Exploring the Variety of Sources for Chronic Pain

Exploring Sources of Chronic Pain

            I saw a healthy young woman this week in her 40s. She told me about a time in her life when she was struggling. She had diffuse muscular pain that progressed to the point where she couldn’t grip the steering wheel or hold a pencil. She had to take three months of medical leave from her corporate position.

            She was referred to a rheumatologist at a prominent Boston hospital. The working diagnosis was “fibromyalgia.” The specialist put her on the pharmaceutical methotrexate, a drug originally developed for chemotherapy, but now more often used for autoimmune conditions like Rheumatoid Arthritis. The drug had no benefit for her.

            She was referred to another rheumatologist who wondered if she might have Lupus. For that diagnosis, there are generally no effective options. She was faced with a life of pain and disability and no real answers. What could she do?

            She did her own research and took control of the situation. She stopped the medication (after being on it 12 months) and made changes to her diet and lifestyle. She followed a diet without wheat, dairy, sugar, alcohol or processed foods. She bought a juicer and drank 16 oz. of carrot apple juice every morning. She started vitamin D and cod liver oil. Her pain started to subside fairly quickly. Within four months, she was pain-free and back to work.

            There are scenarios of chronic pain where the underlying causes are well understood from a traditional perspective. It makes sense if a 90-year-old has degenerative arthritis of his weight-bearing joints from a steady loss of cartilage over his lifetime.

            There are many root causes, however, that can contribute to chronic pain syndromes that are rarely explored by any pain specialist, orthopedic surgeon or rheumatologist. This list would include tick-borne infections from Borrelia species, Bartonella species and others.

            I’ve worked in a Lyme-endemic for over eighteen years and in all of that time, there isn’t a single episode where a patient who might have a chronic tick-borne infection was ever given an alternative explanation for their chronic pain and other symptoms.

            About five years ago, I had a female patient in her late 30s who worked as a nurse convinced she had Rheumatoid Arthritis. Her initial thyroid blood test (the TSH level) was normal, but other labs (free T4 and free T3) showed low normal and potentially suboptimal levels. On Armour thyroid medication, her chronic joint and muscle pains started to improve within a week. She tried to discuss this development with her Endocrinologist. The nurse brought research articles in, but the specialist had no interest. The nurse was told it was impossible that a thyroid condition could be a cause for chronic pain.

            I had a middle-aged male with chronic muscle and joint pain for more than ten years convinced he had chronic Lyme disease. On full review of systems, he had muscle cramps, palpitations, insomnia and other signs more suggestive of chronic mineral deficiencies. On relatively high doses of magnesium malate and mineral tablets, his pain steadily improved and he was about 80% better within two months.

            Many with chronic pain have Chronic Inflammatory Response Syndrome (CIRS) from a build-up of mold and other biological toxins. They don’t teach about this complex condition in medical schools, so I guess it doesn’t exist.

            Delayed food sensitivities can contribute to systemic inflammation. Those with chronic bowel issues can have lipopolysaccharides (LPS) that get into the bloodstream causing pain and inflammation.

            I have had a group of patients with chronic pain with laboratory testing that showed extremely high antibody levels against the Epstein-Barr virus. They started on an immune supporting, viral suppressing regimen. Some had their pain improve significantly.

            Mast cells mediate some of the inflammatory pathways so dysfunctional, hyperactive mast cells can play a role in chronic pain syndromes.

            An intriguing potential cause of “fibromyalgia” comes from the research of a doctor still working in California. Dr. St. Amand makes the case in his book and website that some percentage of those with chronic muscle pain are caused by phosphate deposition in the tissue. One of the savviest patients I’ve seen gave me his book. She traveled all over the world seeing gurus everywhere, spending over a hundred thousand dollars on treatments for many of the causes described in this blog with minimal success. Ultimately, she improved with treatment for St. Amand’s phosphate deposition scenario. One current patient is following this therapy and has had improvement in her pain. Some of her skin nodules have disappeared presumably because the phosphate is being cleared. She went to a conference years ago for the St. Amand protocol and talked to many people there who had their fibromyalgia symptoms improved or cured.

            By my count, this blog describes eleven different underlying root causes that can play a role or be the central cause for those with chronic pain out of proportion to age or lifestyle. None of those are part of standard medical training.

            An analysis can be done through Complex Health Solutions’ website that assesses for all of these potential sources of chronic pain, chronic fatigue, and other systemic issues. It is an algorithm-based machine-learning program that predicts the most likely root causes for a person’s chronic health problems. That would be a good start in sorting things out or you could do your own research. You could also follow the basic anti-inflammatory plan pursued by the first case in this blog and see if things improve.

            Don’t settle for a label like fibromyalgia where the only option is some combination of the pharmaceuticals Tramadol, Gabapentin, Lyrica, Cymbalta, Amitryptiline and Savella plus regular therapy assuming that most of the problem must be in your head.

p.s. When I asked the patient from the first case to review what I had written, she made some corrections, but also wanted to add something: By her own account: “I should also note that I reversed my own seizure disorder. When I was in my freshman year of college, I started to get icepick headaches (cluster headaches). They started as maybe a dozen jabs a day and quickly became over 100 jabs a day. They would knock me off my feet. I spent eight days in the New England Center for Headaches under the care of a specialist. They tried every migraine med under the sun including IV drips. Nothing worked. On the day I was scheduled to go home, they decided to throw caution to the wind and do an EEG. Yet I only experienced pain…never a full seizure. I spent the next 15+ years on Dilantin and Tegretol (they switched it when I got pregnant). About seven years ago, I decided it was time to get off my meds. I put myself on a keto diet and after three months on the diet, I slowly started to wean myself off the meds. When I say slow, I mean slow. I weaned myself off over the course of 10 months. Today, I take no seizure meds and am cluster headache free. Amazing, huh? Mass General Neurology was amazed and wanted to do test after test on me. I refused.”

Andrew Lenhardt, MD