When people have chronic pain after a catastrophic injury, the most common pain-management solutions tend to be pharmaceutical pain relief (such as NSAIDS, opioids, antiseizure, and/or anti-spasticity medication), medicinal cannabis, botox injections and/or psychological treatments (eg. biofeedback, cognitive behaviour therapy).(1, 2) However, a growing body of research is showing a strong link between what people eat and the amount of pain that they experience.

Did you know that what you eat can affect…

Abdominal pain

This includes the pain from Irritable Bowel Syndrome,(3, 4) Inflammatory Bowel Disease such as Crohn’s and Ulcerative Colitis,(5) constipation and food allergies or intolerances.

Inflammatory pain

This includes the pain from osteoarthritis,(6) rheumatoid arthritis,(7) and musculoskeletal injuries.(8)

Neuropathic pain

This includes the pain from spinal cord injuries,(9) diabetic neuropathy (10) and alcoholic neuropathy.(11)

How can food choices affect pain? What is the mechanism of action?

1.  Obesity – obesity not only increases the wear and tear on weight-bearing joints, but it also causes a chronic low-grade level of inflammation throughout the body.(6)  This inflammation can increase the pain response and/or reduce the pain threshold.(12)   Helping clients achieve and maintain a healthy body weight (or at least lose 5-10% of their body weight) has been found to reduce inflammation and pain.(13)

2.  Fat – The type of fat people eat changes the composition of cell membranes and alters the production of inflammatory cytokines and eicosanoids/prostaglandins in the body which cause pain.(14)

• Omega 3 fats (eg. from oily fish, olive oil, rapeseed oil, and supplements) are anti-inflammatory, so the goal is to eat more of them.  If using an omega 3 supplement, you do need quite a high dose and need to make sure that it contains enough of the active ingredients.(15)
• Omega 6 fats (eg. from fried and processed foods) increase inflammation, so the goal is to eat less of these foods.(14)
• Trans/hydrogenated fats (eg. from fried and processed foods) and saturated fat (eg. from fatty meat, cheese and high fat dairy products) both increase inflammation as well, so you want to limit these in your diet.(16)

3.  Mediterranean diet – There is a positive and synergistic effect between the components of a Mediterranean diet and reduced pain.  A Mediterranean diet includes fish, olive oil, vegetables, fruit, nuts and low glycaemic index whole grains.  Together, these foods work to reduce inflammation and reduce oxidative stress and cell damage.(17, 18)

4.  Gut microbiome – Much of the research in this area is still done on animals, but there is increasing evidence that the substances (eg. metabolites/neurotransmitters) produced by organisms in the gut can affect abdominal pain, inflammatory pain and neuropathic pain.(12)  This is primarily because these substances can increase/decrease inflammation, activate pain receptors and can make neurons more excitable and sensitive.(12)  People can increase the healthy organisms in the gut by eating more high fibre foods and/or taking specific probiotic supplements.

5.  Food sensitivities – Certain foods can trigger abdominal pain and other symptoms in people with Irritable Bowel Syndrome, (4) food allergies and/or food intolerances.(19)  Sometimes these sensitivities can trigger inflammation throughout the body as well.

6.  Nutrient deficiencies – Deficiencies in thiamine and vitamin B12 can cause neuropathy, so we do need to make sure that clients are not deficient in these nutrients.(11)

While weight management and dietary changes are unlikely to be “stand alone” therapies for managing pain, they do make for easy, low-cost adjuncts to other pain management strategies that the client may be using.  Dietary therapy is free from side effects and has the bonus of having many other positive health benefits as well.

Check out this great handout by the The International Association for the Study of Pain on Nutrition and Chronic Pain.

To refer a client to a dietitian for the dietary management of pain, please contact Specialist Nutrition Rehab at 0121 384 7087 or info@specialistnutritionrehab.co.uk.

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