Best Doctors in Collin County: Pain Management 2011, 2012, 2013, 2014 Best Doctors: Pain Management 2003, 2004, 2005, 2006, 2007, 2009, 2010

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Robert Bulger, M.D., Southwest Pain Group

I know that diet is very important for general health. Is there a particular diet that will help patients with chronic pain?
Yes, diet can make a huge difference for patients in chronic pain. In a very real sense, food is the most powerful drug a person can take or put in their body. When a person consumes food, a vast and complex cascade of events occur. As the various nutrients are absorbed, there is a complex chain of events that occur involving the secretion of numerous hormones, production of metabolites, production of various by-products of metabolism with numerous effects on enzyme level with resultant effects on neurotransmitters, and numerous chemical reactions. People don’t realize this, but these various metabolic processes can play a major role in metabolism, energy levels, etc.
The importance of consuming a proper diet with the appropriate vitamins, minerals, essential fatty acids, fiber, etc. can have dramatic effects. A proper diet, one that is protein-rich, can make a difference in patients with chronic pain. Poorly controlled pain creates significant nutritional side effects, including unstable glucose, loss of appetite, excessive intake of carbohydrates, muscle wasting, weakness, and poor mentation.
Chronic pain can cause excessive adrenal secretion of cortisol, catecholamines, and impact glucose levels, which can impact the pituitary adrenal system. The net result of all this is that patients in chronic pain often gain weight because of excessive carbohydrate consumption.
In addition, the need for opiate treatment can have a profound effect by compounding the problem of weight gain and sweet food preferences. In short, the use of chronic opiates have been shown to cause a “glucose desire” effect on opiate receptors thus impacting nutritional status, including weight gain, impaired glucose metabolism and excessive sugar cravings.
A higher protein diet is important because amino acids that make-up protein are the precursors of pain-relieving substances such as endorphins, dopamine, serotonin, and Gamma-Aminobutyric acid (GABA). These are pain-modulating neurotransmitters. critical to the control of pain.
In my practice, I recommend patients who have chronic pain focus on a high protein diet by consuming protein at every meal. There is clinical evidence that protein improves the production of these pain modulating neurotransmitters, builds muscle and cartilage, and activates glucagon, a critically important hormone, that actually blocks glucose storage as fat.
If you are in chronic pain, feel like you are gaining weight, and your pain is poorly-controlled despite pain medications, it may be time to look at your clinical nutrition. It can make a significant difference and thus is an important part of my practice.

Dr. Bulger is the only pain management specialist in Collin County trained by Reed to offer the ON-Stim Plus™ therapy for migraine patients.

I have read nutrition is important, but are there any dietary supplements that can help my chronic pain?
Yes. In addition to a high protein diet, there are a number of supplements, minerals and vitamins that I believe make a difference. These include vitamin B, GABA, taurine, carnitine, and many others. These cannot be taken “willy-nilly”. Supplements have to be targeted and focused for the particular problem being addressed.
For example, in a patient with fibromyalgia, I have found a particular combination of vitamins, minerals and prohormones to be extraordinarily effective. Thus, many of my fibromyalgia patients have been able to eliminate their narcotics with this regimen alone.
There was a time when the traditional medical practitioner was very skeptical of vitamin supplements, but in fact, in the 21st century, I use an integrated medicine approach. I have a specialized algorithm for the treatment of patients with fibromyalgia, headaches, and joint pain. I strive to focus on non-narcotic therapies as much as possible. A nutritional approach combined with proper supplementation and hormonal therapy can make a dramatic difference in patients who live with chronic pain.

I’ve heard about “personalized plans” for Pain Management. What new development gives physicians this ability?
Primarily, the now commonplace use of metabolic profiles. This is a simple test—an oral swab—that allows physicians to analyze qualitatively the function of enzymes that metabolize prescribed medications. Not only does this validate whether narcotic therapy is effective, it also helps determine what narcotics should not be prescribed to a patient.

How can this test improve my care?
In several ways. We often see results come back that demonstrate that a particular drug we are giving patients for pain (Oxycodone, for example), is not metabolized normally. Two things can happen as a result of this. If the enzyme abnormality renders more medication available in the circulation, there may be an exaggerated—and perhaps even dangerous—response to this drug, conceivably leading to overdose of the medication. On the other hand, if the drug is metabolized at an accelerated rate, very little will be available to actually act on pain receptors creating a very poor response from what would otherwise appear to be an adequate dose of medication.

Can the results of this test be helpful to my other doctors?
Absolutely. This test measures the activity of all of the enzymes involved in drug metabolism. Therefore, the results are very useful to your primary care physician. We frequently see dramatic changes in dose or outright discontinuation of certain medications based on the results of this study. For that reason, the results need to be shared with your other physicians to maximize the efficacy of your medications and to protect you from those that could harm you.

How often do I have to have this test?
Just once. This is a once in a lifetime study as your enzyme variables remain unchanged.

Dr. Robert Bulger and the physicians of Southwest Pain Group offer a comprehensive full-time pain medicine clinic, as well as injection therapies at multiple centers for patients in Dallas, Richardson, Addison, Plano, Frisco and Irving area. Dr. Bulger has been honored as a “Best Doctor in Dallas” by D Magazine annually since 2007. For more information on Dr. Bulger and his practice,Southwest Pain Group, visit

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