opioids

Nutrition as a Treatment for Pain

It is well known that nutrition plays a role in pain management and wellness. Research has investigated the impact of various diets and types of food on inflammation and whether those effects were maintained long term.

To answer our questions about nutrition as a treatment for pain and inflammation, Consultant360 reached out to Elizabeth Huntoon, MD, who is an associate clinical professor in the Department of Physical Medicine and Rehabilitation Neuroscience at Virginia Commonwealth University in Richmond, Virginia. She recently spoke about nutrition for pain and wellness at the Moving Beyond Opioids for Chronic Pain conference.1

CONSULTANT360: What nutrition plans are proven to reduce pain and improve wellness?

Elizabeth Huntoon: Current evidence suggests strong correlation between “anti-inflammatory” type diets and reduction in pain. An anti-inflammatory diet is basically a Mediterranean diet, and while there is no single definition, the Mediterranean diet typically consists of high consumption of fish, vegetables, fruits, whole grains, beans, nuts and seeds, and olive oil. Moderate amounts of dairy, poultry, and eggs are also central to the Mediterranean diet. In contrast, red meat is eaten only occasionally. The Mediterranean diet is one of the healthy eating plans recommended by the Dietary Guidelines for Americans2 to promote health and prevent chronic disease.

C360: Which foods (or types of food) promote inflammation and pain?

EH: Foods that have been shown to promote inflammation are the highly processed foods and drinks such as sugar-sweetened beverages, processed meat, refined grains, refined oils, and other highly processed foods. Trans fats, found in margarine and certain processed foods, should also be avoided. Exposure to refined oils such as soybean oil, canola, cottonseed, and sunflower seed should be limited or avoided. Keep in mind that anything labeled “low-fat” or “diet” or that looks like it was made in a factory is likely a highly processed food.

C360: What are the key take home messages for neurologists who care for patients with chronic pain?
EH: Basically, we need to share with our patients that pills are not a shortcut to better health. Research on exercise suggests regular walking is associated with lower levels of inflammatory markers and, when combined with healthy eating, can help decrease the risk of inflammation, chronic disease, and pain.

If patients choose to use supplements, they should be advised that the research/results are mixed. In addition, with the current focus on the gut microbiome and health, there is a strong emphasis in the marketplace for probiotic supplements. Probiotics on the market are considered dietary supplements and are not regulated by the US Food and Drug Administration. Thus, it may be questionable if the bacteria listed on the label is actually in the supplement.  Healthy individuals will likely not experience any difficulty and may benefit from good-quality probiotic supplementation, but the medically fragile, elderly, or immunocompromised may not benefit and should be cautioned about using probiotic supplementation until further research proves safety and efficacy in this population.

A potentially safer way to increase the number of healthy gut bacteria is to increase dietary sources of probiotics such as yogurt, especially plain Greek yogurt, fermented vegetables (ie, sauerkraut, pickles) kombucha, kimchi, and tempeh. Some types of cheeses contain probiotics also, including cheddar, mozzarella, and gouda.

The bottom line is that patients can benefit from counseling on how dietary choices can positively or negatively affect not only their health but how they feel. There may be a dose-response effect, meaning the closer you stick to an anti-inflammatory diet, the greater the health benefits.

References:

  1. Huntoon E. Nutrition for pain and wellness. Talk presented at: 2019 Back to the Future: Moving Beyond Opioids for Chronic Pain; September 21-22, 2019: Norfolk, VA. https://vcu.cloud-cme.com/assets/vcu/data/Pain%20Medicine%20Brochure%202019_Print%20Friendly_FINAL.pdf.
  2. Dietary Guidelines for Americans 2015-2020. Office of Disease Prevention and Health Promotion; https://health.gov/dietaryguidelines/2015/guidelines/.