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Managing Pain in the Presence of Autoimmune Disease

One of the leading causes of death in female children and women in all age groups up to 65 years of age is autoimmune disease (AD).1 $100 billion per year is spent in the U.S. for AD-related care compared with $50 billion for all cancer care.1 Only $591 million is spent by the NIH on AD research compared to $6.1 billion spent on cancer research.1 The number-one most popular health topic requested by callers to the National Women’s Health Information Center is AD.1

ADs have classically been considered as multiple different disease states. However, AD could also be considered as one disease that can affect different body parts in different people. The term “polyautoimmunity” has been put forward to better describe this idea. This also helps to describe why, once a person is diagnosed with one AD, they are much more likely to be diagnosed with another AD or multiple ADs.

AD can present with many symptoms when the autoimmune process becomes active. Pain is a symptom that is extremely common in people with an AD and has a huge impact on quality of life. The medications that are typically used to combat AD and the associated pain may potentially contribute to worsening within the very organ systems contributing to the AD in the first place.2-5 Joint pain can be a primary symptom in many ADs such as rheumatoid arthritis and sacroiliitis. Because of the specificity in the body part attacked, antibodies can also attack voltage-gated potassium channels (VGKC).6 The attack on VGKC can cause a broad spectrum of neuronal hypersensitivity disorders. Pain may present in isolation or in association with other neurologic signs such as muscle cramps and twitching which can be regional or diffuse or even seizures.6

In Hashimoto’s thyroiditis, thyroid dysfunction can present with multiple signs and/or symptoms. As such, it has been referred to as “The Great Mimicker.”

Moreover, the biochemical and physiologic changes in the body that cause AD are the same changes that can lead to pain conditions that are not specifically AD pain. Fibromyalgia (FM) is not an AD, but a large percentage of people with an AD also have FM.7 Whereas 1-2% of the U.S. overall has FM, 20% of people with rheumatoid arthritis have FM.7 These changes in the body causing the AD also cause the FM-related pain.

In order to optimally treat the pain in someone with an AD, a better understanding of why the body starts to attack itself is required.

Etiology of AD and Immune System Dysregulation

Genetics and Terrain Plus Environmental Triggers

So how does a person develop an AD and the pain that goes with it? There appears to be some very specific circumstances that must occur in order to start the autoimmune process (Figure 6.1).

Genetics: We used to think that genes were hard wired and destined to be expressed. However, we have a much better understanding now of epigenetics and the effect of environment on genes being turned on or off. The Human Genome Project sought to sequence our genes, and with this information it was thought that all disease could be reversed or prevented by simply altering “bad genes.” However, after 10 years and nearly $3 billion, results thus far have found a few very rare genetic diseases (involving 50 to 100 people in the world) that could be totally reversed using this information.8 More important in the reversal of chronic disease is optimizing gene expression: turning on “good” genes and off “bad” genes. Seven to 8% of the human genome is consistent with viral DNA.910 Pieces of viral DNA have slowly but surely been incorporated into the human genome over time. The bulk of these were integrated during primate evolution. Subsequent mutations in these sequences have rendered older insertions nonfunctional, but some of the younger and more intact sequences have been linked to disease." These genes need to be shut down, as otherwise proteins will be produced that would make us sick. Many bad genes that need to be turned off are on the “X” chromosome.12 Because women have two copies and men only have one, this appears to be one of the reasons why women acquire more ADs than men.12 A close genetic relationship appears to exist among AD, explaining the clustering in individuals and families as well as a common pathway of disease.1

Terrain: The “terrain” in our bodies includes things like how we are eating, sleeping, exercising, and managing stress. How are our vitamin levels and mineral levels? How healthy is our gastrointestinal tract? Do we have chronic infections? Are we carrying a lot of environmental toxins or

internally generated toxic byproducts of metabolism because we can’t clear them effectively? How is the overall hormone balance?

I like to think of terrain like a backyard swimming pool and, ideally, a backyard swimming pool should have crystal clear water. On the other hand, that same backyard swimming pool could be covered in thick algae.

Environmental triggers: Once genetics come into play and the terrain is altered, the immune system has the potential to become dysfunctional enough to create an AD. All that now needs to occur to begin the AD is an environmental trigger. It is very challenging to be a human being as something always seems to be happening that is trying to derail us. We may not have slept well the night before. We caught the flu. A woman gives birth to her third child after a difficult pregnancy or delivery. You were in a car accident. You have just had a surgery. Someone you loved has just died. You got very sick on a trip out of the country. A lot of stress was happening at work or at home over a prolonged period of time. At times, people can tell you exactly what started the whole process that

eventually led to a diagnosis of an AD. “I have never felt well since____.” The blank can be filled

by “the birth of my third child,” “that car accident,” “the death of my mother,” “since I got travelers’ diarrhea on that trip,” “since all that stress surrounding my divorce,” etc.

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