Presentation regarding solutions for chronic pain including myofascial therapies. Prepared by Dr. Richard Burg, Chiropractor, Nutrition Consultant and owner of Active Wellness Chiropractic in Oakland, CA

1. Chronic Pain Solutions
Dr. Richard Burg
Chiropractor, Nutrition Consultant, Certified ART® Provider

2. Disclaimer
 Acute & chronic pain may be a sign of
a serious underlying disease or
condition.
 It is imperative that you see your
physician or health care provider to
determine the cause of your pain.
 This lecture is not intended to
diagnose or treat any condition.

3. The Silent Epidemic
 Estimates are that 50 million
Americans live with chronic pain
caused by disease, disorder or
accident
 25 million people suffer from acute
pain from surgery or accident
 2/3 of these people have had their
pain for more than five years

4. The Silent Epidemic
 The most common types of pain are
arthritic, lower back, bone/joint pain,
muscle pain and fibromyalgia.
 Estimates are that 20% of adult
Americans experienced chronic pain in
1994 and approximately 4.9 million
individuals saw their physician for
chronic pain treatment in 1999.1

5. Pain perception
 Pain receptors in the body send
signals through nerves to the spinal
cord and then up to the brain where
pain is “perceived”.
 In the brain there are areas that bring
awareness to the pain and areas
(limbic system) that determine our
“experience” of pain.

6. The Gate Control Theory
 Melzack & Wall’s theory from the 1960’s
states that in the spinal cord there is a
neuronal “gate” that signals must pass
through and the gate can be open or closed.
 The gate is controlled by movement and
other sensory information that over-rides
pain signals and is specific to the area of
pain

7. The Brain Controls Pain
 The brain has pathways that inhibit or
modulate pain signals
 These pathways rely on
neurotransmitters such as serotonin,
endorphins and enkephalins to
transmits signals that block pain
signals to the brain

8. Underlying Causes
 Chronic low grade inflammation
– Prostaglandin imbalance causes systemic inflammation
which chemically stimulates pain receptors2 Injured pain
receptors give off substance P which causes the release of
histamine which leads to inflammatory prostaglandin
production and sustained activation of the pain receptors.
 Metabolic Syndrome is linked to inflammation
– 2/3 of the Adult US population are overweight or obese
– 25% of Americans have Metabolic Syndrome (insulin
resistance)
– Chronic subclinical inflammation is part of this syndrome

9. Underlying Causes
 Lack of proper motion
– ↓ frequency of firing of mechanoreceptors
– ↓ input into the cerebellum & cortex allows
increased pain signals to be perceived.
– Pain fibers grow into scar tissue and lead to
increased or chronic pain
 Neurotransmitter deficiency or imbalance
– Deficiencies in Serotonin, Endorphins,
Enkephalins

10. Nutritional Solutions
 Anti-inflammatory diet
– Low Glycemic Diet, high blood sugar leads to increased
inflammation
– High Omega 3 diet, fish and flax, decrease fatty meats and
poultry (2.7 g of EPA/DHA 2:1 daily)
 Adequate protein intake
– Your body needs adequate protein over 60 grams per day to
synthesize neurotransmitters and repair muscles and tissues
– Protein with each meal keeps your blood sugar levels normal
 Adequate water intake
– Most all metabolism in your body takes place in water
– You need to drink half your body weight in ounces of water per
day
– Adequate water turns off histamine which reduces inflammation
and pain

11. Neurological Solutions
 Better Brain Chemistry
– Increase your body’s reserves of Endorphins and Enkephalins with DLPA
– DLPA 500 mg (50:50) 1-2 tabs 3x daily before 3 PM or
– DPA 500 mg 1 tab 3x daily before 3 PM
– B complex vitamin daily B6 is required for neurotransmitter synthesis
(serotonin and dopamine)3
– Magnesium 200 mg to 400mg daily, helps prevent over-excitation of
neurons
– Vitamin D 1,000 IU daily (or as recommended from blood test)4
 Chiropractic Care
– Improve frequency of firing of mechanoreceptors to the brain
– Improve your function so you can be more active which uses the Gate
Control Theory to reduce pain signals
– Improved posture reduces chronic pain

12. Manual Therapy Solutions
 Specialized myofascial therapies
– Active Release Techniques® effectively restores
motion and removes interference to normal
tissue function which contributes to pain
– Adhesions trap nerves that travel through
muscle and fascia and can cause chronic pain
and disability
– Movement therapies such as this retrain the
body to move and function correctly to make
everyday activities and exercise easier and more
enjoyable

13. Functional improvements
 Exercises
– Studies indicate that exercise may be the only reliable approach to
resolving the disability of chronic back pain
– Motion is Life and increased motion reduces pain, stabilizes blood sugar,
elevates mood and keeps your weight normal
 Postural awareness and improvement
– Chronic postural distortions result in chronic pain patterns
– Muscles become too tight and short and pull on the body causing the
antagonist muscles to become too long and tight and lead to chronic pain
– Learn how to correct your posture using specialized exercises to change a
chronic pattern
 Cerebellar training
– Cerebellar exercises improve coordination and increase frequency of
firing to the brain which then inhibits excessive pain signals

14. REFERENCES
 1http://www.aapainmanage.org/literat
ure/Articles/PainAnEpidemic.pdf
 2
http://www.jci.org/articles/view/6749
 3
http://ods.od.nih.gov/factsheets/vita
minb6.asp
 4
Ross, J. The Mood Cure (New York:
Penguin Books, 2002) pp. 106-117.