By Dushyant Viswanathan, MD

Chronic neuropathic pain causes a lot of people a lot of misery and suffering. It is one of the reasons why there is a chronic opioid epidemic; patients have untreated pain and are in agony, and opiate medication prescriptions are easy to write and hand over to a patient.

I would like to take a moment to describe how I treat chronic neuropathic pain. To begin, it is important to understand some nuances with regards to the physiology of neuropathic pain:

Pain is a neurologic phenomenon. Neurologic phenomena occur in the brain, the spinal cord, and in the body at large (the neurologic term is “peripheral nerves” throughout the body). The nerve tissue in the brain and spinal cord that are responsible for carrying pain “information” can cause excess pain perception by any of the following features:

  • Amplification of pain signals from the peripheral nerves
  • Damage to axons (the nerve fibers) in the brain and spinal cord (diabetes and autoimmune conditions can do this)
  • Infection (herpes and Lyme do this) of the nerves themselves
  • Toxin disruption of the nerves themselves (mercury does this)
  • Endocannabinoid receptor degradation (leading to amplified pain perception) occurs in the spinal cord
  • Gut microbiome impairment directly leads to brain inflammation (Seen in autism, multiple sclerosis) perhaps via transmission of bacterial metabolites to the brain via lymphatic channels from the gut
  • Gut inflammation causing decreased serotonin production can lead to neuropathic pain by causing less spinal cord modulation of pain signaling, leading to the net effect of amplified pain signaling
  • Chronic stress and depression can lead to pain by causing decreased endorphin (natural opiate) production in the brain, triggering brain inflammation and amplifying pain signals
  • Endocrine conditions can cause neuropathic pain by decreasing norepinephrine levels in the brain which leads to less inhibition/modulation of pain signals, leading to the net effect of amplified pain signaling

Each of these concerns can and should be directly addressed by medical treatments. What is overwhelmingly clear is that simply giving patients narcotic prescriptions to treat chronic pain is not only ineffective to treat chronic pain, but also very dangerous.

My approach is comprehensive. After consultation, physical examination, and diagnostic testing to determine the underlying causes of chronic pain, any of the following treatments are considered and can be customized to best help the patient:

  • Strategies to repair the gut microbiome
  • Strategies to increase opiate production in the brain
  • Strategies to increase endocannabinoid receptor activation in the spine
  • Strategies to increase serotonin levels
  • Strategies to resolve endocrine problems
  • Strategies to increase norepinephrine levels
  • Strategies to resolve nerve infection
  • Strategies to repair damaged nerves
  • Strategies to repair axons / myelin sheaths
  • Increasing modulation of pain signaling to decrease the amplification

The strategies themselves may involve pharmaceutical medications, amino acid formulas, hormone treatments, compounded treatments, anti-microbial treatments, microbiome repair treatments, and holistic treatments such as yoga, meditation, and acupuncture. Ultimately a customized approach is necessary for each person. We do not stop until our patients are pain-free!

It is important to stay up to date about the neurobiology of pain and about how to safely help people become pain-free. If you are interested in exploring how to become pain free, contact us today at 888 250 CCIM (2246)

Dushyant Viswanathan, MD, ABIM, ABOIM, AACE

Chief Medical Officer

The Columbia Center for Integrative Medicine

888 250 2246



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