addiction
Overdoses from opioid abuse has hit an all-time high. In 2014, more than 47,000 people died from a drug overdose. Heroin use jumped 63% in an 11 year span. Prescription drugs like Vicodin and Percocet cause 17,000 deaths per year. Why are so many Americans turning to drugs and why are they in so much pain? On this episode of The Health and Wellness Show we spoke about the hidden hands involved in the rise of drug use and abuse in the US and why pain management is such big business. We also spoke about chronic pain and it's causes, traditional and not-so traditional methods of treatment as well as drug-free alternatives.

Running Time: 01:31:25

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Here's the transcript of the show:

Jonathan: Welcome to the Health and Wellness Show everybody. Today is Friday, August 19th. My name is Jonathan. I'll be your host for today. Joining me in our virtual studio from all over the planet we have Doug, Tiffany and Elliot. Hey guys.

All: Hello

Jonathan: We are missing Gaby and Erica today so we miss them and we hope to have them back soon. So today our topic is Pain, Pain Go Away. We're going to be talking about the opioid epidemic and related topics. Overdoses from opioid abuse hit an all-time high recently. In 2014 more than 47,000 people died from a drug overdose. Heroin use has jumped 63% in an eleven year span, which is pretty incredible. Of course prescription drugs, pharmaceuticals like Vicodin, Percocet, cause about 17,000 deaths per year.

We're wondering why so many Americans are turning to drugs and why are they all in so much pain. So we'll talk about that. We're going to talk about the hidden hands involved in the rise of drug use and abuse in the United States and why pain management is such a big business. It seems like kind of a no-brainer; people are in pain and they want it to go away but it is a little more complex than that. It's not that black and white. So we want to get into that topic. Let's start off by generally talking about the dangers involved in using opioids for pain relievers. Tiffany, in your professional experience, what are your observations on this? Do you see most people just go right to the painkillers and don't try any alternative methods or anything?

Tiffany: I think that's just part of a lot of people's' natures. They want a quick fix. They want a pill for every ill. They just want it to go away. I don't know, people just have a hard time dealing with discomfort and they have limited information about alternatives and they've really bought into the whole medical model. So they go to their doctor and they get a prescription.

A lot of the places that I worked with when I first started nursing, they gave out the pain medications pretty freely. It was a hospital setting so people were in acute pain but maybe they just had surgery so that's understandable. But in out-patient settings it was sometimes given out a little freely too and they tried to crack down on it and come up with some new standards, like they could only give certain pain medications to terminal cancer patients and then the other patients who had chronic pain like back pain or things like that, they would protest. They hated it because they'd been on certain pain medications for years and of course they didn't want to stop it. They developed a certain level of dependency.

And in other places I worked with they'd just say straight out "Don't even ask for narcotic pain medications because we do not give that out." At a lot of places you have to come up with a pain contract. Before you start on a pain medication you have to sign a paper saying that you're going to take it as it's prescribed, as directed, not take any more. You have to take drug tests every now and then when you come in to get your prescription and if you test positive for something else they will stop giving you the medication.

So I guess it just depends on the doctor that you go to, what facility that you go to, like the VA or if you have your own private doctor. We hear about these pill mills but most painkiller prescriptions come from family doctors.

Jonathan: Yeah, one of the articles that we were looking at here "Painkillers do more harm than good", especially for headaches and back pain. There was some interesting stuff in here. I'll just read a couple of quotes.
Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence or addiction.
Tiffany: Yeah.

Jonathan: That is quoted from Time Magazine.
"The opioids can backfire in excessive doses the same way that neurons become over-sensitized to pain and hyper-reactive. High doses of opioids could prime some nerves to respond more intensely to pain signals rather than helping to modulate their reaction.
Tiffany: Yeah, I've noticed that too, with patients I've had who've been on pain medications. They take it for a while. They think it's just going to be short-term but I've known people who've been taking pain medications for years and years and years. And of course their pain never gets any better. It's never fully controlled. They never say that their pain is zero out of 10. A good day of pain for them is maybe like a 4 out of 10. The pain just never subsides and they always have to go up on their prescription and they're always in pain. They call it pain management and that's really all they can do. It's not pain relief, it's management.

Doug: Especially since one of the side effects is making people more sensitive to pain. You start taking these opioids to get rid of the pain and I guess that works while it's in the system but once it's out of the system you are more sensitive to pain. So whereas something would have caused a mild amount of pain before, now you're suddenly more sensitive to that. That's a pretty terrible side effect because it encourages dependency on these painkillers because you become more sensitive to pain then you need more painkillers to try and deal with that pain. It's a vicious cycle.

Tiffany: Yeah, the really bad things like with end of life or hospice care, people have been on pain medications for a long time but then once they're in the hospice they take some really, really heavy duty drugs and they become so sensitive to pain. I think part of it is just fear of death and people have this big fear, "When I die, I just don't want to be in pain. I don't want to feel any pain. Just make sure that I don't feel any pain." But some people become so sensitive. If you move their bed sheets or their blanket on them, even the feeling of the blanket moving across their skin causes them extreme pain. So they're incredibly sensitive.

Jonathan: Wow.

Doug: One of the other issues with the opioids that I was reading about in one of these articles, it was talking about how they - I just lost my train of thought. What was it? Sorry. It'll come back to me.

Jonathan: That's alright. If I could jump in, just talking about the increase in addiction I think is a really interesting topic because there's this stigma in our culture about addicts. If you're addicted to anything well you're just a junkie, you're just an addict, you have no willpower, no self-control and your self-worth, your societal contribution goes down in everybody's eyes. But that I think is mostly related in people's' minds to illegal substances and there's not a lot of talk about people who you are around every day in the professional or other kind of worlds that are addicted to opioids. There's a quote from this article that I was looking at just a minute ago.
There were enough narcotic painkillers being prescribed in the United States in 2010 to medicate every single adult around the clock for a month.
Tiffany: Wow!

Doug: Wow!

Jonathan: So yeah, everybody could be high all the time.

Doug: For a month anyway.

Jonathan: Yeah for a month. But two questions in my mind are why is there so much pain and I think there are some no-brainers answers to that one; modern diseases, inflammation, industrial pollution that causes chronic disease and things like that. But also why big pharma has pushed and pushed this and that's also I think a no-brainer kind of question. It's the profit. They're making billions of dollars off of this industry and they are the most effective, most "talented" drug dealers in the world, these multi-billion dollar companies.

Tiffany: Yeah, I read that OxyContin brought in $20 billion for Purdue, which is a drug company. They made $20 billion in 20 years off of OxyContin.

Elliot: The sad thing about these pharmaceutical companies is that they prey on vulnerable individuals. But the problem is because it's within the confines of the law, they are free to get away with it. They're essentially drug dealers in the real sense of the word but because it's not seen that way by society, then they are free to reap the benefits to the detriment of the people. There are some interesting statistics I copied down from reading some of the articles. One was that more than 47,000 people died from opioid drug overdoses in 2014. The deaths from opioid drug overdoses have hit an all-time record in the US in 2015, rising 14% in just one year. And that was reported by the CDC.

Another one is that since 2000 the rate of deaths from drug overdoses have increased 137% and that's including a 200% increase in the rate of overdose deaths involving opioid painkillers. So this opioid industry is really quite a booming one at the moment and it seems to be increasing I guess as people's' need for pain medication is increasing as well. As you just said Jonathan, when you've got the inflammation, you've got disease, you've got all of these problems on the rise in society, you're going to have a demand which also mimics or mirrors that. It really is an epidemic.

Doug: Yeah. The drugs by their very nature are habit-forming in a lot of ways. There's one article we were looking at called Ushering in a Heroin Nightmare-Big Pharma Exposed for Knowingly Causing Opioid Epidemic. And what they were talking about in this is actually that when you take one of these prescription opioids, or any opioid including heroin, once it's out of your system you actually start to experience withdrawal symptoms which include body aches, nausea, anxiety, very similar to what somebody coming off heroin would feel as well. The way that these drugs are prescribed is very strict and they only allow you to take it every 12 hours but the problem is that the effects actually wear off before that 12 hour mark. So if it only last eight hours the person is going through these withdrawal symptoms for four hours. All their pain is going to come back so suddenly they're suffering even worse.

But it's very strict. You can only take it every 12 hours. So a lot of people actually end up turning to other medications, other painkillers to try and deal with that and the availability of them might be restricted in some way. So that's how people end up turning to heroin or illegal drugs. The whole point of this article is that actually these opioid drugs are driving an increase in heroin usage. I thought that was really disturbing.

Tiffany: Yeah, once they go into this withdrawal they may go to their doctor and say "This OxyContin is not lasting me 12 hours" so they'll up the strength of the dose and it still won't last them quite 12 hours and they go through this withdrawal and then they take their next dose and they get this big burst of endorphins or feel-good chemicals and that sets them up on a physical level for addiction. Then it still doesn't last them their 12 hours and so they might use pot or something and they'll test positive for pot and they'll break their pain contract and their doctor will kick them off the opioid program and then what else are they going to do? Maybe they might try heroin because they're already hooked on a heroin-like substance. So what other choice do they have at that point?

In West Virginia there was a big controversy because it showed that big pharma was colluding with these pain management clinics or pill mills in West Virginia and writing all these prescriptions for opioid pain meds. There's this one company called AmerisourceBergen and they distributed more than 140 million doses of opioid pain meds to West Virginia pharmacies between 2000 and 2012, so that's 140 million doses. I can't even imagine that much! It's just crazy, crazy.

Jonathan: In that context, what's considered a dose? Is that a bottle or a single pill?

Tiffany: I'm thinking it's a single pill. It would be crazy if it was a prescription for a 30 day supply or something.

Elliot: Let's hope it's just the pill.

Doug: I think it is. They're saying dose, right, so that's an individual dose, not a whole prescription. Tiff, I haven't come across this term "pill mill" before. It sounds like it's a pain clinic where the guy just has his prescription pad ready and he writes a prescription for these things for anybody who comes in and says they're in pain.

Tiffany: Basically. And then they go to a friendly pharmacy and the pharmacists have a role in this too because they see so many people coming in from the same clinic with the prescriptions. There's a whole bunch of them coming in getting their prescriptions filled. They have to think something. If they don't they're probably in on the whole thing. But when this whole thing in West Virginia blew up there were doctors who left the country, pharmacists who left the country. They knew what they were doing.

Jonathan: Yeah, that does happen quite a bit. In fact just a couple of weeks ago I was reading a story about a pharmacy that got busted for dealing under the table essentially. And the black market demand for these pills is over the top. One 30-day prescription of something seemingly simple, not even talking about the hard hitters, but Percocet, can be worth thousands of dollars. You might get that, depending on what your co-pay is for what? Fifty bucks? A hundred bucks? And of course if you're down and out you might try to sell it or again on the other hand, you mentioned people that are in the pain management program if they run out too early there are plenty of places all over the place for them to go and find somebody to get a pill from.

So not only are they probably taking drugs that they shouldn't be taking that may interact badly with the ones that they did take, but they're spending an insane amount of money on it and it's just fuelling the black market around the substances.

Tiffany: People have heard of patients who doctor shop. They might have a doctor on this side of town and another doctor on the other side of town and they think that they don't know that they're prescribing the same prescription for one patient? But some states do have databases where they can see "this patient receives this prescription" so they're supposed to be able to avoid those kinds of things but I don't think it happens a lot of the time.

Jonathan: If we have any listeners who have experience in this area of course you can call anonymously. There's no need to give your name on the air, but we would be curious to hear from people who either have experience with this themselves or with relatives. One of our chatters said that her mother was on Vicodin for many years and started to have hallucinations and was blurring the lines between dreams and reality. I'd be curious to hear from anybody else who has a story like that to share. If you're listening to the show on radio.sott.net you can click the red "Speak with the host" button and give us a call but you need a microphone for that. Just to put that out there.

Tiffany: Well it seems like people are catching on. If they didn't know that America has a drug problem by now, they should really know. So Congress got into it and they passed an act called the Comprehensive Addiction and Recovery Act and they're tooting their own horns because they think this is going to actually help the whole drug problem. In the Act it says that they will try and direct addicts into recovery programs instead of jail. I don't think that's going to happen because the justice system or the injustice system makes a lot of money by putting users in jail instead of giving them treatment.

So with this Act they want to give them treatment instead of sending them to prison. They want to expand the access of Naloxone which is used to treat opioid overdoses. It makes the physical effects of the opioid non-existent. But this Act doesn't really stop doctors from prescribing or over-prescribing opioid meds in the first place so it comes in the back door but it doesn't really solve the problem where it starts, which is with the prescribing.

Doug: It's once again the case of blaming the victim. They don't look at the source of the problem. They just look at "Oh, we've got all these people hooked on pills" and them come up with more things that inconveniencing or ruining the lives of the individuals who are actually victims. So it's a racket. They're making billions of dollars off these pills and implementing these non-solutions to try and deal with the fallout from it.

Tiffany: And another thing that this act doesn't do, it doesn't take into account the benefits of medical marijuana for pain. In that same article it said that 80% of medical marijuana users give up prescription pills when they start using medical marijuana and medical marijuana has no side effects unlike these prescription opioids. So there's another thing. Medical marijuana or marijuana is still classified as a Schedule 1 drug and that means that it's the most dangerous and it has no medical uses which is not true because there has been tons and tons of studies showing the medical uses of medical marijuana.

So I think that big pharma does not want medical marijuana use to become so widespread because they're going to lose a lot of their profits.

Elliot: Yeah, I think maybe one of the reasons they aren't so fond of medical marijuana is because it's fairly difficult to control in the sense of developing a patent for it. It would be very difficult and I don't think they'd be able to make that much money off it as well. But it's fairly interesting to see how in the states that have adopted the use of medical marijuana for treating chronic pain, the use of opioid pain medications have dramatically fallen. There was one study that studied 17 states that used medical cannabis and it found that the use of prescription drugs fell significantly.

There was another one which saw a 24.8% lower annual opioid overdose rate. So the amount of people who were overdosing from these prescription drugs also fell dramatically. I think it's kind of silly that the government isn't really paying any attention to these studies and possibly adopting the use of medical marijuana instead of prescribing or allowing the prescription of all of these synthetic opioid drugs that clearly cause people so much pain.

Doug: It's pretty obvious that the government is in on the racket here so I'm sure the government is getting their share of the billions that the pharmaceutical companies are getting. So it's not surprising that when something else comes along that could get people off the really addictive and terrible stuff and start using something that's controversial but nonetheless obviously having a beneficial effect, that they wouldn't be interested. The thing is, in some cases the types of marijuana that they're using for pain mitigation is not the kind that your hippy stoner is smoking in a bong in his basement. They've lowered the amount of the THC which is the stuff that gets you high but it keeps all the pain relieving properties. That's not always the case, sometimes it's just straight-up marijuana but they're researching this and looking into it so it's not necessarily that people are just getting stoned. There are components in marijuana that are actually pain-fighting elements in and of themselves.

Jonathan: Yeah, I think context is really important too. Obviously we're not advocating that everybody go out and smoke pot and there are detrimental effects to long-term, chronic use of marijuana. However, trying to not do the black and white thing, if you're up against taking OxyContins or morphine or something, then marijuana would be much more beneficial in that scenario. You're not going to overdose. It's essentially harmless in the short term and if it works for pain relief this should be considered as a viable alternative. But of course there's a stigma and as Elliot mentioned, it would cut into the profits of the pharmaceutical companies.

Doug: I think we should say that we don't really condone its use, especially if you're in a place where it is not legal. We would never recommend that people engage in any kind of illegal activity.

Jonathan: Right.

Tiffany: And at the same time I mentioned when people want a magic pill, some magical substance that'll just take all their pain away, there are many things that you can try, not just a painkiller pill or not just marijuana that you can do to alleviate your pain. Not everybody is going to be curious enough or have the gumption and the curiosity to actually go out and try other things along with medical marijuana or with a pain medication because I think that seriously, a lot of people who had a choice they would rather have absolutely no pain where they didn't have to take anything but if you find yourself in a situation where you had an accident or something happened to you and you're in pain, you would hope that you only have to take something for a brief amount of time and then eventually your pain would go away. That's why it's important to try other things in tandem if you are in a place where you don't have legal medical marijuana and you have to take an opioid for a time, every now and then so you don't suffer needlessly but there are other things that you can try. We'll get into that. There are other options.

Jonathan: And again, with the context thing, there's obviously a difference between the pain experienced by a burn victim or a cancer patient than somebody who has torn their ACL or has a sore ankle or something like that. There are various levels of pain and I think where it falls down is that, like we've talked about, people get hooked on the lower level opioids and then move to the heavier ones because over time they increase your sensitivity to pain. I know it's a fictional TV show, but if anybody has ever seen the show House, one of the main themes of that show is the doctor's addiction to Vicodin. Over the course of the series it becomes more and more addictive to him to the point where it's highly destructive in his life.
So I think that's a potent example. It is a TV show but that does happen in a lot of people's lives where they're not given any alternative. They're encouraged to use painkillers because they're legal, they're socially acceptable and then they just get more and more addicted over time.

Tiffany: Yeah, and they feel like they have no other options. I don't know about any of you, but I've never had chronic pain. I can only imagine the amount of energy and focus you have to go through just to make it through the day and you have this pain that's just with you 24 hours a day. You can't sleep. That's all you think about. All the emotional energy that you have to deal with just to make it through the day, I'm sure is really debilitating and I can understand how people just lose hope and they'll just try the first thing that they can get their hands on just to get some kind of relief and to be able to sleep. They might have been subjected to surgeries. They thought the surgery was going to work and the surgery didn't work. It probably just made things worse. So yeah, it's a pretty hard situation to be in. I don't want to pass judgment on anybody that has chronic pain because I'm sure it's just a horrible way to live.

Elliot: Well aside from the emotional effects of chronic pain and how difficult that must be on an emotional and psychological level to deal with day-to-day, it does actually have physiological effects as well. There was one article that we read for the show. It was citing a study that actually showed the people with chronic back aches have brains as much as 11% smaller than those of non-sufferers. That was a study in 2004 so I'm not quite sure how to interpret that. It could possibly go the other way. With the cause of the backache is there some underlying physiological issues that have caused the backache and that the smaller brain was actually caused by the underlying issue rather than the experience of chronic pain itself, if that makes any sense?

Jonathan: I think it's about where people go for solutions too. Tiff you mentioned surgery and that's a huge problem. I've seen quite a few times and read about examples of people who have an issue with a disc in their back and they'll go in for surgery and get it fused or get an actual cage put around that part of the spine. In a lot of those cases, obviously not 100% but a lot of those cases could be fixed by correcting diet to reduce inflammation and then going to a chiropractor.

Tiffany: Right.

Jonathan: I've not had severe chronic pain ever, but I had low level chronic joint pain for 10 years. Once I started going to the chiropractor it was done. It was fixed and it was just because I wasn't addressing it correctly. It was a structural problem. In another lifetime I might have gone in and had a surgery and then it would have gotten even worse.

Tiffany: But back to the 11% smaller brains and people with chronic pain, I was just thinking if you're in pain there's only so much you can do. You might spend a lot of time just resting lying down. You can't engage in a lot of activities. You're grumpy. You're irritable. You don't really have the mental energy to read or engage in intellectual pursuits or things that maybe would strengthen or grow your brain or grow the connections between your neurons. So that kind of makes sense that maybe their brains would be smaller or at least function in a different way than a person who does not have chronic pain.

Doug: Yeah, I was thinking along similar lines, that so much of your attention would be focused on the pain so parts of your brain "you don't use it, you lose it". It kind of makes sense from that perspective.

Jonathan: I can say from my experience that I just cited, when I was experiencing that, it's pretty much the only thing you think about on a daily basis.

Tiffany: It is.

Jonathan: So it's hard to concentrate in other activities.

Tiffany: It kind of consumes you.

Jonathan: Yeah, like playing music or drawing or even just going out into nature and walking around, you're always thinking about this pain and it's definitely a distraction.

Tiffany: And it seems like the longer it goes on, there's a saying that neurons that fire together wire together. Even more parts of your brain are devoted to pain signals versus other types of brain functions like visual processing. One of our forum members posted something from how your brain can heal itself and they mention that. He said that chronic pain is like brain plasticity gone wild. All these neurons are firing, devoted towards this whole pain relief or pain signals where in a person who doesn't have chronic pain those other parts of the brain are focused on other things like visual processing or something else, but instead they're all devoted to controlling your pain and allowing you to function with this pain.

So when we get into ways to relieve pain, I guess one of the ways to relieve this pain is to actually focus on your brain, try to change the way your brain functions, not necessarily something that you have to do physically in order to relieve your pain.

Jonathan: Something slightly related but not necessarily about the brain focusing, but let's come back to that. I was just going to say sitting is a huge problem, especially for people have that integrated into their job where they sit for many hours at a time. That was an experience I had years ago - and this is totally stupid - but I think I broke my knee. I'm not certain because I never went to the doctor for it. It got better after a while but then six-to-seven years later it started to ache really badly and it would ache all the time. I did sit at a computer many hours a day and when I switched to using a standing desk and not sitting as much and starting to move around a little bit more then it went away. So I think for a lot of people who are in a profession where they might sit for many hours at a time that can be a big exacerbator of the condition.

Tiffany: Yeah because sitting places more stresses on your spinal column when you sit versus when you're standing up where you have the support of your legs and your core when you're standing up, but when you're sitting you don't have that support so there's a lot of pressure on your back and your spine.

Doug: Dr. Mercola actually talks about that too. There's a lot of information out there about how the human body was not designed to sit as much as we do in our modern society. It makes sense that over-sitting, if you can call it that, would maybe not be the best just from a physiological perspective.

Tiffany: Well you mentioned nutrition before Jonathan. We have to keep in mind that pain is a signal that something is wrong. It's not a diagnosis within itself. It's just something that's telling you "Hey! Something needs to change and maybe the pain will go away." I notice that when I went gluten-free, stopped eating grains, cut out sugars, I stopped getting headaches and I stopped having menstrual cramps every month. The menstrual cramps were just horrible and they would be accompanied by nausea and retching when I first started having menstruation. But once I cut out gluten and grains, all of that went away and the only reason I get a headache now is if I accidentally eat something that doesn't agree with me.

A gluten diet can cause inflammation and pain is just a part of being inflamed.

Jonathan: Ninety percent of the time the pain is the result of some kind of inflammation, unless there's an acute stressor of some kind.

Tiffany: Yeah.

Jonathan: But I would say most of the time it results from some kind of inflammation.

Doug: And diet's definitely a very good way to deal with that. We obviously here on the show advocate a paleo diet, if not ketogenic paleo and one of the things that you get on a diet like that is a lot of omega 3 fats which have a natural anti-inflammatory property to them. So just by changing diet alone to something more paleocentric, you're going to naturally be getting a lot of compounds. Vitamin D is another one. But these natural compounds that have anti-inflammatory properties, in and of itself, aside from cutting out the foods that are inflammatory by their nature, is going to give you some improvement.

Jonathan: Tiff you had mentioned the brain angle and approaching pain from a mental perspective. We have this clip that we were talking about. Do you think it's a good time to go to that? Do you want to introduce that?

Tiffany: Sure. It's a clip from a man named Jon Kabat-Zinn. I got this clip off of YouTube. He helps people deal with chronic pain through meditative exercises and leaning into the pain and not fighting against the pain, coming to know the pain and doing body scans to not run away from it because if you're fighting against it, if you're saying bad things against your body you have to remember that all your cells have consciousness and you want all of your cells to work together as a team. You don't want to declare a war on any part of your body. So I'll let him go into it. This is a clip on how to deal with chronic pain.
People with chronic pain conditions who seek medical treatment thinking of their body as being pretty much like an automobile and that all the doctor needs to do is find out why they are in pain and then make it go away by cutting the right nerve or giving them some magic pills or injections are usually in for a rude awakening. Things are rarely that simple with chronic pain.
In the new paradigm pain is not just a body problem, it is a whole systems problem. Sensory impulses originating both at the surface of your body and internally are transmitted by nerve fibres to the brain where these messages are registered and interpreted as pain. This has to happen before they are considered painful by the organism.

But there are many well-known pathways within the brain and the central nervous system by which higher cognitive and emotional functions can modify the perceptions of pain. Studies we conducted over the years show that there is a dramatic reduction in the average level of pain during the 8-week training period in MBSR as measured by a pain questionnaire called the McGill Melzack Pain Rating Index.

This is a reproducible finding. We see it in every class year after year. In one study 72% of the patients with chronic pain conditions achieved at least a 33% reduction on the pain rating index while 61% of the pain patients achieved at least a 50% reduction. This means that the majority of people who came with pain experienced clinically significant reductions in their pain levels over the eight weeks they were practicing the meditation at home and attending weekly classes at the hospital.
Some people have difficulty understanding why we emphasize that they try to enter into their pain when they simply hate it and just want it to go away. Their feeling is why shouldn't I ignore it or distract myself from it and grit my teeth and just endure it when it's too great? One reason is that there may be times when ignoring it or distracting yourself doesn't work. At such times it's very helpful to have other tricks up your sleeve besides just trying to endure it or depending on drugs to ease it.

Several laboratory experiments with acute pain have shown that tuning into sensations is a more effective way of reducing the level of pain experienced when the pain is intense and prolonged than is distracting yourself.

So where do you begin? The body scan is by far the technique that works the best at the beginning for people with chronic pain, especially if sitting still or moving are difficult. You can do it lying on your back or in any other convenient outstretched position. Move slowly scanning through your entire body. As you move through a problem region, perhaps one in which the sensations of discomfort and pain are quite intense, see if you can treat it like any other part of your body that you come to focus on. In other words, gently breathing into and out from that region, carefully observing the sensations, allowing yourself to feel them and open up to them and letting your whole body relax and soften each time you breathe out.

When it comes time to let go of that region and move on - and you can decide when that moment is - let go of it completely. If it helps try saying "Good-bye" in your mind silently on an out-breath and see if you can flow in that moment into calmness and stillness. And even if the pain doesn't change at all or becomes more intense, just move on to the next region and direct your full attention to it. If the painful sensations in a particular region do change in some way, see if you can note precisely what the qualities of that change are. Let them register fully in your awareness and keep going with the body scan.

It is not helpful to expect pain to disappear but you may find that it changes in intensity, getting momentarily stronger or weaker or that the sensations change, say from sharp to dull or to tingling or burning or throbbing. It can also be helpful to be aware of any thoughts and emotional reactions that you may be having about either your pain, your body, the meditation, or anything else. Just keep up the watching and letting go, watching and letting go, breath-by-breath, moment-by-moment. As best you can manage it, anything you observe about your pain or about your thoughts and feelings is to be noted non-judgmentally as you maintain your focus in the body scan.

In the stress reduction clinic we do this every day for weeks. It can be boring, sometimes even exasperating but that's okay. Boredom and exasperation can also be seen as thoughts and feelings and let go of. Also, do not be overly thrilled with success or overly depressed by lack of so-called progress as you go along. Every day will be different. In fact every moment will be different so don't jump to conclusions after one or two sessions. The work of growth and healing takes time.

Mindfulness involves a determined effort to observe and open to your physical discomfort and your agitated emotions moment-by-moment. Remember, you are trying to find out about your pain, to learn from it, to know it better, not to stop it or get rid of it or escape from it. If you can assume this attitude and be calmly with your pain, looking at it in this way for even one breath or even half a breath, that is a step in the right direction. From there you might be able to expand it and remain calm and open while facing the pain for maybe two or three breaths or even longer.

In the clinic we like to use the expression "putting out the welcome mat" to describe how we work with pain during meditation. Since it's already present in a particular moment we do what we can to be receptive and accepting of it. We try to relate to it in as neutral a way as possible; observing it non-judgmentally, feeling what it actually feels like in detail, riding the waves of the breath, the waves of sensation.

We also ask ourselves the question "How bad is it right now in this very moment?" If you practice doing this you will probably find that most of the time even when you are feeling terrible, when you go right into the sensations and ask "In this moment is it tolerable? Is it okay?" The chances are you will find out that it is. The difficulty is that the next moment is coming and the next and you know they are all going to be filled with more pain. The solution? Try taking each moment as it comes. Try to be 100% in the present in one moment then do the same for the next, right through the 45 minute practice period if necessary or until the intensity subsides at which point you can go back to the body scan.

In working with pain, here's another very important thing you can do as well as observing the bare sensations themselves; that is to be aware of any thoughts or feelings you're having about the sensations, statements such as "This is killing me; I can't stand it any longer; how long will this go on; my whole life is a mess; there's no hope for me; I'll never master this pain" may all move through your mind at one time or another. You may find such thoughts coming and going constantly. None of them are the pain itself. Can you be aware of this as you practice? It is a key realization. Not only are these thoughts not the pain itself, they're not you either nor in all likelihood, are they particularly true or accurate. They are just the understandable reactions of your own mind when it is not ready to accept the pain and wants things to be different from the way they are, in other words pain-free.

When you see and feel the sensations you are experiencing as sensations, pure and simple, you may see that these thoughts about the sensations are useless to you at that moment and that they can actually make things worse than they need to be. Then in letting go of them, you come to accept the sensations simply because they are already here anyway. Why not just accept them for now?

However you cannot reliably let go into accepting the sensations until you realize that it is your thinking that is labelling the sensations as bad. It is your thinking that doesn't want to accept them now or ever because it doesn't like them and just wants them to go away. But notice, now it is not you that won't accept the sensations, it's just your thinking and you already know because you've seen it for yourself firsthand, that your thoughts are not you.

If you suffer from a chronic pain condition there will be times when you will feel like quitting, especially if you don't see quick results in terms of pain reduction. But in doing this work you must also remember that it involves patience and gentleness and loving kindness toward yourself and even toward your pain. It means working at your limits, but gently, not trying too hard, not exhausting yourself, not pushing too hard to break through. The breakthroughs will come by themselves in their own good time if you put in the energy in the spirit of self-discovery.

Mindfulness does not bulldoze through resistance. You have to work gently at the edge of this, a little here and a little there, keeping your vision alive in your heart, particularly during your times of greatest pain and difficulty.
So that was Jon Kabat-Zinn. I like this clip.

Doug: Yeah. It's very interesting.

Jonathan: He makes some interesting points.

Doug: Because he's drawing a parallel between the mind and pain and I thought it was interesting in conjunction with another article we were looking at for this show called Controlling Chronic Back Pain Without Surgery and it's a Dr. Mercola article and he's interviewing a guy named Dr. Hanscom who I believe is a back specialist of some kind who doesn't recommend surgery. His approach is kind of similar. He really looks into the emotional connection to pain, particularly chronic pain. He said something really interesting. He said that by using MRI brain imaging they showed that when people had acute back pain it activated the pain centre in their brain, which is what you would expect. But then when they were looking at people who had chronic pain of 10 years experience, it wasn't actually centred in the pain centre anymore it was actually in the emotional centre of the brain.

So they did an experiment where they took people who had acute pain and started rescanning them every three months and they found that within 12 months if the pain still persisted it had migrated from the pain centre to the emotional centre. So it's kind of interesting in that respect because it's like when you're experiencing chronic pain it's no longer an acute thing so it's not like the body is sending a message that there is pain in this one place because it's experiencing it there, it has moved to the emotional part. It makes you question whether or not the pain is really there anymore or is it just an emotional reaction.

So I found that to be really interesting. And actually one other thing. On the forum right now there's actually some talk about a book called The Divided Mind and it's by John Sarno and his approach is talking about the psychosomatic connection of pain and what he actually says is that pain is often a distraction from dealing with some sort of emotional issue and that your pain is your body's way of avoiding dealing with those kind of emotions. It might not be a universal condition. I don't think anybody who has broken their arm necessarily is suffering from that but in these chronic pain situations it might actually be the body's way of avoiding an emotional response that they're actually afraid of. I thought both of those were tied in with that clip.

Tiffany: Yeah, I've actually seen that with a patient. I don't know what her emotional issues were because she never really got to the bottom of them before she died, but she just needed more and more and more pain medication. No matter how much she was given it was never enough for her and she was very emotionally distraught all of the time. So we all knew that there was something more than just the physical pain going on. But I like the way that in the clip and also in the Mercola interview with Dr. Hascom he said that it's important and he had his patients write down all of their negative emotions and not judge what they were saying, just write it all down, get it all out and also in that clip where he said "You are not your thoughts and your thoughts are not your pain but your thoughts can sometimes exacerbate what's going on with you and make your pain worse. So it's really important to tackle that emotional aspect of your chronic pain in order to actually be able to move through the pain.

Jonathan: Yeah, it requires questioning some of your sacred cows. I think most people would think of pain as being a purely mechanical phenomenon. We see it's not 100% of the time. Sometimes it is but sometimes it can actually be conquered by doing these exercises.

Doug: It's particularly difficult when somebody has had a very literal cause for their pain, like they had an accident or something like that and as a result they have pain and they're saying "No, obviously it's not an emotional thing. I had this accident so that's why I have this pain." But I think when enough time has passed that the physical aspect of it should have healed, maybe that's when you have to start looking into more possible causes of it and that maybe even if it wasn't caused by and emotional issue in the beginning that maybe it's being exacerbated by something.

Tiffany: Yeah, that's the reason it's sticking around because of some kind of emotional issue.

Jonathan: Yeah.

Tiffany: Yeah. That's the good thing about meditation because it lowers your levels of cortisol, gets you out of that fight or flight mode and it de-stresses you so it gets you to a place where you're able to actually work on your emotions. There have been lots of studies where they've put patient in groups where they did meditation and actually felt pain relief but is it so much that it's working on the body on a physical level or it just de-stresses you so much that you're able to better cope with the pain, where it's not so consuming that it just takes up all of your thoughts. I'm trying to figure out what the mechanism is.

Doug: I kind of think of it like meditation putting you in a place where you are separate from that constant stream of thoughts and I think that the more you meditate the more you become aware even in your day-to-day life that you are not your thoughts. I think that the point he was making in the clip there seemed to be that a lot of times that it's not the pain itself that is really driving you crazy, it's your thoughts about the pain, the thoughts like "I can't stand this. When is this going to go away. I need some kind of relief." That that's actually what people tend to be reacting to.

So I think by meditating and putting that separation between you and your thoughts maybe those thoughts don't suddenly become so all consuming. They don't really wrap you up so you're completely identified with the pain or identified with the thoughts about the pain. You're able to separate yourself a little bit more. That's my theory on it anyway.

Tiffany: That's a good theory.

Jonathan: Well let's talk a little bit about some natural alternatives aside from meditation. DMSO and sulphur compounds I think are one interesting area that I've actually had quite a bit of success with. Earlier this summer I blew out my Achilles tendon from being an idiot and taking a 20 mile bike ride when I wasn't ready. So don't do that. But it got super swollen up. It was really painful and I was taking MSM, methylsulfonylmethane, and also putting DMSO on the tendon and the inflammation went down really quickly, within a week. The DMSO helped with the inflammation itself and I'm sure with some of the pain as well, but taking the MSM internally was really quite a mind-blower at how well it worked. So I would recommend, I guess for chronic or acute pain, if you have any kind of pain going on, try that. You need to give it a few days to kick in and get into your system but it really helps.

Tiffany: Yeah, I think that's a good thing to point out too. Don't be impatient. You have to try things more than once to see if they're going to work for you.

Doug: Although DMSO works fairly quickly.

Jonathan: Yes.

Doug: It's really good particularly for joint pain and stuff and MSM as well. I know a lot of people have found a lot of success taking MSM regularly with osteoarthritis or rheumatoid arthritis or injuries, like you were saying Jonathan. DMSO topically right on top of the place that's hurting gets so much good feedback.

Tiffany: You might want to use one of the DMSO creams that's not full 100% DMSO. It might be 70% and depending on how sensitive your skin is, you might want to dilute it even more than that so you don't have any kind of skin irritation from putting the DMSO on.

Jonathan: Yeah, a quick, important note I think about DMSO, it's not a harmless compound. You can put too much on and burn your skin. It's a solvent. And you also want to make sure that the area that you apply it to is really clean. You want to clean it right before you put it on because it can carry anything into your bloodstream pretty much directly so you've got to make sure that you clean the area really well. I used the DMSO gel that I got from a health food store. I did go a little overboard with it once and burned my skin and realized "Okay, that was too much". So you want to start with small amounts. And you will stink. That is not a myth. It won't happen on the first day but if you're using it over time for a week or so, you start to exude a gross smell. Some people call it garlic.

Tiffany: I call it oysters.

Jonathan: Yeah, it was kind of like soured milk.

Doug: I thought it was rotting cabbage, sour milk, yeah.

Tiffany: I don't think it's that bad. I like the taste of oysters.

Doug: Well the thing is, from what I understand, when using it topically you don't usually get that quite as badly as if you're taking it internally. I think it does happen but I don't think it's quite as strong.

Jonathan: I did get it and I was just putting small amounts on my ankle, so even from that access point it was still causing me to smell. I had to sleep on the couch for a few days. So that is something and something to take into consideration. I work from home so it's not a huge problem for me but if you work in an area where you need to interface with people all the time, you might want to pick a weekend to try that.

Doug: Yeah.

Tiffany: Or just do it anyway. How often is somebody going to say "Hey dude, you stink!"

Doug: That's the thing. If you're choosing between really bad pain versus maybe smelling a little bit, often the choice is going to be pretty obvious. The funny thing is that apparently you can't actually smell it if you're the one using it, but everybody else can so you'll be fine. It's just everybody else who's suffers for you.

Jonathan: You're off-loading your suffering. But in lieu of DMSO I would say MSM works really well. It's like a fire extinguisher for inflammation. It's incredible.

Doug: Yeah, it's pretty great.

Jonathan: There are some other herbal remedies and I'm blanking a little bit, off the top of my head. Doug I was going to ask from when you worked in that health food store, did you notice anything that was used more or less by the majority of people?

Doug: The component you find in turmeric called curcumin I'd say by far is the most popular for inflammatory issues. It's a pretty strong anti-inflammatory. I do recommend people use an extract of it instead of using just the herb itself. You can use the herb itself, there's nothing wrong with that and just eating a lot of turmeric. But the human digestive system is not very efficient at extracting the curcumin so if you do something like an extract it's already been taken out so you get a potent dose of the curcumin.

You can do a couple of things like combining it with fat and using black pepper as well, which makes it more bioavailable but I think using an actual medicinal extract tends to be a better way to go. Boswellia is another really good one, otherwise known as Frankincense. That's another good anti-inflammatory. There are tons of them. Devil's claw is really good.

Tiffany: Have you had a good experience with arnica? I've never used it before but people seem to swear by it.

Doug: Yeah. And you can do arnica in two different forms. There's arnica oil which is the flower extract and people apply that topically. But then there's also homeopathic arnica which can be quite effective as well and that can be taken internally or it can be used as a cream in a topical way. There are a lot of blends out there too. I know there was a really popular one for a while called Traumeel. It's not available in North America anymore. It's available in Europe but it contains homeopathic arnica in conjunction with other homeopathics. That was extremely popular. A lot of people found that it was really good either for joint pain or acute issues or whatever the case may be.

Tiffany: Have you tried Maca?

Jonathan: I've never tried that.

Doug: Maca? Yeah, I have. Maca in and of itself isn't really a painkiller. Maca feeds the endocrine system so it's like a hormone regulator. So if the root cause of your pain - more often going along the lines of menstrual cramps or something along those lines - is a hormonal issue, maca can be really helpful because it will balance that hormonal picture if something is out of balance that's causing menstrual cramping or headaches even. A lot of times an imbalance in hormones can actually be behind migraine headaches or other things too that might be causing pain and Maca can be helpful in those situations.

There might be some slight anti-inflammatory property to it just on top of that but Maca wouldn't be my first choice if you're trying to treat an injury or something like that. It deals more with the hormone picture.

Jonathan: None of these herbal cures will knock pain out in that instant. Unfortunately and I think part of the reason for the opioid epidemic is that nothing is quite as effective in the short-term as these pharmaceutical painkillers. They are really effective in the short-term but as we've shown, in the long-term their addictive properties and their potential to increase your sensitivity to pain is the downside. You're rewiring your brain. So if you're sincere about not using opioids then there are these methods but they need to be implemented with a lot of intent and with focus and some patience. I think a combination of things, like using sulphur compounds combined with some meditative practice and some other things we've mentioned, cat's claw, cohosh, things like that that you can use in combination with each other they don't have interactions, that you can manage pain without becoming addicted and then throwing your entire life out of whack.

Doug: It's actually devil's claw I think you're thinking of Jonathan.

Jonathan: Oh, devil's claw. Okay.

Doug: Yeah, cat's claw is used more as an anti-viral.

Jonathan: Okay, right on. My bad. Devil's claw.

Doug: No worries. There's another one, white willow bark which is one that I thought I should mention because it's often used for headaches. White willow bark is where aspirin comes from.

Jonathan: Acetaminophen, right?

Doug: Yeah, exactly. You can take white willow bark because it's the whole plant compound and it doesn't have all of the side effects associated with it that you see from aspirin like digestive upset or wearing away at your digestive tract. So white willow bark can be good. I know a lot of people will take that when they've got a headache and they tend to find it really effective.

Jonathan: I was looking at one of the articles we looked at for the show, Natural Approaches to Cramps and PMS and they mentioned cramp bark and black haw, which I guess sound phonetically similar to devil's claw. I don't know if they are, but cohosh, red raspberry, dong quai, reishi, valerian root. I've never really had any success with valerian with actual pain relief. That's more for anti-stress kind of thing.

Doug: A lot of people just get knocked out on it. It puts you to sleep. I guess if you're doing it before bedtime to try and deal with the pain if you're trying to sleep it's a good thing but I don't know a lot of people who are taking valerian and trying to go about their day.

Tiffany: No.

Doug: No. It is a really effective sleep aid though. You wouldn't want to take it in the morning for sure. They also mentioned kratom. I'm not sure how it's pronounced but that is an herb from southeast Asia. I've never taken it but I'm vaguely familiar with the effects just from having read about it. It is quite powerful but it also has withdrawal symptoms which is a down side to the kratom. There are people who have become addicted to that because it is quite similar to the effects of an opioid.

Doug: I've never come across that one before.

Jonathan: It is quite interesting. It's actually illegal in some states in the United States so that needs to be taken into account but it is also legal in other states. I'm familiar with some stories where people have actually used it to get off of opioids. But then the problem is that it is addictive in and of itself. Just because it's out there and something that people might come across, I would put out that word of caution to try other things before you try kratom for pain relief because it has those negative downsides.

Tiffany: Yeah and if you don't want to actually put anything in your mouth, if you have some niggling back pain you could try using an inversion table. It gives you a nice stretch on your back and moves out the spine a little bit, takes some of the pressure off of your spine. So if you do sit a lot and you can take short breaks, you might want to take a break and use an inversion table. Also I find Epsom salts or magnesium salt baths are really good for relaxing sore muscles. I used that once when I had a little accident and fell out of a window and I felt like I pulled every muscle in my body. The first thing I did was take a magnesium bath. I don't know if it helped me right away with the muscle spasms but it did calm me down because it was a shock to fall that distance. So I did that and it helped.

People also have tried acupuncture to work on their pain. I've never actually tried it myself but people say good things about it.

Doug: Yeah, it can be very helpful in some situations for sure.

Jonathan: There's cupping too which I think is pretty interesting. My girlfriend tried it recently for some shoulder pain that she was having as a result of a sports injury and it didn't knock it out. It helped a little bit, enough to be able to deal with it and then go to the chiropractor and have some more things done. So I don't know, I'm not aware personally of any dramatic success stories with cupping. I don't know if you guys have heard of any.

Doug: Some. With perfectly round bruises. One of our commenters on the chat just mentioned light exercise and that's definitely something that can be very helpful, going for a light walk, yoga, tai chi, stretching, doing proper stretching. All those things can be very helpful for pain management as well.

Tiffany: Yeah, and along with tai chi, yoga and qigong, you're not just stretching and moving slowly, but you're doing the slow, rhythmic diaphragmatic breathing and that calms you down and slows down your fight or flight system. So that's another benefit.

Doug: Well gee Tiff, do you think that the EE program would be helpful for it?

Tiffany: Gee, you think? Talk about calming you down.

Doug: Yeah, definitely. I have had experience teaching EE to people who have chronic pain situations and some of them have reported pretty miraculous results from it, just calming down that fight or flight mechanism and really getting out of the stress response. A lot of times pain is exacerbated by being in a stressed-out situation. But sometimes - going back to Dr. Hanscom, is that his name?

Tiffany: Hanscom?

Doug: Yeah, who was talking about doing emotional writing exercises to de-stress and get those negative emotions out as a way of dealing with these chronic pain situations. So there is a very strong stress connection there. The Éiriú Eolas breathing program that we often promote on this show is definitely something that would be helpful.

Jonathan: If our listeners aren't aware of that program it's Éiriú-Eolas.org. That's where you can get more information about it. Well I guess this may be a good time to go to the pet health segment. What do you guys think?

Tiffany: Yeah. Our furry friends need some pain management tips too.

Jonathan: Yeah, exactly. So let's do that and then we'll wrap up when we come back.

Zoya: Hello and welcome to the pet health segment of the Health and Wellness Show. Today I'm going to share with you information regarding pain management in your pets. First of all there is a need to distinguish between acute and chronic pain.

Acute pain usually follows an injury. The injury can be accidental as in the case of a strain, sprain or fracture, or intentional as in the case of a surgical incision. Chronic pain is usually associated with arthritis or periodontal disease. Conventional medications including opioids track similar to morphine for example and non-steroidal anti-inflammatory medications work very well in the pet with acute pain. Nowadays many veterinarians try and practice preventive analgesia administering pain-relieving medications before intentionally doing something such as surgery that might cause pain. This preventive analgesia decreases the need for extended post-operative pain and is a very holistic way to approach pain relief using medications.

Chronic pain is another matter. While medications can be useful, in this case often a holistic approach is preferable. Most animals with chronic pain, especially that from arthritis, show slower movements, difficulty getting up and down, may wince or growl if touched or handled over the painful part and may show exercise intolerance. Dogs showing any of these signs should be related to determining the exact cause of the pain.
The main benefits of a natural approach to pain relief is the obvious lack of side effects that can be seen with conventional drugs including sedation, gastrointestinal lacerations, kidney or liver disease and the potential to damage already diseased cartilage in the arthritic pet. There are several options for treating the pet with chronic joint disease and pain. These include acupuncture, magnetic therapy, homeopathy, herbal therapy and well accepted use of nutritional therapy.

No one therapy fits every pet and the ultimate decision as to which therapy should be tried depends on a number of factors including cost and convenience for the owner. When it comes to nutritional therapy the most well-known nutritional supplements include shark and bovine cartilage, glucosamine and chondroitin supplements. These supplements are used for two purposes. First, as with conventional allogeneic medicines these supplements can relieve pain and inflammation without the side effects mentioned before.

Second, unlike conventional therapies that can actually further damage the joint cartilage, these therapies supply molecules to nourish and heal the cartilage. These popular complementary therapies are also most well known to conventional veterinarians and are employed by many conventional doctors as first line therapy for dogs with chronic arthritis. This means that even if your doctor is not a holistic doctor per se, he is still likely to be able to prescribe one of these nutritional supplements to help your pet.

Now a bit more about pain management. The same drugs used to control pain in people can be used successfully in dogs and cats. Dogs and cats often require more medication per kilo to relieve pain. Pain in dogs and cats is a legitimate reason to dispense medications. We must learn to cue on other factors than we do in people when judging the degree of pain in a dog or cat. It is hard to objectively judge the severity of pain in human beings and even more difficult to do so in animals. Thresholds of pain differ markedly between people and from one animal to another.

Pain perception depends on species, breed, age, gender, time of day and the individual temperament. Pain may be experienced more at the animal hospital than at home. Young animals tend to have a lower threshold for pain. Older and debilitated pets may not show much response to pain but feel it just the same. Hunting and working breeds of dogs are more stoic and resistant to pain than toy and miniature breeds.

Signs of pain are subtler in cats than in dogs. If anything, veterinarians probably underestimate the degree of pain patients are in because there is no direct way to measure it. You, the pet's owner is more likely to notice signs of pain because you are more attuned to your own pet. In one of the previous shows I already talked about signs and symptoms of pain in pets. Besides behaviour pain alone can actually change the results of blood chemistry analysis. Dogs and cats in pain may have elevated blood sugar. Their blood cortisol and white cell levels can increase. Pain can also interfere with the immune system, increase the risk of infections that slow the healing of wounds in surgery.

Complete elimination of pain is often impossible and undesirable but it can be minimized with medications. There are five major classes of medicine that can be used to control pain in dogs and cats. Many of these medications can be used in cats only with extreme caution.
There are some general rules when using pain control medications in dogs and cats. The first is to try to give the medication early before the pain becomes too intense. The second is that it is usually safer and more effective to give two or more medications that have different modes of action rather than a higher dose of a single medication. Older patients should receive lower doses less frequently than younger, more robust pets. It is also wise to check kidney and liver function when using pain control medication in older pets. There are many pain medications and some are more controversial than others and some can be used quite safely for a limited period of time.

As a responsible owner you can do your own research and also ask your veterinarian to provide you with an explanation of the pain management protocols.

And now a bit about natural treatment for dogs with arthritis. When treating dogs holistically the first factor is to examine their lifestyle, especially their weight and exercise. Obese and even mildly overweight pets have more mobility problems. Often weight loss and reduction of the stress on their joints is sufficient to help these pets regain normal function. If this is appropriate, a meat-based fresh food diet often works best. A varied raw meat-based is even better. Many dogs that seem arthritic and act old can be helped by eating the proper diet. In addition to reducing the carbohydrate fillers and grains that are found in most commercial pet foods, there are certain foods to avoid. Some foods can worsen inflammatory diseases and even primarily harm joint function.

Unfortunately dietary analysis is often overlooked during conventional veterinary care. Certain fats, sugars, milk products and anything in the nightshade family can worsen arthritic symptoms. Nightshades include potatoes, tomatoes, peppers and eggplants. Conversely, specific foods can help reduce the inflammatory products that produce pain. Deeply coloured vegetables and fruits are packed with phytonutrients and vitamins that can help.

Once all lifestyle factors have been addressed some veterinarians prefer then to prescribe a homeopathically chosen medicine to help the body heal. Homeopathic treatment is gentle and is proposed to directly address the vital force that created the arthritic symptoms, not just cover them up. However as I said before, joint supplements can also be very effective in a short period of time. This is okay, but it's important to realize that these natural drugs are not addressing the underlying problem and can actually slow overall improvement by manipulating symptoms. Nutritional supplements work best for dogs who eat inadequate diets, such as dry food. Modify the diet of these pets and the need for supplementation often vanishes.

Another often overlooked and inexpensive helpful dietary modification is the addition of bone broth to the diet. Simple ingredient supplements that help arthritic dogs include glucosamine sulphate, boswellia, curcumin and turmeric, etc. Some of these have been well researched and are quite effective.

The next most common yet natural modifications are acupuncture and chiropractic care. Like homeopathy, these can work well and do so through stimulation of the body's innate healing ability. Be cautious to select a truly holistic practitioner if you elect to use one of those modalities. It is relatively easy but potentially very harmful to misuse any treatment that works at the level of the life force. Acupuncture especially has been widely adopted by conventional veterinarians.

Physical therapy can markedly improve function as well. Proper therapy and rehabilitation after orthopaedic surgery is critical for helping to regain full function and reduce arthritic changes. Gentle massage is also inexpensive, easy to learn and very effective at relieving arthritic discomfort, especially when combined with heat.

Even if you are feeding a great fresh food diet, doing chiropractic treatment and acupuncture, your dog may still suffer from arthritic pain. In such cases there is no choice but to use conventional pain relief medications. Just remember that if you are using those, add a herbal intestinal protectant like liquid aloe vera, slippery elm, licorice, etc. All of these can help intestinal upset and ulceration.

Well this is it for today. Thank you for listening and good-bye.

Jonathan: Those are some pain-free goats. Those are great tips I can attest to. Our dog developed arthritis in her hips and when we moved her to the raw food diet, a couple of years ago now, I don't know if it has gone away 100% but she's so much better. She was actually having a hard time getting up the stairs or jumping into the truck and now she's like a puppy. She's almost 12 years old and she runs around like a maniac. Just the raw food diet alone I think is a huge benefit for dogs and cats.

Unfortunately I don't have a recipe for today. I apologize. If you guys have something at hand you're welcome to give it, but maybe we could say that our recipe is don't use opioids.

Doug: It's not what's for dinner.

Jonathan: No teaspoons of opioids. That's our show for today. We appreciate everybody listening in and participating in the chat and hope that if any of you or your friends or family are experiencing chronic or acute pain, maybe spread the word about this information. Maybe they haven't thought that there are alternatives to pharmaceutical painkillers and if it hasn't crossed somebody's field of awareness you never really know. You don't want to be pushy about it but you can bring it up and say "Hey, check this out" and you might help somebody avoid a long stint with addiction to opioids. There's always that chance.

We will be back next week. We encourage everybody to check out the SOTT Radio show on Sunday at noon eastern time, and if you are not in the eastern time zone go to radio.SOTT.net on Sunday and the air time will show in your local time zone. So be sure to check that out. Thanks again everybody. We'll be back next week.

All: Good-byes