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5 Articles in this Series
An AIPM 2018 Preview with Clay Jackson, MD
Can Nutritional Management Make a Dent in Pain Relief?
Challenges Faced When Implementing an Integrative Care Model
The Role of Cannabis in Pain Care Today
When Pain, Opioid Use, and Mental Health Intersect

Can Nutritional Management Make a Dent in Pain Relief?

The Academy of Integrative Pain Management (AIPM) is offering for the first time, worldwide, a clinical certification program in nutritional pain management. The 6-credit CME workshop was held as part of the 2018 Global Pain Clinician Summit in Boston on November 10. Leaders used common pain conditions (eg, fibromyalgia, migraine, osteoarthritis, chronic low back and musculoskeletal pain), as well as obesity and pain due to degenerative neurologic conditions or autoimmune disorders, to explain the impact of nutrition on managing pain. PPM talked to the workshop's two leaders: Nancy Cotter, MD, FACN, CNS, and Robert Bonakdar, MD, FACN, for additional insight.


Source: 123RF

PPM: While “nutraceuticals” have been around for some time, nutrition may not be considered as a first- or even second-tier approach for managing chronic pain. What has changed in nutritional management for pain in the last few years that may alter clinical strategy going forward?

Drs. Cotter & Bonakdar: Many things have changed. More than ever, people are linking diet to health. Diet and cardiovascular health and metabolic health have been seen for a long time as important elements of decreasing the risk of myocardial infarction or reversing pre-diabetes. As more and more studies support these links, clinicians and patients alike are turning to nutrition for other chronic conditions, such as neurodegenerative diseases and autoimmune conditions. It makes sense that they are now starting to see that pain, a chronic condition with many potential etiologies, can also respond to nutrition.

PPM: Do you feel that nutritional pain management is growing in response to sought-after opioid alternatives, and, in your opinion, can diet changes have as a big an impact on pain relief as pharmacological interventions?

Drs. Cotter & Bonakdar: We have been seeing such an impact in our respective practices for quite some time. Patients, clinicians, and researchers are now more interested than ever in any nonpharmacologic approach to pain due to the opioid crisis. Diet changes can be as impactful as opioid medications, but the results are more gradual and incremental.

PPM: In general terms, how does what a patient consumes potentially promote pain? Could you give an example of a supplement or diet change, and the mechanism involved?

Drs. Cotter & Bonakdar: Food can be associated with headaches, joint pain, muscular pain, and abdominal pain. A classic example is magnesium deficiency and migraine headaches. For a patient with a magnesium-poor diet, migraine headaches have been shown to respond to magnesium replacement either orally or intravenously.

PPM: As experts in this discipline, what does the current literature report in terms of the evidence behind an anti-inflammatory diet and an elimination diet for pain relief?

Drs. Cotter & Bonakdar:  There are many anti-inflammatory diets and elimination diets, so its difficult to summarize in one sentence. In general, there is growing evidence that dietary patterns which increase inflammation also promote pain, and those that reduce inflammation reduce pain. There are many types of elimination diets, but there is growing evidence there too. One example is the low FODMaPs diet (referring to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols), which has been shown to be effective in a large proportion of patients with irritable bowel syndrome symptoms.

PPM: Some of the interventions recommended in the nutritional pain management certificate program are to consider:

  • A specialized diet in specific pain conditions
  • An anti-inflammatory diet
  • An elimination diet
  • The use of herbal supplements (eg, curcumin, boswellia, ginger)
  • The use of non-herbal supplements (eg, omega-3s, CoQ10, B-vitamins, probiotics)

From this list, what would you say are the major takeaways for practitioners?

Drs. Cotter & Bonakdar: The takeaway is that there is a good deal of evidence linking nutrition and pain, and many and varied nutritional tools that clinicians can use.

PPM: Should the role of nutrition change clinicians’ opening assessments and conversations with patients, and how so?

Drs. Cotter & Bonakdar: Absolutely. With chronic pain, there is no one silver bullet for pain relief. In most cases, multiple simultaneous interventions are necessary: exercise, manual therapies, etc. Dietary change can contribute significantly to this multilevel strategy. Busy practitioners may not have time to guide the patient in dietary change but can make general recommendations and collaborate with a nutrition professional, or use handout materials for the patient to explore. All pain professionals would add greatly to their toolbox if they were to offer some basic nutrition advice and collaborate closely with nutrition professionals.

Nancy Cotter, MD, FACN, CNS, is the physician lead for integrative health at the Veterans Administration and an assistant clinical professor of physical medicine and rehabilitation at New Jersey Medical School. Robert Bonakdar, MD, practices family and pain medicine at the Scripps Center for Integrative Medicine in La Jolla, CA. He has conducted award-winning research and presented at numerous conferences in the area of herbal and natural medicines.




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