Tuesday, October 20, 2009

Dealing with Chronic Pain: A Missing Tool

Many of us suffer daily with intractable pain for one reason or another. Doctors try to help with pain medications. Other medical workers concentrate on physical therapy, acupuncture, massage, chiropractic adjustments, hypnotherapy, etc.

These modalities are successful in many cases; yet, chronic pain, particularly arthritic inflammation, is seldom dealt with to everyone’s satisfaction. I believe a seldom used mode of dealing with the pain is focusing on nutrition and the way we process food in the intestines. The recent article “Increased Frequency of Gastrointestinal Symptoms in Patients with Fibromyalgia and Associated Factors” (J. Rheumatology 2009;36:1720) is not the first article to bring up the association between inflammation and our intestinal function. We have known about inflammation arising in the intestines since Metchnikoff won the Nobel Prize in Medicine in 1908.

The implications of this article are far reaching; at least in my clinic, where we are able to help patients with arthritis inflammation 80% of the time.

Sadly, most people are not willing to change their diets to minimize the toxic intestinal environment that begets inflammation. Worse, most doctors continue to ignore articles like this one; they are not able to offer patients the choice that some may welcome to decrease pain.

Sometimes patients are told that they have genetic tendencies that cause the inflammation, ignoring the cutting edge reports that each gene may express up to 30,000 proteins. (J. Cell 2000;101:671) This means that any gene may or may not lead to inflammation: it all depends on environmental clues, like nutrition, toxins, and even our thoughts, beliefs, and relationships.

The article “Transposable Elements: targets for early nutritional effects on epigenetic gene regulation” (J. Molecular & Cell Biology 2003;15:5293) simply means that “control from above” (epigenetic) can decrease an inflammatory genetic tendency; if we change our diets, clean up our environments and improve our thoughts, relationships and beliefs we have a good chance to manage a lot of our pain issues. Of course, there will always be cases where more traditional treatments will be needed.

On a similar note: Why does our health care system “hurt?”
Could we stop the pain (manage the cost) in a more sustainable way?

Hopefully someday we will focus on teaching patients these simple concepts.
Maybe someday we will stop spending most of our money on weapons and concentrate on the health of our people.


At October 22, 2009 at 8:47:00 AM PDT , Blogger Tim Harper said...

Dr. Hugo,

I didn't have chronic pain, but I had asthma that was getting worse and worse. Doctors prescribed pills and inhalers, and I was becoming more & more dependent.

Then you prescribed a diet change.

My asthma has never been back! (except for the few times when I've experimented with some of the old foods I used to eat).

I don't know why this isn't the first thing that doctors think of to try.

Thank you!


At November 4, 2009 at 11:37:00 AM PST , Anonymous Anonymous said...

I have had so much success with my fibromyalgia which includes IBS symptoms, chronic pain, and periodic fatigue. After being abandoned by my rheumatologist when I returned to him saying that I could not tolerate the pain medications he had prescribed for me because they caused me to sleep 22 hours a day, I decided I would try diet change, meditation, and more balanced lifestyle which includes personal spiritual practice and having some fun every week.

I alternated between wheelchair, cane, and electric carts in stores. Within a year I had discarded all but an occasional use of the cane. Now, 7 years later, I don't even know where my cane is and I feel better than I did in 1995.

I do notice that a bout of family related stress can set me back and I have to work to regain what I lose during those times.

Thank you for the good information you share through Our Health Coop, of which I am a customer.

At November 11, 2009 at 12:25:00 PM PST , Blogger Dr. Hugo Rodier said...


So glad to hear you're doing well. Here are a few studies you might find interesting on the phenomenon you've experienced:

“Novel pathophysiological concepts of inflammatory Bowel Disease,” J. Gastroenterology 2006;41:10 tells us that the most important factor in treating Inflammatory Bowel Disease is the diet and re-balancing intestinal flora.

“IBD: new insights into pathogenesis and treatment,” J. Int Med 2002;252;475 tells us that:

* Most affected: mucosal immune system

* “The role of the intestinal milieu and in particular the enteric flora appears to be of greater significance than previously thought.”

* Progress from integration of molecular microbiology, immunophysiology, psychoneuroimmunology.

* “Normal flora functions as inflammatory modulator.”

“Early Life Exposures Associated with Antibiotic use and Risk of Subsequent Chron’s Disease,” (under 5 years of age) Scandinavian J. Gastroenterology 2008;43:961



Very happy to hear you are doing better with simple interventions. I've included a few studies you might find interesting as well.

“Gut-joint axis: cross reactive food antibodies in rheumatoid arthritis,” J. Gut 2006;55:1240

“Therapeutic insight: how the gut talks to the joints-inflammatory bowel disease and spondyloarthropathies”

J. Ant Clin Practice Rheumat 2007;3:667 “The clustering of other chronic inflammatory diseases in Inflammatory Bowel Disease,”

J. Gastroenterology 2005;129:827.
Here is an excerpt from their summary:

Both Ulcerative Colitis and Chron’s disease had a significantly higher likelihood of having arthritis, asthma, bronchitis, and pericarditis than population controls. An increase risk for chronic renal disease and multiple sclerosis was noted in UC, but not in Chron’s disease patients. The most common nonintestinal comorbidities identified were arthritis and asthma. The finding of asthma as the most common comorbidity increased in Chron’s disease patients compared with the general population is novel. These may be diseases with common cause or complications of one disease that lead to the presentation with another.

The gut in Ankylosing Spondylitis, AS, and other spondyloarthropaties: inflammation beneath the surface.@
J. Rheumatology 2003;30:11


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