Seriously Rethinking Chronic Pain

One of the great things about my forays away from mainstream medicine is that some breakthroughs give me unexpected insights into other areas. 


It’s the gift that keeps on giving. 


It’s the bonus question on an elementary school test that gives you 106%. (That was a paradigm shift for me as a kid: you can be more than 100% correct?  Righteous!)

I have been pursuing Ritchie Shoemaker’s work on Chronic Inflammatory Response Syndrome (CIRS) with vigor. His research into mold and biotoxin-related chronic health problems may help me solve other intractable problems in my practice.


The human body has evolved to have counterbalancing mechanisms. There are two opposing sides of our nervous system, the sympathetic that revs us up and parasympathetic that settles things down. There is a neurotransmitter glutamate that is like the accelerator in a car and GABA that is the brake. The body is continuously balancing clotting and bleeding. Much of health involves these intricate mechanisms of homeostasis.


Part of the cascade of effects in CIRS involves chronic inflammation. (This can be seen through elevation of levels like C4a and C3a.) Perhaps the primary reason why patients with CIRS have chronic pain is that the normal anti-inflammatory mechanisms are blunted or suppressed. (This can be seen through abnormally low blood levels of VIP, alpha-MSH and others.)


For the CIRS patient, any source of pain will typically be experienced as more intense and more long-lasting than it would be otherwise. The pain does not seem to make sense if viewed in a non-CIRS context.

Every doctor’s office in America has a subset of patients who complain of pain that is out of proportion. The patient may think they have a low pain threshold, whatever that means. The provider may worry that the patient is a malingerer, complainer or drug seeker.

Might some significant percentage of those with chronic pain that is difficult to manage have CIRS? Perhaps they don’t have CIRS, but the same underlying mechanisms are in play. They have chronic inflammation without the counterbalancing mechanisms that reduce inflammation.

Because Shoemaker’s work is so evidence-based and quantifiable, this question would be relatively easy to answer. Bill and Melinda Gates where are you? Won’t someone put up the resources to answer this basic question? Wouldn’t it be better to figure out why people are in so much pain, than assume they are all drug-seeking losers with nothing better to do than ruin a doctor’s day. 

Maybe some percentage of the drug seekers who are addicted to opiates started with this fundamental problem. Maybe the issue is more complicated than we think and perhaps there are better approaches just waiting to be found.

Andrew Lenhardt, MD

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