Tag Archives: pain

Gluten sensitivity and fibromyalgia… is there really a link?

Marcusby Holistic Osteopath, Marcus Webb

By the time you read this little article I am sure you will have heard about a study linking gluten sensitivity with fibromyalgia and reporting on how ‘remarkable clinical improvement can be achieved with a gluten-free diet in patients with fibromyalgia (FM) even if coeliac disease has been ruled out’. The conclusion also goes on to say that ‘non-coeliac gluten sensitivity may be an underlying treatable cause in FM syndrome’.

However, the plot thickens; in all 20 of the FM subjects studied biopsies of their intestine revealed a pathological change known as intraepithelial lymphocytosis, a finding the authors use to help support their hypothesis that gluten sensitivity is a causal agent and underlies FM. This cause and effect relationship that this latest study hints at does sound convincing especially when we keep in mind that intraepithelial lymphocytosis has been associated with gluten sensitivity in the past but should we be jumping to such a definitive conclusion; what about those FM patients who don’t have intraepithelial lymphocytosis, were they removed from the study because they did not respond to a gluten-free diet? Don’t get me wrong, I am not trying to discredit or down play the study or the potential benefits of a gluten free diet in cases of FM but I am aware that many FM sufferers may read this and feel that they have to follow a gluten-free diet in order to get better but before going on it may be good to lay out a little additional information about intraepithelial lymphocytosis.

Within the tissue of the gut known as (epithelial tissue) special white blood cells known as lymphocytes reside waiting like guard on duty to be triggered into life by an invading army. In the case of the gut this is would normally be a bacterial infection. In around 3% of routine biopsies increased levels of lymphocytes can be observed (ie. intraepithelial lymphocytosis) and between 9-40% of cases celiac disease has eventually been diagnosed. In some cases intraepithelial lymphocytosis occurs in other multi-system disorders such as Hashimoto’s thyroiditis, Graves’s disease, rheumatoid arthritis, psoriasis, multiple sclerosis, Systemic lupus erythematosus, ankylosing spondylitis and autoimmune enteropathy. The other cases tend to be viewed as a non-specific finding related to other health issues such as bacterial overgrowth (SEBO), inflammatory damage secondary to non-steroidal anti-inflammatory drug use or other chronic inflammatory bowel disease. In other words, the presence of intraepithelial lymphocytosis is not diagnostic of gluten sensitivity but in the absence of other causes gluten sensitivity could be a possibility since it has been reported to account for around 10% of the cases of intraepithelial lymphocytosis but it should be kept in mind that hypersensitivity to other non-gluten components of food may also trigger this tissue change. Interestingly, a good number of the 20 subjects had co-existing health problems that have also been linked with the bowel tissue chances characteristic of intraepithelial lymphocytosis such as psoriasis (in 2 cases), hypothyroidism (in 3 cases), inflammarory/irritable bowel (in 5 cases) and gastric reflux (in 10 cases) which is a problem that commonly receives PPI drug therapy. As a drug class, PPI’s are also known to trigger intraepithelial lymphocytosis. However you critique this study as much as you want but what you can’t ignore is the outcome; for many, great relief of their chronic and disabling symptoms using a drug-free approach.

For many FM sufferers having a condition that is resistant to conventional therapies places them in a real corner when it comes to treatment and management options. From my experiences working with FM/CFS sufferers we tend to do what works or what works for that person! Science tends to take its time in catching up with the clinical observations but while it is catching up in many cases there is no real harm in exploring options that appear to have some evidence to support their use such as a trial of a gluten-free diet. From the results of the current study the gluten-free diet was followed for 16 months on average but in one case (a FM sufferer for 20 years) improvement in pain, fatigue and gut symptoms were felt after just 5 months and in another case (a sufferer for 10 years) complete remission of FM and improvements in gut and migraine was also observed after just 5 months. In some cases significant improvements and a return to normal life activities and work were seen after more prolonged (over 30 months) exposure to the gluten-free diet. However you look at it, cutting the gluten has made a dramatic difference to many sufferers in this small study.

If you feel that a gluten free approach is something you fancy trying its not a diet to be taken on lightly… so many foods contain gluten! Despite this, I would advise that you seriously consider going gluten free if your FM is of long standing and you have exhausted all other approaches. Keep in mind that you may have to stick to it for many months before you feel any tangible benefits but again, for what its worth, I can support the observations that many ill-defined inflammatory and pain related conditions simply improve with the elimination of gluten.

To help get you started you should avoid Barley, bulgar wheat, couscous, durum wheat, rye, semolina, spelt, wheat, all biscuits, breads, cakes, chapattis, crackers, muffins, pastries, pizza bases, muesli, wheat based breakfast cereals and anything made from wheat, rye or barley flour. By no stretch of the imagination is this a complete gluten free diet but it’s a start and something you can instigate today. Sitting down with an experienced nutritionist or naturopath should be your next step so you can get a more complete understanding of the complete gluten free diet and what it involves. In the early days of a gluten free diet I tend to recommend the use of a special dietary enzyme supplement based in a blend of plant derived gluten splitting enzymes. In addition to the cellulose digesting enzyme known as cellulase the key ingredient in Gluten Relief is Dipeptidyl Peptidase IV (or DPP-IV for short). DPP-IV is a type of protein splitting enzyme, known as a protease, and has been shown to break down the wheat protein gluten and milk protein casein. This combines with alpha-galactosidase to aid in the digestion of long chain sugars found in beans, broccoli, cabbage, sprouts etc… Using an enzyme preparation such as Gluten Relief (by the Canadian manufacturer Natural Factors) does not replace in anyway a gluten free diet but when you are unsure or are out and about with limited choices it may help to ‘defuse’ a potential gluten containing meal.

Link to study: Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. 

Link to Gluten Relief product

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Spice up your life to cool down inflammation

There has been quite a lot of press interest in the adverse effects of certain anti-inflammatory drugs and their potential to trigger a host of unwanted side effects including heart attacks. It’s no secret that most anti-inflammatory medications can play havoc with your stomach and gut but the news that taking these drugs could cause heart complications was quite a shock to those who have come to rely on these drugs to get them through the day. Interestingly, research over the years into the spice turmeric has revealed some encouraging results when used to treat pain and inflammation. Turmeric is composed of a complex mixture of organic compounds the principle one being curcumin. Although easily confused with the spice cumin, curcumin is completely unrelated and a unique compound to the spice turmeric. It belongs to a group of compounds called curcuminoids that are responsible for the typical yellow colour of turmeric. Anyone who has seen natural turumic root in the supermarket may notice a similarity to another culinary spice, ginger root. However, this is no coincidence because turmeric and ginger both belong to the same botanical family; Zingiberaceae. Both of these spices accumulate pharmacologically important compounds within the root tissue. In the case of turmeric the compounds are known as curcuminoids where as in ginger the compounds are called gingerols. The key fact that interests us is the ability of these compound to effectively reduce inflammation and pain while sparing other tissues the hazardous side effects commonly associated with anti-inflammatory medications. This may sound a bit to good to be true but to understand how turmeric, or more specifically the curcumoid known as curcumin, achieves this we will have to discuss the inflammatory process and a bit of biochemistry!

Inflammation – the basics.

When ever we injure ourselves the body has to mend the damage. To do this, chemicals need to be released that enhance blood supply, neutralise any invading bad bacteria and stimulate the local immune reaction. Over this early (acute) phase inflammation is accompanied by pain, swelling and some heat. In the majority of cases this process is self-limiting and once the injury has been mended all the levels settle to normal along with all the related symptoms. However, this is not always the case especially if there is an ongoing irritant present such as arthritis, joint damage or autoimmune disease. In these cases the inflammation becomes chronic and the sufferer experiences daily pain and disability. Anti-inflammatory drugs can offer great relief but often at a price and their safe long term use has become questionable.

Inflammation – the chemistry

The cascade of events that eventually causes inflammation kicks off within cell membranes. A specific fatty acid, known as arachidonic acid (AA), is released from it’s bound state within the cell membrane by an enzyme (phospholipase-A2). Two key players in the inflammation story, COX and LOX, then act upon the now freed AA. The COX enzyme comes in two forms, COX1 and COX 2. When AA interacts with COX1 it produces a mixture of compounds (prostaglandins; PG’s) that protect the stomach and maintain the ability of the blood to clot. When AA interacts with COX2 in produces PG’s that signal pain and enhance inflammation. The LOX enzyme converts AA into another powerful group of inflammatory compounds known as leukortrines. Drugs that block the COX and LOX enzymes are known as anti-inflammatory drugs for this reason; they block the inflammatory cascade. However, by blocking the COX1 enzyme these drugs also block the stomach and gut protective PG’s and cause thinning and blood vessel leaks as they also block the PG’s that maintain blood clotting. As a result, specific drugs were developed that selectively block the COX2 enzyme but leave the COX1 alone. In theory, this sounded great but in reality the drugs did leave the COX1 enzyme alone in the majority of tissues except the COX1 found within the cells that line the blood vessels. These cells are called endothelial cells and the COX1 enzyme within these cells produces a special compound known as prostacyclin, which in turn maintains the smooth flowing of the blood within the blood vessels. By blocking the action of endothelial COX1 and the production of prostacyclin blood becomes stickier and prone to clotting, which explained the increased heart attack risk associated with drugs that have COX2 inhibitor action.

Inflammation – the natural answer

Research into the anti-inflammatory actions of curcumin has revealed that curcumin is a safe and effective inhibitor of COX2 and of the LOX enzyme that is responsible for the generation of the powerful inflammatory actions of leukortrines. What’s more, curcumin has also been shown to block the initial release of AA from the cell membrane. By doing this curcumin may have an effective preventative action as well as a powerful anti-inflammatory effect when used on a regular basis. To date, there have been no indication or suggestion that curcumin inhibits the endothelial COX1.

One factor that goes against curcumin is it’s poor absorption from the digestive tract. To get around this problem manufacturers have produced a highly bio-available extract; Theracurmin. This innovative ingredient uses a microscopic particle (100 times smaller than regular curcumin powder) size to enhance the curcumin absorption from the gut. Studies using Theracurmin have shown that the microscopic curcumin particles are absorbed up to and reach concentrations 300 times higher than regular powders.

How to take curcumin supplements

Theracurmin is simple and easy to use; take 1-2 capsules daily around a meal time. Because of the lack of available information, those who are pregnant or breast feeding or taking warfarin should only use curcumin based products after taking medical advise.

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50% improvement in pain-related questions by the end of the study (60 days)

NEM paper

A new study was conducted at six different clinical sites throughout Germany to evaluate the efficacy and tolerability of NEM® for the relief of the pain and discomfort associated with osteoarthritis of the knee and/or hip.

NEM® is a natural source of collagen, chondroitin, and hyaluronic acid, each of which is known to support joint health. Much of the benefit with NEM® is thought to be the result of its nutrients boosting the production of critical joint molecules.

Forty-four patients were treated with a daily dosage of 500 mg of NEM®. Clinic visits were scheduled for subjects at study initiation and at 60 days following the onset of treatment. Statistical analysis revealed that supplementation with NEM® produced a significant pain relieving effect within 10 days. On average, nearly 1/4th of the subjects experienced a 30% improvement in pain-related questions within 10 days and almost 20% of the study population experienced a 50% improvement in pain-related questions by the end of the study (60 days). Significant improvement for stiffness was noted at 30 and 60 days after treatment.

An indication of the pain relieving effect of NEM was a drop in analgesic use. For the 30 days prior to study commencement, patients consumed on average 7 doses of acetaminophen. Analgesic use had dropped considerably to 2.43 doses per 30 days after 30 days of supplementation with NEM®.

No side effects were noted with NEM®.

Product link: NEM® capsules

Study link: NEM Brand Eggshell Membrane Effective in the Treatment of Pain Associated with Knee and Hip Osteoarthritis: Results from a Six Center, Open Label German Clinical Study. 2014

Naturopathic Physician, Dr Michael Murray comments on osteoarthritis: What is osteoarthritis?

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Safe & effective use of MSM in knee arthritis

In a just published study, the natural supplement methylsulfonylmethane (MSM) was shown to be effective in managing the pain and limited mobility associated with degenerative osteoarthritis arthritis (OA) in the knees. This painful problem is commonly managed with conventional anti-inflammatory drugs but form many the side effects of these agents outweigh the benefits. The authours of the current study commented on “the lack of clinical side effects” associated with the MSM therapy and that “current research suggests that if side effects to MSM exist, they are minimal and include minor GI symptoms, headaches, insomnia and difficulty concentrating“.

The sudy concluded that; “Patients with OA of the knee taking MSM for 12 weeks showed an improvement in pain and physical function. The results suggest that larger and long- term studies may find additional and greater improvements in knee OA symptoms. These improvements, however, are small and it is yet to be determined if they are of clinical significance. Further trials on MSM are recommended to define the safety, efficacy and appropriate dosage of MSM. We recommend incorporating longer intervention periods, larger and wider patient populations, dose-response trials and comparisons with other health supplements and standard conventional treatments.”

View the study here:

Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: a randomized controlled study. BMC Complementary and Alternative Medicine 2011, 11:50

MSM product link

Pure Opti-MSM 1000mg supplement

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Arnica; the ‘must-have’ remedy…

Sujal Zaveri, Homeopath consulting at Hadley Wood Healthcare

Memories of my childhood include scraped knees and knocked heads and the remedy we were always given was turmeric as an antiseptic and Arnica.

Arnica or Mountain Daisy is found along the slopes of the Andes, Central European Alps, Northern Asia and Siberia. The beautiful large golden flowers are hard to miss and most locals understand the value of this plant that nature has placed intelligently, on slopes, ready for use after accidents.

Saint Hildegarde of Bingen  Germany, first mentioned it in the 2nd century!

The first medical man to document it was Professor Joel in Gottingen in the 16th century.

Its uses are well known for bruises but it is also an invaluable aid in other circumstances.

My one year daughter whilst playing with her cousin managed to slam a door on her thumb. The thumb immediately went a very dark colour. My first response was to grab some Arnica 200 and slip it into her mouth. Not only did it instantly calm her (could be the taste of the sugar for sceptics) but within five minutes the thumb had returned to its normal colour. The children thought it was magic and it definitely felt like it.

One of  the symptoms Arnica is used for is ‘battered and bruised feeling’, this does not necessarily mean literal beating or physical hurt. It is also a feeling we experience eg when we have had a bad night’s sleep.  After a night spent on an Airplane or a night spent listening to torrential rain one can feel battered and exhausted.

Arnica is a great remedy for Jetlag or a sleepless night that leaves one feeling aching and bruised.

It is great for aching after sport, eg after a tough game of tennis Arnica is useful for the aching muscles so Wimbledon players need to take heed !

It is also great for shock whether it is physical or mental. Accidents often leave the patient in a state of shock and Arnica can help greatly to lift this state.

It can be a great pain killer and is used for fractures to help with any bruising and pain and can speed up the healing process.

This summer when you are packing your holiday bags –consider taking a bottle of Arnica 30c with you-you never know when it might be needed!

If you would like to discuss a homeopathic approach for your health problem please call Hadley Wood Healthcare on 0208 441 8352 or email Sujal at sujal@hadleywoodhealthcare.co.uk and see her web page

 

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Miracles of mind-body medicine in chronic pain

Christine Shah, Psychotherapist at Hadley Wood Healthcare

“Tension Myoneural” Syndrome

By Christine Shah, Psychotherapist at Hadley Wood Healthcare

Everyone has experienced physical pain at one point in their lives, but for some, pain can be severe and persistent and turn into chronic pain.

Dr. John Sarno who was the director of the Rusk Institute of Rehabilitation Medicine in New York, discovered that the bulk of musculoskeletal pain was not the result of a structural damage, but in fact a tension-related pain. This condition was referred to as TMS (tension myoneural syndrome) [Sarno J. Healing back pain, New York: Warner Books, 1991]

John Sarno’s theory states that the autonomic nervous system is responsible for the great majority of chronic pain conditions, and that the underlying cause of that pain is the minds defence mechanism against unconscious mental stress which is distracted by  physical pain and therefore conscious awareness is prevented. In other words the physical pain becomes obvious to the patient and emotional pain becomes invisible.

The autonomic nervous system controls the circulation of the blood flow in the body. When there is not enough blood flow to a particular tissue, oxygen is reduced and the result will be symptoms, such as pain, numbness, tingling weakness etc. These symptoms can occur in the neck, knee and other parts of the body.

David Schlechter states that the symptoms have a tendency to move to other parts of the body and considers symptom movement to be an important indicator that the pain is from TMS.

Schlechter and Sarno consider a prior history of other psychosomatic disorders such as irritable bowel syndrome and tension headache as examples of TMS pain. However a physical examination tests and imaging studies may be needed to rule out serious conditions, such as tumours.

Psychological Therapy for TMS patient

The Psychiatrist Henry Maudsley [1918] wrote:  ‘The sorrow which has no vent in tears may make other organs weep’.

He states: When our habitual ways of coping psychologically are overwhelmed, we are capable of somatising psychological pain. In such cases, the mind senses that the emotions are too painful to experience, so it attempts to protect the psyche. That is to say that experiencing the pain physically, as, terrible as it may feel, is more tolerable than feeling the depth of the psychological pain.

Studies have revealed that TMS clients avoid a variety of feeling, such as anger, sadness, helplessness, dependency, envy, guilt, even happiness. Sarno and the psychologists he worked with found that when TMS clients were focused on their physical pain, they were less apt to focus on deeper psychological pain.

Most people have experienced a way of distracting themselves from difficult emotions.

To relieve anxiety or depression, people overeat, smoke, drink alcohol, use drugs etc.  All these activities serve to shift a person’s focus from their emotional pain to a different sensation. Physical pain is simply the minds way of shifting the focus for us.

Examples of repressed emotions could be:

A   certain childhood experiences, such as abuse or lack of love,

B   personality traits such as perfectionism conscientiousness and a strong need to be liked by everyone,

C   current life pressures

D   aging and mortality and

E   situations in which the patient experiences conscious but unexpressed anger

TMS treatment is gaining momentum, and author and physician, Dr. Marc Sopher, speaks for many when he writes: ‘Ultimately, I am confident that TMS theory will become part of mainstream medicine for the simple reason that it is correct, and more successful at alleviating pain than any other modality.

Once TMS has been clinically diagnosed, the client’s acceptance of the diagnosis is an integral part of recovery.

One of the primary goals of TMS treatment is to help clients reframe the meaning of their pain. Instead of focusing on it with frustration, fear and powerlessness, the client learns to use the pain as a guide to become aware of his emotions.

An essential part of counselling is to help the clients to identify these emotions, and eventually accept and express these painful parts of themselves [E Sherman, personal communication, 09/05/09].

If you feel that you have exhausted every other means of treatment perhaps psychological counselling is your answer?

(Parts taken from a BACP article [Therapy Today] published in April 2010, p16 to 21)

References:

National Institute of Health NIH guide:new directions in pain research I. September 1998

Sarno J. Healing back pain.New York, Warner Books,1991

Sarno J. The mindbody prescription: healing the body, healing the pain New York, Warner books, 1998

Sarno J. The divided mind: the epidemic of mindbody disorders , New York, Harper Collins, 2006

Read the interview with Dr Sarno

An Expert Interview With Dr. John Sarno, Part I: Back Pain Is a State of Mind


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A new acupuncture triggered pain relieving pathway discovered

The BBC has reported on some breaking research involving a molecule which may control how acupuncture relieves pain. The US study showed that levels of adenosine – a natural painkiller – increased in tissues near acupuncture sites. admittedly, this work used mice, not people, but the early results only add to the growing body of evidence that supports the scientific basis for acupuncture as an effective pain management tool.
Adenosine is made by the body and controls many internal processes by triggering a response through one of its many receptors (A1, A2A, A2B, and A3) located in the surface of many cells.
With regards to pain, adenosine acts as an inhibitory neurotransmitter – in other words, it slows or blocks the transmission of pain messages. In addition to this, adenosine promotes sleep by accumulating hour by hour while we are awake. When levels reach a certain threshold level we start to feel sleepy… If we take a slug of coffee (or chocolate) we can block this effect because caffeine binds to the adenosine receptors effectively blocking their call for us to seek our bed! The chemical structure of adenosine and caffeine is similar because both are based on a purine ring structure.
The proof that acupuncture boosts adenosine not only supports the pain killing effects but also the commonly reported sedation effects associated with the treatment. Interestingly, those who are non-responders to acupuncture may find avoiding coffee and chocolate around their treatment sessions may it’s effects.
Click here for a download of the study.

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