DIET AND CHRONIC SPINAL
PAIN
DR. PAUL RALSTONHEALTHWISE CHIROPRACTIC
NOT-PALEOPALEO
CHRONIC PAIN
HE HAS SEEN BUT HALF THE WORLD WHO HAS NOT
BEEN SHOWN THE HOUSE OF PAIN
RALPH WALDO EMERSON
PAINFUL STATS A RECENT INSTITUTE OF MEDICINE REPORT FINDS CHRONIC PAIN
AFFECTS MORE THAN 100 MILLION PATIENTS
THE ESTIMATED COSTS OF TREATING PAIN IS BETWEEN $560-$635 BILLION ANNUALLY, OR $2000 PER PERSON PER YEAR
IN A RECENT STUDY BY THE GLOBAL BURDEN DISEASE 2010 PROJECT, LOW-BACK PAIN HAS BECOME THE NUMBER ONE CAUSE OF DISABILITY WORLDWIDE
LOWER BACK PAIN IS ALSO THE NUMBER TWO CAUSE OF MISSED DAYS AT WORK
EVEN FIRST LINE PHARMACOLOGICAL INTERVENTION FOR PAIN IS NOT WITHOUT RISK
ACCORDING TO A STUDY OF 1990S STATISTICS IN THE UNITED STATES, 32,000 HOSPITALIZATIONS AND 3,200 DEATHS OCCUR EACH YEAR AS A RESULT OF NSAID-RELATED GI BLEEDING
INFLAMMATION ANY DISCUSSION OF PAIN WILL INVOLVE A DESCRIPTION OF
INFLAMMATION
IN GENERAL, INFLAMMATION IS DESCRIBED AS EITHER ACUTE OR CHRONIC AND HAS BEEN CLASSIFIED INTO THREE PHASES, THE ACUTE INFLAMMATORY PHASE, THE REPAIR PHASE, AND THE REMODELING PHASE
HOWEVER, IN REAL LIFE, THE INFLAMMATORY PROCESS HAS NO REAL BOUNDARIES
IN MANY CASES, ACUTE INFLAMMATION DOES NOT RESOLVE AND BECOMES CHRONIC; HOWEVER, CHRONIC INFLAMMATION CAN DEVELOP FROM THE START WITHOUT ACUTE INJURY
IN BOTH CASES, INFLAMMATION IS A CHEMICAL EVENT, SO IT IS IMPORTANT TO HAVE A FAVORABLE BIOCHEMISTRY IN THE EVENT OF INJURY, WHETHER IT IS AN INFECTION OR SOFT TISSUE INJURY
INFLAMMATORY MESSENGERS
MANY INFLAMMATORY AND ANTI-INFLAMMATORY MESSENGERS EXIST IN THE BODY
PRO-INFLAMMATORY EICOSANOIDS ARE DERIVED FROM FATTY ACIDS AND INCLUDE PGE-2, TXA-2, LTB-4
PRO-INFLAMMATORY AMINO ACID/PEPTIDE MEDIATORS KNOWN AS CYTOKINES INCLUDE HISTAMINE, IL-1, IL-6, TNF, SUBSTANCE P
HOWEVER, EICOSANOIDS AS WELL AS CYTOKINES CAN ALSO BE ANTI-INFLAMMATORY (PGE-I, PGE-3, LTB-5, IL-4, IL-10)
UNDERSTANDING AND IDENTIFYING THE ROLE AND BALANCE OF THE VARIOUS CHEMICAL MEDIATORS OF THE BODY CAN AID US IN OUR MANAGEMENT OF CHRONIC PAIN AND INFLAMMATION
ITS BECAUSE OF THESE INFLAMMATORY CYTOKINES THAT OBESITY BECOMES MORE OF A CHEMICAL PROBLEM THAN A MECHANICAL
NOCICEPTON NOCICEPTION IS THE TERM FOR THE NERVOUS SYSTEM
COMMUNICATING NOXIOUS STIMULATION
THE RECEPTORS FOR NOXIOUS STIMULI ARE CALLED NOCICEPTORS, PAIN IS HOW YOUR BODY PERCEIVES THESE STIMULI
ONCE STIMULATED, NOCICEPTORS SEND THIS INFORMATION TO THE BRAIN AND THE END RESULT CAN BE THE SUBJECTIVE EXPERIENCE OF PAIN
THE THRESHOLD OF NOCICEPTORS IS KNOWN AS SENSITIZATION AND THIS THRESHOLD CAN BE LOWERED; CALLED NOCICEPTIVE SENSITIZATION
DUE TO THE NEUROPLASTICITY OF THE NERVOUS SYSTEM, NOCICEPTIVE SENSITIZATION CAN OCCUR, RESULTING IN HYPERALGESIA, AN INCREASED SENSITIVITY TO PAIN
AGAIN, WERE GETTING CHEMICAL RESPONSES IN THE BODY WITH EVERY MOVEMENT, SO ITS IMPORTANT TO HAVE A FAVORABLE CHEMISTRY IN THE EVENT OF INJURY
DISC ANATOMY THE INTERVERTEBRAL DISC CONSISTS OF THE INNER NUCLEUS
PULPOSUS, THE TOUGHER, OUTER ANNULUS FIBROSIS, AND THE VERTEBRAL END PLATES
THE NUCLEUS IS A MORE WATER-RICH STRUCTURE IN THE CENTER OF THE DISC AND IS UNDER VERY HIGH PRESSURE, ESPECIALLY WHEN YOU ARE SITTING OR STANDING
THE ANNULUS IS A MUCH TOUGHER COLLAGEN-RICH STRUCTURE WHICH IS RESPONSIBLE FOR RESISTING THE HIGHLY PRESSURIZED NUCLEUS
THE VERTEBRAL END PLATES, DESPITE THEIR NAME, ARE ACTUALLY NOT ATTACHED TO THE VERTEBRAE BUT ARE INTERWOVEN INTO THE DISC AND CONSIDERED PART OF THE DISC
THE SINUVERTEBRAL NERVES INNERVATE THE POSTERIOR THIRD OF THE ANNULUS AND CONTAIN AUTONOMIC AND SENSORY NERVE FIBER
NORMAL DISC ANATOMY
DISC DEGENERATION
THE NORMAL DISC IS CONSIDERED THE LARGEST AVASCULAR STRUCTURE IN THE BODY
IT HAS NO BLOOD SUPPLY AND RELIES ON NUTRITION THROUGH THE VASCULAR BEDS OF THE END PLATE AND GETS ITS LIMITED NUTRITION THROUGH PASSIVE DIFFUSION
BECAUSE OF THE POOR BLOOD SUPPLY, THE DISC IS EXCEPTIONALLY PRONE TO DEGENERATIVE CHANGES AND IN FACT BEGINS TO LOSE BLOOD SUPPLY WITHIN THE FIRST DECADE OF LIFE
THE PARTIAL LOSS OF BLOOD SUPPLY LEADS TO PREMATURE DEATH OF THE PROTEOGLYCANS RESPONSIBLE FOR MAINTAINING THE HYDROSTATIC PRESSURE WITHIN THE DISC
THE ULTIMATE RESULT IS THE TRANSFER OF AXIAL FORCES TO THE OUTER ANNULUS AS WELL AS THE POSTERIOR FACET JOINTS
DISC DEGENERATION
ONE OTHER PROCESS THAT LEADS TO PREMATURE DEGENERATION OF THE DISC IS GLYCATION
GLYCATION OCCURS WHEN REDUCED SUGAR COMES INTO CONTACT WITH THE COLLAGEN FIBERS (PROTEIN) OF THE DISC, RESULTING IN CROSSLINKING
THE END RESULT IS A THICKER, MORE BRITTLE SUBSTANCE MORE SUSCEPTIBLE TO DEGENERATION
DISCOGENIC PAIN INTERNAL DISC DISRUPTION IS THE MOST COMMON CAUSE OF
LOWER BACK PAIN
BOGDUK ESTIMATES 40% OF CHRONIC BACK PAIN IS CAUSED BY RADIAL ANNULAR TEARS
RADIAL TEARS ARE OFTEN PRECEDED BY DISC DEGENERATION AND BEGIN IN THE INNER ANNULUS AND PROGRESS OUTWARD
ONCE A RADIAL TEAR REACHES THE OUTER LIMITS OF THE ANNULUS IT CAN BREAK THROUGH
THE RESULTING NUCLEAR MATERIAL IS HIGHLY INFLAMMATORY AND INFLAMMATORY CYTOKINES SOAK THE SINUVERTEBRAL NERVES RESULTING IN LOW BACK PAIN AND OFTEN LOWER EXTREMITY PAIN (SCIATICA)
IN ADDITION, WITH DISC HERNIATION, THE HYDROSTATIC PRESSURE IS REDUCED, CAUSING MORE LOAD TO BE PLACED ON THE OUTER ANNULUS WHICH CONTAINS THE ALREADY INFLAMED NERVES
ANNULAR TEARS
TRANSVERSESAGITTAL
ANNULAR TEARS
YOUR BRAIN ON PAIN
IS THE PAIN JUST IN YOUR HEAD? A RECENT DOUBLE BLIND, RANDOMIZED, CONTROLLED TRIAL
SHOWED IMPROVED OUTCOME AFTER LUMBAR MICRODISCECTOMY IN PATIENTS WHO WERE SHOWN THEIR EXCISED DISC FRAGMENTS J Neurol Neurosurg Psychiatry. 2009 Sep;80(9):1044-6. doi: 10.1136/jnnp.2008.
IN ANOTHER STUDY, 34 COLLEGE STUDENTS WERE TOLD AN ELECTRIC CURRENT WOULD PASS THROUGH THEIR HEADS AND HEADACHES ARE A COMMON SIDE EFFECT. DESPITE NO CURRENT BEING USED, MORE THAN 2/3 DEVELOPED HEADACHES Headache. 2003 Nov-Dec;43(10):1113-5.
EXPECTATION EFFECTS DEPEND AS MUCH ON WHAT HAPPENS IN THE SPINE AS WHAT HAPPENS IN THE BRAIN, THIS HAS IMPORTANT IMPLICATIONS FOR CLINICAL PRACTICE Pain. 2007 Jul;130(1-2):137-43. Epub 2007 Jan 9.
PSYCHOGENIC PAIN CAN OCCUR WHEN THE PSYCHOLOGIC STATE SUCH AS ANXIETY
OR DEPRESSION FACILITATES NOCICEPTIVE PATHWAYS
RECENT RESEARCH HAS SHOWN INCREASED LEVELS OF CRP IN PATIENTS WITH PTSD AND INTERPERSONAL VIOLENCE
LEVELS OF PRO-INFLAMMATORY CYTOKINES HAVE BEEN IMPLICATED IN DEPRESSION AND MOOD DISORDERS
IN ADDITION, DUE TO THE NEUROPLASTICITY OF THE CENTRAL NERVOUS SYSTEM, SELF DEFEATING BELIEFS AND CATASTROPHIZATION CAN INTERACT WITH THE PAIN REDUCING NEURAL NETWORKS RESULTING IN CHRONIC PAIN
OFTENTIMES THE ORIGINAL INJURY HAS HEALED, BUT CONTINUED BELIEFS, ANTICIPATION OF PAIN, FEAR, AND ANXIETY CAN CREATE CHRONIC PAIN AND INFLAMMATION
PATIENTS CAN COME UNRAVELED ON YOU WHEN YOU TELL THEM THEY WILL NEVER BE ABLE TO DO (X) AGAIN
THE ANTI-INFLAMMATORY DIET BASICALLY AN AUTO-IMMUNE PALEO PROTOCOL FISH, PASTURED MEAT, WILD GAME VEGETABLES AND FRUIT, WITH THE EXCEPTION OF THE
NIGHTSHADE FAMILY
SWEET POTATOES AND OTHER NON-NIGHTSHADE TUBERS RAW NUTS MOST SPICES, ESPECIALLY TURMERIC, GINGER AND GARLIC DARK CHOCOLATE (GREATER THAN 75% CACAO) DONT LET THE PHARMACEUTICAL INDUSTRY FRUSTRATE YOU OR
YOUR PATIENTS
ANTI-INFLAMMATORY SUPPLEMENTATION
THE FOLLOWING NUTRIENTS CAN BE TAKEN DAILY TO SUPPLEMENT AN ANTI-INFLAMMATORY DIET
VITAMIN D3 PROBIOTICS (GI SYMPTOMS HAVE BEEN ASSOCIATED WITH BACK
PAIN)
EPA/DHA MAGNESIUM GLYCINATE (ANIMAL RESEARCH INDICATES LOW
LEVELS OF MAG CREATE LONG TERM SENSITIZATION OF THE NOCICEPTIVE PATHWAYS)
TURMERIC, GINGER PROTEOLYTIC ENZYMES SUCH AS TRYPSIN, CHYMOTRYPSIN, AND
BROMELAIN CAN BE USED AS AN ANTI-INFLAMMATORY, BUT RESEARCH IS DIVIDED ON THEIR EFFICACY
CHRONIC PAIN PRESCRIPTION
ANTI-INFLAMMATORY DIET ANTI-INFLAMMATORY SUPPLEMENTS AVOID LUMBAR FLEXION FOR AT LEAST 2 HOURS AFTER WAKING AVOID PROLONGED SITTING AVOID MECHANICAL POSTURES, MOTIONS, AND LOADS THAT
CAUSE YOU PAIN
IF YOU NEED TREATMENT, PROGRESS FROM CONSERVATIVE (CHIROPRACTIC, ACUPUNCTURE, PHYSICAL THERAPY, MASSAGE, ETC.) TO INVASIVE (DRUGS, INJECTIONS, SURGERY)
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