Archive for the ‘Pain Management’ Category

Good News For Pain Patients & Their Physicians From the U.S. Supreme Court

https://www.paintreatmentdirectory.com/posts/good-news-for-pain-patients-and-their-physicians-from-the-u-s-supreme-court

Good News for Pain Patients and Their Physicians from the U.S. Supreme Court

Good News for Pain Patients and Their Physicians from the U.S. Supreme Court

7/4/22

In a rare unanimous decision, the U.S. Supreme Court recently held that a physician who writes opioid prescriptions for their pain patients is not committing a criminal act. This will hopefully put an end to physicians refusing to treat pain patients due to fear of criminal prosecution.

History of Prosecution of Physicians for Opioid Prescribing

For over two decades the U.S. Drug Enforcement Agency (DEA) has been selectively raiding the offices of physicians who were writing prescriptions for high doses of opioids, seizing their records and assets, and charging them as drug dealers under the Controlled Substances Act (CSA). While a few of these doctors may have been operating pill mills, writing prescriptions or directly selling opioids to recreational users or drug addicts, most were engaging in the legitimate practice of medicine. They were prescribing opioids to help their pain patients manage their pain.

These targeted physicians lost their licenses, life savings and livelihoods, and many ended up in prison, some for terms of 20 years or longer. This has had a chilling effect on other physicians, many of whom abruptly discontinued or abruptly tapered their opioid-dependent patients off their opioids or abandoned them altogether. The practice became much more common after the CDC published opioid prescribing guidelines in 2016 with recommended dosage and duration limits.

This abrupt reduction in opioid prescriptions caused great suffering for pain patients, throwing them into horrific withdrawal and left them with no way to manage their pain. These patients were shunned by other doctors who were afraid to take them on. Some patients committed suicide; others turned to more dangerous street drugs. The rest suffered more and had reduced functionality and quality of life.

The Supreme Court Decision on Prosecution of Opioid-Prescribing Physicians

A unanimous decision of the U.S. Supreme Court issued on June 27, 2022, in the combined cases of Ruan v United States and Kahn v United States may finally put an end to these egregious practices. The Supreme Court held:

“the Government must prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner.

Previously the standard of proof being used was a preponderance of evidence, a lower bar that the justices found unsuitable given the harsh sentences that were possible under the CSA. Also, previously the defense that doctors were acting in good faith to help their pain patients as authorized by their licenses was not accepted by the lower courts.

This is not a “get out of jail free card” for Ruan or Kahn. Their cases are being referred back to the lower courts for review or retrial under the new standards. The same holds true for any other physicians currently serving time for similar charges. It remains to be seen at what point other physicians will feel reassured and feel safe to prescribe opioids again.

One Prosecuted Physician Who Has Been Documenting the Abuses

I recently spoke with Linda Cheek, a retired family practice physician who operates a website, www.doctorsofcourage.org, that tracks cases of physicians charged with opioid drug crimes. Her website currently lists over 1800 physicians who’ve been targeted and the outcomes of their cases. Dr. Cheek was herself charged under the CSA and spent 26 months in prison as a result.

At the time Dr. Cheek was arrested, she was in solo practice as a family practice physician in Virginia. She practiced integrative medicine, combining alternative treatments, including homeopathy and prolotherapy, to treat the root causes of her patients’ pain. She was prescribing opioids as needed until her patients’ pain levels decreased and she could safely taper them off their medication. (As an aside, I first met Dr. Cheek at an integrative pain management conference.)

Dr. Cheek reported that one day 20 law enforcement agents unexpectedly raided her office on the pretext of Medicare/Medicaid fraud and later charged her with drug crimes under the Controlled Substances Act. This is a common tactic, reports Cheek, as almost anyone can be found on a technicality to have committed Medicare/Medicaid fraud. Although Dr. Cheek has completed her prison sentence, her license to practice medicine is still revoked.

According to Dr. Cheek, doctors, particularly minority doctors, who practice alone, have been the primary targets of these arrests. This is because these doctors do not have large institutions to back them up as physicians do who practice in hospital or other large healthcare settings.

What Happens Next

It remains to be seen what will happen to Ruan and Kahn when their cases go back to the lower courts and what will happen with other doctors who have been prosecuted under the CSA. It will most likely take a while for physicians who treat pain to be reassured that they are no longer at legal risk for using tools they are authorized to use to help their patients, but this Supreme Court decision is at least one step in the right direction.

The Bottom Line

As long-time readers of my blog know, I am not a fan of opioids for pain relief. I believe there are safer and more effective options. However, most physicians are not educated in alternative treatments for pain and those that are find that most of their patients cannot afford to access alternatives due to lack of insurance coverage. Criminalization of opioid prescribing for pain has resulted in significant harm to patients and their physicians and the sooner this stops the better. Patients and their doctors need education about and affordable access to alternative care and the ability to voluntarily taper if and when other methods relieve or eliminate their pain.

Find an Alternative Pain Treatment Provider

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The author, Cindy Perlin, is a Licensed Clinical Social Worker, certified biofeedback practitioner and chronic pain survivor. She is the founder and CEO and the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free. She’s located in the Albany, NY area, where she has been helping people improve their health and emotional well-being for over 28 years. See her provider profile HERE. She is available for both in-office and virtual consultations. 

Non-Funded Study Shows LDN is a Broad-Spectrum Analgesic

https://www.futuremedicine.com/doi/10.2217/pmt-2021-0122

Low-dose naltrexone, an opioid-receptor antagonist, is a broad-spectrum analgesic: a retrospective cohort study

Samuel J Martin, Heath B McAnally, Paul Okediji and Moshe Rogosnitzky

Published Online:https://doi.org/10.2217/pmt-2021-0122

Aim: To evaluate the use of low-dose naltrexone (LDN) as a broad-spectrum analgesic. Methods: Retrospective cohort study from a single pain management practice using data from 2014 to 2020. Thirty-six patients using LDN for ≥2 months were matched to 42 controls. Pain scores were assessed at initial visit and at most recent/final documented visit using a 10-point scale. Results: Cases reported significantly greater pain reduction (-37.8%) than controls (-4.3%; p < 0.001). Whole sample multivariate modeling predicts 33% pain reduction with LDN, with number needed to treat (for 50% pain reduction) of 3.2. Patients with neuropathic pain appeared to benefit even more than those with ‘nociceptive’/inflammatory pain. Conclusion: LDN is effective in a variety of chronic pain states, likely mediated by TLR-4 antagonism.

Plain language summary

Naltrexone has historically been used to treat various substance use disorders, but recent discoveries have sparked interest in using low-dose naltrexone (LDN) to manage chronic pain. This study compared pain levels reported by patients before and after at least 2 months of LDN treatment to those reported by patients with the same painful diseases, who did not take LDN. Overall, patients who took LDN reported significantly more pain relief than patients who did not take LDN. How LDN alleviates pain seems complex, but apparently involves an anti-inflammatory effect on cells in the brain and spinal cord. LDN is extraordinarily safe, with no known risks (unlike most standard pain medications), and should be studied more in the treatment of chronic pain.

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**Comment**

And this has been our personal findings as well.

I wish more offices did this internal research.  The data is all there begging to be collected, organized, and published.  This is a perfect example of how we can get answers without  corrupt, conflict riddled research institutions, government, and government collecting (bought out) researchers.

For more on this:  https://madisonarealymesupportgroup.com/2022/06/29/the-urgent-need-to-break-the-public-health-monopoly/

For more on LDN:

Case Report: Severe Back Pain in Child Caused by Lyme Disease

https://www.sciencedirect.com/science/article/abs/pii/S0735675722002297?via%3Dihub

Radiculoneuritis due to Lyme disease in a North American child

https://doi.org/10.1016/j.ajem.2022.03.063Get rights and content

Highlights

  • Peripheral nerve pain can be a presentation of early disseminated Lyme disease
  • Isolated neuroradiculits from Lyme is rare but important to recognize and treat
  • Patients with painful radiculitis should be tested for Borrelia infection

Abstract

Lyme disease is the most frequently reported vector-borne illness in the United States. It is caused by infection with Borrelia burgdorferi via the bite of an infected blacklegged tick (Ixodes spp.) Lyme disease has three stages: early localized, early disseminated, and late. Early disseminated Lyme disease may include neurologic manifestations such as cranial nerve palsy, meningitis, and radicular pain (also called radiculoneuritis). Isolated radiculoneuritis is a rare presentation of early disseminated Lyme disease and is likely underrecognized. We report a case of isolated Lyme radiculoneuritis in a child in Massachusetts characterized by fever and allodynia of the upper back that was treated in the emergency department. Laboratory investigation demonstrated elevated inflammatory markers and positive Lyme testing. Magnetic resonance imaging with gadolinium contrast revealed nerve root enhancement in C5-C6 and C6-C7. The symptoms resolved with oral doxycycline. Neuropathic pain should raise suspicion for neurologic manifestations of Lyme disease in North America even in the absence of meningitis and cranial nerve palsy. We report how timely recognition of this rare syndrome in North America is important and may prevent progression to late disease.

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**Comment**

Again, this is not a “rare” syndrome, but is just “rarely” reported.  Big diff.  The authors even state that this syndrome is “likely underrecognized.”

Anti-Inflammatory Drugs Increase Likelihood of Chronic Pain

https://www.paintreatmentdirectory.com/posts/anti-inflammatory-drugs-increase-likelihood-of-chronic-pain

Anti-Inflammatory Drugs Increase Likelihood of Chronic Pain

Anti-Inflammatory Drugs Increase Likelihood of Chronic Pain

Please see link for article.

SUMMARY:

  • Researchers from Montreal found those who became pain-free had an early inflammatory response that activated neutrophils (white blood cell that fights infection).
  • Those who developed chronic pain had did not have this inflammatory response and lacked these neutrophils.
  • The researchers had similar findings in patients with TMD.
  • The researchers than studied mice:
    • mice given the steroid dexamethasone or the NSAID diclofenac had pain duration that lasted 10 times longer.
      • When these mice were given an injection of neutrophils or associated proteins it prevented the development of long-lasting pain.
    • mice given gabapentin, morphine and lidocaine did not experience this duration of pain.
  • A UK study in 500,000 people with acute low back pain found those who took NSAIDs were nearly twice as likely to still have pain 2-6 years later than those that took anti-inflammatories.
  • NSAIDS have risks including heart attacks, strokes, GI bleeding, kidney damage and suppression of immunity. Risks increase after just a week or two of use.
  • Use of opioids also increases the likelihood for chronic pain, and 10-12% will develop an addiction causing overdoses and deaths. They also suppress the immune system.
  • Cannabinoids found in marijuana and hemp; however, are potent natural anti-inflammaories that have been used safely for thousands of years.
  • Omega 3 fatty acids are also natural and help the body move through inflammation rather than suppress it. Fish oil, a source of omega-3 fatty acids, is more effective in treating arthritis than pharmaceutical anti-inflammatory drugs.
  • Homeopathy has also been used successfully, and similarly helps the body produce a more robust healing response to pain rather than suppressing it.
  • Numerous herbs have been identified that are anti-inflammatory without the serious side effects of NSAIDs. These include curcumin (turmeric), white willow bark, pycnogenol, boswellia, resveratrol, cat’s claw and others.
  • Red and infrared light (low level or cold laser) therapy or photobiomodulation has also been shown to have anti-inflammatory and pain relieving effects without any adverse effects.

FIND ALTERNATIVE PAIN TREATMENT PROVIDERS

FIND NATURAL PAIN RELIEF PRODUCTS

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For more:

Lyme & Headaches: Natural Relief for the 5 Most Common Causes

https://rawlsmd.com/health-articles/lyme-headaches-natural-relief-for-the-5-most-common-causes

by Jenny Menzel, H.C.
Posted 3/17/22

Take a look at just about every ailment in medical literature, and there’s a good chance you’ll see “headache” listed as a possible symptom, but not all headaches are a result of underlying illness. Most people who get occasional headaches will pop an over-the-counter pain reliever and carry on, but it’s not always that simple for those battling chronic Lyme disease.

Lyme-induced headaches can be constant and debilitating, disrupting everyday tasks that can often be taken for granted — like walking the dog, making breakfast for the kids, or going to work. These symptoms can be so severe that getting out of bed to shower might be the day’s largest accomplishment, with modern headache medicine often unable to supply relief.

old age, health problem, vision and people concept - close up of Asian senior woman  sitting on sofa and having headache at home.She may had Headache Symptoms.She looks pain  and sick

Approximately 80% of children and 50% of adults get Lyme-related headaches, with roughly 17% experiencing at least moderate migraines. Many continue suffering through the pain for months to years with little reprieve. Plus, added to the emotional stress of managing chronic headache pain is the maze of trying to figure out what triggered it in the first place.

So why does Lyme disease cause headaches? And what can you do to find lasting relief? If you’ve been struggling for a while with Lyme and the headaches that often accompany this complex illness, consider whether the following might be contributing factors for you. Although some people might stumble upon a quick fix, that’s probably not the norm for most, so you may have to be persistent in your healing efforts before noticing changes.

5 Lyme Headache Causes and Solutions

various microbes icons

Cause 1: Untreated Microbes

A common misperception about microbes is that they’re generally bad and should be killed. However, our bodies house trillions of helpful microorganisms, which outnumber our own cells by about 10 to 1 and account for up to 3% of our body weight. They’re essential to maintaining homeostasis and balancing our body’s microbiome.

But this balance can be upset when Borrelia burgdorferi, the bacteria that causes Lyme, and coinfections, including bartonella, babesia, and mycoplasma, among others, proliferate throughout the body. The result? They may entrench themselves into places like the brain, kicking up a storm of headache-causing neuroinflammation as the body tries its best to corral the stealth pathogens.

herbal supplement bottle and capsule icon

Solution: Suppress Microbes with Antimicrobial Herbs

To make some progress, you may need to focus on long-term ways to suppress harmful microbes. Herbal antimicrobials may not be as potent outright as traditional antibiotics, but they can combat bacteria over an extended period of time without disrupting the microbiome or the toxicity that can come with aggressive drug therapies. Herbs also boost immunity and tame inflammation — typically not something antibiotics have a flair for. Top herbal choices include:

  • Andrographis: Andrographis has a longstanding history of medicinal use in India, and it contains antibacterial, antiviral, and antiparasitic properties. It also has immune-enhancing, cardioprotective, and liver-protective qualities.
  • Cat’s claw: Native to the Amazon region, cat’s claw contains antimicrobial properties and is a foundational herb in most Lyme disease protocols. Additionally, it has immune-modulating and anti-inflammatory qualities.
  • Japanese knotweed: Japanese knotweed with resveratrol has been used for centuries in traditional Asian medicine, and it’s a potent antioxidant with antimicrobial and anti-inflammatory properties. The herb may also assist in combating bartonella.
  • Chinese skullcap: As a multi-purpose herb, Chinese skullcap has antimicrobial properties, decreases cytokines, and supports immunity. It works well with other herbal remedies to enhance their effectiveness.
  • Sarsaparilla: The root of sarsaparilla has been used throughout the tropics for inflammatory conditions of the skin, connective tissues, and the bowel. It binds to and helps dispose of endotoxins that are released from microbes during die-off.

image split between andrographis, cats claw, japanese knotweed, chinese skullcap, and sarsaparilla

Exciting research published in Frontiers adds credence to the use of plant extracts to combat persistent infections. Japanese knotweed, in particular, offered superior protection against a wide range of microbes by busting biofilms and crossing the blood-brain barrier, where Lyme can impact different regions in the brain and potentially produce headaches. Other herbs that showed antimicrobial properties were black walnut, sweet wormwood, Mediterranean rockrose, and cryptolepis, and they were capable of outperforming common Lyme-fighting antibiotics like doxycycline.

If you’re new to herbal therapy, working with a well-trained, Lyme-literate practitioner or doctor can help you find the right blend of antimicrobial herbs to reduce the frequency and intensity of your Lyme headaches.

flame or inflammation icon

Cause 2: Herxheimer Reactions

Herxheimer reactions (usually referred to as a herx or herxing) can occur within days of starting or increasing dosages in your Lyme protocol. And while plant-based antimicrobials are gentler on the body than antibiotics, they still effectively kill bacteria, which means they’re not exempt from causing herx reactions, including headaches, due to pathogenic die-off.

When these microscopic bugs are attacked and killed, pieces of dead bacteria called endotoxins can create an inflammatory autoimmune-like response. If you find your headaches increase after introducing any form of antimicrobial agents to your system, it may be a sign that you’re not expelling endotoxins fast enough.

icon of water drop with circling arrow

Solution: Detoxify Your Body

Getting your organs of elimination (colon, skin, liver, kidneys, lymph, and lungs) opened up and operating optimally is at the core of minimizing herx reactions, and there are many ways to detox and expel inflammatory endotoxins to improve head pain:

Clean Your Pipes

Constipation is a sign of hampered digestion, keeping toxins stuck in your body and recirculating when they need to get out. Eating a whole-food diet full of fibrous fruits and veggies supports a healthy gut microbiome and increases your ability to export toxins. If diet alone isn’t doing the trick, natural remedies like castor oil packs on the belly, professional colonics, or supplementing with magnesium may keep things flowing.

Sweat It Out

Sweating through your body’s largest elimination organ, the skin, is imperative to ejecting toxins. Exercise is a great way to induce sweat but not necessarily when you’re in the throes of a Lyme headache or migraine. If you’re feeling too depleted for exercise, far-infrared (FIR) saunas, red light therapy, or heating pads can raise your body temperature and spark a toxin-removing sweat session while honoring your need for rest.

Support Your Liver

Your liver works hard to filter toxic waste from the blood and breakdown harmful substances in the body — support it with N-acetyl cysteine (NAC), a valuable antioxidant and glutathione precursor which helps reduce inflammatory cytokines, protect nerve tissues, and combat the toxins that may trigger migraines. One study found that NAC helps reduce the frequency of monthly headaches when combined with vitamins C and E as a preventative measure.

Manage Your Lymph Fluid

Much like the circulatory system carries nutrient-rich blood into our cells for nourishment, the lymphatic system has a similar network of vessels that carries waste away from those same cells, helping us stay healthy by fighting infection. However, there’s one major difference: Our hearts automatically pump blood, whereas our lymphatic system has no such pump and requires the action of your muscles and respiratory system to keep it moving. Manage your lymph fluid by exercising, dry brushing your skin, and adequately hydrating to help your body remove toxic waste.

Be Mindful of Your Breath

Deep breathing has displayed a number of detoxifying effects on the body by reducing stress and circulating lymph. Evidence also shows deep breathing can alter the perception of pain by modulating the sympathetic nervous system through relaxation. A breathing technique that can help your body’s ability to rest and digest is the down-regulated breath, which involves slowing your breathing down to four breaths (or less) per minute.

How to practice down-regulated breathing: In a seated or resting position, slowly inhale through your nose for a count of eight, raising your belly and then your lungs. Hold for a bit at the top of the breath. Then, exhale through your nose while deflating your belly and lungs for a count of eight.

Practice this for a few rounds until you feel yourself relaxing. Because of the strong parasympathetic response, this breath is best done after a meal, before bed, or any time you feel anxious (never while driving). It may take time to reach a full eight counts on each inhale and exhale, but with practice, you’ll find your rhythm.

icon of fork and knife

Cause 3: Food Sensitivities

True food allergies and intolerances are hard to miss and can even be life-threatening in some cases. But for many with Lyme, subtle food sensitivities form slowly and go undetected as a result of leaky gut syndrome — an inflammatory condition caused by intestinal permeability, usually due to long-lived gut imbalances from infections, prolonged antibiotic use, poor diet, and stress. Indeed, many people can pinpoint specific foods that bring on headaches and migraines, but what can be done about it?

stomach icon

Solution: Work on Gut Health

While nixing the offending foods should be at the top of the to-do list to minimize headaches, healing your gut is also a priority so that you don’t have to avoid these foods forever. Demulcent herbs like slippery elm can rebuild the mucosa in your gut lining, while digestive enzymes aid in breaking down the food you eat. The abundant amino acid L-glutamine shows ample ability to increase the tight junction proteins needed for a strong intestinal wall. Additionally, bitter herbs like dandelion and burdock will also take a load off the liver to assist digestion.

icon of two different pills

Cause 4: Medications

Headaches are a side effect of some antibiotics. Those with chronic Lyme disease have often tried a range of antibiotic interventions, making it difficult to tell if the headaches stem from medication use or the illness itself. What’s more, in an effort to cope with head pain or migraines, the overuse of certain pain-relieving medications often end up doing the opposite of their intended design: Instead of alleviating headaches, they wind up causing them.

herbal supplement bottle icon

Solution: Seek Natural Pain Relief

Magnesium

Research suggests that different forms of magnesium, the crucial mineral responsible for over 300 biochemical reactions in the body, has promising potential for migraine relief, with intravenous (IV) magnesium sulphate offering the most impressive results. But if IV magnesium isn’t realistic every time you have a Lyme-related headache, supplementing it may be beneficial for you. However, not all magnesium is created equal. For example, inexpensive magnesium oxide isn’t readily absorbed by the body and may cause loose stools and stomach upset. Instead, opt for such bioavailable forms as magnesium glycinate or liposomal magnesium, the form of the mineral most able to cross the blood-brain barrier.

Biofeedback

Biofeedback is a non-invasive way to gain greater awareness and control over certain body functions, and it’s proven itself as a useful tool to reduce migraines as well. As a matter of fact, a study published in Behavioral and Brain Functions found migraine frequency and symptom severity were cut in half for up to 70% in the study participants.

The average sustained results lasted around 14.5 months after therapies were discontinued — and one of three biofeedback therapies used in the trial, hemoencephalography (HEG), was considered to be a superior migraine management tool compared to other biofeedback options. Plus, when administered by a trained professional (like a healthcare provider), most insurance carriers often cover biofeedback sessions.

Curcumin

This primary anti-inflammatory compound found in the spice turmeric has been attributed to providing potent pain relief, according to one study in the International Journal of Preventive Medicine. Curcumin has proven its power to reduce the severity, frequency, and duration of headache and migraine symptoms by targeting the same NF-kB and COX pathways as aspirin and ibuprofen, thereby regulating pain and inflammation known to cause migraine headaches.

lightning bolts for stress icon

Cause 5: Chronic Stress

It’s a safe bet that if we were to dig to the root of all illness, some form of physical, mental, or emotional stress could be found. In fact, according to a study published in The Journal of Headache and Pain, perceived stress is the most common trigger of chronic migraines. There are proven ways to modulate our body’s stress response, but finding the methods that work best for you is what matters most — as it should be something you can maintain long enough to experience the benefits.

calming waves icon

Solution: Calm Your Nervous System

Learning to self-soothe in stressful situations can go a long way toward curbing headaches. However, if you feel like you’ve tried everything to get rid of them, get back to the basics with a stress-reducing, mind-body practice, where you can be in control. But don’t let this be one more thing on your to-do list that stresses you out, too. Keep it simple by choosing one practice you feel curious about, start slow, and be consistent. Some mind-body options to consider include:

Managing these five causes can go a long way toward warding off future headaches and migraines caused by Lyme (and life). And while it may seem overwhelming to keep up with it all, investing time and effort into just a few of these solutions will eventually pay off. Keep at it, even if relief isn’t felt overnight. It can and often does get better.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.

You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.

REFERENCES
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3. Feng J, Leone J, Schweig S, Zhang Y. Evaluation of natural and botanical medicines for activity against growing and non-growing forms of B. Burgdorferi. Frontiers in Medicine. 2020;7. doi: 10.3389/fmed.2020.00006
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7. Rao R, Samak G. Role of Glutamine in Protection of Intestinal Epithelial Tight Junctions. J Epithel Biol Pharmacol. 2012;5(Suppl 1-M7):47-54. doi: 10.2174/1875044301205010047
8. Rebman AW, Bechtold KT, Yang T, et al. The clinical, symptom, and quality-of-life characterization of a well-defined group of patients with Posttreatment Lyme disease syndrome. Frontiers in Medicine. 2017;4. doi: 10.3389/fmed.2017.00224
9. Visser EJ, Drummond PD, Lee-Visser JLA. Reduction in Migraine and Headache Frequency and Intensity With Combined Antioxidant Prophylaxis (N-acetylcysteine, Vitamin E, and Vitamin C): A Randomized Sham-Controlled Pilot Study. Pain Pract. 2020;20(7):737-747. doi: 10.1111/papr.12902
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