POSITIVELY PAIN FREE: A holistic approach to the many root causes of pain Dr. Ann Auburn, DO - Natural Health Improvement Center
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POSITIVELY PAIN FREE: A holistic approach to the many root causes of pain Dr. Ann Auburn, DO 4466 Heritage Court SW Grandville, MI 49418 Ph: (616) 301-0808 FACEBOOK LIVE, April 21,2020
The many faces of pain: • Fibromyalgia (connective • Headaches tissue and muscle pain) – Muscle tension • Chronic Fatigue – Sinus congestion – Migraines • Arthritis (joint pain) • Autoimmune Disease • Myalgia (muscle pain) • Back Pain • Trigger Points (tight • Organs: muscle fibers) – Heartburn/Reflux • Nerve Pain – Irritable Bowel • Post-COVID Pain – Colitis • Stealth Infections: – Menstrual Cramps – EBV, CMV, HHV-6, Lyme
What do these all have in common? INFLAMMATION!! This Photo by Unknown Author is licensed under CC BY-NC
What is PAIN? • Pain is a signal that something has gone wrong. • A signal that there has been injury or that injury is about to occur.
The Assessment of the Patient with Pain • Core questions as part of a pain assessment: – What is the type or category of pain? – Is there a primary cause of the pain? – What additional factors are contributing to the pain? – Are treatments available for the primary cause of the pain? – Are treatments available for the additional factors which contribute to the pain? – Are there medical or psychosocial conditions which would influence the choice of treatment?
What is the type or category of pain? • Nociceptive pain: – This is the typical pain that we’ve all experienced. – It is the signal of tissue irritation, impending injury, or actual injury. – Nociceptors (pain nerves) in the affected area are activated and transmit signals to the brain. – The pain is typically perceived as related to the specific stimulus (hot, sharp, etc.) – Nociceptive pain is usually time limited—arthritis and fibromyalgia are exceptions.
Nociceptive Pain: 2 Types • Visceral pain: a subtype of nociceptive pain which comes from organs and refers pain to other areas. – It tends to come and go and is poorly localized. • Somatic pain: a subtype of nociceptive pain which comes is pain that comes from areas of the body other than organs. – It’s more constant and well localized.
Neuropathic Pain • Neuropathic pain is the result of a malfunction somewhere in the nervous system. • The pain frequently is burning, lancinating, or has electric shock qualities. • A common characteristic of neuropathic pain is persistent ALLODYNIA--pain resulting from a nonpainful stimulus, such as light touch. • Neuropathic pain is frequently chronic, and tends to have a less robust response to treatment with medications.
Neuropathic Pain (cont’d) • The site of the nervous system injury or malfunction can be either in – the central nervous system (brain and spinal cord) or – outside of the central nervous system (in the nerves that are in the tissues, peripheral). • The pain is often triggered by an injury, but this injury may not clearly involve the nervous system • The pain may persist months or years beyond the apparent healing of any damaged tissues. In this setting, pain signals no longer represent ongoing or impending injury, but rather, chronic neuropathic usually mixed with nociceptive pain.
Is there a primary cause of the pain? • After determining if the pain is most likely nociceptive or neuropathic, the next step is to determine, as precisely as possible, the cause or specific source of the pain. • Frequently, reversible causes can be identified. Nociceptive pain indicates ongoing or impending injury; therefore, identification and removal or treatment of the problem is critical. • Is there an underlying sprain, tear, fracture, infection, obstruction, or foreign body? • Is there inflammation caused by an underlying arthritic, autoimmune, endocrine or nutritional disorder?
Musculoskeletal pain considerations: • INFLAMMATION – Local source – Distant source • RESTRICTED MOTION • JOINT HYPERMOBILITY • A LOSS OF NORMAL FUNCTION OF THE TISSUE INVOLVED
Underlying Physical Factors: Other factors contributing to the experience of pain: • Sleep disturbance • Inactivity and poor muscle conditioning • Weight gain • Hormonal imbalance/deficiency • Mineral Deficiencies • Maldigestion/Malabsorption • Food & Environmental Allergies • Bowel Dysbiosis & Leaky Gut Syndrome • Candida Overgrowth Syndrome • Toxicity and impaired immune function: Post-Covid-19 Syndrome, EBV, Lyme, other “stealth” infections, Post- concussion syndrome (Traumatic Brain Injury) • Ligament and Tendon Laxity • Neuromuscular Imbalances
Hormonal imbalance/deficiency Estrogen Deficiency Progesterone Deficiency • Mood Swings/PMS • Hot Flashes/Night Sweats • Hot Flashes • Vaginal Dryness • Night Sweats • Foggy thinking • Vaginal Dryness • Incontinence • Foggy Thinking/Memory Lapses • Tearful/Depressed • Incontinence • Heart Palpitations • Tearful • Bone Loss • Depressed • Sleep disturbance • Sleep Disturbances • Water retention • Heart Palpitations • Breast swelling & tenderness • Bone Loss • Fibroids • Joint/Muscle Pain • Joint/Muscle Pain
Signs of Androgen Deficiency (Pay attention fella’s!) Testosterone deficiency: DHEA deficiency: • Fatigue • Fatigue • Decreased stamina • Decreased body hair • Altered sleep patterns • Muscle loss and weakness • Decreased sex drive • Ligament and tendon laxity • Decreased speed of healing • Decreased sex drive (men • Very similar to the effects of and women) and erectile Testosterone deficiency, function for men • Boredom, disinterest, which is also an androgen decreased self esteem, lack hormone (masculinizing of motivation…your get up hormone) and go has got up and gone! • Muscle loss and weakness • Depression • Ligament and tendon laxity • Osteoporosis • Faster progression of • Increased coronary artery autoimmune disease disease • Adrenal stress
Mineral Deficiencies and Related Imbalances • Mineral Deficiencies • Maldigestion/Malabsorption • Bowel Dysbiosis & Leaky Gut Syndrome • Candida Overgrowth Syndrome • Food & Environmental Allergies
Mineral Deficiencies • Seen on a simple hair analysis • Can also assess with a RBC mineral analysis • Less than 5 deficiencies means likely good digestion • 5 or greater deficiencies means one or more of the related syndromes are causing maldigestion/malabsorption
POST-COVID SYNDROME: Older people and people with many serious medical conditions are the most likely to experience lingering COVID-19 symptoms, but even young, otherwise healthy people can feel unwell for weeks to months after infection. Source: https://www.mayoclinic.org/diseases-conditions/coronavirus/in- depth/coronavirus-long-term-effects/art-20490351
POST-COVID SYMPTOMS: Common signs and symptoms (continued): that linger over time include: • Reactivation of autoimmune • Fatigue conditions • Shortness of breath or • Fast or pounding heartbeat difficulty breathing • Loss of smell or taste • Cough • Depression or anxiety • Joint pain • Fever • Chest pain • Worsened symptoms after • Memory, concentration or physical or mental activities sleep problems • Dizziness when you stand • Muscle pain or headache • Less common: organ • Neurological symptoms damage (heart, lung, kidney, brain) and blood clots
Treatment of Post-Covid Syndrome • Hormone replacement • Ozone iv’s • Look for deficiencies • Treat underlying conditions • Ozone injections causing inflammation • Ultraviolet blood • Test for underlying autoimmune disease irradiation – ANA, Sed rate, RF • Vitamin C iv’s • Test for stealth infections: • Mild Hyperbaric – EBV – Lyme Oxygen Therapy – CMV • Anti-inflammatory – HHV-6 Supplements
Chronic Activated Epstein Barr Virus (CAEBV) • EBV causes mono, • It can also be a or simply an upper precursor to the respiratory infection development of • It can become autoimmune chronic causing disease, several pain, inflammation, cancers and chronic fatigue, neurological fibromyalgia disorders and can be reactivated by Covid-19 infection
Chronic Activated Epstein Barr Virus (CAEBV) • Kasia Kines recently wrote a book called The Epstein Barr Virus Solution • The practitioners of the NHIC participated in Kasia’s course on how to effectively treat EBV and manage it long term, alleviating the symptoms of fatigue and pain • That is a lecture for another time, but we now know how to treat it better than we did before meeting Kasia Kines!
CLINICAL EFFECTS OF OZONE THERAPY 1. Bactericidal, fungicidal and virucidal Therapeutic ozone indirectly activates the non-specific defense system as well as components of cellular and humoral immunity. 2. Anti-inflammatory effect oxidizes the compounds containing double bonds which participate in the development and the sustaining of the inflammatory process, regulates metabolic reactions and resolves pH.
3. Ozone analgesic effect oxidizes the products that act on the nerve endings in the damaged tissue and determine the intensity of pain response. 4. Detoxification effect correction and activation of metabolic processes in the hepatic and renal tissues 5. Activation of oxygen-dependent processes. increase in the content of free and dissolved blood oxygen plus mitochondrion activation resulting in ATP synthesis. 6. Optimization of pro- and anti-oxidant influence on cellular membranes and bringing to balance the levels of lipid peroxidation products
7. Ozone hemostatic effect depends on the dose. High concentrations external use cause hyper coagulation effect, while parenteral administration of low concentrations is characterized by the decrease in thrombocytic and coagulative values 8. Ozone immune-modulating patients with auto-immune pathology (rheumatoid disease, disseminated sclerosis, scleroderma, etc.) are helped For a more complete explanation http://www.absoluteozone.com/Articles/ozone_therapy_in_practice.pdf
Leaky Gut Syndrome When the intestines are not providing adequate “barrier” function, an increased burden is put on the liver. Leaky gut syndrome forces the liver to process higher quantities of internally and externally derived toxins. This stress can lead to a heightened systemic inflammatory state.
Inflammation and Leaky Gut By calming gastrointestinal inflammation and supporting the repair of leaky gut syndrome, nutritional supplements can help to calm systemic inflammation and inflammation in non-GI tissues such as the joints, lungs, and skin. Inflammation is associated with virtually every chronic disease. Inflammation is responsible for the pain and tissue destruction in patients with rheumatoid arthritis and inflammatory bowel disease. It is also thought to play a role in fibromyalgia syndrome.
Potential Causes of Irritable Bowel Syndrome and Leaky Gut Specific Food Intolerances Present in 48% of patients with diarrhea and pain Foods Provoking IBS ▪ Wheat 60% ▪ Tea 25% ▪ Milk 44% ▪ Butter 25% ▪ Corn 44% ▪ Yogurt 24% ▪ Cheese 39% ▪ Citrus 24% ▪ Oats 34% ▪ Barley 24% ▪ Chocolate 22% ▪ Coffee 33% ▪ Nuts 22% ▪ Rye 30% ▪ Preservatives 20% ▪ Eggs 26% British Journal of Nutrition (2002) 88, Suppl.1 S67-S72
The 4R program GI Restoration Fundamentals 1. Remove offending substances from the diet 2. Replace digestive enzymes and digestive acid when necessary 3. Re-inoculate with probiotics 4. Restore digestive mucosa integrity with proper nutrients A possible 5th “R” for Relieve abdominal bloating, cramps with proper relaxants and anti-gas agents.
Toxins as a root cause for pain and disease • Toxicity = Defined as a toxic substance entering into the body and interfering with normal functioning of tissues. • Heavy metals, Chemicals, Pesticides and Herbicides are common toxic substances found in human bodies causing: – Inflammation – Immune system dysfunction – Neurotoxicity (over years to decades)
Toxins and disease • Toxic substances can also include: – Chemicals • Pesticides/Herbicides/Fungicides • Chemical fertilizers • Factory/car/truck/plane emissions • Fast Foods – Drugs, including prescribed and over-the- counter, plus anesthesia used for surgery – Alcohol – Cigarettes/Tobacco
Inexplicable Neuropathy • 59 y/o home maker, husband accountant • Progressive, elusive peripheral neuropathy • EM doc checked for neurotoxic metal retention 40 mg/kg glycine (oral) DMSA (10 mg/kg)
Oral glycine plus DMSA
Ligament and Tendon Laxity and Neuromuscular Imbalances • Pain is due to WEAKNESS • According to the founder of Prolotherapy, Dr. George S. Hackett, MD: “Ligament relaxation is a condition in which the strength of the ligament fibers has become impaired so that a stretching of the fibrous strands occurs when the ligament is submitted to normal or less than normal tension.”
Ligament Laxity and Neuromuscular Imbalances • Ligament Laxity not only leads to pain but to Neuromuscular Imbalance. • Neuromuscular imbalance can have many causes, but simply put, the normal symmetry of the body is lost. • Some muscles are too tight and overworked, fatiguing easily, while others are weak and don’t work as well as they should.
Ligament pain referral patterns • Ligament pain referral patterns from neck
Ligament pain referral patterns • Lumbosacral and Pelvic Joint Pain Referral Patterns.
REGENERATIVE INJECTIONS Prolotherapy, PRP, Prolozone, Stem Cells and Exosomes “The rehabilitation of an incompetent structure such as a ligament or a tendon, by the induced proliferation of new cells.” -Webster’s New International Dictionary
Why Regenerative Injections Work • Blood flow is vital to the body’s healing process • Cartilage, Ligaments and tendons have a naturally poor blood supply • Incomplete healing often results after injury to ligaments and tendons, leading to chronic pain & weak joints • The first step to this healing process is inflammation • The growth factors in PRP, Stem cells and Exosomes add to the healing process
How Regenerative Injections Work • Prolotherapy, PRP, Prolozone, Stem Cells and Exosomes induce a localized inflammatory response at the site of a FIBRO-OSSEOUS JUNCTION (tendon or ligament attachment to bone) and the cartilage surface • Inflammation is the first step to any healing process, inflammation “signals” healing by sending new cells to the site • Adding ozone to this with Prolozone, enhances the deposition of connective tissue and has a pain-relieving effect • PRP, Stem Cells and Exosomes add growth factors to this process to enhance the healing
Ligaments of the Lumbar Spine Ligament and bone structure in the lumbar spine.
Ligaments of the Lumbosacral Area
Ligaments of the shoulder • Weak shoulder • Strong shoulder ligaments before ligaments after prolotherapy prolotherapy
What is PRP? • Platelet Rich Plasma…from the patient’s own blood • a type of regenerative injection intended to rehabilitate an incompetent structure such as a ligament, tendon, bone and cartilage by the induced proliferation of new cells. • By “regenerative” we mean to regenerate tissue and speed the healing process. • This is actually a type of “Prolotherapy” but with a different solution.
Activated Platelets Release Growth Factor Proteins into the Surrounding Tissue The Measure of Available Platelets Relates to the Measure of Growth Factors at the Wound Site Growth Factor Protein
The Role of Platelet Growth Factors •Growth factors are signal proteins that are released from local tissues or blood components and help to modulate cellular functions - including cell proliferation, cell differentiation, tissue regeneration, and wound healing. •Each growth factor binds specific cell surface receptors, which in turn modulate the activities of additional messengers.
How successful are Regenerative Injections? • VERY SUCCESSFUL! Approximately 70-90%! This can be less or take more injections when there is more damage or tissue loss. • This technique can strengthen the joint up to 140%, as proven in experiments by Dr. Hackett and others. • Prolotherapy works to PERMANENTLY STRENGTHEN the ligament, muscle and tendon attachments to the bone. • The average is 3-6 treatments, but this depends on the area and degree of damage and healing needed and the patient’s ability to heal. Usually, less injections are needed with PRP and most cases only require 1 set of stem cells or exosomes.
Symptoms which may benefit from proliferative therapy? • Pain causing trouble sleeping. • Joint dislocation or recurrent sprains. • Joint pain worse with activity and better with rest. • Adjustments help but don't last. • Grinding, popping or clicking in a joint. • If muscle relaxants, arthritis medication, cortisone shots or nerve blocks fail to resolve the problem within 6 to 8 weeks. • When surgery has failed. • Joint pain helped by a sling, brace or splint (instability). • Diagnosed with ligament or tendon sprains or tears. • Deep aching or pulling pain in the joint.
Stem Cells and Exosomes
What are STEM CELLS? • Stem cells are the foundation from which all parts of the human body grow and have the potential to develop into many different cell types in the body during early life and growth. • In addition, in many tissues they serve as a sort of internal repair system, dividing essentially without limit to replenish other cells as long as the person or animal is still alive. • When a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell. 51
Types of STEM CELLS: stem cells are classified by origin (where sourced) or differentiation potential (what they can turn into): STEM CELL TYPES BY ORIGIN: • Embryonic stem cells: pluripotent, meaning they can give rise to every cell type in the fully formed body, except placenta and umbilical cord. • Tissue-specific stem cells: aka, somatic or adult stem cells are more specialized and typically can generate different cell types for the specific tissue or organ in which they live. • Mesenchymal stem cells (MSC): can be derived from bone marrow, fat, amniotic and umbilical cord blood. MSC are isolated from the connective tissue that surrounds other tissues and organs. The first MSCs were discovered in bone marrow and were capable of making bone, cartilage and fat cells. Since then, they have been grown from other tissues, such as fat and cord blood. • Induced pluripotent stem cells (iPS): engineered in the lab by converting tissue-specific cells, like skin cells, into cells that behave like embryonic stem cells. This type of stem cell is critical for research. Stem Cell Article References noted on last slide 52
All stem cells that exist can be classified into 1 of 5 groups based on their DIFFERENTIATION POTENTIAL: Mesenchymal stem cells can differentiate into osteoblasts (a type of bone cell), myocytes (muscle cells), adipocytes (fat cells), and chondrocytes (cartilage cells). These cells types are fairly diverse in their characteristics, which is why mesenchymal stem cells are classified as multipotent stem cells. 53
Rejuv STEM CELLS from Burst Biologics: • Rejuv is a specialty product containing not only mesenchymal stem cells from umbilical cord blood, but also 44 cytokines and growth factors, making this a unique and very effective stem cell product. 54
Why Choose REJUV? 1. Rejuv is sourced from umbilical cord blood, which is a non- invasive procedure for patients as compared to harvesting stems cells from bone marrow or adipose tissue. Umbilical cord blood donors participate voluntarily and are not paid; participants are providing a true donation. 2. The process behind Rejuv begins with a healthy donor during live, healthy planned births. All UCB donations undergo extensive testing to rule out the presence of any virus, aerobic or anaerobic bacteria. Donations are strictly reviewed by a medical director before processing begins in a federally registered tissue bank. 3. Rejuv is proven to evoke a powerful signaling effect. Many patients require only a single treatment of Rejuv. 4. The Rejuv serum is developed to have a consistent composition. Rejuv features an optimal cytokine profile to promote reliable patient outcomes. 55
Stem Cell cases at NHIC • Case #1: – male, mid-70’s, ”bone-on-bone” arthritis. 1 cc Rejuv MSC diluted with 9 cc lactated ringers and injected into bilateral knees, using a walker much of the time due to pain – 2 weeks later: “I can take the stairs without pain now.” – 2 months later: “I can do a half day’s yard work without pain.” • Case #2: – 33 y/o male, MRI shows left knee has patellofemoral OA, partial tears medial and lateral menisci after slipping on basketball court May 2018; swelling, pain, limping, 70% improved after 5 months of PT, but still limping on stairs, unable to play basketball or exercise without pain and functional limitation. 1 cc Rejuv MSC diluted with 9 cc lactated ringers, injected into interarticular space, infrapatellar space, MCL, LCL and pes anserinus. – 2 months later, limping gone, pain and exercise greatly improved – 3 months later, no pain, 7.5 miles on treadmill and full function 3 years later, both patients are doing well. 56
Exosomes: • Exosomes are the signaling molecules on stem cells • They are the little envelopes of information that the stem cells use to do the signaling at the tissue to help it repair • Exosomes can be used intravenously or locally in joint or in the nose or in areas of brown fat to help brain and nervous system repair
What is PROLOZONE? • Prolozone is the same as what we already discussed, prolotherapy or PRP, PLUS injected OZONE. • Ozone gas, O3, has many medical uses. • Ozone is another proliferative agent but is also used medically in my practice for many other treatments. • Ozone use with regenerative injections, adds another layer of healing by getting the localized tissues to utilize oxygen better and produce more ATP, the energy source for the cells, to help cellular function, detox and repair.
HOCATT OZONE SAUNA for Pain •Detoxification for the entire body •Improved Cardiovascular function •Blood pressure improvement •Improved judgment and discernment •Sexual vitality and stamina •Extend the healthy years of your life •Able to Maintain Healthy Weight •Smooth and Youthful Skin •Improved Mental Clarity and Memory •Increased Energy •Noticeable pain reduction •Reduce chronic infections and inflammation & reduce pain •More attractive Appearance •Eliminate Cellulite in legs
Ozone Sauna Therapy • Ozone increases tissue oxygenation and energy production and helps your body to relax and enter a healing state, therefore reduce pain • 30 minutes per treatment • Start off no more than twice a week with lower temps, lower concentrations, and lower exposures to ozone • Max frequency is 3x/week
HOCATT Ozone SAUNA! • HOCATT: Hyperthermic Ozone and Carbonic Acid Transdermal Therapy! ( www.hocatt.com) Some of the wellness benefits include: • Detoxification – an important part of treating auto-immune disorders and cardiovascular health • Oxygenation of the body – improves energy levels quickly by increasing oxygen utilization, and reducing pain. • Promotes wound healing – returning the patient or client to normal more quickly. • Strengthens connective tissue – promoting longevity and improving mobility and reducing pain. • Weight Loss and improved metabolism. • The unit is adjustable so will fit almost anyone. It includes a heart monitor for ease of monitoring the patient, plus water level sensors to remove the guesswork and it is all computer controlled.
HOCATT SAUNA MODALITIES: • Far Infrared • Carbonic Acid Therapy • Ozone Therapy • Electrotherapy • EWOT (Exercise With Oxygen Therapy) • Hyperthermia Therapy • Photon Light Therapy • Aromatherapy • Ultraviolet Irradiation
Physical Therapy: • P.T. is very important, especially with muscle imbalances and chronic or recurrent pain or after surgery. • P.T. makes prolo and PRP treatments work better because the patient is establishing a new neuromuscular balance program for the affected area(s). • P.T. is rehabilitation and reprogramming that goes hand-in-hand with the changes that occur with Prolo and PRP repair of ligaments, tendons and cartilage.
Other reasons for Physical Therapy 1. Improve mood 2. Improve strength 3. Improve cardiovascular status 4. Improve motor control 5. Decrease pain 6. Tools to use at home 7. Maintenance of gains
Modalities used at the NHIC for pain: • Osteopathic Manipulation • Specialized iv therapies: Vit Treatments (OMT) & C, Meyer’s Cocktail, Amino Craniosacral Acids • Trigger Point Injections • Natural anti-inflammatories • Regenerative Injections: • Weight Loss and Lifestyle Prolotherapy, PRP, modification programs Prolozone or Stem cells and Exosomes • Individualized • Steroid injections (only supplementation programs when absolutely needed) • Correction of any other • Acupuncture-Dr. FLYNN underlying disorders: • Medical Massage Thyroid problems, Hormonal • Touch for Health Imbalance, Leaky Gut testing/treatments Syndrome, poor heart or • Orders for Physical Therapy lung function, Food or Occupational Therapy Allergies, Chronic Lyme Disease
Dr. Flynn PAIN RELIEF, ACUPUNCTURE AND ORIENTAL MEDICINE • Studies show for chronic low back pain, "there is evidence of pain relief and functional improvement for acupuncture, compared to no treatment or sham therapy.”
Acupuncture research: • The combination of acupuncture and conventional therapy was slightly better than conventional therapy alone. • A review for the American Pain Society/American College of Physicians found fair evidence that acupuncture is effective for chronic low back pain.
A word on additional therapies that help ligament laxity and pain: • Nutrition: – Multivitamin-multimineral supplement – Omega-3 fatty acids, Calcium-Magnesium, MSM, Glucosamine, Boswellia Complex, UltrainflamX – Low sugar diet (no white food) – Whole food diet – Toxin-free diet – Hormone-free meats – Organic whenever possible – Avoid GMO (genetically modified) soy & corn – Avoid excess weight and obesity, address if it occurs
Additional therapies that help ligament laxity and pain: Detoxification: – Detox diets – Remove food allergies – Sauna sweat program – Improve gastrointestinal health – Treat Candida Related Complex – Colon cleansing/Regular elimination – Heavy Metal and chemical Detox programs
Thank you for listening! Any Questions?
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