Manage Chronic Pain With Natural Therapies

Dr. Chris Kleronomos

A study published in the Journal of Pain reports that 19% of American adults—almost one in five—suffer from persistent pain. Among people over 60, that portion reaches almost 30%.¹ Most doctors approach pain problems with a prescription pad, without ever considering other factors that can help mitigate and eventually end chronic pain. But Dr. Chris Kleronomos is an exception. He is a doctor of acupuncture and Oriental medicine, a nurse practitioner, and clinical director of the Fibromyalgia and Neuromuscular Pain Center of Oregon. In a thoroughly comprehensive approach to pain management, Dr. Kleronomos’ clinic incorporates natural medicine, acupuncture, chiropractic, psychology, diet, biofeedback, injections, bee venom therapy, functional nutrition, and many other therapies. For those unable to visit his Salem, Oregon, clinic, he recently agreed to answer some questions for us about chronic pain and how it can be safely alleviated.

LE: You started out treating pain as a Navy Corpsman and now operate a multimodal pain management clinic focused on therapies rooted in traditional and natural medicine. Can you explain how you first became interested in this field and the journey to where you are now?

CK: Yes, I was a Special Amphibious Reconnaissance Corpsman with the Marine Corp’s elite Force Recon unit. So my interest [in pain management] was really born of the necessity to have field medical and survival options available—since we would often be alone and unsupported for extended periods. I began studying herbal therapies and natural techniques that indigenous people had used when fighting guerilla wars. When I got out of the service, I continued that journey with a Master’s in Traditional Chinese Medicine. I then spent time in Southeast Asia working in animal conservation and learned directly from the indigenous people who worked for me. I eventually came back to the States and completed a doctoral program that focused on advanced natural therapies for oncology, chronic disease, and pain management. Due to my belief in integrated medicine, I went on to become an Advanced Practice Nurse Practitioner and eventually, completed an additional Master of Science in Functional Medicine and Clinical Nutrition.

LE: Many people suffer for years, even the rest of their lives, with chronic pain as a result of incurable conditions such as rheumatoid arthritis or fibromyalgia. Since pain medications seldom provide complete relief, are there other options for these patients?

CK: Lots of options are available for these people, and the research clearly shows that multimodal approaches produce the best outcomes. There is no “magic bullet.” Diet therapy, in my opinion, is critical. Over the last several decades, we have seen a huge increase in allergies, asthma, and autoimmune disease, and it has been identified that chronic inflammation plays a critical role. Specific options such as acupuncture, chiropractic, psychology, hydrotherapy, supplements, and herbs all depend on the individual patient and the situation. Not every option works for everyone—just as not every medication works—and finding the right combination can be challenging. We approach every person as a unique case.

LE: Long-range side effects, or the risk of them, cause many patients to stop using, or cut back on, pain drugs. Clearly, patients are better off with an effective program of supplements and herbs, right?

CK: The majority of supplements and herbs are safe, but they still must be [used] appropriately and in context of the patient’s condition and his or her other medications. Many supplements and herbs treat the contributing mechanisms of pain, such as inflammation or muscle spasms, help to reduce or prevent the escalation of pain medication dosing, or even increase the effect. Another strategy is to use supplements and herbs to address the associated side effects, such as anxiety or insomnia.

LE: Many chronic pain sufferers find that drug painkillers dull, but don’t eliminate, their pain. Surely, natural pain relievers cannot provide stronger pain suppression, can they?

Fibromyalgia: What Causes and What Is This Source Of Chronic Pain?

Although it is a common source of chronic pain, fibromyalgia is a disease that—unlike other painful conditions such as arthritis—does not show up on X-rays or in blood-work. Unfortunately, there is no lab test to confirm the diagnosis of fibromyalgia. It is primarily a diagnosis of exclusion, which means that other diseases and disorders must first be ruled out.

Although it is not well understood, fibromyalgia is identified as a neuro-sensory disorder characterized by disturbances in the way the central nervous system interprets and evaluates stimuli.²

Typically, it is associated with other regional pain syndromes, as well as mood and anxiety disorders. In fact, significant data supports the idea that fibromyalgia, chronic fatigue syndrome, regional chronic pain syndromes, and some emotional disorders all involve abnormal perturbations of the stress response system.^3,4

Because many fibromyalgia patients appear well on physical examination, the diagnosis of fibromyalgia was historically considered controversial and unfortunately, written off by many conventional physicians as a psychosomatic condition.^5,6

We asked Dr. Kleronomos to provide his assessment of the possible origins and mechanisms of fibromyalgia. Here is his analysis of the complexities of this source of chronic pain:

“Currently there is no definitive theory of fibromyalgia. Some critical aspects include increased central sensitization, altered pain signaling, sensory processing issues, hypothalamus-pituitary-adrenal dysfunction, and neurotransmitter imbalance.

“Emerging research performed by our psychologist, who is also my wife, has identified the relationship between ‘dual-trauma’ exposure—having a trauma in both childhood and adulthood—and the development of fibromyalgia. [It] showed that the cascade of endocrine changes seen in severe trauma was similar in fibromyalgia patients, further supporting the concept of changes in brain neuroplasticity [your brain’s ability to reorganize itself by forming new neural connections throughout life].

“My working theory is that there are four primary presentations of fibromyalgia, each with overlapping features.

• Gut-mediated: This is associated with food sensitivities, dysbiosis [microbial imbalance on or inside the body], and leaky gut—which, admittedly, is a ‘chicken-and-the-egg’ pattern and tends to be the most predominant in long-standing cases.
• Structural: Typically, it has an onset of a triggering event, even a minor one, such as a car accident or a fall, and it may be the result of a long- standing, peripheral injury that became centralized or more widespread.
• Psychogenic: This is related to neuroplasticity [and results] from sustained stress and trauma and shows increased activity in limbic structures [brain structures that govern emotions and behavior].
• Metabolic/nutrient: This is really ‘pseudo-fibromyalgia syndrome,’ resulting from deconditioning [a physiological decline in function], systemic inflammation, nutrient deficiencies, and other organic issues such as anemia, hypothyroidism, or chronic infections.

“The specific protocol we use at our clinic can ferret out what presentation it is—and address each in a variety of ways.”

CK: Generally speaking, the cumulative evidence for supplements and herbs is limited but excellent for what has been studied. My experience is that natural pain relievers can be as effective, and since they are applied differently and in combination, they can sometimes be stronger. It is really a matter of perspective. A narcotic medication has a strong, specifically targeted effect, but does not always address the root or underlying problem. For example, Corydalis, the classic “pain” herb is said to have a 1% equivalency to morphine—but it’s also anti-inflammatory, decreases blood viscosity, and acts as a mild sedative and muscle relaxant, in addition to having some adaptogenic or balancing properties to the system. So, in many ways, it could be considered superior to prescription medications.

LE: Anti-inflammatory medicines such as aspirin, ibuprofen, or naproxen work by blocking the enzymes that trigger inflammation, swelling, and pain. Do nutritional and herbal supplements generally work by modulating the same mechanisms or by other, novel pathways?

CK: [It depends.] Willow bark (Salix Spp.), from which modern aspirin is derived, has generally the same effects as the pharmaceutical. It has strong, graded evidence for use, but we know the analgesic actions are typically slow-acting, yet last longer than standard aspirin products. Boswellia spp., a resinous herb with a long history, has demonstrated in animal studies an analgesic effect comparable to a moderate dose of morphine, but it’s known to also inhibit both of the major inflammatory pathways. Turmeric (Curcumin Spp.) is gaining lots of attention for its health and anti-inflammatory benefits. It does this by selectively inhibiting both major pathways of inflammation and the resulting downstream chemical triggers of inflammation. Interestingly, it also increases the potency of standard pharmaceutical nonsteroidal anti-inflammatory drugs, such as celecoxib. It has a variety of other health benefits, acting as a free radical scavenger, antineoplastic [tumor-inhibitor], antimicrobial, and it improves cholesterol synthesis.

LE: You provide a wide range of in-clinic therapies, such as injections. Can you give us an outline of these diverse therapies?

CK: Our clinic employs a variety of techniques. We use acupuncture, chiropractic, and physical modalities such as cupping, gua sha [instrument-assisted scraping of the skin], and Graston [a patented, instrument-assisted technique for breaking up scar tissue]. I also use several injection therapies, including trigger point muscle injections [injections into muscle knots], utilizing a combination of natural substances—such as MSM—and anesthetic, as well as prolotherapy [injection of irritating substances] for the neck, back, and joints. I’m probably most well-known, however, for the use of bee venom therapy. Bee venom, sometimes called api-puncture, has documented use going back thousands of years. Charlemagne is said to have used it to treat his gout during the Crusades, and Alexander the Great reportedly used it for chronic hip pain. Modern research is now able to validate the mechanisms of its action, which includes blocking peripheral pain-signaling, anti-inflammation, central or brain modulation of pain, and immune regulation. Classically, it has been best known [to be] utilized for arthritic conditions, and in the US, has a following for use in multiple sclerosis. I have found it extremely effective for multiple pain conditions including fibromyalgia, rheumatoid arthritis, lupus, and complex regional pain syndrome.

LE: Aside from these in-clinic pain therapies, can you explain what supplement options are available that effectively treat chronic pain?

CK: A good, basic start is a whole-food multivitamin—some data suggests that you would need 27,000 calories to meet all of the recommended daily intake for micronutrients.⁷ This accounts for the most common nutrient deficiencies in the US, which are iron, calcium, magnesium, and D and B vitamins. Generally, I believe that most people need foundation support, depending on how good their diet is, where they live, and what underlying issues they have: an average dose of 4,000 IU daily of vitamin D3; 2,000 to 3,000 mg daily of omega-3; multi-strain live probiotic; and active B vitamins in methylated forms. Also, a multi-mineral with calcium (600 mg twice daily), magnesium (1,000 to 2,000 mg daily), and zinc (20 mg daily), particularly if currently on an antacid medication or diuretic. I [have my patients] use iron with vitamin C if there is anemia, but I am cautious if there is a lot of inflammation. I always add CoQ10 (100 to 300 mg), especially if they are on a statin drug. Other basics include glucosamine, chondroitin, and MSM, especially if there are degenerative changes. Selenium is a good option if [patients] have a thyroid issue—55 micrograms as basic, 200 micrograms if autoimmune. Using either NAC [N-acetyl cysteine] or glutathione can be useful. Green tea and garlic should be included in most people’s regimen, either in food form or extract. These herbs have very broad effects that target several aspects of health. Green tea or EGCG can induce repair of cells at all stages of the cell cycle.

LE: You said that treatment choices depend on the individual patient. Do supplement recommendations also vary with each individual case?

CK: Yes. The individual’s body effect on the supplement or herb—called pharmacokinetics—is important. This can include sensitivities to fillers or the initial source from which it was derived, the amount of stomach acid available to break it down, and the integrity of the gastrointestinal tract, particularly the health of the microbiome. Individual genetics play an important role, especially in B vitamin synthesis, cellular energy production, detoxification, and in the CYP450 system, which is the liver’s ability to process and detoxify.

LE: Is it safe to mix traditional drug pain relievers with supplement pain remedies?

CK: Yes, a review of the literature demonstrated that beliefs about herb-drug interactions are mainly theoretical considerations and not clinically observed facts. Drug interactions with herbs or nutrients do occur, but occur equally to common foods such as broccoli, grapefruit juice, and alcohol. This is also true of cigarette smoking. Certainly, it’s far less of a problem than the over one million [Americans] injured or killed directly related to prescription medication error.

LE: Is exercising helpful and for what painful conditions?

CK: I often say that “motion is lotion.” No question: Exercise is important for a lot of issues relating to chronic pain, including depression and anxiety. It’s suitable for most chronic pain conditions in which furthering structural damage is not a risk—and for those risks, we recommend guidance from a physical therapist. Exercise helps strengthen the core, stabilize structures such as the spine and joints, and improve posture, and it’s also important for reducing negative metabolic consequences such as obesity, high blood pressure, elevated blood sugar, and cholesterol. It even improves cellular energy production by the mitochondria…the recommendation is to maintain a moderate activity level overall, combining various activities such as walking, warm water swimming, and yoga.

LE: Beyond supplements and exercise, do any other lifestyle changes improve pain?

CK: A healthy diet…addresses multiple systems simultaneously to reestablish and support the body’s ability to repair and heal. Many studies show that people who eat certain types of foods are less likely to have health issues. Although many fad diets are in the marketplace, there is a common theme of removing potentially problematic foods, increasing micro-nutrients, restoring healthy gut flora, and reestablishing an appropriate omega-6:omega-3 ratio to decrease inflammation. Carbohydrate restriction and avoidance of refined, processed, and GMO foods is a good start. Generally, anything that decreases depression, anxiety, and focuses on the health condition is helpful—including meditation, stress management, community activities, hobbies, recreational activities, time in nature, and relationships with family and friends. We [use] cognitive behavioral techniques, biofeedback, mindfulness, relaxation exercises, and guided imagery.

LE: For many patients, medical practitioners cannot identify a clear cause. Is there any way to track down the source of their pain?

CK: For complex conditions, there are multiple pieces to the pain “puzzle.” I find a functional medicine approach [focusing on interactions between the environment and the gastrointestinal, endocrine, and immune systems] to be the most efficient in seeking antecedents, triggers, and mediators of the condition. I also look at blood work differently in an attempt to identify patterns. Specialized tests can be useful, such as salivary adrenal and hormone profiles, micronutrient assays, and stool analysis. I [emphasize] finding the underlying dysfunction and correction of systems-level concerns.

LE: Should people who are on blood-thinning drugs check with their doctor before using pain supplements?

CK: Yes, it’s important to have a partnership with your health care provider before starting an herb or supplement regimen—research everything and ask questions. Although the evidence is not overwhelming for interactions, adverse effects have been documented. This is the one area where even food can have an impact.

LE: Very informative. Thank you.

CK: My pleasure.

For more information on Dr. Chris Kleronomos, or on the Fibromyalgia and Neuromuscular Pain Center of Oregon, call 1-844-724-6789.

If you have any questions on the scientific content of this article, please call a Life Extension^® Wellness Specialist at 1-866-864-3027.

References

1. Kennedy J, Roll JM, Schraudner T, Murphy S, McPherson S. Prevalence of persistent pain in the U.S. Adult population: new data from the 2010 national health interview survey. J Pain. 2014 Oct;15(10):979-84.
2. Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum. 2002;46(5):1333-43.
3. Buskila D, Sarzi-Puttini P. Biology and therapy of fibromyalgia. Genetics aspects of fibromyalgia syndrome. Arthritis Res Ther. 2006;8:218-22.
4. Diatchenko L, Nackley AG, Slade GD, et al. Idiopathic pain disorders—pathways of vulnerability. Pain. 2006 Aug;123(3):226-30.
5. Available at: http://www.uptodate.com. Accessed May 1, 2015.
6. Goldenberg DL. Fibromyalgia syndrome a decade later: what have we learned? Arch Intern Med. 1999;159(8):777-85.
7. Calton JB. Prevalence of micronutrient deficiency in popular diet plans. J Int Soc Sports Nutr. 2010 Jun 10;7:24.