I will begin by briefly reviewing the
purpose of pain and general principles of pain relief. By knowing
the type of pain that you are
treating – nerve,
muscle/ligament/tendon, bone/arthritic, inflammatory/infectious, etc. – you
can tailor your treatment approach to make it more effective. Once you understand
the different types of pain and how to treat them, your ability to make the
pain go away will increase dramatically.
What Is Pain?
The International Association for the Study of Pain defines pain as "an
unpleasant sensory and emotional experience associated with actual
or potential tissue damage or described in terms of such damage." Fortunately,
most of you don't need such a complex definition. Your patients
know pain when they feel it. It is useful to categorize pain. Let's
start with two basic categories:
1. Acute pain, which usually results from tissue injury, inflammation,
or illness. Acute pain often occurs suddenly after surgery or injury.
Usually, doctors can figure out what caused the pain, and the pain
goes away on its own or with treatment.
2. Chronic pain can last for many years and is poorly treated medically,
which is why it lasts for years. Chronic pain is the main focus of
Pain is Horrible! Why Do We Have Pain?
Although chronic pain can be devastating, it serves a critical function.
For example, there is a horrible genetic disease, Congenital Insensitivity
to Pain with Anhidrosis (CIPA), that is uniformly fatal and leaves
people horribly deformed and disabled. People who suffer from this
disease are born without a pain system and therefore without any
ability to feel pain. You may think this would be wonderful. It is
not. As a child, if a sufferer of this disease falls off a roof and
breaks a leg, he or she has no pain and still tries to walk, causing
further damage. If his hand is on a hot stove or in a fire, he does
not know it until he smells something burning. Pain is a critical
warning system for the body. Pain tells us when we need to avoid
something so that we do not cause further damage to ourselves. In
addition, pain tells us when our bodies are not getting what they
need (e.g., sleep, nutrients, oxygen, etc.).
Pain is not the enemy; it is designed as a crucial helper. Yet when pain goes
out of balance and becomes chronic, it may end up causing more harm than good.
How Do I Turn Off the Pain Signal?
You turn off the pain by giving your body what it needs and by eliminating
what is damaging or toxic to your body. For example, one of the most
common types of pain is myofascial or muscle pain. The medical profession
in general poorly understands this type of pain. Although we might
think that muscles will go limp if they do not have what they need,
consider rigor mortis. When someone dies and the muscles are not
getting what they need, they do not become loose—in fact, they
become stiff as a board. As noted above, if muscles do not have adequate
nutrients, optimal hormone levels, or enough sleep for tissue repair,
they will get stuck in the shortened position and cause pain. Underlying
infections can also cause muscles to get stuck in the shortened position.
Pain is the body's way of saying that these problems need to
be addressed. You'll be amazed at how pain that has lasted
decades can go away quickly when these problems are resolved.
Often, finding the right natural or prescription therapy for pain
is like trying on different shoes to see which pair fits best. In
the current "medical
shoe store," there are one or two pairs to try on – non-steroidal,
anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors. If these shoes don't
fit, the patient is out of luck. Sadly, when they are used, NSAIDs kill well
over 16,500 Americans a year, and many more die from COX-2 inhibitors. Fortunately,
dozens of other safer and more effective treatments are available outside conventional
medicine, and when one doesn't fit, another often will.
In addition, pain management is a perfect place to combine traditional and
complementary therapies. The difficulty that patients have in finding doctors
that can effectively treat their pain is driving them to alternative healers
in droves. In fact, according to the Journal of the
American Medical Association,
pain is the number one reason why people use alternative medicine,1 which includes
chiropractic medicine, naturopathic medicine, acupuncture, biofeedback, massage,
Reiki, meditation, and other techniques. Often, it is difficult to treat chronic
pain with a single "magic bullet." It takes a practitioner who
is both knowledgeable about many treatment modalities and who is also a compassionate
A number of general principles apply to pain relief and pain management. Many
of these have been discussed earlier, but to summarize, the two main principles
of pain relief are as follows:
1. Supply your body with what it needs for healing and tissue repair. This
includes optimum nutrition (often well beyond RDA levels), eight to ten hours
of deep sleep each night, and optimal hormonal levels (simply having a hormonal
blood test be "normal" may not be adequate). Each of these three
areas is critical. Pain often will not go away until each area is adequately
handled—regardless of the cause of the pain.
2. Treat or eliminate things that stress your body and cause pain. These include
infections; toxins (e.g., chemical and heavy metal) and inflammation; mechanical
stresses on the body; excessive situational, psychological, or physical stresses;
and abnormal tissue compression (e.g., cancers). All need to be considered
and treated. For example, nutritional and hormonal deficiencies and/or fungal
infections (usually secondary to antibiotic use) can aggravate neuropathic
or back pain.
A simple way to remember what pain is telling you metabolically is to think
Sleep: Eight to nine hours a night for tissue repair
Hormonal support, even despite normal labs
When these four areas have been treated, you will often have eliminated the
cause of the pain, and pain will therefore often simply disappear (just as
the oil light shuts off after you add oil to the car).
JACOB TEITELBAUM, MD is the Medical Director
of the Center for Effective CFS/Fibromyalgia Therapies in Annapolis,
Maryland. He is senior author
of the landmark studies, "Effective Treatment of Chronic Fatigue
Syndrome and Fibromyalgia—a Placebo-Controlled Study" and "Effective
Treatment of CFS & Fibromyalgia with D-Ribose," author
of the best-selling book, From Fatigued to Fantastic! (Avery
Penguin Putnam) and two other books, Three Steps to Happiness!
Joy (Deva Press), and the recently released
Pain Free 1-2-3: A Proven Program to Get YOU Pain Free Now! (McGraw-Hill,
2006). Dr. Teitelbaum
refuses to accept money from any pharmaceutical or natural supplement
1. DM Eisenberg et al. Trends in alternative
medicine use in the United States, 1990-1997: results of a follow-up
national survey. Journal
of the American Medical Association. Nov