Nutrition and Pain: Is there a link?
When considering pain, it is imperative to understand that there are a number of factors that influence it. Many times, patients’ will discuss the biomechanical findings that are on imaging (X-Rays, MRIs, etc.). While this is an important aspect to look at, and could be a major driver for many people, chronic pain can become trickier. Chronic pain, or pain that has been prevalent for longer than the expected healing time of the injury at hand (typically > 3 months), affects millions of individuals each year.
Pain is complex. There is still so much to learn. What we do know is that inflammation and oxidative stress are two main pathophysiological pathways of chronic pain. We also know that ones’ diet and the nutrients they consume on a daily basis have an impact on both these pathways and impact their expression. We also know that diets’ that consist of more nutrient poor content (aka empty calories such as products with large amounts of high fructose corn syrup) have more inflammatory markers and can be considered less beneficial calories. Extensive research has shown that unhealthy diets, obesity, smoking, and stress all have a negative impact on the management of chronic pain.
What do we know?
Our bodies use 6 main categories of nutrients from food:
- Protein
- Carbohydrates
- Fat
- Fiber
- Minerals
- Vitamins
What we need varies based on several factors, such as our daily routines and daily exercise, intensity of exercise, genetics, pre-existing medical conditions, current health status, previous injury status/pain status (and more).
Our brains can change, a feature known as neuroplasticity. Repetitive experiences can influence this. The brains’ response to stimuli is modifiable and can change how it responds to these stimuli (and how strongly it responds). New evidence suggests that these alterations in the brain associated with chronic pain are modifiable and reversible, and can be influenced by various clinical interventions, such as:
- Exercise
- Incremental training
- Diet (From a variety of diets from intermittent fasting to caloric restriction, to nutrition supplementation)
The ‘Western Diet’ has been shown to yield imbalances. This diet typically emphasizes processed meat, refined grains, foods high in sugar and preservatives, and a lower percentage of fruits and vegetables. These foods have been shown to increase production of pro-inflammatory mediators, and change the sensitivity of the peripheral afferent neurons (which send signals out to our body). This can influence our overall sensitivity to stimuli, thus altering our pain response and pain threshold. These foods may not necessarily increase inflammation directly for individuals, but it has been shown to yield fewer anti-inflammatory mediators, with one example being antioxidants.
Many people worry alot about the number of calories they are eating. But not all calories are created equal. The quality of the food that you consume plays a strong role!
One of the most difficult factors when discussing nutrition and diets involves how many diets and ‘fads’ there are out there, and what ACTUALLY works and is healthy. While the research is ongoing, finding randomized control studies and longitudinal studies (research studies that look at a large period of time, usually following people for years) is crucial. Here are some highlights from a systematic review that looked at 38 recent studies regarding nutrition and pain:
- Headaches seem to be responsive to low fat diets and omega3 supplements.
- Low intake of micronutrients, specifically Omega-3 fatty acids, Vitamins B1, B3, B6, B12, Vitamin D, magnesium, zinc, and beta-carotene have been associated with chronic neuropathic pain and inflammatory pain. Systematic reviews on low back pain, pain from Rheumatoid arthritis, IBD, migraine, and chronic pelvic pain have revealed that specific micronutrient supplementation as listed above can be beneficial in aiding in overall pain from these conditions.
- In a double-blinded, placebo-controlled parallel trial, patients who experience migraines were randomized into a 24 week study, where one group received a placebo and one group received vitamin D3. There was a statistically significant decrease in migraine frequency vs the placebo group, and also a reduction in the number of migraine days. However, the pressure pain thresholds and severity of the migraines that did occur were not statistically significant. So why is this worth presenting? It demonstrates how nutrients and vitamins can influence medical conditions. While it is not a cure, it can be a great thing to discuss with a licensed Dietitian and/or MD.
This information is important to continue to be researched and studied. There are alot of studies that have already been conducted with promising results (presented above was just the tip of the iceberg!) When addressing pain, remember to take a multi-modal approach. It is just important to understand that nutritional science can play a factor in one’s pain! If you are looking for a change to your diet, it is crucial you see a registered dietitian for a personalized plan.
Dragan S, Șerban MC, Damian G, Buleu F, Valcovici M, Christodorescu R. Dietary Patterns and Interventions to Alleviate Chronic Pain. Nutrients. 2020;12(9):2510. Published 2020 Aug 19. doi:10.3390/nu12092510
