Pain, itching, vertigo and dyspnea are symptoms of many conditions often far apart etiologically. We have seen that, according to our research, these symptoms are related to an acid base abnormality at the tissue level. The ideal treatment would be to remove the cause of the symptom, to act upon the etiological factor. This ideal treatment would be entirely different if the symptom stems from a systemic toxic condition, a cancerous lesion, a local inflammatory process or a local allergy, for example. But the great variety of causes that can induce such symptoms as vertigo, pain, itching and dyspnea, often makes this ideal therapy almost impossible, particularly in everyday medical practice.

Another approach to controlling these symptoms would be one which is not especially concerned with the etiological factors involved but with influencing the specific pathogenic changes underlying each of these symptoms. But as such specific changes have not yet been defined, symptomatic treatment has remained as the only practical recourse in these instances.

Recognition in the physiopathological changes present in pain, itching, vertigo and dyspnea of an acid base pattern, has permitted another therapeutic approach on a different, more precise basis. These symptoms, with their dual pathogenesis, have been treated according to the two possibilities: acid or alkaline pattern. Identification of the specific pattern, as noted previously, is simple. Furthermore, pain results from an abnormality present at one level of organization, the tissues. With two groups of antagonistic agents, both capable of acting at the tissular level, the therapeutic problem is reduced to the choice between these agents according to the pattern present. The therapeutic problem—previously so complex because of the need to consider so many possible etiological factors so often unrecognizable—is simplified by this approach to a choice between two groups of agents, determined by one easily identifiable factor.

The means used to recognize the acid base pattern vary with each symptom. We present here a resume of the research made in this direction.

Pain

We have seen that pain can be sensorial or symptomatic, and that the latter has a dual pathogenesis with an acid or alkaline pattern. Reduced to the problem of an acid or alkaline offbalance occurring at the tissular level, the treatment of pain is greatly simplified.

The first problem was to determine the pattern present. The relationship between variations in the curve of pain intensity and concomitant changes in the urinary pH, previously discussed, has been used for such determinations. The simplified method of comparing two urine samples, one corresponding to a period of pain and the other to one of calm, has proven very useful.

Among other analyses, only changes in serum potassium content have appeared helpful in the recognition of the pain pattern. This can be explained by the fact that most of the other routine analyses do not inform us specifically about changes at the tissue level where pain occurs. A high serum potassium level, increasing during pain exacerbation, indicates an alkaline pattern; a low level, decreasing during pain exacerbation, indicates an acid pattern.

Another, sometimes simpler, technique for recognizing the pattern is the response of pain to administration of acidifying or alkalizing agents, as seen above. Also, some substances, while being used as therapeutic agents, indicate the pattern through the responses they induce. Butanol and sodium thiosulfate in adequate dosages (1 cc. of a 6.5% solution of butanol or 1 cc. of a 4% solution of sodium thiosulfate injected intramuscularly) are examples. The intensity of an acid pattern of pain is increased by butanol, and decreased by thiosulfate. The inverse occurs in pain of an alkaline pattern.

With the pattern of the pain recognized through one of these means, agents are chosen from the two groups, anti A for acid pattern and anti D for alkaline. In each group however, some agents have been found to be more effective than others because of their greater activity at the tissue level. The following agents have been found to be most effective against acid pain, in the order presented: lipoaldehydes and especially propionic aldehyde, sodium thiosulfate, sulfurized tetrahydronaphthalene, the acid lipid fraction of various organs, polyunsaturated fatty acids, epichlorohydrin, and selenium in the form of perselenide. For an alkaline pattern, agents with a positive polar group, such as butanol, nikethamide, insaponifiable fractions, glycerol and heptanol are effective in that order.

Once the agent to be used is chosen, the dose which can vary greatly from case to case, is easily determined from the clinical response. In practice, the patient is given a small dose. If the intensity of the symptom decreases but is not completely controlled, the same dose is usually given three hours later. If the symptom intensity remains the same, the dose is continuously increased more or less rapidly, in accordance with the severity of the symptoms, the medication being repeated this time at intervals varying from a half hour to every three hours.

On the other hand, if the symptom disappears after the first administration of the agent, medication is not repeated until the symptom reappears. If the symptom is controlled for less than six hours by the dose used, the same dose is given when the pain reappears. If more than six hours of relief follow a dose, the next dose is usually reduced in proportion to the period of time the effect lasted. If 24-hour relief occurred, the dose is reduced by half; if relief was of two days' duration, one quarter of the last dose is given. However, if, with three successive doses of medication, the symptom increases in intensity each time, always during the first half hour after the medication is administered, it is discontinued and the entire group of agents to be used is reconsidered. A new test for the pattern is performed. If the pattern is the same as before, other agents from the same group are tried. However, if the pattern now is opposite to the original pattern, the group of substances has to be changed.

This technique has produced, with few exceptions, excellent pain relief. This approach to pain has been the object of several controlled studies. S. A. Barragan Martinez (183) and E. Stoopen, (184) in the journal "Pasteur," confirmed our conclusions. From Stoopen's publication we quote two characteristic observations in Note 1.

An intensive study of head and neck pain was made by B. Welt and published in the American Medical Assn. Journal of Laryngology (185). with the following conclusions:

Summary And Conclusions

A series of 120 patients having the symptom of pain in the region of the head and neck has been studied.

The symptom of pain has been analyzed according to Revici's concept concerning the alkaline or acid pattern of the painful symptom.

Eleven cases were eliminated because no pattern was identified; 109 cases showed an acid or alkaline pattern. The results showed a satisfactory result in 84% of the vascular headaches, 100% in migraine headaches, and 75% in the neuralgic group. These results indicate a correlation of Revici's concepts and the results achieved. The simplicity of this method is indicated.

Additional data about Revici's views are given. The relationship to homeostasis and the biology of the cell is indicated.

The problem confronting the clinician in treating cases of this type, on account of the many factors involved, is simplified according to Revici's concept of dualism.

Two additional active products are presented, one acid and the other alcoholic. The data here presented concerned the incidence of the control of the acute symptoms while under observation. Further experience with this method will be necessary. As the method stands, it is a practical method of therapy for the control of pain. Recurrences were seen and controlled."

Our method of controlling pain was the subject of a panel discussion at the American Academy of Ophthalmology and Otolaryngology, New York, N. Y., September 21 and 22, 1954, and of an article published by B. Welt and M. Welt in Modern Problems of Ophthalmology. (186) (Note 2)