Updated: May 26
Pain response is a self-preservation reaction to a potentially harmful circumstance. Chronic pain, on the other side, is a disorder of the pain perception mechanisms. Chronic pain management should have a multidisciplinary approach including an accurate consideration of the physiological, psychological, emotional, social and environmental dynamics affecting the individual (21). This article will focus on three strategies including a combination of nutritional advice, herbs and supplements that can be helpful in reducing the frequency and intensity of chronic pain
STRATEGY # 1: INFLAMMATION MANAGEMENT
One of the first steps to tackle chronic pain is to reduce the active inflammatory processes in the body to the bare minimum, the reason being that inflammation may lead to a pain response derangement.
Refined sugars (the most common being sucrose, glucose and fructose) have a bad reputation for worsening inflammation (4, 16) and seed and vegetable oils, with exception of very few, are very high in omega-6 which are the building block of pro-inflammatory cytokines (37, 8). Processed foods are strongly pro-inflammatory: not only high in refined sugars but also in trans-fatty acids, which are also an atomic bomb for your immune system (6); Also, alcohol notoriously damages the liver, which plays a vital role in inflammation (35).
On the other hand, oily fish and high quality fish oil supplements are packed with omega-3 fatty acids, which provide the body with the building blocks to manufacture anti-inflammatory cytokines (29). Oxidation and reduction are chemical processes that have a profound implication in chronic inflammation: berries, grapes, green tea, and chocolate together with alpha-lipoic acid (ALA), vitamins A,C and E are excellent sources of exogenous antioxidants and can counteract the damage from free radicals (20,25). Finally, cooking with and juicing turmeric and ginger can also be helpful in managing inflammation (27)
Finally, increased intestinal permeability (Leaky gut syndrome) and imbalanced microbiome (dysbiosis) can have a severe negative impact on the immune function (22) . Including in the diet fermented foods (yogurth, kefir, kimchi etc.) prebiotics (fermentable fibres) and collagen proteins (abundant in bone broth) can support a healthy microbiome and reduce gut permeability (32, 11).
STRATEGY # 2: STRESS MANAGEMENT AND MINDFULNESS FOR CHRONIC PAIN
Mindfulness, as defined by John Kabat-Zinn, is the awareness that arises through paying attention, on purpose, in the present moment, nonjudgmentally (23). Daily mindfulness practices have provided evidence to be helpful to improve the biochemical consequence of stress response improving the life quality of people living with chronic pain (34). A study on more than a hundred patients affected by chronic pain showed that mindfulness is valuable for lowering general anxiety and depression, improving mental quality of life (psychological well-being), promoting feelings of control over the pain, and supporting higher pain acceptance (18).
In regards to herbs and supplements for stress management, adaptogens are the remedy of choice. (36). Every adaptogen exerts a unique effect over the body-mind, but most of them lower serum cortisol, calm the mind and balance the immune system. Popular adaptogenic herbs are Ashwaganda root (Withania somnifera), Schisandra berries (Schisandra sinensis), Korean ginseng (Panax ginseng), Siberian ginseng (Eleutherococcus senticosus), Golden root (Rhodiola rosea), Reishi mushroom (Ganoderma lucidum), Cordyceps mushroom (Cordyceps sinensis) and Chinese foxglove (Rehmannia glutinosa) (36)
STRATEGY # 3: HERBAL ANALGESICS
Ultimately, there are herbs that have anodyne and analgesic effects on the body, meaning that they directly affect and ameliorate pain perception.
Corydalis yanhusuo is a popular painkiller in Chinese pharmacopoeia. It is a distant cousin of opium poppy and contains analgesic and anti-inflammatory compounds which have shown to reduce pain, inflammation and improve depression symptoms (39). It is thought that its properties are linked to a compound called dehydrocorybulbine, which probably improves pain modulation without the side effects of morphine (12)
Eschscholzia californica, also called californian poppy, is another member of the poppy family with analgesic properties. This herb contains a somewhat large amount of psychoactive alkaloids such as sanguinarine, dihydrosanguinarine chelirubine, macarpine which are thought to stimulate GABA receptors and thus promote sedation and analgesia (9,1)
Hypericum perforatum or st. John’s wort is a UK native herb with a strong affinity for the nervous system and commonly used for depression and anxiety. Some evidence supports the use of st. John’s wort as an effective mild analgesic (10)
Mitragyna speciosa, commonly known as kratom, is a plant native to SouthEast Asia and widely used for opiates withdrawal. Although there are some concerns about its long-term safety, it has shown promising analgesic effects similar to the ones exerted by opioid drugs (26)
Chronic pain is a complex phenomena influenced by many physiological and psychological factors. Educating and supporting chronic pain sufferers with proper dietary advice, mindfulness practices and medicinal herbs could result in a remarkable improvement in their quality of life. Seen its extreme burden on healthcare systems across the world and the lack of a silver bullet to cure it, it is of paramount importance to increase the awareness of the small but impactful changes that can be done to reduce the incidence of chronic pain disorders
Al-Snafi, Ali. “ESCHSCHOLZIA CALIFORNICA: A PHYTOCHEMICAL and PHARMACOLOGICAL -REVIEW.” Indo Am J P Sci, vol. 4, Jan. 2017, pp. 257–263.
Arulselvan, Palanisamy, et al. “Role of Antioxidants and Natural Products in Inflammation.” Oxidative Medicine and Cellular Longevity, vol. 2016, 2016, pp. 1–15, www.ncbi.nlm.nih.gov/pmc/articles/PMC5075620/, 10.1155/2016/5276130.
Brandão, M. L., and T. A. Lovick. “Role of the Dorsal Periaqueductal Gray in Posttraumatic Stress Disorder: Mediation by Dopamine and Neurokinin.” Translational Psychiatry, vol. 9, no. 1, 17 Sept. 2019, 10.1038/s41398-019-0565-8. Accessed 14 May 2021.
Chen, Li, et al. “Mechanisms Linking Inflammation to Insulin Resistance.” International Journal of Endocrinology, 28 May 2015, www.hindawi.com/journals/ije/2015/508409/.
Chiu, Hui-Fang, et al. “Improvement of Liver Function in Humans Using a Mixture of Schisandra Fruit Extract and Sesamin.” Phytotherapy Research: PTR, vol. 27, no. 3, 1 Mar. 2013, pp. 368–373, pubmed.ncbi.nlm.nih.gov/22610748/, 10.1002/ptr.4702. Accessed 13 Oct. 2021.
Mozaffarian, D “Trans Fatty Acids - Effects on Systemic Inflammation and Endothelial Function.” Atherosclerosis. Supplements, 1 May 2006, pubmed.ncbi.nlm.nih.gov/16713393/.
Das, Subir Kumar. “Biochemical and Immunological Basis of Silymarin, a Milk Thistle (Silybium Marianum) against Ethanol-Induced Oxidative Damage.” Journal of Analytical & Bioanalytical Techniques, vol. 01, no. 01, 2010, 10.4172/2155-9872.1000019. Accessed 13 Oct. 2021.
DiNicolantonio, James J, and James H O’Keefe. “Importance of Maintaining a Low Omega–6/Omega–3 Ratio for Reducing Inflammation.” Open Heart, vol. 5, no. 2, Nov. 2018, p. e000946, openheart.bmj.com/content/5/2/e000946, 10.1136/openhrt-2018-000946.
Fedurco, Milan, et al. “Modulatory Effects OfEschscholzia CalifornicaAlkaloids on Recombinant GABAAReceptors.” Biochemistry Research International, vol. 2015, 2015, pp. 1–9, 10.1155/2015/617620. Accessed 2 May 2020.
Galeotti, Nicoletta. “Hypericum Perforatum (St John’s Wort) beyond Depression: A Therapeutic Perspective for Pain Conditions.” Journal of Ethnopharmacology, vol. 200, Mar. 2017, pp. 136–146, www.sciencedirect.com/science/article/pii/S0378874116314799, 10.1016/j.jep.2017.02.016. Accessed 18 May 2019.
Guo, Ran, et al. “Pain Regulation by Gut Microbiota: Molecular Mechanisms and Therapeutic Potential.” British Journal of Anaesthesia, vol. 123, no. 5, 1 Nov. 2019, pp. 637–654, www.bjanaesthesia.org/article/S0007-0912(19)30638-5/fulltext, 10.1016/j.bja.2019.07.026. Accessed 25 Sept. 2021.
Hall, Harriet. “Corydalis: An Herbal Medicine for Pain, with Some Thoughts on Drug Development | Science-Based Medicine.” Sciencebasedmedicine.org, 1 Nov. 2016, sciencebasedmedicine.org/corydalis-an-herbal-medicine-for-pain-with-some-thoughts-on-drug-development/. Accessed 14 Oct. 2021.
Hall, N, et al. “Fatty Acids in Beef from Grain- and Grass-Fed Cattle: The Unique South African Scenario.” South African Journal of Clinical Nutrition, vol. 29, no. 2, 31 May 2016, pp. 55–62, 10.1080/16070658.2016.1216359. Accessed 28 Mar. 2021.
Hannibal, K. E., and M. D. Bishop. “Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation.” Physical Therapy, vol. 94, no. 12, 17 July 2014, pp. 1816–1825, www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/, 10.2522/ptj.20130597.
Hilton, Lara, et al. “Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-Analysis.” Annals of Behavioral Medicine, vol. 51, no. 2, 22 Sept. 2016, pp. 199–213, www.ncbi.nlm.nih.gov/pmc/articles/PMC5368208/, 10.1007/s12160-016-9844-2. Accessed 22 Nov. 2019.
Johnson-Greene, Chandra. “Glycemic Index Chart: GI Ratings for Hundreds of Foods.” University Health News, 28 Jan. 2019, universityhealthnews.com/daily/nutrition/glycemic-index-chart/.
Joosen, Annemiek M. C. P., et al. “Effect of Processed and Red Meat on Endogenous Nitrosation and DNA Damage.” Carcinogenesis, vol. 30, no. 8, 1 Aug. 2009, pp. 1402–1407, pubmed.ncbi.nlm.nih.gov/19498009/, 10.1093/carcin/bgp130. Accessed 23 Nov. 2020.
la Cour, Peter, and Marian Petersen. “Effects of Mindfulness Meditation on Chronic Pain: A Randomized Controlled Trial.” Pain Medicine, vol. 16, no. 4, Apr. 2015, pp. 641–652, 10.1111/pme.12605.
Marañón, Gonzalo, et al. “The Effect of Methyl Sulphonyl Methane Supplementation on Biomarkers of Oxidative Stress in Sport Horses Following Jumping Exercise.” Acta Veterinaria Scandinavica, vol. 50, no. 1, 2008, p. 45, 10.1186/1751-0147-50-45. Accessed 20 Sept. 2020.
Mary Anne Dunkin. “Super Foods for Optimal Health.” WebMD, WebMD, 22 Oct. 2008, www.webmd.com/food-recipes/antioxidants-your-immune-system-super-foods-optimal-health.
Mills, Sarah E E, et al. “Chronic Pain: A Review of Its Epidemiology and Associated Factors in Population-Based Studies.” British Journal of Anaesthesia, vol. 123, no. 2, 2019, pp. e273–e283, www.ncbi.nlm.nih.gov/pubmed/31079836, 10.1016/j.bja.2019.03.023.
Mu, Qinghui, et al. “Leaky Gut as a Danger Signal for Autoimmune Diseases.” Frontiers in Immunology, vol. 8, 23 May 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5440529/, 10.3389/fimmu.2017.00598.
Necktar, Amanda. “Use Mindfulness to Cope with Chronic Pain.” Www.mayoclinichealthsystem.org, 5 Sept. 2020, www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/use-mindfulness-to-cope-with-chronic-pain.
Osterweis, Marian, et al. “The Anatomy and Physiology of Pain.” Nih.gov, National Academies Press (US), 2019, www.ncbi.nlm.nih.gov/books/NBK219252/.
Packer, Lester. “α-Lipoic Acid: A Metabolic Antioxidant Which Regulates NF-ΚB Signal Transduction and Protects against Oxidative Injury.” Drug Metabolism Reviews, vol. 30, no. 2, Jan. 1998, pp. 245–275, 10.3109/03602539808996311. Accessed 25 Aug. 2019.
Prozialeck, Walter C., et al. “Kratom Use within the Context of the Evolving Opioid Crisis and the COVID-19 Pandemic in the United States.” Frontiers in Pharmacology, vol. 12, 26 Aug. 2021, 10.3389/fphar.2021.729220. Accessed 14 Oct. 2021.
Rahaman, Md. Moshiur, et al. “The Genus Curcuma and Inflammation: Overview of the Pharmacological Perspectives.” Plants, vol. 10, no. 1, 30 Dec. 2020, p. 63, 10.3390/plants10010063. Accessed 24 Apr. 2021.
Ravn, Sophie Lykkegaard, et al. “The Role of Posttraumatic Stress Symptoms on Chronic Pain Outcomes in Chronic Pain Patients Referred to Rehabilitation.” Journal of Pain Research, vol. Volume 11, Mar. 2018, pp. 527–536, 10.2147/jpr.s155241. Accessed 25 Nov. 2019.
Simopoulos, Artemis P. “Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases.” Journal of the American College of Nutrition, vol. 21, no. 6, Dec. 2002, pp. 495–505, 10.1080/07315724.2002.10719248.
Singh, Manish K. “Chronic Pain Syndrome: Practice Essentials, Etiology, Patient Education.” EMedicine, 14 Jan. 2020, emedicine.medscape.com/article/310834-overview.
Siqveland, Johan, et al. “Prevalence of Posttraumatic Stress Disorder in Persons with Chronic Pain: A Meta-Analysis.” Frontiers in Psychiatry, vol. 8, 14 Sept. 2017, 10.3389/fpsyt.2017.00164.
Song, et al. “Identification and Structure–Activity Relationship of Intestinal Epithelial Barrier Function Protective Collagen Peptides from Alaska Pollock Skin.” Marine Drugs, vol. 17, no. 8, 31 July 2019, p. 450, 10.3390/md17080450.
Tal, Michael. “A Role for Inflammation in Chronic Pain.” Current Review of Pain, vol. 3, no. 6, Nov. 1999, pp. 440–446, 10.1007/s11916-999-0071-4.
Turakitwanakan, Wanpen, et al. “Effects of Mindfulness Meditation on Serum Cortisol of Medical Students.” Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, vol. 96 Suppl 1, 1 Jan. 2013, pp. S90-95, pubmed.ncbi.nlm.nih.gov/23724462/.
Wang, H Joe. “Alcohol, Inflammation, and Gut-Liver-Brain Interactions in Tissue Damage and Disease Development.” World Journal of Gastroenterology, vol. 16, no. 11, 2010, p. 1304, 10.3748/wjg.v16.i11.1304.
Winston, David, and Steven Maimes. Adaptogens : Herbs for Strength, Stamina, and Stress Relief. Rochester, Vermont, Healing Arts Press, 2019.
Wroniak, Małgorzata. “NUTRITIONAL VALUE of COLD-PRESSED RAPESEED OILS.” Zywnosc.Nauka.Technologia.Jakosc/Food.Science.Technology.Quality, vol. 58, no. 1, 17 Dec. 2012, 10.15193/zntj/2012/85/079-092. Accessed 25 June 2020. Wroniak, M., Krygier, K., and Kaczmarczyk, M. (2008). COMPARISON OF THE QUALITY OF COLD PRESSED AND VIRGIN RAPESEED OILS WITH INDUSTRIALLY OBTAINED OILS. Polish Journal of Food and Nutrition Sciences, 58(1), pp.85-89.
Yam, Mun, et al. “General Pathways of Pain Sensation and the Major Neurotransmitters Involved in Pain Regulation.” International Journal of Molecular Sciences, vol. 19, no. 8, 24 July 2018, p. 2164, www.ncbi.nlm.nih.gov/pmc/articles/PMC6121522/, 10.3390/ijms19082164.
Zhang, Jingxia, et al. “A Review of the Traditional Uses, Botany, Phytochemistry, Pharmacology, Pharmacokinetics, and Toxicology OfCorydalis Yanhusuo.” Natural Product Communications, vol. 15, no. 9, 1 Sept. 2020, p. 1934578X2095775, 10.1177/1934578x20957752. Accessed 14 Oct. 2021.