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From the Townsend Letter for Doctors & Patients
January 2005



Treating Chronic Pain with Natural Medicine
by Alan R. Gaby, MD

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Chronic pain is often difficult to treat and can be frustrating for both patient and doctor. However, natural medicine is sometimes beneficial in treating certain conditions that cause chronic pain. While some natural remedies for chronic pain work by a direct analgesic effect, most of the effective treatments are aimed at addressing the cause of the pain. Thus, a treatment that is effective for one type of painful condition may provide little or no relief from the pain caused by a different disorder.

In my experience, the pain of fibromyalgia improves in approximately 50% of cases after intravenous administration of magnesium, calcium, B vitamins, and vitamin C (the Myers' cocktail).1 Some patients do not improve until they have received a total of four weekly injections. After improvement occurs, maintenance injections can be given, as needed, usually every two to four weeks, or less often in some cases. Intravenous nutrient therapy tends to be more effective if other abnormalities associated with fibromyalgia are addressed, such as food allergy and "sub-laboratory hypothyroidism."2

Another potential cause of chronic musculoskeletal pain that can mimic fibromyalgia is vitamin D deficiency. People who live at northern latitudes, stay indoors, or cover themselves completely with clothing or sunscreen, are at risk of developing vitamin D deficiency. Obesity, old age, malabsorption, or avoidance of vitamin D-fortified foods such as dairy products, also increase the risk of becoming deficient in vitamin D. The best diagnostic test for vitamin D deficiency is the serum concentration of 25-hydroxyvitamin D. Some investigators believe that the lower limit of the standard laboratory reference range is too low, and that many patients in the low-normal range can benefit from vitamin D supplementation. While the optimal dose of vitamin D is not known, a growing body of evidence suggests that the RDA of 400 IU/day is not sufficient for some people. Long-term supplementation with 1,000 IU/day of vitamin D appears to be safe for adults, and some investigators have suggested that as much as 4,000 IU/day is safe.3 Despite the apparent safety of relatively high doses of vitamin D, there are probably significant differences in individual tolerance to the vitamin. Consequently, vitamin D therapy should be undertaken with respect for its potential toxicity. Early manifestations of vitamin D toxicity may include hypercalciuria and nephrolithiasis; more advanced toxicity can cause hypercalciuria and soft-tissue calcification. When using large doses of vitamin D, appropriate laboratory monitoring should be done. There is some evidence that vitamin D3 (the type of vitamin D sold over the counter and produced in the skin) is safer than vitamin D2 (the form contained in some prescription vitamin D preparations).

Migraine headaches can often be prevented by identifying and avoiding allergenic foods and by avoiding vasoactive amines such as tyramine and possibly phenylethylamine (present in chocolate). Oral supplementation with magnesium (200 to 600 mg per day), riboflavin (400 mg per day), coenzyme Q10 (150 mg/day) and the herb feverfew have each been reported to reduce the recurrence rate of migraines. When a migraine does occur, the pain can usually be eliminated or greatly reduced within a matter of minutes by intravenous administration of magnesium4 or the Myers' cocktail.

The pain associated with rheumatoid arthritis may respond to the avoidance of allergic foods or to supplementation with nutrients such as zinc, copper, fish oil, and gamma-linolenic acid from borage oil. The symptoms of osteoarthritis may be relieved by glucosamine sulfate, chondroitin sulfate, niacinamide, or ginger.

There is anecdotal evidence that supplementation with approximately 10 grams of vitamin C per day will occasionally relieve the pain caused by cancer, although it is not clear how vitamin C works. There is one older report that daily injections of 20–30 mg of vitamin K relieved cancer-related pain in more than 80% of 115 patients with advanced cancer.5

A direct analgesic effect has been reported for topical capsaicin (Zostrix®; a component of chili peppers) in the treatment of pain caused by postherpetic neuralgia or diabetic neuropathy. Topical application of capsaicin depletes from the skin a compound known as substance P, which is one of the body's mediators of pain. While capsaicin does not appear to influence the disease process, it does provide worthwhile symptomatic relief in some cases. Capsaicin tends to cause transient burning of the skin during the first few days of application.

D,L-phenylalanine has also been reported to exert a direct analgesic effect, supposedly by inhibiting the breakdown of certain endorphin-like compounds in the body. In my experience, however, and in the experience of some of my colleagues, D,L-phenylalanine is not particularly effective as a treatment for pain.

Natural medicine is certainly not effective against all cases of chronic pain, and the results tend to be disappointing when the pain is caused by cancer, hip or vertebral fractures, severe arthritis, or other debilitating conditions. However, because the treatments discussed here are relatively safe and non-addictive, an appropriate therapeutic trial should be considered for individuals dependent on opiates, non-steroidal anti-inflammatory drugs, analgesics, or other pain-relieving medications.

1. Gaby AR. Intravenous nutrient therapy: the "Myers' cocktail." Altern Med Rev 2002;7:389–403.
2. Gaby AR. "Sub-laboratory" hypothyroidism and the empirical use of Armour thyroid.
Altern Med Rev 2004;9:157–179.
3. Vieth R, et al. Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level.
Am J Clin Nutr 2001;73:288–294.
4. Bigal ME, et al. Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura. A randomized, double-blind, placebo-controlled study.
Cephalalgia 2002;22:345–353.
5. Kubovic M, et al. Analgesic property of vitamin K.
Proc Soc Exp Biol Med 1955;90:660–662.




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