepressants, 80–82, 117, 209–12, 227–28,

248–49Antioxidants, 71, 79–80, 83, 92, 95Antiparasitics, 48Antiseizure medications, 81, 123, 129, 208, 209Anxiety, 236–38, 261Apfelbaum, Ananda, 58Applied kinesiology, 102Arachadonic acid, 91Aricept, 218Armour Thyroid, 27, 29, 247Arnica, 179Arthritis, 96–103, 169Arthritis Research Center Foundation, 204–5Artichoke extract, 140Aspartame, 102, 126Aspirin, 119, 135, 155, 168, 202–4AST levels, 44Asthma, 91Aston patterning, 56Attitude change, 248Aun, Neoh Choo, 112

B complex, 100, 101, 143Back pain, chronic. See Chronic back painBaclofen, 108, 207Ballweg, Mary Lou, 148Barth, Werner, 164Baths, hot, 50–51Benadryl, 84, 112, 122, 229Benson, Herb, 59Bernhard Industries, 46Beta-blockers, 123Bias against natural therapies, 163–67Bilateral balance, 70Bioflavonoids, 83Biomedical research, 165Birth control pills, 126–27Bladder infections, 47Bladder problems, 141–45Blood testing, 24–25, 27, 28, 44, 76BMD (bone mineral density), 110Body awareness, 65–67Body Ecology, 42, 248, 262Bodywork, 52–59

for energy flow, 58guidelines for using, 52–54for headaches, 117massage therapies involving, 57–58and movement/exercise, 54–56optimum use of, 58–59

Boiron, 262


Bone, Kerry, 169Bone mineral density (BMD), 110Bone pain, 105, 108–12Borage seed oil, 98Boron, 98, 101, 109Boswellia, 101, 169–70Bowel parasite infections, 49–50Brainwave biofeedback and treatment system,

108Breathing, 54–55, 60Bruxism, 131BuSpar, 212Buspirone, 212Butterbur, 120–21, 124, 125, 180

Caffeine, 119Caffeine withdrawal headaches, 128Calcitonin, 109Calcium, 20, 108–10Calcium carbonate, 109–10Calcium channel blockers, 123Calming Balance Formula, 28, 238, 261, 262CAM. See Complementary and alternative

medicineCancer patients, xii, 75, 105, 111–13Candida, 142Cannabinoids, 221Cape Apothecary, 128, 199, 258Cape Pharmacy, 46Capsaicin, 82, 84, 180–81Carbamazepine, 216Carbonated beverages, 129Carisprodol, 226Carpal tunnel syndrome, 78, 156–57, 164–66Casts, 85Catapres, 212–13CDC (Centers for Disease Control), 97Celebrex, 93, 103, 108, 204, 205Celecoxib, 205Celexa, 211Centers for Disease Control (CDC), 97Certo, 181CFS. See Chronic fatigue syndromeChalk, 109–10Challem, Jack, 94Cheilitis, 220Cherry, 101, 170–71Chest pain, noncardiac, 155–56Chi gong, 55–56Chicken pox, 77Chiropractic, 117, 184–86Chlamydia, 108Chocolates, 94, 95, 126Chondroitin, 99, 102, 171Chondroitin sulfate, 100, 154Chromium, 32Chronic acid reflux, 133–36Chronic back pain, 151–55, 168, 240Chronic fatigue syndrome (CFS), xi, 107,

244–46Chronic nonbacterial prostatis, 148Chronic pain, 4

allopathic-/natural-medicine treatments for,xiv–xv

cost of, xiinumber of people affected by, xiitools for treating, xiii–xivand weight gain, 244–47

Chronic pelvic pain syndrome (CPPS), 148Chronic sinusitis, 41, 42Cialis, 235Cipro, 108Cirrhosis, 44Citricidal, 43Climara, 127Clonazepam, 214, 225–26

Clonidine, 83, 87Clostridium difficile, 139Cluster headaches, 128–29CMV, 107“Cock up” wrist splint, 157Coenzyme Q10, 107, 125Coffee, 126, 135Cohen, Ken, 56Colas, 135Colchicine, 78, 153Colloidal silver, 46, 128, 262Complementary and alternative medicine

(CAM), xiv, 189Complete Illustrated Book of Yoga (Vishnu

Devananda), 54CompleteGest Enzymes, 135, 138, 262Complex regional pain syndrome (CRPS), 84Compounding pharmacies, 257–58Comprehensive pain treatment protocol form,

253–54Consumers Discount Drug Company, 194Copper, 98, 109Copper bracelets, 102Cortef, 32, 33, 47, 103, 107Cortisol, 29, 30, 103, 144Cortisone, 32–33, 158Corvalen, 107, 261, 262Costco pharmacies, 194Costochondritis, 155–56COX (cyclooxygenase), 93COX-2 inhibitors, 103, 204–5CPPS (chronic pelvic pain syndrome), 148Creams, topical. See Topical gels and creamsCrook, William, 43CRPS (complex regional pain syndrome), 84Curcumin, 101, 179–80Customizability, 69–70Cyclobenzaprine, 210–11, 226Cyclooxygenase (COX), 93Cymbalta, 84, 211Cyproheptadine, 212Cytokines, 90, 92, 93

Daily ergonomics journal, 63–65Dalmane, 22Dantrolene, 206Dean, Ward, 142Deep-sleep—inducing tapes and CDs, 21Dehydroepiandrosterone sulfate (DHEA-S),

29–30, 34Delta-wave-sleep—inducing tapes and CDs, 21Demerol, 123Dental pain, 130–31Depakote, 123, 129, 248Depression, 236–39

and hypothyroidism, 26and nerve pain, 82and SAM-e, 100supplements for, 261

Desipramine, 210Dessicated thyroid, 27Desyrel, 106, 211–12Detox bath recipe, 50–51Detoxification, 50–51Devananda, Vishnu, 54DEXA scan, 108Dexedrine, 212Dextromethorphan, 214–15DGL licorice, 134–36DHEA, 90, 107, 111DHEA-S. See Dehydroepiandrosterone sulfateDiabetic neuropathy. See Painful diabetic

neuropathyDiamox, 129Diflucan, 44, 47, 48, 127, 142Dilantin, 84, 215–16

INDEX

288

Disc disease, 152–54D-Mannose, 47DMSO, 143Dolophine, 219Donepezil, 218Doxepin, 81, 123Doxycycline, 46, 108Doxylamine, 229D-Ribose, 107, 261, 262Duloxetine, 211Dysesthesia, 145

E. coli, 47EBV, 107Educational program, 254Effexor, 82, 211, 248Elavil, 81, 83, 106, 117, 123, 142, 210, 248Elimination diet, 126Elliott, Thomas, 236Elmiron, 143Emotional factors, 240–41End Pain formula, 95, 101, 102, 116–17,

260–61Endometriosis, 147–48Endometriosis (Mary Lou Ballweg and

Endometriosis Association), 148Endometriosis Association, 148Energy Revitalization System, 80, 109, 140,

143, 149, 159, 171, 205, 247, 260Enzymatic Therapy, xv, 100, 154, 259, 262Enzymes, 135–38, 176–78, 262Erectile dysfunction, 235Ergonomics, 61–70

and activity, 67and bilateral balance, 70and body awareness, 65–67examples of poor, 61–63and excess weight, 70and furniture, 68–70and ingenuity/devices, 67–68journal-keeping about, 63–65and variety, 65

Erythromycin, 46Eskimo 3, 261Estradiol, 36Estriol, 36Estrogen

and gender differences, 73hormone treatments for deficiency of, 36–37and migraines, 126–27and osteoporosis, 109

Estrogen replacement therapy, 111, 126–27Eszopiclone, 226Exercise, 101, 128, 244, 247

Facial pain, 129Far-infrared saunas, 50, 259FDA. See Food and Drug AdministrationFeldenkrais work, 56Fentanyl lollipops, 122–23Feverfew, 124Fiber, 140Fibromyalgia (FMS), xi, 20, 24–25, 105–8,

244–46“Fight-or-flight response,” 30Fish, 94, 95, 111Fish oils, 91–92, 94, 98, 101, 111, 124–25, 237,

2615-HTP. See Hydroxy L-tryptophanFlaxseed, 92Flexeril, 106, 210–11, 226Fluoxetine, 227“Flushing,” 178–79FMS. See FibromyalgiaFolate, 100Folic acid, 109

Food allergies, 101–2, 125–26Food and Drug Administration (FDA), xv,

165–66, 188Food sensitivity, 102, 126Foot problems, 159–60Fosamax, 109, 110Frankincense, 169Free radicals, 79From Fatigued to Fantastic! (Jacob Teitelbaum),

139, 241Frozen shoulder, 158Fullerton, Brad, 187, 256Fungal infections and overgrowth, 40–44,

47–48avoiding, 44causes of, 41–42and chronic sinusitis, 128conditions indicating, 40and fibromyalgia, 108medical treatments for, 43–44natural treatment of, 42–43and prostadynia, 149recurrent, 47–48and spastic colon, 139

Furniture, 68–70

GABA receptors, 77GABA-augmenting medications, 206–9Gabitril, 84, 208, 227GAG (glycosaminoglycan), 141Gamma linolenic acid (GLA), 98Gels, topical. See Topical gels and creamsGender differences, 73General Nutrition Center, 34, 45Generic medications, 194GHB, 228–29Ginger, 180Ginkgo, 236Ginseng, 236GLA (gamma linolenic acid), 98Glucosamine, 98–100, 102Glucosamine sulfate, 99, 154, 171Glycosaminoglycan (GAG), 141Gott, Peter, 159Grape juice, 102, 181Great Smokies Diagnostic Laboratory, 49, 139,

257Grinding teeth, 131Gross, Cary, 165Growth hormone, 19, 245GS Similase, 135, 138

H. pylori, 136Halcion, 22Haldol, 112Hands on Healing (Jack Angelo), 58Happiness 1-2-3, 238, 261, 262Harris, David, 187, 256Hay fever, 102Headaches, 115–31

caffeine withdrawal, 128cluster, 128–29migraine, 117–27pressure, 129sinus, 127–28tension, 115–17TMJ/TMD, 129–31

Healing Back Pain (John Sarno), 240Health counseling, 257Health Freedom Nutrition, 262Health Resources, 111Heart attacks, 26, 85, 93, 156Heart disease, 91Heartburn Free by Enzymatic Therapy, 135Heat, 71, 101Heel Company, 179, 262

INDEX

289

Heparin, 143Hepatitis, 44Herbal remedies, 116Hereditary sensory and autonomic neuropathy

(HSAN), 4Herpes zoster, 77Hersh, Stephen, 199HHV-6, 107High blood pressure, 126High Tech Health, 50, 259Higher-dose tablets, 194–95High-heeled shoes, 61–62Hip injuries, 85Homeopathic creams, 93, 262Homeopathy, 102–3Hops, 172–73Hormone treatments, 23–37

for adrenal insufficiency, 29–33for DHEA deficiency, 34for estrogen/progesterone deficiency, 36–37for hypothyroidism, 24–29for testosterone deficiency, 34–36

Hormones, 73, 78, 107Horny goat weed, 236Hot baths, 50–51HSAN (hereditary sensory and autonomic

neuropathy), 4Humidifiers, 46Hunninghake, Ronald E., 94Huse, Ron, 159, 178Hydrocortisone, 32, 47Hydroxy L-tryptophan (5-HTP), 20, 174–75,

238Hyoscyamine, 140Hypnosis, 186Hypoglycemia, 29, 31–32, 246Hypothalamic sleep disorder, 107Hypothalamus, 19, 245Hypothyroidism, 24–29, 78, 246, 247

Iberogast, 140IC. See Interstitial cystitisIce, 71Imitrex, 118–20, 127Immobilization, 85Immune stimulants, 45Immune system, 42, 96, 107Inderal, 123Indigestion, 133–36, 156Infections, 5, 39–51

antibiotic-sensitive, 48–49bowel parasite, 49–50detoxification treatment for, 50–51fungal, 40–44, 47–48and muscle pain, 107–8and nutrition, 50respiratory, 45–47

Infertility, 26Inflammation, 89–103

and antioxidants, 71arthritic, 96–103and boswellia, 170and diet, 91–92medical treatments for, 93natural treatments for, 94–96treating, 92–96unhealthy, 90–91and willow bark, 168–69

Inflammation and Aging (Ronald E.Hunninghake), 94

Inflammation Syndrome, The (Jack Challem), 94Inflammatory vulvodynia, 146–47Inositol, 42, 78, 83, 100, 261Integrative Therapeutics, xv, 100, 259, 262International Academy of Compounding

Pharmacies, 257–58

International Association for the Study ofPain, 3

International Society for the Study ofVulvovaginal Disease, 145

Interstitial cystitis (IC), 141–45Intravenous (IV) pain medications, 222–24Iron, 70–71IV pain medications. See Intravenous pain

medications

Jacob, Stanley, 143–44Jacobson, Bren, 39, 51, 61, 70, 257Jamaican dogwood, 172Jar Key, 68Jaw pain, 129–31Jefferies, William, 30, 31, 33Jensen, Maureen, 240JMT, 102Johnstown flood, 196–97Joint Gel, 175–76Joint pain, 96Journal, daily ergonomics, 63–65Journal of the American Medical Association, 5Juvenile rheumatoid arthritis, 97

Kapleau, Philip, 60KDY, 144Keflex, 48Keppra, 84, 216Ketamine, 82, 83, 86, 213–14, 223–24Klabin Marketing, 262Klonopin, 106, 214, 225–26

Lamictal, 84, 154, 216, 248Lamotrigine, 216Land animal fats, 91L-arginine, 144Leg pain, 159Lettuce, wild, 172Levetiracetam, 216Librax, 140Lidocaine, xi, 80–82, 155, 223Lidoderm patches, 103, 130, 199–200Lifting, 68Light exposure, 239Light on Yoga, 54Light sensitivity, 117Limonene, 135Lipoic acid, 44, 78, 80, 171Lithium, 129, 217Liver, 44Localized pain, 81Lorazepam, 112Low back pain, 78, 168Lunesta, 226Lupus, 89, 90Lyme disease, 47, 108Lymphatic drainage massage, 58Lyrica, 208–9

Maca, 236Magnesium, 20, 83, 109, 112–13, 121, 123–24,

222–23Magnets, 186Magnolia, 238Major depressive disorders (MDDs), 236Maltitol, 42Manganese, 109Mantras, 59–60Marijuana, 180, 221Marinakis, Peter, 183, 187Marinol, 180, 221Maryland Acupuncture Society, 189Massage therapies, 57–58Masseter muscles, 130Mastic gum, 135, 136

INDEX

290

Mattresses, 68–69Mauskop, Alexander, 123–24Mayo Clinic, 41MDD (major depressive disorders), 236Medical history, 76Medication management, 248–49Meditation, 55, 59–60MegaZyme, 93, 176–78, 262Melatonin, 20, 175Menstrual cramps, 145Mentharil, 140Methadone, 219–20Methionine, 100Methyl testosterone, 35Metoclopramide, 112Midrin, 117Migraines, 117–27

and estrogen, 36estrogen-induced, 126–27medications for, 118–20natural treatments for, 120–21possible causes of, 118preventing, 123–25rescue medications for, 121–23triggers of, 125–26

Miller, Joyce, 164–65Mind-body connection, 239–42Mindful meditation, 60Mindfulness Meditation (Jon Kabat Zinn), 60Minocycline, 102MiraLax, 140, 218Mnabhi, Anette, 50Money, pharmaceuticals and, 165–66Morton’s neuroma, 160Motrin, 76, 93, 103, 108, 117, 127, 155, 198,

204Mouth guards, 131MPS. See Myofascial painMS Contine, 219MSM, 93, 99, 102, 143–44MSM—the Definitive Guide (Stanley Jacob), 144Multi-Pure filters, 50, 258Multivitamins, 94Muscle pain, 5, 112–13, 147Muscle relaxants, 206, 226Muscle tightness, xi, 5, 51Mycoplasma, 108Myers cocktails, 153, 178–79Mylicon, 140Myofascial Pain and Dysfunction (Janet Travell

and David Simons), 166Myofascial pain syndrome (MPS), xi, 5, 105–8.

See also Muscle painMyxedema, 33

N-acetyl-cysteine (NAC), 107NAET, 102, 126Nambudripad, Devi, 102Naps, 65Narcotic receptors, 84Narcotics, 35, 84, 122, 217–22Nasal congestion, 127Nasal rinses, 45–46Nasal sprays, 118National Cancer Institute, 177National Certification Commission for

Acupuncture and Oriental Medicine(NCCAOM), 188

National Institutes of Health (NIH), 145National Sleep Foundation, 19Natural biestrogen, 36Natural Immunogenics, 262Natural products, 259Natural progesterone, 37Natural sleep aids, 20–21Natural testosterone, 35

Natural therapies, xiv, xv, 163–81arnica, 179bias against, 163–67boswellia, 169–70capsaicin, 180–81cherry, 170–71ginger/butterbur, 180IV Myers cocktails as, 178–79marijuana, 180of nutritional supplements, 171–72oral enzymes as, 176–78Purple Pectin for Pain as, 181Saint-John’s-wort, 180for sleep, 172–75topical gels as, 175–76turmeric, 179–80willow bark, 167–69

Nausea, 112NCCAOM (National Certification Commission

for Acupuncture and Oriental Medicine),188

Nerve entrapments, 78Nerve pain, 75–87

in cancer patients, 112–13lab testing for, 76and medical history, 76RSD, 84–87treating, 79–84types/causes of, 76–79

Neurontin, 80–83, 87, 108, 123, 129, 142,207–8, 226–27

Neuropathic pain. See Nerve painNeuropathic vulvodynia, 146New England Journal of Medicine, 240New York Times, 62NF Formulas, 43, 175Niacin, 101, 178–79Nifedipine, 83Nightshade, 102NIH (National Institutes of Health), 145Nikkan Company, 186NMDA-receptor antagonists, 213–15Noncardiac chest pain, 155–56Nonsteroidal anti-inflammatory drugs

(NSAIDs), 73, 202–4and arthritis, 98families of, 203and fibromyalgia, 108and inflammation, 93, 95for menstrual cramps, 145and nerve pain, 76for shoulder problems, 158in topical creams, 198

Nonulcerative IC, 141Nordic Natural, 261Norepinephrine, 82, 83Norpramin, 210Nortriptyline, 81Nose sprays, 128Novocain, xi, 80NSAIDs. See Nonsteroidal anti-inflammatory

drugsNutraSweet, 102, 126Nutrition, 7–18

disease/chronic pain and deficiencies of, 8–9importance of healthy, 17–18and infections, 50and nerve pain, 78and pain/energy, 16–17skepticism, 9–10supplementation of, 10–16

Nutrition and Healing newsletter, 170Nystatin, 43–44, 46, 47

OAM. See Office of Alternative MedicineOcclusion, 83

INDEX

291

Office of Alternative Medicine (OAM), 188,189

Omega-3 fatty acids, 92Omega-6 fatty acids, 91, 92, 93, 95OMT (osteopathic manipulative treatment),

184Opioids, 76, 82, 234Oral enzymes, 176–78Oral pain medications, 200–217

acetominophen/Tylenol, 205–6alpha-2-adrenergic agonist, 212–13antidepressant, 209–12aspirin/NSAID, 202–4COX-2 inhibitor, 204–5GABA-augmenting, 206–9Keppra, 216Lamictal, 216lithium, 217muscle-relaxant, 206NMDA-receptor antagonist, 213–15sodium-channel-blocking, 215–16Trileptal, 216–17Ultram, 202

Oral transmucosal fentanyl citrate (OTFC), 122Oscillococcinum, 45Osteoarthritis, 96, 169–70Osteopathic manipulative treatment (OMT),

184Osteopathy, 183–84Osteoporosis, 28, 95, 108–11OTFC (oral transmucosal fentanyl citrate), 122Oxcarbazepine, 216–17Oxycodone, 220OxyContin, 219, 220

Pain, 3–5categories of, 4critical function of, 4definition of, 3–4emotional factors associated with, 240–41and mind-body connection, 239–42turning off, 4–5

Pain management, xii, 5Pain relief principles, 1Painful diabetic neuropathy (PDN), 77–78, 80,

82–83Pain-sensitization, 77Palmer, David, 185Pamelor, 210Pancreas, 137Pantothenic acid, 98, 101Parasite infections, 49–50, 107Parasitology Center, 49, 139, 257Paresthesias, 76Paroxetine, 227Passionflower, 173Patches, 80–82, 103, 130, 155, 199–200Paxil, 87, 117, 211, 227PDN. See Painful diabetic neuropathy“Pearls,” 43Pectin, 102, 181Pelvic pain, 141–49

from endometriosis, 147–48from interstitial cystitis, 141–45from menstrual cramping/vulvodynia, 145–47from prostatitis/prostadynia, 148–49

Penicillin, 46, 48Peppermint oil, 140Peppermint Plus, 140Percocet, 220Periactin, 212Perleche, 220Petadolex, 124PGEs (prostaglandins), 202Pharmaceutical Compounding Association, 257Pharmacies, compounding, 257–58

Phenytoin, 215–16PHN (postherpetic neuralgia), 77Physical therapy, 71, 117, 158Physician locater, 255–56Physician organizations, 255–56Phytostan, 43, 44, 47Pilates, 56Pinched nerves, 78Piperine, 101Plantar fasciitis, 159PLO gel, 197Postherpetic neuralgia (PHN), 77Practicioner referrals, 254Pranayama, 55Prednisone, 33Pregabalin, 208–9Premarin, 23, 36Prescription therapies, 193–231

cannabinoid, 221considerations with, 194–97integrative, 230–31intravenous, 222–24narcotic, 217–22oral. See Oral pain medicationspatch, 199–200for sleep, 224–30topical gel, 197–99

Pressure headaches, 129Preventing damage of joints, 101Prevention, pain, 196Priapism, 228Prilosec, 136Primal Defense, 43Probiotic Pearls, 43ProBoost, 45, 46, 262Progesterone, 37Pro-inflammatory fats, 92, 93Prolotherapy, 186–87, 256Promethazine, 112Prometrium, 37Prostadynia, 148–49Prostaglandins (PGEs), 202Prostatitis, 148Prostrate pain, 148–49Provigil, 218Prozac, 26, 211–12, 227, 234–35, 248Prunus cerasus, 170–71Psychological counseling, 257Psychosomatic, 56Pterygoid muscles, 130Pure Water, 50, 258Purple Pectin for Pain, 102, 181Pyridium, 142

Quality control regulation, xvQuercetin, 149Quinine, 159

Range of motion exercises, 158Reflex Sympathetic Dystrophy (RSD), 84–87,

199Reflex Sympathetic Dystrophy Association of

America, 85, 86The Relaxation Response (Herb Benson), 59Remeron, 117Repairing joint cartilage, 98–101Repetitive use syndrome, 65Rescue medications (for migraines), 121–23Respiratory infections, 45–47Rest, ice, compression, elevation (RICE), 93Reston, James, 187Restoring function of joints, 101Revitalizing Sleep Formula, 20, 106, 117, 247,

260Rheumatoid arthritis, 90, 93, 96–97, 102Rhodiola, 235

INDEX

292

Riboflavin, 124RICE (rest, ice, compression, elevation), 93Ritaline, 212Rofecoxib, 205Rolf, Ida P., 57, 61Rolfing. See Structural integration/RolfingRolfing (Ida P. Rolf ), 57Rolfing and Physical Reality (Ida P. Rolf ), 57Rotator cuff tears, 158Roxicet, 220RSD. See Reflex Sympathetic DystrophyRubidium, 238Running, 53–54Russell Stover, 94, 261

Saccharin, 94, 261SAD. See Standard American dietSaint-John’s-wort, 84, 180, 237–38Salicin, 167–69SAM-e, 100, 172, 237Sarno, John, 239, 240Saunas, 50, 259Saw palmetto, 144–45Sciatica, 78, 154Scientific research, lacking knowledge of,

166–67SCM muscles. See Sternocleidomastoid musclesScreaming to Be Heard (Elizabeth Lee Vliet), 36Secondary fibromyalgia, 90, 96Seizure medications, 81Selenium, 98, 101Selye, Hans, 30Sensitivity tests, 257Serotonin, 118Serotonin reuptake, 83Sertraline, 227Sex, benefits of, 60–61, 245–46Sexual dysfunction, 212, 233–36Shingles, 77, 78, 82Shoes, 61–62, 69Shoulders, 85, 158Side effects, 194–95Simethicone, 140Similase, 135, 138Simons, David, xii, 131, 166Sinequan, 142Sinus headaches, 127–28Sinusitis nose sprays, 46, 128Sitz baths, 147The Sivananda Companion to Yoga, 54Skelaxin, 108, 206Skin hypersensitivity, 120SLE (systemic lupus erythematosus), 89Sleep, 18–23, 42, 106–7, 172–75, 245Sleep medications, 22–23, 106–7, 224–30

antidepressants as, 227–28Benadryl, 229combining, 229–30GHB, 228–29muscle-relaxant, 226for pain, 226–27prescription, 224–26Xanax, 228

Sleeping pills, 19Sodium channel blockers, 215–16Soma, 106, 226Somatopsychic, 56Sonata, 226Sound sensitivity, 117Spastic colon, 128, 138–40Spine, 151–55Splenda, 261Sporanox, 44, 47, 48SSRIs, 211–12Standard American diet (SAD), 7–8, 243–44Steam inhalers, 46

Sternocleidomastoid (SCM) muscles, 129–30

Steroids, 93, 95Stevens–Johnson syndrome, 216Stevia, 42, 94, 108, 248, 261, 262Stevita Company, 42Stomach acid, 134Stool tests, 139, 257Stress reduction, 51–61

with bodywork, 52–59with meditation, 59–60with sex, 60–61and weight, 246

“Stretch and spray,” 71, 117Stretching, 101, 159Strontium, 110–11Strontium carbonate, 110Strontium gluconate, 110, 112Structural integration/Rolfing, 56–58Stuckey, John, xiSubcutaneous injections, 118Subluxation, 185Substance P, 118Sugar

and adrenal insufficiency, 31and fungal infections, 40, 42, 47and immune function, 42and inflammation, 95and interstitial cystitis, 142–43sensitivity to, 126and sinus headaches, 127in standard American diet, 7–8

Sugar substitutes, 94–95, 261Sugar-free foods, 94–95Sulfa drugs, 48, 123, 205Sulfur amino acids, 99Supplements, 259–62Sustained-release morphine, 219Sustained-release oxycodone, 219Sweat, 50, 51Sweeteners, 42Symmetrel, 212Synthetic thyroid, 27Synthroid, 27Systemic lupus erythematosus (SLE), 89

Tai chi chuan, 55Tea, 45, 126Teeth, 130Tegretol, 79, 83, 129, 216Teitelbaum, Jacob, 255Telephone consultation, 257Temporomandibular joint dysfunction

(TMJ/TMD), 129–31Tennyson, Alfred Lord, 60Tension headaches, 115–17Tension myositis syndrome (TMS), 240Testosterone, 30, 34–36, 73, 111, 234Tetracyline, 46, 48T4 blood test, 27, 28, 110Thai Massage (Ananda Apfelbaum), 58THC, 180, 221Theanine, 173Thera-zyme (company), 144Thiamine, 28, 238Three Pillars of Zen, The (Philip Kapleau), 60Three Steps to Happiness (Jacob Teitelbaum),

239, 248Thumb tendonitis, 157–58Thymic hormone, 45, 46Thyroid gland, 24. See also HypothyroidismThyroid hormone, 78, 80, 110Tiagabine, 208, 227Tic douloureux, 79Timed-release morphine, 220Tissue compression, 39

INDEX

293

Tizanidine, 227TMJ/TMD. See Temporomandibular joint

dysfunctionTMS (tension myositis syndrome), 240Tofranil, 81Topamax, 84, 123, 129, 209, 248Topical gels and creams, 82–83, 175–76,

197–99, 259Topiramate, 209, 248Trager Mentastics, 56Tramadol, 83–84, 202Transdermal estrogen replacement therapy, 111Trauma, 70–71Traumeel Cream, 93, 179, 262Travell, Janet, xii, 131, 166Trazodone, 211–12, 228Tricyclic antidepressants, 80–82, 210Trigeminal neuraligia, 79, 129Trigger point injections, xiTrigger Point Manual, The (Janet Travell and

David Simons), 131Trigger points, xi, 116Trigger(s) of pain, 39–71

and ergonomics, 61–70infections as, 40–51stress as, 51–61trauma as, 70–71

Trileptal, 84, 216–17Triptans, 118–20TSH test, 24–25Tumor necrosis factor blocking medicines, 93Turmeric, 179–80Tylenol, 117, 205–6

Ultram, 83–84, 103, 108, 117, 202Ultrazyme, 93, 176–78, 262Unprocessed foods, 92Urine/urination, 21–22, 144Urispas, 142URT, 144

Vaginal yeast infections, 43, 48Valen Labs, 262Valerian, 173–74Valium, 22, 140, 214Vaporizers, 46VDY (vulvar dysethesia), 145Viagra, 235Vioxx, 93, 204, 205Vipassana meditation, 55Viral infections, 107Vitaline, 107Vitality101.com, 110, 139, 253–54, 259–62Vitamin A, 98Vitamin B1, 28, 238Vitamin B2, 124, 220Vitamin B6, 78, 80, 83, 94, 109, 164–66Vitamin B12, 78, 83, 109, 124Vitamin C, 45, 83, 86

and arthritis, 101and bone production, 109

and inflammation, 94and rheumatoid arthritis, 98

Vitamin D, 90, 100, 109Vitamin E, 78, 80, 83, 98, 101Vitamin Shoppe, 45Vliet, Elizabeth Lee, 36Vulvar dysethesia (VDY), 145Vulvodynia, 145–47

Walking, 239Water, 45Water filtration, 50, 258Weight gain, 243–49

and arthritis, 101causes of, 243–44and chronic pain, 244–47and ergonomics, 70and hypothyroidism, 26and medication management, 248–49and well-being, 247–48

Weight-bearing exercise, 109Wellbutrin, 212, 248What Your Doctor May Not Tell You About

Migraines (Alexander Mauskop), 123Wheat, 126White, Hillary, 35WHO (World Health Organization), 188Wholesalers, 262Wild lettuce, 172Willow bark, 101, 167–69Women, testosterone deficiency in, 35World Health Organization (WHO), 188Wright, Jonathan, 170Wrist fractures, 86Wrist pain, 156–57Wrist splints, 78, 157Wrist traction device, 157

Xanax, 106, 228Xylitol, 42, 142–43, 261Xyrem, 228–29

Yeast, 43, 48, 126Yeast Connection and the Woman, The (William

Crook), 42–43Yeast overgrowth, 40, 43–44

and interstitial cystitis, 142and sinusitis, 127, 128, 139and weight gain, 246–47, 248

Yoga, 54–55

Zaleplon, 226Zanaflex, 84, 108, 130, 212–13, 227Zazen meditation, 55, 60Zelnorm, 140Zinc, 45, 78, 98, 101, 109Zinn, Jon Kabat, 60Zoloft, 227Zolpidem, 224–25Zonegran, 84, 123, 248Zonisamide, 248

INDEX

294

About the Contributors

Reverend Bren Jacobson has spent the last thirty-five yearsstudying and practicing healing around the world. He offersadvanced Rolfing, pastoral counseling, lifestyle coaching, andergonomic consulting. He also consults on water purificationoptions. He has been the director of the Buffalo Meditation andPhilosophy Center, the Berkley Center for Health MaintenancePractices, and the Annapolis Rolfing and Health Center. He hasworked, taught courses, counseled, and led groups at Esalen Insti-tute, the Human Dimensions Institute, the Amherst CounselingCenter, the Stichting Center in Amsterdam, the Buffalo SuicidePrevention Center, the Ardennes’s Health Center in Belgium, andthe Amethyst Center in Dublin, as well as clinics in Brazil, Ven-ezuela, England, Spain, France, Germany, and Sweden.

Peter Marinakis, Ph.D., Mac., is director of Full CircleHealing Arts, a multidisciplinary well care clinic in Annapolis,Maryland. Dr. Marinakis was on the faculty of Tai Sophia for thelast twenty years and is now a distinguished lecturer at the Insti-tute. He is founder and director of the Community Health Ini-tiative (CHI), a community relationship–based drug abusetreatment and wellness care clinic with some 350 clients per day.He is the past president of the Maryland Acupuncture Society,past president of the American Association of Acupuncture andOriental Medicine (now the AAOM), founding member of theAOM Alliance, and a past accreditation commissioner of theAccreditation Commission for Acupuncture and Oriental Medi-cine. Dr. Marinakis lectures and does workshops throughout theUnited States on energy medicine and emotion.


About the Author

Jacob Teitelbaum, M.D., is medical director of the AnnapolisCenter for Effective CFS and Fibromyalgia Therapies and a worldrenowned author, lecturer, and researcher on effective treatment forpain and fatigue. Having suffered with and overcome chronicfatigue syndrome and the pain of fibromyalgia in 1975, he has spentthe last thirty years creating, researching, and teaching about effec-tive therapies. His office is in Annapolis, Maryland (410-573-5389).

Dr. Teitelbaum is the senior author of the landmark studytitled “Effective Treatment of Chronic Fatigue Syndrome andFibromyalgia—a Placebo-Controlled Study.” He is frequentlyconsulted and quoted as a media expert internationally by CNN,FOX, USA Today, and innumerable other sources. He is also theauthor of the bestselling books From Fatigued to Fantastic! andThree Steps to Happiness! Healing Through Joy. His website can befound at vitality101.com. He lives and sees patients in Annapo-lis, Maryland, and Kona, Hawaii.


teitelbaum, jacob (2005). pain free. 1-2-3. new york, mcgraw-hill

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