Four recent cases of extraordinary outcomes that share the fact they no longer require narcotics for back pain control.
1) cc: 70 y/o female chief complaint: for years coughing up phlegm every morning for 2-3 hours. Therapy initiated including pantoprazole 40 mg, 2 tabs twice daily; cough GONE, discontinued 7 yr hx of Vicodin 3-4x day for back pain (had back surgery in past)...I met her in fall 2010...she remains in remission on high dose ranitidine 3x day
2) 70+ female came in March referred by her minister, chief complaint: long standing cough, rhinorrhea/post nasal drip, voice problems and finally unable to sing in church...I started her on lifestyle change and samples of Dexilant 60mg instructed to use 1 daily for 3 days then 1 twice daily....at follow up in 3 weeks she had reduced her Kadian (morphine) from 80 mg to 40 mg and at follow up last week (July) has been off ALL narcotics 3 weeks. Her back surgery was in 2003, she has had 12 or more invasive pain procedures over the years....the pain clinic provider willingly helped her taper off the morphine but ..."rolled her eyes" when told by the patient what patient believed to be the reason her pain resolved..
3)19 y/o male, post surgical, cervical fracture at age 14 chief complaint: neck pain, bilateral lumbar radicular pain (pain down both legs)....failed pain clinic referral by neurosurgery with PT, narcotics, muscle relaxants, tricyclics....Dexilant 60 mg 3/day completely resolves ALL signs and symptoms....has relapsed several times off Dexilant or on reduced dose over the last 6-8 months
4) 70+ male, Vetrans Administration patient chief complaint: left side radicular (down the leg) pain (10/10)...9 months duration when he came to me...on omeprazole 20 mg for heartburn..titrated to Dexilant 60mg 2-3 daily...pain 0/10....has relapsed several times when he "runs out of pills"....(Dexilant)...told by VA doctor (per patient)..."heartburn does not cause leg pain and leg pain does not cause heartburn."
I have more cases like these. All are documented in the chart and could be validated by checking pharmacy records. I first saw this type response over 10 years ago.
What is the mechanism?
I believe vagal afferents alert the brain of the danger in the distal esophagus, craniosacral nervous system is activated and through recruitment and amplification of the protective mechanisms (NB Reilly's syndrome) sacral roots 2,3,4 carry the message to swell, exstravasate, vasodilate and muscle constriction result in piriformis m. spasm that can impinge on siatic n. thus causing radicular pain. Reduction in the vagal stimulation reduces the autonomic "output" and symptoms including pain resolve. Central sensitization is also part of the mechanism.
I have sent this to the National Institute of Health to encourage them to become involved.
Dr. Barrett
1) cc: 70 y/o female chief complaint: for years coughing up phlegm every morning for 2-3 hours. Therapy initiated including pantoprazole 40 mg, 2 tabs twice daily; cough GONE, discontinued 7 yr hx of Vicodin 3-4x day for back pain (had back surgery in past)...I met her in fall 2010...she remains in remission on high dose ranitidine 3x day
2) 70+ female came in March referred by her minister, chief complaint: long standing cough, rhinorrhea/post nasal drip, voice problems and finally unable to sing in church...I started her on lifestyle change and samples of Dexilant 60mg instructed to use 1 daily for 3 days then 1 twice daily....at follow up in 3 weeks she had reduced her Kadian (morphine) from 80 mg to 40 mg and at follow up last week (July) has been off ALL narcotics 3 weeks. Her back surgery was in 2003, she has had 12 or more invasive pain procedures over the years....the pain clinic provider willingly helped her taper off the morphine but ..."rolled her eyes" when told by the patient what patient believed to be the reason her pain resolved..
3)19 y/o male, post surgical, cervical fracture at age 14 chief complaint: neck pain, bilateral lumbar radicular pain (pain down both legs)....failed pain clinic referral by neurosurgery with PT, narcotics, muscle relaxants, tricyclics....Dexilant 60 mg 3/day completely resolves ALL signs and symptoms....has relapsed several times off Dexilant or on reduced dose over the last 6-8 months
4) 70+ male, Vetrans Administration patient chief complaint: left side radicular (down the leg) pain (10/10)...9 months duration when he came to me...on omeprazole 20 mg for heartburn..titrated to Dexilant 60mg 2-3 daily...pain 0/10....has relapsed several times when he "runs out of pills"....(Dexilant)...told by VA doctor (per patient)..."heartburn does not cause leg pain and leg pain does not cause heartburn."
I have more cases like these. All are documented in the chart and could be validated by checking pharmacy records. I first saw this type response over 10 years ago.
What is the mechanism?
I believe vagal afferents alert the brain of the danger in the distal esophagus, craniosacral nervous system is activated and through recruitment and amplification of the protective mechanisms (NB Reilly's syndrome) sacral roots 2,3,4 carry the message to swell, exstravasate, vasodilate and muscle constriction result in piriformis m. spasm that can impinge on siatic n. thus causing radicular pain. Reduction in the vagal stimulation reduces the autonomic "output" and symptoms including pain resolve. Central sensitization is also part of the mechanism.
I have sent this to the National Institute of Health to encourage them to become involved.
Dr. Barrett