Dr. Ralf Oettmeier
Modern pain therapy should follow causal and individualized principles. In concrete terms, this means the evaluation of the main causes of pain, which are often associated with inflammatory processes. In addition, if local or regional treatments fail, the focus should be on a holistic view using segment reflector complexes, knowledge from TCM and regulatory medicine. It is also important to supplement essential vital substances in the case of proven deficiencies, to include biological dentistry and to use naturopathic analgesics with few or no side effects. The holistic pain medicine is rounded off by psycho-emotional harmonization techniques, which take into account the nature of pain as an unpleasant emotional experience.
The treatment of chronic pain is one of the greatest challenges of modern medicine and creates an enormous socio-economic burden potential. In Germany, Austria and Switzerland, for example, between 42 and 50 painkillers per head are consumed annually. More than half of them are bought over the counter in pharmacies. The remainder, for example, burdens the German health insurance funds with 7.3 billion euros (1). The associated side effects and deaths of regular use of non-steroidal anti-inflammatory drugs (NSAIDs) is serious. According to NOLTE et al, around 2,200 patients died in Germany in 2011 as a result of NSAID abuse. An additional € 750 million had to be raised for the treatment of NSAID side effects (2). A Swiss study was also able to show an increased rate of myocardial infarction and stroke with regular NSAID use when analyzing the data from 31 studies with a total of 120,000 people (3). In the United States, the official death rate from gastrointestinal bleeding due to NSAID abuse is around 16,500 annually (4).
This underlines the necessity of a paradigm shift in pain therapy: away from ostensible pharmaceutical intervention towards an individualized, causal and holistic concept. This article would like to dedicate itself to this premise.
To understand acute and chronic pain
According to the IASP, pain is an uncomfortable sensory and emotional experience that is associated with or described as real or potential tissue damage (5). It is therefore important to differentiate between physiological, biochemical and immaterial aspects at the various levels of pain processing. In the case of acute pain, the processing chain from the periphery to the brain up to the sensation of pain is easy (Fig. 1). Afferent nerve fibers in the periphery are stimulated by mechanical, chemical and physical noxae, which then set a stimulus conduction chain in motion. With the participation of mast cells, chemical substances such as histamine, substance P, bradykinin and prostaglandins are formed as stimulus intensifiers.
Figure 1: Model of the development of acute pain
The linear-mechanistic model is not sufficient to understand how chronic pain develops. To this end, practice-relevant models for defining receptive fields and neuroplasticity as the basis of pain memory were developed in the 1990s and are still valid today (6-9). As illustrated in Figures 2 and 3, there are both peripheral and central activating and inhibiting factors that modulate pain and ultimately influence its perception. Starting with the anamnesis, our attention should be paid to all of these components of the development of pain and the maintenance of its chronicity. This also makes it clear, that in complicated cases for an individual pain analysis a therapeutic team is necessary, taking the complexity of the topic as a whole into account.
Figure 2: Development of chronic pain (schematic)
Figure 3: Main components of the peripheral (left) and central (right) receptive field
In holistic medicine pain is also interpreted as being the tip of an iceberg, which is based on a multiple of its volume of potential causative factors “under the water surface” (Fig. 4). The deeper you go into the anamnestic and diagnostics, the more causal and long-term successful the pain therapy is. Of course, the best medicine would be to completely dissolve the "iceberg of pain". In practice, for chronically ill patients, it can often only be reduced in size due to the increasing organic damage. Simple pain suppression with classic analgesics (NSAIDs, opioids) should only be reserved for situations where other, non-drug methods and natural painkillers fail. This should be the guideline for our actions.
Figure 4: Pain as the tip of a causal iceberg of functional and regulatory disorders as well as deep causal mechanisms
Local holistic pain therapy procedures
These procedures apply to the reduction of the nociceptive stimuli in the periphery of the area affected (felt) by the pain. Often, affected people instinctively take measures such as rest, warming, cooling or the use of ointments or compresses. Naturopathic pain therapy can also provide relief with ointments (frankincense, Traumeel®, Zeel®), local acupuncture or neural therapy, manual therapy, laser treatment or cupping. The classic method of cantharid plaster, Baunscheidtierens and leeches have proven themselves as drainage methods. But the more chronic the pain, the less helpful these methods will be. The Czech manual therapist LEWITT said: "Anyone treating chronic pain only where it is felt is lost."
Segmental therapy for chronic pain
This consequently follows the assumption of the receptive field (see above) and has the reflex zones according to HEAD as well as the segment-reflective complex in the head and neck area as a physiological background (10-11). Non-drug procedures such as manual therapy, acupuncture, cupping, wraps and pads, locoregional magnetic field therapy and special massages are in the foreground. We favor superficial and possibly deep injections with neural therapy using procaine and naturopathic additives tailored to the problem (see table below). For example, a ventral injection is made into the liver-gallbladder segment both below the right costal arch and paravertebrally at the level of Th9-10 interspinal (Procain 1% plus Taraxacum comp. Injeel®, Hepar comp. Injeel® and Mucedokehl® SANUM).
Figure 5: Components of a vertebral segment as the basis of the peripheral receptive field (from v. D. Berg 2003)
Systemic approaches to holistic pain therapy
On the basis of holistic diagnostics, the processes affecting the entire human regulation system represent the focus of our work. These aim to free the system from permanently present neuro-modulative triggers (= interference fields), to have an anti-inflammatory and healing effect. For systematic reasons, we will consider the most important components separately in the following:
a) Detection and deactivation of neuro-modulative triggers
These previously called foci or interference fields are described as pathologically inflamed tissue, which in principle can occur in all areas of the body. They can be objectified through thorough examination, imaging, and functional measurements. We favor bio-thermology (also called regulation thermography) for diagnostics. Figure 6 shows the thermogram of a 62-year-old man who had been suffering from pronounced and previously therapy-resistant chronic lumbar pain for 6 years. However, the thermogram only showed abnormalities in the area of the maxillary sinuses, the tonsils and the upper cervical spine. Targeted neural therapy in these zones made the pain disappear within a few minutes.
Figure 6: Biothermology. The yellow and orange measuring points are noticeable (system thermolytics 3000-IR, SwissMedAnalytics AG), explanation in the text.)
The tooth and jaw region are of great importance in the impact of chronic inflammation sources on the body. In fact, every tooth socket (odontom) is connected with internal organs, joints and spinal column segments (Fig. 7). A routine component of holistic pain therapy is the presentation of the patient to a qualified, biologically thinking dentist. Through a thorough examination, imaging with OPT and possibly DVT, this objectively verifies the foci of inflammation in the tooth and jaw area (such as restostitides, inflammation of dead teeth, displaced teeth, scattered tooth germs, etc.) as well as disorders of the bite setting in the sense of a cranio-mandibular dysfunction. With adequate rehabilitation, sometimes the patients experience spectacular improvement in their pain problems. The OPT in Figure 8 shows a related case. Here, large pus granulomas can be seen in several root-treated teeth. Extraction of these with application of platelet-rich plasma (PRP) locally for wound care resulted in immediate relief from symptoms. The more chronic the problem, the more consistently one should eliminate such foci of inflammation.
Figure 7: Interrelationships between teeth and body (modified from R. VOLL)
Figure 8: Orthopantomogram (OPT) of a 64-year-old lady with migraines, headaches, back pain and upper abdominal pain
b) Detox instead of poison
It is logical, quasi “BIO-logical”, that toxic substances of all kinds also irritate nerves and thus foster pain. This has been clearly shown, for example, in fibromyalgia and exposure to cadmium, lead and mercury (12). Appropriate diagnostics using a chelate mobilization test or photometric element analysis using a SO-Check should be part of the routine. The adequate evacuation and detoxification is done using natural remedies for the liver, lymph and kidneys, antioxidants, zeolite and algae, with evacuation infusions (incl. DMPS, DMSO, EDTA), medical colon irrigation and whole-body hyperthermia. The main focus lies on avoiding new toxic loads through metal-free dental restoration, changing the diet, improving occupational safety and optimizing living and working conditions.
c) The special importance of orthomolecular medicine
Vitamins, minerals, trace elements, fatty acids and also essential amino acids are first examined for deficiencies in chronic pain patients and then adequately supplemented. For example, it was already possible to show in 1976 that a daily dose of 50 mg zinc for several weeks significantly reduces inflammation, swelling, morning stiffness and joint pain in rheumatoid patients (13). The importance of magnesium in pain therapy should also not be underestimated. For example, a 4-week administration of 500 mg magnesium a day produced a significant improvement lasting over 12 weeks of chronic back pain patients (14). Very good results have also been reported with high doses of glucosamine and chondroidin sulfate for osteoarthritis pain (15). Other antioxidants such as vitamin C, E or selenium are also part of a holistic orthomolecular therapy regimen (16). For inflammatory joint pain, we like to use 200-300 µg selenium as an additive to neural therapy. Finally, if there is a discrepancy, we should also systematically influence acid-base discrepancies. CSEUTS was able to show in 37 patients with inflammatory joint pain that this decreased significantly after 4 weeks of administration of base powder (twice daily) over four weeks with a simultaneous increase in the endorphin level. At the same time, the use of NSAIDs and cortisone could be significantly reduced (17). When it comes to unsaturated fatty acids, it is important to ensure a balanced ratio between omega 6 and omega 3 fatty acids, especially the ratio of arachidonic acid (ARA) and eicosapentaenoic acid (EPA). Alpha-linolenic acid EPA and DHA often have to be substituted for deficiencies. Too many animal fats and an excess of linoleic acid have a pro-inflammatory effect and thus aggravate pain.
d) Other proven systemic approaches to non-drug pain therapy
Patients with chronic pain should regularly benefit from the variety of effective non-medicinal procedures. These make use of the knowledge about the reflex zones such as manual therapy, chiropractic therapy, myoreflex techniques and neural therapy. Also somatotopias and complex inner connections are the basis of osteopathy, cranio-sacral therapy, foot reflexology and the Dorn-Breuss technique. On the basis of the meridian theory of TCM, acupuncture, acupressure and acupuncture massages as well as Shiatzu have meanwhile achieved a firm place in holistic pain therapy. Finally, we also like to use passively generated fever in the form of whole-body hyperthermia for systemic pain treatment as a therapeutic tool (18-20).
e) Systemic treatment with procaine and ProcCluster®
Procaine has anti-inflammatory and analgesic effects, promotes peripheral blood and lymph flow, reduces pro-inflammatory cytokines and is sympatholytic. The application as a short infusion and, according to the patient's response, also by means of oral doses of 50-100 mg of the procaine salt ProcCluster® is standard for us in the treatment of chronic pain and inflammation. For further information, we refer to the extensive literature (21-23).
f) Effective pain therapy with naturopathic medicines
Before resorting to the side effect affected NSAIDs and opioids, the possibilities of naturopathic painkillers should be used and applied in the interests of the patient. We have an extensive range of phytotherapeutic, homeopathic and anthroposophic remedies at our disposal (10). The following tables show this as an example.
Table 1: Phytoanalgetics (used in Europe)
Table 2: Important pain problems and main proven homeopathic remedies used in Europe (Spl.® – Similaplex Fa. Pascoe, Opl. ® –Oligoplex Fa. Madaus, Pplx. ® – Plantaplex Fa. Steigerwald, Ptk. ® – Pentarkan Fa. DHU, cyl® – Ho Len Komplex Fa. Liebermann)
g.) Rounding off with psycho-emotional harmonization
Pain is ultimately an unpleasant emotional experience, a feeling, a sensation. Pain as such is difficult to objectify and cannot be measured in the blood: you have to believe the patient. According to neuroscience, the region of the thalamus, hippocampus and the limbic system play an essential neuro-modulative role. The psyche and its stability are the main components that need to be influenced in chronic pain patients (24-26). In some pain patients, the central receptive field is the main disturbance and trigger zone. It requires an empathetic therapist who can understand these relationships. Successful pain psychologists consistently take action here. Ultimately, there is a positive influence on all therapeutic interventions, especially when one “lends a hand” (= treatment). In neural therapy, we always combine the injection with an appropriate healing affirmation for the respective region. Incidentally, it is not a mistake to lay hands on therapeutically, as the specialist literature also describes (27). Let us give a final example to illustrate this: After neural therapy of the painful back of the head, the cervical spine and trapezius region, the patient speaks with the laying on of hands: "Your positive thoughts support this injection, which promotes blood and lymph flow in this region and improves the oxygen supply and ensures that everything that sits on the neck is transported away and frees itself. The heavy backpack, full of contaminated sites, worries and problems is emptied, becomes very light and leads to complete freedom from pain."
Diener et al. PhZ online 37/2013
Nolte et al: STK Zeitschrift 4/2012
Institut Sozial- und Präventivmedizin Bern: Analyse des chronischen Gebrauchs von Naproxen, Ibuprofen, Diclofenac, Celecoxib, Etoricoxib, Rofecoxib und Lumiracoxib bei 120.000 Patienten (2013)
Wolfe MM, Lichtenstein DR, Singh AG. Gastrointestinal Toxicity of Nonsteroidal Antiinflammatory Drugs, The New England Journal of Medicine 1999;340,24:1888–99