It’s worth a try

How is a walk in the woods related to SIRVA?

Are there any natural remedies (I’m talking about free ones here, not supplements) that can help with SIRVA pain? Why not try? Skip to the bottom of this post to get straight to the recommendations without all the blathering.

Shoulder Injury Related to Vaccine Administration (SIRVA) is essentially an aggravated immune system response to the vaccine agents in a place where they don’t belong. The act of injecting most liquids into your shoulder should not necessarily produce the kind of extended pain and visible damage that SIRVA causes. The problem with SIRVA is specifically because of the strongly “immunogenic” or “antigenic” agents in the vaccine, and seems to be nonspecific to which vaccine. Here are the results so far from the SIRVA Survey for which vaccine caused our problems:

SIRVA Survey responses as of 4/30/18

So, we’re mostly flu vaccine recipients, and these numbers certainly relate to the prevalence and frequency (yearly) that we’re recommended to get the flu vaccine. But it is fascinating that SIRVA appears to be unrelated to which vaccine it is.

There is some suggestion in the literature that having previously been exposed to the vaccine before (or, presumably, the actual disease) is part of the problem: the body already recognizes it as a threat. So far, in our Survey results, 100% of people had previously received this vaccine (no one has selected “Never before”):

SIRVA Survey responses as of 4/30/18

The body’s immune system is launching an inappropriately-located response, producing the antibodies to fight the agents in the vaccine (such as inactivated influenza viruses in the case of some flu shots), and it is thought that these agents “hang out” longer in the non-vascular structures of the shoulder when compared to the muscle (where the vaccine is supposed to be injected). There are fascinating articles about how the body’s NORMAL response to a CORRECTLY administered shot (to the right muscle) is affected by factors such as stress, exercise, age, sleep, etc., and how they boost or weaken the immune system and directly affect the antibodies produced that fight the vaccine. Can we learn anything from those studies about how to deal with SIRVA?

This brings me to the point of this post. It makes me wonder: do you want to BOOST your body’s immune response to help it “deal” with these agents better (produce the right antibodies to neutralize the perceived threat to the system) or do you want to SUPPRESS your body’s immune response to keep it from going nuts on your own shoulder structures (tendon, bone, bursa)? Anybody know an immunologist who can turn these uninformed wonderings into a coherent hypothesis? What does SIRVA have in common with other mild to extreme cases where the body has an overactive immune response to a perceived thread (e.g., allergies, autoimmune disorders)? Can we learn something from these much-more-heavily-studied scenarios and apply them to SIRVA?

Recommendations

Therefore, I present below some things that are maybe “Worth a Try.” They are categorized into “immune system boosting” and “immune system suppressing”, within the constraints of available evidence. I don’t claim that the evidence for each of these things is equally strong, and please evaluate the quality of the sources skeptically. I’ll update this list as I hear of other things.

Update–I just added the “meditation” link below. This is fascinating: a study (pdf here, video about it here) analyzed the body’s immune response to the influenza vaccine by measuring antibody levels several times after vaccination. The meditation group had statistically significant increase in antibodies over the control group in antibody to the vaccine (Davidson et al. 2003). A key finding from a more recent rigorous, peer-reviewed 2016 meta-analysis of meditation studies (Black and Slavich, 2016):

“This systematic review of 20 randomized controlled trials, comprising more than 1600 participants, revealed replicated, yet tentative, evidence that mindfulness meditation is associated with changes in select immune system processes involved in inflammation, immunity, and biological aging.”

Immune System Boosting:

Immune System Suppressing:

As for me? Even if the evidence is slim for some of these, and even if I don’t have an answer to the question above (boost or suppress, in the case of SIRVA?), I’ve been trying some immune-system boosting things, like eating healthier (more fruits and vegetables, whole grains, and fish). I take a multi-vitamin now and glucosamine/chondroitin, despite the thin evidence for them helping. On the other hand, I am definitely getting vigorous exercise (I’ve started running, and run to fatigue every time). If you’re feeling guilty about NOT exercising or you would love to be able to do it but you find it aggravates your shoulder pain and SIRVA symptoms, I wouldn’t feel bad about that—it’s unclear from the evidence which is a good idea, exercise or no exercise!

Trying to eat healthy foods every day, like colorful Swiss chard, for their immune-boosting properties.

Supplements?

I have purposely avoided mentioning supplements, because I wanted to suggest things that are completely free and don’t come with the baggage of conflicting interests. But I feel like I’d be remiss for not mentioning things like zinc, multi-vitamins, and glutamine. There is conflicting evidence on whether daily multi-vitamins affect peoples’ responses to the flu vaccine, including a retracted study, which was its own fascinating rabbit hole of research for me.

In one case in the medical literature where the SIRVA patient had severe bone damage from the incident (!), she was given a combination of supplements, over-the-counter medications, and prescription drugs (ibuprofen, bisphosphonates, calcium, and vitamin D3) and experienced reduced pain, but did not recover completely in the follow-up time in the paper (11 months total).

 

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