Functional medicine treatment approaches for chronic pain

Pain can be elusive. It can defy explanation, it can worsen or spontaneously improve without clear reasons, and there are multiple factors that influence individual expression and tolerance to pain. 

To address and treat an individual’s pain, we can apply the broad acting anti-inflammatories, pain relief topical or oral support whether conventional or “natural” but we still need to understand the unique individual factors.   

If we think of the body as a leaky bucket, we all have various sources of leakage, or drains on our system. If we can address multiple sources of “drains” on our body, we will be in a better position to top back up. 

Inflammation
Whether you use high dose omega 3 fish oils, PEA, curcumin, willow bark, or feverfew, for example, these can help at least control, or reduce the anti-inflammatory cascade allowing the tissues to heal, but alone, they still may be setting the bar too low for how we can address chronic and systemic inflammation. While pain reduction or resolution may be a by-product, we are also supporting risk reduction for things like cardiovascular disease by taking on the bigger picture.

One way of looking at an individual’s inflammatory profile is by digging into nutrition and gut health. Food sensitivities can contribute to chronic low-grade inflammation, pain, and changes in mood and sleep. Digestion and food sensitivity assessment can be done in a number of ways:

1. Comprehensive food sensitivity testing: this involves a simple blood test that will map out your IgG immune reaction to a number of foods you consume. This will rank them as high, borderline, or low/no immune response. Food sensitivities can take 4 hours up to 4 days to have their negative impacts on the body, and can have broad acting negative impacts from joint pain, to hair loss, to depression. This can be why it is hard to pinpoint the exact foods. Testing makes it easier. 

2. 30-day elimination diet [including nightshades]: An alternative means of testing for food sensitivities or pain aggravators is by simply removing all suspected and common food allergens from the diet for 30-60 days, then slowly and carefully re-introduce using a particular re-introduction schedule. The elimination phase allows the body and the gut to rest and “cool” off by reducing the ongoing daily insults to the gut and immune system. The reintroduction phase is a process of testing each food one by one, and logging any return of symptoms in a food journal. 

Cortisol Dysregulation
In acute stress, pain, or injury we may experience elevated levels of cortisol. We can adapt to this high level and often continue to function well despite elevated cortisol if it extends past the immediate alert phase. However, continuous elevated cortisol can have negative effects. After prolonged stress, the cumulative and additive end effects begin to occur – we experience a more dysregulation or overall reduced cortisol output, and many of the nutrients involved in the previously high cortisol consumptive state has depleted as a result. 

Stress can be mental or emotional, but it can also be physical. It is cumulative and additive. The “burnout,” low dysregulated cortisol can creep up over time. The problem with this is that cortisol is our master anti-inflammatory hormone. When the brain has downregulated production of cortisol from the adrenal glands [as either a means to protect us from too much cortisol, and/or lack of nutrients to continue this consumptive process of high cortisol output], it does reduce some risk, but does not come without its own associated costs. The low, dysregulated cortisol output can translate into chronic fatigue, dizziness, autoimmune issues, worsened pain, poor sleep, low mood/motivation, and so on. The conventional system views cortisol in terms of the extremes of disease – Addison’s disease [clinical cortisol deficiency] and Cushing’s disease [clinical cortisol excess], but it fails to appreciate the in-between that many people suffer from by the very nature of our lives and environment. In order to combat this component of chronic pain, it is worth investigating:

1. 4-point cortisol testing using saliva or urine throughout the day. The advantage of saliva or urine is the accuracy, ease of testing and ability to assess several points throughout the day. It eliminates the potential of falsely elevated levels due to fear or apprehension with blood draws. It is also a more practical means of getting four samples throughout the day. A conventional approach of looking at only one morning blood sample, or 24-hour urine collection will also only represent either a brief window in the former, and an average of total cortisol in the latter. This won’t capture the dysregulated pattern of inappropriate highs and lows throughout the day. By understanding an individual cortisol curve, it allows us to better target the dysregulation, whether someone is still in a high cortisol output state and we need to calm and support cortisol metabolism, or on the burnout stage and we need to focus on building the body back up with high dose nutrients and advanced adrenal support. 

2. Nutrient therapy: If our body is taxed and depleted in the very minerals that keep our muscles relaxed and the nervous system in rest/digest as opposed to the fight/flight state, then we will be fighting an uphill battle. Magnesium is one of these minerals that is often depleted, but also critical for the muscles, and nervous system. Amino acids and adequate protein are important for both pain, injury and healing, but also supports mood and sleep. Vitamin C is another building block for collagen and ligaments often heavily depleted in chronic stress and chronic pain. Testing these individual nutrients of suspicion and then replacing with the adequate dose for that individual and in the right form is a key component to give the body the tools it needs to heal. 

3. IV nutrient therapy can be another way that NDs and functional medicine practitioners support a depleted body. It allows for direct absorption, bypassing the gut, for high dose nutrient replacement, particularly when there are a number of depletions. 

4. Mental emotional work: If this is part of the picture when it comes to cortisol dysregulation and chronic pain, it will serve as a major barrier to healing. Counselling, practicing meditation, guided imagery, cognitive behavioural therapy, practicing letting go – these can all support the mental emotional piece of the puzzle when it comes to pain reduction, and removing barriers to healing. 

Circulation
There’s a saying that “pain is the prayer of better blood” – in Traditional Chinese Medicine, this can be described as Blood or Qi Stagnation. It’s describing that inadequate circulation and flow both of our blood vessels and lymphatic system can contribute to pain conditions. Circulation is important for a number of reasons:

1. It brings blood to the area of injury or pain. This means the tissue receives oxygen and nutrients required for healthy cellular functioning

2. It brings blood away from the area of injury or pain, which means waste products, toxins, and old white blood cells are taken away from the area of injury

3. Healthy circulation also involves healthy lymphatic circulation. Our lymph is essential to our immune materials and when we have damage, the lymphatic system needs to reach the area of damage, and it needs to be able to clear away the “junk.” 

However, when we are injured, naturally, we move less. Less movement, creates less circulation. Less movement means we’re not getting our heart rate up, which also means less circulation. All of this, while it can initially serve as a protective function, long term, can worsen recovery and healing. So, if you’re in pain, what can you do to improve circulation?

1. Contrast showers: A simple, at-home strategy. Start with 3 minutes of a hot shower, followed by 30 sec-1 min of cold. Then switching back to hot, and repeating this cycle three times, ending on cold. This can be so effective because it promotes longer vasodilation and improvement of blood flow. 

2. Topical castor oil: not only does it act as an anti-inflammatory, but it also improves circulation. It can be applied with heat to the affected area. 

3. Low-level laser light therapy has also been studied for its utility in pain management. By applying certain wavelengths of light, it can improve circulation, healing, and cellular metabolism. 

4. Herbal medicine: There are also a number of herbs and spices which promote circulation, and lymphatic flow. Some of these include cayenne, ginger, rosemary, and blue flag. 

While we can dive deep into the world of pain management from a conventional lens – acetaminophen, NSAIDs, opiods, injection therapy, corticosteroids, and the more “natural” counterparts like turmeric – these tools and way of approaching pain will likely be less effective if there are other drains on the system. They can serve their place in the acute and early stages of pain, but as with anything, if we are not giving the body all the tools and supports it requires we will be missing opportunity for further improvement and health optimization. 

Dr. Ashley Nelson is a Naturopathic Doctor practicing in Barrie, ON at the Rallis Wellness Group and Virtual Medicine across Ontario. She has a clinical focus in Women’s Health, Hormones, and Mental Health. For more information, visit: www.ashleynelsonnd.com.