Hyperbaric Oxygen Therapy for Pain

Feature Image sourced from:

https://pixabay.com/en/diving-air-oxygen-kringel-air-ring-378214/

Dear Pain Matters blog readers,

INTRODUCTION

Hyperbaric oxygen therapy (HBOT) involves the delivery of 100% oxygen at increased atmospheric pressures inside a pressure chamber.

Pressures greater than normal air pressure (i.e. 1 Atmosphere Absolute, or 1 ATA) may be offered by trained personnel.  Many patients are exposed to 2 to 2.4 ATA per session.  Each session may last 1.5 to 2 hours and patients may complete a total of 20 to 30 HBOT sessions.

For those of you who have scuba dived, free dived or snorkelled, 2 ATA is the pressure that one would feel 10 meters (33 feet) under the ocean.  Thus, every 10 meters (33 feet) of sea water is equivalent to an increase of 1 ATA of pressure.

http://www.vhbo2.com/companion/hyperbaric-oxygen-therapy/understanding-hbot/

Source:

https://media.gettyimages.com/photos/students-breath-oxygen-in-a-hyperbaric-oxygen-chamber-to-help-relax-picture-id88232418?k=6&m=88232418&s=612×612&w=0&h=tCQk-S4brc2Dv7E9mF5XGVPp-USamsbrQgspKAf_agE=

Also called hyperbaric medicine or hyperbaric treatment, HBOT can increase oxygen concentration, reduce inflammation and decrease the number and sensitivity of tender and painful points.

This is a cute 2-minute video of a dog inside a pressure chamber (with great background music):

Hyperbaric oxygen therapy can alleviate chronic pain in:

• Complex regional pain syndrome;
• Fibromyalgia;
• Myofascial pain syndrome;
• Idiopathic trigeminal neuralgia;
• Migraines and cluster headaches; and
• Other pain conditions (Yildiz et al, 2006; Yildiz et al, 2006; Efrati et al, 2015)

as well as reduce pain following crush injuries.

PAINFUL CONDITIONS TREATED BY HYPERBARIC OXYGEN THERAPY

LOWER LIMB COMPLEX REGIONAL PAIN SYNDROME (CASE 1) 

A 41-year old man, ‘G.G.’, suffered from Complex Regional Pain Syndrome Type 2 (CRPS Type 2), left foot, caused by a traumatic ‘Weber B’ left ankle fracture that occurred more than a year ago on 21 February 2014.  Specifically, G.G. slipped and fell on ice in a parking lot at the end of a working day.  He immediately suffered severe pain in his left ankle and foot.

Two days later, on 23 February 2014, G.G. had surgery involving open reduction internal fixation of his ankle.  Complications set in including a cellulitis infection that was treated with antibiotics.

Post-surgery, G.G. endured ongoing and severe pain including intermittent shooting pains and severe electric shocks in his left ankle and foot.  Other symptoms included allodynia, swelling, temperature changes and discoloured skin in the left lower limb.

Despite undergoing a rehabilitation program and taking pain medication including pregabalin (75 mg twice daily), acetaminophen and NSAIDs (as needed), multivitamins, calcium, magnesium and glucosamine, G.G.’s severe pain persisted.

A diagnosis of CRPS, left foot, was made in April 2014.

On 5 February 2015, almost one year after his injury, G.G. had surgery to remove the plateau in his left lower limb in an effort to relieve his pain.  Sadly, G.G.’s symptoms including pain and allodynia, swelling, purple discolouration, lower skin temperature as well as muscle weakness in his left lower leg and ankle continued.  With average pain levels at 6 that often rose to 8, G.G. described his pain as (quoting) ‘constant, dull, aching pain with intermittent shooting sensations’.   

Desperate for some pain relief, G.G. decided to try HBOT for his CRPS in his left foot.

After 15 HBOT sessions over 3 weeks, G.G. had significantly less pain and allodynia, reduced swelling, enhanced skin colour and improved range of motion in his left foot.  Following 3 weeks of HBOT, G.G. was able to return to work after more than a year off due to severe left foot pain.

Hyperbaric oxygen therapy may be a valuable therapeutic option for treating chronic CRPS (Katznelson, 2016).

LOWER LIMB COMPLEX REGIONAL PAIN SYNDROME (CASE 2)

A 44-year old woman had CRPS, left foot and ankle.  Her foot and ankle had restricted range of motion, appeared cyanotic and was tender and cool upon touch.

Within only 15 minutes of her first HBOT treatment, she enjoyed complete pain relief in her foot!  Furthermore, her foot felt warm on palpation and (quoting her) ‘pinker than it’s been in years’.  The foot remained pink and warm for 8 hours.  Best of all, she enjoyed nil pain for 18 hours after her first HBOT treatment!

Following amendments to her second HBOT session on the following day, her foot became pink and warm for 1 hour as well as painless for 2 hours.

Further adjustments made to her third HBOT protocol in the following week resulted in her foot remaining painless, warm and pink for 30 hours (!) (Peach, 1995).

COMPLEX REGIONAL PAIN SYNDROME

A double-blind, randomized, placebo-controlled study compared 37 CRPS patients who had HBOT treatment against 34 CRPS patients who received normal air (Control Group).  All 71 CRPS patients underwent 15 sessions inside a hyperbaric chamber.

The HBOT-treated patients enjoyed significantly less pain and edema as well as enhanced range of motion of the wrist. 

Hyperbaric oxygen therapy may offer pain relief, decreased swelling and improved range of motion in CRPS patients (Kiralp et al, 2004).

FIBROMYALGIA

A study involving 60 women aged 21 to 67 who suffered fibromyalgia for more than 2 years underwent 40 HBOT sessions.  These 90-minute sessions were offered 5 days a week and each session involved 100% oxygen at 2 ATA.  Hyperbaric oxygen therapy led to significant improvement in all fibromyalgia symptoms including improved quality of life (Efrati et al, 2015).

MYOFASCIAL PAIN SYNDROME

A study evaluated the effects of HBOT on 20 patients with myofascial pain syndrome (MPS) compared to 10 patients in the control group.  The patients in the HBOT group were offered 10 HBOT sessions over 2 weeks.

There were no complications following hyperbaric oxygen therapy.  The pain threshold was significantly improved as were visual analogue scale (VAS) scores in patients in the HBOT group.  

The researchers concluded that HBOT may offer benefits for patients with MPS (Kiralp et al, 2009).

IDIOPATHIC TRIGEMINAL NEURALGIA

Patients with severe nerve facial pain (i.e. idiopathic trigeminal neuralgia) were offered HBOT sessions for 10 consecutive days.  Specifically, 42 patients aged 40 to 70 (8 men, 34 women) who suffered trigeminal neuralgia for 2 to 20 years were selected for this study.

The researchers concluded that HBOT treatment offered quick, dose-dependent and lasting pain relief.  Thus, HBOT may be an effective treatment for some nerve pain conditions including trigeminal neuralgia (Gu et al, 2012).

MIGRAINES 

Female migraine sufferers were offered either:

• 100% oxygen and nil pressure (control group); or
• Hyperbaric oxygen therapy comprising 100% oxygen and pressure.

The HBOT-treated migraineurs enjoyed some pain relief.  Pain levels remained unchanged in the control group.  

Hyperbaric oxygen therapy may reduce the intensity of migraines and headaches (Wilson et al, 1998).

CRUSH INJURY

Due to their traumatic nature, crush injuries can result in severe injury and pain to various body regions.  Crush injuries can range from minor contusions to limbs facing amputation due to tissue necrosis.

Crush injuries may affect different tissue regions including skin, subcutaneous layers, muscle, tendons, ligaments, cartilage, vasculature including capilliaries, nerves, bones and joints.  Physical trauma can lead to prolonged swelling and edema, stasis and/or internal bleeding including bleeding within myofascial envelopes.  The latter may lead to increased tissue fluid pressure in the skeletal muscle compartment.

Affected tissues may become ischemic due to hypoxia if the tissue fluid pressure (edema) exceeds the capillary perfusion pressure to the muscles and nerves inside the skeletal muscle compartment.

Ongoing edema may result in increased pressure as well as severely compromised microcirculation and limited or nil oxygen transfer across the capillary endothelium.  This may ultimately lead to ischemia and hypoxia.

Complex regional pain syndrome, skeletal muscle compartment syndrome and other painful conditions may develop and/or limb amputation may occur if urgent and effective treatment to prevent hypoxia and ischemia following crush injury is not provided.

Thus, time is of the essence that appropriate treatments are undertaken to reduce localised inflammation and swelling.

Importantly, hyperbaric oxygen may be used as an adjunct treatment to reverse ischemic and hypoxic conditions in crush injuries.  

https://www.uhms.org/4-crush-injury-compartment-syndrome-and-other-acute-traumatic-ischemias.html

WHY MIGHT HYPERBARIC OXYGEN THERAPY WORK?

Note:  This section is written for scientifically-minded readers, and may be skipped altogether by others who may not be so inclined. 

Animal research shows that HBOT blocks the production of tumor necrosis factor (TNF)-α in rats with chronic constriction injury.  Reduced TNF-α levels may lead to decreased nerve pain (Li et al, 2011).  Local overproduction of TNF-α, on the other hand, may play a role in promoting CRPS (Walker and Drummond, 2011).

Many chronic pain conditions include an inflammatory component that may lead to tissue hypoxia, ischemia and microvascular deficits (i.e. inflammatory hypoxia).  Re-oxygenation of injured or diseased tissues is a prerequisite before regeneration can occur.  Therapies such as HBOT may promote tissue re-oxygenation, reversal of inflammatory hypoxia and regeneration (Perdrizet, 2017) that may lead to pain relief.

Ten divers (9 males, 1 female) underwent pressures of 1, 2, 3 and 4 ATA in a supine position for 10 minutes per pressure in a hyperbaric chamber.  The Spanish study found that as the pressure increased, heart rate (HR) decreased and heart rate variability (HRV) moved into the high frequency range, especially after 2, 3 and 4 ATA.  Pressure-evoked increased HRV is indicative of enhanced parasympathetic (vagal) activity  (Barbosa et al, 2010).  Increased parasympathetic activity including enhanced vagal tone may lead to reduced pain, decreased inflammation and other medical benefits (Walker and Drummond, 2011).

Researchers recently suggested that nerve cells may actually communicate via mechanical pulses instead of electric pulses (Fox, 2018).  If true, is it possible that increased atmospheric pressures via HBOT inside a pressure chamber may lead to increased mechanical pulses?  If so, could this result in increased cutaneous sympathetic vasoconstrictor activity?  If yes, could this induce tissue re-oxygenation and reversal of inflammatory hypoxia in some pain patients including CRPS patients?  Research is warranted.

SUMMARY

Hyperbaric oxygen therapy may offer pain relief for some pain patients.

Please ensure that HBOT is done under medical supervision only and by trained personnel.  Refer to References for complications that may arise from HBOT. 

Sabina Walker

Blogger, Pain Matters (in WordPress)

PS Please feel free to share your personal experience with HBOT via this blog. 

REFERENCES

TEXTBOOK

(1) Undersea and Hyperbaric Medical Society (UHMS). Hyperbaric Oxygen Therapy Indications, Thirteenth Edition (April 2014).

ISBN 978-1930536-73-9

https://www.bestpub.com/books/hyperbaric-a-undersea-medicine/product/436-hyperbaric-oxygen-therapy-indications-thirteenth-edition/category_pathway-31.html

PAIN CONDITIONS TREATED BY HBOT

Complex Regional Pain Syndrome

(2A) Katznelson. Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy. Pain Research and Management (2016); Volume 2016, Article ID 3458371, 4 pages.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904619/

https://www.hindawi.com/journals/prm/2016/3458371/

(2B) Peach G. Hyperbaric oxygen and the reflex sympathetic dystrophy syndrome: a case report. Undersea Hyperb Med. 1995; 22(4): 407–8.

Click to access RSD-Case-Report.pdf

(2C) Kiralp et al. Effectiveness of hyperbaric oxygen therapy in the treatment of complex regional pain syndrome. J Int Med Res. (May-June 2004); 32(3): 258-62.

https://www.ncbi.nlm.nih.gov/pubmed/15174218

Fibromyalgia

(3) Efrati et al. Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome – Prospective Clinical Trial. PLoS ONE (26 May 2015); 10(5): e0127012.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127012

Myofascial Pain Syndrome

(4) Kiralp et al. A novel treatment modality for myofascial pain syndrome: hyperbaric oxygen therapy. J Natl Med Assoc. (Jan 2009); 101(1): 77-80.

https://www.ncbi.nlm.nih.gov/pubmed/19245076

Idiopathic Trigeminal Neuralgia

(5) Gu et al. Hyperbaric oxygen therapy attenuates neuropathic hyperalgesia in rats and idiopathic trigeminal neuralgia in patients. Eur J Pain. (2012); 16(8): 1094–105.

https://onlinelibrary.wiley.com/doi/epdf/10.1002/j.1532-2149.2012.00113.x

Migraines 

(6) Wilson JR, Foresman BH, Gamber RG, Wright T. Hyperbaric oxygen in the treatment of migraine with aura. Headache. 1998; 38(2): 112–5.

https://www.ncbi.nlm.nih.gov/pubmed/9529766

Crush Injury

(1) Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischemias. Undersea and Hyperbaric Medical Society (UHMS).

https://www.uhms.org/4-crush-injury-compartment-syndrome-and-other-acute-traumatic-ischemias.html

Other Pain Conditions

NB The following 2 papers are not discussed in this blog post:

(7A) Yildiz et al. Hyperbaric oxygen therapy in chronic pain management.  Curr Pain Headache Rep. (May 2006); 10(2): 95-100.

https://www.researchgate.net/publication/7238531_Hyperbaric_oxygen_therapy_in_chronic_pain_management

(7B) Yildiz et al. Pain management and hyperbaric oxygen therapy. Therapy (2006); 3(5): 597–603.

Click to access ae1e93f42de7371a28774221967dcf67fa0e.pdf

Possible Complications

(1) Complications of Hyperbaric Oxygen Treatment.  Johns Hopkins Medicine

https://www.hopkinsmedicine.org/healthlibrary/conditions/physical_medicine_and_rehabilitation/complications_of_hyperbaric_oxygen_treatment_134,148

Why Might Hyperbaric Oxygen Therapy Offer Pain Relief? 

(1) Li et al. Hyperbaric oxygenation therapy alleviates chronic constrictive injury-induced neuropathic pain and reduces tumor necrosis factor-alpha production. Anesth Analg. (Sept 2011); 113(3): 626-33.

https://www.ncbi.nlm.nih.gov/pubmed/21596875

(2) Perdrizet. Chronic Diseases as Barriers to Oxygen Delivery: A Unifying Hypothesis of Tissue Reoxygenation Therapy. Adv Exp Med Biol. (2017); 977: 15-20.

https://www.ncbi.nlm.nih.gov/pubmed/28685422

(3) Barbosa et al. Effect of hyperbaric pressure during scuba diving on autonomic modulation of the cardiac response: application of the continuous wavelet transform to the analysis of heart rate variability. Mil Med. (Jan 2010); 175(1): 61-4.

https://www.ncbi.nlm.nih.gov/pubmed/20108844

(4) Sabina Walker, Peter D. Drummond; Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome [Review Paper, 24 pages]; Pain Medicine (Dec 2011), 12 (12), 1784–1807.

http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01273.x/abstract

(5) Fox, Douglas. The Brain, Reimagined. Scientific American (April 2018); 318(4): 60-67.

http://www.nature.com/scientificamerican/journal/v318/n4/full/scientificamerican0418-60.html

 

Woohoo! Australia’s ‘One Girl’, Chantelle Baxter, Is Finally On The Road To Recovery From CRPS, Along With Other CRPS Patients, Thanks To Their Own Guardian Angel, Dr Katinka!

Source of Featured Image of Chantelle Baxter:

http://www.onegirl.org.au/about-us/our-awesome-team

Dear Pain Matters readers,

You may remember reading about Chantelle Baxter, co-founder of ‘One Girl’, in a previous blog post:

https://painmatters.wordpress.com/2017/04/23/one-girl-from-australia-named-chantelle-baxter-is-determined-not-to-let-crps-win/

The great news is that Chantelle has finally started to recover from CRPS following a 15-week treatment program recently completed at The Neurologic Relief Center, Arkansas, USA (headed by Dr. Katinka van der Merwe; links below).

While she looks forward to a FULL recovery from CRPS, Chantelle’s progress so far is nothing short of amazing!  None of this would have been possible without her own Guardian Angel, Dr Katinka van der Merwe!  I am very happy for Chantelle!!

Chantelle’s Own Guardian Angel, Dr Katinka van der Merwe

Growing up in South Africa in a chiropractic family and earning a Doctor of Chiropractic degree at the Parker College of Chiropractic, South Africa, in 1999, Dr van der Merwe DC QNP specializes in the treatment of chronic pain.  Her non-invasive approach focuses on rebalancing the autonomic nervous system, with particular emphasis on the vagus nerve.  Dr van der Merwe and her dedicated team have expertise in many non-invasive treatments including:

• Restoring tone to the vagus nerve (via gentle, hands-on upper cervical procedure by Dr Katinka);
• Frequency Specific Microcurrent (for reducing inflammation in the nerves as well as detoxification – see Sunday’s and Jennifer’s CRPS stories);
• Neuromuscular re-education – This helps the nervous system to ‘reconnect’ with skeletal muscles to restore proper mobility and break poor movement habits;
• Neurological/nerve rehabilitation;
• Bioenergetics synchronization technique;
• Functional medicine and neurology;
• Neurologic Relief Centers Technique (NRCT);
• Biologic medicine;
• Quantum Neurology; and
• Nutrition/personalized supplementation (based on genetic profiling).

These treatments are constantly reviewed and updated in order to improve success overall rates.

Two treatments are done within the first week to ensure the patient responds before admitting patients into the lengthy 10-week program.

Alexis’ Own Guardian Angel, Dr Katinka van der Merwe

Chantelle is not the only ‘Happy Camper’ after being cared for by Dr Katinka at The Neurologic Relief Center.

Alexis (18) has full-body CRPS that started in her left knee about a year ago.  Alexis received regular Ketamine treatment (1,200 mg) for her painful CRPS that persisted 24/7.  Ketamine helped bring her pain rating down from ’10+’ to ‘4’, albeit with many of the adverse effects of Ketamine.

Recently, Alexis also received treatment from Dr Katinka and her team.  With treatments including Ketamine and ‘Neuromuscular Re-Education’ (the latter done by Dr Katinka), Alexis’ pain rating dropped to ‘0’ for a week (thereafter, ‘2’).

Shortly before this interview was done, Alexis’ pain rating was ‘0’ (NIL.  ZILCH! NADA!!)!  And this occurred after only 4 ‘Neuromuscular Re-Education’ treatments!

For more details, please see this YouTube dated 4 June 2017 called ‘AlexisCRPS 1 1’:

https://www.youtube.com/watch?v=VQUqLXuXh90

Dr Katinka, all I can say is ‘Wow!  Congratulations for doing such a great job!!’

Some Other Amazing CRPS Patients Successfully Treated By Dr Katinka van der Merwe At The Neurologic Relief Center

(1) Barbara Wall’s CRPS Story – http://rsds.org/journey-back-health-rsd/

(2) Jennifer’s CRPS Story –

https://painmatters.wordpress.com/2017/06/28/the-wandering-nerve-and-crps/

Part 2/2 – https://www.youtube.com/watch?v=PLkqMzLv9Xw

Part 1/2 of Jennifer’s Story is in References.  NB Both YouTubes on Jennifer include some treatment details.

(3A) Sunday’s CRPS Story –

https://painmatters.wordpress.com/2017/06/20/frequency-specific-microcurrent-and-other-non-invasive-treatments-for-crps-by-dr-katinka/

https://m.youtube.com/watch?v=6oS-_tZRcmQ

https://www.youtube.com/watch?v=nf_3GoygF4s

(NB This YouTube includes a discussion of Frequency Specific Microcurrent.)

https://m.youtube.com/watch?v=Ddl-iXxpJDU

(4) David’s CRPS Story – https://www.youtube.com/watch?v=hWIaMBhcvA0&sns=em

NB This YouTube includes the patient’s description of Dr Katinka’s gentle hands-on treatment around the upper neck/below head region to activate his vagus nerve.  This targeted and non-invasive treatment to re-balance his autonomic nervous system during the first week of treatment led to rapid and COMPLETE pain relief for David.

(5) Debbie’s CRPS Story – https://www.youtube.com/watch?v=yxgG6RfcrRY

(6) Kristin’s CRPS Story – https://www.youtube.com/watch?v=ltc8fUKhmZM

(7) Madi’s CRPS Story – https://www.youtube.com/watch?v=IVqSGHwmf-E

(8) Scott’s CRPS Story – https://www.youtube.com/watch?v=3p1dOOHDuio

(9) Brock’s CRPS Story – https://www.youtube.com/watch?v=MU7ggYcdJO4

(10) Billi’s CRPS Story – https://www.youtube.com/watch?v=TpMSqe_aXk0

(11) Carlos’ CRPS Story –

Also, please see https://www.youtube.com/watch?v=tC_JyDfvexM&feature=youtu.be, http://rsds.org/new-approach-rsd-crps/ and http://seeingyouwell.com/testimonials/

(12) Brenda’s CRPS Story – http://seeingyouwell.com/testimonials/

(13) For many other CRPS success stories, please view:

https://www.facebook.com/TheNeurologicReliefCenter/?fref=mentions&pnref=stor

Summary

For Dr van der Merwe’s unique insights into CRPS, please click her following guest blog posts on the RSDSA website, particularly the first one:

(1A) Putting Out the Fire: A Brand New Approach to Treating RSD/CRPS (12 April 2016)

http://rsds.org/new-approach-rsd-crps/

(1B) The Myth of a Cure for CRPS (11 October 2016)

http://rsds.org/crps-cure-myth/

(2) The following is a fantastic YouTube called ‘What Do We Do?’ that explains Dr Katinka’s non-invasive treatments for CRPS (and fibromyalgia):

https://www.youtube.com/watch?v=3U6FE1jpmqU

(3) To help CRPS patients further, Dr. Katinka van der Merwe also wrote a book called ‘Putting Out The Fire – New Hope For RSD/CRPS’ (available in Amazon; links below).

I am soooo happy for Chantelle, Alexis and all the other CRPS patients successfully treated by Dr Katinka van der Merwe!  The list of Dr Katinka’s very happy CRPS patients just keeps growing and growing!!

Dr Katinka has literally given the lives back to the aforementioned, and many other, CRPS patients! 

Sabina Walker, Blogger

Pain Matters (in WordPress)

REFERENCES

(1A) Dr. Katinka van der Merwe. Putting Out The Fire – New Hope For RSD/CRPS (24 October 2016); 288 pages.

ISBN-10: 1534832645
ISBN-13: 978-1534832640

https://drkatinka.com/putting-out-the-fire/

(1B) Dr van der Merwe.  Putting Out The Fire (a 4-minute YouTube)

(1C) Dr Katinka’s website

https://drkatinka.com

(2) The Neurologic Relief Center, Arkansas, USA (headed by Dr. Katinka van der Merwe)

http://seeingyouwell.com/about-us/

https://www.facebook.com/TheNeurologicReliefCenter/?fref=mentions&pnref=stor

Neurologic Relief Centers Technique (NRCT)

http://www.nrc.md

(3) Additional YouTubes of CRPS Patients Successfully Treated By Dr Katinka van der Merwe At The Neurologic Relief Center

(3A) Jennifer’s CRPS Story (Part 1/2;  Part 2/2 is incorporated in this Blog Post, above.)

 

 

External Laser Therapy and Laserneedle Acupuncture for Chronic Pain

Featured Image:   Comb Jelly (Mnemiopsis sp.)

https://i.ytimg.com/vi/weeFO6kLu5o/maxresdefault.jpg

Dear Pain Matters blog readers,

External laser therapy is used to exert various biological/cellular effects in the body including:

• Stimulation of various acupuncture points (via noninvasive, painless Laserneedle acupuncture); and
• Treatment of local damaged areas within the tissue.  Local laser therapy may be done for pain management, rehabilitation and regeneration of damaged tissue.

External laser therapy uses various laser wavelengths (i.e. colours) to penetrate different depths and tissues beneath the skin including:

• Infrared laser (800 – 900 nanometers, ‘nm’; 810 nm, may be used) – 5 to 7 cm depth below the skin;
• Red laser (630 – 680 nm; 658 nm may be used) – 2 to 3 cm depth below the skin.  Red laser can increase cellular activity and blood circulation as well as stimulate immune cells, fibroblasts and mitochondria, leading to regeneration and improved healing including wound healing;
• Green laser  (532 nm) – 0.5 to 1 cm depth beneath the skin.  Green light is largely absorbed by haemoglobin in the red blood cells; and
• Blue laser (405 nm) – 1 to 2 mm depth only.  Blue laser light has anti-inflammatory effects.

External laser therapy can be applied via:

• Single point lasers.  Only one point and 1 wavelength can be used in single point lasers; or
• Laserneedles.  Up to 12 multi-channel lasers/points including different wavelengths/colours/power outputs may be used at the same time (e.g. Weberneedle system, Lasershower).

External laser therapy may treat various painful medical conditions including:

• Spine syndromes/back pain;
• Osteoarthritis;
• Rheumatoid diseases;
• Tendon inflammation;
• Migraine/headache; and
• Trigeminal neuralgia

(Michael Weber MD).

Source:   http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/external-laser-therapy/

Fibromyalgia:

A study involving laser acupuncture treatment for fibromyalgia patients reported an average Pain Scale of 4.4, post-laser acupuncture (compared to an average Pain Scale of 8.5, pre-laser acupuncture).

Further improvements occurred when laser acupuncture plus intravenous laser was offered to fibromyalgia patients (i.e. average Pain Scale of 2.9, post-laser acupuncture plus intravenous laser, compared to 8.9, pre-treatment).

Both:

• Laser acupuncture; and
• Laser acupuncture plus intravenous laser

were more effective for pain management than medication alone (6.8, post-medication, versus 8.7, pre-medication) and metal needle acupuncture (6.0, post-treatment, versus 8.5, pre-treatment) in fibromyalgia patients (Wieden).

(For more on intravenous laser, please refer to:
http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/intravenous-laser-therapy/.)

Possible Mechanisms:

I urge all interested readers to read Chapter 4 called ‘Rewiring a Brain with Light’, in Norman Doidge’s 2nd book, ‘The Brain’s Way of Healing’.  This book provides an excellent introduction into phototherapy (i.e. low level laser therapy; LLLT) (Doidge, 2016).  

Scientists have recently shown that humans (including the human eye and brain) may detect and perceive a single photon (Tinsley et al, 2016).  This is very interesting as it shows the sensitivity of the human body to the biological (hence potential healing) effects of natural light including its visible wavelengths from 400 to 700 nm (blue to red) and invisible wavelengths from 800 to 900 nm (near infrared).

Summary:

Whilst relatively new (and undergoing further research), external laser therapy and Laserneedle acupuncture may be useful for reducing pain in many chronic pain conditions including fibromyalgia.

Dear Pain Matters blog readers, if you would like to get in touch with Dr Michael Weber and his team, please email Martin Junggebauer on:

junggebauer@webermedical.com

Martin is an integral member of Dr Michael Weber’s team, and he will be sure to assist you with your enquiries.

http://www.dr-weber-laser-clinic.com/en/home/

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

(1A) Michael Weber MD

Laser in Pain Therapy and Rehabilitation

http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/pain-therapy-rehabilitation/

http://www.webermedical.com/en/the-business/dr-weber/

http://www.webermedical.com/en/weber-medical-for-professionals/the-principle/

(1B) Michael Weber MD, Robert Weber, Martin Junggebauer

Medical Low Level Laser Therapy – Foundations and Clinical Applications (2nd Edition, June 2015)

http://www.isla-laser.org/en/

(1C) Michael Weber MD, President of International Society for Medical Laser Applications (ISLA)

International Society for Medical Laser Applications (ISLA)

http://www.isla-laser.org/en/

(1D) Michael Weber MD, Thomas Fussgänger-May MD, Tillman Wolf MD

“Needles of Light”: A New Therapeutic Approach

Medical Acupuncture (2007); 19(3)

DOI: 10.1089/acu.2007.0539

http://www.my-dr.de/FG/texte/infounten/Publikationen/Medical_Acupuncture.pdf

(1E) Michael Weber MD, Zulia Frost MD

Multi-Laser Needle Acupuncture and Laser Blood Irradiation Therapy – Clinical Application of Biological Laser Therapy (Pages 1-50)

http://www.metgesacupuntors.org/resources/pdfs/congres_2009/17_30Z_Frost.pdf

Other Papers, Articles and a Blog by Fred Kahn, MD FRCS(C):

(2) Wieden, Torsten E. (MD Anaesthesiologist, Special pain therapy)

e-mail: wieden@schmerzpraxis-celle.de

Fibromyalgia in Pain Therapy – Mechanisms and Treatment Options in Laser Therapy

http://www.isla-laser.org/wp-content/uploads/Fibromyalgia-in-Pain-Therapy.pdf

(3) Pryor, Brian A

Class IV Laser Therapy – Interventional and Case Reports Confirm Positive Therapeutic Outcomes in Multiple Clinical Indications (2009)

http://www1.udel.edu/PT/PT%20Clinical%20Services/journalclub/caserounds/11-12/September/PryorLaserPromotional.pdf

(4) Class IV Laser Therapy – Case Study Reports (Pages 1-39)

http://www.madisonlasertherapy.com/uploads/6/4/3/2/6432749/class_iv_therapy_laser_case_studies_report_2013.pdf

(5) Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F, Ebner F.

Acupuncture Using Laser Needles Modulates Brain Function: First Evidence From Functional Transcranial Doppler Sonography and Functional Magnetic Resonance Imaging.

Lasers Med Sci. 2004;19(1):6-11.

DOI: 10.1007/s10103-004-0291-0

http://www.ncbi.nlm.nih.gov/pubmed/15316852

(6) Norman Doidge MD

The Brain’s Way of Healing – Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity (Chapter 4 – Rewiring a Brain with Light)

Publisher: Penguin Publishing Group (26 January 2016)

ISBN: 9780143128373

http://www.normandoidge.com/?page_id=1042

(7) Blog by Fred Kahn, MD FRCS(C), LLLT Specialist

http://fredkahnmd.com/2016/07/12/current-research-on-the-management-of-pain/

(8) Tinsley JN et al

Direct detection of a single photon by humans.

Nat. Commun. 7:12172

doi: 10.1038/ncomms12172 (2016).

http://www.nature.com/articles/ncomms12172

 

 

Can Sensory Deprivation via Float Therapy Offer Pain Relief for Fibromyalgia and Other Chronic Pain Conditions?

Featured Image (top) taken by Sabina Walker, author of this blog, Pain Matters.

(Yes, I was doing my own ‘float therapy’ in the ocean…and I captured the moment…)

Last year, I met a woman in her 50’s who had fibromyalgia.  I learned more about fibromyalgia from her than from any textbook.  She told me that ‘while she has to live with fibromyalgia, she refuses to let it define her life’.

As the conversation progressed, she told me something very fascinating.  She told me that the only time that she is ever completely free of pain was during float therapy.  In other words, she has nil pain during float therapy!  Isn’t that amazing?

I was amazed by this last bit of information from her.  I thought to myself, how can this be??

I asked her twice,

“So you have NO pain during float therapy?”

She restated, for the second time:

“Absolutely no pain during float therapy.”

I asked,

“How often do you do float therapy?”

She answered,

“Not often enough…I can’t afford to do it very often.”

Admittedly, I was saddened by the fact that it was the lack of finances that was blocking her access to a pain-free state.

What is Float Therapy?:

Since most people with chronic pain (e.g. fibromyalgia) do not live near a warm ocean (including the Dead Sea, the saltiest sea on earth), it may be worthwhile for them to try an isolation (floatation) tank filled with pleasantly warm, very salty water (e.g. Epson salt plus fresh water), surrounded by warm air, for 60-90 minutes instead.

Credit/Source of YouTube and Photo:

Float House (http://www.floathouse.ca) 

Wearing nothing except a ‘birthday suit’ and some earplugs (to block out all external noise) and floating effortlessly in warm, salty water in complete darkness in a tank enables the patient to focus only on the sounds of his/her own body including the sounds of the:

• Heartbeat;
• Breath; and
• GI tract.

Floating on an ‘aqueous mattress’ in pitch-black darkness in a warm and quiet tank can stop the brain from receiving its usual incoming stream of external sensory input including visual (from retinal stimuli), auditory and smell sensation.

Float therapy also leads to nil tactile sensation as the patient does not touch anything while floating.

Being surrounded by air and water that are both perfectly matched to skin temperatures (~34°C, or ~94°F) temporarily alleviates the need to thermoregulate.  This additional source of sensory deprivation results when the warm water no longer provides any sensory stimulation to the brain, and consequently, the brain no longer perceives a boundary between the skin/body and the water.

Sensory deprivation in a zero-gravity environment, due to the reduced demand on the brain to control muscles, is a temporary ‘detachment from all external chatter’ due to a complete loss of all sensation including even a ‘lost’ sense of gravity.  This deeply relaxing state enables the patient to focus on his/her inner self instead of continuously being distracted by external stimuli and stressors.

For many, sensory deprivation via float therapy offers an antidote to the many stresses of everyday life.  Studies show that float therapy can lead to reduced blood pressure and decreased stress hormone (cortisol) levels that persist even after cessation of float therapy.  Decreased anxiety and stress as well as reduced depression can result from float therapy.

Float therapy, where the patient sees and feels nothing (not even gravity), and hears only the sound of his/her body, can quickly facilitate a state of meditation (without even trying).  It can be a ‘shortcut’ to a meditative state for those who may find meditation difficult.

Justin Feinstein, Clinical Neuropsychologist at the Float Clinic and Research Center, Tulsa, Oklahoma, USA, prefers to use the term ‘sensory enhancement’ (instead of ‘sensory deprivation’).  An earlier researcher, Dr Roderick Borrie, preferred ‘REST’, or ‘Restricted Environmental Stimulation Therapy’.

For some people (including the woman I met who has fibromyalgia – see above), sensory deprivation via float therapy can lead to complete pain relief while relaxing in the floatation tank.

A Study on Float Therapy and Fibromyalgia:

Patients with fibromyalgia (n=81) participated in a study involving 3 float therapy sessions.  Many participants benefited from temporary reductions in pain, muscle tension, stress, anxiety and sadness.  Furthermore, the patients were significantly more relaxed and enjoyed a greater sense of well-being as well as increased energy, enhanced ease of movement and improved quality of sleep during each of the 3 float therapy sessions (Borrie et al, 2012).

Summary:

In addition to the woman living with fibromyalgia (described above), I wonder if other chronic pain including fibromyalgia patients may obtain pain relief from float therapy, and if so, which ones?  Research is warranted.

Fibromyalgia and other chronic pain sufferers are encouraged to try float therapy .  After all, there are nil side effects from float therapy other than a risk of claustrophobia or nausea.  In the event of discomfort, patients are welcome to leave the floatation tank at any time.

Sabina Walker

“Sedare dolorem divinum opus est”

“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

(1) Can Float Therapy Really Treat Stress?

Mandy Oaklander

TIME (27 July 2015)

(2) Floating Away: The Science of Sensory Deprivation Therapy

Shelly Fan

Discover Magazine (4 April 2014)

http://blogs.discovermagazine.com/crux/2014/04/04/floating-away-the-science-of-sensory-deprivation-therapy/#.V8jnBmX8f8s

(3) The Effects of Flotation REST on the Symptoms of Fibromyalgia

Roderick Borrie, Tamara Russell, Stefan Schneider

Presented 21 April 2012 at Float Summit 2012 in Gothenburg, Sweden

http://fibromyalgiaflotationproject.com/files/flotation-fibromyalgia-pilot-study-full.pdf

(4) More On Fibromyalgia 

Dr. Katinka van der Merwe. Taming the Beast: A Guide to Conquering Fibromyalgia (13 November 2013); 270 pages.

 

ISBN-10: 1491089903

ISBN-13: 978-1491089903

 

 

The Powers of Distraction – Virtual Reality and Chronic Pain

Dear Pain Matters blog readers,

Being a mom of a teenage boy, I know all about the ‘Powers of Distraction’ of a video game!

Awareness of time and space can completely vanish and your mind can literally be taken away ‘to another world far, far away’ during an immersive 3-dimensional (3-D) virtual reality (VR) experience.

Studies:

Dr Jones and his colleagues collaborated with DeepStreamVR to test a new VR program called “Cool!” (used with VR display goggles) that was specifically designed for chronic pain patients.  The “Cool!” program incorporates biofeedback components that promote mindfulness and resilience training.  Built-in biosensors facilitate a ‘flow state’ to control the intensity of the 3-D VR experience that in turn may maximise pain relief.

https://vimeo.com/201668399

Two (2) studies were performed:

1. The first study included 10 men and 20 women with chronic nonmalignant pain (median age = 50).  All were offered only one 5-minute VR treatment session.  Of these 30 patients, 9 had 100% pain relief (30%).  Average pain scores decreased by 33% ‘after the VR session‘, compared to ‘before‘, while average pain scores decreased by 60% ‘during the VR session‘, compared to ‘before‘.
2. The second study is still ongoing, and includes 7 patients with chronic nonmalignant neuropathic pain (median age = 50).  All 7 patients are offered three (3) 20-minute VR treatments.  Average pain scores decreased by 57% ‘after the first VR session‘, compared to ‘before‘, while average pain scores decreased by 75% ‘during the first VR session‘, compared to ‘before‘.

There were no side effects, and none of the patients experienced headache, nausea or dizziness during either of these 2 studies.  NB An older VR-based pain study noted a significant risk of ‘cyber-sickness’ during VR-based treatment.

Significantly, most of the patients experienced reduced pain that lasted anywhere from 2 to 48 hours, post-VR treatment.

Quoting Dr Jones:

“One of our most exciting early results is that the analgesia from virtual reality lasts after the session is over, sometimes days afterwards.  About 10% of subjects said it did not help, while 30% said it gave them complete pain relief while doing virtual reality.“

“My initial impression is that the analgesia seems to be more pronounced, not surprisingly, in subjects who ‘get into the game’ more.  So regardless of gender, age or amount of depression, if someone allows themselves to be involved in the VR experience, it has pronounced analgesia.“

Dr Jones showing the “Cool!” VR program to a patient.

Source:   DeepStreamVR

An earlier study showed that patients with:

• Fibromyalgia;
• Dental pain; and
• Combat-related burn injuries

may obtain pain relief from VR pain treatment (Wiederhold et al, 2014).

Summary:

More patients may benefit from VR pain programs once they gain affordable and ongoing access via their smartphones.

For more information about VR treatment for pain, please watch a 3-minute YouTube called ‘Healthy Mind – Therapeutic Virtual Reality Against Pain and Anxiety’ (with English subtitles):

 

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

Media:

(1) Virtual Reality Ventures Into Real World of Chronic Pain

Nancy A Melville

Medscape Medical News (27 May 2016)

http://www.medscape.com/viewarticle/863926#vp_2

(2) DeepStreamVR (Provider of the “Cool!” pain program)

http://www.deepstreamvr.com

Peer-Reviewed Papers:

(3) Wiederhold BK, Gao K, Sulea C, Wiederhold MD.

Virtual Reality as a Distraction Technique in Chronic Pain Patients.

Cyberpsychology, Behavior and Social Networking (2014); 17(6):346-352.

doi:10.1089/cyber.2014.0207.

(4) Garrett B, Taverner T, Masinde W, Gromala D, Shaw C, Negraeff M.

A Rapid Evidence Assessment of Immersive Virtual Reality as an Adjunct Therapy in Acute Pain Management in Clinical Practice.

Clinical Journal of Pain (Dec 2014); 30(12):1089–1098.

doi: 10.1097/AJP.0000000000000064

In German:

(5) Grohganz, Thomas. Krankenhaus in Paris testet VR-Therapie zur Schmerzreduktion. VR-Nerds (28 June 2018).

https://www.vrnerds.de/krankenhaus-in-paris-testet-vr-therapie-zur-schmerzreduktion/

Includes a 3-minute YouTube called ‘Healthy Mind – Therapeutic Virtual Reality Against Pain and Anxiety’:

https://www.youtube.com/watch?v=y-gYwvHexQ8&feature=youtu.be

 

Low Level Laser Therapy (LLLT) for Chronic Pain Including Fibromyalgia

Dear Pain Matters blog readers,

I will introduce the topic of low level laser therapy (LLLT) for chronic pain (e.g. fibromyalgia) here, and in future blog posts.

Low level laser therapy (LLLT) is relatively safe, and has no known adverse effects.

People with fibromyalgia often have extreme fatigue, pain and insomnia.  For some sufferers, even getting dressed in the morning can be a daunting task.

Ms Kay Greenlee (aged 70, of Indiana, USA) had suffered from fibromyalgia for years.  This painful condition made it difficult for her to perform domestic chores including washing windows without incurring pain in her legs, shoulders and elsewhere.  Due to allergic reactions, she was unable to take pain medication for pain.

A study by the Indiana State University allocated fibromyalgia patients into 4 groups that performed:

1. Resistance training only;
2. Low level laser therapy (LLLT) only;
3. Placebo (instead of LLLT) only; and
4. Both LLLT and resistance training.

The patients who were in the 4th group enjoyed the most improvements, compared to the other 3 groups.

Ms Greenlee was randomly allocated to the 4th group.  Following months of LLLT and resistance exercise training including chest presses, leg extensions, seated rowing and leg curls, Ms Greenlee had reduced fibromyalgia pain.  

In other words, months later, Ms Greenlee is almost pain free.  As a result, she was able to exercise (see photo).  Quoting Ms Greenlee:

“I have gone from having a lot of pain to very minimal amount of pain in the shoulder. I have little or no pain at all in the legs.”

“It is exciting to be able to go for several hours and be energetic and do the work that needs to be done at home and to enjoy things.”

Targeted LLLT and resistance training may facilitate increased blood flow into the painful areas as well as the release of endorphins, hence contributing to reduced pain.

Quoting Ifeanyi Osude (LLLT researcher, see photo):

“I’ve seen great results. Women came in with immense pain they have had for weeks or even months and after they have done the laser treatment, along with the resistance training, they came to me and said, ‘Ifeanyi, I feel a lot better.'”

Thus, LLLT can help reduce fibromyalgia pain, while physical activity can help keep the painful symptoms at bay.

Source:   http://www2.indstate.edu/news/news.php?newsid=3598

Summary:

Low level laser therapy (LLLT) plus exercise may be useful for reducing pain in fibromyalgia by increasing blood flow into the painful areas (Taylor, 2013). 

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

Media:

(1) Research uses lasers, resistance training to zap fibromyalgia pain

Taylor, Dave

Indiana State University Newsroom (10 June 2013)

http://www2.indstate.edu/news/news.php?newsid=3598

(2) LLLT a treatment option for fibromyalgia patients

Stewart, Dava

Chiropractic Economics (21 August 2014)

https://www.chiroeco.com/lllt-a-treatment-option-for-fibromyalgia-patients/

Peer-Reviewed Papers:

(3) Kingsley JD, Demchak T, Mathis R

Low-level laser therapy as a treatment for chronic pain. Front. Physiol. (2014), 5:306.

doi: 10.3389/fphys.2014.00306

http://journal.frontiersin.org/article/10.3389/fphys.2014.00306/full

Refer also to References section of paper by Kingsley et al (2014) for additional information.

(4) Ruaro, JA, Fréz, AR, Ruaro, MB, et al.

Low-level laser therapy to treat fibromyalgia. Lasers Med Sci (Nov. 2014), 29(6):1815-1819.

doi:10.1007/s10103-014-1566-8

http://www.ncbi.nlm.nih.gov/pubmed/24801056

 

 

 

 

 

Traditional Chinese Medicine (TCM) For Chronic Pain? Let’s Talk About Corydalis, A Traditional Chinese Herbal Remedy For Chronic Pain

Source of Featured Image:

Courtesy of Shutterstock

and

http://www.medicaldaily.com/chinese-poppy-plant-corydalis-works-chronic-pain-266215

Dear Pain Matters blog readers,

Is traditional chinese medicine (TCM) a treasure box that needs to be opened more fully??

In other words, should more research be done to scientifically explore the hidden treasures of TCM?  If we did this, would we find additional effective pain treatment options not yet offered by conventional medicine?

Consider this ancient, nonaddictive, Chinese herbal remedy for chronic nerve pain that may, at times, offer longer lasting pain relief than opiates:

The roots of a flowering poppy plant called Corydalis yanhusuo (C. yanhusuo; Corydalis) has been used for centuries as a Chinese remedy for chronic pain.  Corydalis is grown in China, Japan and Siberia.  The underground tubers from the Corydalis plant must be harvested, dried, ground, and boiled in hot vinegar before they can be used as a remedy for pain including headaches, back pain, menstrual cramps, chest pain and abdominal pain.

Source of photo showing Corydalis yanhusuo:  

http://www.nature.com/nature/journal/v535/n7611_supp/full/535S18a.html

In collaboration with Chinese scientists, University of California researchers have recently identified and isolated a key pain-relieving compound called dehydrocorybulbine (DHCB) in the roots of Corydalis.  Specifically, basic research showed that DHCB (extracted from the Corydalis tubers) reduced acute pain, inflammatory pain as well as injury-induced nerve pain.  The compound, DHCB, blocks dopamine D2 receptors.

More importantly, the DHCB does not interact with the morphine receptor.  As such, the effectiveness of DHCB will not weaken over time, nor will tolerance, addiction and drug dependence become issues (as often occurs with conventional opiate medicine including codeine and morphine).

Researchers felt that DHCB could offer some relief for low-level chronic pain without the risk of addiction or tolerance following repeated use (Zhang et al, 2014; Ingram, 2014).

Patient experiences with Corydalis yanhusuo extracts:

While not scientifically verifiable, the following (partially copied) user comments are interesting to read:

Refer:

User Reviews & Rating – CORYDALIS

http://www.webmd.com/vitamins-supplements/ingredientreview-415-CORYDALIS.aspx?drugid=415&drugname=CORYDALIS

Quoting comments from a disappointed pain patient:

Patient –

“I took my first capsule this morning and have felt tired, dragged out, strangely a little depressed and above all light-headed–dizzy enough to stumble and fall. If anything, my painful back, hips and knees hurt more today. Obviously I won’t take it again.“

Quoting positive comments from people with chronic pain who use Corydalis:

Patient –

“…both knees replaced at the same time, and also suffer from frequent headaches.  I began using this product after my surgery and it has provided me with great relief!  ….easier on my GI system….Love Corydalis!  Been a lifesaver for me!“

Patient –

“I have been taking 1-2 capsules a day.  It helps my joint pain considerably which I’ve had for 20 years….”

Patient –

“I have had severe knee pain for several years due to old sports injuries and have began using the Cordyalis 10:1 pills recently. The first day my pain was so subtle that I hardly noticed it at all. Stairs were a nightmare for me, but they are much, much easier to handle. I know that nothing can completely remove the pain I suffer from, but this is positively changing my quality of life!!“

Patient –

“I have degenerative disc disease and get spinal headaches from intermittent neck pain. I was instructed by a Taiwanese doctor to take 20g boiled in water from 500cc down to 250cc (about 25 minutes on electric stove med-hi), straining out and discarding the root at the end. I found 20g was too much (I experienced worse spasms), tried 5g, and ended up using 10g per serving, up to twice a day. I found that taking it daily was less effective than taking as needed (was hoping to keep the pain away by taking daily.) When I first used it, it made me “high” like cough syrup. After a few servings, I no longer feel that. It’s probably the most effective thing I’ve taken for the pain (I will not take opioids, which tend to make me sick anyway.) …. The tea from root tastes horrible….”

Patient –

“I have had constant shoulder and neck pain for 2 yrs which also cause headaches and migraines. Muscle relaxers and fiorcet are my daily regimine but still constant pain that made me so tired and energy draining. Since using corydalis i have energy and no shoulder pain.“

Patient –

“Has eased my intractable nerve pain.”

Patient –

“Female, 66 – for sciatica. I take the powder: premixed, in hot water – drink it fast so as to obscure the taste. Worked in 30 min. the first time taken. I take it 1/2 hr before eating dinner. I’ve learned to put Stevia in it – helps with the taste.”

Patient –

“This stuff works, however, I have only taken it in the powdered form. It tastes terrible … Its hard to figure out dosages. I take two teaspoons per day on most days to augment my pain medication, hydrocodone. It dramatically extends the time the hydrocodone works and seems to add some additional relief. I am concerned about possible harmful effects and standardization of strengths of the herb……”

[Blogger’s comments:

Based on above, is it possible that the effectiveness of certain conventional pain medication (in this case, hydrocodone) may be increased, and/or prolonged, through the use of Corydalis?  Further research is warranted.]   

Patient –

“I have experience chronic low back pain for about 2 years. The pain is 24/7 and worsens with inactivity or excessive physical fitness. I purchased capsules. The serving size is 8 capsules and I only took 3 and felt amazing relief. I lifted weights today for my legs and shoulders then did 15 minutes of interval sprints and my back feels PHENOMENAL! For $15.99 it is worth the try!….”

Patient –

“I have a bulging disk and pain 24/7, at times it feels like to torture. Corydalis has helped the pain a little so my pain level is 4 instead of 7 or 8.“

Patient –

“I have had fibromyalgia for 25 years and now suffer spinal stenosis after car wreck 10 years ago. I have found acupuncture and this herb to help the pain and neurological problems.….”

A huge word of caution:

While DHCB is currently not available, TCM practitioners can offer Chinese herbal remedies/extracts that specifically include Corydalis yanhusuo extracts or roots/tubers (as they have already done for many centuries).  Corydalis extracts are also available in Chinese specialist stores and on-line.

However, in Dr Civelli’s words, “DHCB is present in low quantities, but it’s there” (Chia, 2014).

Thus, traditional Chinese remedies that include Corydalis yanhusuo extracts or tubers are certainly worth trying (after discussing with your GP first).  

Please discuss with your GP before deciding to undergo any TCM treatments and/or other alternative/complementary medical treatments (as well as post-TCM treatment, if necessary).

Conclusion:

Increased funding and research into TCM including ancient Chinese herbal remedies for pain are warranted.

In particular, we need to expand research into Corydalis, and its key pain-relieving ingredient, DHCB (as well as research into other effective pain-alleviating remedies offered by TCM).

After all, the best approach is a global and unified approach to the global challenge of chronic pain.

Sabina Walker

REFERENCES

(1) Zhang et al; A Novel Analgesic Isolated From a Traditional Chinese Medicine; Current Biology (20 January 2014); 24(2): 117-123.

doi: 10.1016/j.cub.2013.11.039

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912990/

http://www.ncbi.nlm.nih.gov/pubmed/24388848

(2) Ingram; Pain: Identification of novel analgesics from traditional Chinese medicines; Current Biology (3 February 3 2014); 24(3): R114–R116.

doi: 10.1016/j.cub.2013.12.030

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980722/

(3A) Plant Used in Chinese Medicine Fights Chronic Pain; Cell Press (2 January 2014).

http://www.eurekalert.org/pub_releases/2014-01/cp-pui122713.php

(3B) Zhang, Wang, et al; Chinese Herbal Compound Relieves Inflammatory and Neuropathic Pain; UCI News (2 January 2014).

http://news.uci.edu/press-releases/chinese-herbal-compound-relieves-inflammatory-and-neuropathic-pain/

(3C) Ericson, John; Chinese Poppy Plant, Corydalis, Works For Chronic Pain; Drugs (2 January 2014).

http://www.medicaldaily.com/chinese-poppy-plant-corydalis-works-chronic-pain-266215

(3D) Chia, Jessica; The Plant That Could Erase Chronic Pain; Prevention (2 January 2014).

http://www.prevention.com/print/health/health-concerns/chinese-remedy-corydalis-pain

(3E) Pain, Stephanie

Painful Progress

Nature (14 July 2016); 535, S18–S19

doi:10.1038/535S18a

http://www.nature.com/nature/journal/v535/n7611_supp/full/535S18a.html

(4) User Reviews & Rating – CORYDALIS

http://www.webmd.com/vitamins-supplements/ingredientreview-415-CORYDALIS.aspx?drugid=415&drugname=CORYDALIS

Cold Water Immersion or Contrast Hot/Cold Water Immersion Therapy – Does This Reduce Pain?

Dear Pain Matters blog readers,

Summer is fast approaching ‘Down Under’ (where I live, in Sydney, Australia).  As such, I am swimming and snorkelling almost daily in the ocean.  Yesterday, I even tried surfing!

Why am I telling you all this??

Well….Full immersion of the face in cold water (via a jump into the ocean, or otherwise) immediately activates the Mammalian Diving Response.  Why is this interesting? Read on…..

Did you know that our Mammalian Diving Response is the most powerful Autonomic Nervous System reflex known?  For example, this reflex immediately causes:

– Decreased heart rate;

– Vasoconstriction in the periphery (shunting of blood away from the arms and legs, and into the heart, brain and other organs); and

– Apnea/breath-holding, while underwater.

The Mammalian Diving Response can immediately be activated during a ‘relaxing’ cold plunge pool immersion, and also while snorkelling, free diving, and scuba diving in the ocean.

James Nestor, author of Deep, describes the Mammalian Diving Response in the following awe-inspiring 3-minute YouTube:

In sports medicine, Contrast Cold/Warm Water Baths (including full-body immersion) are often used to treat soft tissue and joint injuries.  This treatment promotes alternating vasodilation/vasoconstriction (almost like a ‘pumping action’).  This therapy can reduce swelling, pain and muscle spasm, while also increasing peripheral circulation.

A Turkish review paper discussed the benefits of Cold and Heat Therapy in Fibromyalgia patients.  

Mankind has practised Ice Cold/Cold/Cool/Warm/Hot Water Immersion Therapy (Contrast Water Immersion Therapy) for as long as we can remember.  For example, native Indians often soaked in natural hot springs and washed in cold lakes and rivers.

Immersion in plunge pools with varying water temperatures can give our Autonomic Nervous System a very good work-out.  Blood circulation is re-directed back and forth, from the legs/arms to the heart, brain and other organs (while immersed in cold water), and back to the legs and arms (while immersed in warm water).

You could think of Contrast Hot/Cold Water Immersion Therapy as being like a gym workout for your Autonomic Nervous System!

Immersion in cooler/cold water is a quick, simple, and effective way to re-activate our parasympathetic nervous system (including efferent vagus nerve).  It causes our heart rate to slow and our breathing rate to decrease.  At the same time, blood circulation is diverted away from our arms and legs, and into our organs including heart and brain.

Chronic pain conditions are often associated with localised inflammation, an overactive sympathetic nervous system, an underactive parasympathetic nervous system including reduced efferent vagal output, and reduced heart rate variability.

QUESTIONS: 

Would Cool Water Therapy (including brief facial immersion) lead to increased parasympathetic nervous system activity, reduced inflammation, and reduced pain?  

Could Contrast Cold/Warm/Hot Water Therapy also result in decreased pain?  

Under what circumstances does increased pain occur?

NOTE:  When warranted, this water-based therapy should always be medically supervised.

Wishing you all a good weekend!

Sabina Walker

REFERENCES

(1) Cochrane; Alternating hot and cold water immersion for athlete recovery: A review; Physical Therapy in Sport (2004), 5, Pages 26-32.

Click to access 345485hot%20and%20cold%20baths.pdf

(2) Al Haddad et al; Effect of cold or thermoneutral water immersion on post-exercise heart rate recovery and heart rate variability indices; Autonomic Neuroscience: Basic and Clinical (2010), 156(1-2), Pages 111-116.

http://www.ncbi.nlm.nih.gov/pubmed/20403733

(3) Buchheit et al; Effect of cold water immersion on postexercise parasympathetic reactivation; American Journal of Physiology. Heart and Circulatory Physiology (2009), 296(20), Pages H421-427.

http://www.ncbi.nlm.nih.gov/pubmed/19074671

(4) Aysegul Jale Sarac and Ali Gur; Complementary and Alternative Medical Therapies in Fibromyalgia; Current Pharmaceutical Design (2006), 12, 47-57 47

Click to access 19239028.pdf

(5) Panneton et al; Parasympathetic preganglionic cardiac motoneurons labeled after voluntary diving. Front Physiol. 2014 Jan 28;5:8. doi: 10.3389/fphys.2014.00008

http://www.ncbi.nlm.nih.gov/pubmed/24478721

MORE ON THE MAMMALIAN DIVING RESPONSE

(From a free-diving perspective) 

(6) Nestor, James; Deep – Freediving, Renegade Science and What the Ocean Tells Us About Ourselves; 2014 http://www.amazon.com/Deep-Freediving-Renegade-Science-Ourselves/dp/0547985525

Nabilone for Chronic Pain Including Nerve Pain (eg CRPS)

Dear Pain Matters blog readers,

Dr Mark Ware, McGill University in Montreal, reported that Nabilone (‘Cesamet’), an oral synthetic cannabinoid, may offer some pain relief in both cancer and non cancer pain.  

Specifically, Nabilone may help alleviate painful symptoms in patients with:

– Nerve pain (e.g. complex regional pain syndrome, CRPS);

– Multiple sclerosis;

– Fibromyalgia; 

– Other chronic non cancer pain (eg postoperative or traumatic pain, arthritis, Crohn’s disease, interstitial cystitis, HIV-associated myopathy, post-polio syndrome, idiopathic inguinal pain, and chronic headaches); and

– Cancer pain.

Dr May Ong-Lam reported that in 10 patients with refractory CRPS, Nabilone treatment resulted in up to 60% pain reduction.  Opioids and other pain medication were no longer required by 7 patients following Nabilone therapy.  Improved quality of life and better sleep resulted.  Nabilone treatment resulted in improved physical ability including the ability to bear weight, resume work, and perform housework.  There were few side effects, and patients did not develop tolerance to Nabilone.

Prior to Nabilone treatment, and despite receiving many different pain medications, these 10 CRPS patients suffered burning pain, allodynia, autonomic nervous system changes, and physical disability.  Pre-Nabilone, all 10 CRPS patients ranked CRPS pain as 10 out of 10 (on 10-point visual analog scale; VAS).

Importantly, post-Nabilone therapy, overall pain decreased to 3 – 6 (on VAS) in all 10 CRPS patients.

Fibromyalgia patients reported that Nabilone offered significant benefits in pain relief and functional improvement.

A cancer pain study reported that pain scores in Nabilone-treated cancer patients were significantly reduced, compared to those who were not treated with Nabilone.  Other improvements in Nabilone-treated cancer patients included reduced nausea, less anxiety/overall distress, and slight improvement in appetite.  Nabilone-treated cancer patients were also able to reduce (or discontinue) dosages of other drugs including nonsteroidal anti-inflammatory agents, tricyclic antidepressants, and gabapentin.

A cannabis extract may be used to treat refractory spasticity in multiple sclerosis.

POSSIBLE MECHANISMS

Cannabinoid agonists (including Nabilone) activate cannabinoid receptor types CB1 and CB2.  Activation of CB2 leads to anti-inflammatory effects including reduction of TNF-alpha-induced endothelial cell activation, monocyte migration and adhesion.  This may partly explain why cannabis and cannabinoids are able to reduce pain including nerve pain (CRPS, multiple sclerosis).

For more posts on medical cannabis (aka medical marijuana) as well as cannabis-based pain medication (eg Sativex), please see:

https://painmatters.wordpress.com/2016/09/22/medical-cannabis-medical-marijuana-and-nerve-pain/

and

https://painmatters.wordpress.com/2017/04/10/lets-talk-to-an-inspirational-young-woman-paula-orecklin-about-crps-sativex-physiotherapy-and-neuroplasticity/

Wishing less pain to all pain patients,

Sabina Walker

References:

(1) Mark A. Ware; Cannabinoids in Pain Management: An Update from the 2009 Canadian Pain Society Meeting, Quebec QC

Click to access Viewpoints_in_Cannabinoids_MASTER.pdf

(2) Berlach, Shir, Ware. Experience with the synthetic cannabinoid nabilone in chronic noncancer pain. Pain Med. 2006 Jan-Feb;7(1):25-9.

Click to access Experience%20with%20the%20synthethic%20cannabinoid%20nabilone.pdf

(3) David Wild; Refractory CRPS Patients Discontinue Opiates With Cannabinoid Treatment (A Study by May Ong-Lam, MD, Clinical Assistant Professor, Dept of Medicine, St Paul’s Hospital, Vancouver); Pharmacy Practice News (8 Feb, 2011).

http://www.pharmacypracticenews.com/ViewArticle.aspx?d=Web+Exclusives&d_id=239&i=January+2011&i_id=694&a_id=16601

(4) Skrabek RQ, Galimova L, Ethans K, Perry D; Nabilone for the treatment of pain in fibromyalgia. J Pain 2008;9(2):164-173.

http://www.ncbi.nlm.nih.gov/pubmed/17974490

(5) Maida et al, 2008. Adjunctive nabilone in cancer pain and symptom management: a prospective observational study using propensity scoring. J Support Oncol. 2008 Mar;6(3):119-24.

http://www.ncbi.nlm.nih.gov/pubmed/18402303

(6) Grotenhermen, Müller-Vahl; The therapeutic potential of cannabis and cannabinoids; Dtsch Arztebl Int (2012 July);109(29-30):495-501.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442177/

(7) Rajesh et al; CB2-receptor stimulation attenuates TNF-alpha-inducedCB2-receptor stimulation attenuates TNF-alpha-induced human endothelial cell activation, transendothelial migration of monocytes, and monocyte-endothelial adhesion; Am J Physiol Heart Circ Physiol (2007 Oct);293(4):H2210-8.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2229632/