Nutrition supplementation for pain management

All pain management should be a functional medicine approach, said Nancy Cotter, MD, CNS, at the 2019 Institute for Functional Medicine Annual International Conference in San Antonio, Texas.

“We would all have much better outcomes if we used functional medicine,” said Cotter. “If we look at pain management in a broad concept, nutraceuticals are a small but important part and we need to look at how we can use them as part of a complete program.”

Many patients come to practitioners wanting to replace medications with nutraceuticals. Cotter said this is the wrong approach. Instead, she focuses on the complete picture, first advising patients on their diet, adding nutraceuticals as needed.  

According to the most recent Centers for Disease Control and Prevention report on supplement use in the U.S., the ten most commonly used nutraceuticals included omega-3 fatty acids, glucosamine, echinacea, flaxseed, ginseng, combination hers, ginkgo biloba, chondroitin, garlic, and coenzyme Q-10. Fish oil and glucosamine, in particular, are used for pain management when a patient doesn’t want to go on conventional medications, Cotter said.

“Pain is a big deal for patients,” said Cotter, “and we can see that in the supplements they’re selecting.”

Nociceptive pain is caused by stimulation of a nerve or innervated tissue via trauma or inflammation. For example, arthritis pain, post-surgical pain, and trauma from sports. Neuropathic pain is caused by a lesion or disease of the somatosensory nervous system. Examples of this kind of pain include post-herpetic neuralgia, painful polyneuropathy, and cancer pain. Mixed pain is lumbar radiculopathy, or damage to the nerve root, neuropathic pain, and to local tissue due to inflammation, nociceptive.

Cotter listed some of the most popular nutraceuticals that can be used to target nociceptive pain or neuropathic pain:  

• Fish oil
• Curcumin
• Boswellia
• Glucosamine
• Chondroitin Sulfate
• S-Adenosyl Methionine
• Bromelain
• Probiotics
• Harpagophytum procumbens
• Vitamin C
• Alpha Lipolic Acid

Beyond nutraceuticals, Cotter stresses the importance of helping patients achieve an overall balanced diet for pain management. Results from the 1958 British Birth Cohort Study found smoking, body mass index, and (for women) diet offer support for the hypothesis that lifestyle factors may explain the association between chronic widespread pain and cancer or cardiovascular disease.

A 2007 report in the journal Annals of the Rheumatic Diseases looked at a six-week Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation. The intervention included a six-week Mediterranean cooking class. It found significant benefits in the intervention group compared with controls for patient global assessment at six months; pain score at three and six months; and early morning stiffness at six months.

Supporting herbs for pain management, Cotter said, include:

• Arnicia
• Valerian
• Passionflower
• Rhodiola

“This is about much more than a single source of pain,” said Cotter. “We need to focus on bringing the patient back in to balance, looking at the patient as a whole.” 

Editor’s note: This article is part of Integrative Practitioner’s live coverage of the 2019 Institute for Functional Medicine Annual International Conference. For a full list of coverage, click here.