FACTS YOU NEED TO KNOW IF YOU HOPE
TO CONQUER YOUR CHRONIC PAIN
POOR GUT HEALTH PUTS THE WHEELS OF
CHRONIC PAIN & CHRONIC ILLNESS IN MOTION
- HEALTHY MICROBIOME: Let me start by saying you are your MICROBIOME. In other words, you are the bacteria that are found in and on your body. Allow me to explain. There have been any number of studies (I discussed one of these IN MY LAST POST) where bacteria from sick, fat, or depressed animals are transplanted into healthy animals, almost immediately making them sick, fat, or depressed. What's crazy is that this process can run either direction, back and forth. Put bacteria from healthy subjects back into the "sick" subjects and presto, they become thin, happy, and healthy again. When the ratios of 'good' Gut bacteria to 'bad' Gut bacteria are out of whack, the medical community refers to this as "Dysbiosis" or A DYSBIOTIC MICROBIOME. Bear in mind that research on the Microbiome is arguably the hottest area of study in the biomedical field and has been for several years --- even though your doctor has not mentioned it to you.
- GUT BARRIER INTEGRITY: When it comes to the Immune System, we like to talk about B-Cells, T-Cells, antibodies, antigens, etc, etc, etc (HERE or HERE). Just as important, however, is Gut Barrier Integrity. Fully 80% of your body's entire immune system resides in your Gut, the lining of which (the intestinal wall), is exactly one cell thick. This layer of cells creates a barrier against the myriad of invaders constantly trying to get into your bloodstream and wreak their havoc. A compromised or "leaky" Gut barrier allows these invaders in, causing your immune system to go into hyperdrive, always leading to rampant inflammation, and frequently ('usually' would probably be the best word here) leading to autoimmunity and the NUMEROUS AUTOIMMUNE DISEASES associated with. Although most physicians (yes, probably yours) deny that LEAKY GUT exists, a quick search of the peer-reviewed literature reveals more than 10,000 studies on the subject (hint; this common problem goes by dozens of names including Intestinal Barrier Dysfunction, Increased Intestinal Permeability, Gut Hyper-permeability, etc, etc, etc).
What are the easiest ways to foul the Microbiome? Let me show you by walking you through the life of a chronically ill person struggling with chronic pain. Little Johnnie is born to a mother who took any number of MEDICATIONS, including ANTIBIOTICS, while pregnant (yes, gestational antibiotic exposure causes problems for Johnnie after he is born). A quick look at PubMed.com reveals that mom's SMOKING (not to mention dad's) further degrades Little Johnnie's Microbiome. We must also account for the fact that Little Johnnie was born via C-SECTION and immediately started on FORMULA (SOY).
Because Little Johnnie always seemed to be sick with COLDS and EAR INFECTIONS, he was always at the doctor and always on ANTIBIOTICS and STEROIDS (corticosteroids are immunosuppressive drugs). Because these drugs (as well as the OTHERS HE IS ON for his ASTHMA, ADHD, IBS, and PERPETUALLY UPSET STOMACH) destroy the immune system by destroying Gut bacteria, Little Johhnie has always been that much more susceptible to whatever infection happened to be coming down the pike. And did I mention; because Little Johnnie spent so much time at the doctor, he has had every recommended vaccination and then some --- a significant destroyer of one's Microbiome as well (HERE, HERE, or yesterday's post).
Because things were almost always hectic (crazy might be a better term), Little Johnnie grew up eating lots of HOT DOGS & CHICKEN NUGGETS, frozen pizza, instant macaroni and cheese, cold cereal, and peanut butter sandwiches. Plus, there was always soda and "SNACKS" handy. Since Little Johnnie was frequently sick, his mom told him he couldn't go outside, but could instead hang out in the house and play VIDEO GAMES. After awhile mom noticed that Little Johnnie is not as 'little' as he was, and switches him from regular soda to DIET SODA --- a major destroyer of Gut bacteria (see link).
As Johnnie enters adulthood, he isn't even aware that the fact that he is LIVING THE HIGH CARB LIFESTYLE (and literally never eats vegetables of any kind, except CORN) is contributing to his growing number of health problems and pain. That's right; Johnnie is having joint pain, and his doctor recently told him that he is a borderline diabetic (pre-diabetes, aka Metabolic Syndrome). His doctor started him on some NSAID MEDICATION, DIABETES MEDICATION, and for good measure, an ANTIDEPRESSANT. Since he is significantly overweight, his doctor told Johnnie to CUT BACK ON HIS FAT INTAKE. Johnnie tried it, but feels DRAWN TO the "foods" he grew up with, not even remotely aware that SUGAR AND HIGH GLYCEMIC CARBS FEED DYSBIOSIS.
Although Little Johnnie's case might seem extreme, how many of us have had to deal with at least some of these factors over the course of our lives? Probably most of us, as there are so many novel ways to screw up one's microbiome that I didn't even mention. And ultimately, what a fouled up, leaky, and dysbiotic Gut leads to is inflammation.
INFLAMMATION IS EVERYTHING
In Johnnie's case, as more and more inflammation in the form of red ink pours from the faucet with increasing intensity and volume, it overcomes the ability of the sink's drain to deal with it, eventually overflowing onto the floor. What does Johnnie do? He tries to mop up the inflammation by taking the various drugs his doctors have given him (MOSTLY THESE). Unfortunately for Johnnie, the sink continues to pour red ink out on to the floor, and no matter how much or how intensely Johnnie mops, sponges, and wrings, he can't get ahead of the red wave that is not only destroying his floor, but filling his basement. It's getting so bad that the ink is starting to create a pool that can be seen slowly rising up the walls in his kitchen and living room. Johnnie is all but drowning in red ink.
Johnnie continues to see his doctors, who try all sorts of novel, interesting, and "SCIENTIFIC" treatments to no avail. Even after installing drains in Johnnie's kitchen and living room floors, the level of red ink in his house, even though slowed momentarily, is continuing to rise.
To us who are on the outside looking in, the solution is obvious. Simply walk over and turn off the faucet, stopping the flow of red ink (inflammation) onto the floor, into the basement, and out into the street. Once this first step has been taken, Johnnie could actually make some progress cleaning up the existing mess. It's a fairly easy concept, isn't it? Stop inflammation at its source instead of constantly trying to mop up the mess it leaves behind.
The first thing I want you to understand is what inflammation really is (HERE). Not to pick on my patients, but few do. And not to pick on their doctors, but none are explaining it to them as an overarching principle of health. If you don't know your enemy, how in the world do you propose to conquer him? Secondly, you must understand that while drugs might diminish inflammation for awhile, they don't change health (HERE). And thirdly, realize what causes inflammation. Although we talk in terms of things like SUGAR CAUSING INFLAMMATION, this might not be quite as true as we think. Basically everything we do has consequences on the health of our Gut (HERE), and it's a screwed up Gut that ultimately drives the inflammation. What does inflammation do as far as ill health is concerned? Everything!
There's good reason that you'll sometimes hear physicians (particularly those with a "natural" bent) say that, "Inflammation is everything!". They're correct. Inflammation is what drives the vast majority of our health issues --- even many of those erroneously deemed "GENETIC". Want to know if you are inflamed? Take THIS SELF TEST, Before we leave this topic, I want to talk about inflammation as it relates to both Scar Tissue and Chronic Pain.
Inflammation always (that would be 'always' as in always) leads to something called Fibrosis (HERE). Because most people have no idea what Fibrosis is, in my clinic I refer to it as MICROSCOPIC SCAR TISSUE. Believe me when I tell you that Scar Tissue is a big deal! ADJUSTMENTS, THERAPY, massage, and any number of other therapies and modalities --- therapies and modalities that have the potential to be highly beneficial --- cannot work as they should as long as there is Scar Tissue present in the form of FASCIAL ADHESIONS.
Beyond microscopic scarring in the form of Fibrosis; when chronic inflammation is exposed to injured, damaged, or compromised tissue (particularly nerve), hypersensitivity can result. The famous medical neurologist and father of MODERN DRY NEEDLING, Dr. Chan Gunn, wrote in a RECENT PAPER that various tissues of the body that have had the nerves to them injured have the ability to be hypersensitized to the point they are over a thousand times more pain-sensitive than normal tissues. Not surprisingly, Gunn was mentioned in the foreword of surgeons Rea & Patel's Reversibility of Chronic Degenerative Disease and Hypersensitivity, Volumes 1-5, when they stated, "Thanks to all the great anatomists and physiologists of the ages, especially ... Chan Gunn, MD... and many others whose ideas and facts we used liberally to solidify the concepts of hypersensitivity and chronic degenerative disease."
This sort of scenario is exactly what we find with Scar Tissue and at least part of the mechanism that induces Chronic Pain. Let me hit you with a few studies as related to Inflammation, Fibrosis, and Chronic Pain / Chronic Disease.
CHRONIC PAIN AS A FUNCTION
OF FIBROSIS AND INFLAMMATION
I've SHOWN YOU PREVIOUSLY that there are essentially three types of pain. While inflammation is virtually always a part of the pain process at the beginning, it's not always part of the process at the endpoint. Allow me to elucidate. According to the American Society of Regional Anesthesia and Pain Medicine (Types of Chronic Pain), "Chronic pain may also occur despite healing and with no obvious injury to tissues. This may be the result of damage to the nerves that transmit pain (neuropathic pain), but chronic pain also affects the entire nervous system, sometimes in a permanent way. When any type of pain lasts a long time there can be changes in the spinal cord and the brain that change how we perceive painful sensations. These changes may result in severe pain with little or no painful stimulus." In English, this means that you do whatever it takes to deal with underlying inflammation now because the longer the entire process continues, the greater the chance of it being "locked" into your nervous system where it plays on a continual loop.
- CHRONIC INFLAMMATION = CHRONIC PAIN: Last month's issue of Trends in Immunology (Nociceptor Sensory Neuron-Immune Interactions in Pain and Inflammation) revealed this about nociceptors (pain receptors), "Nociceptor sensory neurons protect organisms from danger by eliciting pain and driving avoidance. Pain also accompanies many types of inflammation and injury. It is increasingly clear that active crosstalk occurs between nociceptor neurons and the immune system to regulate pain, host defense, and inflammatory diseases." In a study from the September issue of RMD Open (Post-Traumatic Arthritis: Overview on Pathogenic Mechanisms and Role of Inflammation), we learn that, "Post-traumatic arthritis (PTA) develops after an acute direct trauma to the joints. The activation of inflammatory mechanisms during the PTA acute phase appears to play a critical role in the chronic disease onset." None of this is rocket science and.........
- NONE OF THIS INFORMATION IS REALLY NEW: Although science is constantly adding to their knowledge-base in this area, it's not like any of this is really new information. For instance, a 2001 issue of the British Journal of Anesthesia (Mechanisms of Inflammatory Pain) revealed that, "One of the cardinal features of inflammatory states is that normally innocuous stimuli produce pain and result in the hypersensitivity state that accompanies inflammation. Symptoms and signs arising from normal tissues exposed to high intensity stimuli generally reflect the intensity, localization and timing of the initiating stimuli. In contrast, pain arising from inflamed or injured tissues may arise spontaneously in the absence of an external trigger. Alternatively, responses to noxious stimuli may be enhanced (hyperalgesia) or normally innocuous stimuli may produce pain (allodynia)." This is a fantastic overview of the entire process, talking at length about the way that specific inflammatory markers (cytokines, interleukins, bradykinnin, prostaglandins, histamine, nitric oxide, substance P, etc, etc, etc,) affect pain pathways. Furthermore, almost two decades ago, Current Reviews in Pain (A Role for Inflammation in Chronic Pain) said that, "Recent studies indicate that inflammatory events induced by nerve injury play a central role in the pathogenesis of neuropathic pain. These involve inflammatory cells (eg, macrophages), the production of molecules that mediate inflammation (cytokines / interleukins), and the production of nerve growth factor (NGF). However, in many instances, neuropathic pain is associated with nerve inflammation, neuritis, in the absence of nerve injury. It is conceivable that biochemical and physiologic changes (inflammatory mediators) that occur along the "pain pathway" (nociceptors, peripheral nerve, dorsal root ganglion, dorsal root, neurons in the spinal cord) may sensitize one or all these sites along the pain pathway and hence lead to chronic pain)." Macrophages are cells in the immune system that clean up invaders by engulfing them and then digesting them like the 1950's movie, The Blob. The cells that do this job in the brain (the brain's macrophages) are called microglial cells, and......
- MICROGLIA ARE A HUGE DEAL WHEN IT COMES TO CHRONIC PAIN: Thought for decades to simply be a structural sort of scaffolding framework for the brain (a sort of "glue" to hold the structure together, MICROGLIAL CELLS are not only at the forefront of Chronic Pain research, but act as both gatekeepers and housekeepers, destroying invading pathogens and cleaning out dead neurons and other cellular debris, often times leaving pro-inflammatory messengers in their wake (remember that inflammation is responsible for tissue repair). This is all a function of the Sympathetic Nervous System, which we will talk about in the next bullet point, and is a part of normal physiological function. But when microglia are let off their leash, bad things can occur. Here are a few studies on the topic. An Italian study from the September issue of CNS & Neurological Disorders Drug Targets (Mast Cell - Glia Dialogue in Chronic Pain and Neuropathic Pain: Blood-Brain Barrier Implications) revealed that the scenario we are discussing today can be related to "LEAKY BRAIN / CORD / NERVE SYNDROME". "Mast cells and microglia, working singly and in partnership, produce inflammatory agents which play key roles in a wide array of nervous system disorders. Such neuroinflammatory settings may compromise integrity of the blood-nerve barrier, the blood-brain barrier, and blood-spinal cord barrier. Mast cells and glia are endowed with homeostatic mechanisms/molecules which come into play following tissue damage." Furthermore, this month's copy of Science (Pain Regulation by Non-Neuronal Cells and Inflammation) said that, "Acute pain is protective and a cardinal feature of inflammation. Chronic pain after arthritis, nerve injury, cancer, and chemotherapy is associated with chronic neuroinflammation, a local inflammation in the peripheral or central nervous system. Accumulating evidence suggests that non-neuronal cells such as immune cells, glial cells...... play active roles in the pathogenesis and resolution of pain. Recent studies also suggest that bacterial infections regulate pain through direct actions on sensory neurons, and specific receptors are present in nociceptors to detect danger signals from infections." Did you catch that? Bacteria are responsible for regulating pain. Can anyone say Gut Health?
- CRPS / RSD; THE SYMPATHETIC NERVOUS SYSTEM RUN AMOK: There are two parts of the Autonomic Nervous System, the Parasympathetic and Sympathetic. The Parasympathetic has to do with rest, relaxation, and digestion, while the Sympathetic is what gives you that jolt of adrenaline (epinephrine) necessary for a "fight or flight" response. When the body is in a state of SYMPATHETIC DOMINANCE, bad things happen. Listen to what Dr. Dr. Katinka van der Merwe of Fayetville Arkansas says in a guest post for the RSDSA website called Putting Out the Fire: A Brand New Approach to Treating RSD/CRPS. "The one thing every CRPS patient has in common is that they are stuck in Sympathetic overdrive, meaning, instead of their nervous system being nicely balanced between these two states, they are stuck in Sympathetic overdrive. This often happens long before they ever develop CRPS (Complex Regional Pain Syndrome). The Vagus Nerve supplies motor Parasympathetic fibers to ALL the organs except the adrenal glands, from the neck down to the transverse colon. The Vagus Nerve (VN) is responsible for many different tasks, including (but not limited to): heart rate, digestion, sweating, speech, coughing, fainting, and vomiting, to name but a few. Remember, people who suffer from CRPS also suffer from Sympathetic dominance (the schoolyard bully), causing the Parasympathetic nervous system to be suppressed and to shut down. This means that people who suffer from CRPS also suffer, by definition, from an underactive VN. An underactive VN may be a result of an injury to your upper cervical spine (neck) directly, such as an old whiplash injury...." The cool thing is, it's fairly easy to measure the degree that a person's neck is not functioning (HERE) as well as the degree of SYMPATHETIC DOMINANCE a person is dealing with. In fact, if you look at the first link in this bullet, you'll note that it is actually a better marker for inflammation than blood biomarkers. BTW, it's virtually universal to see people in Sympathetic Dominance after a WHIPLASH INJURY.
- PARASITES CAN CAUSE INFLAMMATION: I recently had a dear friend nearly die of PARASITES that doctors could neither find nor treat. Fortunately, he got things turned around and is today living a happy, healthy life. Never forget that in similar fashion to bacteria, parasites are huge modulators of the immune system compounds known as "inflammation". A study from this month's issue of Parasite Immunology (Signalling Pathways Associated with IL-6 Production and Epithelial-Mesenchymal Transition Induction in Prostate Epithelial Cells Stimulated with Trichomonas Vaginalis) proved this point in a study concerning the world's most common 'cureable' STD, Trichomonas Vaginalis. "Trichomonas vaginalis (Tv) has been found in patient tissue of benign prostatic hyperplasia (BPH), and suggested to cause chronic prostatitis. IL-6 is known as one of the important factors of chronic inflammation in prostate cancer. Patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) had higher levels of IL-6 in seminal plasma. Furthermore, inflammatory conditions induced by pathogen infections have been shown to promote epithelial-mesenchymal transition (EMT). We found that PECs stimulated with Tv increased the production of IL-6, as well as [numerous other inflammatory markers]. These findings are the first evidence that Tv infection of prostate epithelial cells may induce EMT." Interestingly enough, EMT also happens to be strongly associated with the inflammatory conditions; CANCER and Fibrosis.
- DEPRESSION IS RELATED TO THE WHOLE MESS: We know from research that DEPRESSION is related to both inflammation (which is the known cause of Depression --- HERE) and Chronic Pain (which in my opinion causes a huge amount of Depression --- much more than the reverse). Last month's issue of Epidemiology and Psychiatric Sciences (Patterns of Association of Chronic Medical Conditions and Major Depression) helped prove this by concluding that, "Overall, conditions characterised by pain and inflammation tended to show stronger associations with major depressive episodes. The prevalence of MDE is elevated in association with most chronic conditions, but especially those characterised by inflammation and pain." What exactly are these inflammatory conditions mentioned? They are many found on THIS LIST of inflammatory conditions ("high blood pressure, cancer, migraine, arthritis, diabetes, back pain, cataracts, effects of stroke and heart disease, thyroid disease, epilepsy....). Last month's issue of Neuroscience (The Effects of Extended Pain on Behavior: Recent Progress) stated, "Chronic pain is frequently associated with anxiety, depression, and cognitive dysfunction. This review discusses recent work in rodents that contributes to the understanding of their neurobiological links. Brain regions that contain circuits that mediate persistent changes in behavior that are caused by nerve injury or joint inflammation...... Broadly projecting modulatory systems and widely expressed factors such as cytokines and growth factors also contribute to pain-associated behavior. " If you want to understand the concept of "growth factors" as related to nerve tissue, take a look at the pictures in the "Chronic Pain" link at the very top of my website.
- FIBROMYALGIA AND INFLAMMATION: If there is a more misunderstood systemic health issue than FIBROMYALGIA, I'm not quite sure what it would be. Next month's issue of Neuroscience (Neurobiology of Fibromyalgia and Chronic Widespread Pain) helped shed light on this by not surprisingly revealing that it's related to whole-body inflammation. "Fibromyalgia is the current term for chronic widespread musculoskeletal pain for which no alternative cause can be identified. Emerging evidence has begun exploring other potential mechanisms including a peripheral nervous system component to the generation of pain and the role of systemic inflammation. We conclude that fibromyalgia and related disorders are conditions with a complicated pathobiology, with patients falling along a continuum, with one end a purely peripherally driven painful condition and the other end of the continuum is when pain is purely centrally driven."
Let me assure you that "CENTRALLY DRIVEN" pain is not where you want to be. This is the pain, which in similar fashion to riding a bike, you can't forget because it has become locked into neurological pathways and "memorized" so to speak.
THE PUNCHLINE AND THE SOLUTION
(DON'T PLAY THE FOOL)
"Lasting change takes time. It takes practicing something a little bit very often. 90% of the U.S. population are considered 'health seekers'. This means 9 of 10 of us know we are not practicing regular habits that support a healthy life. (And age has nothing to do with it. There are plenty of people in their 70s and 80s enjoying better health than many 20 and 30 somethings.) Does this mean only 1 in 10 people is a gifted and talented person of health and 9 out 10 have little to no potential for enjoying good health? Of course, it doesn’t. You already knew that! The 10% are no longer looking for better health because they do a little every day to support their health. They're not all triathletes and marathon runners. But, even the super athletes must get off the couch and train every day."
Fortunately for you, there are people out there who are watching your back. Why is this important for you to know? Because many of those whom you have trusted with your health are not helping you out in any tangible way, and probably making you worse. Your doctors? Are you joking me? They ignore the current research every chance they get (HERE), while prescribing increasing numbers of TESTS and DRUGS. And speaking of more drugs; more doctor visits plus more drugs is nothing but status quo healthcare in America. It's the very thing you've been trapped in, but trying to free yourself from for years; maybe decades. The solution often boils down to you being honest with yourself about a simple question; when it comes to your health, are you looking for sympathy or empowerment (HERE)?
How do you get off the medical merry-go-round? For many of you that is the $64,000 question. Fortunately, I'm handing out gold bricks today in the form of an "EXIT STRATEGY". If you are interested in getting out of pain and getting your life back, a great place to start is HERE. And for those of you who found this helpful, take two seconds to reach those you love and care about most by liking or sharing on FACEBOOK. They'll be thrilled you did.