Health Chat with Hong Shen, MD

Friday, August 7, 2015

Description

Chronic pain affects more than 100 million adults in the United States with an annual estimated cost for treatment and lost productivity nearing $635 billion. Managing chronic pain with alternative therapies has become increasingly more popular in recent years. Determining the cause of pain is the first step. Deciding which type of alternative therapy is the best approach is a very individual decision and should be discussed with a qualified professional.

Searching for less expensive, safe and effective approaches to managing pain has led many people to consider alternative therapies. Nutrition plays a prominent role. Eliminating certain foods that may trigger pain can complement the effectiveness of acupuncture, nerve blocks and physical therapy. Learning how the mind-body connection, the effectiveness of Yoga, Tai Chi, Reiki and other alternative therapies can enhance your body’s natural ability to heal can be surprising.

Cleveland Clinic Wellness Institute provides comprehensive holistic, integrated, multidisciplinary treatments. Our team includes physicians, holistic psychotherapists, Yoga therapists, Reiki Masters and acupuncturists. Healing from chronic pain can be a long journey, but is possible, if you are in charge.


About the Speaker

Hong Shen, MD, is a staff member in the Department of Pain Management at Lutheran Hospital and at the Fairview-Westlake Medical Office as well as the Cleveland Clinic Center for Integrative and Lifestyle Medicine.

Dr. Shen earned her medical degree from Suzhou Medical College in Suzhou, China. She completed an internal medicine residency at Hangzhou Red Cross Hospital in Hangzhou, China, an internal medicine residency at Summa Health System in Akron, Ohio, and a physical medicine and rehabilitation residency at MetroHealth Medical Center through Case Western Reserve University in Cleveland, Ohio.

She is board certified in physical medicine and rehabilitation, as well as pain management. She is a member of the American Academy of Physical Medicine and Rehabilitation and the American Academy of Pain Management and has trained in acupuncture from the American Academy of Acupuncture.


Let’s Chat About Alternative Therapies for Managing Pain


Positive Principles

len: I'm 67 and have had osteoarthritis in my knees for a number of years. I also suffer from sciatica/herniated disc(s) in my back. I currently suffer acute pain daily. I'm taking naproxen, hydramorphone and extra strength acetaminophen. Help!

Hong_Shen,_MD: I'm sorry that you are suffering from knee and low back pain. You can have conventional treatments including a gel injection or a steroid injection for your knee pain and an epidural steroid injection for your low back pain. I have general recommendations for all of my patients who live in chronic pain like you. They are:

  1. Eat eight servings of vegetables and fruits a day.
  2. Cut down animal meat. Eat high-quality protein (antibody free, grass-fed beef, free range chicken and eggs) and avoid sugar, gluten and diary. Eat more whole, plant-based food, beans, nut and seeds. Maintain an adequate weight.
  3. Practice stress reduction. Try meditation. Get a good night's sleep.
  4. Exercise regularly.
  5. Avoid toxins including tobacco smoking, sugar, processed food, artificial food additives and hydrogenated fats.

If you follow these principles, your body will slowly heal. Our Alternative Pain Shared Medical Appointment program in the Cleveland Clinic Wellness Institute will offer you alternative treatments such as Yoga, acupuncture, hypnosis, message, meditation and Reiki. We will put all the treatments together and give you power to manage your pain.


Finessing Foods

mrsoulds: My question is in relation to pain management and types of food that can cause inflammation. I have lupus nephritis, systemic lupus erythematosus, and I would like to know which types of food can cause pain and swelling and, therefore, I should avoid. I suffer from arthritis and live in constant pain. I'm told my weight plays a part, which I totally agree with and understand. I am trying to make better choices for my health. Besides losing weight, what foods might I stay away from or what things can I do – besides exercise – to help with pain management? (My legs, hips, knees and feet are my problem spots.) I'm sorry for the long message, but I thought I should give you some background information.

Hong_Shen,_MD: The Number One thing, most of you know, is you’ve got to remove sugar and, specifically, gluten from your diet. Other foods to avoid include: dairy, soy, food additives, MSG, artificial sweeteners, personal food sensitivities and allergens. It is important to eat a more whole, plant-based diet including vegetables, fruits, bean, nuts and seeds. I recommend my patients eat eight servings of vegetables and fruits a day. Raw, leafy green vegetables are very important to our health. They should be included in our diet every day. Pain is caused by inflammation. Being overweight is one of the signs of inflammation. When you eat an anti-inflammatory diet, the pain will get better. Your weight will often reduce itself. However, this will not happen overnight. The more changes you make in your lifestyle, the more dramatic improvement you will experience.


Medical Approaches

bergem: I have a persistent epigastric pain, and all my GI studies were WNL. It was recommended that I undergo a "nerve block of the celiac plexus." Could you please enlighten me: 1) How effective is this treatment? 2) If it is effective, how long does the effect last? 3) Is there a benefit to a repeat block? 4) How often can it be repeated? Thank you.

Hong_Shen,_MD: I don't do celiac blocks. However, I have referred several of my patients with abdominal pain to my colleagues for celiac blocks. Some patients benefit from this treatment, but others may not. I'm sorry I don't have any statistical data. My impression is that, in general, celiac block for abdominal pain does not work as well as epidural injection for low back pain. If one or two blocks don’t help your abdominal pain, I don't recommend an additional block. There is another procedure called an ultrasound-guided transversus abdominis plane (TAP) injection if your pain is from the abdominal wall.

KJ: I am a 60-year-old male with a history of back issues that include: lumbar radiculopathy, degenerative disc disease primarily in the lumbar area and lumbar disc displacement without myelopathy. These problems, when acute, cause pretty significant sciatica pain down my left leg. Last year (August 2014), I underwent a series of three epidural injections (L5-S1 area) and experienced a good reduction of the pain for more than six months. However, the pain is again returning and intensifying. Is it safe to have more epidural injections or should I pursue alternative therapies? If the latter is preferred, what type of alternative therapy would you recommend? I have had several courses of physical therapy in recent years; however, the relief is short lived from that. FYI, I am not overweight. Just an unfortunate guy with a bad back. Thank you!

Hong_Shen,_MD: It is not uncommon to experience recurrent pain after three epidural steroid injections. I don't know the results of your spine MRI. If you have a large disc herniation compressing on your spinal nerve, you might need to have a surgical consultation. If your MRI is unremarkable, you might try alternative treatments. I believe that the epidural injection is a very powerful and excellent treatment for acute sciatica pain. However, lifestyle changes are also very important. Eating healthy food, reducing stress, meditating, getting regular exercise and a good night's sleep and avoiding toxins are important to help your body heal. It is relatively safe to have repeat injection. In the meantime, you should also make lifestyle changes to prevent the pain's return. Another alternative treatment you can try is to eliminate sugar, gluten and dairy from your diet. They are the most common foods that cause pain and inflammation. Food is medicine. We have to treat food with the same respect that we treat any prescription drug. Food can change our hormone release. The right food helps us heal. The wrong food makes us sick.

pjdiffenbach: I have been diagnosed with cervical spine-related pain in my neck, right shoulder area and right arm. The condition started in March 2015 and has become worse. The MRI revealed "multilevel spondylosis of the cervical spine" with "narrowing of the C3-C7 disc spaces." The pain consists of aching in the neck and shoulder and tingling/flaring in the arm and is becoming more intense. Typing messages is very painful and I try and use my left arm. I have been referred to a pain management doctor as of next week. I would appreciate any comments regarding therapies, medicines, surgery, etc. to alleviate this condition. Thank you.

Hong_Shen,_MD: The fastest way to relieve your current condition is to have a cervical epidural steroid injection. It works very quickly and is effective. However, if you want to avoid the pain recurring, you need to change your lifestyle. I tell all of my patients to eat well, avoid toxins (quit smoking), exercise, sleep well and practice stress reduction.


Multiple Maladies

megirn: Hello. I am a 60-year-old Caucasian female who has been on steroid therapy for sarcoidosis for 10 years. In the last five years, my DEXA scan results have started to show osteoporosis that continues to worsen. I have experienced sciatica in my left buttocks/leg since July 2014, with bouts of exacerbation and periods of normalcy. For the past eight weeks, I have had more persistent pain and opted to try acupuncture. I feel wonderful relief for several hours after each treatment, but the pain ultimately returns. Is there any possibility that acupuncture will eventually "cure" this issue, or is it comparable to chiropractic maintenance treatments that may continue for years? I have been paying $70/session and go weekly. I thought about a procedure where the sciatic nerve is "cut," with permanent relief of pain, but part of the pain is from arthritis and osteoporosis. Do you have any comments on stem cell therapy for chronic back and knee pain? Thanking you in advance.

Hong_Shen,_MD: Acupuncture is a form of Chinese medicine that has been practiced for centuries. It stimulates the natural healing of the body. It produces the best results in patients who are young and healthy without multiple medications because their bodies have very good healing potential. Their pain can be cured by a few acupuncture treatments. You have been on steroid treatment for over 10 years for sarcoidosis. Based on my experience, it is unlikely that you will get permanent pain relief by limited acupuncture sessions. It is important to treat the underlying causes of sciatica. If you have a large herniated disc that compresses your spinal nerves, acupuncture treatment may not provide effective treatment. Lumbar epidural steroid injection may provide better and faster pain relief. Sometimes, spinal surgery may be needed if conservative treatments fail. If part of the pain is from arthritis, steroid injects into the small joints in the back, guided by x-ray, can be done to relieve the pain. We have not used stem cell therapy for chronic back pain or knee pain in the clinic practice yet. In animal studies, stem cell transplantation to the disk has shown promise in decelerating or arresting the degenerative process. However, they use a small sample size and varying study designs, and conflicting outcomes in preclinical animal trials have made it difficult to assess the effectiveness of this treatment.

Trykkergirl: I have fibromyalgia, peripheral neuropathy (not diabetic but probably glucose intolerant), venous insufficiency, osteoarthritis, sleep apnea (treated), paroxysmal a fib, three heart valves mildly regurgitating and probably too many health issues to imagine for a person who is still active at 70 years old. I take a variety of medications, although I keep them at a minimum as much as possible, no real blood thinner at this time. A heart catheterization revealed a false positive for coronary artery disease (CAD); I have clear arteries, no plaque. Lucky me on that. My question: My lower legs hurt, from the shin area to outside, and my feet hurt badly top and bottom. I use a dual-headed massager on the bottom of my feet and legs each day to relieve the pain/numbness late in the afternoon. Could this be caused by a deep vein thrombosis (DVT)? People tell me it is dangerous, but I have to have relief, and I do not want to take more than the one Tramadol 50 that I take in the mornings. What is your opinion?

Hong_Shen,_MD: I don't think that massaging your feet will cause DVT. In fact, it is very good self-treatment to help yourself. If you have peripheral neuropathy, it tells me that you have chronic inflammation in your body. If you have glucose intolerance, you are in a pre-diabetic state. Abnormal blood spikes can damage your nerves. You have to treat the underline disease. Your nerve will repair itself.


Specific Disorders

lilyp: I would welcome information regarding pain treatment for polymyalgia rheumatica that would eliminate the need for prednisone. Thank you.

Hong_Shen,_MD: Polymyalgia rheumatica is so similar to arthritis, lupus and other health disorders. There are holistic and home remedies that can help relieve your inflammation and reduce the rheumatic pain. As an inflammatory health condition, you want to start with anti-inflammatory herbal remedies and foods. Reducing your sugar intake and eating or supplementing turmeric and/or ginger root is a good place to start. You may consider acupuncture and/or movement arts such as Tai Chi and Yoga.

The mind is powerful. We can heal our physical illnesses through our minds. Mediation or hypnosis can be used as a tool for stress reduction and helping you sleep. But you cannot stop prednisone abruptly and switch to the alternative treatments yourself without consulting your doctor.

AKCOgirl: Can you recommend some alternative therapies for small fiber neuropathy associated with sarcoidosis? I am currently taking gabapentin, which just takes the edge off the pain and the constant "electrical nervousness" feeling. I would like to know of some possible other ways to "reset" my mind and body when it feels overwhelming. Thank you.

Hong_Shen,_MD: The exact cause of sarcoidosis is not known. It is a type of autoimmune disease associated with an abnormal immune response, but what triggers this response is uncertain. Painful peripheral neuropathy is a common, difficult-to-treat complication associated with a variety of diseases, including diabetes mellitus and sarcoidosis. It is caused by damage of small and autonomic nerve fibers, resulting in potentially debilitating symptoms of neuropathic pain and autonomic dysfunction. Current treatment modalities for neuropathy are based on a trial-and-error approach, have limited efficacy and come with significant side effects. The medications to treat nerve pain include tricyclic antidepressant (amitriptyline), anti- seizure medications (Lyrica and Neurontin) and antidepressants (Cymbalta). The alternative treatments include meditation, hypnosis, acupuncture, an anti-inflammatory diet, a good night's sleep and regular exercise. The Cleveland Clinic Wellness Department offers Alternative Pain Shared Medical Appointments. During them, we teach our patients how to use those alternative treatments to help chronic pain and to improve their function.

MurrayPaulFleming: I was wondering what your thoughts are for someone with sarcoidosis and sore arms/back: massage, acupuncture, chiropractic, etc.?

Hong_Shen,_MD: I don’t have many patients who have sarcoidosis. I cannot tell you how people who have sarcoidosis respond to massage, acupuncture or chiropractic treatment, but you can try. Even patients with the same medical problem might not respond to the same treatment. In general, massage, acupuncture and chiropractic treatments are safe.

Moderator: Murray, we are scheduling a chat in October about sarcoidosis. We have no additional information yet; stay tuned.

WaveWolf: Is R-alpha lipoic acid a recognized treatment for neuropathic pain in the USA? What is the recommended dose?

Hong_Shen,_MD: Take 100 mg of R-alpha lipoic acid a day. You can gradually increase the dose to 300 mg twice a day for the next month. Some suggest that dosage be 1200 to 1800 mg divided daily.

charyvon: I have had severe idiopathic peripheral neuropathy for 20+ years. It began after a severe reaction to a sulpha antibiotic for an ear infection that caused idiopathic thrombocytopenic purpura (ITP). I have taken gabapentin (Neurontin) since 1999. In 2007, hydrocodone and Trileptal were added. Are there long term issues associated with this combination of drugs? I also take five drugs for blood pressure, and metformin was started six months ago for diabetes.

Hong_Shen,_MD: In general, gabapentin and Trileptal are safe for long-term use if you are not pregnant or breastfeeding. However, hydrocodone is a narcotic. It has more risk for long-term use. Tolerance, addiction and dependence are common problems. It can also affect your mood and hormones.

Trykkergirl: If I have glucose intolerance, would taking metformin help even though I am not diabetic? I am relatively sure I have spikes, which may be causing these problems especially in my feet. Yesterday, I rode 24 miles on my recumbent trike, and was fine for 15 or so, but then the pain!! I stopped, took my feet out of the clips and moved my feet around some the last mile or two as I couldn't stand it. That helped a little. Would metformin help me? I just have so much trouble giving up sugar totally.

Hong_Shen,_MD: I recommend food as the first-line of treatment. Food is a powerful medicine and is more effective than metformin. The right foods help you lower your blood sugar level, provide your micronutrients (vitamins, minerals, phytonutrients) and also repair your nerves.


Pain All Over

loveitaly: I haven't been diagnosed with any pain condition as of yet, but I frequently have pain in my low back, on the upper back from shoulder to shoulder, the thighs, waist, etc. For years I went to a chiropractor for maintenance, and after I felt better. I stopped going because back in 2008 my Meniere's disease got very bad, and I couldn't tolerate being upside down, I couldn't drive, etc. The Meniere's crisis came and went for several years. I had injections, medications, acupuncture, etc. Since 2013, it worsened. I haven't been able to drive again. I've had severe vertigoes that made me fall to the floor. I had surgery in the ear last October. I still can't do anything alone, so my life has become very sedentary, and now I have more pain than usual. What type of tests you recommend? Which exercises can I do at home so that I don't have to be worried about the danger of falling on the street, but at the same time I can move and feel better? Thank you so much.

Hong_Shen,_MD: You may have fibromyalgia, but you need to rule out other diseases that may cause your widespread pain. I recommend blood tests including a rheumatoid workup, Vitamin B12, Vitamin D, thyroid function, blood glucose level etc. Sometimes, food like gluten can also cause different pain. An elimination diet may help you find out if you have food sensitivities. You can see a functional medicine doctor to help you find out what is causing your problems. For exercise, the best way to start is to see a physical therapist. They will help you with your balance issue and find the best exercise for your current condition. You can try chair Yoga, swimming or stationary biking for exercise. There is a lot you can do for yourself.

katylyn: I have chronic pelvic pain, neck pain, shoulder pain and extreme fatigue with a positive ANA and an elevated sed rate. I am trying physical therapy and various medications (the latest is Plaquenil) as well as acupuncture and Chinese herbal therapy with minimal to moderate results. In the past, I have done steroid injections with short relief (a few days). What are the alternatives for pain management with steroids?

Hong_Shen,_MD: It is chronic inflammation that is causing your pain in so many places. Steroids are very strong anti-inflammatory drugs. Other alternatives to replace steroids are to eat an anti-inflammatory diet, avoid toxins, exercise, meditate, practice stress reduction and sleep well. You have to do all of these to see the difference.


Pain in Place

thorn4692002: I have been fighting back pain for more than four years. I went in for thoracic pain and they broke my lower back. After treating my lower back for a while, they worked on my thoracic pain. I have been to doctors and have had imaging exams and physical therapy. Anyway, I am having terrible pain in the thoracic area. They say my spine is OK. Sometimes, I feel like it is something inside like it might be kidney or pancreatic in nature. They don't know here, and Mayo Clinic is not taking people. The pain is getting really bad, and I need to go to someplace soon. I think I need an internist maybe. I can still drive. Can you help me? I have insurance, Medicare and a supplement. I am 61 years old. I am at my wits end! Thanks.

Hong_Shen,_MD: I'm so sorry that you are suffering this terrible pain. First you need to find an internist. He or she will evaluate you. If he or she doesn't know how to treat your problems, he or she should refer you to an appropriate specialist.

ShirleyJ49: Hi. I have had 10 back surgeries, all but one being a fusion. The last one I had was one year ago on June 26. It was an ALIF procedure (anterior lumbar interbody fusion) with a PSF procedure (posterior spinal fusion) with my left lower rib being removed. Since that surgery I have had constant stomach pain and a large bloated spot on my left side. I have asked several health care persons about this and no one seems to have an answer. I do not like taking pain medication because it constipates me really badly. Any suggestions would be appreciated.

Hong_Shen,_MD: It is very difficult for me to make a diagnosis on your particular situation without examining you. Sometimes, the scar from surgeries can cause a lot of local tissue adhesion, discomfort and pain. I would evaluate my patient for possible scar adhesions. A scar injection to loosen the adhesions is beneficial in certain patients. You may try massage or acupuncture treatments. If you developed an incisional hernia from the surgery, you may need to have a surgical evaluation.

neuropathy123: I have pain in the back of the left buttocks. This pain has been going on for three months. This pain is intermittent; it comes on suddenly and lasts for several hours and goes away for several hours. This pain is sometimes mild or severe. I've been to several doctors. They told me I had a sore muscle in the buttocks. I've been on naproxen for more than three months now. What other therapies are available to relieve this pain?

Hong_Shen,_MD: Physical therapy is the best way to start. If you try physical therapy for about 10 sessions without any improvement, you may ask your doctor to order an MRI of the spine. You can also change your diet to be gluten free, dairy free and sugar free; reduce animal meat; eat more vegetables and fruits; and add nuts, seeds and beans to your diet if you eat a typical western diet. I have many patients and friends who experienced pain reduction just by changing their diet. You can also try Yoga to help your pain. Exercise is very important, even daily walking will help your pain and improve your general health.

nmaclarren: I get regular pain in my right elbow anytime I do any type of weight lifting. It can be as little as chin ups that cause this. Is there anything I can try to keep from having this pain occur? I can do normal activities with no issue, but something like a curl or throwing a ball seems to aggravate my elbow. Thanks.

Hong_Shen,_MD: Without examining you I don't know exactly which part of your elbow is causing you trouble. Tennis elbow is very common. The pain is located on the thumb side of your elbow. This is due to tendonitis from repetitive motion with your wrist extension and flexion. When you perform weight lifting, you need to stabilize your wrist. You can also wear a tennis elbow band when you exercise. I have had chronic elbow pain for over 10 years. I have tried acupuncture treatment myself when I had severe pain. I also stretch periodically. Those treatments partially helped me. However my elbow pain was completely resolved after I changed my lifestyle, especially my diet. I lost 20 pounds, and my elbow pain disappeared for good.


Appointment Option

Betty: I am 45 years old. My doctor told me that I had fibromyalgia 10 years ago. I had three back surgeries. I also had many nerve blocks, acupuncture, chiropractic treatment and physical therapy. My pain is still there. Last year I got a spinal cord stimulator implant. The implant helps some of my leg pain. My back still hurts. My doctor told me that there was nothing they could do for me. I am miserable. Help me.

Hong_Shen,_MD: I am very sorry that you suffer. It is very difficult to live with chronic pain. I believe that our Alternative Pain Shared Medical Appointment in the Cleveland Clinic Wellness Institute will be able to help you. We offer the complete package needed to help a person regain control of their lives. We as a team will work together to return some of your quality of life. Our team includes doctors, holistic psychotherapists, Yoga instructors, chiropractors, massage therapists and Reiki Masters. Our goal is to reduce your pain, increase your function and activity level, and reduce your emotional distress. It is actually possible to increase your level of functioning and quality of life while reducing your sense of suffering. The key to this, like anything in life, is to have the right skills, support and direction. However, you have to be willing to take an active role to help you move from a patient to an active person. The road is not an easy one, but the rewards far outweigh any temporary issues. You can master coping techniques and control your pain by the end of the program. You will not let the pain control you.


Closing

That is all the time we have for questions today. Thank you, Dr. Shen, for taking time to educate us about the benefits of exploring alternative therapies for pain management.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at http://my.clevelandclinic.org.

For Appointments

To make an appointment with Hong Shen, MD, or any of the other specialists in Cleveland Clinic’s Wellness Institute, please call 216.448-4325 or visit us at clevelandclinic.org/wellness for more information.

For Pain Management: To make an appointment with Dr. Shen please call the Lutheran Hospital location at 216.363.2391 or the Fairview-Westlake location at 440.835.8233.


For More Information

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