Opioid epidemic drives search for new chronic pain treatments, including diet

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With the U.S. waist deep in the opioid epidemic, many patients with chronic pain are suddenly finding opioid treatments restricted by their doctors. As a neurologist and interventional pain physician, I understand their pain and look to the future with hope for newer treatments and therapies.

Academic neurologists and interventional pain physicians, in addition to treating pain, examine the root causes – from spinal headaches to the strain of bone cancer – and figure out how to minimize a person's persistent discomfort.

Part of the reason for this crisis is the way we view chronic pain. Nearly 70 percent of patients’ visits are related to complaints of pain, and the burden of chronic pain on society is bigger than that of stroke, heart disease and cancer. It costs the United States billions in lost productivity from disability.

The opioid epidemic is forcing researchers and clinicians to study additional treatments for managing pain, including physical activity and the cornerstone healthy diet. As non-opioid drugs that are specifically designed to treat chronic pain without harmful side effects are being researched and developed, we're telling folks to eat more fruits, vegetables, whole grains, nuts and seeds in lieu of highly processed foods that contain added sugars, sodium and saturated fats. As simple as it sounds, doing so can lead to less chronic pain and dependence on harmful, addictive opioids.

It's the same advice we've been giving for years for other chronic conditions, such as heart disease, diabetes and stroke, which have shown strong association to diet. Interventions to diet have translated to better disease control.

But first, what is chronic pain?

Chronic pain is often defined as any pain lasting more than six months. It may arise from an initial injury, such as a back sprain, or there may be an ongoing cause, such as illness. Lots of people suffer from it. One of the biggest contributors of chronic pain is aging, as wear and tear on body parts leads to pain. Just as a car will wear down if you drive it for years without changing the tires or oil, our bodies similarly wear down.

By 2035, most of the population will be over 65, so it’s prudent to aggressively look at this issue. For the younger population, we don't want them to be disabled, we want them working, living their lives to the fullest and enjoying hobbies. We’ll also need them to keep the economy going.

How have we treated chronic pain up until now?

The World Health Organization developed a three-step "ladder" for pain relief in adults, starting with non-opioids such as aspirin, then moving to mild opioids such as codeine and, then only, opting for strong opioids such as morphine.

How do we treat pain now?

We prefer to begin pain control by talking about lifestyle modifications – getting enough sleep, moving more and following a high quality diet. 

We then move on to supervised therapy, such as chiropractic, water therapy or acupuncture, before we recommend mild pain relief from Advil or Tylenol. From there, we ratchet up the drug strength, moving from topical creams that can block the nerves to steroids. Than we go to surgical intervention before we prescribe opioids, which is a last resort.

We want people to adopt healthy eating patterns that reduce inflammation and improve health outcomes.  It's important to work with a dietitian, the nutrition expert, to determine the best approach to improving your diet and reducing chronic pain.

Eat your fruits and veggies

The USDA's Dietary Guidelines recommend adults eat anywhere from 5 to 13 servings of fruits and vegetables per day, depending on age, gender, physical activity and overall health. Antioxidants and phytochemicals are compounds produced in your body and found mainly in foods such as fruits and green, leafy vegetables. Both antioxidants and phytochemicals help defend your cells from damage caused by potentially harmful molecules known as free radicals. Too many free radicals in your system may damage various organs and tissue, including nerve cells. There are a number of chronic pain conditions that are worsened by free radicals.  Antioxidants and phytochemicals may help lessen the pain.  We can get these beneficial compounds by eating foods like berries, kale, broccoli, red cabbage, spinach and many others. 

Check out the American Institute for Cancer Research for a more complete list of beneficial foods at: https://www.aicr.org/reduce-your-cancer-risk/diet/elements_phytochemicals.html.

Try an anti-inflammatory diet

The human body uses inflammation to help fight illness and also to protect areas from further harm. In most cases, inflammation is a necessary part of the healing process. However, some medical conditions cause faulty inflammatory responses. These are called chronic inflammatory diseases. One of the best measures a person can take to prevent or reduce inflammation is to try an anti-inflammatory diet like the Dietary Guidelines. Less than 10% of Americans currently follow these recommendations.

Consuming a diet with plenty of non-starch vegetables, whole grains, legumes, and nuts and seeds (in moderation due to higher calorie content) will promote improved health. Check out these foods that have anti- inflammatory effects on the body: https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation.

B vitamins found in certain foods are nutritionally important and have been linked to pain relief because they provide protection to nerve injuries. Foods rich in B vitamins include soybeans, oily fish, tempeh, yogurt, low-fat milk, eggs, turkey, almonds, mushrooms, broccoli and asparagus. Meanwhile, omega-3 fats provide numerous benefits to your body, such as lowering inflammation, and may help reduce risk for Alzheimer's disease and some cancers. Foods high in omega-3 fats include mackerel, salmon, oysters, sardines, flaxseeds, walnuts and chia seeds.

What foods should you avoid?

Foods that cause inflammation include processed meats, added sugars, refined carbohydrates such as white rice and white bread, and saturated fats such as those found in butter, fatty meats, many processed snack foods and coconut oil. 

It’s also a good idea to limit beverages that stimulate the brain and make muscles tense, including coffee and energy drinks. Opt for caffeine-free coffee or tea, which are high in antioxidant benefits, and, of course, good old plain water.

Kiran Rajneesh is director of the Neurological Pain Division in the Department of Neurology at The Ohio State University Wexner Medical Center. He’s also part of the Comprehensive Spine and Pain Centers, Neurological Institute at The Ohio State University.