INJURY, PAIN -- SUCCESSFUL TREATMENT by ROBERT A. NASH, M.D., L. Ac.

Most of us never worry about injury or pain until it happens to us. In the building trades, it's likely that injury may occur during your working life. Pain in the form of headaches, back pain or arthritis pain may also affect you, even if you're not injured. Most doctors have only the treatment methods for injury or pain that they were taught in medical, osteopathic or chiropractic school. However, our knowledge of pain and painful injuries has exploded over the past 20 years. I've been actively involved in the treatment of difficult pain problems during these past 20 years. The purpose of this article is to share some of the good news about pain treatment with you. I'll begin by telling you a little about myself.

I was trained as an engineer. After serving in Viet Nam I left the military after 10 years and went to medical school. I had chronic low back pain and I learned early on that medicine wasn't interested in chronic pain. I devoted much of the next 25 years learning about pain and treating it differently than most doctors do. After medical school, internship and a residency in adult neurology, I came to Virginia Beach in 1976 as the first full time, board certified neurologist in that city.

I practiced medical neurology which treats diseases and injuries of the brain, spinal cord and peripheral nerves without surgery. I learned about chronic post-traumatic pain in 1977 and have been treating it ever since. I have continued my pursuit of knowledge to help you, the patient, ever since. I have become board certified in pain medicine. It's a self-designated specialty recognized by the American Medical Association. I am one of a handful so trained in Virginia. I learned that physical therapy didn't always "cure" soft tissue injuries, so I looked further. I was led to investigate acupuncture and have included that treatment for my patients over the past six years. I may be the only board certified neurologist, board certified pain medicine physician and licensed acupuncturist in Virginia.

So what!? What does that mean to you? During these past 20+ years of treating pain, I've learned a few things that may help patients. One thing that's important to me is that I no longer have chronic pain! If this can happen to me, it can happen to you, your family and your friends. We help many who have failed to improve with traditional medical treatments. The key is to see you early, since I believe we can prevent most chronic pain syndromes from developing with proper treatment.

So, what is the proper treatment? Of course there's no one easy treatment for all pain. In the case of an injury, we must make sure that no bones are broken, no muscles or ligaments are torn to the point of needing surgery and that no nerves are damaged. I, as a medical neurologist and pain medicine physician, can help determine this. The treatment, assuming no surgery, is then support to the injured body part, pain medication, muscle relaxants and something to help sleep. The need for pain medications and sleep medications should resolve in two to three weeks. If they don't you might be one of those unfortunate individuals who could develop chronic pain.

Chronic pain appears to be more frequent in people with low brain serotonin levels. Serotonin is a brain chemical we understand more than most other brain chemicals. It is involved in changing or decreasing the pain signal. Serotonin is also necessary for deep sleep leading to healing and pain relief. During deep sleep the brain signals total relaxation to the muscles of your back and neck. It also produces large amounts of potent morphine-like pain killers called endorphins or encephalins. Many injured workers who develop chronic pain may come from hard-working families where someone in the family may have overused alcohol, pain medicines or other substances.

This is neither good nor bad -- but a fact of genetics. You are some combination of your mother's and your father's genetic material. It appears that low serotonin may account for the perfectionist, hard-working individual every employer desires. It may also account for the hard drinker who on occasion may lose it and might be said to have an explosive temper. It's also a definite factor in the development and perpetuation of chronic pain. Alcohol, narcotic pain medications, valium-like drugs, sleepers called benzodiazepines, and barbiturates found in some headache prescriptions, may inhibit the brain's ability to produce the endorphins and encephalins. It's easy to see why large amount of alcohol, narcotic pain medications, benzodiazepines or barbiturates may potentiate your pain and cause you to develop chronic pain.

Another important factor is deep sleep. As noted earlier, deep sleep not only produces the morphine-like chemicals in your brain, but it also relaxes the muscles of your neck and back. The combination of tight muscles, muscle spasms, and a sleep disturbance are thought to be the major cause of chronic pain. If this chronic pain is post-traumatic, or after an injury, it may be called myofascial pain. If there is no prior injury, it may be called fibromyalgia. Other names such as fibrositis, chronic sprain, post laminectomy syndrome (pain still present after back surgery) and other names may be used when describing chronic pain. Most of us don't care what it's called, we just want to get rid of our chronic pain.

My chronic pain is gone! As I mentioned, it was one of the reasons I had such an interest in pain. I've had it; I've studied it; and I've found a combination of techniques to relieve it. The disturbed sleep patterns can be overcome. The use of drugs that raise serotonin, such as Prozac*, Paxil*, Zoloft* and Luvox*, appear to help re-establish normal sleep patterns. Other non-medication herbs, such as St. John's Wort, Kava, 5HTP and others may help restore normal sleep. A deep relaxing, normal sleep is necessary for pain relief. This is true whether the pain is from trauma, after the trauma, the pain of chronic headache, sports injuries, or just overdoing on the weekends.

The second component of chronic pain is the deep, recurrent muscle spasms. Sometimes just sleeping more deeply will help the pain to decrease enough for you to do more; and on occasion the pain will disappear completely. On other occasions you might benefit from some sort of body work (like massage) to break up the deep spasms. Another technique I believe is even better and more cost effective is acpuncture.

Acupuncture is the ancient art of inserting very small, fine needles into selected points along lines of energy or meridians. It was finally approved by the AMA and government agencies in 1997. Inserting these needles and having them in are not like getting a shot. There's very little pain and no pain at all within about a minute of placement.

Sometimes electrical stimulation of the needles is used. Acupuncture has been proven to increase brain serotonin, endorphins and encephalins. These are the same chemicals that are low in the chronic pain patient. Sometimes even more dramatic is the sudden relaxation of the muscle spasm with needle insertion. In seconds the spasm is gone. Even I'm still impressed every day I perform an acupuncture treatment.

In summary, if you're injured, come see us right away. If you see your own primary care physician or your orthopedic surgeon and are not improved in two weeks, ask for a referral to see Dr. Bob Nash, (757) 490-9311. We'll work with you to get you pain-free and back to work. We help you regain and then retain your health by using the very best and latest in conventional and alternative medicine. This combination is new and exciting. It's call Integrative Medicine and is the medicine of the 21st century. I'm the foremost proponent of Integrative Medicine in Tidewater Virginia. I am the only physician in Tidewater who is board certified in neurology and pain medicine and is also a licensed acupuncturist. There is help. Get it early. Get rid of your pain and get back to work -- joyously and pain-free! Copyright 1998 by Robert A. Nash