March 25th 2006 - By Karen S. Vaughan, MSTOM,
Licensed Acupuncturist, and Herbalist
We have a culture where people think pain is best treated by popping a pill and toughing it out if the pain doesn't abate. In fact, pain can kill you.
I am not talking about taking pain killers inappropriately or succumbing to unwarranted operations because you hurt too badly to consider the alternatives. I am talking about how pain- and pain alone- can tell your kidneys to increase secretion of antidiuretic hormone (ADH) and your fluid and electrolyte balance, essential to life, becomes imbalanced.
If too much ADH (also known as vasopressin) is released it is referred to as Syndrome of Inappropriate ADH (SIADH) secretion. There is a release of ADH from the pituitary gland in response to pain, exercise, stress, or narcotic medications (including some of those given for pain).
The released ADH then instructs the kidneys to hold on to more water which dilutes your electrolyte salts, thus causing a condition called hyponatremia (too little salt). This can be seen in a variety of conditions: after surgery, with head injuries, with lack of oxygen or in response to certain drugs including painkillers and psychiatric medications. Under the right conditions, the pain/stress of marathons or other endurance events may be enough to generate SIADH.
The electrolyte imbalance would be made worse by drinking water, and is corrected by ingesting an electrolyte solution made with salt, sugar, potassium, magnesium and phosphate. Pedialite, Gatorade and other sports drinks are commonly available electrolyte replacement drinks. However in severe cases, emergency treatment must be sought and intravenous treatment is needed, along with medicines called vasopressin antagonists.
The syndrome is best known when marathon runners drink excessive water and dilute the salt, glucose and other electrolytes in their system. That is what killed a Boston Marathon runner in 2003. But severe pain can cause a similar response.
If fluid is too sweet, it may pull sodium out of the bloodstream and into the intestine. Thus, salt, which is already low, is taken from the bloodstream to the intestine which makes electrolyte imbalance worses. It may therefore be better to try something like Pedialite which is less sweet than most sports drinks if someone in pain starts exhibiting symptoms of SIADH. But do not give too much since excess liquid can make things worse.
The signs of SIADH are, low salt levels in the blood and scant concentrated (dark) urine. Common symptoms include weakness, lethargy, headache, lack of eating and weight gain due to water retention. Nausea and vomiting may increase. Muscles may ache or go into spasm. The patient may be restless or irritable. As salt levels fall, there may be brain edema. These symptoms may be followed by confusion, convulsions, coma and death.
SIADH can be chronic and may come on slowly with someone in chronic pain. In one study of geriatric patients in a care facility, 51% showed signs of SIADH. Older patients are more easily imbalanced and it takes longer to balance their electrolytes. Many of these patients were on medications for cancer, depression, pain or other conditions that could affect ADH levels. And probably the food contained little salt in an effort to accomodate patients with high blood pressure. Symptoms like lethargy or confusion were probably confused with old age dementia, so that treatment was not given.
What should you do to prevent this? If you suffer from a condition that causes pain, TREAT IT. Pain control can take a while to perfect, and pain medication does not treat the underlying condition which you must also address. In fact, some pain medications can increase the risk of SIADH. And you may fear the mental cloudiness that pain medications can induce. But you do need to relieve pain while you work on the underlying condition.
There are non-drug pain controls including acupuncture, electrostimulation, heat or cold, massage, epidural injections by a neurologist and physical therapy. I frequently use a combination- heat and massage to open up an area of muscle spasm so that I can needle it and apply electro stimulation through the needles. There are take-home units with pads that can allow frequent electrostimulation via the muscles. None of these forms of pain relief will make you groggy. But they do require repetition to be useful.
Although I try to needle the area of pain if it is not too inflammed, needling can also take place away from the injury. I like to use points low on the affected meridians to pull the pain away from the affected area. I needle a calming point like the one on the top of the head or in the ear, local points near the pain or the cause of referred pain and distal points which pull it away or are specific for the type of pain. Electrostimulation can exhaust the pain response and cause relief.
Herbal medication is less likely to cause imbalances in electrolytes, particularly if given as a decoction (a long-cooked tea). Yanhusuo is as strong as morphine, but doesn't have the addictive potential. Blood movers like frankincense, myrrh, safflower stamens or notoginseng can provide relief. These are mixed with plants that can replenish salts and remove stagnation. There are topical linements designed to go to different levels of the body (skin, tendons, meniscus, ligaments, bone) developed because Chinese martial artists had to train to their maximum potential without being incapacitated if there was an attack.
If you have pain due to sciatica or pressure on a nerve, you need to do exercise to relieve the pressure. By this I do not mean aerobic exercise (although it may also be valuable if possible), but an exercise designed to pull apart (traction) your vertabrae, stretch out your ligaments and strengthen your core muscles so that you do not continue to put pressure the nerve. Matt Furey's Magnificent Seven program, Pilates, yoga, and Callanetics all work on core muscles. They are also good for knee pain. If you can barely move, start with Spring Forest or another form of qi gong, which is simple enough for people with deeply incapacitating conditions and may be enough. Incorporate it as a daily practice, whether or not you are sufering from pain.
The exercise provides the cure for the underlying condition and may prevent surgery, even with severe disc herniation. But do get the pain relief so you can start with the exercise. And don't give up because it takes a while to work. Pain is complex and individual and it takes time to cure. But lack of treatment not only hurts, it can endanger your life.
Acupuncture and Herbs by Karen Vaughan, L.Ac in Park Slope and Manhattan.
118 East 37th Street, New York, NY 10016
Brooklyn, NY 11215
http://www.thedoctorsdoctor.com/diseases/siadh.htm http://www.matfurey.com http://www.callanetics.com http://www.springforestqigong.com/