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    Welcome to our Blog. We'll discuss issues that are more complicated than simple Question and Answer.
    It's been a while. Scroll down for a discussion about an important supplement.

    May 11th, 2012
    Many doctors treat pain. However, when an ongoing painful condition negatively impacts the way you function on a daily basis, there are tremendous advantages to attending a multidisciplinary chronic pain clinic.

    Dr. John Bonica is considered the grandfather of the multidisciplinary pain clinic. People worked in teams before he did, but Bonica took the study of pain in general and especially the treatment of pain by a team of different specialists to a new level. In the 1960's he started what is now recognized as the first multidisciplinary pain clinic out of the University of Washington Medical School, in Seattle. He actually started working in teams as early as 1947 while at the Tacoma General Hospital. Since Bonica, the multidisciplinary pain clinic is considered the gold standard of care and it’s easy to see why.

    Chronic pain is difficult to treat. It changes almost every system in the body. No one can be an expert in all the different body systems, the prescription medication and supplemental nutrients, the physical therapy techniques and the psychological coping methods required to deal with long-standing chronic pain. It helps to work in a team of such experts. McConley et al, and others have demonstrated this in scientific studies.

    Not all multidisciplinary clinics are the same. Some have numerous doctors but no physical therapists or nutritionists. Some have only “alternative” treatment and no medical doctor supervision. Many clinics have team members working “in parallel”. You’ll see one person, they will write up a report, then on to the next person and so on. They may offer numerous services at one site, but there isn’t any communication among team members.

    The best pain clinics have a variety of services available. The first person you see will help you figure out a specific diagnosis (or more than one) for what is causing your pain. They will help you get the diagnostic tests you need, if they haven’t already been done, and help you interpret what you have had done to date. Next, they will set up an individualized treatment plan. There should not be a “cookie cutter” approach for every patient. When it comes to chronic pain, the best approach usually involves several different treatments. Why?

    The human brain is an amazingly adaptable organ. Once chronic pain changes occur, the brain gets reprogrammed to maintain the status quo, even when that means pain and disability. Trying single treatments or medications doesn’t usually work. The brain adapts rapidly to the new treatment to maintain the pain generating state. It needs to be “rewired”. This usually involves removing the pain triggers, boosting your endorphin-releasing and trigger-blocking ability of the brain, improving your nutritional intake and sleep patterns and (even just temporarily) breaking the “pain cycle”. These must all be done simultaneously for any chance of success. A carefully designed treatment plan involving various clinicians has the best chance of rewiring the brain. All team members need to be in constant communication with each other. Treatment needs to change if the expected results aren’t achieved or (on a positive note) if you feel better, faster than expected. Realistic goals must be established at the start, and all team members must be working towards the same goal. It is not reasonable to expect complete relief of pain in every case! Often goals must be reset higher or lower, depending on how you respond after a few treatments, or if unexpected complications appear. This is likely the model that John Bonica envisioned all those years ago.

    An informed patient is his or her own best advocate. Ask about how your pain clinic works. If your pain condition is not responding to treatment, ask to be referred to a multidisciplinary clinic, the gold standard of pain care.

  • February 20th, 2013
    Magnificent Magnesium

    There are a few supplements that every person with chronic pain should take. Magnesium is one of them. This is essential if you get any kind of headache on a regular basis, especially migraines. Magnesium is a mineral found throughout the body. It works in tandem with calcium, especially in your nerves and muscles. We have become conditioned to focus on calcium and consume calcium-containing foods/supplements religiously. Most people forget that the body works best with a calcium-magnesium balance, and that most of us just don't get enough magnesium in our diet or can't keep enough in our body. If you have any type of bowel disease that effects absorption you may be actually losing magnesium. Taking diuretics (water pills) is another cause of magnesium depletion. Some types of anti-seizure medication (ironically, some of these are used as migraine preventers) may also cause a lowering of your magnesium level. Conversely, eating plenty of nuts, seeds and green leafy vegetables will help replace magnesium. This crucial mineral can also be found in avocado, dark chocolate, coconut and natural spring water.

    Are you getting enough magnesium in your diet? Is your level high enough? Should you have your blood level tested? Yes, but the blood test will only tell you a very small part of the story. If for some reason, your blood magnesium level is high, you clearly don't need to supplement. It is likely you will need to have your kidneys checked, as this is the way our bodies get rid of excess magnesium. If your blood level is low, you definitely need a supplement. Your doctor will discuss ways you can get your level back in the normal range quickly, which may be quite important. If however, your blood test reports a "normal" magnesium level, you can not stop there. Blood tests only measure a very small pool of body magnesium. Most by far is stashed away in the muscles where it can't be tested. The blood level is preferentially preserved, which is why a low value is so significant. Most people with a deficiency of magnesium will test "normal".

    This means that if you have frequent headaches or migraines, or any painful condition of your muscles or nerves, you should take a magnesium supplement. Luckily, if your kidneys are functioning properly, it will be difficult to cause any harm by taking an oral magnesium supplement. Magnesium is not well absorbed, which means that the main side effect of too much magnesium is diarrhea and/or bowel cramps. Some companies take advantage of this by using magnesium in their laxatives. These are not the types you want to use to replace magnesium deficiencies. Ask your favourite health store for a better-absorbed type. Generally, these are types that chelate (combine) magnesium to an amino acid. Examples are magnesium malate, magnesium taurate and magnesium glycinate. These are NOT the names of brands, simply the types of magnesium. Several different companies make these types. You may need a lot, as you may be quite deficient. (Don't forget that we can't really know how deficient you are.) It may take months or longer to replenish your level so don't look for immediate changes in your headaches or pain. Take as much as you can without causing diarrhea. The amount you retain from each dose is unknown and probably variable, so the actual strength doesn't really matter. The higher the amount of elemental magnesium (this number is usually found in the white box on the side and will likely vary from the number on the front label) the better, but the higher the possibility of an upset bowel. Hang in there. Spread out your doses, take them with food, but don't take them with some medications like a thyroid supplement.

    In addition to a reduction in migraines, headaches, muscle aches and spasms, you may derive benefits to your heart, blood pressure and general health. Please check with your doctor before adding this or any other supplement to your routine.