One of only a handful of physicians in the country who is board-certified in Family Medicine and Pain Medicine, Gary Kaplan, DO, author of Total Recovery and founder of The Kaplan Center for Integrative Medicine, was able to apply his pioneering perspective to help answer one of the most difficult questions plaguing our country: What is causing my pain?

Here are his main 8 key takeaways to consider when you're trying to figure out why your pain just won't go away.

1. Inflammation, part of the normal repair process, may have gone awry

Cytokines are chemical messengers secreted by the body. They have effects ranging from inciting nerve repair to causing inflammation. In the case of chronic pain, we know that the microglia, which are the innate immune system in the central nervous system, are "stuck" in a mode where they continue to excrete predominantly inflammatory cytokines. Under normal circumstances, microglia will shift from producing inflammatory cytokines to making anti-inflammatory cytokines and call in other cells to initiate the normal repair process.

Balance is restored by eliminating all of the factors that caused the microglia to get turned on in the inflammatory state and then doing things such as meditation, exercise, getting adequate sleep, and using things such as low-dose naltrexone (LDN) and tumeric to get the microglia to go back to their resting state.

2. Allergies can make your pain worse

Anything that incites an inflammatory response in the body has a potential to spill over into the brain and worsen the inflammation in the central nervous system, as with fibromyalgia. The allergies are not the cause of the fibro, but something that is further aggravating it.

3. Your diet can cause inflammation

I would start by thoroughly looking at your diet and make sure there is nothing still in your diet causing inflammation. I saw one woman who is a vegan, and it turned out she was allergic to blueberries. For ongoing inflammation in the brain, turmeric may be helpful.

4. Your fatigue may be a symptom. Don't ignore it

Sleep is not a thing, but rather a series of different brain waves divided into stages 2, 3, 4, and REM. People who are deficient in 3 to 4 sleep will present with chronic pain. If you have sleep apnea, where you stop breathing at night, it can cause chronic pain. If you have restless leg syndrome, it can also cause chronic pain. A proper evaluation of the quality and amount of sleep is necessary for anyone suffering from chronic pain and depression.

5. A migraine problem isn't just in your head–it's in your nervous system

Dehydration, alcohol, bright lights are all triggers that can cause migraines. The underlying cause of the migraine is an irritated nervous system. The nervous system is irritated because of an underlying inflammatory condition in the brain. The key to preventing migraines is to identify what it is that's causing the inflammation. I would start with an anti-inflammatory diet of rice, fish, chicken, fresh fruits, and vegetables.

6. Overlapping problems can come from the same source

Migraines and depression: Brain inflammation
The basis of both the migraines and depression is inflammation in the brain. I address this at length in my book, Total Recovery. Yes, the two are related and the cause of the inflammation needs to be identified.

Chronic pain and weight loss problems: Gut imbalance
One of the reasons that you may not be able to lose weight might be related to either food allergies or sensitivities or mold toxicity. We know that the composition of the bacteria in your gut has a very significant effect on your ability to lose or maintain weight. Skinny people have different gut flora than people who are overweight. If you have other symptoms, it's very likely you have a chronic inflammatory condition but the cause has not been discovered or addressed.

7. The underlying root cause may still need to be identified

Arthritis (…which isn't always arthritis)
Sometimes arthritis in knees and joints can be from Lyme disease, sometimes from rheumatoid arthritis, and sometimes from tendonitis. It can also be associated with food allergies and food sensitivities. The first issue is getting a clear diagnosis.

Complex regional pain syndrome
Also known as CRPS, it is a horrific pain condition. I see a number of patients who suffer from CRPS, and the solution can unfortunately be elusive. Again, it's important to try and understand what it is that has caused the nervous system to be so hyper-reactive. Get evaluated for Lyme disease and it's co-infections, celiac disease, gluten intolerance, and neurotoxins associated with mold, along with a number of other condition that I address in my book. I am familiar with Calmare therapy, and the research on it looks very exciting. While we do not do this therapy in our office, I have referred patients for this therapy. It is certainly worth the trial for anyone suffering from CRPS.

Tinnitus can be an extremely difficult problem to address and can be a result of multiple issues and not a single problem. Meditation and yoga are extremely effective in reducing inflammation, as is curcumin. You also need to identify the causes of the inflammation, such as the trace mineral imbalances, as well as eliminate anything that may be poisoning your system.

8. Your body may be more responsive to alternative therpaies

My mentor, Norm Shealy, MD, PhD, has been a pioneer in working with microcurrent therapy. He has reported very impressive success with a large number of pain conditions. We have not seen the same level of success in our patients, but we find that acupuncture can be extremely effective for a large number of pain conditions. But most commonly our treatments are layered, involving a number of therapeutic approaches, which works synergistically for a comprehensive solution. I also recommend meditation or yoga.

This article originally appeared on