Pharmaceutical strategies include non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, topical and oral steroids, narcotics, opioids (in the class of narcotics), anticonvulsants, and antidepressants. These may help with acute pain but are not very effective with chronic pain. And, the side effects tend to be worse than what they’re treating.
A lot of people take acetaminophen because they think it’s safe. When the maximum recommended dose is not exceeded, it is. However, it has to be used at relatively high doses for effective pain control, and it is often combined with other medications. Thus, it is easy to overshoot the maximum amount in a 24-hour period. Acetaminophen toxicity is actually the number one cause of acute hepatic (liver) failure in the U.S. I saw this a few times during my rotations in the emergency department. The treatment is N-acetyl-cysteine (NAC), which naturopathic physicians use all the time for other health issues!
NSAIDs such as ibuprofen (Advil, Motrin) have cardiovascular and gastrointestinal side effects, including ulcers and GI bleeding.
Oral steroids suppress the immune system, leaving one more prone to infection. They also have blood sugar regulation issues and can cause insomnia, bone loss, and thinning of the skin, which in turn can cause easy bruising and bleeding, along with swelling.
Narcotics make people extremely tired, constipated, and spacy. They’re also highly addictive.
Anticonvulsants (e.g., gabapentin and pregabalin) have common side effects of constipation, difficulty walking or controlling muscle movements, nausea, slurred speech, tremors and weight gain.
Antidepressants can cause nausea, increased appetite and comcomitant weight gain, sexual side effects, fatigue, drowsiness, insomnia, dry mouth, blurred vision, constipation, dizziness, agitation, restlessness, and anxiety.
In my experience, by the time patients seek out a naturopathic physician they are usually on a combination of the aforementioned medications, which normally aren’t working very well and/or the side effects are too debilitating. My treatment strategies are usually two-fold: 1) decrease the side effects of the medications, and 2) target pain management so the drugs work better and therefore can be decreased, which gets us back to #1.
The science and mechanisms of how natural therapeutics address chronic pain are beyond the scope of this article. Instead, I will discuss ways to address chronic pain from a therapeutic order standpoint—i.e., least invasive/least forceful interventions first, drugs and surgery last. My patients have usually been dealing with chronic pain for many, many years. This necessitates being very aggressive with natural agents to get ahead of the pain, and then backing down.
Diet
If you’re overweight, attempting to lose those extra pounds is a must. I have never not seen a food allergy or intolerance play a role in chronic pain. Therefore, it is prudent to put patients on a gluten-free, casein-free, allergy elimination diet. This involves removing a number of “usual suspects” of food intolerances for 2-3 weeks. Then they are systematically challenged every 72 hours to see if there is a reaction. A reaction can take on almost any form, from irritability to sleep issues to increased pain. Patients keep track of any reactions in a journal. If there is a reaction, the next food or food group cannot be challenged until the reaction has subsided. I do this regularly with my patients and have seen diminution of pain along with weight loss.
Exercise, physical therapy, massage therapy, chiropractic care and acupuncture
I’ll lump these together for simplicity. Exercise – even a little – is a must. More movement equals the less pain. The rationale is twofold: 1) endorphins are released that improve mood and decrease pain, and 2) studies consistently show that sedentary lifestyles exacerbate pain. PT and massage can help strengthen bones, ligaments, tendons, fascia (fibrous tissues that surrounds muscles and groups of muscles). Chiropractic therapy is based on the premise that much musculoskeletal dysfunction is from misalignment of the spine. It stands to reason that if nerves coming out of the spine to feed muscles are impinged upon, there will be a deficit in how that nerve and muscle work. Clinical trials have shown chiropractic treatments to be superior to placebo and medication in the treatment of low back pain. Acupuncture has been around for thousands of years in Asia. It has been proven effective in hundreds of clinical trials and is now used in many hospitals and pain clinics throughout North America to treat pain.
