Pain Management in Lyme Disease

Lyme disease is spread through the bite of infected blacklegged ticks, also known as deer ticks.  Ticks can attach to any part of the human body, but tend to reach areas that are difficult to see such as the groin, armpits, or scalp.  Ticks must be attached for 36 hours or more before the Lyme disease bacterium, Borrelia burgdorferi, can be transmitted.

There are four stages in the progression of Lyme disease.  The first stage, known as the early localized stage, takes place between 3-30 days after the tick bite.  The infected person can experience fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes.  One of the most prominent signs of this stage is the Erythema migrans rash, also known as the bull’s-eye rash for its unique shape.  This rash occurs in 60% of infected individuals. (CDC)

The second stage is known as the early disseminated stage and it occurs days to a week after the tick bite if the bite is not treated within the early localized stage.  During this stage, a person starts to experience more noticeable and serious symptoms.  These symptoms include Facial or Bell’s palsy, additional erythema migrans rashes, and stiffness due to meningitis.  At this point, patients begin to feel shooting pains that can interfere with sleep as well as pain and swelling in the large joints.

If the disease is not treated, 60% of patients enter into the late disseminated stage which happens months to years post-tick bite.  These individuals typically develop arthritis with severe pain and swelling in the joints.  It is typically found in the larger joints, for example the knees.  Arthritis caused by Lyme disease exhibits itself differently than other causes of arthritis.  Lyme arthritis is similar to osteoarthritis because of stiffness due to painful swollen joints.  This happens because Lyme bacteria invade the joints and cause inflammation to the tissue that lines the joints, and eventually, if untreated, can cause the cartilage within the joints to become damaged.[1]

The final stage is the lingering symptoms after treatment.  About 10-20% of patients experience symptoms after the patient has taken antibiotics.  This is called Post-treatment Lyme disease syndrome (PTLDS).  Some evidence shows this is due to an autoimmune response, in which the immune system is continuing to respond after the infection has been cleared, causing damage to be done to a body’s tissues.  Symptoms of PTLDS can include muscle and joint pain, cognitive defects, sleep disturbance, and fatigue. (CDC)

The quicker a doctor is able to diagnose Lyme disease, the quicker they can treat it.  Patients can be prescribed antibiotics in order to rid their system of the bacteria.  Most patients who are prescribed the antibiotic during the early stages usually recover quickly and completely.

With the antibiotics working to take care of the bacteria, what is taking care of the pain associated with Lyme disease?  A patient can still be experiencing pain while taking these antibiotics, which progressively becomes worse throughout all the stages Lyme disease.  Patients who experience pain in association with Lyme disease are less likely to be active, sleep well, or eat properly due to pain.

Commonly prescribed pain medications are opioids and NSAIDs.  Both, although common, can be very dangerous.  According to a report released by the National Institute on Drug Abuse, there can be consequences when choosing to use an opioid.  Opioids are easy to abuse because of their addictive qualities.  Regular or long term use of opioids can lead to physical dependence and addiction. Once a patient stops using opioids, they can experience withdrawal symptoms such as restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and involuntary leg movements.  An overdose can cause severe respiratory depression and death. [2]

NSAIDs, although effective in treating pain and inflammation, are linked to adverse side effects which make them inappropriate for use in many patient populations.  There are several serious side effects and toxicity related to use of traditional NSAIDs which can lead to costly hospitalizations or death.  A study on the effects of NSAID induced side effects in the elderly reflected the average direct costs of GI side effects per patient-day on NSAIDs were 3.5 times higher than those of a patient-day not on NSAIDs. Seventy percent of the cost was attributed to GI events resulting from NSAID treatment.[3]  Treatment of GI problems alone caused by the use of NSAIDs is estimated to add over 40% to the cost of arthritis care.[4]

Stephen Harrod Buhner’s book “Healing Lyme Disease Coinfections” discusses an alternative to these common pain medications called Theramine®. Theramine is a medical food specifically designed for the dietary management of pain syndromes. This specialized natural product, provides the specific amino acids and nutrients required by the brain and nervous system to effectively reduce pain and inflammation. Theramine is non-addictive and is not associated with adverse GI or cardiovascular side effects.  It is used in clinical practice to reduce inflammation and improve pain perception by addressing the increased nutritional requirements of pain syndromes.  In two double blind, multi-center clinical studies comparing Theramine and an NSAID, Theramine was shown to be more effective at treating pain and inflammation than either naproxen or ibuprofen. Lyme disease can alter the metabolic requirements of the body, leading to specific amino acid and nutrient deficiencies. Effectively managing the increased demand for these essential physiologic components should be an integral part of any pain management protocol.

 


[1] American Academy of Orthopaedic Surgeons. “Effective treatment of Lyme-disease-related arthritis depends on proper diagnosis.” ScienceDaily. ScienceDaily, 2 February 2011.

<www.sciencedaily.com/releases/2011/02/110202132605.htm>.

[2] “Prescription Drugs: Abuse and Addiction” NIDA. October 2011. National Institute on Drug Abuse.

[3] Br J Clin Pharmacol. 2001 August; 52(2): 185–192. Cost of prescribed NSAID-related gastrointestinal adverse events in elderly patients

[4] Bloom, BS. Direct medical costs of disease and gastrointestinal side effects during treatment for arthritis. Am J Med. 1988; 84(2A): 20-24

Sneeze-Free Spring

Spring has finally arrived, but with those trees and blooming flowers comes the dreaded spring allergies.   Pollen becomes airborne and allergy sufferers begin sniffling and sneezing.  40 million Americans a year suffer from allergic rhinitis, also known as hay fever.

The main cause of spring allergies is pollen.  Trees, grasses, and weeds release pollen into the air which can be inhaled through the nose.  Most seasonal allergies occur when the immune system mistakes the pollen as a foreign invader and releases antibodies.  These antibodies are typically used in order to attack bacteria, viruses, and other illness-causing organisms.  When the antibodies attack these allergens, they release chemicals called histamines into the blood which can help stop itchy and running nose and eyes, sneezing, and coughing.

The higher the pollen count, the more likely allergies will flare up.  For an accurate pollen count in your area, click here.  On breezy days, allergy symptoms become more prominent due to the wind picking up pollen and carrying it through the air.  On rainy days, most allergens are washed away, reducing the number of allergy symptoms.

Many people turn to the help of both prescription and OTC medications to manage allergy symptoms.  As with all medications, there are risks because of the possible side effects.

Anti-histamines can cause drowsiness throughout the day, increasing the risk of falls in the elderly as well as increasing the probability of a work or auto related accident.  Anti-histamines often lose their effectiveness over time.  Most OTC decongestants should only be used for 7-10 days.

Nasal decongestants are effective because they reduce blood flow to the nose, constricting blood vessels and decreasing inflammation.  If they are used for long periods of time they may cause rebound nasal congestion.  Nasal decongestants have been shown to cause high blood pressure and heart palpitations, putting older adults and people with cardiovascular disease particularly at risk.

The common side effects of the various OTC nasal decongestants and anti-histamines are often unappealing to people suffering from allergies, sinusitis, and nasal congestion, leading people to look for drug-free alternatives.  There are many benefits to choosing a drug-free alternative.  Drug-free alternatives are safer, have fewer side effects, and can last for longer periods.

When choosing a drug-free product for allergies and congestion, people should always look for the ingredients that are well known for their safety profile and anti-inflammatory properties.  Look for ingredients that have been carefully selected based on their history of safety and efficacy for supporting the natural processes that reduce inflammation, sinus congestion, and an overactive immune response.

Grape seed extract, for example, increases levels of antioxidants by destroying free radicals which are known to cause premature cell death.  Another ingredient to look out for is Choline Bitratrate.  Choline Bitartrate is the precursor to Acetylcholine (Ach), an essential neurotransmitter in your nervous system which can decrease levels of inflammation in the body.  Ach is the neurotransmitter that also controls mucous secretion, membrane constriction, and blood supply to nasal and sinus cavities.  L-Arginine is another safe and effective ingredient that promotes the production of Nitric Oxide, a neurotransmitter that causes the smooth muscle in  blood vessels to relax which helps to increase blood flow.

There are a few other precautions that a person can take in order to help avoid spring allergy triggers.  Getting an air filter can help circulate air around the house, as well as help trap and get rid of some of the larger particles of pollen.  Vacuuming twice a week can help get rid of dust mites that have been trapped in the carpet.  Washing your hair after going outside can help get rid of pollen that may have been caught in a person’s hair.  Clean air filters and book shelves in order to clear off dust mites that collect in the home.  When driving, keep windows closed because the car filter helps remove allergens from the air.  For more helpful solutions please click here.

The Dangers of Sleep Aids

Quality sleep is necessary not only for proper concentration and daytime alertness, but impacts health a variety of positive ways, including improved immune function, better memory, and decreased risk of obesity.[1]  Commonly used sleep aids such as Benzodiazepines and Zolpidem, help you to fall asleep faster and stay asleep longer, but do not improve deep sleep or REM (dream) sleep and often leave people groggy in the morning.[2]

Benzodiazepines are a type of hypnotic medication that is used by the body to increase the rate at which GABA is used.  GABA is a neurotransmitter that is known for inducing sleep and reducing anxiety.  Short term, these drugs have been shown to be an effective and helpful way to facilitate sleep.  Long term, on the other hand, the use of these medications is not recommended by doctors.  Benzodiazepines are associated with many risks including drug dependence, withdrawal symptoms, drug tolerance, dizziness, and risks of falling.  Rebound insomnia, which causes the symptoms of insomnia to worsen after stopping medications, is also common when people stop taking benzodiazepines.  According to the American Geriatric Society BEERS Criteria, a clinical tool that addresses potentially inappropriate medication use in older adults, the use of benzodiazepines should be avoided due to geriatric patient’ increased sensitivity to benzodiazepines and decreased metabolism of long-acting agents.[3]

The most commonly prescribed sleep aid in the United States is zolpidem (ambien).  The FDA has recently issued additional warning for drugs containing zolpidem (ambien, ambien CR, Edluar, and zopimist) recommending the bedtime dose be lowered especially for women. New data shows that blood levels in some patients can still be high enough in the morning to impair activities that require alertness including driving.

The impact of AM grogginess on function cannot be understated.  Kevin Wright, PhD published a study in JAMA in 2006, showing that patients who suffered with AM grogginess scored worse on cognitive and memory tests than patients who had stayed awake for more than 24 consecutive hours.[4]

Options to improve the quality of sleep without causing AM grogginess are more prevalent now than ever before and are a much safer and more effective way to manage insomnia and other sleep disorders.  Studies show that people can improve their insomnia by changing sleep habits.  Examples of this include going to bed consistently at the same time, having a darkened room, not using your bedroom for non-sleeping activities, and avoiding stimulants about 3 hours before bedtime.

Medical foods are a safe and effective option for patients with insomnia and other sleep disorders. Medical foods are amino acids and other nutrients, that when combined, correct the metabolic deficiencies of diseases and conditions.  They provide a solution that cannot be obtained from diet alone or supplements. They have been found to improve the quality of sleep without the morning grogginess or side effects of other prescription sleep medications. Medical foods may make getting a good nights’ sleep an achievable goal.



[1] Arch Dis Child 2006;91:881-884 doi:10.1136/adc.2005.093013

[2] Zolpidem Containing Products: Drug Safety Communication- FDA Requires Lower Recommended Doses (2013). Retrieved April 23, 2014. http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm334738.htm

[3] AGS BEERS Criteria for Potentially Inappropriate Medication use in Older Adults (2012). Retrieved April 23, 2014. http://www.americangeriatrics.org/files/documents/beers/PrintableBeersPocketCard.pdf

[4] Adam T. Wertz, BS; Joseph M. Ronda, MS; Charles A. Czeisler, PhD, MD; Kenneth P. Wright, PhD

JAMA. 2006;295(2):159-164. doi:10.1001/jama.295.2.163.