Nutritional Supplementation for Pain

Why choose nutritional supplements for pain?

Nutritional supplements can help lower pain. They work by helping to reverse inflammation which worsens pain, mitigate degenerative processes underlying joint pain, and improve tissue healing. Unlike many medications such as NSAIDs and opiates, nutritional supplements are safe and have a very low side effect profile. They are also well tolerated by patients.

In addition to supplementation, food can also exacerbate and precipitate inflammation and worsen the pain. Food can also lessen inflammation and help to improve pain. The typical standard American diet (SAD) is highly inflammatory and serves to worsen the pain. The SAD diet is typically high in carbohydrates, contains excess sugars, and has low omega-3 fatty acids. This is a recipe for increased inflammation. I recommend that patients consume an anti-inflammatory diet that is generally plant-based, eliminates processed foods, and stays away from simple sugars. Anything food that spikes insulin levels (such as sweets) will also increase inflammation.

Here are some recommended supplements which will help with pain:

Glucosamine and chondroitin sulfate

Cartilage is made from nutrients that are transformed into glucosamine and chondroitin sulfate. Supplementation with glucosamine and chondroitin sulfate is meant to improve cartilage in the joints. With inflammation and degenerative processes in the joints, there is a breakdown of cartilage. Oral supplementation with glucosamine and chondroitin sulfate will help to reverse this process.

The daily adult dose for glucosamine is 1500- 2000 mg daily in divided doses. The daily dose for chondroitin sulfate is 1000 mg daily. There are few adverse effects and benefits are realized after 4-6 weeks of treatment.

Niacinamide

In blind, placebo-controlled studies, niacinamide has been shown to improve joint mobility, reduce inflammation, and improved activities of daily living in arthritis patients, as well as reduced medication use.

It is thought to work by 2 mechanisms. It reduces joint-destroying nitric oxide and enhances mitochondrial function in cartilage cells and is so doing, improves cartilage cell function.

The daily dose is 500 mg given up to 6 times per day.

Proteolytic enzymes

These are digestive enzymes and typically contain pancreatin, bromelain, papain, amylase, lipase, trypsin, and alpha-chymotrypsin. These are well absorbed into systemic circulation when taken orally. There are many health benefits to taking enzymes, especially in inflammatory conditions or infections such as cellulitis, sinusitis, diabetic ulcers, and bronchitis. Enzymes have also benefitted patients with various musculoskeletal injuries in studies.

Enzyme supplements are taken between meals, otherwise, they will be used to help digest food. They may be taken up to 3 times per day. I recommend Vascuzyme from Orthomolecular Products. It can be ordered at www.patientservices.com, registration code POR 714-01.

Botanicals

Devil’s claw (harpagophytim procumbens)

This has been used for centuries to reduce pain. It has been shown to reduce pain in the spinal cord. It has also been shown in studies to reduce pain in osteoarthritis patients with minimal adverse effects. Studies have shown that this botanical is at least as effective as commonly used NSAIDs without adverse effects. One study showed that it was at least as effective as the now-banned COX-2 inhibitor Vioxx.

Treatment should be for at least 4 weeks and patients will continue to improve 8 weeks after starting treatment. The usual dose is 30-60 mg per day.

Less than 8% of patients had either mild gastrointestinal symptoms such as diarrhea or mild dizziness.

Cat’s claw (uncaria spp.)

This botanical has also been used for centuries. It reduces inflammatory effects mediated by NFkB, TNF-alpha, COX-2, and PGE-2. Should not be used in pregnancy or in women trying to conceive.

Dosage ranges from 250 mg to 500 mg per dose up to three times per day.

Willow Bark (salix spp)

It has antioxidative, anti-cytokine, cyclo-oxygenase, and lipoxygenase-inhibiting effects. The daily dose is 120 to 240 mg of salicin.

Boswellia (boswellia serrata)

Inhibits the 5-lipoxygenase enzyme but not cyclooxygenase. Works to reduce inflammation. Generally well tolerated though it may have mild gastrointestinal upset. Has also shown promise with rheumatoid arthritis, chronic colitis, ulcerative colitis, Crohn’s disease, bronchial asthma, and peritumoral brain edema according to one study.

The dosage is 150 mg 3 times per day.

Ginger (zingiber officinale)

Ginger has a long history of use as an anti-inflammatory and anti-nausea agent. It inhibits both lipoxygenase and cyclooxygenase to reduce inflammation. It reduces inflammation-promoting prostaglandins and leukotrienes and it inhibits nitric oxide production. Can be used in pregnancy and dosages up to 1 GM per day is tolerable. Can also be consumed as ginger root.

CBD (cannabidiol)

This botanical is derived from cannabis species and there has been a lot of publicity recently regarding the positive effects of CBD. CBD has been used to reduce pain and to augment and/or reduce dependence on pain medication.

CBD modulates the release of pro-inflammatory cytokines such as endothelin-1, IL-1B, IL-6, and TNF alpha. It also exerts direct antioxidant effects. CBD also has direct analgesic effects, anti-nausea, antipsychotic, anxiolytic, and anti-epileptic effects.

CBD inhibits cyclooxygenase and lipoxygenase. The anti-inflammatory effect is several hundred times more potent than aspirin.

CBD can be derived from either marijuana or hemp. CBD from hemp does not contain any THC and therefore has no psychoactive effects.

Dosage can vary depending on the effect. CBD can also be applied topically with excellent results. Appropriate dosages have not been established. At higher doses, it may be sedating and patients should avoid driving or operating machinery. Doses up to 1500 mg per day have been tolerated. I recommend starting at a dose of 250 mg twice a day and then titrating to effect.

Omega 3 fatty acids

Omega 3 fatty acids, which can be consumed from fish oil or flax seed oil, lowers inflammation. Omega 3 fatty acids are also present in many foods such as salmon and avocados. It works directly in the inflammation pathways to lower inflammation. It works by decreasing inflammation in the same pathways that NSAIDs operate without the side effects of NSAIDs. In fish oil, the main omega-3 fatty acids are EPA and DHA, aka, eicosapentaenoic acid and docosahexaenoic acid. In flax seed oil, there is ALA, alpha-linolenic acid. 500-1000 mg daily is my recommended dose, though greater doses can be taken under a doctor’s advice.