Hypersensitivity Disorders

Paul Reller, L.Ac.

A variety of painful or uncomfortable symptoms may occur that are different from the normal sensation of pain and often very alarming or debilitating. These symptoms often come in episodes with sudden inexplicable onset, are difficult to relieve, and go away just as inexplicably. This is of course very alarming and often leads to much anxiety. I hope to give you a little information that helps to explain what might cause these symptoms so that you can take a proactive approach to correcting the causes and perhaps deal with these strange symptoms more objectively.

Nerve related pain, or neuralgia, can take many forms. Usually there is a burning or sudden shooting pain (lancinating), often with a sharp sensation like pins and needles sticking you (dysesthesia), or with numb tingling sensation (paresthesia).; It may also take the form of painful sensitivity to light touch or temperature changes (allodynia), exaggerated pain response (hyperalgia), or alarming pain response (hyperpathia). It may accompany various autoimmune disorders, such as rheumatoid arthritis, vascular or circulatory disorders, such as those involving small blood clots or thromboemboli, reactions to drugs or pesticides, chronic inflammatory conditions, nervous system disorders, such as reflex sympathetic dystrophy, or in most cases, show no clear cause (idiopathic). This array of possibilities and difficulty with diagnosis makes these symptoms that more alarming and creates even more anxiety. Patients often see a number of specialists that give them no clear answers, or worse, are dismissed by frustrated doctors who are unable to help them or give them a quick wrong diagnosis, such as sciatica or carpal tunnel. The medical business often likes to try to placate the patient with a little pain medication and physical therapy, or worse, steroid shots. Their alternative is to spend a lot of money to find the real diagnosis, and then often have little to offer in terms of standard treatment.

Many diseases and syndromes with unknown cause (idiopathic) are thought to be the result of a number of chronic health problems rather than a single cause. The word syndrome is assigned to a condition that has no specific disease mechanism, and the word means that this condition is merely a collection of symptoms that appears to affect a large number of patients in a similar presentation. Modern medicine is not adept at treating problems that require a holistic approach, focusing its attention on using treatments that do specific actions, rather than treating a set of problems that are interconnected. Allopathic treatments focus on blocking specific mechanisms of symptom cause and usually ignore restoration of homeostasis, or normal physiological function. Often, an array of specific pharmaceutical treatments is given as the problems worsen, with the resulting addition of harsh side effects adding to the problem of chronic ill health. While intelligent medical doctors realize that the patient should reduce medications and regain healthy function, they are not trained to help in this regard. The patient needs to understand the need for a full program of care and rehabilitation and take a proactive approach. This process doesn’t happen overnight.

The patient needs to know 2 things to proceed with getting well when confronted with difficult and complex pain and hypersensitivity syndromes. The first is basic information about what makes these symptoms described above occur in the body, and the second is a little information about the possible syndromes or diagnoses that are possible so that you may begin searching for a true diagnostic answer. You must keep in mind that the therapy for many of these syndromes is similar. For most, there is little effective drug or medication therapies that work, and no surgical approaches. Many medical manuals have recommended trigger point needling, myofascial release, physical therapies, stress reduction, cognitive and behavioral therapies, and positive changes in diet and lifestyle as the only alternative and suggest a multidisciplinary approach to treatment for most of these syndromes. This requires some time and work on the part of the patient, but it will pay off. Don’t delay this treatment protocol while you wait for a diagnosis and some miraculous cure. There may be a new effective and necessary treatment waiting for you, but for now, do all that you can to get healthy and continue to pursue correct diagnosis by seeing specialists and running tests.

The thing that you must avoid is unnecessary stress and worry, which will aggravate the nerve related condition. You must convince yourself that you will calmly proceed to understand your condition and do all the right things to heal. The M.D. will often suggest an anti-anxiety medication. There are healthier ways to calm anxiety, but if you must resort to these, try taking them for a short time and be sure to reduce dosage slowly as you go off of the medication.

One of the poorly understood disorders that is diagnosed to account for the symptoms described above is called Reflex Sympathetic Dystrophy. Like a number of diagnoses for difficult diseases, this name merely reflects what appears to be going on in the body rather than something objective that is specifically found wrong with the tissues or the chemistry. The National Institute of Arthritis and Musculoskeletal Skin Diseases of the National Institute of Health states: “Currently, little is known about the cause of this disorder, which leads to frequent misdiagnosis, and ultimately the condition is mistreated or goes untreated.” The term Reflex refers to the episodic nature of the symptoms that are triggered by a usually benign occurrence, such as cold air, light touch, abrasive clothing, or emotion. The term Sympathetic refers to the reflexive part of our nervous system that usually regulates overt responses to danger or excitement. The term Dystrophy refers to a loss of nutritive flow to the tissue, either by the nerve or blood vessels being obstructed or pinched, or because of a systemic metabolic or nerve related deficiency. The sympathetic nervous system is coupled with the parasympathetic nervous system in what we call the autonomic nervous system, which automatically runs everything in your body and is regulated in the brain and spinal cord, which is called the central nervous system, or CNS. When there is an imbalance between the sympathetic and parasympathetic nervous systems, we may see inappropriate responses and sensations in the body.

What causes these reflexive responses? It is known that chronic pain and myofascial syndromes may eventually cause autonomic nerve dysfunction. Myofascial refers to the muscle, myo, and the connective tissue, fascia, and the dysfunction involves constant neural firing due to sustained contracture and/or weakness. The sustained firing, rather than the normal firing and relaxation, may eventually cause the balance between the sympathetic and parasympathetic systems to go awry. The sympathetic nerve response in the muscles involves the constriction and dilation of the blood vessels. This is a reflex response which you have no conscious control over. When the vessels are suddenly constricted or dilated, there may be sudden pain response, as well as hypersensitivity and unusual nerve stimulation due to changes in swelling, temperature or the concentration of inflammatory chemicals. The sympathetic nerve response to the skin involves regulation of sweat or dryness, tightening and reaction of the hairs to stimulation.

Since the ultimate regulation of these nervous systems occurs in the part of the brain called the hypothalamus, there will be an attempt by the body to correct all of this nervous dysfunction. Often, the hypothalamus may struggle, because it is greatly affected by the emotional part of the brain, the limbic system, as well as the hormonal part of the brain, the endocrine system. The degree of complexity in understanding such brain dysfunction is enormous. There is a slight possibility that there is something wrong with the brain tissue itself, such as a tumor or scar tissue, but this is a rare occurrence. The specialist may initially schedule a brain CT scan to rule out such rare disorder, but you shouldn’t by overly alarmed by this test. It will almost always confirm that there is no problem with the brain tissue. Likewise, MRI tests of the spine may be prescribed. EMG tests of the peripheral nerve conduction may also be performed to narrow the diagnostic choices. A thermogram, bone scan, or a sympathetic block may be used to diagnose. There is no definitive objective way to diagnose, and so this evidence is used to support the diagnostic opinion.

While Reflex Sympathetic Dystrophy is the most likely cause of allodynia and other unusual symptoms, there are a few diagnoses that must be considered as possible causes also. Raynaud’s Syndrome involves a reaction to cold temperature with painful lack of circulation to the hands and forearms. Rheumatoid arthritis involves a sudden painful swelling hot pain to the hands. Thromboangitis obliterans involves the accumulation of small emboli in the smaller arteries, obstructing and diverting flow, resulting in episodic pain, sensitivity and numbness, usually at the thigh. Peripheral neuropathy may occur in specific limbs due to thoracic outlet syndrome, reaction to medication, diabetes, or a protein imbalance. Thoracic outlet syndrome is a common disorder of repetitive postural stress that holds the deep muscles of the neck and shoulder in constant contracture that decreases circulation to the extremities, and contributes to cervicobrachial lesions and neural impingement. Exposure to heavy metals and pesticides may eventually cause these symptoms also. The list is long, and these should be explored.

These disorders occur because of an accumulation of health problems combined with excess stress. The body only has energy to deal with so many problems. Often, the patient ignores the mounting problems and continues to work very hard, often with a growing problem of poor sleep and rest, and possibly an insufficient diet. Since the problems are chronic, the patient is often in denial. Chemical imbalances create a pattern of poor nerve and blood supply to the extremities and the body tries to counter with an excess nerve conduction. This results in a hypersensitivity reaction similar to the allergic response that is triggered by an unusual period of physiological stress.

The road back to health demands increased rest and attention to a number of types of therapies for awhile. Failure to adopt a wholehearted approach that is holistic will only hinder the recovery. A decision to change the diet and lifestyle, get frequent treatments, take all the necessary herbs and supplements, and not allow oneself to get anxious and depressed will result in success. You may not fully recover, but you will get to a state that is workable and allows you to go on with your productive life with the most minimal discomfort and debility possible. My experience is that every patient may achieve a full recovery if they work hard at it. Feel free to discuss these issues and facts with me at any time in the future, and I hope that you will allow me to guide your therapy and recovery.

Therapeutic approaches in Complex Regional Pain Syndromes and Hypersensitivity Disorders

Obviously, a short article on the web cannot address the complexities of therapy involved in this set of syndromes. Each type of syndrome must first be diagnosed correctly, and then each individual case must be treated according to the individual problems presented. This involves an integrated medical approach, where the patient is persistent with diagnostic tests and exams by the right specialists, and also persistent with seeking the right therapists. Often, the best diagnostic experts are not the physicians that offer the best therapies.

The knowledgeable Licensed Acupuncturist is able to provide a variety of therapies in a multidisciplinary approach, and work with M.D.s and other physicians to present both a wider diagnostic perspective, as well as an array of effective therapies that complement each other. The patient that takes a proactive approach and manages the integrative care will achieve the most success. This means that the patient becomes knowledgeable on the syndrome, is persistent with the proper diagnostic tests and exams, and obtains copies of these test results to present to various physicians with different specialties. The Complementary Medicine physicians may include the Licensed Acupuncturist, who may be able to combine various physiotherapies with expert herbal knowledge, nutrient therapies, acupuncture, and the time spent teaching the patient appropriate self-administered therapies and changes in diet and lifestyle. The treatment approach may be supported with the latest scientific study, where herbal and nutrient medical research has expanded immensely and is available on the internet.

Often, a variety of problems must be addresed in a coordinated manner. If there are a number of causative or aggravating factors perpetuating the chronic regional pain syndrome or hypersensitivity disorder, attention to only one factor will not stop the problem from continuing. Mechanical physical stresses must be relieved with myofascial release, soft tissue mobilization, and neuromuscular reeducation. Acupuncture stimulation may play an important role in this, as well as other aspects of the syndrome. Alone, the acupuncture may have limitations of benefit, but combined with the appropriate manual soft tissue therapies, the benefits may be dramatic. Likewise, herbal and nutrient medicine may contribute important mechanisms of therapeutic correction, but without the contribution of manual physiotherapies, the effects may be incomplete.

Chemicals in specific herbs are well documented, and the activities of these chemicals have been explored, and often confirmed in human clinical trials. Research continues to uncover specific physiological mechanisms related to the symptom causes, and connect these tissue and immune dysfunctions to specific herbal chemicals. The patient cannot be expected to understand all of the complexities of the physiology in research, but the Licensed Acupuncturist has received a thorough eduction in an approved medical college, and is able to understand the research and find the right herbal chemicals to achieve the necessary results. The United States government and the National Institutes of Health operate various research databases with this information, the most prominent being the PubMed database, which now comprises more than 19 million scientific study citations for biomedical articles published on MEDLINE and various medical and life science journals, as well as links to countless full-text articles on medical research.

An example of holistic protocol in the treatment of chronic regional pain syndrome; treatment of Sympathetic Reflex Dystrophy

One example of a syndrome in the category of chronic regional pain syndromes is reflex sympathetic dystrophy. The name reflects the mechanism of the problem, not the actual disease, or cause. Reflex refers to the fact that this is a nerve and vascular reflex to a stimuli, sympathetic refers to the autonomic nervous system, which is not consciously controlled, and is a balanced nervous system response where the sympathetic and parasympathetic nerve signals create a functional balance of organs, muscle responses, etc. Dystrophy refers to a malnutrition to tissues of blood nutrients and/or nerve signals. Modern medicine understands that this is a syndrome where normal physiological responses act relexively in a dysfunctional manner, and the tissues affected are denied normal blood nutrients and nerve stimuli. We still do not know the exact physiological cause, or causes, but we have observed that the syndrome often has on onset after strong trauma or physiological stress. The syndrome may vary from a severe debilitating upper extremity painful swelling and weakness, to an episodic lower extremity pain and numbness, and is usually accompanied by other autonomic nerve symptomology. Since this is a complex disorder, the treatment strategy in Complementary Medicine must address a more complex array of physiological problems to be successful. Since these various dysfunctions work together as a whole to create the symptoms, the physician cannot just address one dysfunction. This has been tried in allopathic medicine for decades with limited success.

Scientific study has identified that strong sensory sympathetic nerve stimuli to the central nervous system at the spinal cord creates a strong efferent, or exiting, response from the spinal cord to the affected limb. The nerves exhibit a supersensitivity that has probably occurred over long period of time, as well as a loss of autonomic nerve receptors, or denervation. The symptoms occur when these affected nerves are highly stimulated and release excess neurotransmitters at the nerve endings that sometimes stimulate drastic swelling and nerve ending hypersensitivity. A feedback mechanism may also affect the nervous system at the brain or spinal cord, causing an array of other symptoms and perpetuating the dysfunctional responses. Scientific study does show that excess catecholamines are released because potassium triggers an exagerrated dopamine response. Catecholamines are chemicals that may serve as neurotransmitters and hormones, and constantly are produced to regulate the nervous and endocrines responses. Adrenaline is an example of a catecholamine. Decreased catecholamines at nerve endings seem to stimulate a reflexive high release at the beginnings of the nerves, at the spinal cord.

This type of scientific study suggests a number of treatment approaches with herbal chemicals, nutrient medicines, acupuncture and even physiotherapy. Nerve supersensitivity implies that a myofascial syndrome existed prior to the onset of the reflex sympathetic dystrophy. Myofascial release and clearing of accumulated calcium ions and other oxidant stress at trigger points, and restoration of more normal muscular nerve flow will contribute to a correction of the syndrome. Various herbal chemicals block calcium pumps to decrease potassium stimulation, increase peripheral circulation, and thus normalize catecholamines at the spinal cord and peripheral nerve endings. Other herbal chemicals help normalize inflammatory responses that are involved in the dysfunction, and even more herbal chemicals can decrease specific enzyme activities associated with the abnormal inflammatory responses. A successful treatment in standard medicine in the past used an herbal chemical, reserpine, from Rauwolfia serpentina, to effectively decrease the cataecholamine response and decrease peripheral symptoms. Since herbs contain an array of chemicals, many more physiological responses can be achieved with the proper herbal formulas than with synthetic pharmaceuticals, which are created to have narrow responses in the body. Given the many areas of the body affected, a broad step-by-step approach is needed to restore normal functions. Acupuncture may have a broad array of beneficial effects, helping to regulate the autonomic nervous responses and balance the sympathetic and parasympathetic responses, to restore blood and nerve circulation via stimuation, to calm excess immune responses, and to calm the central nervous system.

Since a restoration of normal physiological response is needed on sympathetic reflex dystrophy, called a return of homeostasis, or homeostatic mechanisms, this array of treatments in Traditional Chinese Medicine is ideally suited to solve the problem. Restoration of homeostasis is the goal in TCM. Scientific study of disease mechanisms and matching to herbal chemical databases helps the physician to choose the right herbs and supplements to achieve an array of goals in this regard. The more access the TCM physician has to internet databases of medical research, the more application of herbal chemicals to specific physiological goals may be achieved. By combining an array of therapies in a protocol, the complex regional malfunction may be addressed in a holistic manner, so that various problems that work together can be addressed simultaneously. In this way, the physiological systems can be normalized and the autonomic reflex stopped and circulation restored via an array of therapies that work together in the treatment.

An added benefit to the TCM therapeutic protocol in Reflex Sympathetic Dystrophy is that the patient may need rehabilitation after the homeostatic mechanisms are restored. In severe cases there is muscle wasting, focal osteoporosis, and arthritic changes that need to be addressed. Allopathic medicine, with its focus on a narrow pharmaceutical approach, cannot deliver all of the therapy that the patient needs. What is needed is an integration of Complementary Medicine into the standard protocol, with the M.D. specialists utilizing these amazing therapeutic possibilities of TCM to achieve the best end goal for the patients.

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.