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The many faces of pain with Elizabeth Cowley ND.

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FX MEDICINE PODCAST: The Many Faces of Pain with Elizabeth Cowley

In this episode, Andrew discusses the many faces of pain with naturopath Elizabeth Cowley. They explore how to effectively manage various presentations with herbs, nutrients, diet, and lifestyle interventions.

Covered in this episode

[01:07] Welcoming Elizabeth Cowley
[02:01] Elizabeth discusses her background and practice
[07:33] Acute and chronic pain referrals
[08:49] General herbs for treating pain
[17:20] Nutrients for treating pain
[19:01] Employing a variety of modalities 
[20:26] Sinus pain treatment
[21:58] Treating chronic back pain
[23:33] Cautions and contraindications in pain management 
[24:42] Stress and pain
[26:44] An integrative approach

Andrew: This is FX Radio and I'm Andrew Whitfield-Cook, and with me on the line today is Elizabeth Cowley. Now, Elizabeth has a Bachelor of Health Science in Naturopathy from the University of New England and also an advanced diploma in naturopathy and a diploma of nutrition from Nature Care College in Sydney.

Liz works at Mosman Chiropractic Centre in Sydney and she's especially interested in digestive health, women's health, including supporting pregnancy and birth. But she treats a wide variety of patients being basically a naturopathic general practitioner, if you like. She's also a trainer at Sydney's Nature Care College and she supervises the student clinic there. Liz sustains a healthy balanced green lifestyle, enjoying cooking, yoga, time with her daughter, family and friends on the greater Australian outdoors. Liz, welcome to FX Radio.

Elizabeth: Thanks, Andrew. Nice to be here.

Andrew: Now, Liz, I'm going to focus on one area of your broad practice today and that sort of both acute and chronic pain, but first I'd really like to learn a little bit about your history because it's a little bit different. Tell me where you spring from and what led you to become a naturopath.

Elizabeth: Yes. Well, naturopathy is actually my second career, Andrew. I originally had a Bachelor of Science and worked in advertising for many years. But, you know, as a young mom, I had a very hectic career, which was very deadline-driven with lots of stress combined with my slightly type A personality and, eventually, my health began to suffer. So I was living off antacids, I had terrible reflux, and then IBS, was really quite frazzled and anxious and had chronic tonsillitis and whatnot. So, you know, went to the doctor and kept getting all sorts of prescriptions for different things, which I never really fulfilled because they were giving me sleeping pills, Zantac, antidepressants. And it was actually a naturopathic practitioner that really made a difference in my life and helped me to feel human again. And I thought, "Wow, if someone can help me feel better when I'm in this terrible state, I want to know more about this." And that was my sort of epiphany.

Andrew: Wow.

Elizabeth: And I went off to investigate what this was all about. I mean, I've always had a bit of an interest anyway in things like aromatherapy and herbal teas. But, yeah, and this particular naturopathic said, "Well, what is it that you really want to. Do you don't seem to be loving your job?" And I went, "You know, I'm actually interested in this naturopathic business." So threw away the corporate career and took up naturopathy, and really, it, just from day one, it felt like a calling to me. It's what I was meant to be doing all along.

Andrew: That's a big ask coming from a very objective type of business to quite a, you know, a subjective, touchy-feely, caring type of business. That's a flip.

Elizabeth: It really is because I'm very mathematically and scientifically inclined, that real left-brain side of things. And, yeah, switching more over to, I guess, the right side, in the healing and nurturing. But, you know, what I think my previous history really has served me well in my career at the moment because it's very much about problem-solving and analysing and really breaking things down. So it all comes together and it was all worth it in the end.

Andrew: What's interesting to me as well, and this is just something I've noted, I don't know whether it's true or not, but I just seemed to note that many natural medicine practitioners try the medical model and it failed them. They had some health issue which just didn't work, didn't fit into a box, and they sought outside help, got that help, then got interested. Whereas there's a very small...a much smaller group who, they've always been this sort of searcher, what else is out there sort of thing. I fit into that first box because I was a real skeptic for natural medicine, so I'm a bit of a turncoat. So tell me about, though, your childhood. You said you were always open to this. So, did your parents use natural medicine at all?

Elizabeth: Not so much natural medicines, but mom certainly had a lot of, I guess, the old wives's remedies. So whenever it was a sore throat, we didn't go straight to the doctor. It was, "Well, let's gargle with salt water and let's try the hot lemon and honey," and, you know, a lot of those traditional home remedies as such.

Andrew: Yeah.

Elizabeth: Yeah. So I grew up in a big family as well and we had lots of healthy home-cooked food, never had any junk food in the house. So, I guess, I had really good foundations there from the start. We had fruit trees growing in the backyard…

Andrew: Wow.

Elizabeth: …and lots of nature time, you know, climbing trees and all that, so yeah.

Andrew: So you've now, you know, really progressed and you've got a broad practice. Tell me about some of these patient groups, though. What do you see and how do these patients present?

Elizabeth: Okay, so I'm working in a chiropractic clinic at the moment with two, three, actually, wonderful chiropractors and massage therapists and myself. So we work collaboratively with people. A lot of it is in-house referrals because we all believe in the holistic approach, but we also recognise the limits of our own modalities. So, for example, if the chiropractors have people with acute or chronic back pain, neuralgias, or ongoing migraines, things like that, they address the structural side of things. But there could be an underlying, you know, chemical or nutritional imbalance there, which they then refer on to me to help people to work through and restore their health.

So it works really well together. I see, I guess, what you would say general practice. I see everything from babies with colic and allergies and conditions like that, through to teenagers with their stress and hormonal imbalances. People preparing for pregnancy, fertility issues, stressed out executives with their high blood pressure and high cholesterol, through the elderly I mean, I think our oldest patient in the clinic is about 92.

Andrew: Wow.

Elizabeth: So we really have the whole family and the whole age group covered, which is lovely. 

Andrew: Yeah.

Elizabeth: And also I feel a good handful of people that are very much the rare and unusual, which they often come to us as a last resort again, or people that are trying to avoid having extreme spinal surgery…

Andrew: Yeah.

Elizabeth: …and really want to make sure they've covered all bases. So it's really interesting and I love what I do.

Andrew: So today I want to focus on a sort of very small area of your practice. Well, I shouldn't say small, but a focused area of your practice, which is acute and chronic pain. 

Elizabeth: Yes.

Andrew: So tell me about this group of patients. What do you see and how does it work this into a referral in the clinic?

Elizabeth: Okay, so a look on the spectrum we would have a fair share of acute injuries. So people coming in either with things like slip discs or rolled their ankles, sporting injuries, whiplash from car accidents, etc., through to chronic conditions that are being managed both through chiropractic care and naturopathically. So we might have osteoarthritis, rheumatoid arthritis. There's people with ongoing allergies with sinus pain, etc. I really see a little bit of everything. We have people with occupational issues that are doing a lot of heavy lifting, tradies etc., and therefore maintaining their strength and the state of their health. As well as athletes, I see athletes who are really looking to get the most out of their bodies and prevent injuries and prepare for events.

Andrew: So, you know, this is going to be a piece of string question because we're talking about pain, which is so many aspects to. And I will delve into a little bit about some of those other aspects. But can I just ask, this is a little bit simplistic, what nutrients and herbs do you commonly use and what other therapies do you employ?

Elizabeth: Okay. Well, first of all, I'm a really big prescriber of my herbal medicines, I absolutely love them. So I do tend to use a lot of liquid blends, but there's always some people that really can't tolerate the taste. I don't necessarily blame them. So it's always good to have the various herbal formulations in tableted form to help with that. And the first goal, I guess, is really to give them some sort of symptomatic relief, to get them feeling good and to break that cycle and get the healing process going.

So this is where I'd be calling on my herbs like turmeric, for example, it has a beautiful anti-inflammatory action. We have Jamaican dogwood is another lovely one, really good for helping to calm down when people are in a very stressed out state from their pain. Also, use ginger as well, it's such a simple herb, but in the mix, it works really really well, you know, a COX-2 inhibitor, so reducing the prostaglandins there and highly anti-inflammatory.

Andrew: And you certainly don't have to use a lot.

Elizabeth: That's right. Nice, low dose herb. So really have fun to include in the bottle there. And then look, there's a whole lot of anti-inflammatories. We've got things like your willow bark, Salix alba. We have devil's claw. It really depends if we're looking at, I guess, joints and joint pain, or if they're looking at spasmodic pain or whether it's more than neuralgic pain. So that'll determine what other herbs will be selected to go into the mix.

Andrew: Okay, so maybe we can differentiate a little bit. So if you're talking about like a neuralgic pain, what sort of herbs would you favour?

Elizabeth: Again, it's really, it’s going to depend on the person's, I guess, current medication status as well. So St. John's wort is a beautiful nerve tonic, so everyone knows it for its antidepressant actions, but it's also fantastic for nerve pain. But again, you've got to be mindful of the interactions there if they are on other medications. And then we look at things that are really going to be quite calming to the nervous system as well as an anti-inflammatory. So things such as Kava, which is super relaxing, taking that anxious edge off. You've got your antispasmodic calming herbs, things like Valerian, Californian poppy even. Yeah, so even lemon balm, for example, is a really good nervous system tonic.

Andrew: Yeah. Can I ask you about Valerian? Because I feel that Valerian has been a little bit labeled as having, you know, practitioners say, “Ah no, Valerian, I can't use, it reacts with my patients." I haven't found that huge reaction, some people have it. What's been your experience?

Elizabeth: With my experience, you need to have, you know, a good dose of it for it to be sedative. But it does have this lovely muscle relaxing effect, too, which can be really beneficial when the pain is of a tense origin. You know, it is lots of muscular spasms going on. So it can just help to calm and relax the person overall. And I haven't really seen any adverse effects certainly not from the liquid herb. I've heard people self report that they've taken Valerian elsewhere and it might be, you know, a cheap supermarket version or something. But in clinical practice, I haven't had any issues with Valerian.

Andrew: And tell me more about things like Jamaican dogwood for...you know, you're saying taking the edge off the pain?

Elizabeth: Yes, it tends to work quite quickly. Jamaican dogwood has an anti-inflammatory action, as well as that lovely analgesic effect. And it has a spasmolytic effect as well, so reducing any spasms that are going on. It's mildly sedative, so it can really help to calm a person down if they are feeling quite stressed and anxious with their pain. And really good, therefore, for migraines, neuralgia, even sciatica, for example, and also period pain, very good for.

Andrew: And there's the poster child of any pain relief with herbal medicine that's what spicing medicine, that's curcumin. 

Elizabeth: Yes.

Andrew: Tell me about what do you use it for. But I'm very interested as well in some reported side effects of very high dose, mainly in cancer patients. What's been your experience when you're using fluid extracts?

Elizabeth: Again, I haven't really noticed any adverse effects whatsoever. Then, again, I haven't gone extremely high doses with these things. I tend to dose sort of mid-range and then monitor the person and see how they go. So turmeric is indicated wherever there's any sort of inflammation just to really mop that up, it has a great antioxidant effect. So really helping the liver to deal with toxins that are produced through inflammatory or oxidative stress.

So the only issue is that it is a high dose herb. So if you're making up a liquid form that takes up a lot of space in the bottle. So I do tend to look for the extracts that are in a tableted form there, so I can keep more room in the bottle for other herbs.

Andrew: Well, I like that because that's one of these pragmatic things with herbal dispensing, is you've got to think, well, how much, bottle have I got to work with? You know, sometimes, like ginger, for instance, you get a really punchy dose. You don't want to be using, you know, 20 mils. It will blow your socks off.

Elizabeth: Well, that's right. That's right. And speaking of ginger, I mean, it does go into any pain mix that I make up simply because of its anti-inflammatory effect, that it has a really synergistic effect as well. So there's this...you know, I was taught that it kind of sends the herbs throughout the body because it's such a great circulatory stimulant, as well as being, you know, nature's ball of aspirin. So, you know, that sort of blood-thinning effect. And really low dose like, you said, it's about, you know, 10 to 20 mils in a 200-mil bottle, so you don't have to use a lot of it to get a really nice effect.

Andrew: What about Boswellia? It was a pretty common herb about a decade ago. It's found its place but it doesn't seem to be this hero anymore.

Elizabeth: Yeah, I hadn't really been a huge fan of using it in liquid herbs, not a great taste. 

Andrew: It isn’t.

Elizabeth: It’s actually the resin top of the plant that's the active part there. Look, it's a wonderful herb for your, I guess, joint-related inflammation as well. So it's specific for arthritis and rheumatoid arthritis, but also indicated for things like inflammatory bowel disease and even for managing cancer, too. So it's a great anti-inflammatory and, again, analgesic effects. And it has this anti-proliferative effect as well. So I tend not to use it in liquid herbs, again, I prefer to chew the formulation that has it included in that, so I can still have the benefit without having to deal with in the formulation, yeah.

Andrew: Yeah. Just for the listeners, one of the things that I picked up from a few people is, and this is years ago, they thought, "Oh, it contains Boswellic acid, and I've got a gut complaint. So, therefore, it's an acid and that's going to be bad for my gut complaint." That's not the right thinking. In fact, it's very good for irritable bowel and ulcerative colitis, it's great.

Elizabeth: This is true. It's just they say just be cautious if there's reflux and that sort of acid higher up. 

Andrew: Yeah.

Elizabeth: So it's perfect for lower gut inflammation, but just being mindful, if the person does have a pre-existing reflux.

Andrew: One of my other favourite herbs I used to use quite a lot of is Corydalis, and I'm a real fan of this herb. Tell me about your usage of it.

Elizabeth: Yes, so Corydalis is fantastic for visceral pain. So I tend to use it more where there's pain going on, for example, period pain, also, like more colicky pain, rather than musculoskeletal. I looked at my personal preference for but yet, again, I love working with that and the Jamaican dogwood together for my period pain ladies. And it brings really good results by analgesic and that mild sedative-hypnotic effect as well, which can really help to calm down a person that's feeling very stressed with their pain levels…

Andrew: Yeah.

Elizabeth: …you know, to the point where it's interfering with their quality of life.

Andrew: What about nutrients, though? Magnesium is, you know, I use this too much, the poster child of the nutrient realm, because of its effect on substance P but also relaxing muscles. What about things like bromelain, though?

Elizabeth: Absolutely, bromelain is, I imagine, it's like a little Pacman. It's an enzyme that can go in and sort of eat away at those inflammatory mediators there. So bromelain, tend to use that again in a tableted formulation. In some form, there's a few around that has that and sometimes they even combined with papain as well, which is the enzyme from papaya. Both of them are quite anti-inflammatory and work really well for acute injuries, so things like sprains and strains, I find very, very effective.

Andrew: I once did my ankle falling down a flight of stairs much like the cook-off "Sesame Street." And I held...I actually like really seriously held a very bad sprain for around about 24 hours by taking absolutely huge doses of bromelain and quercetin. And then I got cocky, I thought I couldn't have been that bad, I was just being a, you know, typical male. So I stopped taking it and boof, it was, like, both sides bruising and really horrible. So bromelain really works very effectively and very acutely.

Elizabeth: Absolutely, as does the magnesium as well, if there's muscular spasm involved, which, as you know, if you injure an area, a lot of the muscles of the body will kind of go into protect and compensate. So magnesium is a nutrient I use a lot of with my patients.

Andrew: Well, what about other modalities like acupuncture, massage? You've obviously worked in a chiropractic clinic. So chiropractic in acute injuries like that, like a sprain, can chiropractic work?

Elizabeth: Look, chiropractic is amazing. I wouldn't practice without it actually. Because it has quite instant effect. So chiropractic, working on the spine alignment, as well as the nervous system. So it can really turn down that sympathetic response. And also, if someone has, you know, fallen over, a whiplash and pumping out of alignment, they can pop it back into place and help the muscles to calm down and get quite instant results. As well as then managing the recovery just to make sure that things are healing in the correct position.

So I really look to chiropractic to manage the structural side of things, as well as bring an effect on the nervous system and improving circulation to areas while I'm working more on the internal side for people. 

And acupuncture, absolutely, great results with that. I've had a couple of situations where we've helped a person to maybe about 95% of their healing and there's that last little bit. And if they get acupuncture treatment, it's just the thing that tops it all off. So really good things like your RSI, frozen shoulder, tennis elbow, etc., and even bursitis in the hip.

Andrew: Oh, okay, great. At the very beginning you mentioned sinusitis and sinus pain. It's like when people mention pain, they think of joint, that's the normal thing, you know, sports injuries, but not sinusitis pain. Tell me how you treat. What sort of things do you use?

Elizabeth: So if it's chronic pain I'd be looking at, you know, reducing those inflammatory markers again. So that's where your bromelain can be quite handy and quercetin, even vitamin C, etc. I'm a big fan of using the essential oil steam inhalations as well for that. But working in conjunction with the chiropractors, too, because I can work on, you know, the cranial bones and really help with the drainage through there. So manual therapies, acupuncture, and treating it herbally and nutritionally, and we really get things cleared up for people. And compresses as well, not forgetting. So, you know, even using a warm flannel on the face to really start to, like, melt away that congestion through there and bring a bit of relief to the pressure.

Andrew: You know, I think people so often overlook the use of compresses and inhalations. It might take a little while for an inhalation to work, but, jeepers, you get good relief.

Elizabeth: Absolutely. I mean, when I tell people to go home, get a bucket of water or a bowl of water and a couple of drops of, you know, eucalyptus oil, lavender oil, tea tree oil, towel over the head. They go, "Oh, yeah, used to do that as a child. Completely forgot about that." So having said, there's some wonderful nasal sprays these days that actually contain the essential oils in them, so that's good to use, too.

Andrew: Great. Moving on to chronic pain. Like, you know, for instance, lower back pain, it's so prevalent in our society. I think, was it 90% of people at some time suffer lower back pain in Australia, and I think it's something like 30% at any one time. It's huge. What do you use?

Elizabeth: It is a huge map. Okay, so if we're looking at it from a holistic point of view, first of all, looking in to see, “Well what's the cause of it? What's going on here? Is this a postural thing? Are they carrying extra weight? Is it to do with stress? Is it a previous injury the degeneration going on?" So try to identify the cause and work with that as well. But in terms of bringing relief, looking at anti-inflammatories, again, so all the herbs I've mentioned before, looking at improving circulation if it's a bit of a stagnation picture there. Someone who is, you know, sitting at a desk all week long or driving in a car or bus or whatever for hours on end, and really getting some movement through there. But looking at joint support, too, so your fish oils, glucosamine, chondroitin, etc. And then remembering the topical applications, so working with either heat packs, or if it's, you know, that they need to do some physical therapies, stretching, exercise. 

Andrew: Yep.

Elizabeth: And obviously working with my chiropractors, again, to make sure that everything's in alignment and to get some other tips on what they can do to work their muscles a bit better to support that. Often with lower back pain, it can be not a lot of strength through the abdominal muscles. So getting people to really work on the front in order to stabilise through the back there.

Andrew: Liz, do you find many cautions with medications certainly in dealing with patients with pain?

Elizabeth: Yes, look, I really do. So first thought, the elderly often suffer a lot of pain and can be on a whole load of medications, blood pressure meds, blood thinners, etc. So it's really important to cross-check with them and make sure they're not self-prescribing. Because some of these herbs, after effect, is that they have similar actions to the medications and can actually potentiate the action. So, for example, we have ginger and turmeric, which are both effectively bloods thinners, their COX-2 inhibiting action and can, therefore, potentiate the action of aspirin or warfarin, and lead to bruising and bleeding, which is not good.

And then if it was St. John's wort, for example, included in a formulation, that too can interfere with many medications. So it's really important that people do stick to their practitioners advise and to work with the medications that they're on and get the most out of the herbal treatment as well.

Andrew: You mentioned stress earlier, and I think people underrate the part that stress plays in accentuating pain. And we sort of tend to go, stress and pain equals magnesium rather than herbs. Tell me, what do you use in this situation?

Elizabeth: Well, look, stress can be emotional stress, but it really can lead to extra physical stress because it's creating tension and tightness and constriction. It can certainly exacerbate things like your migraine, headaches, and lower back pain. So, what I do is aim to decrease the stress using things like your nervines, which are very calming to the nervous system. And adrenal tonics as well, all the adaptogen herbs, which are really going to help the person's ability to handle the stress that they're under, and hopefully decrease the negative effects.

So I'd be looking at things like with Withania, licorice, Siberian ginseng, and all the beautiful nervine herbs, everything from, say, chamomile, skullcap, St John's wort again, even motherwort is really good for a highly anxious, stressed out person. And then, you know, making sure they're avoiding the stimulant foods which are also exacerbating the stress effects, so looking at their caffeine intake, sugar, etc.

And then I work with a lot of other holistic approaches. So maybe teaching a little bit of meditation and mindfulness…

Andrew: Beautiful.

Elizabeth: …and deep breathing techniques, for example, referring on to counselling if need be. Or recommending they come for a massage and receive some TLC. Or maybe it's just that they need to, you know, take a holiday and have a look at what's going on in their life. So really looking at the underlying cause, supporting the body through herbal medicine, nutrition, and nutrient supplements, and then using other modalities as well to have that really holistic approach.

Andrew: You and I have spoken previously and you have a brilliant analogy, which you like to use to explain your integrative approach in the clinic. And I think it would be great for you to explain that to the listeners. Would you mind?

Elizabeth: Yeah, sure. So what I tell my patients is that your body is your vehicle. So you've got to treat it like it's a sports car. And, you know, we can do all of this work to make sure that we're putting in the right fuel and that everything's moving nicely through the pipes, etc., and making sure you're not accelerating too fast and burning through your fuel too quickly. But at the end of the day, if you bumped your wheel, and it's a little bit out of alignment, you're going to constantly wear down the tires in the wrong way and unevenly and more quickly than you should, which will then affect, eventually, the axle and maybe even the chassis.

So it's a really good idea to check the structural alignment of your body to make sure that it's all working nicely. And therefore, seeing a chiropractor at the same time working on your nutritional status, you're going to make sure that we're not wearing and tearing your body and your joints down in the wrong way, and getting the most out of it.

Andrew: I think that perfectly explains integrative practice. Well done.

Elizabeth: Thank you.

Andrew: Liz, thank you so much for taking us through what you do for painful conditions in your clinic, because one of the things that I'm so glad you did, it's great to talk about supplements and these, you know, physical interventions that we do. But we must be mindful that a patient is a person with a life outside of our clinic and they experience the stressors they're in. So I'm so glad that you included things like mindfulness and diet and taking holidays and being with life. It's great. And it really accentuates, you know, what you said in your bio, and that is that you love to spend time in the outdoors, enjoying our great country.

Elizabeth: Yeah, sure. A lot of people do suffer from a nature deficiency. They need some fresh air and some sunshine and getting away from, you know, being locked up and feeling like they're trapped in their jobs or their homes. 

Andrew: Indeed.

Elizabeth: So there's a lot to be said to being in the great outdoors.

Andrew: Indeed. Elizabeth Cowley, I thank you so much for joining us today.

Elizabeth: Thanks, Andrew. It's my pressure.

Andrew: This is FX Radio and I'm Andrew Whitfield-Cook.

Elizabeth Cowley is a degree qualified Naturopath with a Bachelor of Health Science in Naturopathy from UNE and an Advanced Diploma of Naturopathy and Diploma of Nutrition from Nature Care College in Sydney. She left behind a corporate career in IT and advertising in 1999 to follow her passion for traditional healing methods and natural medicine. 

Elizabeth is also committed to sharing her clinical knowledge with naturopathic students at the famous Nature Care College, both by lecturing and supervising the clinic to ensure safe, effective delivery of naturopathic principles to patients. 


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