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17 Articles in Volume 20, Issue #1
20/20 with Lynn Webster, MD
Correspondence: Opioid-Induced Hyperalgesia; Pain Care in Older Adults
Don’t Discount the Role of Diet for Chronic Pain Relief
Editorial: Why Haven’t There Been More Breakthrough Analgesics?
Gasping for Air: Sleep-Disordered Breathing and Chronic Opioids
How can botulinum toxin be used in chronic pain syndromes?
Inside the Potential of Peripheral Kappa Opioid Receptor Agonists
Neurodestructive Interventions for Cancer Pain
Obesity and Pain Care: Multifaceted Considerations for Treatment
Obesity and Rheumatoid Arthritis: What Clinicians Should Know
Sickle Cell Pain Crisis: Clinical Guidelines for the Use of Oxygen
The Complexity of Sickle Cell Pain: An Overview
The Perseverance Loop: The Psychology of Pain and Factors in Pain Perception
The Rapid Rise of Non-Opioid Pain Policies
Treating Pain by Overcoming Communication Barriers
Visual Artists Tackle What Pain Looks Like
Will 2020 Be the Year of Patient Education?

Don’t Discount the Role of Diet for Chronic Pain Relief

Incorporating nutrition into pain management may offer a more cost-effective option for patients.
Pages 46-47

Certain nutritional supplements, as well as trace elements and minerals, may help individuals suffering from acute and chronic pain, according to a recently published review by experts from leading institutes across Europe and the Middle East.1 “The ability of the human daily diet to modulate pain onset and peripheral analgesic sensitivity has recently come into the spotlight as physicians are paying increased attention to patient lifestyle,” wrote the team in their review of more than 200 studies, which assessed a variety of dietary elements and their potential roles in pain prevention.

Many substances known to be active antioxidants and anti-inflammatory compounds could potentially be part of a pain management protocol. Some examples of naturally occurring antinociceptive and analgesic compounds include:1

  • flavonoids, which have shown an ability to reduce hyperalgesia and improve neurogenic pain
  • zerumbone (ginger root), which can act as an analgesic against neuropathic pain by targeting anti-inflammatory pathways
  • curcuminoids, which have demonstrated antioxidant effects and have been used in chronic musculoskeletal pain
  • ω-3 polyunsaturated fatty acids (PUFAs), which have shown effectiveness in reducing joint pain associated with inflammatory conditions and with some types of chronic pain, most notably dysmenorrhea.
  • taurine, which notably reduced symptoms of low back pain in a combination with tramadol, paracetamol, and caffeine.2

Data support the value of flavonoids in reducing pain in several ways, including via the COX pathway and by targeting opioid and sigma-1 receptors. In fact, one study showed that flavonoids promoted antinociceptive activity, including both chemically driven hyperalgesia and neurogenic hyperalgesia through a range of pathways.3 Flavonoids are present in a range of fruits and vegetables including apples, strawberries, onions, soybeans, cucumbers, and broccoli.

In addition, the reviewers suggested that proper intake of trace elements and minerals may help to reduce inflammation-related pain. (More on supplements for MSK pain.)

Polyphenols and Polyamines

The anti-inflammatory role of polyphenols, such as capsaicin found in chili peppers, is well-recognized, the researchers noted. Their review included studies of associations between pain relief and the flavonoids found in red wine, berries, green tea, and soy. In general, flavonoids have shown the ability to reduce hyperalgesia and neurogenic pain. However, the reviewers did not provide specific data on how much of these foods are needed to impact pain.

Polyamines, including spermidine, spermine, and putrescine, are less known but promising pain relievers that mediate nociception, the researchers noted. These substances are found in legumes, cereals, mushrooms, and algae, but the amount needed to impact pain is uncertain.

Developing a dietary panel for pain mitigation can be complicated, especially as most research has been conducted in animals. (Image: iStock)

Trace Elements

The review also referenced studies on the roles of trace elements in relieving pain, notably magnesium, zinc, vitamin D, and taurine. In particular, they noted a meta-analysis4 of vitamin D supplementation for chronic widespread pain. In the review of four studies including 287 adults, visual analog pain scores were significantly lower in fibromyalgia patients treated with vitamin D compared with a placebo.

Practically speaking, however, developing a dietary panel for pain mitigation can be complicated, especially as most research has been conducted in animals, the researchers wrote. More studies are needed to determine the best dietary guidance to help reduce pain in patients with comorbidities, possibly through an expert panel, they said. “It is apparent that a recommended dietary program must face numerous cultural differences and nutritional habits worldwide, including socioeconomic burden and food availability,” the reviewers said.

“Despite the many reports about the suitability of dietary panels in preventing and reducing nociception and inflammation or neurogenic pain, diet, together with physical exercise and a proper lifestyle, remains a promising strategy for reducing pain burden,” they concluded.

Clinical Takeaways: Considering Diet for Pain

This review addressed what has long been suspected and understood about key nutrients, said Tiziano Marovino, DPT, FAAPM, senior vice president of Health Strategy and Innovation for the Biogenesis Group, and a member of the PPM Editorial Advisory Board.

“It is important to look at all feasible options when it comes to pain management to reduce the global burden of chronic pain, which is associated with enormous economic costs, lowered human productivity, a reduced human experience (quality years), and persistent pain, which has been the primary cause for reliance on opioid medication,” he said.

Incorporating diet into pain management may offer a more cost-effective option for patients. If researchers were able to identify more natural options for pain relief, there might be more “equitable access to alternative interventions for everyone experiencing chronic pain and not just for those who are insured or can directly pay for it,” he noted. “If dietary manipulation can provide a verifiable reduction in the pain burden of individuals, then we need to explore any and all alternatives to more costly and risky pharmaceuticals.”

Dr. Marovino added that using diet to help manage chronic pain need not be complicated. “We all have to eat,” he said. “[What] we are really talking about is making smarter, more informed choices about the foods we select. Although the science is not all in at the moment, we have enough empirical evidence to know that foods are both nourishment and medicinal.”

His advice to providers is to be prepared when patients raise the question of diet. “In many cases, patients will probably engage us before we engage them when it comes to the healing/medicinal properties of foods and are asking for guidance in this important aspect of living,” he said. “My experience is that most people are willing and would welcome a conversation on optimal nutrition,” he explained.

Is a “Pain-Relieving Diet” on the Way?

PPM Editor Emeritus Forest Tennant, MD, DrPH, head of the Tennant Foundation Arachnoiditis Research & Education Project in West Covina, CA, also commented on the review. He was surprised that the paper did not identify a diet regiment based on key findings, but he noted that, based on sufficient evidence of efficacy, clinicians might consider several dietary compounds as part of a patient’s pain management program. These include unsaturated fatty acids, vitamin D, taurine, selenium, flavonoids, curcumin, wild ginger, zinc, and magnesium.

The presence of flavonoids in many fruits and vegetables supports the perennial argument in favor of these foods, he said. He also noted that the researchers’ identification of taurine’s ability to boost the effects of opioids has implications to help reduce opioid use.

Going forward, Dr. Tennant said that what would be truly helpful to clinicians are “dietary controlled studies in chronic pain patients,” but noted that these are “extremely expensive, time-consuming, and usually controversial.” In the meantime, he suggested that dietary advice to patients living with chronic pain focus on inflammatory pain reduction, weight control, collagen-building, and potentiation of analgesics. 


 

 
Last updated on: June 18, 2020
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