More on the Problem of Pain

Dr. Philip Maffetone

Note: This is a follow up to the first article on pain in the Members section.

The first article on pain discussed various aspects of this problem – what pain is, why it happens and how it’s felt. This article is a follow up which discusses other important information on pain.

Pain can be triggered by chemicals that are directly associated with the balance of fats. For example, too many omega-6 fats, including some saturated ones, can promote pain. The same mechanism promotes excess inflammation. With acute pain, these changes can be an important, healthy part of the healing process of recovery from physical activity, for example. But pain can become chronic, which is not normal or healthy.

Chronic pain may be due to at least three possible problems.
- First, the problem that caused the pain is unresolved. For example, a muscle imbalance causing stress in the knee joint can cause inflammation and pain. Until the cause of the problem is corrected, inflammation and pain will continue.
- Second, in many cases, even when the physical cause of the problem is corrected, the chemical imbalance associated with poor fat balance can be maintained. Until this problem is corrected, pain chemicals (including those causing inflammation) can continually be produced.
- There’s a third possibility for persistent pain even when the physical and chemical causes are resolved. Certain types of brain cells, called glia, the most common ones in the brain, can become overactive following some injuries or imbalance. These overactive glia—like an ongoing inflammatory reaction—continue to stimulate the pain even after the original cause of pain has resolved. What triggers the glia to become overactive is not well understood, but certain pain medications, especially morphine, seem to actually worsen this process. Other substances can potentially turn off the overactive glia. These include cannabinoids, the active component in marijuana, as can stronger prescription drugs (immune suppressant drugs such as etanercept, and narcotic receptor blockers such as naloxone).

Pain is an emotion. It originates in nerve endings found in the skin, blood vessels, nerve fibers, joints, and coverings of bone. These pain nerve endings send messages to the part of the brain responsible for emotions (called the limbic system), where we interpret the feeling as pain. Once pain messages get to the brain, messages are sent back to the source of pain in order for the release of natural analgesics that the body produces, such as endorphins. In between the source of pain and the brain, the spinal cord is the relay station for pain perception. This is one reason why “spinal blocks” can reduce pain, and the reason certain spinal therapies such as massage and manipulation, can reduce pain.

The cause of the pain is sometimes in the same physical areas as the pain itself, but many times pain is associated with problems elsewhere in the body, or with problems that don’t produce symptoms. A common example is knee pain. More often, in those with non-traumatic pain in or around the knee, the mechanical cause of the pain is from some problem in the foot or ankle often due to some muscle imbalance. This foot or ankle imbalance is often silent (asymptomatic). This is one reason why so many knee and other problems are unresolved and become chronic – the cause is never found and corrected.

NSAIDS – How They Work & Hurt
Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, ibuprofen (such as Advil) and naproxen (such as Aleve), are commonly used for pain relief. An important observation to make is that if you have pain that improves by taking NSAIDs, it probably indicates you have an imbalance in dietary fats.

Some people continue taking aspirin for pain despite the fact that they do not obtain significant relief or no longer need it. One study showed that 20 of 44 patients who had osteoarthritis were able to stop their regular NSAIDs without return of significant pain, and without other therapy.

How NSAIDS Work
In the conversion of A, B and C fats to eicosanoids, an important enzyme called cyclooxygenase, or COX, is required. There are actually two COX enzymes, and many people are familiar with the term “COX-2 inhibitors.” These are drugs that attempt to inhibit these enzymes. Aspirin, and all other NSAIDS, including Advil, Ibuprofen, Motrin, Naprosyn and Nuprin, temporarily block the COX enzyme, so much less of the inflammatory series 2 eicosanoids are formed. While this reduces the inflammatory group 2 eicosanoids, these drugs can also eliminate groups 1 and 3, along with their beneficial properties. This may result in an improvement of symptoms, but it also turns off the important anti-inflammatory mechanism. In addition, the cause of the problem — fat imbalance — goes untreated. Most importantly, if aspirin or other NSAIDS makes you feel better, it usually indicates that your fats are not balanced.

How NSAIDS Hurt
NSAIDS cause significant health problems in all types of individuals, including athletes, and they could be deadly. This is just a short list of some of the side effects:
- They slow the process of recovery and repair.
- They cause gut problems, including bleeding in almost everyone taking them (even if it’s not noticeable).
- They can cause muscle dysfunction, and don’t necessarily reduce muscle pain associated with training and competition.
- They can reduce the body’s ability to repair joint and bone stress.
- They can cause kidney damage, especially when you’re dehydrated.
- They can disturb sleep.
- They may not necessarily reduce inflammation.
- They cause immune system stress.
- They can actually contribute to injuries.
- They can increase the risk of heart attack.

Other Types of Pain Drugs
Three other categories of drugs are commonly used to control pain. Like NSAKDS, their use should not be a casual thing – try to avoid any drugs unless absolutely necessary. However, the stress associated with pain may be worse than the drug’s side effects; in this case the smallest dose for the shortest period of time necessary may be best.

Another type of drug used for pain relief includes those with acetaminophen. These don’t act by reducing inflammation, and therefore less likely to interfere with healing and recovery. It’s not clear how these drugs work, but among the side effects are liver stress due to the body needing to break down these drugs (in the liver) which requires large amounts of the amino acid cysteine (best obtained from whey consumption). The most common products containing acetaminophen include Tylenol, along with many generic versions.

A second type of pain reliever includes narcotics, such as opiates. These act in the brain to reduce the sensation of pain, and don’t affect inflammation. However, they are easily addictive, and their use as a pain reliever wears off as the brain cells are desensitized. Common narcotics prescribed for pain include morphine and codeine.

A third drug type is the cannabinoids, the active component in marijuana. This controls pain by stimulating certain receptors in the brain, similar to those that opiates act upon. Cannabinoids can simulate the brain’s natural opiates, like endorphins. The only prescription form is Marinol.

Pain can be a serious issue, but its cause must be found and eliminated. It may be important to seek professional help to rule out more serious conditions and find the cause. Most pain is due to some mechanical problem and associated with inflammation; these often arise from muscle imbalance. Mechanical problems can often be remedied by improving overall fitness and health.