Understanding Pain Management Alternatives

This article first appeared in the Winter 2011 edition of Trial Lawyer magazine, the quarterly journal of the Oregon Trial Lawyers Association.

 

2185150276_0be402bc1dMotivating patients in chronic pain poses a challenging dilemma for most physicians. Pain has become the fifth vital sign and in the day and age of pain management, it is expected that doctors will relieve suffering. It is hard to witness someone’s suffering. If we can relieve it with medication, we feel it imperative to do so.

But perhaps we are looking at chronic pain and incurable conditions all wrong. I’d like to propose another way of looking at suffering and perhaps a way of motivating patients to live their lives to the fullest under any condition. I also suggest we exhaust all options before we relegate patients to managing and coping with their pain.

Sally came to my office accepting the pain from her fibromyalgia and arthritis, that her doctors told her she’d have to cope with the rest of her life. Every change in the weather brought on joint pain, which would be so severe it would wake her up at night. She used a walker for stability and security. She took three doses of 800 mg ofTylenol every day. She was on trazodone for sleep every night.

She told me, “I can’t stop taking this or else the pain will wake me up.” She had a prescription for oxycodone daily as well. And she took prilosec to counteract the inflammation in her gut from all of the pain medications.

I see patients like this every day.They have accepted the pain and dis-ease of their lives. No one has given them a chance for things to be any different.

Changing the mindset about pain management

First, let’s change our mindset for dealing with chronic pain sufferers. Bernie Siegel, M.D., speaks to this directly when he says, “We must realize the pain most people suffer, and redefine our goals. What is healing? Is it a liver transplant or cure of an illness, or is it getting people to have peace of mind and live life to its fullest? One of the most important factors is a patient’s confidence in having the doctor’s undivided attention.”(Siegel, B.S., Love, Medicine and Miracles, New York, NY, Harper and Row Publishers, Inc., 1986)

Naturopathic doctors and acupuncturists tend to spend more time with their patients, listening and witnessing their suffering. Now I know what you are thinking — this is all well and good, but the patient is in extreme pain. I am not suggesting not treating the pain, but this piece of witnessing — being with the person — has been sapped out of current medicine. Many doctors resist such intimacy out of fear of transference.

But as Patch Adams, M.D. writes, “Without intimacy how can healers offset the pain and suffering they are so helpless to cure? Physicians need freedom to cry with patients, to hug them and cradle them in their arms, and to receive the same care in return. Human communication without this exchange of love is phony. It is painful to be a fake.” (Adams, P.,
Gesundheit!, Rochester,VT, Healing Arts Press, 1993)

I think Sally came to my office because she heard me speak at her office and I spoke directly to this point. We are bringing back the doctor patient relationship as a healing modality all of itself. All too often I hear patients complaining they weren’t heard or worse yet, they were told this is as good as they are going to get and they will have to accept their
pain.

Kate, a brain injury patient, was just one of those patients. She came to my clinic on anti-depressants, pain medications and searching for another opinion. She was in counseling with her long-term partner after her accident. Her physicians had told her they had done all they could for her. She was left depressed, on oxycontin, medicated and frustrated that after almost two years of therapy she hadn’t really progressed.

Another way of looking at suffering and meaning is presented by Viktor Frankl. He founded the logotherapy school of psychoanalysis. Logotherapy is based on the belief that it is the striving to find a meaning in one’s life that is the primary, most powerful motivating and driving force in humans.This framework is very helpful when dealing with patients in chronic and debilitating pain.

A short introduction to logotherapy is given in Frankl’s most famous book, Man’s Search for Meaning, in which he outlines how his theories helped him to survive his Holocaust experience and how that experience further developed and reinforced his theories. He concludes there are three ways one can discover a meaning to life:

• By creating a work or doing a deed.
• By experiencing something or encountering someone.
• By the attitude we take toward unavoidable suffering.

We are exploring the third potential here, facing a fate that cannot be changed.

Frankl says, “For what matters is to bear witness to the uniquely human potential at its best, which is to transform personal tragedy into a triumph, to turn one’s predicament into a human achievement.” When we are faced with an incurable condition, we are challenged to change ourselves.

Edith Weisskoph-Joelson, a logotherapy practitioner, says, “Our current mental-hygiene philosophy stresses the idea that people ought to be happy, that unhappiness is a symptom of maladjustment. Such a value system might be responsible for the fact that the burden of unavoidable unhappiness is increased by unhappiness about being unhappy.” She goes on to conclude that logotherapy “may help counteract certain unhealthy trends in the present day culture of the United States, where the incurable sufferer is given very little opportunity to be proud of his suffering and to con- sider it ennobling rather than degrading,” so that “he is not only unhappy, but also ashamed of being unhappy.”

More treatment options

4882443718_e389501a6eSo let’s return to our original question: how to motivate patients in chronic pain? First we look to reframe the process, and then we explore whether the condition is really incurable or recalcitrant to treatment. The current western medicine approach is to prescribe heavier and heavier narcotics for the person in chronic pain, and to prescribe pain management classes on how they are to cope with their current situation. These medications often times are highly addictive, which poses its own set of issues.

As a result, patients oftentimes lose hope of improving and are left to suffer. Unfortunately, many physicians and patients themselves don’t realize they have options that have never been explored. We see a lot of chronic pain sufferers improve with our treatments. Often, the options are not known or there is a bias against more natural treatment options.

I often hear physicians telling their patients that there is not enough research to support even trying the options. While I agree there could be more research on all therapies done today (this includes many allopathic treatments as well, as only 12% of western therapies have adequate research), it is still worth trying them, as they MAY be beneficial.

Sally, with her debilitating arthritis, had accepted her path of suffering. Fortunately I had the opportunity to speak with her. I offered to treat her for four visits to see how she would respond to acupuncture. Through a four-day report of findings, I see how someone responds to treatment. In Sally’s case, she got great relief from her pain, more mobility in her joints and better quality sleep. She responded well to acupuncture.

From there we set up a treatment plan in which we used Chinese herbs and enzyme therapy to reduce inflammation naturally and break up fibrinogen adhesions. We also treated her as a whole person, not just a chronic pain patient or someone with fibromyalgia.

Sally is a success story. Two years later she is still pain free, only needing occasional tune-ups.

What’s best for the patient

A lot of times patients think they can’t talk with their medical doctor about their naturopathic doctors. They feel they are “cheating” on the medical doctor. When I hear this, I tell them that my goal is patient-centered care, and their MD’s goal should be the same. Patient-centered care is the best care on the planet, since it involves all health care models working for the patient to get the person the best outcome possible.

I have seen patients with chronic knee pain for 14 years finally try acupuncture, and with a short course, all of their pain was resolved. I have seen patients who suffered needlessly after motor vehicle accidents because all they were given were pain medications and muscle relaxants after their accident.

Twenty years later they come to our office saying, “You know, I’ve never been well since that car accident.” All too often this is the result of under-treatment, and masking of symptoms, without addressing the underlying dysfunction.

I recently saw Kate after about a year of her intensive treatment at the clinic. She remembered how she was when she arrived at our clinic and thanked me for the work we do. She was able to get off all of the drugs she was on. Her pain resolved. She exhibited none of the anxiety or other effects from the brain trauma she had when she first arrived. Her previous team of physicians had all but left her, but she had more healing to do.

Will we be able to help everyone? Of course not. I am a realist and don’t give false hope, but by not trying we are not helping anyone. I always say to patients that we MIGHT be able to help relieve their suffering, and that everyone responds differently to treatment. Everyone arrives at our office with their own genetic background, their own story of trauma.We treat individuals, not pathology.

What we offer with our style of treatment are providers who will not give up on their patients. I have a patient, Amy, for whom we haven’t been able to reach the big breakthrough. We have done several rounds of acupuncture, different pain reducing IV therapies, diet therapy, supplements, medications, manipulations, neurological relief technique and cranio-sacral therapy, to name just a few. She has been struggling from a low impact motor vehicle accident.

The IME called her a liar. She has been in and out of depression. We have been working on reframing her experience with her. Allowing her to have the pain, but also knowing that she can choose what she does with her situation.

For my western medicine counterparts, one of the frustrating things about
naturopaths is that we don’t have set protocols for conditions. I could have ten chronic pain patients in my office and could develop 12 different treatment plans to help resolve their issues.

Multiple treatment plans

The treatments I use include acupuncture, physical medicine such as manipulation and massage, and physiotherapy (use of interferential and ultrasound). Another options is therapeutic injections, which is discussed in more detail later in this article.

The hierarchies of treatments start with the least invasive. We begin with diet therapy (anti-inflammatory in nature), then move on to acupuncture and Chinese herbs, manipulation and massage (to work on nerve communication and regulation of the body, as well as lymphatic/blood flow), nutraceuticals such as turmeric (natural anti-inflammatory), enzymes to change the terrain and fibrous adhesions of inflammation, and essential fatty acids (such as omega-3’s).

All these treatments work on changing the inflammatory cascade. For pain treatment, we begin by working on the diet. That is where the nutrients that flow in the blood come from. If someone is missing the building blocks for their body to heal — whether it’s protein, complex carbohydrates, or essential fatty acids — it doesn’t matter what therapy we use for the individual, they won’t get better. For the first few years of my practice I didn’t address my patients’ diets. Because of that, my patients and I didn’t get the results we are getting today.

Nutrition is crucial to the body’s ability to heal itself. I have seen patients with chronic back pain, whom we adjusted week in and week out with pain returning. When we finally started to work on diet, they were holding their adjustments much longer to the point of total rehabilitation — without any back pain at all.

When addressing diet, I often hear “it’s too hard,” or “I don’t want my diet addressed.” I clearly remember when one of the first patients I saw, Jocelyn, told me she would not give up peanut butter, because it was her favorite food. She also had chronic headaches and back pain.

We did an elimination diet and her symptoms improved, actually went away. She had struggled with these symptoms for 20 years. She was at a party and there was a tray of peanut butter cookies. Of course she had one (well maybe two). When she next came to the clinic she announced she would not be eating peanut butter anymore because the symptoms she experienced were just not worth it!

Results equal motivation

Everyone has choices. I find that when patients remove their obstacles to health and begin to see results, they are very motivated to make changes. Our goal is not to have everyone eat like a monk in Sichuan province. We want to make sustainable and very doable treatment plans. Small steps are all it takes to rule diet out as the root of disease in the patient. Food is ultimately our best medicine.

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For pain, Chinese medicine is another front line therapy. The therapies have been well researched, and it is easy to see if it’s beneficial for someone in pain — either they feel different with treatment or they don’t.

Acupuncture  works on blood flow. The healing properties of the body travel in the blood. Oxygen, vitamins and nutrients flow into the cell as waste products, and carbon dioxide flows out. Acupuncture works by increasing or decreasing the blood flow to certain areas of body.

When the first steps in pain treatment don’t get results, we move onto trigger point injection therapy and prolotherapy. Trigger point injection therapy works by releasing chronically spasmed muscles.

Janet Travell described the process in her monumental book, The Trigger Point Manual, which she wrote in 1983. Trigger point injections work by getting the muscle spasm to release and relax, taking the spasm off the nerve and thus relieving the pain.

Prolotherapy treatment is useful for many different types of musculoskeletal pain, including arthritis, back pain, neck pain, fibromyalgia, sports injuries, unresolved whiplash injuries, carpal tunnel syndrome, chronic tendonitis, partially torn tendons, ligaments and cartilage, degenerated or herniated discs, TMJ and sciatica. Prolotherapy uses a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in the weak areas, which then increases the blood supply and flow of nutrients, and stimulates the tissue to repair itself.

Working together for results

In my experience, the natural approach coupled with traditional pain management tends to give the best results for patients. While not always resolving the issue, this patient-centered care can help provide a practitioner who will look for and exhaust all options. Naturopathic doctors and Chinese medicine practitioners are caregivers who listen to the patient and use techniques and counseling that can help motivate the patient.

Images courtesy Martin Kingsley, Ramberg Media ImagesThunderchild

Health Savings Account: Use it or Lose it

     Well it’s that time of year again.  We are in the final countdown to years end (I can’t believe we are in November already!)  with all kinds of healthcare changes.  Perhaps you’ve met your deductible, your out of pocket max or you have a flex spending or health savings account that doesn’t roll over.  Now is the time to take care of your health (and use those dollars you have put aside for yourself).

     We are heading into the dark months and the holidays, now is the time to get ahead of the game.  Come in and get your health evaluated, get a plan to keep the holiday weight off, get established on an exercise plan, get your blood work evaluated, you get the picture, come in!

As I’m sure you’ve read, we have welcomed Sarieah Macdonald, CNM into our practice.  I am really excited to be offering truly integrative care.  I’ve always talked about patient centered care, were east meets west, we’ve got it all under one roof here at Nature Cures!

With the holidays approaching the office will be closed on Thanksgiving and the day after, additionally we will be closed Wednesday December 25th through Tuesday January 2nd.  We have a lot in store for you in this next year, why not get started now.  Come in and use it or lose it, deductibles renew next year, get that work done now.

Come in for a complimentary consult and discuss what your health concerns or goals are and let’s see if what we do may be helpful for you and your health concern!

 

 

Resolutions Need a Boost? Choose Integrative Health Care at Nature Cures Clinic!

 

2646438199_b309cffd65Isn’t it crazy how fast time seems to pass?  Summer is here then gone – fall and winter blend together and before you know it there are buds coming out on the trees and spring is here!  We think we have all the time in the world because we have 6 months stretched out before us, and then – poof! – it’s gone.  It’s something to think about when you have a summer event coming up that you want to look and feel your best for…say a family reunion? Or a wedding?  Your good health and vibrancy is often a progressive endeavor and to do it right requires desire, discipline and most importantly – time.   The most common cause of stress for people is toxicity in the body.  Environmental pollutants, food allergies, pharmaceutical meds and even too many unnecessary supplements can create significant imbalance in the body resulting in hormone imbalance, brain fog, fatigue, irritability and overall lack of feeling good.  Most of us have experienced these symptoms and have had the thought “I should feel better than this” or commonly “I’m way too young to feel this way.”

You’re right!  And we can help!  But you have to decide to start….

How to start? We recommend that everyone do a supervised liver detoxification at least twice a year. Incorporating Infrared Sauna therapy is a fabulous addition to any detox as a way to remove heavy metals from the body – one of the most effective and pleasant ways to do this!  Further, If you haven’t taken the time to find out what potential food allergies you have then we recommend that as a vital part of any comprehensive detox and weight loss program.  Food intolerance is a major source of imbalance and consequent weight gain – this information is so important!

Finally – and very importantly – you need to know where your opportunities are at the beginning.  Having a thorough health exam by a primary care practitioner should be your number one priority!  We offer a truly integrative health care service by having our own Certified Nurse Midwife in the clinic, Sarieah Macdonald, who will provide you with the foundation of knowledge you need in order to take charge of your health.  If you haven’t been in for awhile or haven’t had blood work, now is the time to schedule in with your provider, we’d love to see you and continue to ensure you are maintaining at optimal wellness.

Building a Supportive Network for Those with Post-Traumatic Brain Injury (TBI)

Often I see patients suffering from post-concussive and post-TBI syndromes that have been told by their physicians that there’s nothing more they can do.  One or two years have passed, and their chronic condition is just something they should accept and learn to live with.

I’m offering a different message.  CONTINUE FOCUSSING ON THE HEALING!!  There are many ways to support your nervous system and improve brain function.  Some of my best results have come with patients that are two plus years post-injury.

The brain is constantly reorganizing and regenerating the terrain.  Think of a map where city lines are defined by activity, business, and the amount of people moving into the area.  If a city like Portland, Oregon is desirable, people move there and the city grows.  As a result it takes up more space on the map.  The brain works in a similar way.  What you focus on, your daily activities and repetitive movements and thoughts, all define your brain map.  If you are focussing on specific exercises that generate more balance, more cross-hemispheric integration, the brain will respond by appropriating more space for these functions.  As a result these skills improve.

There are other factors affecting this growth process.  Just like a growing city, the brain must have the building blocks necessary to create the infrastructure for growth.  That is why you must include NUTRITION as part of a brain-restorative program.  The combination of FOCUS and ATTENTION together with the right balance of NUTRIENTS results in the restoration of FUNCTION.

If you are not seeing restoration of function, then continue looking for guidance in your rehabilitation process.

Here at Nature Cures Clinic, in downtown Portland, we have an extensive Brain Recovery Program involving many modules of care, including nutrition, acupuncture, IV nutrient support and Qi Gong.  I’m seeing excellent results with patients immediately after injury as well as with chronic recalcitrant cases of post TBI and post concussive syndrome.  Acupuncture provides relief for pain, muscle spasticity, mood disorders, and insomnia.  Qi Gong offers movement exercises to generate better balance and cross-hemispheric integration.  IV nutrition allows us to bring therapeutic doses of antioxidants and metabolic support directly to the brain to assure it has the building blocks for growth and healing of neurons.

My hope is that more people with traumatic brain injury (TBI) know about these options for recovery.

I’m currently building a network of practitioners in the Portland area dedicated to generating more awareness of rehabilitation options for patients with TBI.   Practitioners, please contact me to discuss a cross-referral network in the greater Portland area.

Needles in my ears!?

Most of my patients know that I am a fan of auricular acupuncture – needling acupuncture points in the ear.  Many have squirmed when told that I’m heading for their ears next.  “My ears?!  But I don’t have any ear problems.”  Well rest assured, dear patients, there IS a method to my madness.  Auricular points are used for far more than treating ear problems.  Like the hand or foot in traditional reflexology, the ear is a microsystem representing your entire body.  There are points on your ears for everything, from your neck and back, to your liver and heart.  There are even a few points for your ears on your ears!

We in the needle poking biz view the ear as an upside down fetus.  The head is imaged on the earlobe, with the spine extending up the curve of the ear.  The number of auricular points and exact imaging varies slightly between acupuncture styles, but all in all, the inverted fetus reference is widely accepted.  Because the entire body is represented on the ear, ear points provide an effective way to treat areas that may be difficult to access, depending on a patient’s position or mobility.  They are also ideal when the area you’re targeting is too sensitive to needle directly, such as a surgery site or fracture.  In fact, there are practitioners who successfully treat their patients needling ONLY  ear points.  And here’s a fun fact:  The “eye point”, located in the center of the earlobe, happens to be the point traditionally pierced for earrings, and rumor has it, that is not a coincidence.  Pirates began piercing that point long ago to improve their vision when scanning the horizon for land or ships.  It seems that even the sea bandits were microsystem- savvy!

In addition to needling auricular points, applying ear seeds, or beads, to the points is another powerful way to treat the body.  The seeds vary in style from actual plant seeds to tiny metal beads, which are taped over specific points.  The tape provides enough pressure to maintain light acupressure on the selected points, and to enhance their effect, I teach patients how to squeeze the seeds for stronger stimulation when needed.  They can be left in for 1-2 weeks at a times, and allow for treatment to continue long after leaving the clinic.

I find auricular acupuncture to be as fascinating as it is effective.  Who’d have guessed that you can relieve hip pain by squeezing your ear!  So the next time I’m poking around in your ear, ask me what point I’m needling.  You may be surprised to find that you will feel changes in the related area of your body.

 

 

 

 

Making Changes

I used to work at a gym.  Checking people in, passing out towels, making small talk.  January at the gym was fascinating.  Membership instantly quadrupled, as folks catapulted themselves into their New Year’s fitness resolutions.  Endless lines formed for the cardio machines.  Yogis wrestled for mat space in surprisingly unZen-like fashion.  Fat burners and protein powder flew off the shelves and personal trainers packed their schedules.

4457047403_cf2709a179But by mid February, the “resolutionaries” quietly dissipated.  Part of me was relieved to see the crowds thin, but a bigger part was sad, knowing that most of those who had stopped coming had given up the ghost.  I don’t think they quit for lack of want, but rather support.  When real life began to overshadow their fragile new routines, they didn’t have the backing to encourage them along, offer guidance and ease the discomfort that often accompanies change.

Now, as a care provider, I have the privilege of helping others make changes, both big and small, to improve their wellbeing.  Take the standard goal of dropping a few pounds.  Most people wanting to lose weight are battling food cravings and low energy.  Acupuncture and Chinese herbs work wonders for improving digestion and reducing stress — two key players when battling cravings.  And that sluggish, foggy-headed, heavy-limbed feeling that’s been interfering with your hopes of working out?  That’s a perfect example of “qi stagnation.”

Our “qi”, or “chi”, is the vital energy flowing through our body.  It makes our heart beat and our synapses fire.  When our qi gets bogged down and begins to stagnate, we feel it everywhere.  We lose our pep, that spring in our step and gleam in our eye.  Digestion becomes less efficient, focus and clarity wanes, and we find ourselves sinking into the couch with a bowl of ice cream, instead of hitting the gym.

Acupuncture assists our qi in flowing smoothly again.  Prodding it along, until eventually it resumes a balanced, healthy pace, and that foggy feeling begins to lift.

A cleanse is another killer means of boosting your energy, metabolism and spirits.  What better way to kick off the New Year, than by detoxing all of the crud you accumulated in 2010.  While a cleanse may be intimidating to do on your own, consider having a support team to guide you through the process.   With your help, we’ll formulate a plan to ensure that the process suites your lifestyle.  We’ll work to minimize detox side effects, such as hunger and low energy, and enhance your body’s cleansing abilities.  As a practitioner, few things are more exciting than watching a patient on a cleanse.  The effects are visible.  Bloating melts away, the skin begins to glow, energy peaks, your eyes dramatically brighten.  With a little planning, acupuncture, nutritional support, and cheerleading, you’ll be popping out of bed with newfound energy, and bypassing the coffee and pastries without a second thought.

Long story short, enlisting a support team is the most effective way to ensure that your goals are attained.  Share your plans with others, so that you’ll be held accountable for your actions.  Plan ahead.  When you foresee irritability, withdrawal headaches or sleeplessness in your future, get some acupuncture treatments on the books.  When your legs get achy from covering those miles, get a massage.

All in all, there are plenty of ways to spoil yourself and maintain momentum as you make a change for the better.  So whether you made an official New Year’s resolution or not, take this time to focus on your wellbeing, realize your body’s potential, and know that you’re not in it alone.

 

image courtesy lululemon athletica

Summer First Aid: Nature Cures HealthChat Podcast

Summer First Aid podcast
Dr. Greg Eckel give you some ideas and tips for dealing with bumps, bruises, scrapes, and sunburns during the active summer months, and give you a list of things to include in your summer first aid kit. View the video version of this podcast at the Nature Cures Clinic video page.

Over Prescribed, Record Broken

I have a running record that you don’t want to break. Previous record was a person on 26 different daily medications, which I thought was outrageous. Then it happened at the Diabetes Expo in Portland, Oregon. A woman sat down and pulled out her list of medications. 33. She is on 33 medications a day. I looked at her, looked at the list, looked at her symptoms she had checked off a list of stress survey, and wanted to scream. Modern medicine is failing her. This can’t be what we are hoping Americans have access to. I am hoping patients can explore their options and try Chinese medicine, acupuncture, and naturopathic medicine as they might be able to help at the very least reduce the amount of medication they are on, at best help them correct the underlying imbalance and thrive. Continue reading “Over Prescribed, Record Broken”

The Naturopathic Approach to Back Pain

Listen to the Back Pain Podcast

In this podcast, Dr. Eckel and Dr. Nigh address back pain, an issue that affects an estimated 85 percent of all people at some point in their lives.  Find out what the naturopathic approach to treating back pain is.  Dr. Nigh also challenges you to undergo a test that could surprisingly get rid of many symptoms you may have going on, aside from just back pain.  It’ll be the cheapest medical test you’ll ever undergo.  And it tastes good.

The Healing Art of Chinese Medicine

Listen to The Healing Art of Chinese Medicine

In this podcast, Portland naturopathic doctor, Dr. Greg Eckel alk about the psychological ties to illness, which is a major component to the healing art of Chinese medicine.  They discuss the specific relationships between human emotions and organs of the body, explaining how correcting imbalances in these organs can address psychological symptoms that patients maybe exhibiting.

Tainted Flu Vaccines

Chiron Corp., maker of flu vaccines, has found that about 4 million of the 50 million doses of vaccine it has produced are “tainted.” While it is never stated exactly what the vaccines are tainted with, a vice president of the company made an ironic statement regarding the problem: “We are confident that we’ve identified the root cause.”

The pharmaceutical makers will spend millions of dollars and go to enormous lengths to identify the “root cause” of contamination of their products. However, there is absolutely no focus at all in examining the “root cause” of influenza itself. Continue reading “Tainted Flu Vaccines”