Pain medications and muscle relaxants

Pain is a symptom of Th1 diseaseAny of the chronic inflammatory diseases caused by bacterial pathogens. and can be exacerbated by immunopathology. Marshall Protocol (MP) patients should always use 40mg of olmesartan (Benicar)Medication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. every four hours, or more often, before resorting to pain medications. 20mg OLM under the tongue is quicker where pain is extreme.

There are also other strategies for managing pain.

When the usual strategies for managing immunopathology are not enough to control pain, some Marshall Protocol (MP) patients may need pain medications. Except for corticosteroidsA first-line treatment for a number of diseases. Corticosteroids work by slowing the innate immune response. This provides some patients with temporary symptom palliation but exacerbates the disease over the long-term by allowing chronic pathogens to proliferate., there is no pain medication contraindicated specifically because a patient is on the Marshall Protocol. Opioids are the preferred (short term) method of dealing with extreme pain in the MP cohort.

The effects of pain medications drugs on the immune system are not known. At present, it can't be said to what extent these drugs interfere with immunopathology. While it's strongly possible that some pain medications might temper immune system activity, patients taking them have made progress while taking them. As long as patients feel they're still experiencing immunopathology and that the medications are taken for reasons of necessity, pain medications are not contraindicated.

In conjunction with their physician or a pain management specialist, patients may want to experiment with different pain killers to see if any of them seem to lower not just pain but other disease symptoms. If they feel a particular pain medication is lowering immunopathology they are able to tolerate, they may want to ask their physician to change to a medication that does not elicit such an effect.

slowly I determined that caffeine, stress, and heat were triggers for all of my muscle spasms ..Internet article by MS sufferer

Listed below are common varieties of pain medications. Note that the substance names are in lower case and that any brand names are capitalized.

• acetaminophen (Tylenol) – Tylenol dosage should be limited to a total of 3 grams (3,000mg, six 500mg tablets) in each 24 hour period for patients with healthy livers.
• aspirin – not recommend in the routine use of aspirin for its touted preventative characteristics; see NSAIDs
• celecoxib (Celebrex) – a COX-2 inhibitor; not recommended
• corticosteroids – contraindicated - may cause IP instablity
• diazepam (Valium) – okay for patients to take; only the brand name, Valium, has seemed to work for patients with Th1 inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue.; half the 2mg (white tablet, the one with the V cut from the center) seems to often be enough to reduce anxiety and calm restless muscles; stay away from the generic diazepam and the higher strengths; make sure your doctor orders Valium 2mg to use “as directed” and writes “no substitutions” on the prescription; Valium is usually taken 1-4 times per day.
• hydrocodone-acetaminophen (Lortab, Norco, Percocet, Vicodin, Xodol) - Generally reported OK
• ibuprofen (Motrin, Advil) – of Motrin and Advil, Advil is preferred: Motrin has two times the additives a Motrin – 18 versus 9 – and the additives are some very difficult substances for the body to break down; see NSAIDs
• ketamine – An anesthetic drug commonly used in Lyme disease and chronic fatigue syndrome. Reports suggested that Ketamine doesn't work very well at palliation, and it loses efficacy quickly as the months go by. Also, Ketamine may damage bladder function.¹⁾
• morphine – avoid if possible - shown to be immunosuppressive in a study²⁾
• naltrexone – an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. Naltrexone appears to negatively impact the ability of the MP to return the human immune system to full function again. Lymphocytes express opioid receptors, probably for a good reason. Even though that reason is not fully understood, it is not a good idea to block those opioid receptors (with naltrexone) if one expects to be able to return your immune system to normal.

Ultra-low dose naltrexone enhances cannabinoid-induced antinociception. ³⁾

Surprisingly, the analgesic effects of opioids are enhanced by ultra-low doses (nanomolar to picomolar) of the opioid antagonist, naltrexone.

Low dose naltrexone (LDN) is palliative. It doesn't help the innate immune system in any significant way. If it were helping the immune system to kill the microbiota then your immunopathology would increase, not decrease. However, I have looked into whether it is likely to stop healing, and it does not seem to interfere with the known actions of OlmesartanMedication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. Also known by the trade name Benicar. on the VDRThe Vitamin D Receptor. A nuclear receptor located throughout the body that plays a key role in the innate immune response.. So it seems a “safe” palliative. There was a thread on CureMyTh1.org where these issues were briefly discussed.

LDN is special because it is a very low dose drug, and it must therefore be targeted tightly towards whatever it affects. Science is still not completely sure what LDN does, which is why there is this myth about it helping the immune system. However, it doesn't seem to get in the way of olmesartan, especially at low doses.

Speaking of that, has Doc allowed you to try even smaller doses to see if the extra symptoms are less of a problem for you? As a palliative, it should be able to be used p.r.n. (as you need it), every other day, or even every other week, if it helps you.

Naltrexone is suspected to operate via a similar pathway to Ketamine, known to have pain-killing powers, and therefore any relief you get from idiopathic pain should not be unexpected.

Trevor Marshall, PhD, MarshallProtocol.com

• naproxen (Aleve, Anaprox, Miranax, Naprogesic, Naprosyn, Naprelan, Synflex)
• oxycodone (Oxycontin) - Generally reported OK
• oxycodone-acetaminophen (Oxycocet, Percocet) - Generally reported OK
• pregabalin (Lyrica) – a “small” molecule, one which is very non-specific in what it targets in the body; there are tens, probably hundreds of potential targets for a molecule that small; not recommended
• propoxyphene-acetaminophen (Darvocet, Propox-N)
• tramadol (Ultracet, Ultram, Ultram ER, Zytram XL) – possibly okay for patients to take; an atypical opioid and centrally acting analgesic used for treating moderate to severe pain. There have been reports of severe reactions from MP members - best to avoid this and use oxycodone or hydrocodone, which tend to have more positive than negative reports.

Temporary use of opioids are the preferred method of dealing with extreme pain in the MP cohort.

An opioid is any agent that binds to opioid receptors, found principally in the central nervous system and gastrointestinal tract. Opioids work to relieve pain in two ways. First, they attach to opioid receptors, which are specific proteins on the surface of cells in the brain, spinal cord and gastrointestinal tract. These drugs interfere and stop the transmissionAn incident in which an infectious disease is transmitted. of pain messages to the brain. Second, they work in the brain to alter the sensation of pain. These drugs do not take the pain away, but they do reduce and alter the patient’s perception of the pain.

Many physicians are hesitant to prescribe what they feel is a lot of pain medication. Patients may need to demand that they give you enough pain medication to take care of their pain; Patients have a right to have their pain relieved. Opioids used to treat existing pain are not addicting.

I would suggest regularly changing around opioids so as to make sure that only the pain was being affected by them. There are opioid receptors on lymphocytes. In general terms, if your doctor prescribes opioids for your pain, they seem to have less interaction with Th1 disease than some of the other pain medications (aspirin, for example). This has to be a decision between you and your licensed physician.

I am generally comfortable with opioids, they are definitely the preferred pain killer, after higher-dose olmesartan. If the olmesartan doesn't control the pain then you should discuss opioids with your doctor. Talk with your doctor about more than one type. Try three weeks on one, three weeks on another or some other regime with which your doctor is comfortable with. That is really the only way to observe cause and effect.

Trevor Marshall, PhD

Opioids do suppress the immune system,⁴⁾ so it is important not to use them more than necessary. Patients should work with their physician to find an appropriate dose.

Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are commonly used for mild to moderate pain. The most commonly used members of this group are over the counter drugs: aspirin, ibuprofen, and naproxen. Taken regularly, NSAIDs can lead to stomach upset and prolonged bleeding. NSAIDs should only be taken with a physician's say so. NSAIDs can inhibit the excretion of sodium and lithium as well as interfere with other medications.

NSAIDS and COX-2 inhibitors can inhibit antibody production in human cells, thus lowering host defense.⁵⁾ NSAIDs can also increase the risk of life-threatening heart or circulation problems, including heart attack or stroke. This risk will increase the longer they are used. A recent study indicated that Naproxen may pose less risk to the circulatory system than the others.⁶⁾

NSAIDs are not the way to [best treat pain]. Pain should be treated with acetominophen/paracetamol (Tylenol, Panadol) or one of the [preferred] opioids, none of which significantly affect the immune system [as NSAIDs do]

Trevor Marshall, PhD

Patients with liver disease should use all over the counter pain medications, including ibuprofen, aspirin and acetaminophen (Tylenol), with caution. Any pain medication can jeopardize an already struggling liver, as many patients with Th1 inflammation have subclinical liver inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue.. One's physician is the best source of information regarding the safety of pain medication.

For localized pain, topical pain relievers may provide some temporary relief. Patients are advised to avoid those with salicylates such as Ben-Gay.

Over the counter topical creams with capsaicin, a component in hot peppers, in them work well. They produce a sensation of heat which fools the nerve endings into not noticing the pain. This might work well on joints.

Patients should be careful to wash their hands well after applying it as it can be very painful if it gets in one's eyes.

A muscle relaxant is a drug that affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia (overresponsive reflexes). The term “muscle relaxant” is used to refer to two major therapeutic groups: neuromuscular blockers and spasmolytics. Neuromuscular blockers are used during surgical procedures and in intensive care. Spasmolytics, also known as “centrally-acting” muscle relaxants, are used to alleviate musculoskeletal pain and spasms and to reduce spasticity in a variety of neurological diseases. As with pain medications, it is okay for MP patients to take muscle relaxants in order to help manage intolerable symptoms.

Muscle relaxants include:

• baclofen (Kemstro, Lioresal, and Gablofen)
• bentazepam (Thiadipone)
• carisoprodol (SOMA, Sanoma, Carisoma)
• chlormezanone (Trancopal)
• chlorphenesin (Maolate, Musil)
• chlorzoxazone (Muscol, Parafon Forte)
• cyclobenzaprine
• diazepam (Valium)
• donepezil (Aricept)
• eperisone (Myonal)
• febarbamate
• flopropione (Compacsul, Cospanon, Ecapron, Pellegal, Argobyl, Floveton, Saritron, Spamorin, Labrodax, Tryalon, Mirulevatin, Padeskin, Profenon)
• lorazepam (Ativan, Temesta)
• mephenesin
• mephenoxalone (Dorsiflex, Moderamin)
• meprobamate (Equanil, Miltown, Meprospan)
• metaxalone (Skelaxin)
• methocarbamol (Robaxin)
• nitrazepam (Alodorm, Arem, Insoma, Mogadon, Nitrados, Nitrazadon, Ormodon, Paxadorm, Remnos, Somnite)
• orphenadrine
• phenprobamate (Gamaquil, Isotonil)
• phenyramidol
• pridinol
• promoxolane (Dimethylane)
• quinine (Qualaquin)
• styramate
• tetrazepam (Clinoxan, Epsipam, Myolastan, Musaril, Relaxam, Spasmorelax))
• thiocolchicoside (Muscoril, Myoril, Neoflax)
• tizanidine (Zanaflex, Sirdalud)
• tolperisone (Biocalm, Mydeton, Mydocalm, Myolax, Myoxan, Viveo)
• trazodone (Desyrel, Oleptro, Beneficat, Deprax, Desirel, Molipaxin, Thombran, Trazorel, Trialodine, Trittico, Mesyrel)
• tybamate

I didn't relish speaking with my doctor about the possibility of prescribing opioids to help manage my pain while on the MP. I've had a bad experience with a physiological addiction to Ativan at low levels (used as a sleep aid) in the past and I wasn't sure who would be more reticent about the use of opiods.

I figured I would wait until after I experienced intolerable pain to speak with my doctor. I mean, I'm pretty good with pain.

Wrong move. During one 12-day period about a week into beginning the antibiotics, I had about five different body pains occurring at the same time (ranging from a 5 to a 9 in pain on a scale of ten) and a migraine with little relief throughout. It was intolerable. I was bereft. Speaking to my doctor about opiods over the phone was not what I wanted to do, and so I toughed it out.

At my next appointment, I got a prescription for oxycodone. I took just half the dose at the next mega-pain attack and the overall pain level was dropped to about a four, which was not only tolerable, but allowed me to know that I was still killing the bacteria and also when the response stopped. Thankfully, unlike the 12-day bout, it stopped after 8 hours. I went from feeling like a big wimp to feeling like I could manage my pain and therefore survive the MP.

I encourage everyone to talk with your Doctor about pain management in advance no matter how well you think you have managed the various pains you've had in the past.

Claire, MarshallProtocol.com

I have been taking 2mg Valium for muscle cramping associated with rheumatoid arthritis (I take it perhaps once or twice a week). As Jeannine advised, the brand name version of this drug usually works much better and at lower doses than the generic diazepam. I have followed this advice and used the brand name Valium with good results.

Until recently, when I attempted to refill my prescription at a new pharmacy in a remote location. I was told they could not obtain brand name Valium and that no pharmacy that they knew of within several hundred miles carried the brand name version. I accepted the generic, and very quickly found out that Dr. Marshall was right (as usual). Even when I took double the dose, I got no relief from my muscle cramps and in fact, my joint and muscle pain was worse.

Carol, MarshallProtocol.com

I took a low dose of LDN (Low Dose Naltrexone) last night (I think prescribed at my request, as I was trying to think of different meds to try so I could stop the Tramadol and I've already taken Vicodin) and had one of the worst experiences of my life. It's a little pill, 3.5mg.

It made me feel like I had drank paint thinner. It made my insides burn, gave me a terrible headache, caused my organs to burn. That horrible feeling went on for more than 5 hours. I took it at 8 pm, felt absolutely horrible for hours, couldn't read or watch TV, finally fell asleep about 1:15 am. I don't think it was an allergic reaction, so I wonder why it made me feel so horrible. It was a really, really awful experience. Worst med I've ever taken. I've had a couple make me feel way too drowsy before but nothing like this.

SanDiegoJoy, MarshallProtocol.com