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	The Herbal Approach to Curing Chronic Pain Connective Tissue Deficiency The treatment of connective tissue deficiency involves three main principles Connective Tissue Inhibitors Nuke the Narcotics Weaning from Narcotics Herbal Connective Tissue Regenerators Nutriceutical Connective Tissue Regenerators The Connective Tissue Regeneration Program Nutriceutical Products for Connective Tissue Regeneration Direct Connective Tissue Regeneration Summary End notes

The Herbal Approach to Curing Chronic Pain
"Doc, what can I take to speed up the healing process?" "Should I stay on my same supplements while I get Prolotherapy?" "Do you have any recommendations on supplements to take?" "Is anything I am doing interfering with the healing process?" This is just a sampling of the myriad of questions that are asked by patients receiving Prolotherapy. The herbal approach to curing chronic pain will be discussed in this chapter, with an emphasis on the products that we use at Caring Medical and Rehabilitation Services in Oak Park, Illinois. Top

Connective Tissue Deficiency
To understand the role of herbal nutriceuticals in the healing process, it is necessary to for you to look at the condition as a connective tissue deficiency problem; or, as we like to call it, The Hauser Syndrome. This disorder is defined as a deficiency of, or weakness in, the connective tissues. The main connective tissues in the body are the muscles, ligaments, tendons, skin, hair, nails, and vascular system. The symptoms can vary from chronic pain to varicose veins, depending on the connective tissues involved. Chronic pain, simply put, most often represents a weakness in a particular connective tissue. For instance, the physician can reproduce most chronic knee pain by palpating the medial aspect (inside) of the knee, which is the location of the pes anserina tendons. The traditional doctor diagnoses "pes anserina tendonitis." A better term, however, is "pes anserina tendon weakness." The allopathic (traditional) physician believes the problem relates to excess inflammation, therefore, anti-inflammatory medication or cortisone shots are administered. As discussed in our books, these medications, at best, just cover up the pain; but more importantly, they accelerate the weakness and degeneration of the tendon. A better approach to cure the chronic pes anserina tendon pain is to utilize treatments that will strengthen the weakened tendons. Likewise, for chronic neck and back pain, treatments that aid in the regeneration of the weakened ligaments are in order. Top

The treatment of connective tissue deficiency involves three main principles:

1. Stop ingesting substances that inhibit connective tissue regeneration.
2. Start ingesting substances that stimulate connective tissue regeneration.
3. Directly stimulate the connective tissues to regenerate.

If these simple principles are followed, the likelihood of curing the chronic pain is great. Top

Connective Tissue Inhibitors
It is sad to realize that most people with connective tissue deficiency have it because of medications prescribed by their doctors. As discussed at length in our books, the main inhibitors of connective tissue are the following:

· Nonsteroidal anti-inflammatory medications (NSAIDs)
· Corticosteroids (Steroids)
· Estradiol and its synthetic derivatives (Birth Control pills and traditional hormone replacement therapy)
· Narcotics (Pain medications)

All of the above substances have the potential to halt the healing process. Ibuprofen and other anti-inflammatory medications are often given right after an injury, thus causing the non-healing of many connective tissue injuries. When these do not help the pain, the patients are then advanced to various steroids, such as cortisone shots and oral Prednisone, which further inhibit healing. Because women have much more estradiol than men, they are especially at risk for nonhealing of their injuries. Unfortunately, the most commonly prescribed drug in America is Premarin, which contains estradiol that is derived from pregnant mare urine (hence the name Premarin) and thus contributes to this problem. Most people in chronic pain do not know that narcotic pain prescriptions are also potent inhibitors of connective tissue regeneration because they suppress the immune system. Top

Nuke the Narcotics
Yes, narcotics have tremendous immunosuppressive effects. No one has really ever adequately explained why cancer or chronic pain patients, once placed on narcotics, seem to never be able to come off of them. Well, as it turns out, in vitro (in a petrie dish) and in vivo (in living subjects)) studies have show that one of the long-term side effects of narcotics is a suppression of mononuclear cell function.^{1, 2} Mononuclear cells are part of the immune response that helps repair the connective tissues after injuries. Even more frightening is the following statement taken directly out of the main pharmacology text used by medical students, "… the administration of morphine to animals causes suppression of the cytotoxic activity of natural killer cells and enhances the growth of implanted tumors."³ Synthetic narcotics, like morphine, cause hypoplasia (shrinkage) of the thymus gland, which is the main gland from which the immune cells that repair or heal the body originate.^{4, 5} Basically, synthetic narcotics, like codeine, Vicodin, and Morphine have negative effects on the immune system, which inhibit soft tissue or connective tissue healing. This is probably why chronic pain patients and cancer patients continue to get worse when placed on these medications, even when appropriate treatments are given. The treatments cannot work because of the negative effects the synthetic narcotics have on the immune system. Of interest is a statement out of the same pharmacology text book on our own natural narcotics, "By contrast, B-endorphin enhances the cytotoxic activity of human monocytes in vitro and increases the recruitment of precursor cells into the killer cell population: this peptide can also exert a potent chemotactic (attraction) effect on these cells.³ One can surmise from the above statements that our bodies need to produce our own natural narcotics which stimulate the immune system after suffering trauma or injury. Substituting these for synthetic narcotics or anti-inflammatory medications is just going to inhibit the repair process.

To further stress this point, think of narcotic medications as low dose chemotherapy. Chemotherapy, as everyone knows, has a significant inhibitory affect on the immune system. Well, so do narcotics. According to the 1998 Journal of Neuroimmunology in a summary article on the effects of narcotics on the immune system, the verdict is clear. "The literature describing the effects of morphine on the cells of the immune system points to the clear conclusion that morphine given in vivo suppresses a variety of immune responses that involve the major cell types in the immune system, including natural killer cells, T cells, B cells, macrophages and polymorphonuclear leukocytes. A good amount of literature is available demonstrating the down regulation of phagocytic cell function by morphine, particularly for human peripheral blood mononuclear cells and polymorphonuclear leuckocytes. Phagocytosis, chemotactic responses, interleukin production, and generation of activated oxygen intermediates and arachidonic acid products (needed for inflammation) have all been reported to be inhibited. In aggregate, the literature supports the existence of an in vivo neural-immune circuit through which morphine acts to depress the function of all cells of the immune system." Narcotic medications inhibit the body's healing abilities. No doubt about it! Top

Weaning from Narcotics
We are commonly asked, "How can I get off of the narcotic medications when I am in so much pain?"

In order for the body to be able to heal, it is vital for patients to get off of these narcotic medications. The sooner the narcotic medications are weaned, the quicker the patients will improve. Various dietary and nutritional supplements are also given to assist the body's healing ability, depending on each individual case. Anabolic hormones are also used, such as DHEA or testosterone. Prolotherapy injections are given to stimulate the exact site of the injury to heal. Patients are typically seen once per month for follow-up, until complete healing is achieved.

It is important for patients to realize that narcotics are physiologically addicting and must be weaned slowly. Depending on the dose of the medication, a person can typically safely decrease the narcotic dose by decreasing by one pill every five days. For example, a person who normally takes ten Vicodin ES per day, will decrease to nine per day after five days; then decrease to eight per day five days later; and so on. If the weaning is done too quickly, drug withdrawal symptoms may occur. These include symptoms such as intense craving for the drug, insomnia, fatigue, vomiting, diarrhea, anxiety, tremors, sweating, nightmares, muscular aches, and chills. If these occur during the weaning process, you should contact our office.

To help make the weaning process more tolerable, various nutritional supplements are given. These can include protease enzymes such as Bromelain or TRMA, Ashwaghanda and Ginseng (adaptogens), as well as many others. Various supplements are given depending on the physical and emotional state of the person.** It is important to remember that the weaning process can be very tolerable, but it starts with you wanting to do it! Motivation is a key element required to wean from the narcotics.

If you are really scared or do not think you can the above types of things, there are various programs that will assist you in the weaning process. If you are looking to wean off narcotics quickly, the best program we know is called Ultra Rapid Opiate Detoxification (UROD) and is located at the University of Illinois Medical Center at Chicago. In this program, you are detoxified from the narcotics in a 24-hour period, by being anesthetized in the hospital. This is then followed by a comprehensive counseling program.

To obtain further information on this program, please contact the Center for the Investigation and Treatment of Addictions at the University of Illinois at 1-888-996-2482 or 1-312-355-0746. The following places also have UROD available: Mount Sinai Medical Center, Miami, Florida; Centinela Hospital and Medical Center, Los Angeles, California; and SunHealth Specialty Hospital; Denver, Colorado.

**For further information on herbal supplements used to help wean people off of narcotics please contact Beulah Land Nutritionals at www.benuts.com or call 1-708-848-5011. Top

Herbal Connective Tissue Regenerators
In reviewing the lab results with a young lady who originally came to the office for Prolotherapy to relieve her headaches, but instead first received a battery of lab tests on her first visit, her mother demanded, "Why were these tests done and how are they going to help my daughter's headaches?" This is not unusual for people to react this way because it is not the traditional approach to treating pain. Prolotherapy starts the inflammatory reaction at the site the pain, but it is your own immune system that repairs the painful area. The stronger your overall health and immune function, the more effective the Prolotherapy will be.

A person must be able to mount an immune reaction to the injected solutions in order that Prolotherapy work. This means that you should feel stiffness and/or swelling for at least 24 hours after Prolotherapy. If this does not occur, then the Prolotherapy solution may not be strong enough or the immune system may be weakened for some reason. In the latter situation, it is helpful to obtain diagnostic testing to determine the reason for the impaired immune system and to start an herbal connective tissue regeneration (CTR) program. These products are a good idea to help speed up the healing process even if you have a healthy immune system. Let's face it, we could all probably use a little help as we age.

CTRs are substances that enhance connective tissue healing of cartilage, ligaments, tendons, and muscles by either providing substrates for the connective tissues or enhancing the repair process by optimizing immune system function. Most of the natural nutriceuticals that are effective at helping people heal soft tissue injuries fall into these two categories.

There are characteristically three stages that the body goes through to heal the ligament and tendons after an injury or Prolotherapy (because Prolotherapy actually mimics a new injury): inflammatory, proliferative, and remodeling. It is this normal healing inflammatory cascade that requires stimulation for complete healing to occur. Natural nutriceuticals act at various points in this cascade to aid healing. For instance, glucosamine, a well-known component of connective tissues such as cartilage, is used as a substrate by fibroblasts to form collagen. What most people do not know is that fibroblasts need an array of amino acids, such as proline and cysteine, to adequately form collagen, as well as numerous vitamins and minerals. To aid in immune system activation, various nutriceuticals, such as ginseng, gotu kola, and nucleotides, can be taken. To help phagocytosis, the process by which macrophage cells clean up injured damaged debris, proteolytic enzymes, such as bromelaine, trypsin, and chymotrypsin, are used. A wide array of nutriceuticals may be used to promote healing. A summary of some of these products can be seen below. For a more thorough explanation on these substances and others that are used to help heal soft tissue injuries please refer to the references. 6-13 Top

Nutriceutical Connective Tissue Regenerators

Nutritional Product Mechanism of Action

Proline Provides substrate for collagen
Cysteine Helps give collagen its pliability
Glucosamine Provides a component of tendon and ligament tissue
Horsetail Provides a natural source of silica
Gotu Kola Enhances connective tissue structure
Fo-Ti Stimulates cellular immunity
MSM Provides a natural source of sulfur
Grape Seed Procyanadins Provides a natural antioxidant
Ginseng Increases ability to handle stress
Nucleotides (RNA) Stimulates immune function
Proteolytic Enzymes Assists in removal of necrotic (dead) tissue
Whey protein Provides a source of branched-chain amino acids
Carnitine Transports fatty acids
Cayenne pepper Stimulates circulation
Malic Acid Provides energy production
Cod Liver Oil Provides essential fatty acids Top

The Connective Tissue Regeneration Program
Curing chronic pain has connective tissue regeneration at its core. Unfortunately, most people in chronic pain ingest innumerable quantities of Vicodin, codeine, Celebrex, Ibuprofen, and other narcotics and anti-inflammatory medications, instead of taking herbal connective tissue regenerators (CTRs),. A better approach that has more long-term healing effects is to start a regime of nutriceuticals that contain CTRs. A list of the products that Beulah Land Nutritionals carries is found below. Many of these products were developed because of the unique needs of the chronic pain patients in our office, combining CTRs with substances that help handle stress. This is necessary because the adrenal gland (stress gland) in most people with chronic pain has been on overdrive for so long, that it is often not producing the necessary hormones for proper immune function by the time they reach Caring Medical in Oak Park, Illinois. Thus, many of the products used at Caring Medical contain various adaptogenic substances which help people handle stress, such as Ginseng, Gotu kola, and Ashwaghanda. Top

Nutriceutical Products for Connective Tissue Regeneration

**For a complete listing of the vitamins, minerals, and nutriceuticals available for purchase, contact Beulah Land Nutritionals at www.benuts.com or 1-708-848-5011. Top

Direct Connective Tissue Regeneration
As good as herbal nutriceutical products are, the body will often still not completely heal a connective tissue injury, even if appropriate products are taken. All the products can do is get the body in the healing mode, which does not ensure that the injury will be healed. It is quite common to hear people tell us that the nutriceutical products listed above have helped decrease their pain by 50% or more, but they desire complete pain relief. The person who has whole body pain or severe pain, a 50% reduction is great; but the 50% remaining may still be life-altering. Direct connective tissue regeneration is needed with Prolotherapy for people like this. Prolotherapy is the only treatment that directly stimulates connective tissue structures, such as tendons and ligaments, to regenerate. In other words, Prolotherapy can take weakened, degenerated, tendons and ligaments, and stimulate them to heal by inflammation. Prolotherapy, thus, directly stimulates the exact pain-producing structure. It is then up to the immune system to repair the area.

The woman with chronic low back pain, for example, most often needs to cure the chronic pain by direct stimulation to the sacroiliac joint. Prolotherapy to the structures in and around the joint will start the normal healing inflammatory reaction. Strong immune systems will allow each subsequent treatment to produce more and more healing, until the injured structure is eventually repaired. The typical person with chronic pain usually requires anywhere from three to six Prolotherapy treatments. A person with a weakened immune may require more treatments. For this reason, most people who need Prolotherapy do better with nutriceutical CTRs to aid the healing process. In addition, most people would rather take a few extra supplements than experience a lot more injections! Top

Summary
People in chronic pain have a deficit in the amount or strength in their various connective tissues. Thus, it is best to think of chronic pain as a connective tissue deficiency problem. The treatment of connective tissue deficiency involves three main principles:
1. Stop ingesting substances that inhibit connective tissue regeneration.
2. Start taking substances that stimulate connective tissue regeneration.
3. Directly stimulate the connective tissues to regenerate with Prolotherapy.

Most people in chronic pain experience connective tissue deficiency, in large measure, because of the medications that have been prescribed by their doctors. The main inhibitors of connective tissue are nonsteroidal ant-iinflammatory medications (NSAIDs), corticosteroids, estradiol and its synthetic derivatives, and narcotics. People desiring to maximize the chances of healing their weakened connective tissues, must stop the consumption of these drugs.

To assist connective tissue healing, it is better to intake herbal connective tissue regenerators. These are substances that assist the normal healing inflammatory reaction. These substances are necessary, in some cases, because of the inability to heal, even with Prolotherapy. There are a myriad of substances, many of which contain such nutriceuticals as glucosamine, horsetail, gotu kola, proteolytic enzymes, malic acid, minerals, vitamins, and various protein sources. These substances generally either provide the substrates necessary to heal, help the immune system clean up the damaged cells, or aid in the immune reaction that occurs after an injury or Prolotherapy.

For the person unable to heal even with nutriceuticals, direct connective tissue regeneration is needed. Prolotherapy is the only treatment that directly stimulates the exact site of the pain. Prolotherapy stimulates the body to repair the painful area(s). Once the area is completely repaired, the chronic pain is totally eliminated. Top

End notes
1. Written correspondence with Brewer Library 1/6/99 written by Maria Fracchia, Reference Librarian.
2. Sibinga, N. Opioid peptides and opioid receptors in cells of the immune system. Ann. Rev. Imunol. 1988; 6: 219-249.
3. Jaffe, J. Opioid analgesics and antagonists. In Gilman, A. (ed.) Goodman and Gilman's The Pharmacological Basis of Therapeutics. New York: McGraw-Hill, 1990, 485-496.
4. Bryant, H. Role of adrenal cortical activation in the immunosuppressive effects of chronic morphine treatment. Endocrinology. 1991; 128: 3253-3258.
5. Sei, Y. Morphine-induced thymic hypoplasia is glucocorticoid-dependent. Journal of Immunology. 1991; 146: 194-198.
6. Murray, M. Encyclopedia of Natural Medicine. Revised 2nd edition. Prima Publishing, Rocklin, California,1998.
7. Seaman, D. Clinical Nutrition for Pain, Inflammation, and Tissue Healing. NutrAnalysis, Inc. Hendersonville, NC, 1998.
8. Werbach, M. Nutritional Influences on Illness. Keats Publishing, New Canaan, Conneticut, 1988.
9. Lininger, S. The Natural Pharmacy. Prima Publishing, Rocklin, California, 1998.
10. Barney, P. Doctor's Guide to Natural Medicine. Woodland Publishing, Pleasant Grove, Utah, 1998.
11. Bucci, L. Nutrition Applied to Injury Rehabilitation and Sports Medicine. CRC Press, Boca Raton, Florida, 1995.
12. Wolinsky, I. Sports Nutrition. CRC Press, Boca Raton, Florida, 1997.
13. Hauser, R., Hauser, M. Prolo Your Sports Injuries Away! Beulah Land Press, Oak Park, Illinois, 2001.

Disclaimer: Certain persons considered experts may disagree with one or more statements made. Nevertheless, what is stated is based on sound authority, medical experience, and actual treatments of patients. Top