By Forest Tennant, PNN Columnist
Intractable pain syndrome (IPS) requires a personalized care plan for each person, based on their underlying pain condition and clinical severity.
There are therapeutic, pharmacological, dietary, and physical measures you can take to specifically target the cause of IPS. The first step in finding relief and recovery is to target the cause of the pain, not just to take the “shotgun” approach with only symptomatic pain relievers. A multidimensional approach is needed.
The 7-component therapy described here is to help patients, families and physicians formulate an individualized IPS care plan.
1) Suppression of inflammation
Underlying cause: The injury or disease that originally produced the pain can continuously generate inflammation that requires removal by a variety of means. Common measures to reduce inflammation include anti-inflammatory agents, electromagnetic therapies, local injections, or topical agents.
Inflammation of the central nerve: IPS is caused by inflammation of the central nervous system (CNS) (neuroinflammation) which destroys or damages neurotransmitter systems. Only certain treatment agents cross the blood-brain barrier and suppress neuroinflammation. Some common agents: naltrexone, ketorolac, indomethacin, methylprednisolone, acetazolamide and dexamethasone.
2) Restoring sleep
It is during sleep that the CNS regenerates the neurotransmitters that you need to control pain. Sufficient sleep is necessary for this to happen. Some common agents: Ambien, trazadone, temazepam (Restoril), amitriptyline, melatonin, and Benadryl.
3) Control of electric currents
Certain drugs now called “neuropathic” normalize the conduction of electrical current, which is erratic due to nerve damage. Some common agents: gabapentin (Neurontin), pregabalin (Lyrica) and benzodiazepines (Klonopin and Valium).
4) Pain control
The constant pain of IPS is made up of two types of pain: ascending and descending. IPS control requires agents for both types.
Ascending pain: Some common agents: cannabinoids, opioids, ketamine, clonidine, kratom, and naltrexone (if not already on opioids).
Descending pain: Some common agents: amphetamine salts (Adderall), phentermine, modafinil, methylphenidate, mucuna.
5) Supplementation of hormones and neurotransmitters
Groups of hormones now known as neurosteroids and biochemical molecules called neurotransmitters are made in the brain and spinal cord. Their function includes suppressing inflammation, rebuilding damaged tissue, and controlling pain. Pain relievers / pain relievers will not work if a neurosteroid or neurotransmitter is deficient. Neurotransmitter testing is now available.
Hormones: DHEA, pregnenolone, testosterone, progesterone.
Neurotransmitters: dopamine-norepinephrine, serotonin, GABA.
6) Anabolic measures (tissue building)
In IPS, tissue degeneration is constantly present due to inflammation. Some genetic connective tissue / collagen diseases such as Ehlers-Danlos syndrome (EDS) have a constant component of integrated tissue degeneration (catabolic).
Tissue strengthening (“anabolic”) measures are essential in countering tissue degeneration, and several agents have been identified that do so: nandrolone, human chorionic gonadotropin (HCG), colostrum, antler velvet and amino acid / collagen supplements are recommended.
7) disease specific exercise
Cerebrospinal fluid circulates in and around the brain and spine. It eliminates biological waste such as inflammation. It also delivers nutrients to inflamed and / or damaged nerves for healing.
Exercises that improve the circulation of cerebrospinal fluid include walking, rocking in a chair, and gentle bouncing. Practice exercises and stretches that will prevent tissue shrinkage, paralysis, and dysfunction of your extremities or other organs specific to your underlying condition.
All seven of these components should be considered for inclusion in an IPS program of care.
Forest Tennant has retired from clinical practice, but continues his groundbreaking research into intractable pain and arachnoiditis. This column is adapted from the newsletters recently published by the IPS research and education project of the Tennant Foundation. Readers interested in subscribing to the newsletter can subscribe by Click here.
The Tennant Foundation provided financial support to Pain News Network and its sponsors PNN Patient Resources Section.