Nutrition is a critical, yet often overlooked, component of chronic pain management. Food choices—how you nourish your body—and the amount of food consumed can determine how you feel and how your body reacts. Many painful conditions (carpal tunnel syndrome, rheumatoid arthritis, osteoarthritis, lower back pain, fibromyalgia, gout, migraines, headaches and more) can be improved by choosing anti-inflammatory foods and spices. Chronic pain can make life seem out of one’s control; the ability to control pain through nutrition can be a powerful, useful tool. It’s important to note that individuals who are overweight typically suffer from increased pain levels and don’t receive the same degree of pain relief from the typical treatments and interventions as individuals that are of a healthy weight.

DIET & PRESCRIPTION MEDICATION

Many people living with chronic pain take prescription medication, which may cause fluctuations in weight and appetite. A decrease in appetite can lead to skipping meals, causing a missed opportunity to consume functional nutrients that play a role in decreasing inflammation. An example of appetite-supressing medication is Topamax, commonly used for chronic migraines or back pain. Lyrica, commonly used to treat neuropathic pain and fibromyalgia, can boost appetite, resulting in overeating.

OTHER NUTRITION CHALLENGES FOR PEOPLE IN PAIN

Another challenge for people who live with chronic pain is that the pain may preoccupy thoughts and cause an individual to ignore the body’s hunger signals. Pain can also impact one’s physical abilities, making it difficult to stand for lengthy periods, shop for groceries or cook. For some suffering from chronic pain, food may be the only pleasurable aspect of a daily routine, possibly resulting in overconsumption and sub-sequent weight gain. A body suffering from a lack of nutrients as well as a body overloaded with excess weight is at risk for an intensified level of pain,a decreased benefit from pain treatments and an overall increase in systemic inflammation.

FOODS THAT PREVENT INFLAMMATION

To help to control inflammation, decrease pain and enhance quality of life, it is important to know what foods to choose. Food choices can be broken down into two categories: anti-inflammatory and pro-inflammatory foods. Anti-inflammatory foods are those rich in omega-3 fatty acids, antioxidants and phytochemicals. These include cold-water fish, a variety of spices, fruits and vegetables. Pro-inflammatory foods typically have a high glycemic load (how much the food will raise a person’s blood glucose level), contain empty calories, are highly processed, contain preservatives and are rich in omega-6 fatty acids. These include packaged foods, animal products and many oils. A diet rich in anti-inflammatory foods provides an abundance of essential nutrients without sacrificing taste or satisfaction.

INFLAMMATION, PAIN & SAD

Controlling inflammation through lifestyle modifications is a vital and integrative way to help manage pain. Obesity is considered a pro-inflammatory state that exacerbates chronic conditions and pain.

The Standard American Diet (SAD) is a term dietitians use to describe the typical American diet. The SAD is rich in refined grains, added fats and sugars. It is typically low in fiber, fruits and vegetables. The rise in the prevalence of this diet may be related to the increase in convenience foods (on-the-go eating) and consuming meals out of the home. The 2010 Dietary Guidelines for Americans indicate that the average SAD includes six ounces of equivalents of refined grains per day (50 percent more than recommended). In addition, an average of 19 percent of total calories are consumed from solid fats. Added sugars contribute an average of 16percent of total calories, including high fructose corn syrup, white sugar, brown sugar, corn syrup, corn syrup solids, raw sugar, malt syrup, maple syrup, pancake syrup, fructose sweetener, liquid fructose, honey, molasses, anhydrous dextrose and crystal dextrose.

In addition, the SAD provides an excess of omega-6 fatty acids, commonly found in refined vegetables oils such as soy, corn, cottonseed, grape seed, peanut, safflower and sunflower. These oils are inexpensive and shelf stable, making them appealing to the food industry. Fast food and processed foods like instant pastas and rice, cookies, crackers and other packaged foods are very high in these processed oils.

To reduce consumption of these pro-inflammatory oils, consumers should avoid most convenience foods sold in a pack-aged box, can or bag. A general guideline is to look for items with five ingredients or fewer; this likely eliminates many shelf-stable products and encourages eating whole foods—foods that have not been processed and are free from additives and artificial ingredients. When grocery shopping, shop the perimeter of the store and choose plenty of produce, lean meats, low-fat and fat-free dairy and whole grains. Avoid the inner aisles with highly processed foods.

Another reason to commit to making healthier choices is that the increased mechanical stress of obesity on the body overtime causes a breakdown of cartilage and production of pro-inflammatory cytokines. An increased circulation of cytokines reduces serotonin levels and can contribute to depression. Chronic pain, obesity and depression contribute to the continuation of a sedentary lifestyle. And although a sedentary lifestyle can seem to reduce pain in the short term, in the long term it may contribute to physical deconditioning, joint immobility, cartilage degradation and a greater degree of pain.

FATTY ACIDS: WHAT’S THE DIFFERENCE?
OMEGA-3 VS. OMEGA-6

nutrition2Omega-3 and omega-6s are types of polyunsaturated, essential fatty acids (EFAs). EFAs must be consumed through the diet because the body can’t synthesize them. In order to maintain homeostasis, these two fats work in opposition. Omega-6 fatty acids (FAs) increase inflammation, blood clotting, cell proliferation and blood pressure, while omega-3 FAs decrease inflammation and these functions. It is important that both are consumed to ensure a healthy balance of vital functions. A proper ratio of omega-3 to omega-6 allows the body’s inflammatory process to react to acute inflammation in the presence of infection, trauma or damage, repairing tissues and then returning to normal functioning. A disruption to this ratio, favoringomega-6 FAs, promotes chronic inflammation and subsequent pain.

Omega-6 FAs are also found in animal products. Arachidonic acid, an omega-6 FA found in red meat and dairy, is converted into pro-inflammatory eicosanoids such as prostaglandin, thromboxane and leukotrienes. These hormones contribute to a constant low-grade inflammatory state, resulting in pain. To decrease omega-6 FA consumption, maintain a low to moderate intake of animal products, replacing them with plant foods. Beans and lentils are a great source of protein, fiber, vitamins, minerals and phytochemicals.

It’s important to not only decrease the intake of omega-6 FAs but also to increase the intake of omega-3 FAs. Omega-3 FAs are found in cold-water fish, including salmon, sardines, herring, mackerel, black cod and blue -fish. Vegetarian sources of omega-3 FAs include walnuts, flaxseeds, hemp seeds, chia seeds and green leafy vegetables. For adequate levels of Omega-3, try eating fatty fish three times per week, adding walnuts to a leafy green salad or adding chia seeds to a breakfast smoothie.

ANTIOXIDANTS AND PHYTOCHEMICALS

Antioxidants are molecules that rid the body of free radicals. Free radicals damage cells and cause inflammation. An adequate intake of antioxidants prevents the initiation of the inflammatory process that may lead to chronic pain. Whole foods such as fruits and vegetables are an excellent source of vitamins and minerals that act as antioxidants. For example, vitamin E is found in whole grains, green leafy vegetables, nuts, seeds, olives, egg yolks, liver and wheat germ. Vitamin C is found in citrus fruits, tomatoes, broccoli, strawberries, cabbage, watermelon, sweet potatoes and green leafy vegetables. Selenium is in meat, bread and Brazil nuts. Beta-carotene, a precursor to vitamin A, is found in dark leafy greens, broccoli, cantaloupe, carrots, sweet potatoes, pumpkin, winter squash and apricots. Lycopeneis in tomatoes, watermelon, pink grapefruit, blood oranges, guava, apricots and papaya. Lutein is in collard greens, spinach and kale. It is easy to consume an abundance of antioxidants when the diet is rich in plant foods. Registered dietitians recommend that half of your plate consists of fruits and vegetables at all meals.

Phytochemicals, more simply termed “plant nutrients,” are substances found in plant foods such as fruits, vegetables, beans and other legumes. Phytochemicals are responsible for the color, odor and flavor of these foods. Evidence suggests that these important plant substances help to reduce inflammation, regulate hormones and protect cells from carcinogens, in addition to their antibacterial properties. Phytochemicals also decrease the inflammatory process by decreasing pro-inflammatory cytokines that lead to pain.

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SPICES

One of the most overlooked aspects of a Western diet is herbs and spices. Just like foods, herbs and spices contain antioxidants and phytochemicals that help combat inflammation. In particular, turmeric is well known as a potent anti-inflammatory spice. Turmeric is composed of curcuminoids, a group of polyphenols. Curcumin suppresses the production of pro-inflammatory cytokines such as tumornecros is factor (TNF). Research demonstrates an anti-inflammatory effect, aiding in pain related to osteoarthritis. This action is closely related to the action of NSAIDs and steroidal drugs. Let the spice-rich cuisines of India, Morocco or Thailand inspire greater creativity in the kitchen. Include turmeric, red pepper, black pepper, licorice, cumin, nutmeg, cinnamon, clove, ginger, cayenne, garlic, coriander, oregano and rosemary in your meals. The liberal use of spices is a safe, cost-effective way to obtain anti-inflammatory benefits from food.

NUTRITION: PART OF AN INTEGRATIVE PAIN MANAGEMENT PLAN

Battling chronic pain requires a multifactorial approach. It is becoming increasingly apparent that obesity, diet and physical activity play an important role in pain management. Even small substitutions in food choices or a 5 percent decrease in body weight can significantly reduce pain. Start out small. Instead of that daily bag of potato chips, try one-half cup of vitamin C-rich strawberries and reap the benefits of plant-based eating. Visit a registered dietitian to discuss individualized diet and lifestyle changes that may decrease pain and inflammation and increase quality of life. {PP}

Resources
  1. “Arizona Center for Integrative Medicine.” The Anti-Inflammatory Diet. January 1, 2014. [Accessed September 17, 2014]
  2. Bonakdar, Robert, A. “Obesity-related Pain: Time for a New Approach that Targets Systemic Inflammation.” Supplement to the Journal of Family Practice 62, no. 9 (2013): 22-28. chronicpainperspectives.com [Accessed September 1, 2014]
  3. Mayo Clinic. “Normal Weight Obesity: An Emerging Risk Factor for Heart and Metabolic Problems.” ScienceDaily.     sciencedaily.com/releases/2008/03/080327172025.htm [Accessed September 17, 2014]
  4. MPR: Concise Prescription and OTC Drug Information. empr.com [Accessed September 25, 2014]
  5. Sedig, Sheila. “Modulating Chronic Pain.” Nutrition in Complementary Care 8, no. 2 (2005):23-38. integrativerd.org [Accessed September 1, 2014]
  6. Weil, Andrew. “Anti-Inflammatory Diet & Pyramid.” Official Website of Andrew Weil, M.D. drweil.com Accessed September 17, 2014]