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Did you know – pain
- First attested in English in 1297
- Comes from the Latin poena meaning “punishment, penalty” torment, hardship, suffering
- Science doesn’t fully understand pain
- Pain is a complex mixture of emotions, culture, experience, spirit and sensation
- Pain can be experienced both physically and emotionally
- Everyone perceives pain differently based on a multitude of factors, such as structural and chemical changes in your brain, inflammation levels in your body, beliefs about pain from previous experiences that affect how you react emotionally, etc.
- Acute pain is your body’s way of waving a red flag for immediate attention, a warning sign – like stop what you’re doing, move your hand from the flame, etc.
- Chronic pain can last for weeks, months, or years
- Chronic pain affects more than 76.2 million Americans, more than cancer, diabetes, and heart disease combined
- Chronic pain often becomes psychologically stressful and can lead to emotions like anger and frustration.
- Pain can increase stress levels, and increased levels of stress can make pain worse
- Chronic pain can cause depression and make it difficult to concentrate
- Women feel more pain than men – of course we do! – Think menstruation, childbirth, migraines etc
- Women experience pain more intensely — than men do
- Some studies show that women may require twice as much pain medication to get the same relief as males.
- Women are more sensitive to pain during premenstrual and menstrual times in the cycle – probably due to the drop in Estrogen
- Redheads are more sensitive to pain, genetically more resistant to anaesthetics – maybe
- The brain doesn’t feel pain as it does not have pain-sensitive nerves. Only the structures that surround the brain feel pain. This is why surgeons can operate in the brain without anaesthesia (once inside).
- Apparently pain is normal
- About 75 million U.S residents endure chronic or recurrent pain, 25 million with migraines and 1 in 6 suffer arthritis
- Back pain is the most common pain – more than 26 million Americans aged 20 to 64 suffer from back pain
- Chronic pain shrinks the brain
- A 2004 study showed the brains of people with chronic backaches were as much as 11% smaller than those of non-sufferers
- Migraines and sex go hand in hand, a 2006 study found that female migraine sufferers had a 20% higher level of sexual desire than those suffering from tension headaches – probably due to higher Estrogen levels
- Sex can relieve pain as it increases endorphins (as does Estrogen)
- What you eat can affect how much pain you feel
- Meditation and cognitive behavioural therapy, which address underlying thoughts and beliefs, can help mitigate pain
- You can distract yourself or override the pain by pumping up another sensation as the brain has trouble registering more than one sensation at a time
- The global pain industry pulls in more than $50 billion in drugs a year
- Yet for chronic pain sufferers, over-the-counter pills are typically little help, whereas morphine and other narcotics can be addictive sedatives.
Meet Sally and get to know all about pain
Intro
What is pain
Chronic SILENT inflammation
Pain & the gut brain axis
Pain 101
- Pain is an uncomfortable feeling that tells you something may be wrong
- It can be:
– Steady
– Throbbing
– Stabbing
– Aching
– Pinching
The origin of all pain is inflammation
- Inflammation is a biological response, which occurs due to tissue damage and or, as part of the body’s immune response
- The process often initiates because of:
– Trauma
– Allergic reactions
– Bacterial infection
– Chemical toxins
– Heavy metals
– Radioactive radiation
- Registered via 5 types of sensory receptors:
– Noci – pain
– Mekano – movements and positions
– Thermo – heat and temperature
– Chemo – O2, CO2, pH levels, etc.
– Photo – electromagnetic
- Immune cells called the macrophages (those that eat everything) release cytokines – the immune system’s signalling molecules
– TNF – tumor necrosis factor-alpha
– Interleukins – IL-1 and IL-6 may be IL-8
– TNF alpha and IL-1 and IL-6 and CRP – C-reactive protein can be measured in the blood and indicate the level of inflammation – see the article in this blog
Symptoms of Inflammation
Cytokines stimulate immune cells to release chemicals which create the symptoms of inflammation
5 key symptoms
- PAIN
- Redness
- Heat
- Swelling
- Disability and mobility impairment
Pain – in Latin Dolor
- Is a reaction to the cells around the damaged area secreting substances, called bradykins and cytokines, etc., that irritate the pain-sensitive nerve endings in the area.
Redness – in Latin Rubor
- Is caused by the increased blood flow in the area.
Heat – in Latin Calor
- Is also caused by the increased blood flow, as well as increased energy production in the cells involved.
Swelling / Oedema – in Latin Tumor
- The dilation of the blood vessels, cause the increased blood flow but also that the vessels become leaky. This causes fluid and cells to leak into the tissue and cause swelling / oedema.
Disability – in Latin Funcio lesa
- Think of a sprained ankle – how much can you move it or stand on it?
Chemicals of inflammation
- histamine
- bradykinins
- serotonin
- prostaglandiner E2
- leukotrienes B4
Histamine
- responsible for redness, swelling by increasing the permeability of the venules (the areas in blood vessels where the smallest arteries become veins)
- also causes itching and pain hypersensitivity
Bradykinin
- responsible for pain by directly stimulating primary sensory neurons
- provokes the release of substance P, neurokinin, and calcitonin gene-related peptide.
- Is a bronchoconstrictor linked to asthma and rhinitis.
Serotonin
- responsible for redness and swelling by increasing the permeability of the venules (the areas where arteries become veins)
- can both promote and inhibit pain
Prostaglandin E2
- responsible for pain (increasing the effect of bradykinin)
- cause swelling and fever
Leukotriene B4
- Is 1000 times more inflammatory than histamine, often creating massive tissue destruction.
- Seen in connection with allergy and parasite attacks.
- LTB4 increases white blood cell production and their ability to adhere to the endothelial cells (walls) of blood vessels and increases free radical (ROS – reactive oxygen species) production and levels of oxidative stress
- Causes increased sensitivity to feeling pain and an extreme response to pain
Nutrients shown to reduce and or prevent the production of inflammatory molecules
Histamine
- Zinc, Magnesium, Vit E, Vit C, Bioflavonoids – Quercetin, Hesperidin, Turmeric, Curcumin
Serotonin
- Magnesium, Zinc, Vit C, Vit E, EPA, Bioflavonoids – Turmeric, Ginger, Bromelain
Bradykinin
- Zinc, Bioflavonoids – Bromelain, Hesperidin, Naringin
Prostaglandins
- GLA, EPA, Zinc, Magnesium, B6, Folate acid, B3, Vit C, Vit A
Leukotrienes
- GLA, EPA, Vit E, Selenium, Glutathione, Ginger.
Types of pain
- Acute pain
- Chronic pain
- Neuropathic pain
- Nociceptive pain
- Radicular pain.
Acute pain
- short in duration – minutes to about 3 months
- often related to a soft-tissue injury or a temporary illness
- subsides after the injury heals or the illness subsides
- can evolve into chronic pain if the injury doesn’t heal correctly or if the pain signals malfunction.
Chronic pain
- longer in duration
- can be constant or intermittent
- headaches can be considered chronic pain when they continue over many months or years – even if the pain isn’t always present
- often due to a health condition, like arthritis, fibromyalgia, or a spine condition.
Neuropathic pain
- due to damage to the nerves or other parts of the nervous system
- often described as shooting, stabbing, or burning pain, or it feels like pins and needles
- can also affect sensitivity to touch, such as difficulty feeling hot or cold sensations
- a common type of chronic pain
- may be intermittent
- can be so severe that it makes performing everyday tasks difficult
- can also lead to mobility issues
- phantom pain is pain felt in a part of the body that has been amputated, or from which the brain no longer receives signals is a type of neuropathic pain
Nociceptive pain
- caused by damage to body tissue
- often described as being a sharp, achy, or throbbing pain
- often caused by an external injury, eg. you hit your elbow, stub your toe, twist your ankle, or fall and scrape up your knee
- often experienced in the joints, muscles, skin, tendons, and bones
- can be both acute and chronic.
Radicular pain
- a very specific type of pain that radiates from the spine
- can occur when the spinal nerve gets compressed or inflamed
- can radiate from the back and hip into the leg(s) and toes
- can radiate from the neck to the shoulder and arm(s) and fingers
- can cause pain, tingling, numbness, and muscle weakness
- in the lower back it is commonly known as sciatica because the sciatic nerve is in some way affected
- sciatica is one of the most common forms of radicular pain.
Killing pain
The treatment of pain is complex since its perception is influenced by neurobiological and psychological factors as well as hormone levels and by social-cultural differences and is thereby individual
2 primary ways of killing pain
- Decreasing inflammation – anti-inflammatory
- Decreasing the perception of pain – opiates
Decreasing Inflammation
Anti-Inflammatory Regimes
The best way to resolve inflammation is to decrease pro-inflammatory actions and foods combined with increasing anti-inflammatory actions and foods.
Focus on increasing anti-inflammatory foods alone will never been sufficient
Reduce / Remove / Avoid Pro-inflammatory Actions & Conditions
- Unresolved injuries, such as joint and muscle pain or headaches
- Chronic infections
- Chronic allergies, to specific foods, such as gluten, milk and milk products, eggs, nuts, animal hair, etc.
- Chronic gut problems
- Unstable blood sugar
- Excessive endurance training
- Stress in its self will increase inflammation and impair the immune defence, especially in the gut
- Obesity especially high visceral fat. Visceral fat produces inflammatory molecules, and is connected with an increased risk of CV problems, Type 2 diabetes, poor liver function and more.
Increase Anti-inflammatory Actions
- Maintain a stable blood sugar
- Follow Cortisol’s 24 hours cycle as closely as possible – 6am – 6pm activity / 6pm – 6am resting
- A good night’s sleep from 10pm
- Go for a walk every day
- Intermittent fasting / Time Restricted Eating – TRE
- Acupuncture ’dry needling’ is excellent for muscle and joint inflammation
- TCM acupuncture for systemic inflammation
- Improve gut health
Reduce, Remove, Avoid Pro-inflammatory foods
- Sugar especially foods and drinks with added sugars and artificial sweeteners
- Omega 6 fatty acids, ie. plant oils and margarines, and processed foods that use these oils and margarines
- Gluten, ie in wheat, rye, barley, spelt, Graham flours and their products
- Anti-nutrients, such as lectins, phytates, oxalates in greens, pulses, grains, seeds and nuts, etc.
- Increase Anti-inflammatory foods
- Organ meats – Liver, kidney, etc contain more nutrients per gram weight than any other foods and no antinutrients
- Bone Broth – Contains many anti-inflammatory nutrients, such as collagen and the amino acids glycine and arginine
- High fat fruits – Avocado and olives
- Healthy fats – Olive oil, coconut oil and organic butter, beef tallow
- Oily fish – Salmon, sardines, herring, mackerel and anchovies, but due to breeding methods, toxic metals and plastics, etc their fats can be less healthy may even increase inflammation. EPA levels in the ’farmed’ fish often low increasing the need to supplement with fish oils
- Sulphur foods – Eggs
- Sea vegetables – Seaweed and kelp (cooked)
- Deeply coloured fruits, berries, papaya, mango, etc.
- Anti-inflammatory herbs and spices perfect for homemade herbal teas
- Rosemary
- Thyme
- Sage
- Ginger
- Turmeric
- Cardamom
- Ginseng
- Green Tea
- Eucalyptus
Anti-inflammatory supplements
- Fish oil/Vegan oil contains EPA fatty acids, which reduce inflammation. EQ Pure Artic Oil or Pure Vegan Oil
- Sulforaphane increases the production of glutathione, one of the body’s most important antioxidants. Decreasing oxidative stress decreases inflammation
- Alpha Lipoic Acid is a fatty acid, which the body makes and is a strong antioxidant and anti-inflammatory molecule
- Resveratrol is an antioxidant type molecule found in red wine, the skins of red grapes and peanuty
Medical Anti-inflammatory
Glucocorticoids / Steroids / Hydrocortisone / Cortisol
- Anti-inflammatory by preventing the release of the substances that create inflammation, such as histamine
- Immunosuppressant by down-regulates interleukin production
- Not the most effective painkiller
NSAID – Non Steroid Anti Inflammatory Drugs
- Prescription and over-the-counter, such as panodil, ipren and Ibuprofen
- May be less effect than natural anti-inflammatory ingredients (supplements)
- Have many side effects. Check Medline – an internet based register for documentation of medical studies
Decomposes the cartilage in the joints
Inhibits healing of bone fractures and ligament injuries
Increases risk of bone fractures and sports injuries
Cause of up to 800 deaths per years in DK
Reason for 300,000 admissions per. years in DK
80% increased risk of miscarriage
Increases risk of birth defects
Increases risk of breast cancer
Increases risk of stomach bleeding and intestinal bleeding
30% increased risk of blood clots and cerebral Haemorrhage. Cox-2 / cyclooxygenase is the enzyme that breaks down Omega 6 AA fatty acids into prostaglandins responsible for creating inflammation. Cox-2 inhibitory medication is responsible for many deaths due blood clots and cerebral haemorrhages.
Decreasing the Perception of Pain
Opiates – Codeine, Morphine, Oxycodone
- Are not anti-inflammatory
- Affect a person’s interpretation / perception of pain
- Are psychoactive substance that acts on the central, peripheral and intestinal nervous systems
- One of the world’s oldest drugs derived from the poppy plant
- Pain-relieving effects stem from the decreased perception of pain and increased pain tolerance
- Side effects include euphoria, constipation, decreased breathing and sedation
- Dosage is essential to prevent side effects and addiction
- Can be combined with anti-inflammatories, such as NSAID, to create combination medication like Tylenol, Nurofen, Paramol.
Measuring Inflammation
Blood tests
CRP – C-Reactive Protein
- Measures the levels of C-reactive protein in the blood
- CRP is a protein made by your liver, sent into your bloodstream in response to inflammation.
ESR – Erythrocyte Sedimentation Rate
- Measures how quickly erythrocytes (red blood cells) settle at the bottom of the test tube blood sample.
- Normally, red blood cells settle relatively slowly. A faster-than-normal rate may indicate inflammation in the body.
TNF-alpha
- Measures the level of TNF-alpha in the blood
- TNF an immune signalling molecule stands for Tumour necrosis factor
- High levels will indicate inflammation
IL-6
- Measures the level of IL-6 in the blood
- IL-6 an immune signalling molecule stands for Interleukin 6
- High levels will indicate inflammation
Ferritin
- Measures the level of iron in the blood.
- Ferritin is a protein inside your cells that stores iron.
- High levels can indicate inflammation.
DHEA-S
- Measures the levels of DHEA sulfate (DHEAS) in your blood.
- DHEAS a male hormone stands for dehydroepiandrosterone sulfate.
- Low levels can indicate inflammation
Hs-CRP – private test
- Measures C-reactive protein
- BUY HERE
Bloodspot Fatty Acids
- Measures Omega 6 & Omega 3 fatty acids
- BUY HERE
Stool tests
- Calprotectin – inflammation in the gut
- BUY HERE
GI Map
Gene test
- DNA Health
- BUY HERE
DNA sport inflammation
Opiates or Opioids
- Both groups of drugs are “narcotics.”
- The word “narcotic” simply means sleep-inducing or numbness-inducing – from the Medieval Latin narcoticus, from the Greek narkoun “to benumb.”
- Today both groups are often referred to as opioids
- Both opiates and opioids are used medically.
- They may be prescribed for:
– pain relief
– anesthesia
– cough suppression
– diarrhea suppression
– treatment of opiate/opioid use disorder.
- Both opiates and opioids may also be used illicitly by people with a substance use disorder.
- Both can create addictions
- Switching to a different opiate or opioid can help maintain the addiction
The only real difference is in how opiates and opioids are made.
Opiates
- Are chemical compounds that are extracted or refined from natural plant matter (poppy sap and fibres). Examples of opiates:
– Opium
– Morphine
– Codeine
– Heroin
Opioids
- Are chemical compounds that generally are not derived from natural plant matter.
- Most opioids are “made in the lab” or “synthesized.”
- Opiates and endogenous peptides such as the endorphins are classified as opioids.
- Hydrocodone, hydromorphone, oxycodone may be partially synthesized from chemical components of opium
- The pharmaceutical industry has created more than 500 different opioid molecules.
Examples of well-known opioids used medically in the EU and UK
Codeine
– available in 13 EU countries without prescription
Tramadol
– Ultram
Dihydrocodeine
– Paramol, Paracodeine
Examples of well-known opioids used medically in the U.S
Dextromethorphan
– available in the U.S. without prescription – NyQuil, Robitussin, TheraFlu, Vicks
Dextropropoxyphene
– Darvon, Darvocet-N
Loperamide
– Imodium
Hydrocodone
– Vicodin
Oxycodone
– Oxycontin, Percocet
Oxymorphone
– Opana
Meperidine
– Demerol
Methadone
– Dolophine
Fentanyl
– Ultiva, Sublimaze, Duragesic patch
Carfentanyl
– Wildnil, for veterinary use.
Cannabis & Pain
- Two of the cannabinoids found in cannabis,
– TCH – tetrahydrocannabinol
– CBD – cannabidiol.
- Inhibit the release of neurotransmitters and neuropeptides from presynaptic nerve endings, such Substance P
- Are potent anti-inflammatory agents, suppressing cytokine production and inducing T-regulatory cell production
- And therefore can reduce pain, how effectively is still unclear.
CBD vs. THC
- Both CBD and THC have the exact same molecular structure: 21 carbon atoms, 30 hydrogen atoms, and 2 oxygen atoms. A slight difference in how the atoms are arranged accounts for the differing effects on your body.
- Both CBD and THC are chemically similar to your body’s endocannabinoids. This allows them to interact with your cannabinoid receptors.
- The interaction affects the release of neurotransmitters in your brain.
- Neurotransmitters are chemicals responsible for relaying messages between cells and have roles in pain, immune function, stress, and sleep, etc.
- CBD is psychoactive, just not in the same manner as THC. It doesn’t produce the high associated with THC. CBD is shown to help with anxiety, depression, and seizures.
- THC binds with the CB1 – cannabinoid 1 receptors in the brain and produces the high or sense of euphoria.
- CBD binds very weakly, if at all, to CB1 receptors and needs THC to bind to the CB1 receptor
- In turn CBD can help reduce some of the unwanted psychoactive effects of THC, such as euphoria or sedation.
- Otherwise CBD and THC have many of the same medical benefits. providing relief from several of the same conditions.
- In June 2018, the FDA approved Epidiolex, the first prescription medication to contain CBD. It’s used to treat rare, difficult-to-control forms of epilepsy. (Epidiolex is not currently approved for any of the other conditions listed below.)
- Cannabis has a higher concentration of THC.
- Hemp has a higher concentration of CBD.
CBD is used to help with other various conditions, such as:
- seizures
- inflammation
- pain
- psychosis or mental disorders
- inflammatory bowel disease
- nausea
- migraine
- depression
- anxiety
THC is used to help with the following:
- pain
- muscle spasticity
- glaucoma
- insomnia
- low appetite
- nausea
- anxiety
CBD vs. THC: Side effects
- CBD is well tolerated, even in large doses
- Any side effects that occur with CBD are likely the result of drug-to-drug interactions between CBD and other medications you may be taking.
THC causes temporary side effects, such as:
- increased heart rate
- coordination problems
- dry mouth
- red eyes
- slower reaction times
- memory loss
- anxiety
CBD’s side effects may include:
- appetite changes
- fatigue
- weight loss
- dizziness
- diarrhea
Neither compound is fatal.
Side effects of High THC use
- May be connected to long-term negative psychiatric effects.
- Especially true for adolescents who consume large amounts of THC
- There’s no conclusive evidence that using cannabis causes psychiatric disorders like schizophrenia.
CBD vs. THC: Drug testing
- Cannabinoids like THC and CBD are stored in the body’s fat. They can show up on drug tests for several days or weeks after you use them.
- Not every drug test will be able to detect CBD, but CBD-sensitive tests are available.
- Most standard drug tests will look for chemicals related to THC, so THC or marijuana use might show up on a screening.
- Likewise, hemp can produce some THC in addition to CBD, so a test could be positive for THC even if you haven’t used it.
- NB! – Products that claim to be THC-free may not be so
Is it legal
Yes and NO
Chronic ‘Silent’ Inflammation
- When something damages your cells, your body releases chemicals that trigger a response from your immune system creating inflammation.
- When this response lingers and your immune system is in a constant state of alert chronic inflammation is created.
- Over time, chronic inflammation has a negative impact on your tissues and organs.
- Could also play a role in a range of conditions, from cancer to stroke.
Silence
- Is ‘deadly’ dangerous
- Acute inflammation often causes noticeable symptoms, like pain, redness, or swelling.
- Chronic inflammation symptoms are usually much more subtle, even silent making them easier to overlook.
- Symptoms fall below the threshold of perceived pain.
- You don’t take any steps to stop it as it smoulders for years, if not decades
- Eventually erupting into what we call chronic disease (which may seem to appear ‘suddenly’)
Common causes of Chronic silent inflammation
- untreated causes of acute inflammation, like an infection or injury
- an autoimmune disorder, which involves your immune system mistakenly attacking healthy tissue
- long-term exposure to irritants, like industrial chemicals or polluted air
- some cases of chronic inflammation don’t have a clear underlying cause but chronic stress is probably involved
Factors that may contribute to chronic silent inflammation
- smoking
- obesity
- alcohol
- chronic stress
- oxidative stress
Common symptoms of chronic silent inflammation
- Fatigue
- Insomnia
- Brain fog
- Depression
- Anxiety
- Joint stiffness
- Digestive problems
- Diarrhoea or constipation
- Acid reflux
- Weight gain
- Belly fat
- Weight loss
- Persistent infections
- Weakness
What to do?
Check the article – Killing Pain in this blog.
Chronic Pain & The Gut Brain Axis
- The relationship between gut microbiota and chronic pain, is receiving increasing attention.
- The gut microbiota influence many types of chronic pain, such as visceral, inflammatory, headache, neuropathic pain, and affects opioid tolerance.
- The gut microbiota can directly modulate numerous signalling molecules that regulate neuroinflammation in the peripheral and central nervous systems and can thereby mediate the development of chronic pain.
- Targeting gut microbiota through dietary intervention, probiotics, and or faecal microbiota transplantation, presents a potentially fruitful strategy for chronic pain management
- ‘Leaky gut’ allows toxins and bacteria to leak into the body. This can trigger inflammation in the gut and throughout the body and cause a chain reaction of problems, such as bloating, gas, cramps, food sensitivities, fatigue, headaches, and joint pain
Questions? Please don't hesitate to contact me
