Dr. Amy Nett: I don’t know what medication you’re talking about, if it’s something like gabapentin or something that you’re using for nerve-related pain. I would wonder if it is an option to get them off. You’re saying it’s not, so we’ll just take that as it is. If they’re not able to get off of the medications, I would still do the gut testing. If they have SIBO, I would treat SIBO. If they have dysbiosis, I would treat dysbiosis. If they have low stomach acid, I would support that with digestive enzymes and HCl. For constipation, I would use magnesium. For bloating, you might use Iberogast, and digestive enzymes might help for that.
I think you can still treat the patient, and I don’t think I would necessarily do anything any differently. I would investigate whether or not they might be able to get off the medication. Maybe think about something like low-dose naltrexone. I don’t know if you’ve already investigated that for dealing with the chronic pain, but again, if they’re just like, “This is my medication. I’m on it forever, period. We’re not going to have this as a conversation,” OK, that’s fine. Then treat the SIBO, treat whatever you can of that. If the SIBO recurs, then you treat the SIBO again, unfortunately. I would approach that just like any other patient, and hopefully by decreasing inflammation in the body, maybe there will be enough relief from pain that maybe you’ll be able to at least decrease the medication so it causes a little bit less disruption in general and maybe provide some relief that allows you to play with the medication and the pain management a little bit more. It sounds like a tricky situation.