Neuropathic Pain

Neuropathic pain results from damage to or dysfunction of the peripheral or central nervous system , triggered by trauma, infections and nervous system disorders. It is often characterized  by pain out of proportion to tissue injury.  Pain can develop after injury to any level of the nervous system, peripheral or central; the sympathetic nervous system may be involved. Specific syndromes include postherpetic neuralgia, root avulsions, painful traumatic mononeuropathy, painful polyneuropathy (particularly due to diabetes), central pain syndromes (potentially caused by any lesion at any level of the nervous system), postsurgical pain syndromes, and complex regional pain syndrome.  In 2007, a study cited in the Journal of Pain estimated that 170 to 270 million people around the world suffer from peripheral neuropathy (e.g., phantom limb syndrome and complex regional pain syndrome) and neuropathic pain. Neuropathic pain has been described as numbing or burning, plus sensations of tingling, electric shock, crawling, itching, or shooting. Mild pain stimuli are perceived as very painful. Pain on one side of the body is also felt on the other side. The area of pain increases to include larger and larger areas of the body. This type of pain is difficult to treat and often requires a combination of pharmacological therapies, psychological counseling and the use of some form of alternative and complementary medicine.   Standard medical treatments: Antidepressants – SSRI’s including Prozac or Cymbalta, Tricyclic Antidepressantss – Elavil Anticonvulsants Neurontin or Lyrica Topical medications, such as capsaicin cream and Lidocaine patches Opioids – Oxydodone, Morphine, etc. Other medications, such as muscle relaxants, anti-anxiety medicines and sleep medicines Physical therapy TENS unit treatment Treatment of underlying metabolic problem   Supportive and alternative treatments: Nutritional – Fish oil – anti-inflammatory Capsaicin cream 0.01% – increases circulation Vitamin B complex, especially B6 – nerve nutrient Magnesium – muscle relaxant, often low in peripheral neuropathy Alpha lipoic acid – antioxidant used in diabetic neuropathy Glutathione – strong antioxidant Homeopathic – Hypericum – for nerve pain Herbal – Oat seed – nerve calming and tonic Ginko biloba – increases peripheral circulation St. Johnswort – increases serotonin and nerve tonic Hydrotherapy – hot epsom salt soaks, herbal warm packs Analgesic packs – castor oil, hemp oil, Chinese herbal liniment Acupuncture Massage therapy Biofeedback   Neuropathic Pain and Cannabis Cannabis has been known to be effective for nerve pain since the 1800s. Patients often report that they achieve better control of neuropathic pain with cannabis than with many other medications and can often decrease or eliminate their need for Neurontin or Lyrica. It is also helpful used topically, for conditions like shingles or sciatica. The treatment of pain, particularly neuropathic pain, is one of the therapeutic applications of cannabis that is currently under investigation. Several research studies of the efficacy of cannabis in treating neuropathic pain have recently been published. Sativex, a cannabis based medicine has been approved in Great Britain for use in the treatment of neuropathic pain in Multiple Sclerosis. Cannabis is slowly becoming accepted as a useful option in the treatment of neuropathic pain. In addition to cannabis’s analgesic (pain reduction) properties it also can improve depression that often arises from chronic pain. It may improve appetite, help sleep and eliminate the nausea often caused by opiate...

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Neck Pain

Most neck pain occurs in the occipital, cervical or upper back area. Most cases of neck pain are self-limiting sprains or strains. Whiplash is a neck injury caused by impact from the rear such as a motor vehicle accident. This may result in fracture, subluxation, joint instability, disc herniation or facet impingement. Disc herniation may cause never numbness or weakness down the arm. Arthritis, bone spurs, and spinal stenosis also cause neck pain. Spinal Stenosis Spinal stenosis can also occur in the cervical region. As the spinal canal shrinks the nerves that go through it are squeezed. This may cause neck pain or arm pain, numbness and weakness. Arthritis, falls, accidents and wear and tear on the bones and joints in the spine play a part in stenosis. Spinal stenosis is found most often in those over 50 due to aging.   Degenerative Disc Disease, OA – See separate information page   Standard medical treatments: Rest NSAIDS (anti-inflammatory drugs) Muscle relaxants Pain medicine Posture modification Steroid injections Physical therapy Ice packs/heating pad Exercise Water exercise Spinal surgery   Supportive and alternative treatments: Nutritional – Magnesium – muscle relaxant Bromelain – enzymatic anti-inflammatory Glucosamine sulfate – well researched anti-inflammatory Serrapeptase – enzymatic anti-inflammatory and dissolves scar tissue Homeopathic – Traumeel – combination remedy for inflammation and would healing Zeel – combination remedy for arthritic joint pain Symphytum – for bone and periosteum healing Hydrotherapy – hot epsom salt soaks, herbal warm packs Analgesic packs – castor oil, hemp oil, Chinese herbal liniment Acupuncture Chiropractic Massage therapy Rolfing – deep tissue massage   Neck Pain and Cannabis Cannabis is helpful for muscle spasm of the neck muscles, pain and inflammation. It can be used internally and/or topically, applied directly to the affected area, to provide relief without psychoactive effects. A prominent California Orthopedic Surgeon supports the use of cannabis to treat pain in his patients. “I can state confidently, as a physician with an extensive practice and specialized expertise in pain management, that marijuana can prove (and has proven) medically useful to at least some chronic pain patients. Cannabis can serve at least two important roles in safe, effective pain management. It can provide relief from the pain itself (either alone or in combination with other analgesics), and it can control the nausea associated with taking opiod drugs, as well as the nausea, vomiting and dizziness that often accompany severe, prolonged...

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Multiple Sclerosis

Multiple Sclerosis is a disease that involves the demyelination of nerves of the central nervous system. These nerves are covered in a protective sheath, called myelin; much like the plastic sheath around an electrical wire. In MS, the sheaths become inflamed and damaged, leaving the underlying nerve exposed and vulnerable to scarring (plaques).  The plaques create a “short circuit” in the nerve, which results in a dysfunctional transmission. It affects some 350,000 people in the U.S. and 2 million worldwide, and occurs most commonly in young adults.  Women have a 1 in 200 lifetime risk and are more affected than men. Patients feel a variety of symptoms, including weakness, stiffness, tremors, spasticity, numbness, dizziness, heat sensitivity, blurred vision, bowel and urinary dysfunction and fatigue. The cause of the demyelination in MS is still unknown. The dominant theoretical model involves an experimental autoimmune “allergic” encephalomyelitis (EAE). In this model T cells specific for myelin antigens induce inflammation. The immune system reacts in the attack on nerves by one’s own macrophage cells. Theories behind the inflammation include a combination of genetic predisposition, viral triggers, and toxic exposures.   The clinical course of MS involves periods of exacerbation and periods of remission. The goal of treatment is to promote remissions, reduce inflammation and relieve symptoms to optimize the quality of life.   Standard medical treatments: Corticosteroids Interferon Antispasmodic drugs – Baclofen, Clonazepam Physical therapy Exercise Water exercise   Supportive and alternative treatments: Nutritional – avoid food allergens, especially gluten Raw food cleansing diet Low fat diet Fish oil / flax oil – anti-inflammatory Lecithin – for nerve renewal Glutathione infusions – strong antioxidant Homeopathy Acupuncture Chiropractic Massage Remove heavy metals Electromagnetic therapy   Multiple Sclerosis and Cannabis A large study of 630 patients published  in 2003 found no objective evidence of a treatment effect on muscle spasticity.  However, significantly more participants taking either cannabis oil or THC reported subjective improvements in spasticity, spasms, sleep and pain, but not tremor or bladder symptoms.  The implication of these studies is that marijuana makes patients feel better, even if doesn’t show any objective improvement. A later British study gave some more promising information.  Walking times before and during treatment were obtained from 278 participants; The group taking THC had improved walking time. There was no improvement on any other another mobility test.  Also, investigators noted there were fewer relapses in the cannabis treatment groups. More recently studies using Sativex, a standardized cannabis medicine showed reduced spasticity in MS patients. MS patients can sometimes reduce their need for Baclofen with cannabis...

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Migraine Headache

Migraines are recurrent headache episodes often lasting up to 24 hours or more, involving moderate to severe pain. The pain is often one-sided throbbing, accompanied by nausea, vomiting, dizziness, and sensitivity to light, sound, and other sensory stimuli. The mechanism involves an initial vasoconstriction followed by a rebound vasodilation of head blood vessels, requiring different therapy at each stage. It occurs more often in women, with a peak incidence in middle age. 70% of migraine sufferers have a family history indicating a biochemical cause. It is often hormonally mediated, associated with oral contraceptive use and may or may not be alleviated by menopause. Triggers include alcohol, aged cheeses, red wine, chocolate, changes in altitude or weather, and hunger, sleeplessness or stress. Consideration of nicotine and/or caffeine use is important in that withdrawal from either can bring on a migraine. Emotional triggers including anxiety, stress, and anger may play a major role in precipitating a migraine as well.   Standard medical treatments: NSAIDs (anti-inflammatory drugs) Ergotamine derivatives Triptan drugs Intranasal medicines Antidepressants Anti-nausea drugs Preventive adrenergic or calcium channel blockers Pain medicine   Supportive and alternative treatments: Nutritional – dietary restriction, eliminate allergens and triggers 5HTP – 5-hydroxytryptophan, an amino acid derivative, pre-serotonin Ginger – anti-inflammatory Herbal – Feverfew – anti-inflammatory Homeopathy – belladonna Biofeedback Massage therapy Relaxation therapies Acupuncture Hormone balancing Hydrotherapy – warm footbath, cold compress Chiropractic   Migraine Headache and Cannabis   Often, when acute episodes of vomiting are present, oral medication cannot be used. In these instances patients usually receive treatment from an ER where IM or even IV injections are used. If vomiting is particularly severe dehydration is a consideration and IV fluids may be administered. Many of the medicines prescribed for the treatment and/or prevention of migraine can have serious adverse reactions and side effects. Non-drug preventative measures including recognizing and avoiding migraine “triggers” are important. Cannabis preparations in the 19th century were widely prescribed for migraine. In England and America, cannabis was the primary drug used to treat “sick headache.” Cannabis contains a variety of cannabinoids that act synergistically to help relieve migraine symptoms. Recent research demonstrates that cannabis is also a mild vasodilator that can lower blood pressure. It is important to use cannabis at the earliest signs of the start of a migraine, so that the vasodilation effect can put a halt to the progression into a full blown headache. Tinctures are available that are absorbed under the tongue (sublingual) and work in minutes. Inhalation through a vaporizer or smoking can produce even more rapid relief. Cannabis is both anti-inflammatory and analgesic in addition to its known anti-emetic properties. Cannabis can provide relief from muscle cramps that can accompany migraine (particularly of the neck and shoulders)....

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Low Back Pain

Low back pain can be caused by several things – a sprain, a strain, a muscle spasm, joint problems, spinal stenosis, arthritis, or disc problems. Problems may develop from injury or as a result of aging. LBP is often episodic, not constant. The pain may change with a change in position or movement. 80% of Americans have low back pain at some time in their life,   Spinal Stenosis Lumbar spinal canal stenosis is a narrowing of the space in the lower spine that carries the nerves to the legs. As the spinal canal shrinks the nerves that go through it are squeezed. This may cause back pain or leg pain, numbness and weakness. People with lumbar stenosis have back pain most of the time. The pain is increased by standing or walking.  Arthritis, falls, accidents and wear and tear on the bones and joints in the spine play a part in stenosis. Spinal stenosis is found most often in those over 50 due to aging.   Degenerative Disc Disease, OA – See separate information page   Standard medical treatments: Rest NSAIDS (anti-inflammatory drugs) Muscle relaxants Pain medicine Posture modification Weight loss Steroid injections Physical therapy Ice packs/heating pad Exercise Water exercise Spinal surgery   Supportive and alternative treatments: Nutritional – Magnesium – muscle relaxant Bromelain – enzymatic anti-inflammatory Glucosamine sulfate – well researched anti-inflammatory Serrapeptase – enzymatic anti-inflammatory and dissolves scar tissue Homeopathic – Traumeel – combination remedy for inflammation and would healing Zeel – combination remedy for arthritic joint pain Symphytum – for bone and periosteum healing Hydrotherapy – hot epsom salt soaks, herbal warm packs Analgesic packs – castor oil, hemp oil, Chinese herbal liniment Acupuncture Chiropractic Massage therapy Rolfing – deep tissue massage   Low Back Pain and Cannabis Cannabis is helpful for muscle spasm of the back muscles, pain and inflammation. It can be used internally and/or topically, applied directly to the affected area, to provide relief without psychoactive effects. A prominent California Orthopedic Surgeon supports the use of cannabis to treat pain in his patients. “I can state confidently, as a physician with an extensive practice and specialized expertise in pain management, that marijuana can prove (and has proven) medically useful to at least some chronic pain patients. Cannabis can serve at least two important roles in safe, effective pain management. It can provide relief from the pain itself (either alone or in combination with other analgesics), and it can control the nausea associated with taking opiod drugs, as well as the nausea, vomiting and dizziness that often accompany severe, prolonged...

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