Are you living with chronic pain (Part 2)
Standard medical treatments don’t work for everyone with chronic pain, and even if they do, the side-effects may outweigh the benefits, so you may want to consider trying one or more complementary and alternative medicines (CAM). I’ve put together a list of CAMs that have been tested in randomized controlled trials (RCTs) and found to be safe and effective for chronic pain, but as always, you should first speak to your doctor before making any changes to your treatment regime.
During my research, I’ve also found that what we eat on a daily basis can have a significant effect on our pain levels, but that people living with chronic pain, day in, day out, may not feel up to planning and preparing healthy meals, and may instead be living on snacks, cereals, ready meals, and take-aways. This is particularly true if they’re depressed and have lost their appetite, or are over-eating for the emotional comfort it provides. Most are probably unaware that diet can have a positive or negative effect on their pain experience, and that a plant-based or Mediterranean style diet has been identified as an effective tool in pain management - whereas an unhealthy diet of processed foods and a lack of fruit and vegetables, can aggravate their condition.
Eat more plants
A diet based on vegetables, legumes (beans, peas, lentils) and whole grains, is packed with phytochemicals (plant-based compounds) that include antioxidants, flavonoids and carotenoids, all of which can help control insulin and cholesterol levels, and reduce the inflammation that may be causing the chronic pain. However, it’s important to talk to a doctor before making any dietary changes such as giving up meat and/or dairy, because vegetarians, and especially vegans, can be deficient in vitamins B-12 and D, so a supplement may be required. Find more information here:
Cut down on fat and sugar
Harmful saturated fats are common in the Western diet and include meat, dairy products, and many commercially prepared pastries, cakes, cookies, and snacks. Sugar is highly inflammatory and isn’t always easy to spot in manufactured products. Large amounts can be ‘hidden’ in products that advertise themselves as being healthy, such as yoghurts, sports drinks, protein bars, and granola.
Choose whole grains
When choosing bread, cereal and pasta, avoid refined grains. Grains are made up of three parts: The bran is the outer skin of the grain kernel, the germ is the innermost part that grows into a new plant, and the endosperm is the central part that provides food for the plant. Whole grains such as barley, buckwheat, oats, quinoa, brown rice, rye, and wheat contain all three parts. Refined grains such as white bread, white rice, cookies and cakes have removed the bran and germ, where most of the vitamins, minerals and protein are contained. Not only are these highly processed grains limited in nutrition, but they can also worsen inflammation throughout the body because they’re quickly broken down and turned into sugar.
Omega-3 and Omega-6 fatty acids
The increased availability of animal products and processed foods in the Western world has led to a substantial increase in our consumption of foods containing the polyunsaturated fat Omega-6, and has caused an imbalance in its relationship with Omega-3. Ideally the ratio should be 2:1, but the average person now has around 15 times more Omega-6 than Omega-3, and this overproduction is linked to inflammation and several types of chronic pain, and may be one of the leading drivers of the most serious modern diseases, such as heart disease, metabolic syndrome, diabetes, arthritis, Alzheimers, and many types of cancer. So it’s important that pain patients avoid excessive intake of Omega-6, and ensure they have a sufficient intake of Omega-3. This can be achieved by consuming less of the Omega-6 oils that are found in meat, poultry, manufactured cakes, pastries, fast foods and snacks, and more of the Omega-3 fats. Find more information here:
Olive oil
Olive oil is a key ingredient of the Mediterranean diet. Its main anti-inflammatory effects are produced by Oleic acid, an Omega-9 fatty acid that can reduce levels of important inflammatory markers like C-reactive protein, and the antioxidant Oleocanthal, which has been shown to work similarly to Ibuprofen, an anti-inflammatory drug. Olive oils are graded by production method, acidity content, and flavour. Extra-virgin oils are made from the first pressing of the olives and retain most of their antioxidants and bioactive compounds, and for this reason are considered healthier than the more refined (and cheaper) varieties. Find more information here:
Cherries
Several studies have found that Anthocyanin, which is the water-soluble pigment responsible for the red, purple, and blue colours in fruit and vegetables, acts on inflammation and modulates pain, and is comparable to nonsteroidal anti-inflammatory drugs (NSAIDs). Much of the research has so far centred on cherries because they contain particularly high concentrations of Anthocyanin, but similarly coloured foods such as strawberries, plums, and blueberries may also be effective. Until more is known, most researchers are reluctant to recommend a specific cherry regimen. But many agree that for overall health, and as a possible tool in managing gout and osteoarthritis pain, a handful of cherries, especially a tart variety such as Montmorency, or a glass of cherry juice every day may be beneficial. Find more information here:
Vitamin D
It’s well known that vitamin D plays a key role in maintaining bone health, particularly for post-menopausal women who are at risk of developing osteoporosis. However, recent studies have also shown a link between vitamin D deficiency and nonspecific bone pain, muscle weakness, headaches and fatigue. Vitamin D deficiency was present in 58% to 71% of the chronic pain patients in the trials. Find more information here:
Indian Frankincense
This Ayurvedic remedy prevents the production of hormone-like substances in the body that act as triggers for joint inflammation, and in trials it has proved effective in treating participants with osteoarthritis of the knee. Find more information here:
Butterbur
Based on two high-quality studies, the American Academy of Neurology and the American Headache Society have endorsed the use of butterbur extract, made from the root of the plant, to reduce the frequency of migraines. However, the raw, unprocessed butterbur plant contains chemicals called pyrrolizidine alkaloids (PAs) which can cause liver damage, so only butterbur products that have been processed to remove PAs should be used. Find more information here:
Capsaicin
Available by prescription in the form of gels, creams and plasters, capsaicin is extracted from chilli peppers. It works mainly because of its ability to reduce Substance P, a pain transmitter, and can be effective in reducing the pain and tenderness caused by osteoarthritis. Find more information here:
Meditation and mindfulness
Electrophysiological (EEG) and brain imaging methods have been used to identify the beneficial effects of mindfulness meditation on chronic pain. There are a wide variety of mindfulness-based practices, such as Shamatha (focused attention) and Vipassana (open monitoring), during which the practitioner is taught to sustain attention on a stimulus, such as breath sensations, in order to disengage from their pain. Find more information here:
Reiki
Originally developed in the 1920s in Japan, Reiki is an ‘energy therapy’ that uses gentle hand techniques that are thought to help re-pattern the patient's energy field and accelerate healing of the body, mind and spirit, and research suggests that it is an effective way to treat pain. Find more information here:
Acupuncture
Acupuncture is a treatment derived from ancient Chinese medicine that’s based on the belief that an energy, or ‘life force’, flows through our bodies in channels called meridians. This life force is known as Qi (pronounced ‘chee’), and traditional acupuncture practitioners believe that when Qi is unable to flow freely through the body, it results in illness. By inserting fine acupuncture needles into specific sites in the body, they believe they can restore the flow of Qi, and so restore health. Western medical acupuncture involves the use of needles to stimulate sensory nerves under the skin, producing pain-relieving endorphins, and it's likely that these naturally released substances are responsible for acupuncture’s beneficial effects, particularly in relation to back and knee pain. Find more information here:
T’ai Chi
A Chinese martial art, which developed in the 13th century, that combines gentle, graceful movements with mindfulness, deep breathing, and relaxation. It features constant shifting of body weight between the legs, with both knees remaining flexible all the time, practiced at a slow and even speed. There is some evidence to suggest that practicing T’ai Chi may help people manage chronic pain associated with knee osteoarthritis and fibromyalgia. Find more information here:
Massage
Pressure and friction by the therapist’s hands promotes healing and may reduce inflammation by helping muscles relax and boosting blood flow. While there’s only a little evidence that massage is effective in rheumatoid arthritis or osteoarthritis, there’s consistent evidence from a number of trials to suggest that it’s effective in treating some of the symptoms of fibromyalgia, neck, and low back pain. Find more information here:
Alexander Technique
Practitioners believe that musculoskeletal pain related to the habitual under-use of some muscles, and over-tightening of others, is likely to reduce when posture and coordination improves. The Alexander technique teaches patients to improve poise and posture, and to move with less physical effort. It’s safe to practice, and the evidence suggests that it is particularly effective for neck pain. Find more information here:
Biofeedback
A form of self-regulation that trains patients to improve their health by controlling bodily processes that normally happen automatically; for example heart rate, blood pressure, skin temperature and muscle tension. During biofeedback therapy, the patient is asked to perform a task (involving a particular muscle group, for example), and electrodes are attached to the skin. As the patient performs the task, they receive information about their muscle activity via a computer monitor.
The three most commonly used forms of biofeedback therapy are:
• Electromyography (EMG), which measures muscle tension
• Thermal biofeedback, which measures skin temperature
• Electroencephalography (EEG; sometimes referred to as neurofeedback), which measures brainwave activity.
Biofeedback is based on the belief that the mind and body are linked, and that if an individual is aware of their bodily activities, they can learn how to regulate them. Evidence suggests it is effective in treating migraines. Find more information here:
Yoga
Originating in India approximately 4,000 years ago, there are several different types of yoga and many disciplines within the practice. It combines breathing exercises, physical postures, and meditation to enhance well-being, and has been found to be an effective treatment for chronic pain, particularly back pain. Find more information here:
Osteopathy
Treatment focuses on strengthening the musculoskeletal framework, which includes the joints and muscles, but a key feature of osteopathy is spinal manipulation. Osteopaths use touch, manipulation, stretching and massage to increase joint mobility, relieve muscle tension, improve blood and nerve supply to tissues, and help the body’s own healing processes. They may also provide advice on posture and exercise to aid recovery and prevent symptoms returning. Evidence suggests it is effective for low back pain. Find more information here:
Hypnosis
And finally… you wouldn’t expect me to overlook the use of hypnotherapy as an aid to pain relief, now would you? In a recent study, (the largest review of its kind), evidence of over 3,500 people from 85 controlled studies provided researchers with convincing evidence that hypnosis produces altered activity in key regions of the brain involved in pain regulation. For the majority of people, who are only moderately receptive to hypnosis, it resulted in a 29% reduction in their pain. However, for around 15% of people, those who are highly receptive to hypnosis, it led to just over a 40% decrease in their pain. Read the full report here:
Thank you for reading this blog post. If you have any thoughts to share, or ideas for future posts, please do let me know. I would love to hear from you.