“Education is the most powerful weapon which you can use to change the world.”
What’s New in Accurate Education
This page provides links to those areas on the website that have recently been updated, along with a brief description of each updated section including a reference to who may specially benefit from reviewing the section.
Dr. Ehlenberger has a new Youtube channeL: @EricEhlenbergerMD. In an effort to provide a medium of presenting educational materials that is more accessible and more appealing than the written word, I have begun the task of offering videos on each educational topic on this websites. The links to these videos will be posted at the beginning of each educational page and, of course, the available videos can be found on the home page of the @EricEhlenbergerMD Youtube channel.
To be notified of newly uploaded videos, please subscribe to my channel. You will not be bombarded with any ads. If one has requests for new videos on any particular topic, please post them.
“Soothe” BCP/PEA Topical Cream
This topical cream is new and contains both BCP and PEA, tow components is highly recommended as a trial for nerve pain,. joint and muscle pain and arthritis. Also, evidence suggests that the BCP in this cream may reduce the joint pain associated with cold weather (see below). BCP, or beta-caryophylline, is a substance found in many plants including black pepper and cannabis and has been shown to have many clinical benefits. PEA (palmitoylethanolamide) is a substance that has extensive research supporting its potential benefit for neuropathic pain as well as muscle and joint pain (See: PEA palmitoylethanolamide. Please review the above link for more information regarding BCP.
CBD/BCP Topical Cream
This topical cream with CBD and BCP is highly recommended as a trial for joint and muscle pain, arthritis and especially for those with rheumatoid arthritis. Also, evidence suggests that the BCP in this cream may reduce the joint pain associated with cold weather (see below). BCP, or beta-caryophylline, is a substance found in many plants including black pepper and cannabis and has been shown to have many clinical benefits. Please review the above link for more information regarding BCP. The clinical benefits of CBD are covered here.
The following website offers a $2 sample size: AliceCBD.com.
Topical Medications for Pain
Topically applied medications are important treatment options for those with both acute and chronic pain. This section provides the information needed to make informed decisions regarding OTC products as well as providing insight as to prescription medications recommended by a clinician.
Inversion therapy is a form of spinal traction achieved by hanging by the legs, ankles, or feet in an inverted angle or entirely upside down to achieve therapeutic benefits. It. Gravity boots or ankle supports are designed to support inversion therapy.
Sensitization – Central and Peripheral
Central and peripheral sensitization are very common but under-addressed processes that afflict a large portion of chronic pain patients suffering from chronic neck or back pain, migraine headaches, fibromyalgia and visceral organ pain (like pancreas or liver). These sensitization processes also impact conditions not specifically related to pain including anxiety, panic attacks and restless legs syndrome.
Additionally, central (CS) and peripheral sensitization (PS) contribute to the transition of acute to chronic pain, whereby the pain from an acute injury becomes chronic, despite resolution of the original injury initially triggering pain.
Knowledge of PS and CS is important to anyone that suffers from chronic pain. Understanding them will provide insights as to why pain becomes so severe but more importantly, understanding CS in particular may allow one to reduce further development of CS and possibly reduce the severity of existing central sensitivity.
What can you do about increased pain with cold weather?
Why do wild giant pandas frequently roll in horse manure?
This is a burning question that I know you need to be answered!
The answer lies in understanding “β‐caryophyllene“
Citicoline is a brain nutrient that supports mental energy, focus, attention, and overall cognitive health. This supplement is recommended for those with impaired or inefficient memory whether due to aging, underlying neurologic disorders such as stroke or Parkinsons or for those suffering from brain fog related to fibromyalgia or long haul COVID.
New Recommended Supplements
See: AIAO for a full account of these supplements. These supplements are now available at Rodriguez Pharmacy, downstairs from Accurate Clinic.
Carolina Cannabinoidsis offering a collection of 4 new supplements. These supplements are now available and are directed at treating three conditions:
- Current Pain – to reduce pain, as well as to reduce anxiety and facilitate sleep, with these benefits expected to be appreciated same day.
- Future Pain – to reduce pain in the weeks, months and years to come, by reducing neuroinflammation, the driving force that transitions and maintains acute pain to chronic pain and is responsible for the central sensitization that magnifies the experience of pain over time.
- Systemic Inflammation (SI) – to reduce the driving force, SI, behind the risk for developing the diseases associated with aging, including diabetes, fatty liver, heart attacks, strokes, Alzheimers and some forms of cancer.
The following are links to these aforementioned topics for further exploration; they will be developed further over the next few weeks.
The Anti-Inflammatory & Anti-Oxidants supplements are now offered in 4 formulations (CarolinaCannabinoids.US):
- Anti-Inflammatory & Anti-Oxidants only (product label)
- Anti-Inflammatory & Anti-Oxidants, an EnhancedBroad Spectrum CBD (2000 mg) – No THC (product label)
- Anti-Inflammatory & Anti-Oxidants, an EnhancedFull Spectrum THC/CBD (300/3000 mg)(product label)
- Anti-Inflammatory & Anti-Oxidants, an Enhanced Full Spectrum THC/CBD (450/3000 mg)(product label)
List of Ingredients and their Respective Benefits
Please be aware that the two products that contain THC may cause one to get “high,” impair judgement and/or cause sedation. Use of these products should not be started without first consulting with your physician regarding the safety concerns regarding the use of THC, including the potential for drug to drug interactions with other prescribed medications.
For more info on THC: THC (delta-9 THC)
And as a reminder, the oral supplements by Carolina Cannabinoids (below) contain large amounts of BCP and have been reported by my patients that they help with reducing cold weather-induced pain.
When the products become available, each product above will have a link to the Carolina Cannabinoids website for purchase. Also, Rodriguez Pharmacy downstairs from Accurate Clinic will carry them.
(Dr. Ehlenberger serves as an unpaid medical consultant for Carolina Cannabinoids, but please note that he receives no financial remuneration for sales of these products).
Acute-pain – Avoiding Transition to Chronic Pain
A section discussing the role of lidocaine in suppressing acute and chronic nerve pain and the transition of acute to chronic pain.
New Weight Loss Medications:
GLP-1 Receptor Agonists: Semaglutide (Wegovy) and Liraglutide (Saxenda)
A new class of medications offering substantial and sustained weight loss is gaining popular attention based on their effectiveness and safety
The Gut Microbiota (or Microbiome)
The gut microbiota is implicated in the pathophysiology of a wide range of physical and psychological disorders. The food and supplements industries have bombarded advertising and sales of food and supplement products promoting “prebiotics” and “probiotics” related to the gut microbiome. This section will review what is currently “known” in an effort to guide patients in this new therapeutic world.
Due to the frequent addition of new marijuana flower products available in Louisiana, the following is a list of the flyers for these products which can be referred to until full reviews of each product is available on the Flower Products page:
Opiates / Opioids
This introductory page offers a review of topics related to opioids including opioid dependence vs tolerance, opioid-induced hyperalgesia, long-acting vs. short acting opioid formulations, opioid potency and morphine equivalency and their context with overdose potential, comparing different opioids and synergy with opioids and other medications.
More than 50 new publications have been uploaded, offering a complete update on information pertaining to kratom – its potential benefits and dangers, insights on how it works, issues of kratom abuse and addiction, drug interactions and overviews regarding it current use in the United States.
Ever since the CDC published their 2016 guidelines for the management of chronic pain with special emphasis on the use of opioids, the problems related to opioids, drug overdoses and pain management have worsened, not improved. This worsening is largely due to the erroneous assumptions upon which the political responses were built and the misguided actions engaged by the regulatory agencies and medical institutions to correct the underlying problems. While efforts are currently being made to roll back the damages done, the pain management community of patients and clinicians continues to suffer the severe consequences of the politics of pain.
Politics of Pain – The Consequences
The education section regarding medical use of marijuana has been significantly updated, reorganized and restructured to make it easier to navigate to the information sought. Information sheets on the many new cannabis flower products can now be downloaded from the Flower section. Large sections have been split up and use of the link below offers an organized list of links to all marijuana-oriented pages:
Link to Marijuana Education Pages
Myofascial pain, arising from muscle and surrounding fascia tissues, is one of the most overlooked and ignored causes of chronic pain. Muscle and fascia both contain pain receptors that contribute to most if not all chronic, painful musculoskeletal conditions as well as visceral pain conditions including endometriosis, interstitial cystitis, irritable bowel syndrome, painful menstruation and prostatitis.
Why do wild giant pandas frequently roll in horse manure?
This is a burning question that I know you need to be answered!
The answer lies in understanding terpenes …
Read about “β‐caryophyllene“
Terpenes are an important pharmacologic class of constitutents found in marijuana plants that may play signifcant roles in the therapeutic benefits of medical marijuana plants and products. Understanding which terpenes offer which benefits allows an informed approach to selecting which marijuana product may be most helpful to an individual.
Cannabiniods are the dominant class of pharmacologically active constitutents with therapeutic potentia found in cannabis plants. The two most common and best understood cannabinoids are THC and CBD but other “minor” cannabinoids also contribute to the therapeutic benefits of cannabis.
The Endocannabinoid System
The Endocannabinoid System (ECS) is a communication network that is present throughout the brain, nervous system and the rest of the body that plays a role in many physiological processes. It is this system where many of the constituents found in marijuana impact their effects, especially THC. The ECS regulates many physiologic functions including gastrointestinal (GI) function, appetite and metabolism, memory, movement, immunity, and inflammation. The ECS is very important in pain and stress.
Gratitude, the Science
The use of the mind as a tool for improving the quality of one’s emotional, mental and physical well-being is of paramount importance for most everyone, but especially for those who struggle with chronic pain. The practice of gratitude is an extraordinarily simple and effective tool for improving one’s quality of life and learning simple practice methods can literally be life changing. It is highly recommended for all to read and explore. It only takes a few minutes.
This new section introduces a new, speculative form of therapy using light exposure for achieving therapeutic benefits including pain, The research is preliminary and thought provoking but may lead to effective, non-pharmacologic methods of treating pain.
Cold Weather & Pain
For those individuals who experience worsening of their pain associated with cold weather, this section discusses how this may occur and supplements that may offer some relief. Did you read about Why wild giant pandas frequently roll in horse manure?
Cannabis Use Disorder
Diet & Pain – An Overview
This section looks at the role of the food one eats and how it affects chronic pain.
Acute Pain – Initial Post-Injury
Acute Pain – Avoiding Transition to Chronic Pain
Acute Pain-The Transition of Acute Opioid Use to Chronic Opioid Use
Insomnia is a common problem affecting up to 50% of the population at least one night a week. It is especially problematic in patients with chronic pain. These two pages review management of insomnia including the use of Suvorexant (Belsomra), a relatively new sleep medication.
Irritable Bowel Syndrome (IBS)
IBS is one of the most common gastrointestinal diseases and is not uncommonly found in patients with chronic pain and central sensitization. Those patients with frequent abdominal pain or discomfort relieved by passing stool or release of gases along with altered bowel habits should familiarize themselves with this condition.
Central sensitization is an important mechanism contributing to the severity and persistence of chronic pain. Because the majority of chronic pain syndromes are susceptible to central sensitization, most chronic pain patients should understand the role of central sensitization and how to reduce its impact on the pain experience.
Updates on COVID vaccinations for those who remain hesitant or against vaccination:
- The truth about COVID-19 vaccines – Everything you need to know
- Your questions about the COVID-19 vaccine, answered
- Covid-19 vaccine myths
Accurate Clinic is open, post-hurricane Ida
These three new education sections are directed to those with acute pain conditions of less than 3 months duration. They review management options for treating acute pain with emphasis on reducing the risks for developing chronic pain and the chronic use of opioids.
- Acute Pain: Initial Post-Injury
- Acute Pain: Avoiding Transition to Chronic Pain
- Acute Pain Management: The Transition of Acute Opioid Use to Chronic Opioid Use
Fibromyalgia – CAM Treatment
Many new journal articles published in 2019-2021 have been added, including many that evaluate the role of diet in fibromyalgia pain.
Oxidative Stress, Pain and Disease
Multiple new recent articles evaluating the role of oxidative stress and pain. Oxidative stress is a condition underlying many disease processes including not only pain but vulnerability to the degenerative dieseases that impact ones health including diabetes, heart disease and cancer. Understanding oxidative stress can provide one with tools that may help one reduce the risk for these conditions and their severity.
Mast Cell Activation Disease (MCAD)
This is a new section that explores conditions associated with activation and dysregulation of mast cells, conditions once thought to be rare but now proposed to affect as many as 1 in 6 people. The increased pain associated with cold weather is related to mast cell activation. Conditions that may be impacted by mast cell activity include COVID-19, migraine headaches, fibromyalgia, connective tissue disorders such as rheumatoid arthritis (RA) and Lupus, asthma and irritable bowel syndrome (IBS). Mast cells have been linked to depression, anxiety and other mental health conditions. They may also be linked to Ehler Danlos Syndrome and interstitial cystitis (IC).
Who should read this section:
- Chronic pain patients who experience worsening pain with changes in weather, especially cold.
- Patients with conditions such as fibromyalgia, irritable bowel disease (IBS), interstitial cystitis or other conditions noted above.
- Patients with other conditions associated with multi-system symptoms not well diagnosed.
Key to Links:
- Grey text – handout
- Red text – another page on this website
- Blue text – Journal publication or outside website
Definitions and Terms Related to Pain