Acute and chronic pain has affected humans since the beginning of time. Ancient healers, shamans and, nowadays, medical doctors, naturopaths, chiropractors, and acupuncturists utilize varied approaches to treat both acute and chronic pain syndromes. Chronic pain is diagnosed when a person endures pain in a specific area for more than six weeks—it usually results from inflammation, which creates an imbalance within the body.

Frequently, the following conditions are associated with chronic pain and reduced enjoyment of life:

• Osteoarthritis and degenerative joint disease
• Rheumatoid arthritis
• Back pain and degenerative disc disease
• Fibromyalgia
• Peripheral neuropathy
• Complex Regional Pain Syndrome (CRPS)
• Migraine headaches
• Chronic pain related to shingles (post-herpetic neuralgia)

Drug companies have created medications to help patients reduce the pain associated with these conditions and improve quality of life. However, medications are not without side effects, some of which can be life-threatening. I frequently prescribe these medications as they work very well. However, I believe they should be used as a last resort—getting to the root cause of the inflammation and pain is a wiser route for long-term management.

The following have been shown to increase pain throughout the body:

• Systemic Inflammation
• Poor sleep
• Altered biomechanics (trouble walking, moving, etc.)
• Sedentary lifestyle
• Obesity
• Insulin resistance (due to being overweight and/or obesity)
• Diet high in animal-based products
• Diet high in fast foods and processed foods
• Relationship difficulties – A 2014 study in the Journal of Pain and a 2017 study in the European Journal of Neuroscience showed that negative remarks from another person, i.e. spouse or friend, can worsen your physical pain
• Feelings of guilt
• Feelings of anger towards another

Addressing the underlying problem causing chronic pain is the first step that should be undertaken. However, sometimes medications may be needed, especially when lifestyle and supplements are not sufficient. Do not stop taking any medications without consulting your physician first.

The following can help reduce chronic pain symptoms:

• Routine exercise as tolerated
• Good sleep habits
• Stress relief
• Improving blood sugar control in those with diabetes
• Consuming a primarily plant-based diet
• Consuming a diet rich in nuts, seeds, and foods with omega-3 fats.
• Love of self and others
• Attitude of forgiveness toward self and others
• Good social support
• Certain medications and supplements

The Good and Bad of Prescription Pain Medications

Common medications used for chronic pain include acetaminophen (Tylenol, paracetamol), Non-Steroidal Anti-inflammatory Drugs (NSAIDS), and narcotic-based medicinals. These classes of medications have helped millions get through the day by reducing pain. But, there are risks, which will be discussed below.

Paracetamol /Acetaminophen

Paracetamol, or acetaminophen in the United States, is also known by the trade names of  Tylenol, Calpol or Panadol. Discovered in 1877, this medication is available without a prescription. While helpful for many, paracetamol can put oxidative stress on the liver. When taken in excess or for prolonged periods of time, it can induce liver damage or, rarely, fatal skin reactions where the skin severely blisters. Avoid drinking alcohol if you consume paracetamol or acetaminophen regularly.

Nutrients depleted:

• Glutathione

Supplements advised:  

• NAC or N-acetyl cysteine (the body converts NAC to glutathione)

Non-Steroidal Anti-inflammatory Drugs (NSAIDS)

Non-Steroidal Anti-Inflammatory (NSAIDs) drugs are available with and without a doctor’s prescription, depending on their strength. This category of medications is frequently used to treat headaches, back aches, neck pain, and arthritis-related pain.   

I frequently prescribe them, when appropriate. When taken for a few days or weeks, they are relatively safe. However, these medications are not without side effects when used long-term for chronic pain and can increases risk of stomach ulcer, kidney disease, stroke, and heart attacks.

In 1999, the Federal Drug Administration approved rofecoxib (Vioxx, Ceoxx, and Ceeoxx) for treatment of osteoarthritis pain. Five years later, the medication was withdrawn from the market after it was blamed for causing heart attacks.  

Experts believe up to 60,000 people may have died due to side effects of this drug.  Fortunately, the other options on the market appear to be safer, but they do have risks associated with them, including nutrient depletion.

Drugs in this class include: Ibuprofen (Advil, Motrin, Brufen, Nurofen, Eve, etc.), Naproxen (Naprosyn, Aleve), diclofenac,  indomethacin and  meloxicam (Mobic)

Nutrients Depleted

• Folate – important for heart and brain health
• Vitamin C – may account for some of the increased bruising seen in chronic users
• Vitamin E – important for heart health
• Melatonin – may account for insomnia related symptoms some experience

Supplements Advised

• Folate – take as directed on the label
• Vitamin C – 500 to 2,000 mg per day
• Vitamin E – 200 to 400 IU per day
• Melatonin – 3 mg to 10 mg 1-2 hours before bed

Narcotics:

Narcotics are commonly used for chronic pain disorders. They are derived from the opium poppy. They do not fix the underlying problem nor reduce inflammation—they simply create a sense of euphoria or well being.  Overuse and abuse of narcotics is an epidemic in the United States, Europe, Russia and Asia. When used short term, they can be helpful. Long-term use may actually increase pain levels and increase the risk for a person to stop breathing. According to the Centers for Disease Control (CDC), in 2015, more than 33,000 people died from an opiate overdose in the United States. Half the deaths were due to prescription opiate drugs. One in ten people who take these medications is at risk for addiction.

Drugs in this class include: Codeine, tramadol, hydrocodone, oxycodone, morphine sulfate, fentanyl (see acetaminophen /paracetamol if taking combination narcotic/acetaminophen/APAP).

Cigarette use makes narcotics less effective by increasing body’s elimination of the narcotic.  When narcotics are combined with alcohol or other controlled medications, the results can be fatal—the combination can result in heart rate to slow and breathing stop.

Nutrients Depleted

• Vitamin C
• Melatonin

Supplements Advised:

• Vitamin C – 500 to 2,000 mg per day
• Melatonin – 3 mg to 10 mg 1-2 hours before bed

Safer Alternatives Using Nutrition and Natural Anti-inflammatory Supplements

Nutritional Approach to Chronic Pain Relief

• Consuming a primarily plant-based diet is the best for reducing chronic inflammation and pain in the joints and back.  
• Studies demonstrate that the Mediterranean diet can be helpful in reducing joint-related pain from arthritis. This diet is rich in fruits, vegetables, fish, poultry and olive oil.
• A study in the Lancet demonstrated that patients who consumed a vegan, gluten-free diet for three to five months and then switched to a lacto-vegetarian (dairy-vegetarian) diet significantly reduced their joint pain for up to 1 year.
• Limiting animal-based products such as dairy, cheese, beef, and chicken helps reduce chronic pain. Grass fed, hormone and antibiotic-free beef, and poultry are a better option.
• Avoid sugars, simple carbohydrates. trans-fats (hydrogenated oils) which cause more inflammation and, therefore, more pain.
• Consume cultured foods in your diet such as kefir, kombucha, miso soup, and sauerkraut
• Reach your optimal weight, which for most is a body mass index (BMI) < 25.  Carrying excess weight, especially in the abdomen, places more stress on your back and joints. Extra weight also increases inflammatory proteins (ie. cytokines) in your blood resulting in more elevated pain.
• Organic fruits and vegetables contain phytonutrients, which decrease inflammation and help reduce overall pain.  Aim for five to nine servings per day. Familiarize yourself with the Environmental Working Group’s Clean 15  and the Dirty Dozen.
• People with food sensitivities may have increased joint pain with dairy, grains (gluten sensitivity), and nightshade vegetables (tobacco, tomato, white potato, and bell peppers).
• Do a two-week elimination diet to see if these foods are associated with your joint pain.

Alternative Therapies

• Acupuncture and Qigong may help with knee arthritis pain.
• Mindfulness and meditation is helpful in minimizing pain associated with osteoarthritis and rheumatoid arthritis.
• Tai Chi has been shown to be helpful in alleviating knee pain among other pains.
• Yoga has been shown to lessen joint pain in those with rheumatoid and osteoarthritis.

Primary Nutritional Supplements for Chronic Inflammation and Pain

• Curcumin/Turmeric - Studies show this herb is helpful in reducing pain in both rheumatoid and osteoarthritis.  It can also be helpful in those with back pain and nerve- related pain. Scientists have discovered that this herb does things similar to multiple blockbuster prescription drugs since it modifies NF-KB signaling and reduces pro-inflammatory chemicals such as  COX-2 and 5-LOX. Suggested dose:  500 mg one up to three times per day
• Omega 3 Fish Oil (EPA/DHA) - Studies show essential fatty acids help improve pain and reduce use of NSAIDs. Studies also show a reduction of joint stiffness when fish oil is taken daily. Omega-3s can also be helpful for those with chronic back pain.  Suggested dose: 500 mg up to 4,000 mg per day

• Nigella Sativa (Black cumin seed oil) - A medicinal herb shown to reduce inflammation in both rheumatoid arthritis and osteoarthritis.  It does so by inhibiting inflammatory chemicals called interleukin-1, 6 and nuclear factor KB.    Suggested dose:  As directed on the label
• Boswellia - This Ayurvedic herbal supplement can help reduce pain and inflammation markers in the blood, like CRP in rheumatoid arthritis, and reduce pain due to osteoarthritis. Studies also show boswellia can be helpful in those with pain due to peripheral neuropathy. Suggested dose:  50 mg per day or as directed.
• Ginger - Ginger can help reduce inflammatory markers and pain in arthritis. Ginger is a COX inhibitor, meaning it works similarly to ibuprofen and naproxen to reduce pain and inflammation. Fortunately, it does not have the dangerous side effects.  Suggested dose:  25 mg daily or as directed

The above supplements can be taken separately or taken in a combination nutraceutical supplement.

• Vitamin D –Studies show that those with higher levels of vitamin D are less likely to develop rheumatoid arthritis. Routine consumption also reduces chronic pain. Suggested dose: 2,000- 5,000 IU daily.
• Probiotics – Probiotics, can help reduce chronic pain by optimizing gut health and helping to reverse a leaky gut. Consumption of a probiotic that contains both Lactobacillus and Bifidobacterium is advised.  Suggested dose: 5 billion to 30 billion units once or twice per day
• Magnesium – Studies show magnesium, a natural muscle relaxer, can be helpful in those with fibromyalgia. A 2013 study in Rheumatology International showed that oral magnesium citrate reduced pain in those with fibromyalgia-related pain. Further, a 2015 study in the Journal of Integrative Medicine demonstrated that when magnesium chloride was applied to the skin, there was a reduction in pain. Some studies have also shown that a combination of magnesium and malic acid could be helpful. Magnesium is available in capsules, sprays, and lotion formulations. Suggested oral dose:  125 mg to 500 mg or as directed on label

Secondary Nutritional Supplements for Chronic Pain

• Glucosamine-Chondroitin Sulfate has been shown to reduce knee pain, according to a large review that compared 4,900 patients who took the supplement vs 4,100 who took a placebo.
• SAM-e is also effective in lowering pain associated with chronic arthritis and neuropathy pain.  Suggested dose: 400 mg 2-3 times per day
• Bromelain is an enzyme extracted from pineapples. It helps reduce chronic pain in the joints due to inflammation. Bromelain could also help pain associated with peripheral diabetic neuropathy.  Suggested dose:  Bromelain 500 mg 2-3 times per day
• White Willow Bark has been used by Native Americans for fever and pain for centuries. It contains salicin, the compound aspirin comes from. Do not take this herb if you take aspirin, blood thinners or NSAIDs drugs.  Suggested dose: Take as directed on the label

Summary

Chronic pain is a primary cause of life dissatisfaction. Prescription medications can be helpful but are not without side effects which concern many. Balancing risks and benefits is crucial. Choosing a healthy lifestyle that focuses on generous daily servings of fruits, vegetables and increased physical activity as tolerated is instrumental to feeling better and reducing chronic inflammation. There are various supplements on the market which have been helpful for many people who are afflicted with chronic pain. Many start with supplements such as vitamin D, Omega-3 fish oil and probiotics. Thereafter, many consider adding magnesium, turmeric, ginger and others as discussed above.  Go forth and seek wellness and happiness. Eat healthy, think healthy, and be healthy.

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