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A Diet for Patients With Chronic Pain

Patients with chronic pain need a high-protein-intake diet, with avoidance of carbohydrate-induced episodes of hypoglycemia and weight gain.
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In contrast to a lot of other medical diets, I allow sugar-free, caffeinated drinks. It is well known that caffeine raises brain dopamine levels, which gives a little extra pain relief. Salt is restricted, because opioids may cause edema, and extra edema around pain sites may aggravate pain. Unless weight is normal, I restrict milk, as it is quite fattening.

Hyperlipidemia

High cholesterol, lipids, and glucose are almost universal in patients with uncontrolled pain because of excess cortisol secretion from the adrenal gland. Good pain control will usually lower high serum lipid and glucose levels. Adequate intake of protein with carbohydrate restriction also will help to control lipid and glucose levels. I believe that good pain control and a high-protein diet should be achieved before starting any anticholesterol medications.

Weight and Obesity

Many patients with pain have pain sites in the spine, hips, knees, and feet that may be aggravated by excess weight. Other patients with pain, such as those with fibromyalgia, headaches, or some neuropathic pain, may not be affected by excess weight. The diet recommended here is, with some exceptions, akin to the low-carbohydrate (Atkins) diet that is used in many weight control programs. It does not eliminate carbohydrates but attempts to restrict them by emphasizing protein intake.

The problem with reducing weight in patients with chronic pain is multifaceted. Chances are, patients can’t move or exercise enough to lose much weight. Medication that will relieve pain, whether an opioid, sedative, muscle relaxant, or antidepressant, may suppress the body’s metabolism and cause weight gain. Anorexiants may be of little assistance because the patient with pain may be eating very little. If the protein diet recommended here doesn’t cause weight loss, I recommend adding a stimulant such as phentermine.

Dietary Supplements

Certain dietary supplements may enhance any diet recommended for patients with pain. My pain diet recommends a daily vitamin–mineral preparation, an osteoporosis prevention compound (vitamin D, magnesium, and calcium), regular vitamin B12, and protein supplements.

There are many amino acid powders, bars, and drinks marketed to athletes and bodybuilders. They make excellent supplements for patients with chronic pain. I like to use protein supplements simply to ensure that there is enough amino acid substrate in the body to synthesize the neurotransmitters, hormones, muscle, and cartilage required for pain control and regeneration of tissue.

Follow-up Critical

One-time dietary counseling alone won’t change nutritional habits. It is highly recommended that periodic nutrition follow-up be done. At each clinic visit, I use a form that asks patients what protein they have eaten in the 2 days just prior to their clinic visit and to list their dietary supplements. If these inquiries are in writing and part of a routine follow-up clinic visit, patients are constantly reminded that diet and nutrition are important.

Summary

A high-protein diet combined with restriction of carbohydrate and salt is recommended for patients with chronic pain. Protein contains the amino acids that are critical for many pain control functions, including formation of many neurotransmitters, hormones, muscle, and cartilage. Other components of a chronic pain diet ideally should contain select dietary supplements that help reduce inflammation, control weight, prevent osteopenia and osteoporosis, and regenerate nerve cells. Practitioners are urged to take a dietary history because the majority of chronic pain patients are woefully deficient in protein intake. Clearly, dietary counseling must be a component of chronic pain care.

Last updated on: December 21, 2012
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