Archive for the ‘Pain Management’ Category

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.


  • 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.




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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.

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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


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 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.


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.

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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.

1. Busch V, Magerl W, Kern U, Haas J, Hajak G, Eichhammer P. The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing–an experimental study. Pain Med. 2012;13(2):215-228. doi: 10.1111/j.1526-4637.2011.01243.x
2. Donta ST. Issues in the diagnosis and treatment of lyme disease. Open Neurol J. 2012;6:140-145. doi: 10.2174/1874205X01206010140
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
4. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of lyme disease. New England Journal of Medicine. 1990;323(21):1438-1444. doi: 10.1056/nejm199011223232102
5. Moon HJ, Seo JG, Park SP. Perceived stress in patients with migraine: a case-control study. J Headache Pain. 2017;18(1):73. doi: 10.1186/s10194-017-0780-8
6. Naik GS, Gaur GS, Pal GK. Effect of Modified Slow Breathing Exercise on Perceived Stress and Basal Cardiovascular Parameters. Int J Yoga. 2018;11(1):53-58. doi: 10.4103/ijoy.IJOY_41_16
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
10. Yablon LA, Mauskop A. Magnesium in headache. In: Vink R, Nechifor M, editors. Magnesium in the Central Nervous System [Internet]. Adelaide (AU): University of Adelaide Press; 2011. Available from:

Why Do Some People Develop Severe Lyme Arthritis & Others Don’t?

Why do some people develop severe Lyme arthritis and others don’t?

By Doug Dollemore, University of Utah

April 12, 2022

Janis J. Weis, PhD

Understanding how and why Lyme arthritis occurs has puzzled scientists for decades. In a step toward unraveling this mystery, University of Utah Health researchers report they have discovered a new genetic pathway that could help explain why some individuals have more severe Lyme disease arthritis than others.

They say the finding, based on laboratory experiments and animal studies, could eventually lead to new and improved treatments for the condition.

“The association of severe Lyme arthritis with a heightened presence of interferon, an important regulator of the autoimmune response, suggests the genetic pathway we identified could offer important new insights into how interferon regulation impacts the onset and progression of Lyme disease and other human diseases associated with elevated interferon,” says Janis J. Weis, PhD, the study’s corresponding author and a professor of pathology in the Division of Microbiology and Immunology at U of U Health.

The study appears in PLOS Pathogens.

Previously, scientists found that interferon plays a role in the onset of Lyme arthritis. However, because of interferon’s vital role in the immune system, directly inhibiting its activity would leave the body vulnerable to a host of viral infections.

Genetic pathways

To get around this problem, Weis and Jinze Li, a graduate student in her lab, decided to take a closer look at the genetic pathways that lead to interferon production.

In studies of laboratory mouse cells, they found that Borrelia burgdorferi, the bacteria that causes Lyme disease, uses a protein called p19ARF to help regulate interferon production. They also determined that the p19ARF pathway is more active in mouse strains with severe Lyme arthritis. If this is also true in people, it could help explain why some patients with Lyme arthritis have more severe symptoms than others.

“We know that some variation in the symptoms of Lyme arthritis is caused by genetic properties of the bacteria itself,” Li says. “But this study illuminates the importance of genetic differences in the hosts.”

To test this theory, Weis and Li dampened the activity of the p19ARF genetic pathway in one set of laboratory mice while inducing elevated activity of it in other mice. The animals with elevated p19ARF genetic activity developed more severe symptoms of Lyme arthritis.

Weis says that this pathway appears to be exclusively set in motion by bacteria. Thus, it is possible that therapeutic interventions could one day relieve or prevent Lyme arthritis without disrupting interferon’s key role in preventing viral infections.

PRESS RELEASE SOURCE: University of Utah Health



Having to go down the Lyme arthritis road myself, I’ve discovered a few things:

  1. Diet can have a huge impact.  Gluten was my problem, but never appeared to be a problem before.  Removing it has made all the difference. I’m not celiac.  Some also struggle with dairy or the nightshade plants.  Do an elimination diet to determine if these things can help you.
  2. Supplements can really help.
    1. MSM & DMSO
    2. LDN
    3. CBD
    4. Staying hydrated with water
    5. Niacinamide, please see Dr. Saul’s website for many other articles
    6. Vitamin C
    7. Various laser therapies
    8. Systemic or proteolytic enzymes

If you are willing to spend $50, you may want to read a brief testimonial from someone who used  “The Arthritis Strategy” by Shelly Manning.  While I have not used it myself, it appears to be sound advice – although as always “buyer beware.”  It’s always wise to run things by your LLMD to make sure.  What’s nice about this is it’s about a month long strategy that will educate you fairly quickly on the things you can tangibly do yourself that could make a world of difference.  Sometimes it’s overwhelming to attack all these issues on your own.  With this strategy, you will have someone who has been there, giving you advice that worked for them.

For more:

Dear Lyme Warrior Help! Lyme Disease and Mood Swings, Epstein-Barr Virus, and Body Aches

Dear Lyme Warrior…Help! Lyme disease and Mood Swings, Epstein-Barr Virus, and Body Aches.

Every few months, Jennifer Crystal devotes a column to answering your questions. Below she answers some that she’s recently received. Do you have a question for Jennifer? If so, email her at
Were your moods always shifting with Lyme disease?

Lyme disease can cause anxiety and depression as well as other psychiatric issues, so certainly mood swings are not uncommon. In his book Lyme Disease: Medical Myopia and the Hidden Global Pandemic, psychiatrist Bernard Raxlen, M.D. describes patients who were “ordinarily upbeat, optimistic, outgoing, socially engaged and level-headed” experiencing a “personality shift” and becoming “irritable, disagreeable, withdrawn, antisocial and up-tight.” [i] Some Lyme disease patients feel that they become an entirely different person.

I generally kept my demeanor, but I certainly had mood swings much more easily than I did when I was healthy. I remember laughing in a buffet line with my sister, when suddenly I got cranky and snapped at her. “Whoa,” she said. “Why the sudden mood shift?” There could have been several explanations that probably were not mutually exclusive. It’s possible that my blood sugar dropped; one of my other tick-borne illnesses, babesiosis, causes hypoglycemia. I also may have run out of energy; the tank can fall to empty unexpectedly for Lyme patients, and when it does, there’s nothing left to give. The shift may also just have been indicative of the way tick-borne illnesses were affecting my brain.

Now that I am in remission, my moods are more stable, thanks to diminished infection in my body as well as medication for anxiety and depression. I get sad easily when I’m overtired, but that usually improves after a good night’s sleep. I do sometimes still get “Lyme rage”—going  from 0 to 60 very quickly when something small goes wrong—but again, this happens almost exclusively when my tank is on empty. Getting appropriate rest, pacing myself, keeping my infections at bay, and utilizing talk therapy and medication all have helped me stabilize my moods.

You mentioned you also had Epstein-Barr virus in addition to tick-borne illnesses. How did you get it under control?

Epstein-Barr virus (EBV) is the virus that causes mononucleosis. People who have infectious mononucleosis keep Epstein-Barr antibodies forever, but for most, the infection becomes dormant. For those struggling with compromised immune systems or other infections, however, Epstein Barr virus can either remain active after mononucleosis or get reactivated during times of stress. As I explain in my “Reactivated Infections: A Possible Piece of the Chronic Illness Puzzle” post, my own case of mono slipped into chronic active Epstein-Barr virus, leaving me bedridden for two years, because I didn’t realize my body was wrestling underlying tick-borne infections.

Many Lyme disease patients have high Epstein Barr titers for similar reasons—their immune systems are too overtaxed to adequately fight both tick-borne illness and EBV. Researchers are also newly discovering how EBV can actually cause other diseases, such as a recently discovered link between EBV and Multiple Sclerosis (MS).

No matter how Lyme disease and EBV are related, patients just want to relieve suffering from both. For me, this relief was concurrent. Once I adequately treated my tick-borne illnesses, my fatigue—caused by both the tick-borne illnesses and EBV—got much better.

In addition to antibiotics, anti-inflammatories, and anti-malarials for my tick-borne illnesses, my doctor also put me on a number of vitamins and supplements to help boost my immune system. These included Transfer Factors. It’s important to remember that what works for one patient might not work for another. There is no set protocol for treating tick-borne illness or EBV. Your LLMD, and perhaps your PCP, need to look at biomarkers to see how your immune system is functioning overall, what nutrients you might be missing, and what you may need to reduce your viral and bacterial loads.

Adjunct therapies like integrative manual therapy and neurofeedback helped with the impacts of all of my illnesses. Most importantly, EBV required rest, rest, and more rest. And as I also note in my “Reactivated Infections: A Possible Piece of the Chronic Illness Puzzle” post, my EBV is in remission, but it can flare up if I’m not careful. Talk to your doctors to see how you can get your own EBV under control.

When you had aches and pains with Lyme disease, did they extend into your quads? How about into your calves? Did the pain move around?

Yes! Something that sets Lyme disease pain apart from the pain of, say Rheumatoid Arthritis, is that it is migratory. You might feel it in your left elbow one day, and your right knee the next. Lyme is an inflammatory disease, and inflammation can happen anywhere in the body. You can feel pain in your joints as well as your muscles and bones. If you are experiencing this type of moving pain and have not yet seen a Lyme Literate Medical Doctor (LLMD) to determine if the pain might be caused by tick-borne illness, I encourage you to do so!

 [i] Raxlen, Bernard, M.D. with Cashel, Allie. Lyme Disease: Medical Myopia and the Hidden Global Pandemic. London: Hammersmith Health Books, 2019 (21).

Opinions expressed by contributors are their own. Jennifer Crystal is a writer and educator in Boston. Her work has appeared in local and national publications including Harvard Health Publishing and The Boston Globe. As a GLA columnist for over six years, her work on has received mention in publications such as The New Yorker,, CQ Researcher, and Jennifer is a patient advocate who has dealt with chronic illness, including Lyme and other tick-borne infections. Her memoir about her medical journey is forthcoming. Contact her via email below.


Lyme Disease: An Underdiagnosed Cause of Mono-Arthritis?

Lyme disease: An underdiagnosed cause of mono-arthritis?


Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 26-year-old man who was diagnosed with mono-arthritis after his clinical evaluation overlooked the possibility of Lyme disease.

The case was described by Marcelis and colleagues in a paper entitled “Lyme disease: A probably underdiagnosed cause of Mono-arthritis.”1

A 26-year-old man presented with acute knee pain. He recalled having similar knee pain occurring one year prior when he began walking for extended periods of time.

A magnetic resonance imaging (MRI) of the knee revealed a large joint effusion. He was not diagnosed or treated for Lyme disease.

Four months later, he had a follow-up MRI, which showed again a persistent joint effusion with diffuse enhancement, thickening of the synovium, enlarged lymph nodes in the popliteal fossa and enhancement of the soleus muscle.

He was subsequently evaluated again for acute knee pain that had been present for several days.  On further questioning, the 26-year-old man recalled a history of serologically confirmed Lyme disease.

“The combination of synovitis, lymphadenopathy in the popliteal fossa, and serology led to the diagnosis of Lyme mono-arthritis,” wrote the authors.

“Mono- and oligoarthritis is one of the most common manifestations [of Lyme disease], mostly affecting the knee, although the hip, ankle, elbow, and wrist may be affected.”

There was no evidence of septic arthritis.  The authors highlighted the need for a careful clinical history to avoid overlooking Lyme disease.

The following questions are addressed in this Podcast episode:

  1. What is synovitis?
  2. What is Lyme arthritis?
  3. What is septic arthritis?
  4. What manifestations of Lyme disease are there?
  5. Why is timely treatment of Lyme disease important?
  6. Could the treatment delay have been avoided?
  7. What are the therapeutic options?

READ MORE: Causes of treatment delays for Lyme disease

Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook page and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

  1. Marcelis S, Vanhoenacker F. Lyme Disease: A Probably Underdiagnosed Cause of Mono-Arthritis. J Belg Soc Radiol. 2021;105(1):80. doi:10.5334/jbsr.2625



I fully intend to write an article on Lyme arthritis and various helpful treatments in the future but for now I’ll share what I’m personally doing and learning (briefly, it’s always conplicated!).

For more: