A significant number of chronic pain patients have found pertinent pain relief when using D-L phenylalanine. While DLPA often has value for chronic pain disorders it has no value for acute pain. This confirms that chronic and acute pain use somewhat different mechanisms and pathways as these peripheral sensations are projected to brain centers involved in the conscious perception of pain. It is believed that the dextrorotatory phenylalanine which is relatively inactive biologically is responsible for inhibiting or preventing metabolic destruction of synaptic endorphine or enkephaline. In that instance these naturally occurring neurotransmitters will be more effective in blocking the transmission and perception of pain.

A trial of 750 mgm of this D-L mixture t.i.d. can be used for a week to check upon the clinical response. If no response occurs the amount can be doubled for another week to be sure that enough had been used. When relief has occurred a few patients can reduce the amount required to maintain this relief. Some can even discontinue its use for as long as a week before needing to begin its use again.

It is of interest that this is a "pharmacologic" use of a large dosage of this amino acid because the biolocally active levorotatory compound is not effective in causing pain relief. Both versions are easily metabolized and very safe to use in large doses. However, since we are not using the D-phenylalanine to supplement intracellular metabolic activity, the D-L phenylalanine amounts to a "non orthomolecular" use of megadoses of a safe, non-toxic compound.

The patient is a 50 year old retired man whose major problem involved a toxic sensitivity to industrial fumes. He was also sensitive to several foods, particularly wheat, sodium glutamate in Chinese dishes, also alcohol, especially white wines which could increase his sense of exhaustion. He had chronic generalized pain in his extremeties and particularly in his lumbar paraspinal area which was caused by a non-union fracture of a lamella of the fifth lumbar vertebrae.

The use of D-L phenylalanine, 750 mgm t.i.d. with meals had no apparent effect for the first 4 days. On awakening the fifth day he realized that he could roll over to get out of bed without discomfort. He had become so inured to this level of pain that he did not identify it even to himself as pain. During this time he was using no alcohol since it would increase his physical complaints when he felt depressed. Within 2 days he found that the chronic low level pain in his extremities, especially hands and ankles, had disappeared. Several days later he had a "special dinner" out with his wife to celebrate this relief, and had 2 drinks. He had pain in both achilles tendons and in the tendons of his hands that evening and a return to his lower back pain the following day. These pains were not so severe as previously, and were relieved in one day by the continuing use of D-L phenylalanine. He has subsequently found that the use of alcohol is consistently related to a prompt recurrence of the tendon pains, and by low back pains on the following day. He has found that when he increased his physical activity and began to work on postponed projects that he had acute aches and pains while getting into better physical condition.

In short, he had a clear relief from chronic tendon and musculoskeletal pain, with no relief from acute pains, including those which occur while getting into better condition for increased physical efforts. He was surprised to find that pain in his achilles and his finger tendons could consistently recur, even though at decreased intensity, when he drank socially. The depression which he was experiencing at the start of therapy decreased as he was able to increase his activity, and he returned to a "normal" level of moods within a month of beginning to use the phenylalanine. This relief from chronic pains has continued for over one year. He must maintain dosage at the same level as when he began its use. If he reduces the amount to 375 mgm t.i.d., or to 750 mgm HS alone, the chronic pains return at a lower level of intensity in three days. When he uses 750 mgm t.i.d. he can continue a normal activity in comfort and good spirits.

Robert E. Buckley, M.D.