What  Patients Need to Know about Pain

There is something frustrating about talking to patients who take pain medications and believe in their heart that the drugs are doing them good. We see the advertisement for Alleve that show a woman with arthritis taking Alleve so she can have a better work out. Doctors, when prescribing NSAIDs, impart the idea that the drugs actually help the condition. Too often people in pain are given drugs to mask their symptoms, but are given the idea that healing is somehow being facilitated. The purpose of this paper is to give the practitioner a tool to teach patients.

When people are given dietary advice and told that it will affect their pain, they get an expression on their face that a dog might make at a strange noise. The head tilts; the mouth drops open and there is a blank expression on the face. Their pain is physical, so why would diet have anything to do with it?

Chronic pain is the most costly health problem in America, with an estimated annual cost of about $90 billion per year. This cost includes lost productivity, legal costs, doctors’ visits and medication; 80% of all visits to the doctor are pain related.

An estimated 40 million Americans have arthritis or other rheumatic condition. That number is expected to climb to 59.4 million, or 18.2% of the population, by the year 2020, according to a new report published as a collaborative effort between the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Arthritis Foundation, and the American College of Rheumatology.1

Approximately 12% of all Americans suffer from migraine headaches.2,3 Nine out of 10 migraine sufferers report they can’t “function normally” during days in which a Migraine strikes. Three out of 10 migraine sufferers require bed rest when suffering from a migraine2,3.

In 2001, over 13 million people saw a physician for the treatment of back pain.  According to the NIH, 65 to 80% of all people have back pain at some time in their life. Half of all working Americans admit to having back pain symptoms each year4. Back pain costs an estimated $50 billion each year5.

There is a tendency for patients to think of pain medicine as the only way to treat pain and inflammation. Many people automatically take medication when they have pain and think that they are somehow helping their condition. More than $4 billion is spent each year on over-the-counter pain medications for headaches. Americans consume 20,000 tons of aspirin each year. But we all know medication is not a cure for pain; and it often makes matters worse, and this fact needs to be communicated to our patients.

According to research appearing in the American Journal of Medicine, “Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nosteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under appreciated”6

Other research links pain medications to high blood pressure7, kidney failure8, heart failure9, ulceration of the GI tract10, and some drugs even interfere with bone repair11.  One study found that in 2,000 arthritic patients, NSAID use increased ulcer risk 10-fold. Almost 25% of NSAID users have ulcers, most of which are without symptoms10.

NSAIDs perpetuate the very problem that they are designed to treat. They actually increase the body’s oxidative stress—leading to further inflammation and pain. Research has demonstrated that NSAIDs interfere with the formation of cartilage12, 13. So someone with arthritis who takes these drugs is trading short-term relief for long-term degeneration. The drugs actually make the condition worse.

Many arthritis sufferers take glucosamine sulfate or chondroitan sulfate products. Many studies have shown that these products can help arthritis sufferers. Patients suffering from arthritis in the knee experienced relief in a study published in the journal, Drugs and Aging. The researchers concluded, “In short-term clinical trials, glucosamine provided effective symptomatic relief for patients with osteoarthritis of the knee. In addition, glucosamine has shown promising results in modifying the progression of arthritis over a 3-year period. Glucosamine may therefore prove to be a useful treatment option for osteoarthritis.” The Journal of the American Medical Association acknowledged that these supplements may be of benefit to arthritis sufferers13. The Lancet has also published research supporting the use of these supplements14.

Patients hear about research like this, and their tendency is to go out and buy glucosamine supplements and to take them in place of the NSAIDs, They are still looking to a pill to solve their problem. Scientific studies contribute to this thinking. Researchers will give one group in the study a drug and the other group will take glucosamine or chondroitan supplements—they are merely comparing one pill to another. Generally, in the beginning of the study, the people taking the drug will feel better than the group taking the supplements, but as time progresses, the group taking the supplements do better. This should be obvious, because the supplements help to repair cartilage and the drugs destroy it. The drugs also undermine the body’s general health and make it more prone to inflammation—short term relief turns into long term degeneration.

Various herbs, like boswellia, ginger, willow bark or curcumin15,16,18 are anti-inflammatory. Taking herbs can indeed help reduce pain and inflammation. And there is research supporting their value. The problem is that people want to use these things like they are drugs—addressing symptoms. They need to understand that natural health care works best when you combine diet, lifestyle and therapy. In natural health care, you are not treating symptoms, but improving the body’s infrastructure to overcome the pain. Healthy bodies don’t hurt.

There is also a lot of research to support the importance of diet and exercise in eliminating pain. How you live and what you eat really does have an effect on how much pain you feel. Eating a diet that is high in fresh fruit and vegetables will decrease your pain and inflammation. In a study published in the American Journal of Clinical Nutrition, Researchers at the University of Athens Medical School found that people who ate the highest amount of cooked vegetables had a 75% lesser risk of developing rheumatoid arthritis than those who ate few vegetables17. Also, the Journal of the American Medical Association has published research that a diet high in vegetables and olive oil—the so called “Mediterranean Diet” helps to reduce inflammation19.

A combination of fish oil and vitamin E reduced the levels of cytokines (which are pro-inflammatory proteins that cause the joint swelling, pain and tenderness). Fish oil, in general is anti-inflammatory. Dr Richard Sperling, found in his research that fish oil may reduce inflammatory substances produced by white blood cells. Professor Caterson and other Scientists at Cardiff University in Wales have found that the Omega-3 fatty acids in cod liver oil work to inhibit enzymes that break down joint cartilage. There is so much research showing the anti-inflammatory effect of fish oil24,25,26,27.

The bottom line is; that for patients to minimize pain, they should be consuming a lot of fresh fruit and vegetables, and omega-3 fatty acids, like those found in fish oil. They also need to avoid foods that promote pain and inflammation. High fat and high sugar diets promote inflammation, according to research appearing in the American Journal of Clinical Nutrition20. Even the Journal of the American Medical Association has published research that says a low-sugar diet reduces pain and inflammation19.  To most of us, this is obvious, but it is hard to make patients understand.

Exercise can also help to reduce pain. Children with juvenile arthritis took part in an eight-week individualized program of resistance exercise at the University at Buffalo. Their ability to function was greatly improved by the exercise. Some improved by as much as 200%21. According to a study, found in the Journal of Nursing Scholarship22, Tai Chi can reduce arthritic pain.

Natural approaches to pain include:

  • First, eat plenty of fresh fruits and vegetables. Eat live food, brightly colored produce—natural foods that are dark green, purple, yellow, orange, or red. Those rich colors are actually antioxidants that protect the plant. They contain antioxidants and phytochemicals that protect your cells as well.
  • Avoid foods that contain refined sugar, or high fructose corn syrup; like soda pop, candy cookies, donuts and other sweet snacks. Also avoid refined grains like white bread, white noodles. These foods promote pain and inflammation.
  • Change the oil—the chemicals that produce inflammation are made from fatty acids. Certain fats are anti-inflammatory, and some contribute to pain and inflammation. Absolutely avoid hydrogenated and partially hydrogenated oils, avoid trans fats—these are linked to cancer and heart disease, but they are also linked to pain and inflammation28. This is huge, we have all seen that step alone get many people out of chronic pain. Animal fats are also linked to inflammation—eat lean meats, chicken and fish and avoid high fat items like bacon and sausage. Omega 3 fatty acids, like those found in fish oil and in flax seed oil are very useful for reducing pain and inflammation.
  • Avoid chemical additives. These promote inflammation
  • Get moving.

Patients who make these changes are often amazed at their improvement. I try to get them to follow the dietary advice here for 30 days. It’s long enough for the patient to feel the difference without making them think they have to change forever. We need to get them to understand that drugs manipulate the body’s chemistry to block pain; this is simply a way to control the body’s chemistry naturally and reduce pain.

Patients get very good results from following this very simple advice. Some may find the dietary changes difficult, but the results make it worthwhile.

  1. Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998;41:778-99.
  2. Press Release: “Study Finds Millions of Migraine Sufferers Continue to Live with Pain Despite Available Preventive Treatments.” Philadelphia: June 24, 2005.
  3. Loder, Elizabeth & Biondi, David (2005) “General Principles of Migraine Management: The Changing Role of Prevention.” Headache: The Journal of Head and Face Pain 45 (s1), S33-S47. doi: 10.1111/j.1526-4610.2005.4501002.
  4. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
  5. Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD, Summer 1994.
  6. American Journal of Medicine, July 27, 1998
  7.  Archives of Internal Medicine (October 28, 2002;162:2204-2208)
  8. New England Journal of Medicine (December 20, 2001;345:1801-1808)
  9. Archives of Internal Medicine (February 11, 2002;162:265-270).
  10.  Archives of Internal Medicine (July 23, 1996)
  11. Journal of Bone and Mineral Research (June, 2002 17:963)
  12. Journal of the American Medical Association (2000; 283(11):1469-75)
  13. The Journal of the American Medical Association (March 15, 2000;283:1469-1475, 1483-1484)
  14. Long-Term Effects of Glucosamine Sulphate on Osteoarthritis Progression:  A Randomized, Placebo-Controlled Clinical Trial,” The Lancet, 2001;357:251-256.
  15. Phytomedicine (Jan, 2003; 10(1):3-7)
  16. Gagnier J, Vantulder M, Berman B, et al. Herbal medicine for low back pain. Cochrane Database Syst Rev 2006; 19:CD004504.
  17. American Journal of Clinical Nutrition (1999 Dec;70(6):1077-1082)
  18. American Journal of Medicine (2000;109 9-14)
  19. JAMA Vol. 292 No. 12, September 22/29, 2004
  20. JAMA (2004Nov 24; 292(20):2482-90)
  21. American Journal of Clinical Nutrition (2004 Jul;80(1):51-7); American Journal of Clinical Nutrition (2004;79(4):682-90))
  22. Study performed at the University of Buffalo 1999; source: Science Blog
  23. Journal of Nursing Scholarship (May, 2001)
  24. Journal of the American College of Nutrition
  25. British Journal of Rheumatology (1993 Nov;32(11):982-9)
  26. Journal of Gastroenterology and Hepatology (Volume 13 Issue 12 Page 1183; December 1998),
  27. Annals of Internal Medicine(1987 Apr 106(4):497-503)
  28. Journal of Clinical Nutrition November, 2004