posted
Until recently pain had not been a symptom for hubby. Unfortunately chiropractic seems to be making things worse or at least is not helping. A sublaxation/possibly dislocated shoulder has really been interfering with his sleep and aggravates myoclonus.
This is a very good article that explains many choices of meds for pain and how they work. Notice the references to glutamate, MSG, and aspartame - all can increase pain. I previously posted the GARD diet which is designed to decrease food sources of these substances. Hubby's pain problems started around the same time as his gastritis - do feel diet is contributing to pain.
The pain clinic which posted this article has several other articles of interest. Discusses many diagnostic tests for pain I had never heard of. The home website is
Which Medication and Why: Non-Narcotic Pain Pharmacology
Despite the long-standing availability of pain medication, confusion still exists as to which medication is best for the treatment of neuro-musculoskeletal pain. This is due in large part to a relative lack of understanding of pain receptor pharmacology and the number of agents available. This article will review various non-opiate medications that can be used to treat pain.
Several neuropathic disorders share similar pain perception pathways, including diabetic peripheral neuropathy, post herpetic neuralgia, Reflex Sympathetic Dystrophy (Complex Regional Pain Syndrome), post surgical/traumatic neuropathy, and toxic and idiopathic neuropathies. Medications directed toward these pathways can also provide relief for neck and low back pain, acute and chronic ligamentous strain, arthritis, fibromyalgia, and other muscular aches and pains.
In the majority of cases, pain signals are first generated from peripheral nerve fibers and then transmitted to the central nervous system. Once in the central nervous system, the pain signal is modulated so that it is ignored, moderated or enhanced. In order to effectively treat pain, both peripheral and central receptors may have to be addressed. There is also ample evidence, however, that by treating peripheral receptors alone, central receptors are influenced.
The key receptor in the central nervous system for pain modulation is NMDA. Glutamate and Glycine are important NMDA stimulants. They work by opening voltage-dependant channels at the cell membrane level. This means that eating foods that are spiced with MSG or that contain glycerine increases the pain experience.
When pain-modulating receptors are made more excitable, the pain experience is upgraded. Chemical mediators such as Substance P, Alpha agonists and antagonists, GABA agonists, and free radicals can affect these modulating receptors. Agonists are things that make something stronger and antagonists are things that make something weaker. Gabitril is an anti-seizure medication that enhances GABA and therefore reduces the pain experience.
Ultimately, all receptors are functionally dependant on the status of their voltage-dependant channels, or gates. These gates are typically specific for minerals such as calcium, magnesium, potassium, or sodium. Many people lack proper mineral balance and inadvertently affect ion gate function to their disadvantage as a result of bad eating habits.
Enhancing sodium and reducing calcium channel activity have been found to have important down-regulatory effects on the NMDA receptor. Procardia is an anti-hypertensive that prevents calcium dependent voltage gate opening. Mexitil is a cardiac anti-arrhythmic engineered to stabilize sodium channels. Both have been used successfully to treat painful conditions.
Tegretol, Depakote, Dilantin and Zonegran are anti-seizure drugs that also reduce pain by producing a stabilizing effect on sodium channel opening. Neurontin is a seizure medication that is commonly used as a pain reliever. Lyrica is a second-generation Neurontin made specifically to treat neuropathic pain.
Lidoderm and Emla patches are placed on the skin. They reduce pain via their sodium channel blocking activity. Capsaicin cream is a topical that inhibits the release of substance P, a painful mediator also found in skin. Since NMDA receptors have been found in peripheral nerve and skin, Ketamine cream, which down regulates NMDA, is effective in relieving pain.
There are also non-NMDA receptors. An important one is called AMPA. Aspartame (which contains aspartate) is an AMPA receptor stimulant, so avoiding this food supplement can reduce pain. Most would not choose this sweetener anyway if they knew it was metabolized into formaldehyde once it passed through the liver.
Alpha agonists block the release of norepinephrine from sympathetic nerve endings. Norepinephrine can both reduce blood flow and increase metabolic demand of the tissues it affects, so blocking the release of it can lead to pain reduction. Guanethidine, which has considerable anesthetic activity, works by depressing postganglionic adrenergic fibers (it inhibits sympathetic activation). Catapres, an anti-hypertensive agent that has agonist effects on the alpha-receptors in both the central and peripheral nervous system, has been used successfully to relieve pain.
Zanaflex is muscle relaxer. It is an alpha agonist that reduces reflex activity within the spinal cord, lowering the release of excitatory amino acids. This in turn results in fewer stimuli that upgrade NMDA activity. Most muscle relaxers inhibit central nervous system activity. Examples include Skelaxin and Baclofen.
Soma is a muscle relaxer with a dual effect; when it is metabolized in the liver it is degraded into a molecule that has direct opiate activity with little or no addicting properties. Ultram is an opiod receptor agonist engineered to have minimal addicting qualities and has therefore been referred to a non-addicting mu receptor agonist that can directly reduce pain.
Flexeril is a muscle relaxer that has anti-depressant-like effects as its mechanism of action in pain reduction. Elavil was one of the first anti-depressants found to have direct pain-relieving effects. It works through its action on norepinephrine. Pamelor, Trazadone, and Deseryl work in a similar fashion.
Newer anti-depressants such as Effexor and Cymbalta have been specifically designed to take advantage of the pain relief afforded by blocking norepinephrine reuptake. While the selective seratonin re-uptake inhibitors (SSRI's) such as Prozac, Zoloft, Lexapro, and Paxil have much less of an effect on norepinephrine, they can reduce depression and anxiety associated with pain.
Imitrex, Maxalt, Axert, and Relpax are a special group of seratonin medications that work on blood vessel tone in the brain. Collectively these medications are referred to as Tryptans and they have a specific indication for migraine headache. Fioricet, Esgic, and Bupap contain butalbital in combination with acetaminophen. They provide greater pain relief then acetaminophen would alone due to the central calming effects of butalbital.
Many major tranquilizers such as Mellaril, Zyprexa and Seroquel have been found to reduce pain. Their effect may be due muscle relaxation resulting from anxiety reduction or improved sleep. Symbyax is a medication that has tried to combine the best effects of Zyprexa and Prozac. All of the drugs in this class may reduce pain by through improved thinking, which allows patients to differentiate symptoms that can be ignored from those that are more deserving of attention.
Promoting wakefulness during the day hours with a medication such as Provigil, and proper sleep during the evening hours with hypnotics such as Ambien, Sonata or Restoril, is very important in controlling pain. When sleep cannot be controlled with one of the hypnotics, and a major tranquilizer is too strong, an intermediate anxielytic such as Ativan, Tranxene, or Klonopin can be very useful in pain reduction. Triavil is an older mediation that combines the best of Ativan and Elavil.
It should go without saying that co-morbid disease management facilitates healing and nerve membrane stability. When infection is present, appropriate use of certain antibiotics can provide dramatic relief. This is especially true for those who have a predisposition to rheumatic conditions.
Benicar, a hypertension medication, can reduce infection associated pain and inflammation. It is referred to as an Angiotensin Receptor Blocker (ARB) and is used primarily for control of hypertension. After Benicar was released, angiotensin, which is made in the kidney, has been found to facilitate hidden infection, which may be the cause for many other diseases. Antiviral agents such as Amantidine and Zovirax can reduce immune response related inflammation and associated neuropathic pain as well.
Because infection, heart attack, stroke, and inflammation are frequently thought of as having direct interactions upon each other, medications that address these problems can provide the backdrop needed to promote pain reduction. For example Plavix and Pletal, anti-platelet agents used to prevent stroke and heart attack, are also useful in treating claudication (vascular leg pain).
The new COX-2 Non-Steroidal Anti-Inflammatory Drugs (NSAIDS), which work as inhibitors of prostaglandin (a primary up-regulator of inflammation), and are compatible with the anti-platelet agents, have both peripheral and central pain relieving effects. The central nervous system pain relieving effects of Celebrex has been thoroughly described. In numerous clinical studies they have demonstrated a 40 percent reduction in opiate use when used for post-surgical pain.
Immune modulators such as Enbrel reduce inflammation associated with tissue necrosis factor (TNF) activation. Pain relief occurs as a result. Aredia, used for weak bones, also modulates TNF as a side effect.
While this is only a brief review of non-narcotic pain relieving medications, it should be clear that numerous agents are used to reduce the pain experience. As our understanding of pain increases and new agents are brought to market, we should expect to see more use of non-narcotic treatment options that are receptor, voltage gate, or co-morbid disease driven.
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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minoucat
Frequent Contributor (1K+ posts)
Member # 5175
posted
Hi Bea. here are some other links explaining the nature of pain.
As I read more about different detox approaches I'm struck by the similarities and differences, especially in avoiding pain-producing foods. I've just started reading Kane's detoxx protocol, adn although it seems rather high on dairy, it's death on wheat and other glutamate producers. In a funny sort of way this is all swinging around to "it's all in your mind"!
-------------------- ********************* RECIDITE, PLEBES! Gero rem imperialem! (Stand aside plebians! I am on imperial business.)
Aniek
Frequent Contributor (1K+ posts)
Member # 5374
posted
Intersting article. I'll read it more closely when I'm not suffering from insomnia
Flexeril was a life saver for me. Was the only thing that got my muscles to relax. But I've just weaned off it because my doctor treating my autonomic nervous system disorder thinks the Flexeril was making it worse.
I've just started numerous supplements to help with pain. I can't vouch for their effectiveness yet.
Nattokinase is to replace the Flexeril. It is a natural enzyme from soy that thins blood, and is known to reduce chronic muscle pain.
Quercetin with Vitamin C is supposed to work as a pain killer. My doc thinks it might be able to replace Vicodin.
Bromelain to reduce inflammation.
That said, I strongly urge people not to stay away from narcotic medications if those are the right drugs for them.
Narcotic pain medications do work at stopping pain. And if used properly, they are rarely addictive.
Needing to increase the dose is a sign of phsyical dependency and not addiction. Physical dependency just means that your body has adapted to the drug and you need a higher dose to kill the pain.
-------------------- "When there is pain, there are no words." - Toni Morrison Posts: 4711 | From Washington, DC | Registered: Mar 2004
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minoucat
Frequent Contributor (1K+ posts)
Member # 5175
posted
I just want to second what Aniek says about narcotic pain relievers. I took butalbytal for my headaches, and it saved my life. When the headaches finally ended (after babs tx) I went off it easily and have never craved it.
Which is not to say that you don't have to be careful and aware on the narcotic pain killers, but being out of pain was a huge part of healing for me.
-------------------- ********************* RECIDITE, PLEBES! Gero rem imperialem! (Stand aside plebians! I am on imperial business.)
posted
FWIW, i found this old/new pain killer in the uspatent data base, but don't know the commercial names for this. N-butanol mixed with magnesium thiosulfate and other important ingredients:
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