3 accessible nutrients for musculoskeletal pains AND concussion.
Natural compounds for pain management.
Some of you might wonder what it is exactly that I treat. For the last two weeks the blog has been concussions, and now today it’s pain?
In the simplest form, I treat motivated people who like to move their bodies - think athletes, former athletes, weekend warriors, fitness enthusiasts.
What that means is that I end up treating brains, pains, and performance.
Brains: If you’re active in team or contact sports, you’re at risk of concussion.
Pains: If you’re active in athletics or fitness, in general, you’re at risk of injury, aches, or pains.
Performance: If you’re involved in either of these categories, you’re likely interested in optimizing your body and brain for peak performance.
Hi, I’m Dr. Mark and if your active and would like to remain active, I’d love to work with you.
Now, let’s talk about pain.
Big picture: In the US, around 126 million adults suffer chronic pain and 40 million of them are suffering from severe pain. And pain management in the US costs us $560 to $635 billion each year.
Observation…
When we spend GOBS of money on a condition….
AND people are actively seeking alternatives….
Medicine probably isn’t doing a great job.
In my practice, many of the individuals suffering from chronic pain are either suffering chronic pain as a part of their post-concussion syndrome or they’re now dealing with old injuries from their “glory days.”
So, if you or someone you know is suffering from chronic pain, what can be done?
A quick look at conventional management.
Tylenol is the leading cause of liver failure in the United States and has been since 1998. NSAIDs have been associated with GI side-effects and GI bleeding. Antidepressants likely only work in chronic pain if you’re dealing with depression in the first place. And we’re currently dealing with what has been called an “opioid crisis...”
Chronic pain also causes suffering, as reflected by the finding in the Global Burden of Disease Study 2013 that chronic low back pain was the leading cause of years lived with disability. In addition to the contribution of pain to disability, that study showed that the associated problem of opioid use disorders accounted for 5.8 million additional years lived with disability, an observation that underpins attempts to treat pain with drugs other than opioids. Long-term opioid administration has minimal effects on chronic pain and can cause tolerance, drowsiness, and dependence, as well as impaired memory, concentration, and judgment. For these reasons, the International Association for the Study of Pain recommends caution in prescribing opioids for chronic pain, and there has been an increased emphasis on the use of nonopioid pain management.
- Finnerup, N. B. (2019). Nonnarcotic methods of pain management. New England Journal of Medicine, 380(25), 2440-2448.
A natural approach.
You’re never NOT going to hear me harp on nutrition, movement, and mindset.
When it comes to chronic pain, the scientific and medical literature highly favors movement and mindset in concussion. For example...
Exercise like yoga only has to be performed 1 time per week to see a benefit in pain patients. Tai chi has solid amounts of literature. Even water aerobics have research! Muscle and movement are medicine.
Beyond that, we’ve got research that shows 8 weeks of mindfulness-based stress reduction (MBSR) can result in better pain management for the next 6-12 months. Your relationship to your pain matters.
So what about nutrition?
I’m going to save the discussion surrounding food and diet for a later day. Instead, in line with last week's supplement post, I am going to cover some of the better-researched supplements for managing your pain.
The reality is that there are effective options out there that can minimize side-effects and maximize outcomes. So, let’s dig in.
A selection of natural products for pain management.
I continually scan peer-reviewed research for the latest evidence-based approaches for non-narcotic and natural pain management. Recently, I put together a Pain Management Guide that included the following supplements found in the research:
Omega-3 Fatty Acids (EPA/DHA)
Curcumin
Vitamin D
Magnesium
Glucosamine
Chondroitin
Methylsulfonylmethane (MSM)
CoQ10
Lipoic Acid
Melatonin
To learn about each of these and their role in beating pain, download your free pain guide here. In this article, however, I am going to look at three supplements that play a role in both pain management and concussion recovery.
First: Curcumin
Curcumin is an extract from the Indian spice, turmeric. It’s what gives turmeric its bright yellow color. In powdered form, it is considered relatively poorly absorbed and it is recommended to be paired with black pepper to improve bioavailability. Some argue that the poor bioavailability and absorption is actually a good thing because it allows curcumin to accumulate and exert anti-inflammatory effects in the gut. And, as we’re learning, the health of the gut seems to reflect your health, in general.
With that said, there are patented supplemental extracts of curcumin available (e.g Meriva) that improve bioavailability when taken orally. What does the research show?
Pain Management: Curcumin a component of the turmeric spice, at 2g per day, showed similar efficacy to Tylenol, COX-2 Inhibitors, and NSAIDs. However, the onset to relief was slower than these other agents.
Concussion Recovery: Animal studies of TBI have shown curcumin to protect nerve cells and the blood-brain barrier, protects mitochondria and brain energy metabolism, and protect neuroplasticity! To learn more about why this is important in concussion, click here.
Second: Magnesium
Roughly 68% of Americans do not get enough magnesium (Mg) each day. Found largely in fresh fruits, veggies, nuts, and seeds, many North Americans do not eat enough of these things to meet the minimum RDA recommendation of 300-400mg per day.
The consequence? Inflammation. Magnesium deficiency has been associated with greater levels of inflammation, and this is not good for folks looking to get out of pain or recover from a concussion.
Pain Management: Supplementation of Mg (compared to placebo) led to decreased low back pain over 6 months in one study. Benefits in fibromyalgia have also been reported in research. Another common use in pain patients, anecdotally, is the relief of muscle tension that comes with magnesium supplementation and magnesium (Epsom salt) soaks.
Concussion Prevention/Recovery: Magnesium acts as a mineral “gatekeeper” to the NMDA receptor which is involved with glutamate and calcium - both key players in the excitotoxicity seen in concussion. In theory, healthy magnesium levels can ensure the regulation of these NMDA receptors to minimize excitotoxic damage. To learn more about why this is important in concussion, click here. The beneficial use of magnesium following a TBI has yet to be solidified in human studies.
Third: Omega-3 Fatty Acid (EPA/DHA)
Fish oil is a popular supplement that's received mixed press in recent years. The undeniable fact about fish oil is that it contains ESSENTIAL fatty acids, EPA/DHA. These fats can technically be made by the body from ALA, however, the conversion rate is low and supplementation has shown significant benefit in the realm of concussion and pain.
Pain management: Omega-3 Fatty Acids (EPA/DHA) used in a 4 week RCT with 250 people found that 59% of participants stopped needing their NSAIDs and 60% noted overall improvements in their pain. Also of note, diets that decrease Omega-6 and increase Omega-3 fats show improvements in pain.
Concussion recovery: In animal studies of TBI, EPA/DHA have both been shown to reduce excitotoxicity, protect mitochondria, protect brain metabolism, and protect neuroplasticity. This is likely due to the anti-inflammatory effects of EPA and the structural support from DHA.
This is the tip of the iceberg.
We only took a look at 3 of the 10 listed supplements, and those are only 10 of the many nutrients, peptides, or botanicals that are used in the management of pain.
Beyond that, we didn't even scratch the surface on movement strategies - corrective exercise, functional movement, soft-tissue manipulation, regenerative injections, etc... - that can be used to manage pain.
Further, we didn't even begin to look at the mindset - mindfulness, paced breathing, language - that goes into taking control of your body and putting pain to the back burner.
The point?
You have options.
Please never be satisfied with a doctor that tells you "this is the way it is" or that you don't have options outside of drugs or surgeries.
If there's anything you can say back to the doctor that tells you these things for certain, it is that 126 million people and $600 billion says that those options probably don't work as well as they are telling you they do.
It's worth repeating: Nutrition, movement, and mindset are critical.
You have to put in the work, yes. No one can do it for you. There is no magic pill. There is no magic diet.
But, once you're given the tools, you now have the power. It comes down to consistency, grit, and support along the way.
Dr. Mark Heisig is a licensed naturopathic doctor with continuing mTBI education from The American Academy of Neurology (AAN), Complete Concussion. Management (CCMI) and The Carrick Institute. His office is located in Scottsdale, AZ.
References:
Bonakdar, R. A. (2017). Integrative pain management. Medical Clinics, 101(5), 987-1004.
Finnerup, N. B. (2019). Nonnarcotic Methods of Pain Management. New England Journal of Medicine, 380(25), 2440-2448.
Nahin, R. L., Boineau, R., Khalsa, P. S., Stussman, B. J., & Weber, W. J. (2016, September). Evidencebased evaluation of complementary health approaches for pain management in the United States. In Mayo Clinic Proceedings (Vol. 91, No. 9, pp. 1292-1306). Elsevier.
Nijs, J., Daenen, L., Cras, P., Struyf, F., Roussel, N., & Oostendorp, R. A. (2012). Nociception affects motor output: a review on sensory-motor interaction with focus on clinical implications. The Clinical journal of pain, 28(2), 175-181.
Tick, H. (2015). Nutrition and pain. Physical Medicine and Rehabilitation Clinics, 26(2), 309- 320.