Nutrition & Pain management
March 2022
Healthy Nutrition & Lifestyle in the Management of Long-term Pain
Dr Jasdeep Gupta (Nutritionist) ; Dr Vishal Gupta (Pain Specialist)
‘Nutritional interventions have a significant effect on pain reduction’ (1) – International Association for Study of Pain (IASP) 2020.
Chronic pain is the condition that has persisted for more than 3 months (12 weeks) after the initial trigger has subsided or has been removed.
Around 20% of the population suffers from chronic pain.
The pain can persist for years and can negatively impact on the individual’s life in many ways, affecting the physical, psychological and social wellbeing.
It is not uncommon for patients suffering from long term pain to have associated mental health issues. This along with restricted mobility and dependency on others (partner or carers) can cause a tendency to neglect their nutrition. The associated side effects of the common pain medications can also contribute to reduced appetite and disturbed sleep.
The medicines prescribed in these cases come with hurdles & barriers like-
Side effects- nausea, vomiting, mental clouding, constipation, drowsiness.
Activity Limitations- Driving issues due to drowsiness, Inability to concentrate in high skilled work.
Inadequate pain relief and body developing resistance to medicines after some time …. Requiring dose escalation or change of medication, which leads to dis-satisfaction, reduced compliance and loss of trust.
How has our nutrition changed now-days?
We have moved from being predominantly plant-based to more high energy density and processed foods, including a substantial increase in the intake of saturated fats and sugars.
The modern diet is highly calorific, more inflammatory and less nourishing – affecting our digestive system, our healthy gut bacteria and lacks essential nutrients which are required for detoxification and body rejuvenation.
Multinational companies are offering a quick fix via nutritional supplements as a first line to compensate for nutritional deficiencies rather than adjusting or diet.
Is there a natural option?
Yes…there is, the holistic management of pain. The body produces natural pain killers called ‘endorphins’- which are morphine like substances. These are chemicals produced naturally in our brain which help to dampen our pain signals in our everyday life. The other chemicals like serotonin and norepinephrine (also known as happy chemicals), which help to elevate our mood, are also produced by our nervous system.
How can optimising nutrition help?
For the synthesis of these natural pain modulating chemical and hormones, the body needs essential nutrients, which can only be supplied via a balanced diet.
Dietary intake can enhance the function of the nervous, immune and endocrine systems, directly impacting pain symptoms & experiences.
Weight reduction or maintaining weight reduces the load on joints, and reduces micro-inflammation, reducing pain.
Dietary intake and weight optimisation reduces the severity of other chronic diseases (e.g., cardiovascular disease, diabetes and mental health disorders, including anxiety and depression), often occurring concurrently with chronic pain (1).
Nutrients that can help with pain:
Essential Amino acids- Serotonin synthesis in the brain requires specific nutrients like the essential amino acid tryptophan. This is present in eggs, oats, beans, nuts/seeds and chicken.
Vitamins -Deficiency of Vitamin C can lead to oral pain & Vitamin D can cause generalised musculoskeletal pain, low mood and low back pain. Nerve pain (neuropathic) in hands & feet has been linked to vitamin B12 deficiency due to peripheral neuropathy.
Essential Fatty acids - Both Omega‑3 and Omega‑6 fatty acids are required, in an optimal balance, by the body to maintain its inflammatory and anti-inflammatory action. Omega 6 has been associated with inflammation, which is normally required for healing, but the exaggerated response can lead to heart disease, cancer and auto-immune inflammatory conditions. Omega 3 has an anti- inflammatory role in decreasing symptoms in rheumatoid arthritis.
The WHO recommendation is to maintain a ratio between 1:1 to 5:1 of omega 6: omega 3. Our modern diet of processed food has shifted that ration to 15-25:1. Therefore foods rich in omega 3 like oily fish and flax seeds are recommended.
Certain oils like virgin olive oil, have shown anti-inflammatory properties similar to pain killers due to presence of ‘oleocanthal’.
Antioxidants - Flavonoids are powerful substances that are found in fresh fruits & vegetables that help to boost immunity and help our body in fighting an illness. These are present everywhere in the plant kingdom, including fruits, vegetables, roots, bark etc. They also have anti- inflammatory, anti-oxidative and neuro-protective properties.
Nutrients that can aggravate pain:
Polyamines -Polyamines are important for cell growth, but they can upregulate the activity of a receptor in the nervous system which is involved in amplifying pain. A polyamine deficient diet has been shown in animal studies to reduce pain hypersensitivity. Peanuts, potato crisps, oranges and orange juice contain very high levels of polyamines. Consumption of these foods in large quantities can exacerbate chronic pain.
Caffeinated beverages - These drinks are not absolutely contraindicated but high levels of these caffeine containing beverages like coffee, cola and energy drinks can aggravate pain symptoms. They do this in multiple ways-
1. They stimulate or excite your nervous system and can disturb the normal sleep pattern, which can cause fatigue and pain flare ups.
2. There is some suggestion that caffeine also counteracts the effects of certain neurotransmitters in the body, which can worsen for chronic headaches.
3. The sugar content of the energy drinks can lead to increase indirect daily sugar consumption, which again is pro-inflammatory.
What is the take home message?
Maintain an optimal weight: Although there is no direct correlation between pain and excess body weight, there is an indirect association. Patients with pain often find themselves in a ‘catch 22’ situation when it comes to engaging with exercises to lose weight. The accompanying mood issues can also lead to demotivation. In these circumstances, the nutritionist can help you reduce and control weight via a customised diet plan.
Dietary pattern: Just like a regular sleep cycle is important, a healthy eating pattern also needs to be established. The day should start with a healthy breakfast and regular meals with healthy snacks in between. Skipping the meals for weight loss is not ideal, rather the focus should be on the quality of calories consumed.
Essential fatty acid intake: Pain patients should include foods rich in omega‑3 in their diet and be careful with regards to foods rich in omega‑6. Swapping dietary vegetable oils high in Omega‑6 fatty acids (such as soybean, safflower or sunflower oils) with oils high in Omega‑3 fatty acids (such as rapeseed or flaxseed oils) or monounsaturated oils such as olive oil will help optimise the Omega‑6/Omega‑3 fatty acid ratio, as will eating more fish and less red meat.
Prevent vitamin and mineral deficiencies: Vitamin B12 & B6 are essential for the functioning of our nervous system. They are abundant in shellfish, fish, egg yolks, meat and dairy.
Vitamin D comes primarily from exposure to sunlight, it is an antioxidant and is required for the absorption of calcium, phosphate & magnesium. Vitamin D deficiency has been implicated in various pain conditions of muscles and bones, especially in females. A recent systematic review found a high prevalence of Vitamin D deficiency in patients with low back pain. Winter months can predispose to seasonal affective disorder (SAD). Foods fortified with vitamin D, like some dairy products, orange juice, soy milk & cereals, and cod liver oil are good sources.
Magnesium deficiency is associated with muscle spasm, inflammation and nerve pain [2]. Wholegrains and green leafy vegetables are high in magnesium.
Vitamin C is an antioxidant with anti-inflammatory effects. It also boosts immunity against viral infections. Vitamin C is also recommended in the early management of Shingles. Rich sources are citrus fruits and vegetables such as lemon, strawberries, oranges, green chillies, kiwi, broccoli, and red peppers.
Water intake: The recommended daily intake is 2-3 litres/day for adults. Frequent water intake creates a sense of ‘satiety and fullness’ and helps to control our snacking due to dehydration disguised as hunger. It is also useful for the circulation of essential nutrients inside the body cells and elimination of toxic waste.
Increase fibre: This helps in smooth digestive function, prevents constipation and helps the good bacteria flourish in our digestive system. This can be achieved by incorporating wholemeal/wholegrain bread, pasta, bran, mixed vegetables, fruits, lentils, legumes and beans.
Reduce and limit ultra-processed foods and sugar intake: This group of food will only add high amounts of immediate release calories, with little or no essential nutrients added to it. They will also make the person prone to health problems like weight gain, nutritional deficiencies, and cardiovascular diseases.
References:
- Nutrition and chronic pain: 2020 Prevention of Pain-www.iasp-pain.org/resources/fact-sheets/nutrition-and-chronic-pain/
- Brain K, Burrows TL, Rollo ME, Chai LK, Clarke ED, Hayes C, Hodson FJ, Collins CE. A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain. J Human Nutrition Diet 2019; 32(2):198-225.
- https://painconcern.org.uk/diet-and-pain.