Chronic Pain Dietary Interventions

Chronic Pain Dietary Interventions

Pain is one of the most common and problematic clinical complaints, yet most clients suffer chronically and are unable to get relief.

Chronic pain is typically defined as pain persisting longer than 3-months and generally refers to pain that has become a disease entity of itself and distinct from pain associated with acute injury or disease.

As a unique disease state, chronic pain has unique biological features, clinical symptoms, and long-term consequences.

Chronic pain can be divided into primary or secondary classifications.

Primary chronic pain is used to classify conditions in which pain itself has become the primary disease and includes presentations such as fibromyalgia and non-specific low-back pain.

Secondary chronic pain includes post-surgical or post-traumatic pain, secondary headache, secondary visceral pain, and secondary musculoskeletal pain.

The consequences of chronic pain are significant and impact psychological and physical health including adverse impact on sleep, cognitive processes and brain function, mood, mental health, cardiovascular health, sexual function, appetite and nutrition, medication dependence, social connection, and overall quality of life.

The biology and pathophysiology are diverse and highly individual, however there may be important sharded mechanism across seemingly disparate clinical conditions that could help identify mechanism-based as opposed to symptom-based treatments.

A key feature of chronic pain is central sensitisation, which is characterised by increased activity in neurons and circuits involved in processing pain in the central nervous system coupled with reduced inhibition and ineffective endogenous pain control.

Inflammatory mediators sensitise pain sensing neurones and enhance pain transmission.

Mitochondria are implicated in the development of chronic pain with dysfunction of mitochondrial metabolism and related ATP deficiency, excessive reactive oxygen species and impaired calcium buffering.

Oxidative stress could contribute to the development and maintenance of chronic pain.

In the central nervous system, reactive oxygen species can produce central sensitisation and hyperalgesia in the absence of nerve damage or tissue inflammation.

Nutritional neuropathies are an important and overlooked cause of chronic pain, with deficiencies in vitamins B1, B3, B6, B13, vitamin E and copper of particular importance.

Several nutrients have been shown to modulate pain, including amino acids (tryptophan, phenylalanine, carnitine), fatty acids (omega-3 fatty acids, resolvins, n-palmitoylethanolamide), minerals (selenium, magnesium, iron, manganese) and vitamins (vitamins B, C, D, E and K).

Dietary therapy is a foundation of chronic pain management. A range of dietary interventions across different clinical pain syndromes have been studied. A review of 37 clinical trials, found that dietary interventions such as caloric restriction and fasting, enriched polyunsaturated fatty acid diets, low-fat plant-based diets, high-protein diets, and elimination diets all generally revealed positive results.

Food choices in chronic pain conditions should be based on anti-inflammatory and antioxidant foods, including carbohydrates with low glycaemic index, fruits and vegetables, yogurt, and extra virgin olive oil, legumes and fish, white meat, eggs, and fresh cheese weekly, and red or processed meats once per week in addition to personalised nutritional supplementation.

“Food and nutrition are foundational tools in the treatment of painful and inflammatory conditions. There is compelling evidence showing the benefits of a healthy diet composed mainly of unprocessed, plant-based foods.”

– Dr. Heather Tick; Nutrition and pain.

Phys Med Rehabil Clin N Am. 2015

May;26(2):309-20.