At this time,
I would like to thank
our Claude and
Vaughniltis outstandingly
Dr. Nathan offered to come to lecture on a few different topics that I think are really
important and this is the first lecture of three that he's going to be presenting here at the
hospital. This one is on chronic pain. There's also going to be one on autism and then there's
also going to be one on neurodegenerative diseases, multiple cirrhosis, Parkinson's and these are
there's one in January, one in February, one in March. Before Dr. Nathan begins I just wanted
to point out that we do have a new calendar. I have a large calendar for well there are brochures
available. There are brochures available here at the hospital in different places around town,
hopefully the Chamber of Commerce, that lists the ongoing education here. There are fitness classes
and then there are also lectures and support groups and they're all intended to be free or
low-cost. So all the lectures here at the hospital are free and if you don't want to come and pick
up a paper copy you can go online to ncdh.org slash calendar. So it's there also and without
much further information I'd like to say please welcome Dr. Nathan. Thank you. Well good evening
everybody. I'm Neil Nathan. I've much before being called Neil to Dr. Neil or Dr. Nathan or most anything else. I am working these days at
Gordon Medical Associates which is an alternative health clinic in Santa Rosa and I go down there on
Mondays and Tuesdays. I stay overnight in Santa Rosa because I live here in Fort Bragg and I have we
have opened a branch at Gordon Medical at the Women's Health Center and it's Dr. Abramson and
got an ex-opist here and I do work there on Thursdays. We are getting busy so we will probably
expand that very soon. And so let me give you a little background about who I am and what I do. I was told I needed to tell you about the wellness
series. So this is the first of three lectures that I'll be giving. On February 11th I'm going to be giving a talk on autism and that will also include
information on ADD and ADHD. Basically it's all in a spectrum and we're going to talk about how to look at it from a whole different
perspective. Not the Rilland perspective but in terms of the biochemical imbalances that cause that and what we can do to treat that because it's really
treatable and it's important I think that the public know that. The third lecture will be March 18th and we're going to talk about what is called neurodegenerative diseases.
That's a horribly complicated word and really it means multiple sclerosis, Parkinson's disease and almost anything that causes some deterioration of the nervous system
and what we can do about it. Now my perspective will be alternative. It's to expand your awareness of things that are not in conventional medicine and that's what I'm
going to do to a certain extent today. Today's lecture will be a tad more conventional than others but my hope is to simply expand your knowledge of what it is we think we know.
As we, I name the medical profession. That's kind of what I'm hoping to do. A brief discussion of who I am. I came to the Medecino Coast back in 1974.
I'm an intern at San Francisco General Hospital and I worked here from 74 to 79 here at the hospital. I delivered babies, I did surgery, I worked in the emergency room.
I was even Chief of Staff for a year during that period of time. So the fact that I'm back on the coast, people go, how did you find Medecino?
I'm not sure my heart ever left Medecino. I kind of always knew I'd come back and here I am. I'm back with my wife, three dogs and a cat.
My kids are all grown up and they love coming back also. So it's really a joy to be back here. A brief discussion of why do I think I'm knowledgeable enough about pain to give this talk.
After my work as a family physician, and I am board certified in family medicine, I'm board certified in pain management and I'm also board certified in holistic medicine.
After my start in conventional medicine, I became really interested in helping people at a deeper level.
And back in the 70s when I was here, I used probably every cent I made, I went running around the country to study with anybody who had something to teach.
And I studied a whole lot of things that I didn't think were very valuable, and I studied a whole lot of things that were. And I'm trying to distill through my studies what works and what doesn't work.
I'm very practical, which is the only truth that matters to me, is whether my patient is getting better. If they are, then I have something valuable to offer them.
If they're not, it's simply verbal conjecture and hypothesis guessing. And I don't think that's very helpful.
So the truth of anything that I say is always in how my patients do. And I'm pretty hard nosed about my results.
So that when people are not getting better, I'm often the first in our relationship to go, you know, what I'm doing is not working. We need to take another tack. We need to look at it differently.
And that's the approach that I take to what I'm doing. So over the years, I got really interested in a whole lot of alternatives.
And I studied acupuncture, osteopathic manipulation, and although I am an MD, I have 35 years of osteopathic training under my belt.
Homeopathy, a whole lot of biochemical evaluations, prolotherapy, which we'll talk about today.
And over a period of time, my practice evolved into, it became more and more obvious that the best use of my time was to work with people that other people didn't know what to do anything for.
My bag of tricks or tools became big enough that I began to treat people that the word I used for it, fall through the medical cracks, where they'd seen specialists, they'd seen other people, did not know what to do next.
And I sort of was the next step. Some people even started calling me the last resort, but I said, no, that's Vegas, Meno, Barbados. That's not who I am.
And then it evolved into even more of that. So it got to the point that my last leg of my journey, I was in Missouri where I had run Dr. Norm Shealy's pain clinic for a number of years.
It got to the point that really all I did was treat people that other people didn't quite know what to do.
And so it wasn't really the best use of my time to treat sore throats and bladder infections and things like that, you know, any of my colleagues could do that.
When it came to pain, I got involved with Norm Shealy, who some of you may have heard of, and most of you may not, who was a neurosurgeon who developed some of the first pain clinics in the country.
And I worked with Norm when he was in La Crosse, Wisconsin. And then later on he invited me to come work with him in St. Philip, Missouri.
Before that, I had run a regional pain clinic inpatient in Duluth, Minnesota for eight years.
And that means that we have patients with chronic pain problems who stayed with us in the hospital for four weeks at a time while we figured out what they had and what to do about it.
And we use a process that is what in general is right now where you have a team of people, which include psychologists, physical therapists, massage therapists, occupational therapists.
It's a whole team of people that analyze the patient from every way possible to figure out what is this individual need and how can we give that to them.
And that's the model that has evolved over the years into how to treat chronic pain when you don't quite know what to do next.
So over the years I have treated thousands of people with chronic pain and have evolved my own understanding of what that means and how to do it.
So tonight what I'd like to share with you is my perspective on pain, which includes acute pain, which we'll talk about for a while.
Chronic pain. And that means both an understanding of the principles of treating it and then I'd like to talk about specific things that you may or may not have heard of, of newer things that we have available that can help to treat pain.
So my perspective is if we have to, you may have to learn to live with your pain.
But most of the time we can not only make it better or fix it. And unfortunately that is not the basic attitude in medicine today.
The basic attitude of my colleagues is I don't have time to evaluate it and they usually don't have the skills to evaluate it.
So I'm going to give you some medication and then you'll go away for at least a while and then you can come back.
The problem with that concept is it doesn't work. At best medication will take the edge off pain.
It is not a cure because it does not address cause. And so the big issue if you leave tonight with only one understanding, it's, and this is true not just for pain but anything, is you have to have a really clear diagnosis.
That means what is causing this pain? And by that the current term in pain clinics is you have to find the pain generator.
Fancy word for what's causing this pain. Where's it coming from? And by that I mean what tissue or tissues is causing the pain?
Is it joint, bone, ligament, tendon, nerve or combinations of the above? You really have to be precise about it.
And one of my biases that made me kind of a maverick or renegade in the field is that many, many conventional specialists don't believe that you can make that diagnosis.
And so I'm going to start out with a very brief discussion of the basic concept of how my profession use acute low back pain.
And we're going to go from that to the evolution of product pain and how that works.
And I'm going to toss in a study that we did when I was in Springfield, Missouri, which I hope will prove my point. Not that the study is preventing it, but whatever.
Okay. Pain is really important now. In the last two years it is now considered in hospitals the fifth vital sign along with temperature, blood pressure, pulse and respiration.
Now hospitals are required to document and log the amount of pain that people experience. And here's the problem.
Pain is absolutely totally subjective. So we can't define it. You have to define it. And we do it by simply having people have a 0 to 10 scale.
And you either draw a number or give a number of how much your pain is, with 10 being the worst pain you could imagine and 0 is not.
And then we log that in throughout someone's hospital stay and we determine therefore how we do it.
Simple and important. Again, pain is completely subjective. It is always real.
Malamering is rare, but embellishment happens sometimes. That's just human nature.
But I really want to emphasize that. One of the things that plagues my profession is an obsession with not wanting to give medications or drugs or treatment to people who are malingering.
And many people who are not in the pain field are not aware that malingering is really rare.
In the eight years that I ran an inpatient pain clinic, I found three malingers total. And my whole...it's just rare.
And many physicians are obsessed with the fear that someone will put something over on them and get medication that's not truly warranted.
And I can tell you that by statistics in every other way possible, pain is real. Whatever someone tells me they're experiencing, I have no reason to doubt it.
And if it eventually shows that that's not the case, so be it. They have no reason to doubt the reality of someone's pain.
And that's just really important. I hope you all understand and accept that. That all pain is real. It's not in people's heads.
It's real. Does the head process it? Yes.
There are three kinds of pain. Acute, chronic, and relapsing or recurring pain.
And often we really work to distinguish them because there's a big difference in the treatment between acute pain and chronic pain.
We'll talk about that in more detail later. But they're carried on different nerve fibers, they're experienced by the body differently, and they're treated differently.
It is much, much, much easier to treat acute pain than much harder to treat chronic pain.
Once it becomes chronic, the nerves move into a series of cycles, which we will go over in more detail, and the cycles are harder to break.
However, a lot of people get immediately lumped as having chronic pain, what they really have is acute relapsing pain,
and that behaves like acute pain that needs to be treated more aggressively.
And the reason this is important is that often if someone, if a physician hears that you have had pain for 10 years,
they're likely to assume that you have chronic pain and not treat it effectively and may not therefore make the right choices in terms of what's really going on.
So taking the time to really get a good history from a patient is always important.
And it's not true so much here on the coast, but in HMO clinics where I have work in communities where HMOs have the majority of health care,
Kaiser for example, which some of you may belong to, the physician usually doesn't have time a lot to actually do the kind of job you have to do to listen and get the information that we need.
And that's really unfortunate, and it leads to unfortunate things.
So again to emphasize it, treatment begins with a clear diagnosis.
Without that, we are sitting in the dark, and although I am a good guesser, I am way better at what I do when I know what I do.
It seems like that would be.
Simple and reasonably obvious.
So the interesting question is, you may not even know it's a question, is that can a diagnosis, a clear diagnosis of where the pain is coming from be made?
And you may be surprised to discover that the position of the medical establishment is that it can't.
Deo, who is a well-known writer on the subject of low back pain, has written the position paper of the medical establishment.
It says that 85% of people with low back pain cannot be given a diagnosis of where it's coming from.
Wow, they're pretty prominent. Well, we do, if that's the case.
And in fact, this is taken from Essentials of Orthopedic Medicine. It is the orthopedic textbook.
This is mechanical low back pain, and this is how it is diagnosed.
So if you have pain in that area, you have, by orthopedic standards, mechanical low back pain.
And the numbers of tissues in that area are, there are dozens of different tissues that cause that pain.
And if you believe that you can't make a diagnosis, that's as good as you can do, localizing pain, then you probably shouldn't be treated.
If I didn't say it before, you'll discover I'm quite an opinionator, so I'll be firing those off this week.
The Agency for Healthcare Research and Quality, which is nicknamed AHRQ, is the federal agency that determines guidelines by which physicians should practice.
So this is what most physicians are looking at as their guideline about what they should and should not do.
Now, leave it around, I'm not making this up.
The focus is on detecting red flags. Now, red flags means we don't want to miss really serious things that could reflect itself as low back pain.
And those red flags are metastatic disease, meaning metastatic cancer, disc protrusion, where the nerve is being pinched and we are losing function of a leg or another body part because the nerve is being pinched.
Spinal stenosis, where the actual cord is being pinched or compressed so the nerve, again, nerve function is being cut off.
Loss of bowel or bladder and a loss of sensation or strength.
Those are big deals and by all my guideline criteria, do those matter? Absolutely not. Does it happen very often? No. Right?
So by those criteria, if a patient does not have red flags, and I assure you that the vast, vast, vast majority of patients, talking 98 plus percent, if they have low back pain, do not have a red flag.
So if you don't have a red flag, this is the standard of care that is espoused by conventional medicine.
It is imaging studies, meaning x-rays or MRIs or CT scans are not recommended for at least four weeks.
The treatment recommended are NSAIDs, which basically mean mesononesteroidal endoclavities.
That means aspirin, botrin, aloe. Their spinal manipulation have been shown to be useful.
Other medications are not recommended or warranted by their assessment.
So stronger pain medications, muscle relaxants, those are not on the list of what is the accepted way of treating acute low back pain.
Bed rest for more than four days is not helpful. I agree with that.
And the sooner you can get someone active, the better it is for them. And I agree with that too.
We do know that the sooner you get around and start moving, if you have an acute back injury, the better it is for you. Those are true.
And I want to call attention to this, and I only put one of these slides on. I have a whole bunch more of them.
I didn't want to get too carried away with it. But the important thing to take away is if you have acute low back pain,
there is 10% of patients will not get better in four to six weeks and will ultimately go on to get chronic pain.
In addition, over 50% of people who have an acute episode of back pain, within six months to a year, will have another episode,
and most of those will go on to get chronic pain.
What I mean by that, and these are not my statistics, this is well documented in the medical field,
is that if you don't treat acute pain quickly, properly, and well, there is a really good chance it will become chronic and it will keep coming back.
However, according to the experts, you can't make a diagnosis of what's causing it 85% of the time,
and the treatment is take some aspirin or Aleve or see a chiropractor or osteopath and don't come back for four weeks, and then we'll talk about it.
So we know that if you don't do anything, it's likely to become chronic, but there's not much you can do.
That's the medical model we're working with, and part of my message tonight is I don't believe that that's true at all.
So let me talk for just a few minutes about pain generators.
Where does pain come from?
Well, it comes from the joints between the vertebrae.
It comes over here as well, through the sacroiliac joints.
It comes from the ligaments, and I'll go into these in a bit more detail, the ligaments through here.
It comes from tendons, muscles, and anything that's there can generate pain.
So our job is what does the being who is in front of us have?
Why do they hurt?
And I would submit to you that it is possible to determine that with accuracy and do something about it, and thereby prevent chronic pain.
So the first step of preventing chronic pain is to treat acute pain as properly as we possibly know how.
This was a theory of mine for many years, and I decided eventually to get off my tail and prove it.
So one of the things I did when I worked in Springfield, Missouri is I took a job, another job, I didn't already have a day job,
but I went to work with an occupational health clinic who had a captive audience that they took care of the majority of people who worked for the largest corporations in Springfield, Missouri.
Those patients had to come to this clinic for health care if they got injured on the job.
So if they had back pain, they had to see the clinic. If it came back, they had to see the clinic.
And so this was to me a great way to be able to follow people for several years to see if treatment that we gave actually resulted in not getting injured again,
not having pain again, and not becoming chronic, because it was a captive audience. They weren't going anywhere else.
And my job at the clinic was to treat the people that weren't getting better by the other practitioners who worked in the occupational health clinic.
So it was, understand that the people that are in this study were not your ordinary back problems.
These were the problem back problems, the ones that weren't responding to the simpler measures that were provided by my colleagues at the occupational health clinic.
So these numbers are a bit skewed. And by a bit skewed, I mean these are the worst patients that I've got here, because that was my job. That's what I did.
And it is my contention that you can diagnose where pain is coming from. And what we discovered was that in people who had 243 consecutive low back injuries,
and no one was eliminated from the study. One of my pet peeves with doing research studies is a lot of people doctor the numbers so they get better numbers.
There's no doctoring. Every single person who I saw was included in the study. Whether I like the outcome or not, you know, that's the nature of what I call decent research.
Interestingly, the vast majority came from the sacroiliac joint. In a few moments I'll tell you how did I determine that with precision. We'll talk about that.
And the second most common is the piriformis muscle. We'll talk about that muscle and why it's important. The quadratus muscle, pain coming from a rib head where a rib joins the spine.
Other muscles. And you'll notice that there's a lot more than 100% here. And that's because some people have more than one of those components. It's not all one.
So that's where most of the pain comes from. Rarer, herniated discs, which is what a lot of people focus on in evaluating a low back, is an obsession with the disc.
And this study, by the way, my study echoes every other study that's ever been done on this. So that a 3% incidence of herniated disc is standard in the medical field.
So despite the obsession that we have with ruling out a disc, it's not common. 97% of the time it's not a disc. A facet joint is a possibility.
Ileo rotation, which means the hips are rotated. Some of you may hear that phrase from chiropractors who tell you that someone is out of place.
That means that when you examine them, one leg is shorter than the other, but that's because the hip is rotated. And the technical term for that is just ileo rotation.
Then we have several types of bursitis, which I'll talk about. Sacro coccidial injury, which just means tailbone injury. Sorry for the medical terms.
I used these slides in some medical presentations some time back. The ileo lumbar ligament, which we'll show you.
And spinal stenosis is really rare. In all of those patients, only 0.5% of people have that, either.
So really what we're talking about is the vast, vast, vast majority of our patients had a strain injury to the sacroiliac joint and the muscle surrounding it.
That's really the simple part of it.
So let me just give you a better visual picture of what I'm talking about when I throw these words around.
So this is the quadratus lumborum muscle right here. It's a big, thick muscle sitting back here.
It's what a lot of people think of as their back muscle. But we don't have a back muscle. We have lots and lots of names for stuff.
So this is our name for it. And what I'm going to show you in these drawings here is that each muscle in the body has what are called trigger points.
Trigger points are the place where the artery and the nerve enter the muscle.
And when a muscle has been tight for a long time, the trigger point acts up and becomes a tender nodule, which you can palpate and feel.
It is not mystical. It is easily palpated.
The deep trigger points radiate pain to this area.
So if you have sacroiliac pain, you don't know is it coming from the sacroiliac joint? Is it coming from something around it?
Pain in these spots shoots to these areas. So that means you actually have to examine somebody to find out where pain is coming from.
Another pet peeve. The majority of people that I have seen as a pain specialist have never been examined, even by the specialist that they've seen.
And never is a strong term. I cannot count the number of people that when I do my initial evaluation on it, they'll say, you know,
I've seen orthopedic surgeons. I've seen neurosurgeons. I've seen physiatrists. I've seen rheumatologists.
Nobody actually touched it. They put the MRI scan up. They put up the x-rays. They would look at the studies, the water and EMG.
Nobody examined it. I do not understand that. This is the only way you can tell where things are coming from.
So if someone hurts here and they hurt here, these may be connected events. But by no means is this impossible to diagnose.
I think this is... I'm sorry. Okay. I'm going to get off my pen right again.
Now the superficial trigger points here radiate pain to these areas.
Now what that... I'm talking about radiation patterns. That means where you hurt may not be where the problem is.
It could be a little bit away from that and you need to know the anatomy and the structure in order to know where we're looking at.
Now, high on my list of diagnostic importance was this muscle here called the piriformis.
It goes from the sacrum, which is the stick-wad of bone that attaches to the glute and attaches to the hip right at the top.
And the piriformis muscle is one of the most uniquely important muscles because the sciatic nerve runs through it.
And what that means is that 80% of the time when people complain of sciatica or pain shooting down their leg,
it is not coming from the disc, which is where everybody looks. It's coming from the back.
Because that's where the piriformis is. It runs smack across the body.
So if that muscle has tightened up to protect the sacroiliac joint or to protect anything around it because that's what muscles do,
they try to protect us. They tighten up to try to protect us.
If it tightens up to protect us, it may pinch the sciatic nerve called sciatica.
So when we see sciatic pain, actually this is the most common cause by far.
Nothing else comes close and is often overlooked and missed and not discovered by my profession.
So it's really important to...not that you need to know this anatomy.
This is not going to be a pop quiz or anything after this.
It's just so you get a better feel. What I'm going to be covering here is a whole system.
And I want to sort of flush out this system so you get the idea of all the muscles and nerves and ligaments
and the kinds of things that we want to look at in order to make a good diagnosis and treat it properly.
So this is just an example because low back pain is probably one of the most common things that anyone ever goes to the doctor for.
Another muscle in place here is called the iliopsoas muscle. Now that's made up of two muscles.
The psoas, which starts oddly enough way in the back on the spine.
It's the only muscle in the body that starts in the back and comes out in front.
And it comes out into the front right into the groin here.
So that's the psoas. And the fibers connect with the iliacus muscle which is in the pelvic brim here.
So that contains a muscle. Important here is the piriformis, which I just told you about.
And the psoas are antagonists and they work together.
So as a general rule, if one goes out, the other goes out.
And that's why you kind of have to look at both to know what you're looking at because it is extremely common for both to be out of whack because they work together.
It's not, again, it's not a hard thing to figure out.
There's another muscle that starts up at the top of the hip and comes all the way down to the side of the knee.
And these are the radiation point areas for some of these muscles. So these are the trigger points.
And again, you can see, you can get pain in your thigh and you can go, well, what's causing that?
But it's simply a muscle which is not too far away.
I'm going to just, again, these are other muscle groups that we look at.
I'm going to move on into other areas.
What I want to call your attention to is this thick ligament in here, which is the thickest ligament in the body.
It's the posterior sacroiliac ligament.
Again, no problem quiz.
This is what holds the stability of the back together.
What many people don't know is that all joints in the body are basically held together by ligaments.
That's where the strength is.
All right?
So that's true for your knee and it's true for your low back.
And so where the body needs to have tremendous stability, like in the low back area, it builds a thick one.
All right?
The angelic engineering crew figured this out long, long ago and that's how they designed it.
That's how it works.
So this particular ligament is the thickest and strongest one in the body.
And there's a couple of others here, and I'm pointing them out just so you understand a little better.
These are called the ilio lumbar ligaments, which attach to the lower vertebrae and they attach in here.
So you can imagine that this holds this whole joint here together.
The other thing that I will just point out because we'll see it again is these joints in here are called facet joints.
And oddly enough, in the spine we give a different name to joints.
It's almost like, because the word facet just means joint, so it's a little bit like the Department of Redundancy Department.
It's called a joint joint.
It's a different word so most people don't realize it.
Those are the joints that give the spine its mobility.
Okay.
So the reason I've given you this anatomy lesson is to help you understand how we go about to make the diagnosis.
I've said that it is my belief that we can precisely identify where pain is coming from.
First of all, we can if we actually touch in the mix.
When you actually touch a body, you can tell that there's pain in the sacroiliac joint.
You can tell if the ligaments hurt. You can tell if the spine is painful.
You can feel the muscles. You can feel trigger points.
It's all available to us by just putting our hands on an individual who's in pain.
But second of all, if we want to know where it's coming from, let's take the sacroiliac joint,
which is this big, long joint right in here.
It's a very long, complicated joint.
So many other tissues are near it that it really helps to know is the pain coming from that or from the tissues around it.
For example, if you hurt here, is that pain coming from the sacroiliac joint?
Is it coming from the ilioelumbar ligament, which is just above it?
Is it coming from the facet joint, which is right over here?
Is it coming from that quadratus lumborum muscle, which is just above it that I showed you a few minutes ago?
So it's not as, I'm not trying to say it's simple, but we have to at least ask the questions.
Okay, I can tell that you hurt right here and that's over your sacroiliac joint.
But where is the pain generated?
That first question keeps coming back.
And so the method that we have used for years is we inject into that area to see if that takes the pain away.
Here's the supposition.
If I inject this spot and only that spot, then someone's pain goes away immediately.
And I mean pretty much completely.
I know with absolute precision the death's where it's coming from.
It's not coming from the muscle because I ain't going to hear the muscle.
It's not coming from the facet.
It's not coming from the ilioelumbar joint because I'm not there.
If I can get the pain to go away and I know where it's coming from, then I know exactly what I need to do to treat that.
So that's the basic process by which I generated all of those numbers on that research study.
Yes?
Inject what?
Usually, the answer varies actually, but usually it is either a penicillin, which is marquise, or cortisol, or both.
It depends on what I'm trying to achieve and what I think is going on.
Diagnostically, all I need is the marking, which is a local anesthetic.
And if it works, it works immediately.
And by immediately, I mean the patient gets off the table and within five minutes they will say, whoa, where's my pain?
So it is a very clear diagnostic tool as to what's going on.
Now, if I'm really sure that it's a sacroiliac joint, I may put some cortisol in there also because especially for acute injuries, that will take 70% of, that will cure 70%.
A second one will take care of almost the rest.
So it's a very wonderful tool.
I know cortisol is, you know, in the 30-word category.
It's an alcohol-hungerable, terrible substance.
Everyone needs it.
As a holistic physician, here I am saying, I use cortisol.
Whoa.
Am I a renegade or what?
Used occasionally, it is absolutely safe.
And we use a form of it that's called depo-medro.
Depo meaning depo.
And it pretty much stays where I put it.
Very little of it gets into the circulation.
And so if I use it sparingly and only occasionally, it's a very safe thing to do.
And in fact, in the study we've done, I think we can prove it when you look and see how the numbers came out.
People did not go on to develop problems with it.
The reason cortisol has a really bad rep is because if you take it constantly, regularly, for a variety of medical conditions, rheumatoid arthritis,
chronic obstructive lung disease, or asthma on a long-term basis, if you are taking it long-term, it has every side effect in the universe.
It will weaken the bones, it will weaken the immune system, it will weaken the tissues.
You don't want to do that.
So I am not advocating widespread, one-ton, and irresponsible use of it.
I am saying it is also not the worst thing in the world.
An example is one of my partners has had some surgery two years ago and had some sacroiliac joint pain since,
but absolutely refused because of his concerns with cortisol to let anybody, and everybody in my clinic goes out to do this, by the way,
but he wouldn't let anybody inject it.
He finally was so tired of being in pain that he came to me a few weeks ago and said, treat it.
And I did a variety of things that helped him, and I finally said, try an injection.
It is simple, it is not bad, it is not horrible.
I finally screwed up his courage, and he had the shot, and he walked off the table and said, what did you do?
I said, I did what everyone else here has wanted to do for two years.
Actually, I injected him two months ago, and he has been pain free ever since, and he had it for two years.
So he just keeps shaking his head, and I am like, why didn't I get the shot?
So I don't want to trivialize this, but I can't count the number of people where that has actually happened.
It is really not a bad treatment.
Okay, so the last, that is where the needle would go for a sacroiliac joint injection.
This is a needle pointed over the facets.
This is a facet joint in here.
Just giving you a kind of little visual image of the kinds of things I am going to be talking about.
That is a needle touching the tip of the, it is called the transverse process that comes off of the vertebrae,
and that is what the iliolumbar ligament attaches to.
This is a needle that is literally a pain in the butt because it is sitting on the sitting bone.
This is where you sit, it is called the ischial tuberosity, that is the fancy word for it,
and people can get, believe it or not, an ischial tuberosity versus sinus,
because there is a little bursa where you sit that lubricates that area,
and a lot of medical professions have never heard of it.
But sometimes people will say, this is where I hurt.
And one story for example is I had a well-known radiologist from Kansas City who heard about me
and came down to see me in Springfield.
He had seen several neurosurgeons, several orthopedic surgeons.
They had convinced him that his pain was from his disc.
They resected his disc, and they were offering him more and more surgery.
And he had been going on in pain for five years.
When I examined him, he had no pain over his lower back area.
In other words, this upper area here, no pain whatsoever.
I am not pressing on it, I am not pushing on it, nothing.
But when I got to his, I don't have a better word for it,
derriere, but that's a reasonable medical term,
right there over his sitting bone, exquisitely tense.
And I said, and when that happens, the piriformis muscle tends up to protect it.
Remember our friend the piriformis?
So he had sciatic pain that came from that spot.
And so what I did was I injected cortisone and marcain into this spot.
I injected his piriformis muscle just with marcain,
and I stretched it out, I treated the muscle,
and he got off the table and said, where's my pain?
So I've been wrestling with this for five years.
He said, it can't be that simple.
Because you can do this, I'm going to do this in my office.
This literally takes two minutes, this is not complicated.
I don't need a fluoroscope, I don't need to do this.
An x-ray department, this is easy.
He said, that's not possible.
Okay?
So you keep noticing whether what is not possible is,
and you know, come back and see me in three weeks.
We came back in three weeks.
He had had a slight recurrence of his pain.
He had been 90% better.
I treated him one more time, same way,
and he was completely cured of his disc problem
and low back problem, which he never had.
Again, this is a plea for actually touching people,
putting your hands on their body.
I really believe it is possible to make a clear diagnosis
of where pain is coming from,
and I really believe it's possible to treat it.
Understand that these are not the only ways that you can treat these.
You can treat sacroiliac joints in many, many, many other ways.
This does it.
This is just the one that, in my experience,
works the fastest and the easiest.
That's the bursa that sits over the hip.
People get pain over in this area.
It's often a hip bursa problem.
I mentioned the fact that you could get rib injuries,
and one of the most underdiagnosed problems in the back,
and this goes all the way up the whole back, is a jammed rib.
A jammed rib is not a term that most physicians use.
It's an osteopathic term, actually.
What it means is that actually the rib is jammed,
and there are joints in a rib that enable them to be jammed.
This is a close-up picture showing the joints,
but there are several actual joints in a rib,
and if there is a blow to the rib,
if someone catches their arm and falls on it,
if you reach up into a position that is not physiological,
a rib can jam in a position where it's not supposed to be.
If that happens, you get pain, especially in the shoulder area.
Let me use you as an example.
Some of the pain that people have in this area is a jammed rib.
Everyone treats muscles that are going out of style,
but often it's these ribs that get jammed.
The first thing that most people say is,
you have ribs up here?
Actually, yes.
The first rib starts here, second, third,
so we've got lots of ribs over here, and we'll start now.
In the lower back area, we have ribs as well.
Now, again, looking at the bigger picture,
I showed you a picture of this muscle that goes up the back,
the quadratus lumborum, it attaches to the ribs.
If it goes into spasm and gets tight,
it will pull on the ribs and jam them,
and then it becomes hard to treat that muscle if you don't free up the ribs also.
So you have to look at this whole system here to really do this appropriately.
This is simply a picture of a simple osteopathic technique that we use
to free up the ribs.
This shows the ribs up here, and what we're going to be doing
is putting traction on the ribs in the direction that the rib goes.
It's gentle traction. It's not a pumping technique.
You simply put traction on the rib until it lets go,
and it's not hard or difficult to do, but if you don't do it,
the muscle has trouble letting go because it keeps trying to protect the jammed rib.
So what I hope I'm keep conveying,
I'm trying to slowly build a model of complexity up,
but also to tell you that that model of complexity is what we are working with,
and it's very possible to tease out these pieces so that we can work with them.
Okay, so in my model, which was, I believe that you can make a diagnosis
with precision of where pain is coming from,
and then you can apply the appropriate treatment to it.
So in the low back area, what are our options?
And these are the ones that I used in the study that I'm discussing,
which is you can treat the sacroiliac joints, the iliolumbar ligaments,
the bursa, trigger points, the ribs, the vertebrae can be out of alignment,
which is what osteopaths call somatic dysfunction.
Sorry about the fancy term, but that is what it's called.
You can block the facet nerves to see if they're jammed in the facets,
and what I mean by that is I show you the joints in the spine.
There is a teeny, teeny nerve called a facet nerve
that comes from the main nerve and just wraps around into the joint.
If someone is injured, you can actually compress
or pinch the facet nerve in the joint.
And, for example, one of the common ways that happens is when patients
have compression fractures, and the whole spine gets compressed
because there's a 95% of the time that feels fine, no problem.
But that percent of the time, people will experience a constant aching,
very annoying pain that goes on and on and on forever.
And what's usually happening is the facet nerve is being pinched
in the area that got compressed.
How can you tell? You can inject it with fluoroscopy,
knowing exactly where you're putting a needle.
And if you exactly know what you're doing, and again, this is not cortisol.
This is simply marquette, which is like light of day.
And you can hear those words.
If someone has a facet nerve that's being pinched,
they will get off the x-ray table and say, my pain is gone.
So we have our diagnosis.
And here's the good news.
This sounds horrible, but I'm going to give it to you anyway.
Then you can kill the nerve.
And when I start saying words like kill the nerve, I get that thing again.
Keep in mind I worked in Missouri for a long time,
which is the buckle of the Bible belt, and this was done a lot.
But when I say kill the nerve, the nerve that causes the scent pain
is a teeny filamentous branch.
It does not go to any muscle.
It does not have any other sensation.
All it is is a nerve that's being pinched and is saying, out, out, out, out, out, out, out, out, out, out, out.
And it just doesn't shut out.
It goes on and on.
It'll go on forever if you don't play it.
So if you kill that nerve, it is a very safe procedure.
You're at no risk, zero, at damaging anything else.
We're not talking about cutting a nerve and losing function.
The nerve couldn't do that, can't do it.
So we can simply inject a little phenol.
Again, by injection, it does not require surgery.
You can inject phenol into the same place you put the lammortain.
And within a couple of days, pain is permanently relieved.
It is a very, very wonderful technique for people who've had pain for years
who don't know that their pain is coming from the facets.
A lot of physicians, even some pain specialists,
who pop facets and say it doesn't matter.
I have helped hundreds and hundreds and hundreds of people with severe pain
to be completely pain-free by knocking out their facets, nerves.
Very simple, very safe, and very underutilized.
But it's a procedure that really needs to be looked at more.
So back to my little study.
We treated not just low back pain, but since I was working,
I was like, let's do the whole thing.
So basically I looked at every type of pain that people came in with acutely.
And I took consecutive patients.
Every single patient that I saw.
And remember, these were the ones who were the worst,
not the simple ones that got better and relieved.
These are the ones that my colleagues after a week or two said,
you're not responding to what I'm doing.
Why don't you take a look?
So for these patients, we treated 364, 243 were in the back,
71 in the back and shoulder, 39 in the ribs, and 11 in the head.
Now, remember that statistics show that re-injury occurs
in over 50% of people within six months to a year.
I can maintain that if we really treat it properly,
people don't get re-injured because they don't have weak tissues.
They're healed.
They don't tend to re-injure.
So the number of re-injuries was 7.4%, which is way lower than greater than 50%.
And we followed these patients for over three years.
So we're not talking six months or a year.
It's over three years.
Captive population, there was no place else to go.
They had to come and see us.
So we think that actually means something.
Which of those went on to become chronic?
A whopping 3.2%.
And in the standard medical treatment, if pain becomes,
50% of these people would become chronic if they recurred and didn't get better.
So 3.2% versus 50% is, from our perspective, fairly significant.
So I can get up in front of you and say that I actually have some data and research that shows that.
If we treat chronic pain properly and aggressively,
we actually can do a good job of helping people to heal and heal more permanently.
So that's my take on the message.
The number one thing with chronic pain is can it be prevented?
And I think, not in every case, but often it can if we really take the pain seriously.
Okay?
Pain Mike, here.
That's just the back pain alone, the re-injury and the chronic and the back pain is basically the same.
So now that I've broad beaten you about the importance of precise diagnosis,
I want to do two main more things tonight.
You know, I'm available to you all as long as you want. I'm happy to talk about any number of subjects later on in the year if you want.
Someone asked, what about fibromyalgia? That's a whole two-hour lecture. I'm happy to do that.
But what I want to do tonight is I want to now explain the differences in treating chronic pain from acute pain,
and then I want to talk about alternatives.
And I want to go over some of the newer stuff that we're working with that we're excited about that's been very helpful.
So again, being a little technical, but I really want to emphasize acute pain is neurologically completely different than chronic pain,
and that's why we have to treat it differently.
Acute pain is carried on neurologically what we call A delta fibers, again, no test, and chronic pain is carried on C fibers.
They have a different feel to them. Acute pain is when you reach out, you know, and get a pin stuck in your finger,
and you get this immediate withdrawal reaction.
That is a different pain than the chronic nagging ache of a low back when it's been operating for a long period of time.
So, but one thing to understand is that we have recently realized that over time, if pain continues, if it doesn't get treated,
the nerve actually gets irritated, and you develop an additional type of pain called neuropathic pain,
which means that the nerve itself is irritated, and that has to be treated separately also, and they're all different.
Meaning, acute pain responds very well to a variety of medications.
That's not a bad thing. Once again, we don't have to do this, you know, when they say medication, again,
what's a holistic boy like you talking about? Pain medication, boy.
When you're in acute pain, the muscles around that tighten up to protect the body,
and it is very helpful to make them relax by tricking them into thinking there's no pain.
It's not evil, it's not wrong, and it's not bad, and that speeds up the healing,
because if those muscles relax, you get a better blood supply, and the tissues will heal faster.
So there's nothing wrong about using pain medication for acute pain. It's a useful tool.
In chronic pain, medication has a limited role. Not only is it prone to getting people addicted,
but it barely takes the edge off most of the time, and that varies from person to person.
But the vast majority of our patients on chronic pain will say,
I need it to live with, but it's just taking the edge off.
Keeping in mind that neither, medication in either case doesn't address cost.
So going back to that. Now if we have neuropathic pain,
we have a variety of medications that treat the pain coming from nerves, and that's different.
So we have a whole family of medications like Neurontin, Tegretol, the newer ones, Lyrica,
are all based on numbing nerves, and they're useful and quite valuable,
but we have to be precise about which nerves are causing the pain,
because even our choice of medication may be in the wrong arena if we're not working on the right tissues.
So let me talk for a minute about something that is one of the understandings of chronic pain called reverberating loops,
which is why does the pain become chronic? Why is it the body doesn't figure out what to do with it and deal with it?
And one of the concepts that has been best proven and has been around for a long time is that when you are in pain,
let's say here's a muscle or the skin over here, you damage the muscle, you bang it, you hurt it,
there's a contusion of the muscle, the nerves are affected, the nerves come from the skin,
from the muscle into the spinal cord, and then up to the brain, where you go out.
The basic process, it's simply a wiring diagram, an electrician would be fine with it,
from the muscle into the spinal cord to the brain.
I want to focus on this area in here for just a second.
I'm going to blow it up. So we have the nerve coming in here, it synapses with another nerve that goes up to the brain.
Simple straightforward thing. However, in this area here, there are millions and millions and millions of nerve endings right there.
And what happens sometimes is that these are so close to each other that you get one that loops on itself,
which is where the word reverberating loop comes from.
What happens is, even when the muscle is healed, the original injury pattern stimulates itself.
It means the body, this is done, but on a neurological basis, it's like a short in the system electrically,
it just keeps telling the brain that you hurt.
And that's why identifying this as chronic pain is an important way to change the reverberating loop.
Now you can change reverberating loops in a number of known ways,
and we'll talk about that in more detail when we get to treatments,
but things like hypnosis, acupuncture, various types of nerve blocks,
anything that shuts this system down briefly has the capacity to break the habit and to change this.
My current favorite way of doing it is with an electrical device that's recently been released called a frequency-specific microcard.
And it is my new favorite toy because over the years, helping nerves to heal has been the hardest thing that I've ever had to work with.
And I have found frequency-specific microcard to be the best tool to get inflammation out of nerves and to literally reboot the system.
Because that's what we're talking about here, is rebooting it.
It's like, it's confused.
It's just like a little computer system that's just simulating itself. If you can break this, you can break the cycle.
So I hope I'm making sense out of that. Is that clear?
Yes.
The other things I want to at least talk about for a bit are what I call the vicious cycles of pain.
Because there are certain things in chronic pain where pain begins more pain.
And if you don't break the cycle, you can't fix it.
These are all very basic to any chronic pain problem.
So we have the muscle spasm contraction cycle.
We have the muscle weakness deconditioning cycle.
The depression, fatigue, insomnia cycle, and the disability compensation part of the cycle.
The muscle spasm contraction cycle is a very simple one.
We kind of alluded to it.
When you're in pain, the muscles tighten up to protect you.
When they do so, they are actually compressing their own blood supply.
It's not physiologically. It's designed for short-term use.
It's as if the body has gotten confused and it doesn't think no one is doing properly.
So the artery goes into the muscle.
But if that muscle is tightening up, it literally shuts off its own blood supply.
And not to the point that it dies or atrophies, but enough that the waste products are not getting out of the muscle properly.
And there's a buildup of lactic acid in the muscle.
And inflammatory irritants build up in the muscle.
What does the muscle do when that happens?
It gets tighter.
So it tightens a little bit more.
It shuts off its blood supply a little bit more.
It gets a little bit more of the irritants in there.
And how does it respond to that?
It tightens up a little bit more.
And so you get, I call it a vicious cycle, or it's actually a vicious spiral.
If you don't deal with that, it's really hard to treat chronic pain.
You have to get a better blood supply to the muscle, and you have to get it to relax.
So that muscle relaxation strategies, of which there's a small trillion, are all useful and valuable when treating chronic pain.
And that can be heat.
It can be massage, a variety of electrical stimulation devices, ultrasound, acupuncture.
Ice.
Massage.
Ice, no, because ice actually makes it tighten up.
Keep in mind that ice and heat are not opposites, which you would think they are, but they do different things to the body.
Ice works in a different way.
It doesn't work, but it's not.
But what it does do, now some people do feel better when they use ice, because it overloads the mechanical receptors,
it sort of shuts down the riverbane loop for a little while.
Usually not long enough to be permanent, but it can do that.
On the other hand, it does tighten up the muscles and make them contract.
So generally, for chronic pain, I'm a big fan of heat.
Not for everybody.
There are some patients who will say to me, Neil, the ice feels better than the heat, and I go, great, they use the ice.
Whatever feels better is your body's way of telling you what works better.
But as a general rule, philosophically, the heat is more likely to stimulate better blood flow and to get the muscle to relax.
Biofeedback, meditation, yoga, stretching, all of these things are ways that we can get the muscles to relax in our mind,
and that's critical in reversing this cycle.
The second one is the muscle weakness deconditioning part of the cycle, where when you're in pain, you do less.
The less you do, the more deconditioned you get.
And as an exclamation point way of describing that, a study's been done that shows that hospitalized patients can lose up to 18% of their muscle mass
in the first week of hospitalization when they're very old.
Now, the good news is it doesn't keep happening, because that would be five weeks and you're wasting your time.
It drops off after a while.
But that's an extraordinary amount of muscle weakness in a very short period of time.
For some hospitalized patients, it's not an option to get up and exercise, depending on what you're there for.
So what that means is that people become deconditioned much faster and to a much more profound degree
when they realize when they've been in pain for a while.
And that cycle is the same kind of a vicious cycle.
The more you hurt, the less you do.
The less you do, the weaker you get, the less you can do.
And what happens to most human beings is they finally get to the point is that I can't stand it anymore.
I'm getting out of this house and I'm doing blah, blah, blah, whatever that happens to be.
And that's fine, but often that exceeds the body's ability to do that, and they get into more pain,
and then they have to rest more, and then they get more deconditioned, and you can see how the cycle goes.
So part of the second part of treating chronic pain is it has to have built into it some degree of physical activity.
And here's the tricky part.
It has to be gentle enough that you don't overdo, and not so bad that you make yourself worse so you'd set yourself back.
And that place isn't the set place.
You kind of have to keep finding that place.
That is not a simple thing to do.
However, that's critical in whatever program you're going to put together, however you're going to think about it,
that becomes important that you reverse the decondition.
It has to be built into it.
Then we get the depression and salmoneth, the peak part of the cycle.
25% of patients with chronic low back pain become depressed.
The vast majority of them also have difficulties with sexual function, which they don't always talk about,
but that also bothers and disturbs people to understand the weak-brain degree.
So when they become depressed, that becomes part of the problem.
So the more depressed you are, the less you do, the more pain you're in, it changes the chemicals in your body.
Depression is a deficiency to a certain extent in serotonin.
Serotonin is critical in sleep and in pain relief.
So the same chemicals that get depleted by one affect the other, and we're off to the races.
So again, ignoring depression and saying, oh, it just comes with the territory, I'm depressed because I'm in pain.
True, but that doesn't mean that we should be ignoring that,
because that's another piece that we can work on and fix in a variety of ways.
And then there's the disability compensation part of it, where it gets hard to treat it when you're disabled,
when you're getting disability payments for your pain.
It adds to the difficulty, because the natural tendency of human beings is,
if I'm going to accept money for this, I guess I have to suffer.
And that adds another whole piece to it.
So our whole disability system is not designed for optimal improvement.
I'm leading with that, but I'm going to give a lot of political comments about it, but I won't.
A couple of other things that I've been stressed that are important is we talk about perpetuating factors.
The chemistry changes when you've been in pain for a while, and a lot of my colleagues are not aware of this,
so I want to emphasize this.
First of all, magnesium deficiency is present in 90 to 95 percent of people with chronic pain.
And magnesium is a critical mineral in all muscle and nerve function.
So replacing magnesium needs becomes biochemically important,
because if you don't have the raw materials in your body to deal with, it's hard to heal.
And ignoring that does not help at all.
So let me emphasize the magnesium part of that story.
DHEA is the main hormone made by the adrenal gland.
And when you have been in pain for a long period of time, you will also get stressed.
Stress is what depletes DHEA.
Now what does DHEA do from a feeling point of view?
When your DHEA is low, and it is in 95 plus percent of people with chronic pain.
Fatigue, fatigue, fatigue, fatigue, to emphasize that.
And problems with focus, memory, concentration, sex drive.
These are almost universal in chronic pain patients, and therefore I submit that measuring magnesium and DHEA levels
is an integral part of that, and if it's low, treating that is really important.
And so I want to emphasize, we also have to look at the biochemistry of someone who has been in pain for a long time,
because that can be treated.
Again, these are treatable pieces.
And then we have the obvious things of really looking at people's movement, posture, things like that,
which is, is someone sitting or standing in such a way that they are not allowing those muscles to relax,
or the ribs to take the back up on them.
What do you consider treatment amounts of magnesium DHEA?
What type of...
Well, first of all, I usually measure it so that I have a better idea of what you need to take.
Magnesium can be tricky.
First of all, the kind of magnesium you use matters greatly.
The commonest magnesium available in most stores is magnesium oxide.
Only 10% of that is absorbed.
So you want to use chelated forms of magnesium.
My favorite is one that's called magnesium tarant.
T-A-V-R-A-T-E.
And typically I recommend taking at least two capsules at bedtime.
That may not be sufficient.
Some people with really low magnesiums need to actually take it intravenously to go look back up if it's really low.
Concerning finding out what the levels are in your body, if you go and you request your physician,
can they do a blood test for you?
They can, and it's not a good test.
Okay. So what is a good test? Or is there one?
There is, but you're...
We should try to keep it simple, but we'll make it complicated.
Magnesium is primarily in the body an intracellular mineral,
meaning that it's inside cells.
It doesn't flutter around in the bloodstream much.
So if you get a blood test for magnesium, that may not reflect a deficiency.
The body will pull magnesium out of bones and anywhere it needs to to keep your blood level low.
By the time you have an abnormal blood level, your magnesium is really, really deficient.
My sister-in-law has multiple myeloma, and magnesium is pulling it from the bottom.
So the way you measure it accurately is you can get what's called an intracellular magnesium,
and the way it's done is you take a scraping under the tongue.
My patients call it a pap smear under the tongue.
It's not painful like a pap smear, I thought.
You just take a rub of a wooden blade, scrape the tongue, you smear on the slide,
and then it is analyzed by spectrophotometric methods in one lab where they do it.
And that tells us what the intracellular levels are, and it's really the only accurate way to do it.
This particular lab, does it take insurance?
Does it?
Take insurance, or is it not?
It does, and actually it takes Medicare.
Okay, that's...
And it's called intracellular diagnostics.
That's the name of the lab.
They will send, if you don't mind, they can send your doctor a kit.
It consists of a little glass slide, and you put the stuff on it, spray it, and send it back to them.
It's not hard at all.
DHEA can be measured by a simple blood test.
It is available anywhere.
The best lab to do it in this area is Quest.
And Quest, except here on the coast, they're readily available.
And if you get a DHEA from Quest, you can get your level and know what you need.
And again, with DHEA, I do like, with any hormone, you really want to know that someone needs it,
not just to take it for another.
So if a patient comes to you concerning this chronic pain thing,
is this one of the things that you do have checked?
Fairly routinely.
So you do a root kidney, and then, due to the factor, you can then be able to send it to their labs in terms of, okay.
Absolutely.
These are two of the commonest tests that I run.
And two of the most useful tests that I run, because the results really help me to help people.
You build up magnesium in DHEA, often people discover that that horrible fatigue that they've had for years is the biggest.
When you wrestle with pain all the time, it is exhausting.
And it's exhausting to the adrenal gland, and the adrenal gland needs some attention.
Right?
Okay.
I think I've kind of talked about this.
Leave the subject without talking about spiritual or emotional parts of pain.
That's a whole two-hour lecture.
But pain, the body is a unity.
Mind, body, spirit.
And you can't affect any aspect of it without affecting any other aspect of it.
So part of pain is understanding the meaning that the pain has for an individual,
and helping people perhaps to focus on other things in their life that will give their life more meaning.
What happens to a number of patients is the strength.
Pain takes over.
It becomes their whole life.
And that is not healthy.
At that point, people are living in pain where it becomes the whole part of their life.
And that isn't going to help them to heal.
So it's really, really important to help people rediscover the natural parts of themselves.
Not to create something that's not there, but to have someone go,
well, I used to play the piano and I really used to love doing that, but I don't do it anymore.
And it's like, well, okay.
That's a starting point.
That's part of what we need to do.
So bringing meaning back into someone's life is really important in this process.
I'm going to pass this up and go elsewhere.
Let me talk about some other stuff.
There's a whole lot, and this is a partial list,
there's a whole lot of alternatives that are available to treat chronic pain.
I'm going to focus on a few tonight you may not have heard of or don't know much about.
Let me talk about prolotherapy maybe first.
How many of you here know about prolotherapy?
Better than most.
Prolotherapy is a technique, it's an injection technique,
which has to do with strengthening ligaments and tendon attachments that are weak.
The way it's done, sorry, it's by injection,
is we inject an intentionally irritating material into the ligaments and tendons
to stimulate the body's fibroblast, which is the cell that we have
that makes up the tendons and ligaments, to grow.
It's the only technique I know that will actually strengthen a ligament or a tendon.
Even surgery, when you reattach it, it weakens it, it doesn't make it any stronger.
And so it is a fabulous way to strengthen it.
It is superb for joint pain of almost every type.
Let me explain the rationale for that.
Okay, that's not going to work.
Because it's a little bit counterintuitive.
This is the structure of a knee, for example.
We have a joint space in here.
What holds the integrity of the joint together are the ligaments along the side
and the ones that crisscross in the inter, the cruciate ligaments.
So these ligaments are what hold the integrity of that joint together.
If these ligaments get injured, then what happens is, literally,
the joint is being held apart with the fluid, with the joint fluid in it.
It's being held apart by the tightness of these ligaments.
If these ligaments get weak, or torn to any way, not even a complete tear,
if the ligaments get weak, what you get is a collapse of the joint on itself.
So picture it tight, it holds it apart.
If it collapses, the joint collapses on itself.
So all of arthritis is about the wearing away of the cartilage,
which is at the end of the joint space.
This is what we call in a knee bone on bone.
So if you have bone rubbing on bone, you're just going to rub the cartilage away.
Ultimately, that will mean an orthopedist is going to have to do a total knee.
Can this be treated in another way?
Yes, prolotherapy can do that.
Now, usually we hope people aren't in this state,
because at this state it's much harder to turn it around.
I have, but it's much harder to use prolotherapy to strengthen a joint.
And you can do that in any joint.
Shoulder, knee, ankle, you name the joint, you can use prolotherapy for it.
But it is a very underused treatment that I believe will become a lot more used very soon.
The reason for that is that in the last two years we have discovered
that what we used to call tendonitis is not.
It is now tendinosis.
What's the difference other than the change in language?
Tendinitis implies that there is an inflammation of the tendon.
The biopsies of the tendon don't show inflammation.
It shows damage to the insertion of the tendons and ligaments, not inflammation.
So for years we have treated it with anti-inflammatories,
which are pain relievers, so they will help it to feel better.
They're not helping the pathology of the joint or the tendon.
They don't do anything for it.
And in fact, if you put cortisone into it, you're not helping it at all, you're going to weaken it.
So do we have a treatment for it?
Yes, prolotherapy, because it addresses the issue.
It takes those damaged tendon fibers and allows the fiberglass to grow, and it tightens them up.
It's a beautiful technique.
It is being used more, although the vast majority of orthopedists would rather do a total knee
than spend, you know, for $40,000 to spend, you know, $500 to $1000 to do prolotherapy.
That's how it works.
Sorry.
Is it usually just one treatment with the prolotherapy or more than one?
The number of treatments depends on the size of the ligaments in the joint we're going to be treating.
So in a shoulder, usually you can fix it with three treatments.
In the ankle, wrist, two or three.
But in knees and low backs, which are much, much bigger ligamentous structures,
with more ligamentous damage, it usually takes six treatments or more to treat.
How about hips?
Three.
Sorry, I'm kind of late.
But it works.
It's superb.
I can't tell you how many people I've helped with prolotherapy.
And I've had it done on myself as well.
Both of my shoulders have been done.
My low back's been done.
And I'm a great believer that it is a fabulous way.
I had my shoulders done.
When I had my right shoulder done, I couldn't raise it above here.
That was eight, nine years ago.
And what really motivated me to do it was that I couldn't put my arm around my wife when we watched television.
That was unacceptable.
Keep in mind that no sane human being does prolotherapy unless you can put up with some pain.
It is not a comfortable thing.
It is not for the weak of spirit or will.
It's not horrible.
It's just a bit painful.
And you've got to put up with a little pain if you're going to be doing it.
But within three treatments, my shoulder was normal.
I haven't had a twinge in it for eight, nine years.
So there's no question about it in my mind.
It's a superb tool used properly.
On that particular thing, the important thing with Prolo is to get going on it when you first start doing things instead of looking at, you know, go home and take the pain pills.
Right?
The sooner we work on it, the better it is.
If I catch it early, one or two treatments may do wonders.
If I catch it when we're bone on bone, I may not even be able to fix it adequately.
It helps with the pain.
What?
It helps with the pain.
It can.
I'm just saying that there's no tool that I have as a cure-all.
It helps some people some of the time, select it properly.
But it's not a matter that everyone with pain gets prolotherapy.
I don't work that way.
I have to, by exam, they have to have a loose ligament.
Or else there'd be no point in my doing that.
Okay?
Most of these are probably reasonably well known to most of you.
Let me just go through some of them quickly.
I know she hasn't talked about chiropractic.
Is that a reason for it or just isn't it?
No.
It's, no, I don't have any reason at all.
My first partner here on the coast was a chiropractor.
I didn't know it at the time, but it was probably illegal for me to be in,
to share the office with him.
I didn't know it at the time.
It is dead warm.
My profession would have thrown me out if I had known that it was happening.
He had superpians.
For those of you who've been around the coastal walls,
his name is Dan Weisenberg.
I don't know if you understand or a fabulous chiropractor.
No, I do a ton of oscic types of manipulation.
It's just, it's whatever.
It's the hands of the person doing it.
It's not the field.
There are fabulous chiropractors.
There are lousy chiropractors.
There are fabulous physicians.
There are lousy physicians.
It's the person and their skill, not the field person.
Do I believe in it? Absolutely.
Have chiropractors treated me? Absolutely.
It's whatever.
For me, it's whoever in my community has the skills that I need.
And that's kind of what I work with.
You all know about TENS?
TENS is an electrical device.
There are three kinds of TENS that you may not know so much about.
The original TENS unit was invented by my partner,
Norm Shealy, many years ago.
We used a small ton of TENS, so I'm very, very familiar with it.
That TENS unit operates at a frequency of 2 to 4 hertz or 200 hertz
and sometimes flips back and forth depending on the unit.
Now, the 2 to 4 hertz stimulates serotonin,
and the 200 hertz stimulates dopamine.
So you can get different neurotransmitters stimulated by the type of TENS you use
and the frequency you use it.
Basically, it works a lot like acupuncture.
The concept in Chinese medicine would be
if there is a blockage in energy flow, that is where pain comes from.
So the idea is to get energy or a chain moving through the area of blockage.
TENS does it by putting energy above, through, and out the other side
of a very light electrical dose.
And if you can get the energy moving through there,
then often it will be very helpful in treating pain.
Now, there are other types of TENS as well.
One is called the cranial electrical stimulation,
originally developed by Saul Liss,
which operates at a very different frequency.
It works at 15,000 hertz, and it uses a carrier wave,
which means it's another frequency that goes with it.
So it tricks the body into letting electrical stimulation enter it.
It works, it can work on the head in ways that TENS does not.
TENS is not supposed to be used on the head because of the rain wave stimulation,
but Liss can't.
And it can improve depression, migraines, headaches.
It can stimulate epinephrine, norepinephrine, dopamine, and serotonin profoundly
by using a little bit of electrical stimulation for short periods of time.
The last major type of TENS is the giga-TENS,
which uses TENS at the 15 to 70 billion hertz,
and that has been used again by my mentor and friend, Norm Shealy,
to treat a variety of illnesses, particularly autoimmune diseases
like rheumatoid arthritis.
You can do some amazing things with the right type of electrical stimulation.
I'm going to talk about microcurrent in just a few minutes.
Yeah, we did enough on polo.
I'm going to go zipping through there.
Another type of treatment that you may not have heard of is mesotherapy.
It's used a lot more for cosmetic purposes than paint,
but it works really well for paint.
And what it consists of is teeny, teeny amounts of materials,
and the materials are often in the form of a little bit of magnesium,
a little bit of procaine ejected just under the skin,
a teeny blob under the skin.
And you do a series of them over the area of paint.
And for reasons that are not clear to us yet,
those materials stay in the body longer and produces prolonged relief of pain
by doing that.
And so I've had some patients where nothing has helped them,
but if I've done that particular technique,
I've sometimes had some really nice success with that.
And these are some of the little ingredients.
This is similar in concept to neuro-therapy.
Is that something people have heard of?
Some yeses, most unknowns.
Neuro-therapy is a German concept that...
If the body has a scar in it,
often peripheral nerves get trapped in the scar as the scar heals,
and it stimulates and irritates the nerve on a profound continuing level.
Often we'll see it with people who have had a cholecystectomy,
a laparotomy, any number of surgical procedures.
And what they say is, the pain has never left my scar, not ever.
Or the pain can radiate from that area to somewhere near it.
And when someone says, I have this pain here,
and I had an abdominal surgery,
and it came on within a month of that and it's never gone away,
the concept is that there may be a pinatina nerve that is trapped in there
that is sending this rubber-banging loop message, as I heard, I heard, I heard, I heard.
You can shut it down by injecting a little bit of anesthetic,
like cocaine, marcane, directly into the scar.
Not particularly painful, it's very simple,
and you can find out the diagnosis with one injection.
If that takes the pain away, then people go,
oh, okay, I think I know where the pain is coming from.
If you continue the injection on a regular basis, it breaks the loop.
Once the loop is broken, we're done, and the story of the pain is gone.
So it's another pain thing that we can look at that you all might want to be aware of.
Are you going to touch your herbal or?
What?
Herbal or?
No.
Okay.
Want me to go back?
On the screen.
Oh, okay.
Just a couple of really basic things.
You're a pretty sophisticated audience.
I'm not going to go into the stuff.
Nothing really brand new.
That is, $300 herbs.
Oh, I know.
Okay, my newest, latest, favoritest toy,
frequency-specific microcurrent.
It uses two different frequencies.
Microcurrent means we're talking a thousandth of an amp.
So no electricity is felt in the body.
If you use a tens unit, if you crank unit up, you will feel electricity.
You're not going to feel microcurrent.
It's at a level that you will not perceive it.
My most sensitive patient cannot tell that they're receiving it.
However, it has the capacity to reboot the nervous system.
Okay?
I'm not quite sure how it does it, but I'm amazingly impressed with its ability to do that.
So things that we haven't been able to treat before around, we can now.
Peripheral neuropathies, all sorts of nerve problems where there is a type of fibromyalgia
called cervical trauma mediated fibromyalgia,
which is different than other fibromyalgia and is set off by injury to the cervical spine, to the neck.
And one of the ways you can tell that that's going on is, A, by history, people will say,
you know, I was in a minor fender bender.
I didn't think it was that big a deal.
Within two months, I had fibromyalgia, and now I'm where I am.
The tip-off is on physical examination, again, something that people don't do much.
If you check the reflexes, the reflexes of the knees are hyperactive.
They jump out.
And that is indicative that there is irritation of the spinal cord.
Basically, cord irritation, which causes nerve segment facilitation and irritation of the nervous system.
Now, here's the beauty.
The woman who put frequency-specific microcurrent on the map,
her first study was to take 80 people with cervical mediated fibromyalgia,
which as you know, the medical profession does not allow that treatment.
And treated them with FSM.
All of them got better.
You know, 60% were cured in three or four months, and I mean flat-out cured.
So it is clear that this type of electrical stimulation can literally reboot the nervous system.
It can shut down irritating stimuli that people have not figured out what to do with for a long period of time.
I'm very impressed with it. I've been using it now for about six months.
I use it a lot at the clinic and it's a beautiful tool.
It also can be used for other things as well.
You say it helps with peripheral neuropathy?
Yes.
Feet burning, etc., etc.
It depends on what causes the peripheral neuropathy.
It depends on whether it's barnella or...
Yes.
There are other causes. Once again, I go back to you have to treat the cause.
If it's merely nerve irritation, yes.
It can help even barnella-induced peripheral neuropathy,
but you still have to get the barnella out of the system, though we're not doing it anyway.
Can you get some relief while you're trying to get the barnella out?
Yeah.
In fact, there's a whole FSM protocol for Lyme disease now that we are starting to work with,
and we're going to be doing some research on that very soon.
Because there are frequencies you can use to affect parasites, bacteria, toxins in the body.
It's a whole bunch of amazing things this little device can do.
It's my new favorite toy.
You guys don't know me that well, but my whole professional life I have fallen in love and am in love
with a wide, wide, wide variety of treatments, and this is my current favorite.
How exactly is that applied?
There's a number of ways you can...
The way we like to do it the most is with...
We wrap electrodes in wet towels, and we'll put one at the top of the body,
and then at the bottom of the part we want to treat.
So if the part I want to treat is an arm, I'll put one at the neck and one on the hand.
If it's the whole body or the peripheral neuropathy goes down to the feet,
we'll put a towel here, we'll put a towel at the bottom of the feet,
then lie it flat on the table, and then we'll adjust the frequencies to a variety of frequencies.
There's two frequencies, left and right, and the one on the left deals with what we call physiology,
and then one on the right deals with tissues.
So these won't mean anything to you because it's a numerically based system,
but we would start in a cervical trauma fibromyalgia with a 40 on the left and a 10 on the right.
10 is spinal cord, 40 is inflammation.
We then might leave it on the anti-inflammation frequency
and then put it on nerves, muscles, ligaments, tendons, and we would just keep changing the frequency.
You can monitor the body with your hand and see when the body is loosening up and softening.
You know you've given it enough and then you change the frequency.
So we're taught to use our hands to monitor that.
Why do you put the towel at the base of the neck?
Just that's the starting point for all therapies?
Well, I'm running it through the body.
I can use it on top of the head, I can use it anywhere I want.
I recently had a patient with acute belt palsy
where both sides were all affected.
We could use a towel behind the head and I can actually, there's a glove that's attached to it,
I can put a glove on the mouth and I can literally run the frequency right along the facial nerve.
And within a week of treatment she was 50% better from an acute event.
And that's almost unheard of neurologically.
So do you use this only when it's cervical trauma
or you're using in general fibromyalgia on certain areas to relieve pain?
I can use it on any body tissue whatsoever.
It's best use is for acute pain and pain that people don't know what to do with.
But its beauty is nerve pain because nothing else touches nerve pain very well.
It's the only device I've ever found that allows me to actually take the inflammation out of the nerve.
There are multiple, you can use it for the skin, you can use it for the respiratory tract.
There are frequencies for the intestines to make them work better.
It's a very, very comprehensive device in terms of what it can do.
So it's like an electrical stimulation?
It is, the amount of electricity is minimal.
It's really taking two waves, two electrical waves and putting it into the body
and at the interfaces of those waves it resets nervous systems.
I don't know how it does it. I just have seen it work and I...
It's like turning off the electrical switch.
It's kind of like throwing a breaker switch and throwing it back on again later.
Yeah, a little bit like that.
So it has multiple uses. I'm emphasizing the ones that I think make it unique.
But there's a lot more that it can do.
Is there, have there been studies that show which frequencies work?
Yes.
On which body parts?
Yes.
There are, there's been amazing studies done.
The lab work was done at the NIH where in people who have the cervical trauma fibromyalgia
they measured the inflammatory chemicals in the body before a treatment
and then an hour into the treatment, two hours into the treatment
and there was a final drop of the inflammatory chemicals.
I don't know anything else that could make those chemicals drop that fast.
Never heard of it.
No drug that I've ever heard of could make the chemicals drop that fast.
So it clearly is doing something to the body that works at a profound level.
So it sounds homeopathic?
Or is it going to trigger your body?
Conceptually, sort of.
I mean homeopathics are energy remedies
and it's like getting the energy to vibrate at the right frequency.
What happens with the inflammatory chemicals?
The body gets rid of them.
So there's a detoxification thing that happens?
Yeah.
The essence of fibromyalgia, for example, as well as a whole bunch of other things
is that the body has, again it's one of these loops
where the body is making inflammatory chemicals called cytokines
and it doesn't know how to turn them off.
If you can suddenly turn them off, that is a major shift in body chemistry.
Mold toxin, for those of you who lived up here, is like that.
Mold toxin sets off these inflammatory cytokines.
For those people who are mold sensitive, not allergy, but mold toxin sensitive,
of course no one up here has ever seen a mold.
For those who are sensitive, and it's a genetic issue,
75% of people won't be bothered by it and 25% of people will.
Once that gets set off, if you keep going back into a moldy environment,
you cannot turn off these chemicals and it can really make people sick.
Are you going to talk about laser, which you see advertised in pulp page ads now from Santa Rosa?
Well, there's always what laser?
Well, it's like in connection with chronic pain.
Usually they're talking about using laser primarily as an acupuncture adjunct.
They're usually using laser over acupuncture points, and it is effective and works that way.
Any more questions?
I'm pretty much done from a sub-adjust, so if you have questions for her, I'll respond.
You did say that you were up here one day a week?
I live here, but we're working Thursday mornings over at the Women's Health Center,
and we're going to be expanding because I'm getting busy enough that I need to do it.
So is it in the best interest to go to your Santa Rosa office out where you are to start with, or here?
It depends on the issue.
If you need anything elaborate like IVs or things like that, Santa Rosa.
But I am bringing the frequency-specific microcard with me.
I do prolo here.
Much of what I do, I can do up here.
So it just depends on the issue.
If you want to reach us, if you're interested in doing that, call.
I have some cards here, and you can call the number on the card.
You schedule it through the Santa Rosa office, not through the Women's Health Center.
And my medical assistant who is Karen or anyone else at the clinic can go over with you your needs and where would be best.
And what records?
I mean, when you're getting a son or a daughter on a bad or anything, do you need all the records brought to you?
I like records. I like to look at what's been done.
I don't want to reinvent the wheel.
Only because some of them are.
Do you have any suggestions for someone who is on Medicare?
How they would pursue treating their pain?
What would you do if you were?
You know, I don't know that it's possible for me to put myself in someone else's.
With my personality, I would move heaven and earth to get my pain helped anyway I could.
And if I had to spend some money out of pocket, I probably would.
What if you don't have a pocket anymore?
I mean, after being this way for 16 years, you know, you run out of money.
I understand. What we do is alternative and not covered by Medicare.
And we have had to sign off from Medicare at this point.
Everyone in my office has done that.
The problem with that, you may not understand it, is that if Medicare audits a chart
and finds that we have provided a treatment that they do not authorize,
and believe me, they don't authorize most of what we do,
they can fine us $10,000 per procedure in the chart.
So I try to do five things in that one chart.
That's a $50,000 fine.
No, you're misunderstanding me. I'm not talking to you for not taking Medicare at all.
I'm asking you, do you know of any way that people who are on the low end of the economic spectrum
can get treatment other than robbing a bank?
Because the longer you've been in pain, the poorer you get.
I totally understand. I've been doing this for a long, long time.
I don't have a good answer for you.
It's a sociological problem that needs to be solved.
I hoped that Obama might address that at some point in the health legislation.
I am less hopeful than I was.
When he was running, I was on his alternative health committee.
And that committee isn't around anymore.
So I think he's up to his eyeballs and alligators right now in that.
I hope that things can change.
Because what I do, although it's called alternative, there's nothing alternative about it.
It's just a medicine. And it should be available to everybody.
I have a question for you.
If you come in for one of these treatments, what does it cost you to have one?
It's an office visit. It's $175.
Okay.
If the treatment works, and if you're thrilled with it,
we have home units where you can take it home and use it every day or three times a week.
And move your treatment along much faster.
So the purpose of the first treatment or two is to give a precise treatment to know whether it's going to work or not.
And if it does, then we recommend that you don't come in and spend a lot of money.
If you're doing injections, though, for people, Medicare would cover it.
It's just if you get into the...
We're not accepting without...
I see.
So that you don't have a conflict.
I've had to sign off for Medicare.
Okay.
For 38 years, I took Medicare.
No, I understand.
I'm just expecting.
It's complex for people to understand.
So, yeah, sorry.
Billion aspect.
Do you think you could...
Just a little bit off topic, but something that you said.
You mentioned mold allergies or mold...
Mold toxicity.
Thank you.
I just moved up here.
I've never heard of that before.
What are the symptoms for the people who are sensitive?
Problems with focus, memory, concentration, thinking, joint pain, chest tightness, odd neurological sensations,
numbness and pain in different parts of the body, electrical sensations in places that you shouldn't have electrical sensations,
eye symptoms, eye irritation, redness, there's a wide, wide spectrum.
And coughing and sneezing.
Coughing and sneezing are more traditional mold allergies.
These are toxin symptoms and it's treated very differently.
It's not an allergy.
It's a toxin buildup in the body.
You've done it with the toxin for people to get that.
Yes, ma'am.
Is numbness in joints treated with these electrical variations?
Could be.
Could be.
Yes.
How important is a good mattress to keep away aches and pains?
Depends on the being.
There's no right pillow or mattress.
Only the right one for you.
I get that question a lot.
What's the best pillow?
It depends on your neck structure and what makes you comfortable.
So I tell people to experiment and find what makes you most comfortable.
It's not a right or a wrong.
Years ago we always talked about hard mattresses.
Those are out of favor now.
Now people are doing soft mattresses again.
So there are fans to that.
You don't want to get caught up in the fed.
It's what does my body like?
So if you call for the appointment,
and did they send out a questionnaire and stuff to you
so you have that ready for the week, you'd be okay.
Great.
Yes, ma'am.
I have one last question.
Yes.
This hasn't been covered.
Have you, over your years, in your practice,
ever worked with anyone who has been completely fused from scoliosis
with metal rods and nuts and bolts and screws?
Yes, several.
Have you?
Yes.
With any success?
It depends on the individual.
I have several that I've worked with for a long time who got a lot better.
I would almost use the word almost here,
meaning they needed treatment every two, three months,
but basically were pain free in between,
and I got a lot of all pain medication.
So again, it depends, but I've had people fused.
Rods and cages and everything.
Yes, ma'am.
Thank you.
Thank you all for your attention and time.
Thank you for braving the elements and coming out in this weather.
And I hope this is helpful.
Thank you.
Thank you.
Thank you.
Thank you.