The Problem Of Chronic Pain In Canada

Dr. Angela Mailis, Founder

Dr. Angela Mailis, Founder

Chronic pain of one sort or another affects approximately 1 in 3-4 Canadians. In raw numbers this means 3-4 million people in Ontario alone and 9-12 million people across the nation. Chronis pain is no “small business”. The term “chronic” means pain that is present daily or very often, for weeks and years. It can be constant or comes in spells, can be there at rest or appear only with movement, weather changes, touch etc. Pain may be the result of damage or disease to the nervous system (neuropathic pain), the musculoskeletal system (muscles, bones, ligaments etc), the internal organs (heart, kidneys, urinary bladder, gut), in which case is called “visceral pain” or a mix of those types. 

The estimated annual cost of pain from all causes in USA is approximately 61.2 billion per year and approximately 6 billion per year in Canada. What these figures do not include, is the immense cost of human suffering that cannot be expressed in dollar figures. Despite this, chronic pain seems to be unrecognized and is highly undertreated in most parts of our country. When it comes to research, less than 1% of all research funds spent in Canada is devoted to pain research (even though Canada is a true pioneer in many research fronts including children’s pain, imaging the brain, pain genetics etc). When it comes to waiting to be seen by doctors skilled in chronic pain, wait list across the country vary between many months to 5 years.

Family doctors are our “gate keepers” and manage 90% of chronic pain. But, our doctors have not been trained in medical schools to deal with pain (a veterinarian gets 5 times more training in dealing with our animals than your doctor). They need more time to deal with the complex physical and psychosocial issues that come with chronic pain, but the fee-for-service system does not allow proper remunerative time, nor do they have access to resources such as nurses, psychologists or social workers to assist them in getting the “whole person picture” of their patients with chronic pain. And of course, many Canadians do not have a family doctor to start with. Many chronic pain sufferers do not have access to doctors treating pain due to distance or just because such doctors and clinics do not exist in large parts of the country. Many treatments for chronic pain (outside interventions such as injections and surgery) are not funded by the fee-for-service system in our country unless you have a third party covering you such as workers compensation or extended health care. These treatments include not only medications but most importantly, physical and psychological treatments and “whole person treatments” in well organized pain clinics and setting. 


Intravenous Vitamin Therapy For Health

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

Vitamins and minerals are the raw materials that allow our cells to function properly. Without them cells would not be able to produce enough energy for normal processes, repair damage and replicate DNA. Ideally we can get these essential nutrients through our diet but often, despite our best efforts we often don’t get adequate levels absorbed and delivered to our cells. Sometimes even a great diet may not translate to proper nutrition at the cellular level. There can be many causes of this, which may include: poor digestion, food sensitivities, chronic inflammation, poor immune function, chronic stress, toxicity or any disease or sickness. A vicious cycle ensues – our cells are not healthy and they need nutrients to heal but can’t get them delivered because of poor absorption. However, the nutrients are not available because our cells are too weak to transport the vitamins and minerals to where they are needed. This scenario describes a typical situation in which intravenous vitamin (I.V.) therapy would be indicated. I.V. therapy involves the administration of nutrients in high concentrations to rapidly aid cellular healing. The advantage of intravenous administration is that the nutrients bypass the stomach and intestines and get directly to the bloodstream where they are needed. This will allow the cells to rapidly repair and regain strength. Once this happens, the cells will be able to function normally again and begin to repair the disease process.

I.V. therapy can be effective in many situations. Typically it is used in situations were, as discussed, digestive function is compromised and/or there is urgent need to “kick-start” the healing process that would otherwise take much longer though diet and other supplementation or ultra high doses of vitamins are required to combat a certain disease process. A very common and effective use of I.V. therapy is using high doses of vitamin C in integrated cancer care. This has been shown to be preferentially cytotoxic to tumour cells, maximize tissue healing and minimize the side effects of chemotherapy. Such high doses can only be achieved through I.V. therapy that is supervised by a qualified Naturopathic doctor (ND).

A knowledgeable ND can tailor the I.V. protocol by varying the type and amounts of nutrients. When this is done, IV therapy can also be beneficial for: migraines, fibromyalgia and chronic fatigue syndrome, detoxification, allergies, asthma, Parkinson’s disease, macular degeneration, depression, chronic diseases, and malnutrition. It can even be used periodically in healthy people to enhance overall well-being, prepare for surgery (to enhance recovery and healing) or as an extremely effective therapy to combat colds and flus.

I.V. vitamin therapy has been used for over 25 years to help people boost or regain health. It is an aggressive treatment, so the patient must be informed of all treatment details before commencing such a protocol. Nevertheless, when done by knowledgeable practitioner, I.V. therapy can provide very safe and effective results that may not be found in other therapies. When our cells are given the nutrients they need, they will be able to function properly and thus allow the restoration of our body’s inherent healing mechanisms.


I Can't Talk But I Can Feel

Dr. Angela Mailis, Founder

Dr. Angela Mailis, Founder

An administrator in the hospital called me on the phone quite distraught. Her father with Alzheimer’s was residing in a nursing home. While he was forgetful, he was quite self sufficient in personal care, pleasant and well interacting with the family who visited often. That is, until he was diagnosed with neck cancer and was sent for a number of radiation treatments localized to the neck. Unfortunately, the radiation caused some serious burns in the neck that needed lots of local treatments and dressings to help the burns heal. This is when the man changed. The bewildered daughter described him as unable to speak or respond to close family members, thrusting violently at times and quite unable to even feed himself. So, she called me to discuss him as the nursing home staff had no clue what to do. One of the reasons people with substantial cognitive loss get derailed and confused, is when there is big change in their environment. The old man had been taken frequently for a number of treatments in an outside unfamiliar facility. That could partially explain his behavior.  The other big reason is untreated pain. I strongly recommended that he is given some liquid morphine regularly, so the daughter went back to the nursing home staff and suggested this. The change was dramatic. Within 20-30 minutes after the ingestion of liquid morphine her father would be able to sit up, eat and communicate. A couple of hours later, when the drug wore out or when the dose was insufficient, he would resort back to silence and inability to do his basic things, wincing and unable to interact or talk. I suggested dose increase and also more liberal use of the drug in frequent intervals. Two weeks later, as his burns were healing well, the morphine was much reduced and he was returning to his old good self.

In another extremely sad case I saw, a 45 year old woman was brought to me from a nursing home outside the Greater Toronto area by her caring sister. She was bound to a reclining wheelchair, the left leg was in a brace with the knee straight and the left hand curled under the covers. Her story was the stuff horror movies are made off. About 5 years ago she was shot by her husband in the head while he committed suicide afterwards. This lady survived but with huge injuries. The bullet went behind her eyes and destroyed her eyeballs, so that the eyes had to be removed from their sockets leaving her blind. The neurosurgeons tried to clean up the bullet fragments from her brain. After this surgery, unfortunately, she got a stroke that damaged the right part of her brain. Specific areas of the brain control both movements and sensation in our body. When this lady’s right brain was damaged, it was the left side of her body that got paralyzed. So, here she is, blind, brain damaged and paralyzed in one side, which left him totally dependent on others for everything. But the tragic story did not finish here. Shortly after the stroke she started complaining bitterly (whichever way she could, with some words, sounds or body jerks) of pain across the whole left paralyzed side. Moving her from chair to bed and vice versa was an ordeal, and the staff (inpatient, untrained and not educated in her condition) let her and the relatives know that probably this “was all in her head”.

They were absolutely right, it was all in her head, but to be correct, not the way they meant it (as a “figment of her imagination”). This unfortunate lady had suffered a serious and very difficult to treat neuropathic pain syndrome seen in about 8% of all people with stroke, that we call “central post stroke pain syndrome”. When I examined my patient with a soft feathery make up brush, she found it very painful. Over the years she had been able to recover her ability to speak and respond to questions, so she told me clearly how uncomfortable my little brush felt on her skin. Touching her with a sharp pointy object was even worse, while the slightest movement of her paralyzed side was unbearable. Her very long toenails on that left leg were the proof of her inability to tolerate the slightest touch or movement and the skin over the toes was dry and scaly as water on the skin was not tolerated.

Probably my most important contribution to this lady’s care was a scalding note to the nursing home indicating what the diagnosis is with advice to handle her very gently and stressing “this was in her head, but in her brain”!

Why did I tell you all this? Simply to show you that pain in institutionalized settings in a huge issue, untreated and poorly understood for people who are seriously  physically impaired and/or have reduced cognitive capacity or ability to communicate. This goes as well for young kids with cognitive impairment but I am not a kids’ pain doctor, so I leave this to specialists in pediatric pain. Stats Canada told us that in institutionalized seniors, chronic pain affects  close to 4 people out of every 10. 


Is Vitamin D The Missing Link In Chronic Pain?

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

Chronic pain is one of the most common health concern for which people seek medical treatment. Research suggests that up to 50% of the population may be suffering from some kind of chronic pain, with back pain being the most common.1 There are number of possible causes such as diet, posture, age and injury that contribute to chronic pain but vitamin D is one factor that is now being added to the list. Vitamin D deficiency is a very common occurrence, especially in people living in colder climates. It has been linked to numerous health conditions, one of which being musculoskeletal (MSK) pain.2

A study published in November 2012 found that MSK pain is related to vitamin D deficiency, and replacement of vitamin D improved pain. The researchers found that 95.4 percent of the subjects were vitamin D deficient, and 85.5 percent of the subjects had improvement in pain with vitamin D supplementation.2 Of the subjects that responded to the treatment, post-treatment serum vitamin D levels were significantly higher than in the subjects who did not respond to vitamin D supplementation. The study concluded, “Treatment with vitamin D can relieve the pain in majority of the patients with vitamin D deficiency. Lack of response can be due to insufficient increase in serum vitamin D concentration.”2 This study confirms the results of a number of other studies that have found the same results.3,4,5 The studies found that vitamin D deficiency may be responsible for generalized, non-specific pain especially if it is resistant to manual and conventional treatments. 

Due to the large proportion of the population that experience both chronic pain and vitamin deficiency it would be prudent that both doctors and patients consider vitamin D levels a possible key-contributing factor. The most recent data suggests that less than 50 nmol/L of serum vitamin D is a deficient state. The optimal levels are 100-160nmol/L. The most effective and accurate way to determine what dosage is required to reach optimal levels is to have your serum 25-hydroxyvitamin D assessed. Most health agencies agree that 500-2000IU daily are effective to maintain adequate levels but its not enough if you are deficient. 

Vitamin D can be a simple yet very effective therapy for chronic, non-specific pain if you are deficient. To determine if is may be contributing to your pain, have a qualified healthcare practitioner assess your serum levels and supplement appropriately to restore your optimal levels. Consider liquid, oil based formulations to increase the ease of achieving higher dosages. In medicine, sometimes the simplest piece is often the most important. Vitamin D once again forces us to go back to the basics in the quest to achieve pain free function.  



1) Andersson HI, Ejlertsson G, Leden I, Rosenberg C. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain. 1993;9(3):174-82

2) Abbasi M, et al. Is vitamin D deficiency associated with non specific musculoskeletal pain? Glob J Health Sci. 2012;1:107-11.

3) Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain.

Mayo Clin Proc. 2003 Dec;78(12):1463-70.

4) Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine (Phila Pa 1976). 2003 Jan 15;28(2):177-9.

5) Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003 Dec;78(12):1457-9.

Long Winding Road To Pain Relief

Dr. Angela Mailis, Founder

Dr. Angela Mailis, Founder

Mr. J. an 89 year old gentleman, bright and well educated, saw me 3 years ago, on the desperate plea of his son and daughter. Dad had developed a painful condition in his left lower leg with sharp jabs of knife-like and burning pain and bouts of uncomfortable pins and needles sensation.  To make the story short, the moment I saw Mr. J. I noticed very slow movements of his toes in that affected leg. He had become aware of them since the onset of the pain but did not know what to make out of these movements. I thought of a very rare and painful syndrome named “painful legs, moving toes”.  The commonest abnormality associated with the syndrome comes from the spine when a nerve root is pinched and compressed usually because of degenerative changes. There was only one problem: Mr. J. had nothing but minor back pain for years to the point he felt it was not worth talking about. I sent Mr. J for a spinal MRI and nerve tests. The MRI was clear: he had an absolutely lousy back and his nerve root was squeezed at the site of the painful leg. A nerve test  was able to confirm that Mr. J. had a pinched nerve in his back. The tests made me confident that my original diagnosis of “painful legs, moving toes” was right. 

Since there is no cure for this condition, I decided to target different issues that contributed to Mr. J.’s pain.  I prescribed a medication to sleep, another one to sooth the nerve pain (which by the way is not covered by the province of Ontario even for those over 65) and a powerful opioid, liquid morphine. Mr. J originally reacted to my last proposal:  “My God, doctor, I do not want to get hooked and addicted”! It took me time to convince Mr. J. and his daughter who always comes with him, that he needs the drug, he will not get hooked because he has a good medical reason to take it, and I promised I will start him with baby doses. Three years later, at the remarkable age of 92, though he hardly looks early 70s, Mr. J. continues to use the medications I prescribed, and he is doing very well. His pain is much better controlled and he has a very active life as he is a widow living alone. As a matter of fact he just went to Europe for a long holiday. Leaving my office, ready to pack and go with the family to his trip, he gave me a big hug and a warm kiss. “Without you doctor, I would have been unable to go to this trip”. “By the way” he continued, “did I tell you, you are my #41 doctor”? I certainly did not believe my ears. My good old Mr. J. had seen 40 doctors before me over the course of few years seeking  diagnosis and treatment and had kept meticulous notes, so I had to believe him.

Why did Mr. J. made the rounds of 40 physicians and countless non medical practitioners before he got diagnosis and treatment? Why were some of his important medications not covered by the system even if he was over 65? How much money did my patient spend out of pocket throughout the years of  his ordeal? Where did Mr. J. get his fear of being hooked on drops of morphine? The answer is simple: because the province of Ontario and several other provinces do not have a comprehensive strategy for pain management, a strategy that will equip professionals, public at large, patients, administrators and policy makers with necessary education and knowledge to tackle the problem, define the gaps of care, coordinate existing resources, reallocate funds from money wasted in the system to processes that are useful and effective, provide smooth flow from one level of care to the other and even provide the public with techniques to prevent and self manage pain. 

Another time I will explain how the  province of Ontario tries to address the issue of chronic pain.


Nutrients: When Is Diet Not Enough

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

We live in a world of calorie dense but nutrient poor foods. Do to over farming and poor agricultural practices many vegetables, fruits and grains have lower amounts of minerals and vitamins then they had in the past. While the trend is moving toward organic and whole food options the question is can a healthy diet still provide enough nutrients and vitamins to meet our daily needs? Most experts agree that a well rounded, plant based, whole foods diet is more then adequate to meet the needs of most healthy people but what about if you are deficient in a particular nutrient? Is diet enough to correct it? What’s the difference between measurable and functional (the optimum a your body needs to function) deficiency? Clinical experience among integrative doctors suggests for people with deficiencies extra supplements are needed to restore adequate levels. A good way to look at this is while a balanced diet is great for maintenance of nutrient status but if you have a health condition you are in a “health rut” and you need a little extra help to get out. This is where extra minerals and vitamins can be very useful. 

The following are a few conditions or situations where deficiencies of minerals or vitamins can play a role in the disease process. Adequately replacing these essential nutrients may help reverse the following conditions:

High blood pressure: Magnesium plays a key role in blood vessel relaxation. Low levels lead to constricted blood vessels and increased pressure. Chronic magnesium deficiency also allows calcium to build up in the lining of the vessels creating constriction and hardening. 

Depression: Zinc, magnesium, vitamin B6 and B3 are all essential for the formation of the “feel good” neurotransmitter serotonin. Deficiencies in the above nutrients can lead to poor production of serotonin and melatonin decreasing mood and impairing sleep. Unfortunately, anti-depressant drugs don’t address this root cause since they don’t increase production of serotonin but only keep it in the brain longer. 

Hypothyroidism: Most people have heard of iodine being essential to thyroid hormone production but selenium and zinc are also required in this process. Selenium is especially important since it is required for the conversion of T4 to T3 (the active form of thyroid hormone) in the liver and peripheral tissues. Additionally it also reduces autoimmunity against the thyroid gland (Hashimoto’s thyroiditis).   

Acne: Zinc plays an essential anti-inflammatory role by stabilizing the immune system. When levels are low people may be predisposed to more acne outbreaks and increased severity. It’s important to note that copper should always be supplemented along with zinc since long-term zinc use can lead to a copper deficiency. 

Fibromyalgia and muscle pain: Magnesium is a key factor in muscle function and some research shows that people with fibromyalgia have low intracellular magnesium levels despite blood levels being normal. The combination of magnesium and malic acid has been shown to have a positive effect on symptoms.   

Restless legs syndrome (RLS): Iron is an often-overlooked mineral in RLS. It is required for the formation of dopamine in the brain, which regulates muscle movement. Before supplementing be sure to get your ferritin levels checked to see if you are iron deficient. 



Altura et al. Magnesium deficiency upregulates sphingomyelinases in cardiovascular tissues and cells: cross-talk among proto-oncogenes, Mg(2+), NF-κB and ceramide and their potential relationships to resistant hypertension, atherogenesis and cardiac failure. Int J Clin Exp Med. 2013 Oct 25;6(10):861-79. 

Moorkens et al. Magnesium deficit in a sample of the Belgian population presenting with chronic fatigue. Magnes Res. 1997 Dec;10(4):329-37.

Strange Things About Chronic Pain

Dr. Angela Mailis, Founder

Dr. Angela Mailis, Founder

Acute pain is kind of straightforward. For example, when you break a bone it hurts. Once the fracture is stabilized in a cast, the pain stops.  We can also understand why a chronic injury like bad knee arthritis or a permanently damaged nerve can hurt for long. 

Chronic pain, however, can be strange and difficult to understand in many fronts and not just where it comes from. Here is a long list of questions:  

  • Why does pain persist after an injury that seems to be very little and insignificant or for all practical purposes has healed long time ago? 
  • What about pain that seems to start in one part of the body localized to the site of a sprain or other injury, and then spreads everywhere? 
  • Why two people with the same injury seem to be affected very differently?  
  • Why do women seem to suffer from a lot of painful conditions unlike men? 
  • Why do people with the same condition respond differently to the same treatment? Why do kids who come from homes with relatives who have chronic pain seem more prone to develop painful conditions later in life? 
  • What is the reason people from different cultures and races feel and express pain differently?

I will address each of these questions in future blogs.


Magnesium: Are You Deficient in This Essential, Pain Fighting Mineral?

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

Magnesium is a supplement that is very well known for its benefits through out the natural health community. It is involved in over 300 biochemical processes in the body. One of its most important functions is that it plays a key role in producing energy. This makes it vitality important for all cellular functions and processes. It helps maintain normal muscle and nerve function, keeps heart rhythm regular, supports a healthy immune system, and keeps bones strong. Its wide range of health benefits and biological activity make it effective in addressing a number of common diseases and conditions including fibromyalgia, chronic pain, diabetes, osteoporosis, cardiovascular disease and headaches. Numerous studies have demonstrated that magnesium supplementation and correction of deficiency has improved the aforementioned conditions.1 Specifically in chronic pain magnesium can be helpful for offsetting the effects of calcium, which relaxes muscles and nerves. Magnesium acts like a plug in nerve receptors that are over-stimulated. 

The problem with this essential mineral is that most people do not have sufficient levels for optimal health. A gradual depletion of nutrients from our soils has left many vegetables with lower levels of magnesium. Another factor that contributes to magnesium deficiency is that is often is depleted by various common conditions (i.e. IBS, crohns disease) and medications (i.e. proton pump inhibitors, diuretics). Its difficult to accurately assess your magnesium levels by lab testing since they don’t reflect actually tissue stores. Most integrative doctors just assume their patients are not getting enough and are deficient. 

How can you get more magnesium? 

Unfortunately most foods have a relatively low level of magnesium those at the top of the list are nuts and seeds (almonds, sunflower and pumpkin seeds) and dark green leafy veggies (kale swiss chard and spinach). As a supplement, magnesium is most commonly found in small amounts in multivitamins and in certain over the counter laxatives. Minerals such as magnesium or calcium are combined with another molecule to stabilize the compound. Each combination, referred to as a chelate, (such as magnesium citrate) has different absorption, bioavailability and therapeutic value. These additional molecules can really impact the medicinal value of the magnesium and some even have beneficial effects in their own right. The most common forms and their benefits are listed below. 

Magnesium oxide is often used in milk of magnesia products since this form has a strong laxative effect. Even though this combination contains a large proportion of magnesium compare to the oxide molecule it has poor bioavailability and readily causes loose stools therefore it is considered the least optimal form to use as a supplement. 

Magnesium sulfate is most commonly found in Epsom bath salts. 

Magnesium citrate is a commonly used form that has a good bioavailability compared to oxide. It is also very rapidly absorbed in the digestive tract but it does have a stool loosening effect2. This form is found in many supplements and remains a solid option for delivering magnesium into the body.

Magnesium glycinate: Glycine is well known calming amino acid. This combination has good bioavailability and it does not have a laxative effect since glycine is actively transported through the intestinal wall. Due to the calming and relaxing effect of both glycine and magnesium this combination has been used successfully for chronic pain and muscle hyper tonicity.3 

Magnesium Malate: The little known combination has been studied for use in fibromyalgia. Since malate is a substrate in the cellular energy cycle, it can help improve ATP production and there is some preliminary evidence that it may reduce muscle pain and tender points in fibromyalgia patients.4 

The nice thing is that there really isn’t any side effects other then loose stools when taking to much magnesium unless you have a kidney disorder or are taking certain blood pressure medications. Your body just eliminates the magnesium it doesn’t use. Due to its broad ranging beneficial effects, magnesium has really emerged as a quintessential health supplement with an excellent safety profile. Various forms of magnesium can be employed for specific health concerns especially chronic pain. Ask your health care practitioner which form is best for you. 



  1. Fawcett, W. J., Haxby, E. J. & Male, D. A. Magnesium: physiology and pharmacology. Br. J. Anaesth. 83, 302–320 (1999).
  2. Coudray C, Rambeau M, Feillet-Coudray C, Gueux E, Tressol JC, Mazur A, Rayssiguier Y: Study of magnesium bioavailability from ten organic and inorganic Mg salts in Mg- depleted rats using a stable isotope approach. Magnes Res 2005;18:215–223.
  3. Lamontagne C, Sewell JA, Vaillancourt R, Kuhzarani C, (2012) Rapid Resolution of Chronic Back Pain with Magnesium Glycinate in a Pediatric Patient. J Pain Relief 1:101
  4. Abraham GE, Flechas JD. Management of Fibromyalgia: Rationale for the Use of Magnesium and Malic Acid. Journal of Nutritional Medicine (1992) 3, 49-59.

Another PWC Success Story

Dr. Angela Mailis, Founder

Dr. Angela Mailis, Founder

A 38 year old carpenter had his hand caught in a machine in February 2014 and suffered amputation of most of his right hand fingers. Three months later he attempted suicide by hanging himself because of intractable pain, saved by the neighbour who heard his barking dog. He walks by our new clinic in late September, he sees our sign and asks his family doctor for a referral sent to us the same day. He was seen within 24 hrs. We are now treating him with combination of appropriate medications for pain and depression, while he is also counselled by our psychiatrist and psychologist. When I saw him recently in follow-up, he had a huge smile: “I trust you doctor and now I know I will get better” he said.

TAKE HOME MESSAGE: Severe pain can lead to despair and even suicide, and must be managed in a comprehensive physical, mental and emotional approach.


Addressing The Metabolic Aspects of Concussions With Nutrition And Natural Compounds

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

Traumatic brain injuries (TBI) and concussions are generating greater medical and research interest as public awareness grows, especially in the impact on younger and more vulnerable populations. An explosion of recent research has uncovered some of the underlying pathways involved in TBI and concussions. While one complete theory has yet to be confirmed, there is emerging science that brain trauma causes neurotransmitter and calcium release which initiates a viscous cycle of excitotoxin production, impaired energy production, neuro-inflammation and immune activation. 

People that have a concussion undergo a very brief period (minutes to hours) of increased energy production as brain cells try to restore balance followed by a period of reduced brain function, as the ability of brain cells to produce energy is greatly impaired. This state can last 7 days or longer (30 days in severe cases) depending on the severity of the injury. While in this “impaired” state, the risk of a concussion appears to increase when the brain has suffered a prior concussive injury and has not yet fully healed. 

Unfortunately, at this time there are no neuro-protective treatment options that exist to improve symptoms after a TBI or post concussive syndrome. Drug and pharmaceutical approaches have shown limited benefits and currently are not recommended as a treatment. Now many scientists are starting to study a wide range of natural compounds and vitamins that have promising broad-spectrum, neuroprotective and anti-inflammatory activity. Curcumin, green tea, essential fatty acids, resveratrol, and vitamin E are some of the compounds with potential therapeutic benefit. 

Considering the large number of changes that occur after a brain injury a potential solution also needs be able to have a broad spectrum of therapeutic action. Unfortunately drugs can be very effective but are inadequate in TBI since they usually address one very specific factor. This is where nutrition and natural substances can be a very powerful tool to speed up injury recovery and promote healing. The foods that you eat can powerfully reduce the amount of overall inflammation in you have in your body. Specific evidence based natural supplements can also address a wide range of targets including mitochondrial function and neuro-inflammation. Additionally this approach can also improve the ability of your brain to heal during and after a concussion if employed as a preventative strategy. If you are looking to improve your overall brain resilience or want address the chronic effects of a brain injury consider enhancing your brain metabolism with nutrition and natural supplementation. 

Key definitions:

Neurotransmitter: A signaling molecule found in the brain (i.e glutamate)

Mitochondria: The part of each cell that is responsible for energy production. They are essential in order for a cell to survive.  

Calcium release: Calcium is a mineral that plays a key role in nerve function. Excessive calcium release after a concussion can damage the ability of a nerve cell to produce energy. 

Excitotoxin production: excitotoxins are signaling molecules produced in the brain after trauma. They disrupt normal brain function by excessively stimulating nerve activity. 

Impaired energy production: Excessive calcium and excitotoxin production damage the mitochondria in brain cells which in turn impairs their ability to produce energy. Without energy brain cell function slows and eventually can stop. This the mechanism behind many post-concussion related symptoms. 

Neuro-inflammation: inflammation is produced to stimulate healing in the short term but can be very damaging when it continually in produced without being resolved. 

Immune activation: Specialized immune cells in the brain called microglia are turned on after a brain injury. Once fully activated they can produce inflammation. 



Giza CC, Difiori JP. Pathophysiology of sports-related concussion: an update on basic science and translational research. Sports Health. 2011 Jan;3(1):46-51

Maroon JC, Lepere DB, Blaylock RL, Bost JW. Postconcussion syndrome: a review of pathophysiology and potential nonpharmacological approaches to treatment. Phys Sportsmed. 2012 Nov;40(4):73-87

PWC Success Stories: Nagging Pain Can Become Chronic If Left Unchecked

Dr. Angela Mailis, Founder

Dr. Angela Mailis, Founder

A 68 year old housewife comes to see us in October for severe right hip pain since February. She has hard time walking around and finds it very hard to climb stairs. She has been treated in a local physiotherapy facility but she has not been helped. She tells us she needs a cortisone injection in her hip as she is diagnosed with “bursitis”. She is anxious to get better as she will travel for holidays planned long ago, in mid-November. After a full examination both by myself and one of my chiropractors, we ask her to allow the therapist to work with her for a different form of therapy and we promised her that if she does not improve in 2 weeks, we will inject her hip. By the second treatment, she was able to walk in the Eaton centre for hours of shopping without pain.

TAKE HOME MESSAGE: Even simple problems as in the case of bursitis, can become chronic and disabling if the patient does not receive appropriate medical and physical management .


10 Things You May Not Have Known About Naturopathic Doctors

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

1) Even though a visit with a ND is not covered by OHIP most extended health plans now cover Naturopathic visits. Check yours to see if you are covered. This is actually a big advantage since ND's are not restricted by OHIP regulations (paid by the number of patients you see etc) and can take enough time to treat each patient thoroughly.  

2) Did you know that a typical visit your family doctor lasts on average 7 minutes? A first visit with your ND can be anywhere from 60-120 minutes and a follow up is approximately 30 minutes. This allows for enough time to address the root cause of your symptoms. 

3) ND's have eight years of post graduate education; this consists of four years of university undergraduate studies and four years of medical college. This is equivalent to the length of education for medical doctors and chiropractors. Our education includes a residency program, preceptorship and a possibility of specialization. 

4) ND's have are trained and certified in a wide variety of treatment modalities. These include:

  • Nutritional therapy
  • Orthomolecular medicine (vitamins and minerals)
  • Botanical medicine
  • Acupuncture
  • Naturopathic manipulation/hands on therapy
  • Injection therapy
  • Intravenous therapy
  • Homeopathy

5) In Ontario, ND's are now legislated under the Naturopathy Act (which is under the Regulated Healthcare Practitioners Act). This means they are government approved and supported. Full proclamation is slated for 2014. 

6) ND's practicing in British Colombia and some US states are able to prescribe certain pharmaceutical drugs such as antibiotics. This allows them to act as primary care doctors and better help their patients. As part of a ND's education they are required to learn pharmacology and the safety if how natural substances interact with drugs. 

7) Naturopathic medicine is evidence-based. As an example, a recent study (april 2013) published in the prestigious Canadian Medical Association Journal found that Naturopathic medicine reduced the risk of cardiovascular disease. There also is a large body of research supporting each of the therapies that are used by ND's. For example, try typing the word probiotics into pubmed to see how many references you get (hint: it's in the thousands).

8) ND's are the "Sherlock Holmes" of all healthcare practitioners. Many patients visit an ND after no other doctor or health care practitioner was able to help them or get to the bottom of their symptoms. ND's use a comprehensive assessment, physical exam skills and lab testing to assess all aspects of their patients.

9) ND's use both conventional and cutting edge lab testing to assess their patients. For example they look at standard blood values such as iron levels and white blood cells but also are able to use testing from around the world to assess for hidden infections such as Lyme disease or immune activation by food allergies. 

10) Did you know the word "doctor" means "teacher?" Naturopathic doctors take their roles as teachers very seriously. Our goal is to teach our patients how to improve their health through dietary and lifestyle changes so they can have lasting and vibrant health without having to take drugs or supplements forever.


PWC Success Stories: Multi-Step Therapy

Dr. Angela Mailis, Founder

Dr. Angela Mailis, Founder

A 46-year-old businessman was involved in a multi-vehicle accident and experienced immediate nausea, dizziness, headache and disorientation. When he sees us 3 weeks after the injury, he is unable to drive and continues to complain of significant post-concussion symptoms and post-traumatic headaches. After our medical and manual therapy assessment, he decides to come back to our centre for manual therapy and medical acupuncture as well as proper nutritional guidance from our naturopathic doctor, with quick and substantial improvement, while he manages to return to work full time.

TAKE HOME MESSAGE: Proper manual and other physical therapy can assist recovery from a concussion, as  many of the symptoms are due to dysfunction of the neck structures.


  • Pain must be treated early to prevent it from becoming chronic.
  • Proper pain management requires the close collaboration of many health care professionals, including pain doctors, psychiatrists, psychologists and neuropsychologists, manual therapists, nutritional experts, mindfullness facilitators and others.
  • A holistic approach to pain management must address simultaneously the physical, emotional and mental aspects of pain. 
  • Empowering the patient to self-manage aspects of his or her pain together with health providers, guarantees a much higher level of success. 


What is Suffering: Part 2

Louisa Mailis, Mindfulness & Meditation Instructor

Louisa Mailis, Mindfulness & Meditation Instructor

My last blog entry talked about how suffering is inevitable and even small grievances can give us a lot of unwanted anxiety. Let’s dig a little deeper into what is actually going on in the brain.

If you find yourself consistently sweating the small stuff, then you should consider the physiological effects stress has on you. I’m sure all of you are somewhat familiar with the sympathetic nervous system, also known as the fight or flight response.  I won’t bore you with too many scientific details, but, in a nutshell, stress activates the sympathetic nervous system (SNS), which then soaks our system with a cascade of stress hormones, including cortisol.  Stress hormones are important for us and can be beneficial in the short run, but chronic exposure to stress hormones is actually detrimental to our health. For example, too much cortisol, even by way of low-level stress responses, can shrink the hippocampus, the part of our brain that is responsible for thinking and remembering. 

When you’re under stress and your SNS is activated, your brain is focused on getting you out of the stressful situation and nothing else. We often times can't think straight when we're stressed out because our brains are much too busy avoiding danger to be stringing together a coherent sentence. That's why it is common to say or do dumb things in a moment of high stress. Hear that? There is actually a scientific reason why you sound like a bumbling idiot when you're arguing with your spouse!

The biological system of fight or flight has significant evolutionary advantages; it kept us alive by allowing us to either fight the sabre-toothed tiger or run for our lives. But ongoing, unmanageable stress is not something we are meant to experience on a consistent level, and suffering from stress has serious consequences. Here are some of the side effects stress can cause (do any sound familiar?).


  • Low energy
  • Headaches
  • Digestive problems
  • Muscle pain
  • Insomnia
  • Low immune system


  • Inability to regulate emotions
  • Irritability
  • Self-esteem issues
  • Lack of social skills
  • Constant worrying
  • Forgetfulness
  • Inability to focus
  • Poor judgement
  • Pessimism

It’s easy to see how low-level or high-level stress is in fact physical and emotional suffering when you read through this list. The good news is that there are ways to regulate it and to take back control. 

In the third part of this blog series, I will reveal tools and techniques that can help you conquer stress from the inside out! 


PWC Success Stories: Motor Vehicle Accident Patient

Dr. Angela Mailis, Founder

Dr. Angela Mailis, Founder

A 38 year old woman who was involved in a serious car accident when her car was broadsided by another vehicle on Highway 400 and subsequently flipped over in a ditch. Neck x-rays in emergency were reported as normal, but her right knee was not x-rayed despite the fact she had severe knee pain. She came to our clinic 10 days after the accident in horrific pain, unable to walk without a cane and needing help to even put her clothes on. Her husband had to take a leave of absence to take care of her. An extensive medical examination as well as an examination by our chiropractor showed multiple tender areas. Additionally, she had severe anxiety and nightmares from the accident. Our psychologist saw her the same day and diagnosed her with severe post-traumatic stress disorder. We submitted her to quick investigations (x-rays, bone scans, etc.) to make sure we were not missing a fracture. At that point we started treating her intensely with a combination of medications for pain and sleep disorder, manual therapy, postural and other exercises, as well as with a psychological intervention for her  post-traumatic stress disorder. 

TAKE HOME MESSAGE: A quick interdisciplinary approach, addressing the proper diagnosis and both physical and psychological components of the patient’s condition, is the best way to prevent pain from becoming chronic and very difficult to treat.


Are You Drinking Too Much?

Dr. Karen Spivak, Psychology

Dr. Karen Spivak, Psychology

Hi there!

My name is Karen Spivak and I’m a psychologist at the Pain and Wellness Centre. I’m sure many of you have been thinking about how to improve your health moving forward in 2015. I know I have. I’ve been thinking about how to be more active, how to fit more sleep into my schedule, and how to handle stress in a more efficient way. You may have similar goals or have other improvements in mind. I wonder if alcohol is one of them? Drinking can have an enormous impact on one’s health and in keeping an overall healthy lifestyle.  Do you ever wonder if you are drinking too much? Binge drinking is when you drink a lot of alcohol over a short period of time. Many people will experience symptoms like feeling giddy, drunk, dizzy, nauseated, off balance, unable to focus or remember certain things and hung-over the next day. A lot of people will wave off binge drinking as a “way to let loose” but ask yourself:  has this type of drinking affected your sleep, mood, concentration, motivation, relationships and/or physical health? Then, you may be drinking too much!  Not everybody binges when they drink. You may have a pattern where you drink every day or almost every day, usually starting at the end of the work/school day and continuing until close to bedtime.  The drinking may be more spaced out and you may not feel ‘drunk’ like in binge drinking but ask yourself:  “when I drink like this, am I interested in doing anything productive? Does the alcohol make me less interested in going for a walk, to the gym, meeting with friends or doing chores around the house? Do I feel less interested in talking/interacting with my family? Does it interfere with my energy level, my sleep and the way I feel/think in the morning”? If yes, to any of these questions, then you may be drinking too much!

A healthier lifestyle needs to include low-risk drinking practices to optimize your physical, mental and emotional health.  How should you start?  Begin by paying attention to your drinking behaviours: What time of day to you drink? Who are you with? Are you drinking to cope with a bad feeling and/or stress?  How many drinks are you planning to have? Research has shown that just by paying attention to your drinking behaviour can have an impact on changing it.  Want more information? Do you feel that you may need help in making changes to your drinking practices? 

Call me at the Pain and Wellness Centre (1-800-597-5733) and I would be happy to address your concerns. 


Simple New Years Resolutions That You Can Actually Keep

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

It’s halfway through January and I hope your New Years resolutions are in full swing. You may have noticed that the gym is more full and the yoga studio is a tighter squeeze. While I am a big fan of resolving to live a healthier life, I think New Year resolutions usually don’t last, often leaving us frustrated. Because of this,  I wanted to give you some simple some resolutions that you will actually keep and will improve your health on multiple levels. 

The key to successful resolutions is keeping them simple and achievable. This will increase your chance to actually stick with the changes you want to make. Start with small steps before jumping to lofty goals. Also, challenge yourself to be healthier not just in your body but also in your mind and spirit. We need to respect all aspects of who we are and not ignore essential parts of what makes us truly healthy. 

1) Sweat more – This resolution seems simple but it actually covers a lot of key bases. Instead of resolving to exercise more, make a commitment to doing something that gets your sweaty at least once a week. This could be doing a spin class at the gym, going for a run, lifting weights, or doing a yoga class. It can also be something very simple such as climbing a flight of stairs or going for a brisk walk. It will be different for each person but just as powerful. We often are afraid to get sweaty but it’s our body’s way to eliminate toxins and promote circulation. Don’t be afraid to sweat this year!

2) Eat less – I think this is something we have all tried to do to lose a little weight. However, something so simple can be very helpful not just in cutting back on the extra calories but also promoting longevity. Studies have found that organisms that eat less live longer. Recent evidence shows that this approach promotes brain function and improves blood sugar control. Most North Americans over-eat so don’t fall into that trap this year and resolve to cut down your portions by as little as 20%. It doesn’t require calorie counting or weighing your food, just serve less food on your plate then you usually do. 

3) Vent more – We can’t avoid getting irritated or angry. It just happens, especially when we are stressed and tired. The key thing is what we do with that anger when we experience it. A recent study found those people that internalized anxiety ran the risk of an elevated pulse, which increases the risk of high blood pressure, heart disease and other ailments. This year resolve to vent or discharge your frustration or anger in a healthy way. This can be something like conscious deep-breathing exercise or even try martial arts or yoga. 

4) Sleep more – Sleep is one of the most important things you can do to maintain good health. Numerous studies have found that sleep improves immunity, increases the ability to cope with stress, and improves weight loss by cutting cravings. I often tell patients that the single, most powerful change you can make to improve your health is to go to bed one hour earlier. There are so many health benefits from making this simple resolution. 

5) Be silent more – Just as you have to exercise regularly to build your muscle you have to also prioritize time to build your mind and spirit. The problem is that we are so use to getting things done by doing more, not slowing down and doing less. Taking the time to meditate, pray or just be silent is one of the most difficult things to do for most people. However, once you make it a habit it becomes the most rewarding. I challenge you to start with just 5 minutes a day to just sit and be still. Don’t do this right before bed or when you are distracted but rather be deliberate with putting aside time in your day. To focus on the right thing try this simple method. Pick one simple shape or image and focus on that thing in your mind. Take a stopwatch or timer (your smart phone has one) and start it. Every time you lose focus on that one image or shape, re-start the timer. You will be surprised how short your focus can be. Challenge yourself to do this daily and work towards getting up to 5 minutes without re-starting. 

Making and keeping New Year’s resolutions does not have to be difficult. Implement these 5 simple changes and maintain them, even if you start by doing each one once a week. Remember, the road to failure is littered with good intentions. Make your 2015 resolutions simple and sustainable. 

Have a healthy and happy New Year and if you'd like to know more or would like to work with me to help you achieve some of your resolutions feel free to call our clinic in Vaughan at any time to book an appointment: 1-800-597-5733

Dr Paul Hrkal


PWC Success Stories Part 1

Dr. Angela Mailis, Founder

Dr. Angela Mailis, Founder

I wanted to share a few examples of success stories that I've experienced in the short time that our clinic has been open. Here is the first installment. These are the types of things that keep me going and bolster my commitment to bringing comprehensive pain treatment and care to the city of Vaughan and the surrounding neighborhoods.

A 51 year old bank manager with a weak left leg from an old polio infection broke her thigh bone slipping off her staircase at home 1.5 years ago. She had 3 knee surgeries and was left with a hot, swollen and extremely painful (due to nerve damage) knee, which is permanently locked. Within a week we had arranged for an urgent appointment with one of our expert orthopedic surgeons at the Toronto Western Hospital, where she was placed on the urgent list for surgery. At the same time we prescribed appropriate medications for her pain and the nerve damage in her knee, while she sees our psychiatrist for support.

TAKE HOME MESSAGE: Quick referral to an academic hospital, appropriate pain management, and treatment of depression, is the best way to treat such a serious and complex problem.


Meet the Doctor: Dr Paul Hrkal ND

Dr. Paul Hrkal, Naturopathic Doctor   

Dr. Paul Hrkal, Naturopathic Doctor


I wanted to briefly introduce myself as a new member of The Pain & Wellness Centre healthcare team. In the spirit of community and relationship that is so central to the mission of the Pain and Wellness Centre, I wanted to share a little bit more about myself and my clinical practice as a Naturopathic doctor. 

I was born in Toronto area spending my childhood years in the Caledon area north of the city. I graduated from McMaster University with a degree in Kinesiology and then went on to complete my medical studies at the Canadian College of Naturopathic Medicine in North York.

During my university years, I was member of the McMaster varsity volleyball team. I had the privilege and opportunity to compete at the national level, traveling throughout North America to play against the top teams from the both Canada and the United states. I have a strong background in sports medicine and work with athletes to allow them to quickly recover from injuries and optimize their performance. 

In addition to my physical and sports medicine background, I actively have an interest in a number of clinical areas. These include, but are not limited to pain management, cancer, and neurological health.  Despite my interest areas, I maintain a broad practice base, applying Naturopathic principles and tools to numerous conditions. 

One of the most exciting areas in natural medicine is the integrative and cooperative style of patient care at the Pain and Wellness Centre. The beauty of naturopathic medicine is that the wisdom of ancient and proven therapies such as acupuncture and botanical medicine are complemented with the latest approaches such as intravenous therapies. Powerful and safe results can be achieved through the synergy of traditional and modern medical approaches.      

I pride myself in taking an active role in the community. One of the key principles of Naturopathic medicine is the doctor as a teacher. In fact, the word doctor actually comes from the latin word docere, which means ‘to teach’. I work with a number of organizations in the GTA area and am an active public speaker, educating patients on the science and application of natural medicine. For my latest public event and speaking event please visit my website ( or stay tuned to my facebook and twitter feeds. 

What excites me the most is seeing the power of patient-centred medicine at work.  So many factors and stresses impact us on a daily basis, pushing us into a state of disharmony which ultimately leads to illness and dysfunction in multiple bodily systems. The strength of naturopathic medicine is to get to the root cause of our disease and restore our health at every level.  Naturopathic medicine is strategically positioned to use tools and strategies to bring about not only symptom relief but disease resolution and a higher state of health. I hope you join me and the members of the Pain and Wellness Centre team to promote optimal wellness and spread the word on how naturopathic medicine can change your life; I know it has changed mine.  

In Health,

Dr Paul Hrkal ND


What is Suffering?

Louisa Mailis, Mindfulness & Meditation Instructor

Louisa Mailis, Mindfulness & Meditation Instructor

Suffering is inevitable. We are always going to encounter it. There is no way around it, no way to fight it, it will happen whether we like it or not. Suffering can be extreme and come in the form of a physical impairment like breaking a limb or an emotional pain like the loss of a loved one. But suffering can creep up on us in even more discrete and insidious ways. Suffering includes the minor but constant stressful moments in our lives. Yes, the dreaded “S” word- STRESS. We all experience stress, most of us every single day, but I bet you didn’t think it could actually be suffering, did you?

Stress IS suffering and we encounter it all the time. When you’re late for work and racing up the highway ramp to see a traffic jam with no end in sight and you want to scream at the top of your lungs, that is suffering. You reach in your pocket to pull out that 20 dollar bill only to discover a handful of lint and a mint from dinner the night before. You were sure it was in there and the thought of losing money drives you crazy, that’s suffering.  You wait patiently by your phone hoping desperately to hear it ring only to realize hours later that she’s never going to call and are alone again on a Saturday night, that’s suffering. It’s when you have a successful job interview only to be told that the position was given to someone with better qualifications or more work experience. It’s a broken nail, a stubbed toe, a glob of bird poop on your freshly washed car, overdue paperwork, missed deadlines, or a fight with your spouse. Suffering is everywhere, big and small. Some suffering causes us more pain but ultimately suffering is always the same. It is the way we relate to it, the way we perceive it, that changes. How we view suffering and how we manage it that makes all the difference.

A lot of you would probably consider these little examples of suffering to be minor annoyances, things that everyone experiences and there’s really no way around it. You’re right, there is no way around it, but have you ever wondered how these consistent, little inconveniences affect you? There are huge physical, emotional, cognitive, and behavioural ramifications of suffering and if you're not aware of it, it can cause more harm than you thought.

Stay tuned for my next blog entry where I will go deeper into the side effects of suffering and ways you can overcome it.

For more information about me, visit