Lyme Disease Pain

One of the most disabling symptoms for the patient with Lyme-MSIDS is chronic pain. Over the counter medications only provide minimal really. By the time they seei lyme aware physicians some of the patients are on high dose narcotics to control pain. These patients frequently have seen rheumatologists and, depending on the clinical presentation, they may have been told that they suffer from sero-negative rheumatoid arthritis or from a non-specific auto immune disease. They are then placed on steroids such as prednisone, or disease modifying antirheumatic drug regimens, such as methotrexate.  These agents might give temporary relief but can have significant side effects.Pain can be so debilitating that some people lose their ability to function in a meaningful and productive way. Many turned the pain management specialist, who then often prescribe multiple drug regimens to provide pain relief. Despite these physicians best attempts, patients may still have pain, and as the narcotics wear off, higher and higher doses are required to control and discomfort.-the end result is that pain sufferers and up on disability, and are unable to work or go to school.

Lyme disease can cause pain in every part of the body.  Although this pain may be limited to one of two areas, and be more or less constant, one particular hallmark of tick  areborne disease, and particularly Borrelia Bergdorferi , is that pain comes and goes and migrates.

This includes arthritis pain, myalgia’s (Muscle pain), and neuropathic pain (nerve pain),  all of which normally do not tend to migrate. In women the pain is also influenced by hormonal cycles, since women usually flare several days right before, during, and after the Menses.We can also suspect a tick-borne disorder when antibiotic use increases pain (From a Jarisch-Herxheimer reaction) or decreases pain. This will occasionally happen in patients treated for a unrelated bacterial infection such as sinusitis or urinary tract infection, who are unaware that they have lime disease.If pain is associated with multiple systemic symptoms, especially the ones listed in the Horowitz questionnaire, then it is quite likely that it is cause by lyme –MSIDS. A patient who just presents with neck pain or an isolated pain in a joint might simply have a herniated disk with neuropathy, or osteoarthritis.If the patient circles many of the symptoms on this sheet  one should suspected tick-borne disorder and order the appropriate tests. Establishing a proper pain aetiology can be difficult, because as we have seen above Lyme – MSIDS can mimic most common pain syndromes.

Simultaneously treating the three I’s of lyme disease-  infection inflammation and immune dysfunction may be the key to alleviating chronic pain. Finally inadequate phase I and phase  II liver detoxification, with inadequate production or over utilisation of glutathione, and the subsequent inability to remove Neuro toxins and cytokines often seen with lyme– MSIDS, will also result in pain. Many different medical problems that are listed on the MSIDS Map can cause pain, and may be contributing overlapping factors. Each of these different factors can increase free radical production and increase cytokines, and may need to be simultaneously addressed to achieve adequate pain control in both lyme– MSIDS and non-lyme– MSIDS.

These will include

1.  Detoxification problems
2.  endocrine abnormalities
3.  food allergies
4.  heavy metals and environmental toxins
5.  nutritional and enzyme deficiencies
6.  other infections including bacteria parasites viruses and opportunistic infections(Candida)
7.  sleep disorders

Psychological disorders may also increase discomfort, as the amygdala is the part of the brain deals with the emotions and pain sensation when patients suffer from depression and anxiety, their pain thresholds can be lowered, leading to increased perception of pain.

Early diagnosis and treatment are important to stop the progression of the Lyme disease. If untreated, the disease can result in neurological disorders such as peripheral neuropathy, including Bell’s palsy, as well as pain, numbness or weakness in the limbs. The onset of peripheral neuropathy typically develops weeks, months or years later, if the disease is left untreated.

While potentially serious, Lyme disease can be treated, especially in the early stages. It is important to take preventive measures when outdoors in areas known to have infected deer ticks. Some helpful steps include: wearing enclosed shoes and light colored clothing; checking clothing and exposed skin frequently for ticks; and using insect repellant containing DEET (Diethyl-meta-toluamide) on skin or clothes.

SYMPTOMS
(Not all symptoms and signs may be present.)

Lyme disease progresses in three stages of severity:

First Stage:
• Fatigue
• Fever and chills
• Muscle and joint pain
• Red circular rash
• Stiff neck
• Swollen lymph nodes

Second Stage:
• Facial paralysis (Bell’s palsy)
• Irregular heartbeat
• Meningitis (fever, stiff neck, severe headaches)
• Numbness and pain in arms and legs
• Stiff neck
• Poor coordination

Third Stage:
• Chronic arthritis and swelling in large joints, especially the knees
• Chronic pain in muscles
• Problems with sleeping
• Numbness and pain in arms and legs
• Nervous system problems
• Difficulty concentrating
• Memory loss
• Numbness and tingling
• Peripheral neuropathy
• Pain, numbness and tingling in limbs
• Paralysis of facial muscles (Bell’s palsy)

EVALUATION AND TESTS
(Not all evaluation and tests may be necessary.)

• Neurological exam
• Electromyography
• Nerve conduction velocity test
• Blood tests, including tests for antibody against the agent that causes Lyme disease and tests to detect the agent itself.

TREATMENT AND THERAPY
(Not all treatments and therapies may be indicated.)

• Antibiotics
• Intravenous therapy
For Bell’s palsy (facial paralysis)
• Eye drops for affected eye
• 
Medications such as steroids to reduce inflammation of nerve and decrease
• Surgery (in rare cases to improve appearance)
• Treatment of underlying inflammatory condition, if present

If experiencing weakness, pain, or inflammation (in limbs or knees)
• Ask your doctor about special therapeutic shoes or a knee brace (which may be covered by Medicare and other insurance)
• Take safety measures to compensate for loss of sensation
• 
Lyme disease is curable, if treated early

Lyme Pain treatment: see Lyme disease treatment.

Lyme Disease Numbness

Possible related medical conditions:

1.  Lyme disease
2.  Bartonella
3.  autoimmune disorders
4.  carpal or cubital tunnel  or any nerve entrapment syndrome
5.  diabetes
6.  hypothyroidism
7.  pregnancy
8.  heavy metal toxicity
9.  other environmental toxins
10.  vitamin deficiencies
11.  immune deficiency
12.  mitochondrial dysfunction
13.  MS
14.  strokes or TIAs
15.  anxiety with hyperventilation

Shifting numbness is a classic symptom of Lyme disease.

  • Mayo Clinic: Neurological problems. Weeks, months or even years after infection, you might develop inflammation of the membranes surrounding your brain (meningitis), temporary paralysis of one side of your face (Bell’s palsy), numbness or weakness in your limbs, and impaired muscle movement.
  • The Foundation for Peripheral Neuropathy:
    Early diagnosis and treatment are important to stop the progression of the disease. If untreated, the disease can result in neurological disorders such as peripheral neuropathy, including Bell’s palsy, as well as pain, numbness or weakness in the limbs. The onset of peripheral neuropathy typically develops weeks, months or years later, if the disease is left untreated.

    While potentially serious, Lyme disease can be treated, especially in the early stages. It is important to take preventive measures when outdoors in areas known to have infected deer ticks. Some helpful steps include: wearing enclosed shoes and light colored clothing; checking clothing and exposed skin frequently for ticks; and using insect repellant containing DEET (Diethyl-meta-toluamide) on skin or clothes.

    SYMPTOMS
    (Not all symptoms and signs may be present.)
    Lyme disease progresses in three stages of severity:

  • First Stage:
  • Fatigue
  • Fever and chills
  • Muscle and joint pain
  • Red circular rash
  • Stiff neck
  • Swollen lymph nodes
  • Second Stage:
  • Facial paralysis (Bell’s palsy)
  • Irregular heartbeat
  • Meningitis (fever, stiff neck, severe headaches)
  • Numbness and pain in arms and legs
  • Stiff neck
  • Poor coordination
  • Third Stage:
  • Chronic arthritis and swelling in large joints, especially the knees
  • Chronic pain in muscles
  • Problems with sleeping
  • Numbness and pain in arms and legs
  • Nervous system problems
  • Difficulty concentrating
  • Memory loss
  • Numbness and tingling
  • Peripheral neuropathy
  • Pain, numbness and tingling in limbs
  • Paralysis of facial muscles (Bell’s palsy)

    EVALUATION AND TESTS
    (Not all evaluation and tests may be necessary.)

  • Neurological exam
  • Electromyography
  • Nerve conduction velocity test
  • Blood tests, including tests for antibody against the agent that causes Lyme disease and tests to detect the agent itself.

    TREATMENT AND THERAPY
    (Not all treatments and therapies may be indicated.)

  • Antibiotics
  • Intravenous therapy

    For Bell’s palsy (facial paralysis)

  • Eye drops for affected eye
  • Medications such as steroids to reduce inflammation of nerve and decrease pain
  • Surgery (in rare cases to improve appearance)
  • Treatment of underlying inflammatory condition, if present

    If experiencing weakness, pain, or inflammation (in limbs or knees)

  • Ask your doctor about special therapeutic shoes or a knee brace (which may be covered by Medicare and other insurance)
  • Take safety measures to compensate for loss of sensation

    Lyme disease is curable, if treated early

Lyme Disease Co-Infections

Is it normal to be losing your memory as you get older? Is it normal to have an Alzheimer’s
epidemic affecting not only the United States and also the rest of the world? Or is it  possible that there are multiple etiologies at the root of these conditions? We find that the majority of lyme patients with co- infections have severe memory and concentration problems.

Evidence of the connection between infection and dementia can be found in a report from pathologist Dr Alan MacDonald who examined brain biopsies from the McLean hospital (an affiliate of Harvard University) data bank from patients with confirmed Alzheimer’s disease.

His PCR analysis show that 7/10 of these patients had the DNA of Borrelia Bergdorferi in their brain, the ETO logic agent of lyme disease. We also fine at The majority of our chronically ill patients with lyme disease and co- infections have been exposed to high levels of heavy meals, such as Mercury and lead, and occasionally to aluminium. These also can cause memory and concentration problems, and can cause the production of elevated levels of free radicals, which can increase inflammation.

Similarly we are exposed to hundreds of environmental chemicals every day that are fat-soluble and therefore are deposited in brain. These can and do affect cognitive processing. We have enough causes for an epidemic of dementia in the general population. Drugs prescribed for Alzheimer’s only slow down the cognitive decline. Horowitz has seen the improvements in cognitive functioning after treating these patients for chronic tick borne infections, by  detoxifying them of fat-soluble toxins with glutathione, by using oral chelation agents to remove mercury lead and aluminium, and by identifying and treating B12 deficiencies and/or hypothyroidism.Horowitz screened 50 lyme patients for co- are infections with Ehrlichia, Babesia microti, Mycoplasma, and Bartonella henselae. He reported that treatment with two drugs was better than treatment with one drug, especially where intracellular bugs are concerned.

Horowitz tests for a broad range of co-infections including different strains of babesiosis, Ehrlichia, Anaplasma, Bartonella, Rickettsial infections such as Rocky Mountain spotted fever, Q fever, and typhus, tularemia, Brucella, chlamydia pneumonia, Mycoplasma species, viruses such as EBV, CMV, HHV 6, and parasites such as toxoplasmosis.

And increase in neuropsychiatric symptoms also takes place when a patient has contract in co- infections, such as a babesiosis, where Babesia  you can exacerbate underlying lyme disease symptoms including depression.

Other co- infections also can influence psychiatric symptoms. Ehrlichiosis  can cause central nervous system symptoms, as can viruses and intracellular infections with Mycoplasma spp. And Chlamydia pneumonia,  which are frequently found in MSIDS patients.

Often the patients with the worst neurological symptoms have lyme disease,  mycoplasma and/ Bartonella simultaneously, with or without the other co- infections . Bartonella henselae,  organism that causes cat Scratch fever, exacerbates many of the neurological and neuropsychiatric symptoms we see with lyme disease, and has been linked to anxiety disorders and depression, as well as various central nervous system abnormalities.

These include encephalomyelitis ( involving inflammation in both the brain and spinal cord, leading to difficulties with cognition and motor function) ;  transverse myelitis(inflammation and demyelination  of the spinal cord, leaving to difficulty walking);  spastic para paresis(stiffness and spasm in the lower extremities, affecting walking); seizures with hemiparesis (Weakness on one side of the body); cerebellar syndromes (Primarily defined by symptoms of dizziness and poor balance) and movement disorders (which can cause a variety of symptoms, including spasms twitching and involuntary movements).

Bartonella  can also be transmitted to the foetus.  Therefore resistant neuropsychiatric symptoms in children might be linked to maternal transmission of the organism, and should be suspected of the patient is living in a lyme endemic area or has cats at home.

Some patients with Bartonella have other severe neurologic manifestations with a ophthalmologic involvement i.e.  inflammation VI manifesting as optic neuritis, episcleritis, conjunctivitis, uveitis or iritis.

Bartonella  can also cause an oculoglandular  syndrome with preauricular adenopathy and conjunctivitis, neuroretinitis, branch retinal artery occlusion and vision loss. Bartonella should therefore be considered when patients present with particularly severe opthalmological  symptoms.

If we look at the symptom complex used to define CFS, we see that the symptoms overlap those seeing in lyme disease and associated co-infections and it explains why lyme disease is frequently misdiagnosed. Apart from the results of a spinal tap, one of the primary differences is the symptoms of persistent lyme disease tend to come and go, fluctuating with good and bad days, and the symptoms tend to  migrate.

Lyme disease diagnosis

The first most essential tool for the medical detective is therefore compassion and proper motivation.

Most Lyme patients have a long history of chronic complex illnesses and bring a stack of medical records and a long list of complaints. By meticulously reviewing their records and using the Horowitz questionnaire we can ensure a proper history.

The Horowitz questionnaire also provides the opportunity to formulate the most probable differential diagnosis while interviewing the patient. Taking a history from these patients usually takes an hour.

It usually takes between two and three hours with each new patient to complete a social history, family history, and environmental exposure history and to review their symptoms,conduct a complete physical exam, and assessment, and devise a treatment plan.

This model is quite comprehensive in its scope, and it has the potential to lead to diagnosis and treatment in the shortest period of time while costing the health-care system the least amount of precious resources.

One of the essential problems with the current medical model is that doctors are taught in medical school that there is generally only one a areetiology for each illness. One implication of this model is that if a doctor can’t find a single answer to your host of problems, then they assert that the problem must be in your head, since the sophisticated laboratory tests and imaging studies in modern day clinics and hospitals surely are reliable and comprehensive.

The majority of Lyme patients generally do not have one sole cause for their symptoms. They often have an overlapping set of medical problems.

Horowitz identified sixteen likely categories of illnesses that can occur simultaneously with Lyme disease ‘Lyme-MSIDS’, or exacerbate the symptoms of other diseases that occur without Lyme disease (non-Lyme-MSIDS).

The difficulty in establishing a diagnosis is that Lyme disease can cause symptoms that are seen with each of these sixteen separate medical conditions. Lyme disease like its cousin syphilis, can mimic many illnesses commonly seen in modern day medical practice and exacerbate previous medical problems. For example, if you were always prone to headaches, you may begin to have migraines.

Laboratory Testing to diagnose Lyme disease:

According to the CDC surveillance case definition, late manifestations require laboratory confirmation. This may involve obtaining a positive culture for Borrelia burgdorferi from, blood, skin, a joint or cerebral spinal fluid, or by identifying antibodies to the bacterium in the CSF: the most common method, however, known as the two tier testing algorithm, uses a specific sequence of blood tests. The first is the ELISA, the second is a Western blot.

These are indirect tests of infection because instead of identifying the organism itself, they look for antibodies to Borrelia burgdorferi that were made by the immune system.

ELISA tests measure the total amount of anti Borrelia Bergdorferi antibodies present,   while Western blots identify individual antibodies  and look for specific proteins patterns that are unique to Borrelia.  If enough of Borrelia proteins are present the test is considered to be positive.The CDC points out that there are problems with testing, and that a patient with lime disease may not be diagnose using these criteria. The  presently  used two tiered testing missed 81% of the lyme cases,  especially when the patient did not have a Bullseye rash.One of the most comprehensive reviews of the standard lyme tests  comes from a 2005 Study at John’s  Hopkins University confirming the poor sensitivity of the ELISA.Another study published in 2007 in the British medical Journal by Ray Stricker MD found that the overall sensitivity of the combined Eliza Western blot  was only 56%.

Polymerase Chain Reaction (PCR),  a DNA test,  is an important diagnostic tool for patients who have negative blood tests, at Many require multiple samples over time, using specimens from different body compartments(Such as serum, aspirated joint fluid, synovial tissue, urine, cord blood, placenta, and/or spinal fluid),  and it must be performed at a reliable laboratory.  The PCR has an overall sensitivity of around 30% when any individual specimens, with a specificity of over 99% (It is highly specific for the disease, with a few false positive results).  New tests increased the sensitivity to 62% in early lyme disease.  Horowitz says that he may need to send off several sets of PCRs on blood or urine before getting back a positive result.

Other tick borne diseases such as the Babesia and Bartonella can be transmitted with the same tick bite the transmits lyme disease. These diseases complicated clinical  presentation often making the symptoms of lyme disease much worse.

Identifying multiple systemic infectious disease syndrome:

Horowitz created the differential diagnostic system as a roadmap for identifying multiple components of MSIDS. Health care providers finally have a single tool that organises the list of seemingly unrelated symptoms that a chronically your patient brings to the doctor.

Chronic inflammation lies at the heart of most chronic illnesses, and addressing the underlying causes of inflammation, using the MSIDS Map, has the potential to decrease inflammation and improve health.

The initial inflammation may have developed as a direct effect of lime disease and associated coinfections, or it could be a response to an over stimulated immune system, environmental toxins, food allergies, or an associated sleep disorder.

The MSIDS model  offers an intelligent and sensible path to help diminish the cost and the burden of disease for Lyme and associated co-infections. By not driving lyme patients to search relentlessly  and fruitlessly, year after year, for other diseases that might be responsible for symptoms, it provides the methodology for processing diagnosis and treatment options that can save millions of dollars annually.

MSIDS:  overlapping factors contributing to chronic illness

1. Lyme disease and co- infections

2.  Immune dysfunction

3.  inflammation

4.  environmental toxins

5.  functional medicine abnormalities with nutritional deficiencies

6.  mitochondrial dysfunction

7.  endocrine abnormalities

8.  neurodegenerative disorders

9.  neuropsychiatric disorders

10.  sleep disorders

11.  autonomic nervous system dysfunction and pots

12.  allergies

13.  gastrointestinal disorders

14.  liver dysfunction

15.  pain disorders/ addiction

16.  lack of exercise/ deconditioning

Horowitz on page 68 of his text describes the appropriate laboratory testing for medical conditions associated with his 16 point MSIDS Map.  This approach allows us to combine different intracellular medications simultaneously to maximise the effect and reduce possible side-effects.

Perhaps the patient has not gotten well because he/ she suffers from adrenal fatigue with  a low cortisol levels. This condition is quite commonly soon in patients with MSIDS. These patients may need adrenal supplements and/or hydrocortisone. Often we will see clinical improvements once a patient’s adrenal function is normalised.

Poor sleep can be the reason the patients fatigue and memory and concentration  problems processed. Or perhaps they have nutritional deficiencies in magnesium, iodine or zinc, which are needed for proper hormone production, detoxification and immune function.

Other possibilities include mitochondrial dysfunction from oxidative stress which has not been corrected, or perhaps they have a parasite that has not yet been discovered and are decondition from a lack of exercise, which could account for their ongoing fatigue.