Painkillers 2

Typical pain comes from one of three reasons: anoxia – lack of oxygen, inflammatory – release of pain-causing chemicals, and neuropathic – pain caused by nerve damage. For medical decision-making purposes, a doctor will want to know if the pain is acute (just started) or chronic (more than 2 months old). What we discussed last week is now called nociplastic pain – pain without any obvious cause. Knowing the mechanism behind generating the pain is essential for figuring out what will work best to control the pain.

A good example of this is pain which is caused by a loss of blood flow to some tissue. The loss of blood flow might be due to a muscle spasm squashing the blood vessels, a blood vessel blockage or tissue swelling acting like a spasm does. The body really does not like not getting the oxygen it needs second to second. The pain this triggers will not be helped by anti-inflammatory drugs. Anoxic or oxygen-block pain is really intense and needs to get that flow of oxygen happening right away, so it will force you to move or do something to get the blood moving. Leg cramp pain is this type of pain. Heart attack pain is this type of pain, and taking a Tylenol will do nothing for it. This kind of pain wants heat, rubbing, and movement – things that stimulate circulation. Sometimes the blockage to flow is caused by tissue swelling. In these cases, the body wants cold to chase the swelling away.

Inflammatory pain is usually secondary to some sort of tissue damage. When cell walls are broken open during an injury or when destroyed by a pathogen, tiny pain-causing chemicals called cytokines get released into the inter-cellular fluid that communicates the damage to the nearby cells. Receptors on the nearby cells act like taste buds to sample these cytokines and trigger defensive changes to help limit the damage to themselves. These same cytokines will trigger responses in specialized pain-receptive nerves to let the brain know about the damage. For example, if you fall and scrape your knee, these cytokines start the changes in the damaged area to begin the healing process while also sending pain signals to the brain to let you know that you hurt your knee.

In addition to cytokines, damaged cells also release various enzymes that promote the conversion of chemicals called prostaglandins into pain-causing chemicals that also promote changes in the area like more or less blood flow, attraction of white blood cells to fight any infection, swelling, fever, and so on to support the healing process. It is blocking this pathway that most of your over-the-counter painkillers like ibuprofen, Tylenol (acetaminophen), Naproxen, and aspirin work on. So in the short run, for injury or infection causing tissue damage, these are the go-to medications for most people. Each of them works better for some types of pain. For instance, aspirin is better for body aches, Naproxen is best for menstrual cramps, Tylenol for colds and flu, and ibuprofen is best for inflammation.

There are major downsides to these over-the-counter painkillers, however. Aspirin thins the blood and causes major stomach issues such as ulcers. Aspirin overdose shuts down your lungs and makes it look like you have died from some killer flu. Ibuprofen can cause heart problems, Naproxen also causes severe stomach issues, while Tylenol is very easily overdosed causing liver failure. It is estimated that Tylenol creates the need for over 200,000 liver transplants each year. The other three drugs are hard on the kidneys and can damage them. These are not safe drugs to take on a regular basis. A couple of tablets a week can be handled by the body just fine. Taking any of these on a daily basis does cause damage to your organs.

The third category of pain causes are those pains due to some sort of nerve inflammation due to disease, damage, or injury. This type of pain does not respond well to OTC pain medications, because the prostaglandin pathway is not generally involved in nerve pain. When you stab your finger with a thumb tack, that pain is immediate and caused by damaged nerve endings. There has been no time for chemical inflammation to take place. An hour or two later there might be chemicals that will respond to those painkillers, but not immediately. My personal worst experience with nerve pain was a kidney stone that got trapped between my kidney and bladder. I was passing large amounts of blood and doubled over in a lot of pain. The doc-in-the-box gave me a shot of Toridol, which did nothing at all. With all that blood they rushed me to the hospital where I was put on an IV drip of morphine. That was the good stuff! It knocked down that intense pain nicely. I was in love with that IV drip.

Opioids are typically the only thing that will touch nerve pain. The problem is, not only do you start forming an addiction within 4 to 5 days, but in that same time frame the opioids cause neuroplastic changes in the brain that train the brain to keep repeating the pain signal even when the original cause is gone. Taking the opioid creates the need to keep taking it on a pain level, not just an addiction level. This is part of why it is so hard for patients to get off opioid painkillers. Without the opioids, their pain feels like it comes back all the time. It can take months to years to retrain the brain back to normal. This brain reaction is part of why it is so hard for fibromyalgia patients to get better. Their brain learns their pain and just keeps repeating it even when the body’s cause is gone. But beyond these issues, opioids are not as directly damaging to the organs. Their main side effect is to slow down your bowels to the point of constipation.

So what other options do we have? Here we can look at natural and traditional medicine. Folks have been dealing with pain for thousands of years, so there has always been a need for painkillers. Various herbal remedies for different pain conditions abound. One of the easiest on the body is CBDs from hemp plants. Another is white willow bark, the natural source aspirin was found in. Interestingly the white willow bark does not have the toxicity profile synthetic aspirin has. I find it gentle on the stomach. Many natural anti-inflammatory herbs like turmeric, frankincense, ginger, chamomile, aloe vera, melaleuca, and arnica are all good for pain.

I would be remiss if I did not mention Chiropractic and acupuncture as natural remedies for pain. Pain relief is the bulk of my practice. For some pain patterns exercise can be a good source of pain relief. For example, repetitive no no-impact movement is the best thing for osteoarthritis pain of the knee.

The last and most immediately available resource for pain relief is using our own brains to turn down the pain. Our brain has a volume knob for pain awareness. This is what hypnosis manipulates to turn off pain. So self-hypnosis is an ever available tool for managing pain levels. Basically, we slow down our thoughts and get really calm. This will turn down our perception of pain. Distraction can also be used to focus us on something other than pain. When something is personally much more important to you than your pain, you don’t notice your pain as much. So that wraps up my pain relief story. There are many options when dealing with pain. We don’t need to limit ourselves to just options that will cost us our health in the long run.

Take care,

David

Ellen

While I am in Cabo I made a gummy treat for Ellen to satisfy her sweet cravings. The gummy has allulose, glutamine, creatine, and is flavored with lemonade flavored BHB. This supports the health of both the large and small intestine as well as calm those sweet cravings.