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This chapter is meant to be an introduction to how plant extracts, vitamins, functional foods, minerals, nutraceuticals, and therapeutic diets might be utilized to improve symptoms in chronic pain. Emphasis will be placed on physiological processes and conditions where some form of nutritional intervention will have a high probability of being efficacious. An in-depth treatise on all pain mechanisms will not occur, as this will be covered elsewhere. Also, an exhaustive review of the clinical studies for or against specific treatments will not be undertaken. Inflammation, cytokines, neurohormones, and oxidative stress all play important roles in persistent pain conditions. Many aspects of immune and neuroendocrine function may be modified by dietary factors such as phenols, saponins, sterols, and antioxidants. Inflammation may be controlled at different levels. Omega-3 fatty acid supplementation can modify the eicosanoid cascade, tipping the balancevadjusts toward an anti-inflammatory profile. Lowering insulin and neurotoxin levels may also help to reduce inflammation by modulation of PLA2 activity. Flavanoids, such as rutin and quercetin, and retinoids, such as vitamin A, additionally help to inhibit PLA2 activity. Some examples of chronic pain conditions that may be amenable to dietary interventions include osteoarthritis, rheumatoid arthritis, fibromyalgia, autoimmune diseases, migraine headache, chronic abdominal pain, Crohn's disease, and arthralgia. Dietary interventions for pain include increasing fruit and vegetable intake, consumption of grass-fed beef and DHA eggs, lowering lectin consumption, adding functional foods such as soy and green tea, and elimination of food allergens. Lowering inflammatory cytokines and modifying the eicosanoid cascade with n-3 fats may attenuate systemic inflammation. Neuroendocrine perturbations, notably of cortisol and growth hormone, exist in many chronic pain states. Vital neurohormones such as melatonin and serotonin may be lower in chronic pain patients in connection with plasma amino acid imbalances. Metabolic deficits in mitochondrial function and glycemic control should also be addressed in order to reduce systemic inflammation and oxidative stress. Acid-base disturbances, primarily of dietary origin, may contribute to the progression of osteoporosis, which can lead to painful fractures and disability. The cartilage destruction seen in osteoarthritis is the result of an imbalance between catabolic and anabolic activity and may be modified by various antioxidants, as well as glucosamine, Chondroitin, and SAMe. Evidence indicates that obesity and insulin resistance contribute to chronic inflammation, providing good rationale for aggressive lifestyle and diet intervention in obese patients with chronic pain conditions. Targeted clinical nutritional interventions may effectively inhibit synthesis of inflammatory prostaglandins and cytokines. Though the subject of treating pain with nutritional factors is rarely discussed in medical textbooks, published data on the use of nutritional interventions in the treatment of various chronic inflammatory conditions does exist. Many opportunities to improve our treatment of chronic pain conditions through dietary changes exist and will be further elaborated on in the chapter "Nutrition and Supplements" that follows. [ABSTRACT FROM AUTHOR] |
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