Written By: Julane R. Contursi, MS, RDN, LD
Pain is defined by The International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Its impact is significant, exerting a burden on personal and economic health and affects ~ 30% of people worldwide. Pain can be from tissue injury, nerve injury, or from a sensitized nervous system. The development of acute to chronic pain encompasses pathophysiological changes in both the peripheral and central nervous systems.
Addressing pain involves a multidisciplinary approach (medications, psychological support, and rehab), the most sophisticated being a university-based center that includes teaching and research.
What about nutrition? It, too, plays an important role since the food we consume can be inflammatory to the injured tissues/nerves, exacerbating pain or the inability to minimize or attenuate that pain.
The American diet is plentiful in unhealthy fats, refined carbohydrates, sugar, sodium, all of which are pro-inflammatory. Those consuming a high red meat intake is correlated with an increase in inflammatory biomarkers according to one eight-week study where subjects were given either meat or legumes for their protein source.
Healthy fats such as extra virgin olive oil, fats in cold-water fatty fish such as herring, salmon, tuna, mackerel, trout, halibut, pollock, & flounder), flaxseed, walnuts, leafy green vegetables, canola, and soybean oil exhibit anti-inflammatory properties. Recommended fatty fish consumption for health benefits include two, 4-oz. servings weekly.
Red wine contains a phytochemical, flavonoid, that help combat inflammation (5 oz./d for women; 2, 5 oz./d for men).
Vitamin D deficiencies impact chronic pain. Vitamin D deficiency, more common in elderly, is associated with an increased sensitivity to mechanical pain. Many people, young and elderly, are deficient in Vitamin D, so a simple lab test should be done to assess status. If deficient, your physician will prescribe a therapeutic dose to treat deficiency. Once Vitamin D level in the blood has returned to a “normal range,” a lower maintenance dose is recommended to mitigate future deficiencies. There are few high Vitamin D-containing foods (salmon, tuna, sardines, milk, and eggs).
Vitamin B12 deficiencies, also more common in the elderly, affect neurological dysfunction and chronic pain due to atrophic gastritis, a condition where the stomach lining becomes inflamed leading to a decreased gastric (hydrochloric) acid secretion. This decreased gastric acid secretion contains a component, Intrinsic Factor, necessary for B12 absorption. Treatment usually involves an intramuscular injection of B12 by a physician.
Magnesium, a plentiful mineral in foods and the human body, can become low in the elderly due to less food intake and a decreased absorption from the gut. Some medications like antibiotics, diuretics, and proton pump inhibitors can affect Magnesium status. Foods high in this mineral include cereals, nuts, legumes, and spinach.
Water, an often overlooked “nutrient,” is important in that a hypohydration state is associated with chronic pain. The mechanism isn’t quite understood and could be due to a cardiovascular response or an increase in cortisol, a naturally occurring steroid hormone that is best known as the body’s stress response hormone. Cortisol is involved with other functions such as regulating blood pressure, carbohydrate metabolism, immunity, insulin release, and inflammation. Too much cortisol in the body can be proinflammatory. Because the elderly’s thirst receptors are decreased, hypohydration or dehydration is not uncommon.
What Can Be Done About Chronic Pain?
So, what can be done to help mitigate chronic pain associated with inflammation? Some general nutrition tips are listed below:
- Adhere as closely as possible to a Mediterranean diet.
- Hydration: 1.5-2L water daily (may vary depending on weight, meds, activity)
- At least 5 servings of fruits and vegetables daily
- More high-fiber foods such as whole grains, legumes, fruits, and vegetables (strive for 25-35 grams fiber daily)
- Less refined carbohydrates (sugary foods/drinks, white pasta/rice)
- Include more healthy fats such as extra virgin olive oil, fatty fish
- Substitute some plant-based proteins for red meat
- Consume two, 4-oz. servings of fatty fish weekly
- IF a red wine consumer, 5 oz. red wine for women and two, 5-oz. red wine servings for men can be beneficial (if not contraindicated with other health issues)
- Possibly supplement with Vitamins B12 and D, omega 3 fatty acids, and a multivitamin/mineral supplement