Chronic Pain Relief

Today, a look at the relationship between diet and inflammation. And, we start with a story about the best way to alleviate chronic pain syndrome.

Fibromyalgia is a common disorder whose cardinal manifestation is chronic, widespread pain. Well, not so common, affecting 2 to 4 percent of the population, though probably more like 2 percent, and especially women. For decades, some medical professionals dismissed fibromyalgia as all in people’s heads, but this outdated view has been refuted by more recent research characterizing it as a disorder of pain regulation and sensitization. Brain imaging studies have shown several perturbations of pain processing and regulation that amplify pain in people with the condition.

Twin studies have shown that about half of fibromyalgia is genetic, but the other half we can do something about. There are lots of drugs with lots of side effects to help with some of the symptoms, but what about lifestyle approaches? Engagement in regular physical activity is considered imperative for effective management of fibromyalgia.

A systematic review and meta-analysis of randomized clinical trials on the effectiveness of therapeutic exercise in fibromyalgia found that both aerobic and resistance exercises are effective ways of reducing pain and improving global well-being in people with fibromyalgia. Patients may worry and perceive that exercise will worsen their pain and fatigue, and so you have to start slow and work your way up as tolerated, with the goal of eventually achieving daily 30 to 60 minutes of moderate intensity aerobic exercise in addition to muscle-strengthening exercises (1 to 3 sets of 8–11 exercises; 8–10 repetitions with a load of about 7 pounds, or 45 percent of the max you can lift). But what about dietary interventions in terms of dialing down the pain sensitivity?

Well, what causes it in the first place? Inflammation. During the inflammatory response, pain receptors are activated. And chronic inflammation can cause chronic activation, which may cause chronic pain due to this prolonged hypersensitization of pain pathways.

No wonder, then, that a pro-inflammatory diet was found to be associated with pain hypersensitivity in patients with fibromyalgia syndrome. Exactly which foods are pro-inflammatory and which foods are anti-inflammatory? Check out those twin videos, but broadly speaking, components of processed foods and animal products, such as saturated fat, trans fat, and cholesterol, were found to be pro-inflammatory, while constituents of whole plant foods, such as fiber and phytonutrients, were strongly anti-inflammatory.

The intake of dietary fiber found concentrated in only one place—whole plant foods—is fundamental to reducing not only the risk of abdominal pain, but also muscle and joint pain. We think it’s because of these short-chain fatty acids that our good gut bugs produce when we eat fiber. These short-chain fatty acids are important mediators of pain, fundamentally because they modulate inflammation. So, having lots of fiber-feeding bugs in your colon is like carrying around your own anti-inflammatory compound factory. But to cultivate them, you actually have to eat the foods that feed them.

In terms of phytonutrients, plant-derived polyphenols are widely acknowledged to also act as anti-inflammatory substances. Here are some foods packed with anti-pain pathway nutrients: berries, greens, citrus, nuts, spices like turmeric and ginger, edamame, and green tea. That’s why you can do a randomized, double-blind crossover trial showing that about three cups worth of strawberries a day can significantly improve pain and inflammation. If that’s what a single plant can do, what about a diet chock full of plant foods?

Put people on a strictly plant-based diet rich in fresh fruits and vegetables, whole grains, and various legumes, which are beans, split peas, chickpeas, and lentils, as well as nuts and seeds, and you can drop C-reactive protein levels (a leading blood marker of systemic inflammation) 33 percent in three weeks. But does that translate into less pain?

The answer is yes, when it comes to migraine headaches. Yes, when it comes to painful periods. A significant reduction in menstrual pain duration and pain intensity, in addition to premenstrual symptoms. In fact, even just a single plant, cinnamon, about a third of a teaspoon three times a day during your period can help, though it doesn’t work as well as ibuprofen. Ginger powder—ground ginger—on the other hand, has been found to be comparable to ibuprofen in relieving pain in women with painful cramps. You can learn more in my video on the topic.

Whole food plant-based diets also alleviate the symptoms of osteoarthritis. Several studies have shown improvements in rheumatoid arthritis symptoms with diets excluding animal products, though it may be just as much a function of increasing the quantity of healthy plant foods. But it’s not just because plant-based diets are so effective in causing weight loss. Even at the same weight, there’s an improvement in rheumatoid arthritis from more plant-based diets. And plant-based diets can also alleviate fibromyalgia symptoms.

This is the latest study, which enrolled anyone with chronic musculoskeletal pain, fibromyalgia or not. Yes, diets high in animal proteins and fats have been linked to chronic pain and inflammation, while plant-based diets produce anti-inflammatory responses. Did it actually work when put to the test for pain? Yes. Consumption of a plant-based diet produced positive improvements in chronic pain and function. How much? A minimally clinically important difference in chronic musculoskeletal pain is 1 point on the Numeric Pain Rating Scale, which is just a scale from 1 to 10 on how much pain you’re feeling. On the plant-based diet, perceived pain decreased an average of 3 points on a 10-point scale, from an average of 5 or 6 out of 10 down to 2. Now, unlike most of the prior studies, there was no control group. But what’s the downside of giving healthier eating a try? In fact, those with chronic pain are more likely to be overweight and have nutrition-related maladies such as high blood pressure, diabetes, and heart disease––all of which can be prevented, arrested, and in some cases even reversed with a healthy enough plant-based diet. So, any pain benefit is just icing on the cake of health.

Uh, scratch that. How about the dollop of guacamole on your bean burrito?

In our next story, we look at how plant-based diets may be effective in the treatment of fibromyalgia, a condition suffered by millions.

According to the latest review on fibromyalgia and nutrition, a vegetarian diet “could have some beneficial effects.” But, based on what kind of evidence? Well, back in 1991, a survey was sent to a few hundred folks suffering from various chronic pain conditions, including fibromyalgia, asking if they found any success trying different diets. Some folks tried a vegetarian diet; some folks tried a vegan diet. Some reported the various diets helped with pain, stiffness, and swelling.

Vegan diets were reported to reduce disease symptoms more effectively than the vegetarian diet, with rheumatoid arthritis. But, what we needed was to put these diets to the test, in formal studies. First one was in ’93; ten fibromyalgia patients were put on a vegetarian diet for three weeks. The measured levels of oxidation, and inflammation, and cholesterol went down; no surprise.

But, “[o]f interest from a clinical point of view is the positive effect of the treatment upon pain status of most of the patients.” Seven out of ten felt better. They weren’t sure if it was the improved condition of the fibromyalgia patients in this course of treatment with a vegetarian diet, whether it was due to the improvement of their antioxidant status, or what it was about a meat-free diet that seemed to help so much.

A vegan diet was first put to the test in 2000 in Helsinki. You can tell English is not the researchers’ first language, with sentences like “Plants face heavy load of light.” The point they’re making is good, though. “UV light generates [free] radicals in their tissues…All this means [is] that plants must be [very] well prepared to meet the challenges of the oxygen radical stress and contain a broad variety of antioxidant[s].” That’s why plants don’t get sunburned and their DNA damaged, hanging out all day in the sun without any sunblock on.

So, what would happen if you had people “live exclusively on plant items?” In other words, what might be the effects of a “strict vegan diet on the symptoms of fibromyalgia?” In fact, this study used a raw vegan diet. “The rheumatoid patients [said they felt better] when they started to eat [the] living food diet, and the symptoms got worse, when they returned back [to] their previous omnivorous diet.”

But, what about the fibromyalgia patients? “Both groups reported having quite a lot of pain at rest in the beginning of the study, but there was a significant decrease in the [raw vegan] group,” which [gradually] “disappeared after shifting back to the omnivorous diet.” They also found other significant changes, such as improvement in the quality of sleep, reduction of morning stiffness, and improvement in measures of general health.

They started out about the same. But, after about a month and a half, those eating vegan felt significantly less stiff, which continued through the end of the three-month study. And, when they went back to eating their regular diet, the stiffness returned. What about pains at rest? Same thing. So, significant improvements in fibromyalgia stiffness, pain, and general health on a plant-based diet.

The study only lasted three months, but it can be concluded that eating vegan has “beneficial effects on fibromyalgia symptoms at least in the short run.”

Finally today, we look at a study that suggests chocolate may improve symptoms for those suffering from chronic fatigue syndrome.

Chronic fatigue syndrome is a debilitating condition characterized by a minimum of six months of crushing mental and physical exhaustion, and we have no idea what causes it. We don’t even have a good idea of how many people even have it. The Centers for Disease Control estimates that as many as seven and a half million Americans currently suffer from it. And we as physicians have very little to offer patients in terms of relieving those symptoms. So, this is one of the conditions that I’m always keeping an eye out for in terms of new treatments.

And one of the latest they just discovered? Chocolate.

Evidently, Montezuma the Second, who reigned in the Aztec empire 500 years ago, noted: “This divine drink, which builds up resistance, and fights fatigue. A cup of [cocoa] permits people to walk for a whole day without food.’’ Not willing to take the emperor’s word for it, it was put to the test.

I’m always skeptical of industry-supported research, but it was actually a pretty good study. At first glance, it looked like they were basically saying eat three chocolate bars a day for eight weeks and call me in the morning. But it was actually a randomized, double-blind, placebo-controlled crossover trial, which is about as good as you can get.

The mad scientists over at Nestle took white chocolate, dyed it brown, and then added some sort of fake chocolate flavor, such that people couldn’t tell if they were eating the real chocolate or the fake. Comparable amounts of sugar and fat, but one had cocoa solids—phytonutrients—and the other basically didn’t.

So, they were able to put people on one, and then switch them over, without anyone knowing, to see if their chronic fatigue symptoms got better or worse. And there was a significant improvement in the real chocolate group, meaning it apparently wasn’t just the yummy taste of chocolate, but the action of the cacao phytonutrients.

Of course, no one should be eating three chocolate bars a day, but you can get the equivalent dose of cocoa solids, the equivalent dose of those wonderful cocoa phytonutrients, by consuming two and a half tablespoons of cocoa powder a day. You can put it in coffee, you can make a chocolaty smoothie, or, my personal favorite, you can blend it in a high-speed blender with frozen cherries or strawberries, a touch of non-dairy milk, vanilla extract, and some erythritol or some dates, and you have instant, decadent chocolate ice cream; low-fat, low-calorie, no cholesterol, no added sugar chocolate ice cream. The more you eat, the healthier you are—whether or not you’re suffering from chronic fatigue.