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Part 1 of Top 10 Prescribed Medications: Vicodin (1) and Gabapentin (5)

CONDITIONS TREATED: PAIN, CONVULSIONS AND SEIZURES


Vicodin (Hydrocodone/Acetaminophen) and Gabapentin (Neurontin) are the 1st and 5th most prescribed medications in America, respectively.


Vicodin, an opiate, is the most widely prescribed medication in the United States. Vicodin is mostly used for pain after surgery, and is still widely used for acute pain, although pressure is put on doctors to limit prescriptions. Opiate addiction is an epidemic, killing over 100,000 Americans in 2021. Opiate addiction often starts with a Vicodin prescription.


Gabapentin is the new go-to medication for treatment of non-specific pain now that doctors are urged to cut opiate prescriptions, and I suspect this is why it made the list. Gabapentin is specific for nerve pain, but is also used for seizures and convulsions. Gabapentin can be effective against pain and theoretically does not pose the same dependency risk as Vicodin, but this is debated. Gabapentin is also intoxicating and some say it makes them feel drunk. Gabapentin is now being prescribed much the same way opiates were at the turn of the millennia - increasing doses as needed for pain.


Dealing with pain is difficult, and without being too harsh, some amount of "suck it up" is necessary when healing. As Buddha said, and other great religions teach, life is suffering. How much suffering should we bear before taking the action of squashing it with a drug? Decision making is all about evaluating the pros and cons. Making a decision is what freedom is all about, make decisions fully informed for the best possible outcome.


Treatment of pain is one of my biggest challenges as a provider. Pain is a sign something is awry, and pain killers put a mask on the pain. Sometimes, this chemical pain reduction can assist healing, such as after major surgery. Pain is stressful, and stressed bodies do not heal. However, if there's a source of pain not being addressed, pain will continue. The following lifestyle measures are safe and effective ways to address pain, speed healing, and address the source.


FUNDAMENTALS OF HEALTH: Pain


DIET

1. Work towards a healthy weight


There's no question that achieving a healthy weight reduces pain for those that are overweight. Pain increases with excess pounds. Weight loss requires a calorie deficit, and is most sustainable at a 250-500 calorie deficit per day. There is no way around the calorie deficit, losing weight is impossible without burning more calories than eaten. To determine how many calories to eat, use a TDEE (total dietary energy expenditure) calculator, widely available online. Use an app such as my fitness pal to count calories, at least at first; it is cumbersome but helpful if unfamiliar with the caloric density of foods. Underestimating calorie intake is more common than overestimating calorie intake. Make sure to record everything that you swallow unless it's water.


A higher calorie deficit results in quicker weight loss, but these low calorie diets tend to be unsustainable over time. Look ahead a year from now. You'll be better off losing 1 pound per week on a 500 daily calorie deficit, eating 1600-2100 calories per day, than you will be eating 900 calories a day for 8 weeks and losing 25 pounds. Those 25 pounds will easily come back when no longer able to endure that extreme deficit. Losing 1 pound per week for a year is 52 pounds in a year.


  • An alternative to counting calories is counting macros - proteins, fats and carbohydrates - and is arguably as cumbersome as calories. A popular formula to calculate individual macros is to eat your goal weight in grams of protein and carbohydrates, and half your goal weight in grams of fats. For instance, if goal weight is 150 pounds, eat 150 grams carbs, 150 grams protein, and 75 grams fat per day. Counting macros helps us learn about foods and their nutrients.

Eating in a calorie deficit is hard enough, restricting whole food groups as a weight loss strategy rarely works in the long-run. Avoiding foods eaten by most of your family and friends is hard because we're social creatures. Instead of avoiding foods, what foods can you add? Non-starchy vegetables are a great way to fill up with fewer calories. The goal plate is 50% non-starchy vegetables.


Grazing or snacking all day involves putting food in our mouths about 16 hours per day, resulting in over-consumption of calories and the body's chemistry constantly being in the "fed state", or weight gain mode. Instead of grazing all day, enjoy a standard portion of delicious nature-made food 3 times per day, preferably with others. If eating alone, don't check Instagram or read this article, stop and enjoy the food instead. When snacks are avoided, so are man-made foods.


2. Some foods may affect pain.

  • The hallmarks of inflammation are pain, redness, swelling, and heat. It's often argued the heat in spicy foods only adds to this inflammation. Anecdotally, many clients have eliminated all peppers, including black pepper, with great reduction in pain after 1-2 weeks. Peppers are in the night shade family of plants and removal of other night shades, such as tomatoes and egg plant, may be recommended. In my experience, elimination of tomatoes and eggplant have not had an effect on pain levels. Interesting note: I often feed wildlife leftovers, and the wildlife won't eat peppers.

  • Diabetes is a common disease and I will cover sugar reduction more extensively in the Metformin part of the series. Consume sugars from whole fruit instead of sodas, cookies, ice cream, or other forms of refined sugar products. Pineapple contains bromelain, a natural digestive enzyme that has anti-inflammatory and pro-healing effects. Bromelain promotes the immune system's release of anti-inflammatory compounds and can help break up scar tissue. The amount of pineapple to eat is difficult to dose, just have some frequently, fresh or frozen. Papaya and kiwi are other fruits with similar compounds.

  • Gabapentin is specifically be used to address convulsions and seizures. The clinical research showing success of ketogenic diets (low carbohydrate/high fat) in the treatment of those with chronic seizures and convulsions has been going on since the 1920s. Although most Americans eat a diet too high in carbohydrates, eating them in only slight amounts comes with its own concerns. Make sure you do your research well, or reach out to those who are familiar with the healthy application of low carbohydrate dieting. As always, avoid the processed foods advertised as "keto" and choose whole low carbohydrate foods like animal products and non-starchy, low sugar plant foods instead.


EXERCISE


1. Build muscle.


It is theorized that 80-90% of pain is caused by muscle dysfunction - muscles pulling on a joint, muscle spasms, when spasms pinch a nerve, etc. Building muscle improves the function of muscle, and because muscle dysfunction causes pain, improving the function of the muscle decreases pain. Building muscle also reduces body fat, body fat percentage and pain are positively correlated. Larger muscles take load off joints, preventing knee, hip and ankle pain, to name a few. Find a strengthening routine that works for you. Weight lifting, calisthenics, some forms of yoga and pilates, are all great examples.

  • Having a coach/trainer, a buddy, or other support system increases likelihood of success when starting an exercise routine. Investing money into building muscle will help your chances of success and prevent injury - a good gym is more expensive than a box gym because the programs are likely superior. Class environments are often more affordable than personal training and can teach the proper technique for injury avoidance and muscle gains. Find a gym that advertises personal attention, seek reviews from your acquaintances, take advantage of trial offers. A coach/trainer is an investment in health and should be the right fit more than the expected price. If you're 55 years old, chances are a 21-year old newbie will have no idea what is necessary for your body.

  • With training frequency, it's best to start low, maybe 2 times per week for 20-60 minutes, and build up from there. Just think - working out 2 times per week will be 104 workouts after a year. That builds more muscle than working out 5 days a week for 3 weeks in January, then pooping out because the body isn't ready.

  • If money is an issue, You tube has some great options. I like Mad Fit, she walks you through proper form and has a good mix of full body exercises.

2. Start walking.


Walking is the basic movement of the human being. I suggest walking close to where you live or work to make it sustainable. Walking in the woods exposes you to the aroma of the trees, or chemicals called phytonsides, which have a calming effect. These chemicals are the same as diluted essential oils and are free in the forest! Work up to walking for at least 30 minutes per day. Be creative. What everyday errand can be on foot? Is there a walk that could be built into your commute? Would you do better with a walking buddy?


SLEEP


Tips and tricks for optimal sleep will come out with every part of this series. Sleep restores and heals the body, and adequate sleep is necessary for healing from pain. Sleep starts with prioritizing 7-8 hours for sleep in a 24-hour period. Notice I said get 7-8 hours sleep in 24 hours - it doesn't have to be all at one time. It's widely accepted natural human circadian rhythm is to sleep when it's dark and be awake during the lightest times, but, as is life, there are variations. Early parenthood is a time famous for lack of sleep, shift work requires we adapt against nature to be awake at night and asleep during the day. These are instances where finding a couple hours during the day for rest is helpful. Sleeping, or even resting, once or a few times per day to reach that 7-8 hour goal is as good as sleeping all hours at once. In fact, sleeping a continuous 8-hours is new to industrialization. Ask a full-time farmer about his or her sleeping habits.


STRESS MANAGEMENT

Pain is difficult to endure, even torturous, and results in the body's stress response. The stress response increases pain levels and reduces the body's ability to heal. Opiates are very effective against pain and are euphoric, which results in abundant client satisfaction. This euphoria, a stress reducing quality, is part of the danger in using Opiates to address pain.


Everyone has a different mindset when it comes to dealing with pain, some have a high-tolerance for pain and some have a low-tolerance for pain. Many endure severe pain for years and take nothing, not even ibuprofen. For others, pain is interpreted as something being broken, and when something is broken, it should be fixed. Pills are a common fix, and the fix we were brought up to use. The Mind Body Prescription: Healing the Body and Healing Pain by John Sarno, MD is an alternative method for reducing pain that is based on using the mind. This book has rave reviews and I have seen it work first-hand. Progressive Muscle Relaxation (PMR) is another effective biofeedback technique to decrease stress and pain, there are videos on Youtube teaching this technique.


Saunas are helpful for both reducing pain and reducing stress. In fact, adding heat in any manner - a hot tub or hot bath, for instance - can work similarly. Rhonda Patrick, PhD, does a great job of summing up the studies on saunas and has an extensive online presence. Heat increases circulation, relaxes muscles, and promotes the production of chemicals that dampen response to pain signals, a process known as hormesis. Hormesis is the same reason adding heat is effective for stress management; hormesis makes the body more resilient against stress hormones.

  • Adding heat, especially in the form of a hot sauna, can be demanding and it's important to start low and work up to more time. Follow the guide of your device, or search online for one - they are widely available.

  • The best way to find a local sauna is through a search online or through social media. Infrared sauna bags are a great alternative for smaller spaces, here is a great one many clients are pleased with: .https://amzn.to/3F6XsHV. A small sauna can also be purchased, if you have the room, here is a popular one on Amazon: https://amzn.to/3n81ucZ.


Opposite to heat is cold, and cold is a classic pain and inflammation modulator for acute injury. Cryotherapy, or cold therapy, is getting more attention in popular health circles, both for acute injury and to promote recovery. Social media influencers make themselves an ice bath barrel from ice and water and sit in daily, 2-15 minutes., recording it all for Instagram. In most cities, there are cryotherapy services available. Look into the work of Wim Hof, the ice man. He also discusses breathing, a topic I will discuss extensively in future sections. Exposure to cold reduces inflammation, of which pain is a cardinal feature. Ice is a classic pain remedy often overlooked.


Add hot and cold together and you get contrast hydrotherapy, another technique for reducing pain. Traditional contrast hydrotherapy uses towels and buckets of cold and hot water, and a practitioner or loved one changes the towel(s) between hot and cold at timed intervals. The towel(s) are placed at the location(s) to be treated at timed intervals, 3 minutes for hot and 30 seconds for cold. This process is repeated, usually 5 times or more. The heat brings the blood, and the cold sends it away. Benefits include decreased pain and healing time through stimulation of the body's own healing capacity.

  • The point of contrast hydrotherapy is the application of hot and then cold, and there are endless methods. The timing is not dogma, you're still doing contrast if spending 20 minutes in a sauna and then jumping in a cold plunge for 30 seconds. There will still be results.


ADDRESS SIDE EFFECTS

Vicodin and all opiates cause constipation, which can become severe. Moving the bowels may require strong laxatives, and these are harmful over time. Learn what works for you, and discuss options with your prescribing doctor. Prunes or prune juice is very safe and often an effective enough remedy.


CONCLUSION

Much of the time, higher doses of Vicodin are needed to maintain pain levels, making the body dependent. Alternatively, many chronic pain sufferers have been taking the same dose of Vicodin for years, even decades, without increasing dose. The general opinion of those who have recovered from an opiate addiction is the pain of coming off is much worse than the pain opiates initially treated. Millions of people who have recovered from major surgery praise opiates. My point here is pain medication use is a complex decision. It's important to practice self-regulation when faced with a situation which Vicodin is used to address pain levels.


If you've developed a physical dependency to Vicodin, reach out to others for support when you decide to quit. Whomever that is depends on what works for you. In-patient treatment centers, out patient treatment centers, online treatment, narcotics anonymous (sponsors save lives), Schick Shadel Hospital, and many other options exist. Quitting Vicodin when there's physical dependency involves a period of feeling very unwell both physically and mentally, and for this reason, in-patient is often the only option. The physical symptoms don't last as long as the mental symptoms, and there is a very real syndrome known as post acute withdrawal syndrome (PAWS). Support from others who know about drug dependency is paramount during these times, PAWS can last for several months.





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