A Holistic Approach To Emotions And Neuropathic Pain

Today's post from blog.aapainmanage.org (see link below) is an interesting one for neuropathy sufferers because it addresses the effects emotional response can have on your pain. It's written from the point of view of a holistic doctor with special emphasis on traditional Chinese medicine. I would personally argue that neuropathic pain is so specifically 'different' that your emotional state has little effect on the strength of your pain. However, it's undoubtedly true that the better you feel, the better you are able to deal with neuropathic symptoms. The question is: is it a chicken and egg situation where the pain causes the emotion and not the other way around? Worth a read to see where your situation fits on the grid.

How Emotion Can Relate to Location of Pain
By Jennifer Johnston, PhD, DNM, NMD Posted by The Academy, Jun 29, 2016,

Research is well established on the influence of emotions on perception of pain, pain treatment, catastrophizing, and speed of healing. The Institute of Medicine reports, “people’s experience of pain can be influenced by genes, cultural attitudes toward hardships, stress, depression, ability to understand health information, and other behavioral, cultural, and emotional factors. Successful treatment, management, and prevention of pain require an integrated approach that responds to all the factors that influence pain” (1).

Emotions of stress, joy, sadness, or even anxiety are all a natural part of life and are often felt physically. When preparing to step on the stage to give an important speech we may feel our anxiety as a physical sensation of knocking knees or even butterflies in the stomach. When meeting to go on a first date we may experience anxious feelings as a flutter in the chest, swirling feeling in the head, or nervous smile. Each of us may describe how we experience a situation differently, but most agree on how basic feelings are experienced in the body.

When emotions become excessive, suppressed, or turned inward they may begin to influence our overall physical function and how and where we perceive pain. Studies have established that emotions have distinct biological expressions that influence overall health. Additionally, emotions are responsible for prompting the body to prepare us to react to environmental challenges by communicating with the cardiovascular, skeletomuscular, neuroendocrine, and autonomic nervous system. For example, stress can both be the cause and influencing factor for a variety of physiological responses that can enhance health or promote disease (2). When we sense fear our flight or fight responses are activated and we feel that fear in the body. By taking a deeper look at how emotions correlate with the location of pain we may find a deeper understanding on why and how patients experience pain.

Body Mapping

In 2014 researchers were able to identify locations of body sensations related to emotions using a topographical body mapping method. Results reveal consistent and distinct maps associated with basic emotions. Physical sensory information is known to trigger conscious emotional experiences. This study showed that different emotional states are associated with distinct and culturally universal body regions. These regions could aid in our understanding of how emotions correspond with pain locations in the body (See figure 1, below) (3).



Researchers ran five studies with a total of 701 participants and identified that different emotions were reliably associated with statistically identifiable bodily sensation. These maps were equal among both West European and East Asian samples. They propose that emotions are represented in the somatosensory system as culturally universal categorical somatotopic maps (3).

TCM: Emotions and Meridians

Traditional Chinese Medicine (TCM) views the body as a whole, with mind, body, and emotions as correlated factors influencing overall health and happiness. A TCM fundamental principle states that everything experienced on the outside of the body reflects the quality of health on the inside (4). Certain areas of the body are more vulnerable to injury due to potential underlying emotion, energy, or organ imbalance. Many individuals experience a physical event, such as a slip or fall, so why do some experience injury and others do not? Why do some individuals experience injuries to their knee, ankle, hip, low back, or wrist? Why is there so much variation in the potential for injury and the location of the injury?

Sports Medicine Journal reported that 1.5 million young men participate in football and an estimated 1.2 million football-related injuries are reported annually. Overall, 50% of all injuries were lower extremity injuries (with knee injuries accounting for up to 36%). Thirty percent of injuries occurred in the upper extremities. Overall, sprains and strains accounted for 40% of injuries, contusions 25%, fractures 10%, concussions 5%, and dislocations 15% (5).

Pain can result from an external source, such as an auto or sports injury that damages the meridians and physical structure, as well as from an internal condition, such as an organ or energy imbalance. It is often easier for the practitioner to identify and treat the cause when it is related to external visible factors. Pain related to internal or emotional conditions has a tendency to be more complex, and effective treatment requires a closer look to determine the root cause.

All emotions can influence the body’s response to external factors such as injuries and accidents. It is when emotions become out-of-balance, excessive, or repressed that overall health and pain responses are influenced. Excessive or repressed emotions are understood to contribute to organ imbalance thereby leaving the body more susceptible to physical damage, pain, and injury.

The reverse is also true. Individual organ health can similarly influence the experience of emotions and pain. The theory is that balancing the organ that is associated with the emotion results in a balancing of the associated emotion. Sometimes the organ is out of balance and produces the emotional imbalance or potential physical vulnerability for injury. The difference is important to the practitioner in identifying and reducing future recurrence of the symptom.

Meridians are a three-dimensional energy network in the body that make pathways that connect to each other and to every bone, tendon, tissue, organ, and skin cell. These intercommunication networks function within the entire physical and emotional framework. There are 12 major meridians that run through the body (4). The left and right sides of the body mirror each other, while the back and front are different. Each meridian corresponds to an internal organ along with the associated emotions and other similar energy frequencies. (See Figure 2, below).



Liver and Gallbladder. An individual experiencing feelings of anger, frustration, irritability, and stress may be suffering from a liver imbalance. Liver and gallbladder meridians are correlated with migraine headache, tendon and ligament problems, ankle and hip pain, menstrual cramps, and arthritis. When the liver becomes healthier, the associated physical pain and emotion will reduce or disappear. However, a persistent lifestyle situation that increases or continues feelings of stress and anger will cause the liver imbalance to continue, along with the associated pain (4).

Spleen and Stomach. The spleen and stomach are associated with feelings of worry and over-thinking. Imbalances in these meridians can result in excessive or easy bruising, muscle injuries, or pain conditions related to the torso, front of the legs, and feet. Pain felt in the big toe can be linked to digestive imbalances involving the liver and spleen, as both meridians end in the big toe (4).

Kidney and Bladder. The kidney and bladder are associated with the emotions of fear and anxiety and their meridians are further related to pain associated with the knee, heel, neck, low back, feet, and bones. In a case study involving kidney function and meridian location, a female reported sore knees after skiing season and a subsequent right knee injury resulting from skiing (6). In this case, the sore and injured knees are related to the activity of skiing but, why the knees and not the hips or ankles? TCM theory links the state of the individual’s kidney energy and function to the health and resilience of the knee area (4).

Lung and Large Intestine. The lung and large intestine are associated with the emotions of sadness, depression, and grief. Pain conditions correlated with these organs and their meridian locations include painful skin conditions and shoulder, elbow, and hand injuries (4).

Heart and Small Intestine. The heart and the small intestine are related to the emotions of joy and happiness and are further associated with pain experienced in the upper body, chest, shoulders, and hands.

For instance, a broken heart from a problematic relationship will eventually cause an organ function disorder if the emotion is not addressed and resolved. Joy is the heart’s corresponding emotion. When an individual loses the capacity to experience joy, the heart’s health can be negatively affected resulting in both physical and emotional pain (4).

Due to the complexity of pain and emotions, the diagnostic process should include many questions related to lifestyle, emotional wellbeing, and physical health to aid in identifying the root cause of the pain. Our job as practitioners is to help patients evaluate all contributing factors related to their pain condition, not just the physical. Once the key underlying cause is identified, then the imbalance can be addressed and the environment that created that imbalance can be changed.

Additionally, when considering emotional correlates to pain it is important to remember that cause and effect are not linear but circular. For example, after an auto accident we can say that the accident caused a neck injury, but why the neck location for that individual? The sore neck is the symptom of the effect of the auto accident which is the cause. But what set the stage for the injury in the first place?

Pain can be a complex symptom and the cause may not be so straightforward, which is especially true when dealing with emotional factors. Which preexisting emotional patterns or organ imbalances have contributed to the individual’s specific pain symptoms and locations? We have the opportunity as practitioners to identify underlying factors that contribute to pain in order to help patients relieve and/or reduce the manifestation of pain.

Finding the time to help our patients identify emotional and lifestyle factors related to pain symptoms can be challenging. It is also important to take the time to examine and identify how our own personal choices influence our physical and emotional experiences. Finding time to relax, take a nap, or have some much needed fun is always a good first step toward improved health and happiness.

Jennifer Johnston, PhD, NMD, MS, is a board-certified practitioner at Holistic Health Solutions, Inc. with more than 13 years’ experience in naturopathic and Traditional Chinese medicines. She has a master’s of science with studies in psychoneuroendocrinology and a doctorate in clinical nutrition. Dr. Johnston is part of TCM World Foundation’s advanced studies program and is certified to practice LifeForce: Tao of Medical Qigong, Dragon’s Way®, Menopause and Breast Health programs.

References
Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011.
Institute of Medicine (US) Committee on Health and Behavior: Research, Practice, and Policy. Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences. Washington, DC: National Academies Press (US); 2001.
Nummenmaa L, Glerean E, Hari R, Hietanen JK. Proc Natl Acad Sci USA. 2014;111(2):646–651.
Nan L, Schaplowsky E. Traditional Chinese Medicine: A Natural Guide to Weight Loss That Lasts. New York, NY; TCM World Foundation; 2000: 139-142, 159-161, 180, 200-203, 218-223.
Saal JA. Common American football injuries. Sports Med. 1991;12(2):132-147.
Nan L. Ask Dr. Lu: Volume One. New York, NY: TCM World Foundation; 2011: 97-99 & 121-122.

From The Pain Practitioner, Fall 2015 issue. Join the Academy to receive The Pain Practitioner.

http://blog.aapainmanage.org/emotion-can-relate-location-pain/

Finally A Common Sense Approach To Cannabis For Nerve Pain

Today's post from nytimes.com (see link below) illustrates the new approach and ideas about cannabis as a pain killer perfectly. It reflects the sort of common sense that is finally gaining ground when it comes to cannabis hysteria. The older people in this article clearly benefit from (what seems to be) cannabis oil (CBD) administered to relieve their neuropathic pain and you have to give credit to the authorities that allow this to happen. One thing that comes across very strongly in this article is that people are still afraid of, or suffer, stigma associated with medicinal cannabis. Others seem to be convinced that patients will get high and are even taking it for that very reason, which of course, with cannabis oil is patent nonsense. What the future holds for medical cannabis in the current US climate of right wing political thought, is very much up in the air but neuropathy patients across the world will be hoping that common sense prevails and that even more research and study will be done until medical cannabis becomes as accepted as aspirin.

When Retirement Comes With a Daily Dose of Cannabis
By WINNIE HUFEB. 19, 2017

Ruth Brunn finally said yes to marijuana. She is 98.

She pops a green pill filled with cannabis oil into her mouth with a sip of vitamin water. Then Ms. Brunn, who has neuropathy, settles back in her wheelchair and waits for the jabbing pain in her shoulders, arms and hands to ebb.

“I don’t feel high or stoned,” she said. “All I know is I feel better when I take this.”

Ms. Brunn will soon have company. The nursing home in New York City where she lives, the Hebrew Home at Riverdale, is taking the unusual step of helping its residents use medical marijuana under a new program to treat various illnesses with an alternative to prescription drugs. While the staff will not store or administer pot, residents are allowed to buy it from a dispensary, keep it in locked boxes in their rooms and take it on their own.

From retirement communities to nursing homes, older Americans are increasingly turning to marijuana for relief from aches and pains. Many have embraced it as an alternative to powerful drugs like morphine, saying that marijuana is less addictive, with fewer side effects.

For some people, it is a last resort when nothing else helps.

Marijuana, which is banned by federal law, has been approved for medical use in 29 states, including New York, and the District of Columbia. Accumulating scientific evidence has shown its effectiveness in treating certain medical conditions. Among them: neuropathic pain, severe muscle spasms associated with multiple sclerosis, unintentional weight loss, and vomiting and nausea from chemotherapy. There have also been reports that pot has helped people with Alzheimer’s disease and other types of dementia as well as Parkinson’s disease.

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Across the nation, the number of marijuana users who are in their later years is still relatively limited, but the increase has been significant, especially among those 65 and older, according to recent studies.
 
Marcia Dunetz, 80, said that she worried at first about what people would think. “It’s got a stigma,” she said. “People don’t really believe you’re not really getting high if you take it.” 

“It’s a bigger issue than we thought,” said Brian Kaskie, a professor of health policy at the University of Iowa who co-wrote a study published in January, “The Increasing Use of Cannabis Among Older Americans: A Public Health Crisis or Viable Policy Alternative?” “This is an elephant we’re just starting to get our hands on.”

A medical marijuana education and support club started by residents of Rossmoor Walnut Creek, a retirement community east of San Francisco, has grown to 530 members — so many that it has changed meeting rooms three times.

“I would be in a lot worse shape if I wasn’t using cannabis, both physically and mentally,” said Anita Mataraso, 72, a grandmother of six who is the program director and takes marijuana daily for arthritis and nerve pain, among other ailments.

In the state of Washington, at least a dozen assisted living facilities have formal medical marijuana policies in response to demands from their residents, said Robin Dale, the executive director of the Washington Health Care Association. The association, an industry group, has posted a sample medical marijuana policy on its website.

In March, an influential group of medical providers, AMDA — The Society for Post-Acute and Long-Term Care Medicine, will tackle the issue at its annual conference. Cari Levy, the group’s vice president, will offer a “Marijuana 101” lesson on the benefits, the risks and the potential pitfalls for providers.

“People are using it, and we need to know how to respond,” she said.

But as older people come to represent an emerging frontier in the use of marijuana for medical purposes, questions are being raised about safety and accessibility. Even in states where medical marijuana is legal, older people who stand to benefit often cannot get it. Most nursing homes do not openly sanction its use, and many doctors are reluctant to endorse pot use, saying not enough is known about the risks in the oldest age groups.

The president and chief executive of RiverSpring Health, Daniel Reingold. He said he administered marijuana to his father as a painkiller shortly before his death.

“This is a target demographic that may have their access limited, if not cut off altogether, simply because they reside in a facility,” said Paul Armentano, deputy director of NORML, a group that advocates the legalization of marijuana. “It is a problem that may infringe on their quality of life.”

While there is no shortage of research on marijuana, relatively little of it has focused explicitly on older users even as their numbers grow — and not just in the United States. In Israel, for instance, older people have been treated with medical marijuana for years. And Americans for Safe Access, an advocacy group, helped open a research center in the Czech Republic that is evaluating its impact on older people.

“It’s an area that’s very important to look at,” said Dr. Igor Grant, the director of the Center for Medicinal Cannabis Research at the University of California, San Diego, adding that older people are now one of the center’s research priorities.

“Older people can be more sensitive to medicine,” he said. “It’s possible a dose safe for a 40-year-old may not be in an 80-year-old.”

Dr. Thomas Strouse, a psychiatrist and palliative care doctor at the University of California, Los Angeles, said that just as sleeping and pain medications could harm older people, marijuana could possibly make them confused, dizzy or more likely to fall.

“There is no evidence that it is particularly helpful to older people, and some reason that it could be harmful,” he said.

Most nursing homes have also taken a cautious position, often resorting to a “don’t ask, don’t tell” approach.

“If residents are taking it, they are taking it undercover without the staff knowing so it’s not part of their care plan,” said Dr. Cheryl Phillips, senior vice president for public policy and health services for LeadingAge, an industry group representing more than 2,000 nursing homes. “I think that creates a safety problem.”

Fred Miles, a Colorado lawyer who represents nursing home operators, said nursing homes — unlike assisted living facilities — were regulated by the federal government, and were fearful of jeopardizing their Medicare and Medicaid funding. Staff members who administer marijuana could also theoretically face criminal prosecution under federal law, he said, though he has never heard of that happening.

The federal Centers for Medicare and Medicaid Services said no nursing home had specifically lost financing or been penalized for permitting the use of marijuana. In New York State, which started a medical marijuana program in 2016, its use is restricted to people with designated medical conditions, including neuropathy, epilepsy, multiple sclerosis, Parkinson’s, H.I.V., AIDS and cancer.

At the Hebrew Home in the Bronx, the medical marijuana program was years in the making. Daniel Reingold, the president and chief executive of RiverSpring Health, which operates the home, said he saw its powers firsthand when his own father, Jacob, was dying from cancer in 1999. To ease his father’s pain, Mr. Reingold boiled marijuana into a murky brown tea. His father loved it, and was soon laughing and eating again.

“The only relief he got in those last two weeks was the tea,” Mr. Reingold said.

When Mr. Reingold requested approval from the nursing home’s board members, there were no objections or concerns, he said. Instead, they joked that they would have to increase the food budget.

Then Dr. Zachary Palace, the medical director, developed a program that seeks to offer marijuana as an option but also comply with federal regulations: Though the nursing home recommends and monitors its use, residents are responsible for buying, storing and administering it themselves.

Last fall, the first three residents started taking marijuana pills. Their families obtain the pills at a dispensary in Yonkers run by Etain, a company licensed by the state to sell medical marijuana to qualifying patients or their designated caregivers, who must live in New York. Dr. Palace said that as the program expanded this month, as many as 50 residents could be using marijuana.

Marcia Dunetz, 80, a retired art teacher who has Parkinson’s, said she worried at first about what people would think. “It’s got a stigma,” she said. “People don’t really believe you’re not really getting high if you take it.”

But she decided to try it anyway. Now, she no longer wakes up with headaches and feels less dizzy and nauseated. Her legs also do not freeze up as often.

For Ms. Brunn, the marijuana pills have worked so well that she has cut back on her other pain medication, morphine.

Her daughter, Faith Holman, 61, said the pills cost $240 a month, which is not covered by health insurance. Ms. Holman, who lives in New Jersey, also has to ask a family friend to go to the Yonkers dispensary.

“Obstacles had to be overcome,” Ms. Holman said. “But I think she was meant to have it because everything has worked out.”

https://www.nytimes.com/2017/02/19/nyregion/retirement-medicinal-marijuana.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region&region=top-news&WT.nav=top-news