Pain Doctor: No Need to Suffer. Pain Center of Orlando

Splenius Capitis Syndrome: Muscle Tension Headache

 

David S. Klein, MD, FACA, FACPM

 

Headache is one of the most prevalent of all complaints that might bring a patient to seek medical attention. Diagnostic evaluation of the patient may be simple or comprehensive, dictated by the clinical situation and patient presentation.  Statistically, however, the most common etiology of headache is found to be muscle tension in nature.

 

While the diagnosis of muscle tension headache might suffice for most circumstances, unless the clinician locates the precise physical site of the ‘pain generator,’ the chances of successful treatment are slim.  On the other hand, treatment is likely to be successful, if diagnosis is refined from the generic ‘muscle tension headache,’ to the more specific diagnosis.   

 

The most common cause of muscle tension headache (MTH) results from inflammatory changes at the site of muscular attachment on the occipital ridge.  In the adult, this occurs most often at the attachment of the Splenius Capitis and Semispinalis Capitis Muscles.  As inflammation develops, entrapment and irritation of Greater Occipital Nerve results. The typical symptom complex results from muscle spasm as well as from neuralgia.

 

Occipital neuralgia results in a distinct type of pain that is most commonly characterized by piercing, throbbing, or lancinating  pain in the upper neck, back of the head, and behind the eyes  Most commonly the problem is unilateral and because pain in the eye is typical, the mis-diagnosis of ‘migraine’ is made. The pain of Splenius Capitis Syndrome (SCS) begins in the neck and then spreads cephalad with referred pain behind the eye.    Anatomic variation is the rule, rather than the exception, and clinical presentations will therefore vary. 

 

The pain is caused by inflammation, irritation or injury to the nerves that inntervate the nerve, called the nervi nervorum.  Muscular spasm results in a second pain constellation. Interestingly, the pain of muscle spasm and the pain that results from the neuralgia need not occur simultaneously and the nature of the pain will, therefore, change from episode to episode, adding to clinical confusion.

 

Causes of Splenius Capitis Syndrome result of trauma to the back of the head, pinching of the nerves by overly tight neck muscles, and compression of the nerve as it leaves the spine due to osteoarthritis.    Localized inflammation or infection can result in SCS, although this is quite rare.  It is possible that it can be caused by diabetes (mononeuritis multiplex), and blood vessel inflammation (vasculitis).  Clearly, the most frequent cause is postural, that is, from prolonged periods of keeping the head in a downward, rotated and forward position. The muscle tension results in micro trauma to the muscular attachment, swelling ensues, and myalgia/neuralgia result.  In many cases, however, no precipitant cause can be found. 

Symptom Complex

 

w        Occipital & Shoulder Pain

w        Pain behind the eyes

–        Awaken with pain

w        Pain looking up.

w        Pain looking down, particularly with rotation.

w        “Migraine” diagnosis is common.

w        Worse with menses, ovulation & salt load.

w        Anticipate sleep disorder.

 

 

Causes of Splenius Capitis Syndrome

 

w        Trauma of a rotational nature

w        Blunt Trauma, pugilism

w        Flexion/Extension injury

w        Vigorous Cervical Manipulation

w        Surgery

–        Dental chair

–        Mastoid Surgery

 

 

The causes of SCS can be quite distant from the site of pain.  That is, postural problems can result from foot pathology, ankle, knee and hip problems that result in muscular dystony.  As occurs in other species, such as the horse physical problems in the lower extremity can cause physical changes in the axial skeleton. Postural pathology can result from an arthritic toe or heel spur, resulting in contralateral hip pain, and same-sided headache.

 

Injection is performed in a short series, that is, once or twice with pain relief lasting from a few weeks to many months.  Skillful injection technique results in the most satisfactory results, and concurrent use of common anti-inflammatories speed recovery, particularly when combined with a low-dose diuretic. Muscle relaxant or anti-convulsants, dosed at bed time provide relief of the neuralgia and side effects are minimized by the bed-time administration.

 

If exacerbation of pain is triggered by ovulation or dietary salt-load, routine or periodic administration of a mild diuretic is worthwhile.    

 

 David Stephen Klein, MD, FACA, FACPM

Pain Center of Orlando, Inc.                                          407-679-3337

225 W. SR 434 Suite #205  Longwood, Florida  32750

www.suffernomore.com                   www.stages-of-life.com

Nutritional Conditioning, Stretch and Prevention of Muscular Injury

Nutritional Conditioning, Stretch and Prevention of Muscular Injury

 

It is well known that stretch is necessary to prevent sports-related muscular injury.  What is less well appreciated is what additional steps must be taken to minimize trauma to muscle, tendon and connective tissues.

 

A warm up is intended to raise body temperature, increase blood flow, and permit time to focus on the physical challenge to come.  The time investment required is rather individual.  The length of time required will increase with the age of the athlete.  Younger athletes may require as little as 15 to 20 minutes, the  time investment will increase to as much as 45 minutes for more mature participants.  The warm up begins with systematic stretch of the extremities and torso, and should precede cardio challenge.  A gradual warm up will increase range of motion, permit muscular stretch, prior to challenging aerobic performance.

A satisfactory warm up will result in a 2 to 3 degree rise in body temperature.  This rise in body temperature reflects an increase in metabolic rate, and can be expected to last 30 to 45 minutes after exercise ceases. The degree of temperature rise reflects hormonal status, thyroid function and level of conditioning. 

The increase in temperature results in dilation of the peripheral vasculature, resulting in increased blood flow to the muscles, connective tissue and joints.  The increase in temperature should increase flexibility of the joints and connective tissues.  The intention, of course, is to reduce the risk of injury to joint, muscle and tendon. 

Nutritional conditioning is another matter, entirely. The athlete can influence blood flow to the muscles, increase toxin wash-out, and improve stamina by selecting nutraceutical supplementation. Every athlete has a preferred dietary protein and calorie regimen, and it is well beyond the scope of this brief article to opine as to the relative benefits and risks of different approaches.  There are interventions that can be taken irrespective of the individual preferences, beliefs and intentions.

Enhancing Blood Flow

After eliminating discussion of protein and carbohydrate loading, consideration should be given to enhancing muscular stamina through modulation of regional blood flow, capillary resistance and anti-oxidant reserve. 

Blood flow can be enhanced by decreasing blood viscosity (thinning the blood), opening the microvasculature thereby tempering the effects of lactic acid accumulation, the net effect will be an increase in blood flow and an increase in oxygen delivery to muscle tissue. This can be accomplished with selective use of fish oil products and/or olive oil.  Only the highest quality fish oil should be used due to mercury contamination and fish protein intolerance.  A ‘concentrated’ fish oil is generally distilled, and this removes mercury and most fish protein.  The concentrated fish oil should be taken, at a minimum, of 2 grams twice daily.  Alternatively, one ounce of olive oil, preferably taken in a ‘shot glass’ followed by fruit juice of choice.

Small vessel dilation can be accomplished with hawthorn berry extract, vinpocetin and huperzine.  Taken in combination, these nutraceuticals dilate small vessels through blocking the phosphodiesterase (PDE) receptors in various organs and tissues.

Huperzine 100 mcg, combined with vinpocetin 20-40 mg and hawthorne berry extract 450-600 mg daily.

Anti-Oxidants for Improved Stamina

Clever use of anti oxidants can improve muscular function and improve stamina.  These anti-oxidants are not necessarily widely recognized but they are widely available.  Alpha lipoic acid, taken 250 mg four times daily, combined with taurine 500 mg twice daily will provide an anti-oxidant reserve that will increase muscular stamina and endurance.   

Conclusion

Muscular endurance and athletic stamina can be enhanced through the thoughtful use of nutraceuticals that increase microvascular blood flow, decrease blood viscosity and enhance anti-oxidant reserve.

Applicable to most nutritional regimens, the addition of a few easily specific nutraceuticals can provide noticeable improvement in performance and comfort.

 

David S. Klein, MD, FACA, FACPM, FAAMIMS

Pain Center of Orlando, Inc.

225 W. SR 434 Suite #205

Longwood, Florida 32779

407-679-3337

www.suffernomore.com

www.stages-of-life.com

Dr. Klein has practice pain medicine for the past 25 years and is the author of over 50 published articles and textbook chapters.  He has lectured extensively both nationally and internationally.

Curcumin and Curcuminoids in the Treatment of Inflammatory Bowel Diseases

Curcumin and Curcuminoids in the Treatment of Inflammatory Bowel Diseases Including Crohn's Disease and Ulcerative Colitis

Curcumin inhibits a number of enzymes that are involved  in the synthesis of inflammatory chemical modulators. Curcumin has been recognized as an anti-inflammatory agent as well as a pain reliever.  Research studies have demonstrated that the anti-inflammatory activity of curcumin is comparable in strength to steroidal and non-steroidal prescription medications. 

TNF-alpha elevation is an important component of the inflammatory process,  involved in the pathogenesis of many inflammatory disorders, including Crohn's Disease, Irritable Bowel, rheumatoid and lupus.

Curcumin, a flavonoid from the herb turmeric is a well studies known inhibitor of TNF-alpha. Studies have demonstrated that TNF-alpha increased intestinal permeability and curcumin inhibited the NFkappa Beta- induced-TNF-alpha-stimulated increase in intestinal 'leakiness.'

Curcumin inhibits several of the cytokines and genes involved in the pathogenesis of inflammatory bowel disease, and curcumin down regulates or shuts down the production of  several pro-inflammatory prostaglandins and leukotrienes. 

Inflammation results from a complex cascade of chemical changes that are triggered by  responses to tissue damage.  Chronic inflammation leads to degenerative conditions like arthritis, arteriosclerosis, etc. 

The rate, route and amount of administration of curcumin will depend entirely on the gender, age and other disease states that may exist in a patient.  Curcumin is very inexpensive, but it must be taken properly for it to be most effective.  We keep it in the office for our patients, but it is in our catalogue, as well. 

Follow this link:  CURCUMIN

Please feel free to pass this note along.  Inflammatory bowel diseases, auto-immune disorders and many chronic pain problems can be treated with this agent.

For more information:  Pain Center of Orlando   www.suffernomore.com

dsklein@earthlink.net

David S. Klein, MD, FACA, FACPM

Hypothyroidism- The silent epidemic

Hypothyroidism: The Silent Epidemic

Hypothyroidism can be loosely defined as a medical condition that results from the under-secretion of Thyroid Hormone. The difficulty with this traditional approach to diagnosis of hypothyroidism is that it relies on ‘normal values,’ or reference ranges that are defined by the population itself. It has been estimated that as many as 50 million American suffer from undiagnosed hypothyroidism.

Fact #1: Thyroid hormone is necessary to maintain basal metabolic rate, or the amount of fuel that is consumed to sustain health. The manifestation is that of temperature.

a. When a person is generating too little thyroid hormone, or if the individual has an imbalance that involves thyroid metabolism, body temperatures will fall.

b. These persons may be told that they ‘normally have low temperatures.’

c. This bit of nonsense is causing tremendous problems for society.

d. The result is weight gain, depression and elevations in cholesterol levels.

Fact #2: The traditional approach to the diagnosis of hypothyroidism involves measurement of a hormone released by the pituitary gland, TSH. If the central nervous system senses that there is inadequate thyroid hormone in the blood stream, TSH levels will increase. Increase in TSH should lead to increases in the release of Thyroid Hormone from the Thyroid Gland. As levels of Thyroid Hormone reach adequate levels, TSH release decreases.

Problem #1: Unfortunately, a lot can go wrong between the brain, pituitary gland and the thyroid gland, itself. Inadequate levels of thyroid hormone can persist, and the brain will ‘reset’ to new and lower levels of this hormone. Factors that can cause this include:

1. chronic stress

2. pregnancy

3. trauma

4. chronic disease states.

5. autoimmune conditions

6. fasting or famine conditions.

As TSH levels drop back to normal, the diagnosis of hypothyroidism becomes more difficult, if all the practitioner relies upon is the TSH level. Unfortunately, this is the case more times than not.

Problem #2: Thyroid Hormone does not work alone. It requires adequate levels of estradiol, estrone, progesterone, testosterone, cortisol, insulin, DHEA and a host of other hormones, peptides, fatty acids and humoral elements. If any one of these necessary pieces are missing, out of balance, or in excess, thyroid hormone may not work properly, leading to a state of ‘functional hypothyroidism.’

TSH levels, thyroid hormone levels are ‘normal,’ but the body does not function properly and resembles the hypothyroid condition.

Problem #3: Thyroid Hormone replacement may be inadequate or improper for the patient. That is, not all thyroid replacement works for all patients. There are chemicals in some of the commercially available thyroid preparations that cause all manners of problems. One such substance is ‘Acacia,’ which is a family of shrubs and trees, and portions of this plant are used in some medications to provide form and shape to tablets. Lactose is also used in the most popular of the Thyroid Replacement Hormones. Not only is Lactose an allergic trigger for people with lactose intolerance, but it may actually block the absorption of the thyroid replacement, itself. Signs of lactose intolerance include nausea, cramps, bloating, gas, and diarrhea.

It is very common to hear patients tell the doctor that the thyroid medicine that they are receiving is ‘making me sicker.’ Unfortunately, the practitioner does not often make the effort to figure out why this might be the case.

Problem #4: Certain foods make thyroid conditions worse. Patients with auto-immune disorders may be more sensitive to soy-protein than other persons. Soy contains two chemicals that inhibit an important enzyme that is necessary for thyroid hormone replacement. If a person is already ‘on the edge,’ taking soy protein can make the condition worse. To a lesser extent, peanuts, pinto beans do this, as well.

Recommendations:

1. In order to sort through the diagnosis of thyroid related problems, it is important to determine not only the levels of thyroid hormones and TSH, but it is important to determine the presence of antibodies to the binding protein and converting enzymes.

2. If you suspect that you have hypothyroidism, it is necessary to cease eating anything that contains soy, soy lecithin, peanuts and pinto beans.

3. Replacement of thyroid hormone should be accomplished with products that do not contain lactose, Acacia, and artificial colorations.

4. Thyroid hormone must be taken on an empty stomach.

5. Determination of hormone imbalances that affect thyroid metabolism must be accomplished.

David S. Klein, MD, FACA
Pain Center of Orlando, Inc.
225 W. SR 434 Suite #205
Longwood, Florida  32750      dsklein@earthlink.net

www.suffernomore.com

www.stages-of-life.com

New Herbal Treatment for Pancreatic Cancer?

David S. Klein, MD---------      Pain Center of Orlando, Inc.
225 W. SR 434 Suite #205
Longwood, Florida  32750

www.suffernomore.com


Thymoquinone, the major constituent of the oil extract from a Middle Eastern herbal seed called Nigella sativa, exhibited anti-inflammatory properties that reduced the release of inflammatory mediators in pancreatic cancer cells.

Nigella sativa seeds and oil are used in traditional medicine by many Middle Eastern and Asian countries.  Previous studies have also shown it to have anti-cancer effects on prostate and colon cancers.

Based upon their previously published findings that thymoquinone inhibits histone deacetylases (HDACs), Dr. Arafat and her colleagues compared the anti-inflammatory properties of thymoquinone and trichostatin A, an HDAC inhibitor that has previously shown to ameliorate inflammation-associated cancers.

The herb also inhibited the activation and synthesis of NF-kappaB, a transcription factor that has been implicated in inflammation-associated cancer. Activation of NF-kappaB has been observed in pancreatic cancer and may be a factor in pancreatic cancer's resistance to chemotherapeutic agents. When animal models of pancreatic cancer were treated with thymoquinone, 67 percent of the tumors were significantly shrunken, and the levels of proinflammatory cytokines in the tumors were significantly reduced.

Inflammation has been implicated in the development of several solid tumor malignancies. Chronic pancreatitis, both hereditary and sporadic, is associated with the risk of developing pancreatic cancer.

Pancreatic cancer is the fourth leading cause of cancer death in the United States, with approximately 32,000 deaths a year. Only five percent of individuals with pancreatic cancer live for at least one year after diagnosis.

Early Self-Treatment for Influenza

Very important: Get stocked up on Licorice Root Extract and Colostrum capsules and NAC for what might be a swine flu epidemic. Needs to be taken at first sign of difficulties. I ordered up a bunch, but it needs to be 'on hand' to be effective.

I will be happy to provide the dosages and regimen.  Needs to be individualized, a bit.  Better, however, to over-treat than to under-treat.

FDA Acts Against Unapproved Narcotic Drugs

FDA Acts Against Unapproved Narcotic Drugs

By John Gever, Senior Editor, MedPage Today Published: March 31, 2009 .

SILVER SPRING, Md., March 31 -- The FDA has taken steps to pull 14 unapproved painkillers containing immediate-release morphine sulfate, oxycodone, and hydromorphone from the market. The agency has warned nine companies that make the unapproved products to stop manufacturing them within 60 days and to cease distribution within 90 days. Among the drugs affected by the enforcement action are two branded products containing morphine sulfate and oxycodone (Roxanol and Roxicodone, respectively) as well as generic versions of the three painkillers. All the affected products are tablets or oral solutions. Oxycodone capsules were not among the products targeted in the action, Deborah Autor, J.D., director of the compliance office in FDA's Center for Drug Evaluation and Research, emphasized at a press briefing today. Extended-release opioids were also unaffected by today's action. Patients who have been taking the unapproved medications are urged to seek prescriptions for equivalent or similar approved products. "We believe [the action] will not disrupt patient care," Autor said. She said some patients may have to switch to products not exactly identical to the unapproved drugs. Seven of the letters cited immediate-release 20 mg/mL morphine sulfate solutions. There is no approved version of morphine solution at that concentration, although 20 mg/5 mL is available. Autor said supplies of alternative products were sufficient to replace the unapproved products, even though immediate-release oxycodone appears on the FDA's most recent drug-shortage list, updated March 25. "There will be no shortage for consumers," she said. The companies told to pull their products are Mallinckrodt, Boehringer Ingelheim Roxane, Roxane Laboratories, Glenmark Generics, Lannett Company, Lehigh Valley Technologies, Physicians Total Care, Xanodyne Pharmaceuticals, and Cody Laboratories. Autor said the companies must submit responses to the warning letters within 15 days or face sanctions. At a press briefing announcing the action, Autor said the companies may seek approval for the products, but in the meantime they still must be pulled from the market.

Weight Gain, Insulin Resistance and Metabolic Syndrome "X"

Pain Center of Orlando, Inc.
225 W. SR 434 Suite #205
Longwood, Florida 32779
www.suffernomore.com
407-679-3337
407-678-7246

Weight Gain, Insulin Resistance and Metabolic Syndrome “X”

Insulin Resistance Syndrome (IRS), sometimes referred to as Metabolic Syndrome “X” is a medical condition affecting as many as one in four Americans. Considered to be a ‘pre-diabetic’ state, IRS precedes the development of diabetes by as much as 10 years.

Insulin is a hormone, secreted by the pancreas. Insulin has two principal functions: (1) control of blood sugar, and (2) deposition of free fatty acids into the fat cells. If the insulin receptor becomes dysfunctional, it takes more and more insulin to maintain normal blood sugars. Unfortunately, the increase in the Insulin level results in fat deposition, mostly in the abdomen.

As more and more insulin is needed to maintain blood sugar levels, the fat cells respond to the situation by becoming ‘fatter.’ This in turn results in even higher insulin levels. Eventually, blood sugar levels cannot be maintained, even with the very high insulin levels, and ‘diabetes’ is diagnosed. Clearly, the animals were well out of the barn by the time ‘diabetes’ was finally diagnosed.

The key to diabetes prevention is detecting ‘insulin resistance’ before things get totally out of control. In order to do this, serum insulin levels should be determined simultaneously with blood glucose.

NOTE: Healthy blood sugar to insulin ratio should be greater than 10 to 1.

The first step to restore more normal, lower insulin levels is to treat with a combination of trace minerals. The key here is balance. Chromium and vanadium are associated with insulin receptor dysfunction, but these should not be taken without adequate intake of zinc and selenium. I use a product called “Magic Minerals,” which is a mixture of organic mineral salts called ‘chelates.’

The mixture is less expensive than buying the individual components, so my patients seem to be a bit happier with it. For the average adult, two capsules are taken twice daily. A bottle of 120 will last 4 weeks. Many patients will experience some weight loss with “Magic Minerals.” Typically, patients will lose 4-8 pounds over the course of 6 to 8 weeks.

After 1-2 weeks of mineral use, blood sugar levels can be expected to drop. When weight loss ends, additional chromium is administered. Typically chromium 200 mcg, taken twice daily is added to the ‘Magic Minerals.’ Alpha Lipoic Acid (ALA) 500 mg taken twice daily will further sensitize the cells to insulin.

"Magic Minerals" is a balanced mineral chelate, and it is a very good value. It is soy, gluten and egg free.

David Stephen Klein, MD, FACA, FACPM, FACMIMS

Curcumin: Breast Cancer Treatment & Prevention

Curcumin:  Breast Cancer Treatment & Prevention

 

Cucumin is a spice extracted from turmeric root.  This commonly available spice may be a key to fighting cancer.

1.  Curcumin reduces number of lung metastases and makes the chemotherapy agent, Taxol, less toxic.

Taxol, as is true with many chemotherapeutic agents, provokes an inflammatory  response, which leads to drug resistance. When administered with the chemotherapy, curcumin inhibited Taxol's inflammatory response by blocking nuclear factor-kappa B (NF-kappa B) which regulates inflammation, cell proliferation, and apoptosis (cell death).

2. Curcumin shuts down the production of NF-Kappa B, the "Smoke-Sensor"

It was determined that curcumin suppresses  tumor necrosis factor (TNF), from activating NF-kappa B.  By inhibiting TNF-induced NF-kappa B activation, curcumin reduced the expression of genes that regulate every stage of cancer development.

3.  Curcumin inhibits cancer cell growth rate

By inactivating NF-kappa B, genes involved in cell proliferation, such as COX-2, cyclin D1, and c-myc, are inhibited. This means that curcumin suppresses production of proteins needed for uncontrolled growth and proliferation, inflammation and inhibition of PGE-
2.

4.  Curcumin restores normal control of  Apoptosis (Cell Death)

Cancer may be a condition that damages he normal control mechanism involved in normal cell death. Curcumin helps to restore normal programmed cell death. The chemotherapy agent Taxol induced NF-kappa B activation, which leads to cell immortality, reducing the drug's ability to kill cancer cells.  In that drug resistance is a huge problem, curcumin can help to make chemotherapeutic agents more effective.

5.  Curcumin assists in controlling cancer cell metastasis

By inactivating NF-kappa B, genes promoting metastasis,  curcumin inhibits cancer metastasis.

 

Summary:

1. Curcumin has been demonstrated to be useful in the treatment and prevention of breast cancer.
2. Curcumin acts at the gene-activating level, and is involved in pathways that are common in inflammatory conditions.

 

NOTES TO MY PATIENTS:

1. Curcumin is useful  not only for breast cancer issues, but for prostate cancer, pancreatitis, and arthritis. 
2. I am preparing a newsletter looking at the use of Curcumin as it may pertain to prevention of heart disease.
3. Curcumin may reduce elevated CRP levels, something of intense interest to patients with heart disease, cholesterol and stroke concerns.
4. Dosage of Curcumin depends upon the strength and purity of the curcumin preparation.
5. The top of the line curcumin costs pennies more than the garbage that is generally available at the ‘health store.’ Using curcumin for the purposes above requires ‘solvent-free’ curcumin, and I am aware of only one reliable source.
6. Currently, I am recommending Curcumin (Vital Nutrients, Inc.) 500 mg twice daily.  Cost per month is around $24.  The cheaper brands cost a bit less, but you get a lot less.
7. You can get it from our website, if you wish. 

The link is http://stages-of-life.com/Store/search.aspx?q=curcumin

 

David S. Klein, MD, FACA, FACPM, FAAMIMS

Pain Center of Orlando, Inc. Suite #225 W. SR 434

Longwood, Florida  32750

 

Lake Mary Life Magazine Article 3/1/09

Focus on Pain Center of Orlando
Peter Reilly

Chronic pain is the symptom that your body is out of balance. At the Pain Center of Orlando, Dr. David Klein works to restore hormonal and nutritional balance as well as to relieve pain.

He has helped many headache, hand-, foot- and back-pain sufferers regain their health, taking great satisfaction in curing those who have sought treatment elsewhere and haven’t found relief.

“I want to see the patients who are not satisfied with their care, those who have not found relief elsewhere,” he says from his Longwood office, the walls of which are lined with bookcases and decorated with models of antique cars and motorcycles. “I want the ones who are not getting better. I want to see the patients that no one else can figure out.”

With prior training and experience as an analytical chemist, and with nearly 30 years of clinical experience in medicine, a specialty in anesthesiology and with the subspecialty of pain medicine, Dr. Klein, a Longwood resident, is prepared to diagnose and deal with just about any pain-related disorder. He spent seven years as a Navy physician and five years in the Air Force as a flight surgeon, both on active reserve.

Dr. Klein earned his medical degree from the University of Maryland School of Medicine, surgical internship at University of North Carolina, and residency at Duke University. He has served on the clinical teaching faculties of Ohio State University, the National Naval Medical Center, and Portsmouth Naval Hospital, as well as on many editorial review boards for medical journals.

Certified by five medical boards, the doctor has given countless lectures, invented several medical products, and has been published more than 100 times.

With a resume like that you’d think Dr. Klein would be part of a large assembly-line practice with a big staff of nurses and physician’s assistants, but the decorated Gulf War veteran is a sole practitioner who doesn’t rush through visits or overbook appointments.

“There are no physician assistants or nurses in this office,” he says. “I see every patient, every visit, every time.” In fact, Dr. Klein feels that the only way to correctly diagnose what’s wrong is to spend a lot of time with each patient. Pain medicine is one of the most complicated and detail-oriented specialties in medicine.

“You have to look at the entire person to find the cause of his or her pain, or lack of sleep, or whatever the symptom happens to be,” he says.

His practice attracts patients from all over the country, with some coming from as far away as Europe and China. He has treated everyone from diabetics with nerve pain to colitis sufferers with cramping using his unique approach. In addition to traditional treatments, he finds that many pain sufferers are helped with nutritional supplements and hormone replacement therapy.

“Two-thirds of what I do is actually hormone replacement and nutrition,” says Dr. Klein, who was the reserve flight surgeon to the VIP squadron at Andrews AFB under President Reagan. “When you provide the appropriate nutritional intervention, you may need some prescription medications, but you need far less than are traditionally prescribed to get the job done.”

Dr. Klein believes that many chronic ailments result because people are overweight, but undernourished. Americans take in more than enough calories, but don’t get enough of the right vitamins and minerals. The minerals, in particular, are lacking in what we eat. To deal with this, he offers a line of very specific and focused nutritional products through his practice. “One size does not fit all,” he says.

Lifestyle, age, and genetics can also knock a person’s endocrine system out of whack, causing hormones like testosterone, estrogen, insulin and cortisol to become unbalanced.

“You begin with these common health problems,” he says. “But you can correct them with bio-identical hormone replacement, but it must be done precisely and properly. The safety of my patients is most important. I’m here for one reason, to help them get better. (For more information on this subject, check out Dr. Klein’s column on page 92.)

The Pain Center of Orlando is located at 225 West S.R. 434, Suite 205 in Longwood. For more information or to schedule an appointment, call 407-679-3337 or visit Dr. Klein’s informative website at www.suffernomore.com