The Neurogenic Inflammatory Root of Chronic Pain

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There are many theories of as to why some people suffer from pain that lingers far longer than the typical time it takes to heal tissue that has been traumatized.  In our youth our parents and health care providers would praise our young bodies’ ability to recover quickly without long-term sequelae.  Certainly the term ‘over-use’ is thrown about as a threat as we look to our elders and see knee and hip replacements, and a variety of pharmaceutical pain relievers to deal with the sins of youth when we were young and spry (or thinking we could do something we used to be able to but are in fact too old and stiff).  Why do we suffer more from physical injury as we age?  Why do we seem to lose the ability to heal quickly over time?  What types of lifestyle and nutritional choices can we make to improve our bodies’ ability to deal with pain and heal effectively?

The first thing to understand is that pain is only one manifestation of inflammation.  Inflammation is actually the stimulus that begins the healing process.  In fact, inflammation is a cascade of events whereby signals are sent from the injured tissue to recruit cells and chemicals to either rid the body of the injurious substance (microbes or toxins) and the consequences of that injury (necrotic/dead tissue).  The result of inflammation is often the laying down of fibrotic tissue.  This can restrict bloodflow, lead to tissue hypoxia (poor oxygenation), and initiate a process of chronic inflammation mediated by the nervous system.

We do not sense inflammation in any way except perhaps through either visualization of the overlying skin, or through the feeling of pain.  Pain is transmitted from tissue that is injured through a variety of nerve fibres.  Chronic pain is the inflammation of the nerve fibres themselves that is unresolved and continues long after the offending injury is gone.

For example: knee pain, whether it is originally from a torn ligament or osteoarthritic degeneration, causes nerve compression from local tissue swelling, resulting in inflammation of the nerve supplying the joint itself.  Because this nerve is also responsible for supplying the over-lying superficial tissues surrounding the joint, we often feel pain with light touch, as the superficial nerves here will also be inflamed.  

Why do some people seem to suffer from pain for longer than others?  There is a theory that chronic pain is a result of improper cellular signalling of the Peptigergic Sensory System (PSS).  This is a network of nerve fibers whose primary role is tissue homeostasis.  These nerves relay messages from the brain to stimulate repair and renewal of injured tissue.  Their secondary function is nociception, the relay of messages from injured tissue to the brain resulting in our perception of pain.  When there is too much inflammation, these nerves become ‘stuck’ in their secondary function, and are unable to perform their primary function of repair and renewal.  Thus, the cyclical nature of chronic pain is established, and the tissue continues to be inflamed while the brain is unable to properly send signals for repair.  This is called Neurogenic Inflammation, and is the theory behind chronic pain.

Treatment considerations for Neurogenic Inflammation must include reducing inflammation systemically.  Nociceptive nerves use neuropeptides as messengers to initiate the cascade of events that results in our perception of pain.  While not all of these neuropeptides are inflammatory in nature, many of them are, and it is only logical to consider systemic inflammation reduction through every avenue possible.  Reduce foods that are directly inflammatory (sugar, wheat, dairy, pork, nightshades, peppers, eggplant, tomatoes) and also known immune system triggers that affect you on an individual level.  These include known allergens and food sensitivities.  Add anti-inflammatory foods into the diet, such as omega 3 fatty acids and fresh, organic vegetables and fruits.  Consider also switching to non-conventionally raised beef or chicken (where available) as an alternative to typical store-bought meat.  

Supplemental considerations are plentiful and certainly many herbs claim some type of anti-inflammatory benefit.  Research shows that curcumin from tumeric has potent anti-inflammatory benefit and I see this clinically as well.  Ginger, frankincense, and devil’s claw are all anti-inflammatory as well as analgesic to a certain extent.  Omega 3 fish oils help to shift the inflammation cascade toward one that promotes anti-inflammatory responses.  Enzymes such as bromelain and serrapeptase when taken on an empty stomach break down the over-abundance of neuropeptides released when there is inflammation, thereby reducing pain.  

Neuroprolotherapy is an injection therapy similar to prolotherapy to target Neurogenic Inflammation.  Using only 5% dextrose and injecting superficially over the inflamed tissue, an analgesic effect is produce often after the first treatment.  Continued injections can help to reduce the secondary function of the PSS, instead allowing these nerves to carry on with their primary function of repair and renewal.  Over time, the tissue is repair to the point that the nerves are no longer inflamed and the pain has dissipated.  Typical treatments last 15-30minutes and most patients require between 5-7 visits, spaced 1 week-6 months apart depending on severity of pain and level of inflammation.

Chronic pain is not an easy fix, especially if there is also chronic stress and emotional baggage associated.  An open dialogue of potential emotional roots may also help to unearth hidden reasons we may be holding onto certain pain patterns.  Consideration of either a psychologist or therapist to address any underlying emotional imbalances is something I recommend frequently as part of a wholistic approach.
Finally, I think it is important that we trust that our body has the ability to heal itself.  We can control many aspects of how we choose to treat our body, and a healthy mind-body connection is something that every healthcare practitioner should teach their patients suffering from chronic pain.

Dr. Jessica Beatty, BSc. ND
Naturopathic Doctor (MNA, OncANP)
dr.beatty@vianatural.ca

Appointment Hours:
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Tuesdays & Thursdays: 9:30 am – 4:30 pm

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