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A Multidisciplinary Approach to Fibromyalgia and Complex Regional Pain Syndrome

A Multidisciplinary Approach to Fibromyalgia and Complex Regional Pain Syndrome

Fibromyalgia and Complex Regional Pain Syndrome (CRPS) are complex conditions that do not respond well to conventional pain treatment and often require a multi-faceted approach to achieve significant relief.

In order to learn more about alternative therapies used to treat fibromyalgia and complex regional pain syndrome (CRPS), the Alternative Pain Treatment Directory spoke with Dr. Chris Kleronomos, owner and medical director of Medipro Holistic Health in Beaverton, Oregon.

Could you tell us a little bit about your background?

I became interested in medicine while a Corpsman in the U.S. Navy. I served with the Marine Corps elite Special Operations Teams. After leaving the military, I became a Nurse Practitioner and a Doctor of Acupuncture and Oriental Medicine. I also have an M.S. in Functional Medicine and Clinical Nutrition. I am board certified in Family Practice and acupuncture and am a board diplomate in Pain Management and Anti-Aging medicine. I’m also a Professionally Registered Herbalist.

What is your specialty?

I specialize using an integrative approach to treat complex chronic conditions including chronic pain, fibromyalgia, chronic fatigue, and autoimmune disorders. 

When did you start working with pain patients?

At the beginning of my medical career, I worked in the pain management clinic at a hospital where I worked alongside Western medicine fellowship-trained pain management specialists. They were more focused on structural issues, and there really isn’t a significant amount beyond drugs and injections to treat central pain syndrome of which fibromyalgia would fall under. 

What conditions fall under the category of central pain syndrome?

Any condition where the pain is coming from brain and neurological changes rather than a structural or direct localized inflammatory condition.

How were you able to incorporate functional medicine at the hospital pain clinic?

We were able to expand out from procedural-based things to a more holistic model that incorporated corrective features not just symptom management. Symptom management is important, it’s just not the whole picture. We added things like diet therapy, acupuncture, cupping, and ASTM (Assisted Soft Tissue Mobilization). We were featured on National Geographic for using bee venom as a peptide that is specific for pain.

Why bee venom?

It contains a peptide called melittin which has a variety of pain-relieving effects on localized pain mechanisms in addition to gating which is in part how acupuncture works. It also changes how pain signaling within the spine is embraced. It actually dampens down the pain volume. But it’s a hard therapy to use in a clinical setting because we don’t have an isolated form of bee venom right now. You have to build it up gradually over time and do it regularly, so that can make it impractical. With that being said, if you are running out of options, it’s something people are more willing to consider. 

Do you use bee venom in your practice?

I do. You can use it as injectable or as a direct (a bee sting), but I utilize the injectable.  

After working at the hospital, what was the next step in your career?

I worked at the hospital for several years before opening a clinic for fibromyalgia and central pain syndromes. I am now the owner and medical director Medipro Holistic Health , a multidisciplinary clinic. We have acupuncture, chiropractic, nutritionists, and primary care naturopaths. We have a total of eight practitioners, and we also partner with a mental health group.

What is your approach to treating chronic pain?

I take a very broad approach to treating chronic pain. I do everything from medication adjustments to finding the right Western medication for symptom relief. I also utilize atypical or non-FDA approved medications. As example, we might use things like low-dose naltrexone or peptide therapy. Peptide therapy is one of my specialties and is an emerging class of treatments for pharmaceutical companies. They can be used for a variety of things—everything from resetting your circadian rhythms for sleep to calming down anxiety to reducing inflammation. 

We also recommend diets based on a patient’s underlying conditions. We also identify and treat GI dysfunction.

Low-dose naltrexone (LDN) has been demonstrated to reduce symptom severity in conditions such as fibromyalgia, Crohn’s disease, multiple sclerosis, and complex regional pain syndrome. Peptide treatment has shown promise in treatment of neuropathic pain.)

What role does diet play in the treatment of chronic pain syndromes?

Diet plays a major role, and we start by eliminating the most common triggers which tend to be gluten--sometimes grain altogether—as well as corn, dairy, soy, alcohol, refined sugars, and processed foods. Those all go pretty quickly. Patients can respond very well to dietary changes depending on the primary pain generator that is causing their issues. There are central pain syndromes induced from autoimmunity, Ehlers-Danlos, altered gut microbiomes, chronic infection that trigger an immune response—it really depends on what the trigger is.  Typically patients respond more noticeably to dietary changes when that trigger is GI or inflammatory related. But in general, all patients need changes made to their diets. 

Why is gluten so widely maligned?

It’s not necessarily gluten the molecule although it certainly can be for people with gluten intolerance. There are issues associated with grain production in the United States. Grain is hybridized, highly processed, and stored for long periods of time before it is transported during which time it can get contaminated. We brominate some of our grains which is a toxin similar to fluoride. It’s not like in small European countries where the grain is local and not brominated and covered in all of those things.

Should the general population stop eating gluten?

No, not necessarily. A healthy person with a good intact gut can eat whole grains that contain some gluten. I don’t recommend excessive amounts or highly processed forms of it. I recommend organic whole grain products, and if you can afford it, the ancient grain products.

What is an example of a “typical” diet for someone with chronic pain?

Whole foods, meats, fermented foods, and good fats. The diet is low in legumes, and we do take away peanuts which are a very common allergen. We tend to allow red and black beans because they have a higher nutrient content.

Are most patients receptive to eliminating so many foods from their diets?

No, not in general. It’s really about motivation, and some people aren’t at that point yet. People need to be ready to get better. People often use food as comfort, and there is high degree of depression associated with both chronic pain and fibromyalgia in general. In addition, people can become addicted to dairy and sugar—literally addicted. Dairy has a protein in it called Casomorphin that can partially bind to opioid receptors like a drug. Sugar can trigger the same reward center in the brain as things like cocaine.

How important is it for chronic pain patients to make dietary adjustments?

As I like to tell my patients, not everybody is going to be cured with a diet, but I can almost guarantee that you won’t be cured without one. Diet is an integral part of treating any chronic disease.

What else do you recommend for your patients suffering from fibromyalgia and other complex pain syndromes?

There’s typically a degree of nutrient repletion with general supplements and specific supplements as needed. Depending on a patient’s labs, we can use injectable or intravenous forms of supplements. 

I almost always start with screening hormones because it is a very easy intervention that can help people to feel better more quickly. I look at thyroid and sex hormones even in premenopausal women. I look at testosterone levels because testosterone is important for pain management. It’s not typical to test testosterone in women, and even when we find deficiencies, insurance doesn’t cover the therapy. We also look at thyroid differently than a conventional primary care physician. Even though people often badmouth primary care, that’s not entirely fair. Primary care has a particular role and are there to screen for disease states and big problems. They are looking at population adjusted values to look for problems. They are looking at lab values in a very different manner than we are because when someone comes to me, we know they are in a diseased state. As a result, the normal values may not apply.

Besides testosterone and thyroid hormone, what other systems are often out of balance in chronic pain patients?

In general, there is a lot of pituitary/adrenal/hypothalamus disfunction in many of these syndromes. Some of it is induced, and some of it isn’t induced. Your hormones respond to things like nutrient status, inflammation, obesity, and sugar. Often in central pain syndromes and fibromyalgia in particular, doctors are giving out narcotics like oxycodone and Vicodin which bind to the completely wrong receptors. They are minimally impactful if at all, and over time they suppress the entire hormonal and endocrine system of the body. You have this combined problem happening; you have the underlying issue and then we are making it worse. There are also situations where doctors are piling on so many drugs that that’s causing a problem.

What kind of problem does that cause?

Depending on what literature you look at, something like 6 to 8 medications will guarantee a 100 percent drug/drug interaction. We don’t necessarily know what that’s doing. I’m not saying that it’s a dangerous drug interaction, but we know there will be an interaction happening that we may or may not be able to identify. 

What can you do for people taking multiple medications?

A lot of people are on a lot of medications, and we can try to optimize those medications. We determine if it’s possible to overlap a couple of different conditions with one medication instead of four. That can involve removing or changing medications. We can also try to get away from certain medications by using targeted injections.

What are targeted injections used for?

They can anything from muscle injections using specific substances to standard interventional pain epidural injections or medial branch nerve blocks. We can also do regenerative injections if that is cost accessible for a patient.

Are many of these treatment options covered by insurance?

I have a hybrid clinic, and although we do take insurance, many of the treatments that we have available aren’t covered. Taking an all-natural treatment approach can cost between $500 and $3,000 a month. If a patient is early in their treatment process and they can’t afford these treatments, we will start by using standard FDA-approved medications and hope for the best. We can also address diet, exercise, and sleep--sleep medicine is covered by insurance.

What role does sleep medicine play in helping patients suffering from chronic pain?

There is a fair amount of sleep apnea in the general population, and then when you have a central pain condition, there can be actual neurological-based sleep architecture changes. Some of it is induced by certain meds. For example, doctors may give Ambien or something similar for long-term use, and that doesn’t necessarily put you into a restorative sleep. If you go a year without being in a restorative sleep, you are never going to be able to control inflammation, calm your nervous system down, reduce your pain, or repair your body. It’s just not going to happen. 

You mentioned that your clinic partners with a mental health group. What role does mental health play in treating chronic pain conditions?

Sometimes the mental health aspects of our patients are above our pay grade and require specialists. The group that we are partnered with can do medication evaluations and more importantly, they can do transcranial magnetic stimulation. That is currently only approved for major depressive disorder, so there are a lot of hoops to jump through to get it done. It can be very helpful for complex pain syndromes because the same receptors targeted by the pulsed magnet can be helpful for anxiety, pain, OCD, and PTSD. 

Do you utilize telemedicine in order to see patients from outside of Oregon?

I do not. Because I take insurance, I would have to be licensed in every state. It’s a pet peeve of mine that people are doing virtual treatments because technically, you are not supposed to prescribe without an exam. You are also supposed to be licensed in the state in order to provide a diagnosis or provide direct medical advice. A lot of people are floating in more of a gray area when it comes to that.

Do you have advice for chronic pain sufferers who are looking for a holistic practitioner in their area?

I suggest finding a naturopath who is trained in or specializes in pain management. They can also look for trained functional medicine MD or NP because they are usually pretty well rounded. There are a lot of top-notch integrative medicine practitioners out there. A great place to start looking for one is on the Alternative Pain Treatment Directory. 

Christine Graf is a freelance writer who lives in Ballston Lake, New York. She is a regular contributor to several publications and has written extensively about health, mental health, and entrepreneurship.

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