A panel of experts discuss causes and natural treatments for pain and inflammation so that patients can feel their best.
Kristin Chapman, Product Manager, Life Extension, Fort Lauderdale, FL, www.lifeextension.com
Crystal M. Gossard, DCN, Education Specialist, Life Extension, Fort Lauderdale, FL, www.lifeextension.com
Dayna Dye, Education Content Writer, Life Extension, Fort Lauderdale, FL, www.lifeextension.com
Vanessa Pavey, ND, Education Specialist, Life Extension, Fort Lauderdale, FL, www.lifeextension.com
Laura Fuentes, RPh, Chief Officer of Science & Innovation, Green Roads Inc., Deerfield Beach, FL, www.greenroads.com
Scott Griffin, Founder, Basic Vigor Nutraceuticals/Migrastil, Wilmington, NC, www.migrastil.com
Tim Hammond, Vice President of Sales & Marketing, Bergstrom Nutrition, Vancouver, WA, www.bergstromnutrition.com
Fabio Lanzieri, Director, Lanfam LLC/Proleeva, Fort Lauderdale, FL, www.proleeva.com
Cheryl Myers, Chief of Scientific Affairs and Education, EuroMedica, Inc., Green Bay, WI, www.euromedicausa.com
Kim Plaza, Technical Advisor, ADM Protexin, Doral, FL, www.protexin.com
Polina Robinson, ND, MS, CNS, LDN, Faculty for the Naturopathic Medicine Program, National University of Health Sciences, Lombard, IL and ND at Nourish Healthcare, Downers Grove, IL, www.nuhs.edu
Corey B. Schuler, FNP, DC, CNS, Director of Medical Science, Gaia Herbs, Mills River, NC, www.gaiaherbs.com
Chava Weinberg, DACM, LAc, LMT, Current Faculty, Clinical Supervisor and Herbal Medicine Department Chair, Pacific College of Health and Science, New York, NY, www.pacificcollege.edu
Céline Torres-Moon, Science Writer, Protocol for Life Balance, Bloomingdale, IL, www.protocolforlife.com
Jacob Teitelbaum, MD, Fibromyalgia and Fatigue Centers, Kailua Kona, HI, www.vitality101.com
Pejman Taghavi, MD, Medical Director, Hollywood Healthcare and Diagnostic Imaging and Advisor, Cymbiotika LLC, San Diego, CA, www.cymbiotika.com
Pain and inflammation are two of the most common ailments facing the world’s population today. Naturally intertwined, pain and inflammation can be acute or chronic—but in either case, it can cause discomfort that significantly impacts one’s day-to-day life. According to the Centers for Disease Control and Prevention (CDC), “chronic pain, one of the most common reasons adults seek medical care, has been linked to restrictions in mobility and daily activities, dependence on opioids, anxiety and depression, and poor perceived health or reduced quality of life.”
WebMD lists conditions linked to chronic inflammation including cancer, heart disease, diabetes, asthma and Alzheimer’s disease, and inflammation can also cause some types of arthritis. Symptoms of inflammation, according to WebMD, include redness, a swollen joint that may be warm to the touch, joint pain, joint stiffness, a joint that doesn’t work as well as it should, fever, chills, fatigue/loss of energy, headaches, loss of appetite and muscle stiffness.
Luckily, the natural products industry offers a range of products and guidance for those suffering with pain and inflammation. A panel of experts has offered insight into the most common causes of pain and inflammation, the best natural approaches for treating it, what practitioners can do to best help their patients and more.
NP: What are some of the most common pain and inflammation issues in the U.S.?
Chapman, Dye, Gossard and Pavey: Common acute pain and inflammation issues are low back pain, migraine, sprains, dental pain and postsurgical pain.1
Common chronic syndromes that involve pain and inflammation include arthritis, back pain, neck pain, fibromyalgia, interstitial cystitis, migraine, neuropathy, complex regional pain syndrome/reflex sympathetic dystrophy (CRPS/RSD), bursitis, shoulder pain and vulvodynia.2 Chronic pain itself involves inflammation and, in addition to being a symptom, is recognized as a disease entity.3
Plaza: Estimates of chronic pain among Americans range from 11 percent to 40 percent.4 The Centers for Disease Control and Prevention (CDC) note that chronic pain has been linked to numerous physical and mental health issues, contributing to high health care costs and loss of productivity.5 Some of the related issues include restricted mobility, limited daily activity, dependence upon opioid medication, anxiety, depression and a poor quality of life.5 Despite all of these influences, there is still a lack of research being conducted in the area of chronic pain and inflammation.6
Dr. Robinson: In my experience, some of the most common inflammatory disorders for which natural health care solutions are sought out are autoimmune conditions, like lupus, rheumatoid arthritis, psoriasis, Crohn’s disease and ulcerative colitis, to name a few.
Dr. Taghavi: Related to physical activity (Muscle and bone injury results in fluid accumulating in the area where the trauma had occurred). Within that fluid the body is directing inflammatory cells to come and clean up the damaged tissues and lay the foundation for new cells. That cleanup process is like pouring acid into the damaged area to dissolve all the damaged cells and lay a clean slate for new cells to grow.
Systemic inflammation (this is those same inflammatory cells that show up to damaged areas that are circulating in your blood and causing havoc in different area) can result in cognitive (brain), cardiac (heart), pulmonary (lungs), gastrointestinal (stomach and bowel), musculoskeletal and renal (kidneys) issues, among others.
Dr. Teitelbaum: Anything that ends with “-itis” suggests an inflammatory condition. For example, arthritis, tendinitis and appendicitis. But excessive inflammation also contributes to cardiovascular disease, Alzheimer’s, cancer and likely the majority of chronic human illnesses.
Dr. Weinberg: Most providers in my area of practice are used to seeing a steady stream of injury recovery patients, training athletes and surgical recovery cases seeking pain management. Chinese medicine, and specifically the use of acupuncture, was early on associated with effective pain management. There is a large amount of current research data on the use of acupuncture as a tool for management of pain and inflammatory response in the body. Because of this, many people find their way to an acupuncturist’s office for the first time due to an issue with pain and may be surprised to find we treat other concerns as well.
What I have noticed in practice is a larger percentage of people accepting some level of pain and inflammation as normative for their baseline. Issues such as menstrual pain, headaches, digestive upset or stiff joints are sometimes dismissed as “something to deal with” but not serious enough to seek treatment. So, patient education here is important. These are signs from the body we don’t want to ignore.
Another common clinical experience is the pain patient with previous trauma or surgery. Scar tissue is often looked at only as a cosmetic concern, however, it can be a source of pain and movement restriction, or even organ dysfunction. Since the trauma is healed, we can sometimes discount that experience and its impact on the patient’s health today.
NP: What are the main causes of these issues?
Chapman, Dye, Gossard and Pavey: Pain is a response associated with injury or disease, defined by the International Association for the Study of Pain as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”7 While pain is caused by inflammation, some inflammation is chronic and silent.2
Lanzieri: The main causes of pain and inflammation are due to age, stress, obesity, autoimmune conditions, genetic variants, lifestyle habits (smoking, diet, alcohol, lack of exercise), viral and bacterial infections, allergens and toxins in the food we eat, and long-term exposure to irritants (e.g., polluted air and industrial chemicals). However, the major five are: poor diet; toxic environment; stress; lack of physical activity; [and] microbes in the environment.
Plaza: The reason a person may experience pain is very individual. Acute pain is activated by a specific disease or injury and chronic pain is recognized as a disease in its own right.8 Nociceptive pain (the most common way we describe pain) is often accompanied by inflammation and is caused through the stimulation of nociceptors by external factors and/or the release of pain-causing substances.8 The inflammatory process is associated with the immune system and is an adaptive function that can actually exacerbate pain;8 therefore, although it may sound counterintuitive, pain and inflammation are protective processes that are initialized to encourage healing.
Inflammation is a complex cascade of events in response to perceived harmful stimuli. Although inflammation offers a rapid response to injury, it may also damage host tissues in the process.8 After damage to tissue, local macrophages release compounds that are suggested to cause the inflammatory response. These compounds acidify the tissue, which activates the nociception and the sensation of pain.8 Lowering inflammation, and therefore reducing pain, is the action of many pharmaceutical drugs and is an extremely common form of medication. Between the years 2015-2018, 10.7 percent of U.S. adults reported using one or more prescription pain medications in the past 30 days.9 Many of these medicines are, however, associated with various safety risks. There is, therefore, a substantial market for more natural alternatives to assist in the management of pain and inflammation.
NP: What are some of the best natural approaches for pain and inflammation?
Chapman, Dye, Gossard and Pavey: Natural approaches for pain and inflammation can include physical therapy, massage, biofeedback, acupuncture and avoiding the intake of a diet that is associated with greater inflammation, as indicated by high Dietary Inflammatory Index scores.10,11 The fatty acid palmitoylethanolamide (PEA) and pro-resolving mediators, as well as turmeric, Boswellia serrata and black sesame—alone or in combination—are among the best nutritional supplements to support comfort and healthy levels of inflammation.
Fuentes: Camphor and menthol are two powerful, proven pain relievers. Botanicals with anti-inflammatory effects like extracts of black cohosh root and chickweed can help manage challenges related to arthritis. Vitamin D may help preserve healthy bones and joints, while proper hydration and adequate rest are always necessary.
Griffin: The best natural approach is a “whole person” approach. I think people know this intuitively. Pain and inflammation, especially as chronic conditions, require an integrative approach. People should build a strong foundation with the basics: healthy diet, enough quality sleep, staying hydrated, using stress reduction techniques (mediation and yoga are great!). Supplements are most effective when used as just that: supplements to an overall healthy lifestyle.
Lanzieri: Managing chronic inflammation and pain requires a multifaceted approach. Eating a healthy diet, living in a clean environment, learning to live with stress and staying active are all very important for slowing the rate of cell loss in your body, which promotes optimal immune system function and keeps the microbes of your microbiome contained. Additionally, several herbs and lifestyle modifications can help keep inflammation at bay. When it comes to keeping inflammation in check, there is one thing you can do that is more important than anything else: take herbs! Herbal therapy counteracts every aspect of chronic inflammation by providing potent antioxidants that directly neutralize damaging free radicals; certain herbs, such as turmeric, block inflammatory messengers; the phytochemicals of herbs modulate or balance immune system functions, which calms destructive inflammation; and certain herbs contain phytochemicals that suppress microbes that are flourishing in tissues.
Plaza: Probiotics are live microorganisms which, when administered in adequate amounts, confer health benefits on the host.12 Some of the health benefits documented include improving various conditions associated with inflammation,13 such as cardiovascular disease, allergies, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), autoimmune diseases and cancers.14, 15 One potential mechanism is instigating changes to the intestinal microbiota, to increase production of short-chain fatty acids (SCFAs), physiologically active by-products of bacterial fermentation, which are suggested to modulate systemic inflammation.16
Torres-Moon: For joint pain, we recommend the use of a combination of nutrients supporting the structural integrity of joint tissue as well as botanicals and other nutrients that are traditionally used to support the normal immune system response to joint stress secondary to physical exertion.* Other practices such as acupuncture, chiropractic care, massage, relaxation, yoga and many more traditional/natural techniques exist to alleviate pain in patients suffering from its effects.
Dr. Weinberg: Movement is key. No matter the etiology of the pain or inflammation, having a patient doing movement to their capacity will always support better clinical outcomes and get them more involved in recovery. I’m a big fan of sending patients home with stretching homework. Not only to benefit from increased movement capacity, but it also has a positive mental effect, reconnecting the patient with the strength and potential of their body.
While in the office I make good use of red light therapy and PEMF (pulsed electromagnetic frequency) mats, both of which support reduction of inflammation, improved cell repair and metabolism, and pain reduction. I’ve had several patients find these useful self-care tools and have purchased their own for home use with great results.
The most important piece of my treatment plan, however, will be diet and herbal recommendations. Many patients in this category feel they are eating a healthy diet, while they are actually feeding the inflammation. Consumption of sugars, hydrogenated seed oils, issues metabolizing oxalates and plant lectins, and food sensitivities are common themes we see in these patients. Almost universally I will put patients with pain and inflammation on an elimination diet.
NP: What trends are driving forces within the pain and inflammation category?
Chapman, Dye, Gossard and Pavey: Consumers are turning more and more to supplements to address minor and acute issues such as post-exercise muscle and joint discomfort. As with conventional approaches to pain, consumers expect immediate relief, and identifying ingredients that provide a quick response is key. Within this category, consumers are looking for relief that is noticeable and can be felt within hours. Additionally, consumers, especially younger generations, are looking to address discomfort before it begins and are becoming more proactive in maintaining a healthy state.
Hammond: One trend we have noticed is consumers’ desire for supplements that address multiple health issues. For practitioners, that provides an opportunity to suggest supplements such as MSM that not only aid in mitigating pain and inflammation issues, but that also show efficacy for immune support, healthy hair, skin and nails, exercise recovery and overall benefits for healthy aging.
Dr. Robinson: The landscape is shifting toward a multidisciplinary approach aimed at treating the whole person. This necessitates a comprehensive assessment of physical, mental, emotional and social elements of health as well as a treatment plan that is personalized to each individual. Combining different modalities, such as nutraceuticals, acupuncture and manual therapy, for example, would allow multiple practitioners to work together to optimize healing.
Dr. Weinberg: The conversation around the health of the gut and its impact on the health of the body as a whole is continuing to deepen and expand. I expect us to improve our understanding of the gut microbiome, its role in pain and inflammation, and how to best repair its vitality. Coming from my background in Chinese medicine, I expect the best approach clinically will still be an individual approach. But I look forward to the cataloging of more clinical approaches to healing the body by healing the gut.
Light therapy, especially red light therapy has also been very exciting in this area, and growing over the past few years. More and more we are looking at many health concerns as issues of inflammation and tissue healing. Phototherapy has been an effective and accessible tool for many providers in this area. Light therapy has been an effective tool for me, along with microneedling to repair areas of limiting scar tissue.
NP: Can you talk a bit about your company’s pain/inflammation products for the practitioner market?
Chapman, Dye, Gossard and Pavey: A sampling of our top formulations designed to ease discomfort and inhibit inflammation include:
Life Extension Discomfort Relief (Berry Flavor): Multiple clinical trials have demonstrated efficacy at doses of 600 mg and 1,200 mg of palmitoylethanolamide (PEA), which is why we created a 600 mg PEA chewable tablet that can be taken once or twice per day. PEA works at the site of the original injury by lowering peripheral neuroinflammation. In addition, there is a growing trend in adult consumers who are looking for alternatives to traditional pills and capsules. Life Extension formulated our PEA product as a chewable tablet to provide a tasty alternative.17-20
Life Extension Fast Acting Relief: Turmeric and Indian Frankincense (also known as boswellia) have long been prized for their ability to inhibit inflammation in the muscle tissue, joints and ligaments. Turmeric extracts have the ability to slow down the activity of two key enzymes that play a role in inflammation, cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX). Boswellia also inhibits 5-LOX while black sesame seeds help modulate delta-5 desaturase, an enzyme that regulates the inflammatory pathways. Beneficial as individual ingredients, but even more effective when combined. 1,000 mg of the combination of turmeric, boswellia and black sesame extracts was found to relieve discomfort within two and a half hours.21-24
Life Extension Pro-Resolving Mediators: When inflammation goes unresolved, it can become chronic. The resolution of inflammation is guided by signaling molecules called specialized pro-resolving mediators (PRMs). PRMs work in concert to resolve inflammation in three steps. Step one is removing cellular debris; step two is restoring balance to the cytokines that regulate inflammation; and step three is supporting healthy tissue rejuvenation. The body creates PRMs from fatty acids such as EPA and DHA omega-3s. But fish oil is not completely converted to PRMs, so you may not get the optimal health benefit from taking a fish oil alone. Instead, ingesting the PRM precursors, 18-hydroxyeicosapentaenoic acid, 17-hydroxydocosahexaenoic acid and 14-hydroxydocosahexaenoic acid is a more effective way to help support a healthy post-inflammatory response.25-28
Fuentes: Green Roads Arthritis Pain Relief Roll-On—OTC Strength contains camphor 4 percent and menthol 8 percent for the temporary relief of minor aches and pains of muscles and joints associated with arthritis; cannabidiol (CBD) to help manage everyday physical stressors; and a proprietary blend of botanicals, including black cohosh root extract, chickweed herb extract, comfrey leaf extract, devil’s claw root extract, evening primrose flower extract and horsetail grass extract, all of which have a deep tradition of use in arthritis.
Green Roads Pain Relief Cream—OTC Strength contains methyl salicylate (oil of wintergreen) 10 percent and menthol 4 percent for the temporary relief of minor aches and pains of muscles and joints associated with arthritis, strains, sprains, simple backaches and bruises; CBD to help manage everyday physical stressors; and avocado oil, vitamin E and cucumber fruit extract for added skin support.
Green Roads Heat Relief CBD Roll-On contains menthol and camphor as a counterirritant; capsaicin, an active component of chili peppers which produces a sensation of burning when applied topically; and CBD to help manage everyday physical stressors.
Green Roads Cool Relief CBD Roll-On contains menthol (peppermint oil) as a cooling compound to offer relief and soothing comfort, as well as CBD to help manage everyday physical stressors.
Green Roads Muscle & Joint Relief CBD Cream contains CBD to help manage everyday physical stressors; avocado oil, vitamin E and cucumber fruit extract for added skin support; and lavender oil for a light and pleasant scent.
Schuler: Gaia Herbs’ Turmeric Supreme Pain helps provide relief for occasional aches and pains from overexertion. A combination of turmeric and black pepper aids the absorption of curcuminoids that help manage inflammation and enhance recovery of active individuals. Devil’s claw has long been used to support the inflammatory response as well as manage the pain response to provide foundational support. Other ingredients like feverfew and Jamaican dogwood modulate pain and tension, delivering a product that addresses occasional pain and inflammation. For the best efficacy, adults should take two purity-tested capsules, three times daily.
Griffin: Migrastil Soothing Neck and Shoulder Cream is made with deep penetrating plant extracts to gently soothe neck and shoulder pain and tension. Our non-greasy, moisturizing formula has a very light, pleasing ginger mint scent.
Migrastil PainBlock is a rollon and a natural product formulated to alleviate minor muscle and joint pain from too much exercise, arthritis, fibromyalgia, sciatica, etc. It’s perfect for achy knees, backs, shoulders, elbows or wherever you hurt. PainBlock contains safe, recognizable ingredients: Fractionated coconut oil, menthol, frankincense, eucalyptus, peppermint and ginger essential oils.
Migrastil Extra Strength Neuropathy Cream provides gentle, but effective relief without the tingling and burning associated with other neuropathy creams. Our neuropathy cream contains natural plant extracts that penetrate deeply to promote circulation and relieve inflammation.
Migrastil Migraine Stick, our flagship product, uses essential oils to help relieve migraine and tension headache pain.
Hammond: The product we offer to supplement-manufacturers is OptiMSM, our branded formulation of methylsulfonylmethane (MSM). Numerous studies have shown how OptiMSM helps deter the accumulation of oxidative damage, which contributes to the body’s pain and inflammation responses. MSM’s ability to reduce oxidative stress, down-regulate the expression of inflammatory markers and mitigate inflammation caused by exercise, supports its inclusion in overall wellness, healthy aging and joint health applications.
Several in-vitro studies suggest MSM exerts an anti-inflammatory effect through the reduction in cytokine expression. Other clinical trials also suggest it is effective in reducing pain, as indicated by the VAC pain scale, WOMAC pain subscale, sf36 pain subscale and the Lequesne index.
Lanzieri: At this moment, we have only one product on the market, Proleeva. Proleeva is developed and formulated to attend to a specific disease state, as spelled out by the definition of a medical food, which is: “a food which is formulated to be consumed or administered enterally (through the gut) and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.”
Myers: Curaphen is one of our original formulas for pain relief. It is truly a breakthrough for people who have tried every other avenue for relief and simply can’t find a safe, effective option. It features clinically proven ingredients, including BCM-95 curcumin, which combines curcumin with turmeric essential oil for enhanced bioavailability and blood retention.
In the Curaphen and Curaphen Extra Strength formulas, this curcumin is combined with BOS-10 boswellia, which is standardized to deliver up to 10 times more acetyl-11-keto-B-boswellic acid (AKBA) than unstandardized forms. This key compound is especially helpful along 5-LOX inflammatory pathways, which makes it a highly valuable ingredient for pain relief.
Additionally, both our Curaphen and our Curaphen Extra Strength formulas combine these two botanicals with dl-phenylalanine (DLPA). DLPA improves mood-elevating chemicals in the brain, such as dopamine, epinephrine and norepinephrine. It also appears to block a nervous system enzyme that would otherwise intensify pain signals. DLPA helps prevent the breakdown of one of the brain’s natural pain-killing substances, enkephalins, which are in the same family as endorphins. Each formula also includes nattokinase, an enzyme that supports healthy nutrient delivery, especially to the joint capsule, via its support of microcirculation.
One of our more recent formulas for pain relief, and a favorite among practitioners and patients alike, is Acute Pain Relief. Like our Curaphen formulas, it delivers BCM-95 curcumin and BOS-10 boswellia, but it delivers both of those botanicals in an emulsified matrix of black sesame seed oil that has been clinically proven to help these ingredients provide fast results in a small, easy-to-swallow liquid gel. Black sesame seed oil has been traditionally used in ayurvedic medicine to aid in carrying and dispersing fat-soluble ingredients, plus it is an anti-inflammatory in its own right, which makes it doubly valuable in this formula.
Plaza: We offer eight products within the Bio-Kult range. Bio-Kult Original contains 14 different strains of probiotics and has been used in a variety of clinical studies. Bio-Kult Original is helpful if a client has not taken probiotics before or is sensitive to a high CFU content. This is because the dose can be split over the day, with a recommended dose being one to four capsules daily. Bio-Kult Original is also useful if a practitioner wishes to include a probiotic without any additional nutrients included, therefore making it an easy accompaniment to an existing nutraceutical program.
Bio-Kult Boosted contains the same 14 strains of bacteria as Bio-Kult Original, but this may be more suited to a client that has taken probiotics before or would need to take more capsules to achieve the CFU they are after. Bio-Kult Boosted contains bacteria at 8 billion CFU per capsule. It also contains vitamin B12 which has also been suggested to play a role in pain management, through a number of possible mechanisms.29 Vitamin B12 is known for its use in contributing to immune function, which could be helpful for regulating inflammation.
Bio-Kult Migréa contains 14 strains of probiotics that were recently used in a clinical study in migraineurs. Researchers found that after using these strains for eight weeks, the frequency and severity of migraine attacks were significantly decreased and the use of adjuvant medications was reduced also—so the individuals did not need as many additional drugs.30 Migraines are multifactorial in nature and many theories have been suggested to establish their etiology. Evidence has demonstrated that gut dysbiosis may influence impaired gut barrier function and lead to systemic inflammation. The inflammation is then suggested to be involved in-part by stimulating the trigeminal nerve, which is found to be activated in cases of migraine.31 This mechanism may therefore confirm one way in which supporting the gut influences health in other body systems.
Bio-Kult Migréa also contains magnesium and vitamin B6, which may be useful in supporting barrier function of the blood-brain barrier,32 while vitamin B6 could be particularly helpful for supporting hormonal regulation and potentially reduce hormone-related migraines in women.33
Dr. Taghavi: Some of our best products for treating chronic pain include The Omega, our plant-based DHA/EPA formula sourced from algae; our Zinc Complex, which is key for maintaining a healthy immune system; our Adrenal Super Tonic, an herbal formula designed to relieve stress and anxiety; and our Ultimate Pain Balm, a topical anti-inflammatory formula packed with healing plant compounds.
The Omega contains DHA and EPA, omega-3 fatty acids that reduce inflammation and help decrease chronic pain. Our Zinc Complex contains zinc picolinate, OptiZinc and Sucrosomial Zinc, which work synergistically to support proper immune health. Our Adrenal Super Tonic contains potent adaptogens such as ashwagandha and holy basil, which help the body respond more effectively to stress. Our Ultimate Pain Balm contains white camphor and ginger oil, which relax sore muscles and joints, as well as cooling menthol crystals for pain relief.
Torres-Moon: I’ll focus here on our newest product Ache Action. It is composed of three active ingredients: willow bark, ginger and boswellia extracts.
Willow bark extracts have been used for centuries to modulate the immune system response to pain and injury related to overexertion.* Its main bioactive constituent, salicin, is the progenitor of the pharmaceutical, acetylsalicylic acid, also known as aspirin. Willow bark extracts have been shown to inhibit cyclooxygenase-2 (COX-2) mediated prostaglandin release without affecting either COX-1 or COX-2 activity.* Constituents of willow bark other than salicin may also have lipoxygenase-inhibiting and free radical neutralizing effects that could contribute to its analgesic properties.* They might also influence prostaglandin and cytokine release.* Human clinical studies confirm that willow bark extracts can help to alleviate minor aches and pains associated with overexertion.*
Ginger root is another traditional herb with many applications. It is usually thought of in the context of relief from occasional nausea, but it has also been used for centuries by herbalists for its pain relieving effects.* Ginger possesses numerous active constituents, including gingerol, gingerdione, shogaol, and sesquiterpene and monoterpene volatile oils. Research indicates that the pain-relieving effects of ginger are likely to be related to the inhibitory effect of 6-shogaol on the release of substance P.* Another possible mechanism of action is the inhibition of prostaglandin synthesis by gingerols and shogaols.* Ginger influences a number of aspects of the immune response to biological stress.* It is known to suppress prostaglandin synthesis through inhibition of COX-1 and COX-2, as well as leukotriene biosynthesis by inhibiting 5-lipoxygenase.* In addition, human and laboratory research indicate that ginger may inhibit the NF-kB pathway* and stimulate peroxisome proliferator-activated receptors (PPARs).* It also seems to inhibit the synthesis of prostaglandin-E2 (PGE2) and thromboxane B2 (TXB2), which mediate normal immune responses.* Clinical evidence demonstrates that ginger root and ginger extracts are effective relievers of pain due to overstress or exertion, as well as for occasional pain related to typical menstrual cycles.*
Boswellia serrata is a botanical commonly used in ayurveda for minor aches and pain.* The principle constituents of boswellia are boswellic acid and alpha- and beta-boswellic acid. Boswellia serrata is often standardized to the 3-O-acetyl-11-keto-beta-boswellic acid (AKBA) constituent. Boswellic acids, especially AKBA, inhibit 5-LOX, reduce leukotriene synthesis, and inhibit leukocyte elastase, which are the likely mechanisms for its ability to influence normal immune responses to biological stress and alleviate the pains of overexertion.* Boswellic acids also might help to preserve and maintain healthy joint tissue through its effects on matrix metalloproteinase-3 (MMP-3).* AprèsFlex is a proprietary boswellia extract that has been clinically shown to reduce the minor aches and pains of overexertion, while positively influencing joint mobility.* AprèsFlex has efficacy at a relatively low dosage—only 50 mg twice daily—which made this ingredient ideal for this formula.*
NP: Overall, how can practitioners better serve and help their patients when it comes to pain and inflammation?
Chapman, Dye, Gossard and Pavey: Practitioners should incorporate a detailed intake process to identify the root cause for someone’s pain and inflammation. They should investigate diet, repetitive movements, nutritional deficiencies, lack of physical activity, overweight/obesity, chronic inflammation, etc. They should see themselves as educators and partner with the patient to build a trusting relationship and work together to develop a treatment strategy. This will improve compliance and patient by-in. Lastly, if a patient is healthy, focus on preventative strategies to keep them healthy.
Hammond: It is ever more important for practitioners to consider a complementary course of treatment options that may incorporate both traditional and alternative medicine/health care. Among those options are offering patients understanding of and access to over-the-counter supplementation products that are of high quality and have proven benefits for overall health and wellbeing. When we work together as manufacturers and providers to address consumer health issues, it broadens the spectrum of options people can use to live their best lives actively and as pain-free as possible.
Plaza: Practitioners should consider an holistic approach to pain relief for their clients. This should include diet, lifestyle and supplementary advice where needed. Anti-inflammatory foods may be a useful addition to pain relief programs. Such foods may include fruits and vegetables and beneficial oils such as omega-3. It may also be worth assessing whether the client is sensitive to any foods or additives and preservatives, and avoiding sensitizing foods for a while may help to reduce inflammation and enable healing.
Despite mobility being an established issue when discussing pain, an individualized approach to physical activity may be helpful for modulating inflammation and reducing pain. Other lifestyle considerations such as stress management and sleep hygiene should also be included within a protocol.
Dr. Robinson: Because pain can be such a variable experience, the emphasis on patient-centered care becomes even more important. Practitioners should strive to empower patients to actively participate in their own care through education on illness and prevention as well as collaboration on management strategies.
Dr. Taghavi: Practitioners should encourage patients to keep a journal of their pain. Patients can write down when and how severe their pain symptoms are and any triggering factors. This allows clinicians to target the inciting factor and relieve the patients pain. Also, clinicians should focus on curing pain rather than prescribing pain medications for temporary relief.
Dr. Teitelbaum: Begin by decreasing sugar and white flour intake, which are highly inflammatory. Switch from grain fed red meats to fish and grass-fed red meats, which decrease inflammation.
Especially important is the use of the highly absorbed curcumin. Most are poorly absorbed and ineffective. Despite being very healthy myself, I take a CuraPro 750 mg capsule (by EuroMedica) daily myself to maintain optimal health and balance body wide inflammation.
After the CuraPro, the next thing that I add is boswellia (also known as frankincense) 500 mg two to three times a day, as this settles down another key inflammatory pathway called LOX (lipoxygenase). It is very synergistic with the CuraPro. I use a form called BosPro, which has very high levels of the active and beneficial AKBA component. For people with arthritis or pain, I use CuraPhen, which combines both of these two herbs, and which has been a pain relief miracle for people I treat. In three head on arthritis studies, it was more effective than Celebrex.
Torres-Moon: Pain is a complex, non-specific symptom, often difficult to treat. Patients often see multiple specialists and doctors to address their pain and inflammation issues. In addition to investigating the underlying condition(s) responsible for the pain, practitioners should not underestimate the psychological damage induced by pain and inflammation. Keeping a mind open and listening consistently to their patients is probably how practitioners can better serve their patients.
Dr. Weinberg: The issues around pain and inflammation are complex and can be caused or influenced by a number of physiologic, psychogenic and lifestyle parameters. Practitioners treating patients in this area need to engage in lifelong learning and keep abreast of the changing landscape here. We need to understand baseline physiology and pathophysiology as well as nutrition, trauma response, endocrinology, immunology and more to best grasp this topic. Then we need to always be cultivating new tools in our toolbox for clinical intervention. If this is your main patient population, you need to love patient education and be good at it.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
CoolCura’s Take on Feng Fu Ice Therapy
Feng Fu is an ancient Chinese tradition that requires applying ice to the back of the head at the Feng Fu point to help center the body and promote general wellness. CoolCura pairs this practice with modern convenience for a comfortable, easy-to-use neck band with a freezable/reusable stainless steel eco ice pod for daily use. The flexible band ensures a secure fit, making it perfect for anyone.
How Feng Fu works: In traditional Chinese medicine, the body contains a key acupuncture point called Feng Fu which is located on the back of the neck where the skullcap meets the top of the neck. The nerves associated with your Feng Fu point control the blood supply to both the organs and pituitary gland. When ice is applied to the Feng Fu point, it introduces endorphins into the bloodstream. Endorphins are natural pain relievers that reside in the brain and spinal cord. When released into the body, the result is a pain-free, euphoric feeling.
While the company doesn’t claim that Feng Fu ice therapy is capable of treating, preventing or curing any health conditions, it does help combat stress and creates a soothing, relaxing experience, particularly for those experiencing pain or sickness.
For more information, visit www.coolcura.com.
1 Centers for Disease Control and Prevention. Clinical guidance for selected common acute pain conditions. Accessed 2022 June 5. www.cdc.gov/acute-pain/index.html.
2 Med Hypotheses. 2007;69(6):1169-78.
3 Pain. 2019;160(1):19-27.
4 NINDS. National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. 2015 papers3://publication/uuid/2C08F635-67AB-4815-A0F0-484B89C85BFA.
5 Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2019; 67: 1001–6.
6 Zajacova A, Grol-Prokopczyk H, Zimmer Z. Pain Trends Among American Adults, 2002–2018: Patterns, Disparities, and Correlates. Demography 2021; 58: 711.
7 22 Pain Med. 2020;21(3):586-594.
8 Varrassi G, Alon E, Bagnasco M, et al. Towards an Effective and Safe Treatment of Inflammatory Pain: A Delphi-Guided Expert Consensus. Adv Ther 2019; 36: 2618.
9 Prevalence of Prescription Pain Medication Use Among Adults: United States, 2015–2018. Centers Dis. Control Prev. 2020. www.cdc.gov/nchs/products/databriefs/db369.htm (accessed May 30, 2022).
10 1. Pain Med. 2020;21(3):586-594.
11 2. BMC Res Notes. 2020;13(1):448.
12 Probiotics – International Scientific Association for Probiotics and Prebiotics (ISAPP). https://isappscience.org/for-scientists/resources/probiotics/ (accessed Aug 7, 2020). 13 Campbell AW. Inflammation and a solution: Probiotics. Altern. Ther. Health Med. 2016; 22: 8–10.
14 Goldin BR, Gorbach SL. Clinical indications for probiotics: An overview. In: Clinical Infectious Diseases. Clin Infect Dis, 2008. DOI:10.1086/523333.
15 Kaur IP, Kuhad A, Garg A, Chopra K. Probiotics: Delineation of prophylactic and therapeutic benefits. J. Med. Food. 2009; 12: 219–35.
16 Li M, van Esch BCAM, Wagenaar GTM, Garssen J, Folkerts G, Henricks PAJ. Pro- and anti-inflammatory effects of short chain fatty acids on immune and endothelial cells. Eur J Pharmacol 2018; 831: 52–9.
17 Chirchiglia D, et al. Front Neurol. 2018; 9:674.
18 Conigliaro R, et al. Minerva Med. 2011; 102(2):141-7.
19 Marini I, et al. J Orofac Pain. 2012; 26(2):99-104.
20 Paladini A, et al. Pain Physician. 2016; 19(2):11-24.
21 Rudrappa GH, et al. Medicine (Baltimore). 2020 Jul 10; 99(28): e20373.
22 Rao CV. Adv Exp Med Biol. 2007; 595:213-226.
23 Sengupta K, et al. Arthritis Res Ther. 2008; 10(4):R85.
24 Medicine (Baltimore). 2020;99(28):e20373.
25 Serhan CN. Mol Aspects Med. 2017; 58:1-11.
26 Whittington RA, et al. Front Immunol. 2017; 8:1464.
27 Serhan CN. Nature. 2014; 510(7503):92-101.
28 Barden AE, et al. Am J Clin Nutr. 2015; 102(6):1357-64.
29 Julian T, Syeed R, Glascow N, Angelopoulou E, Zis P. B12 as a Treatment for Peripheral Neuropathic Pain: A Systematic Review. Nutrients 2020; 12: 1–16.
30 Martami F, Togha M, Seifishahpar M, et al. The effects of a multispecies probiotic supplement on inflammatory markers and episodic and chronic migraine characteristics: A randomized double-blind controlled trial. Cephalalgia 2019; 39: 033310241882010.
31 van Hemert S, Breedveld AC, Rovers JMP, et al. Migraine associated with gastrointestinal disorders: review of the literature and clinical implications. Front Neurol 2014; 5: 241.
32 Zhu D, Su Y, Fu B, Xu H. Magnesium Reduces Blood-Brain Barrier Permeability and Regulates Amyloid-β Transcytosis. Mol Neurobiol 2018; 55: 7118–31.
33 Sadeghi O, Nasiri M, Maghsoudi Z, Pahlavani N, Rezaie M, Askari G. Effects of pyridoxine supplementation on severity, frequency and duration of migraine attacks
in migraine patients with aura: A double-blind randomized clinical trial study in Iran. Iran J Neurol 2015; 14: 74–80.
Healthy Take Aways
• Population-based estimates of chronic pain among U.S. adults range from 11 to 40 percent.
• According to the Centers for Disease Control and Prevention (CDC), “chronic pain, one of the most common reasons adults seek medical care, has been linked to restrictions in mobility and daily activities, dependence on opioids, anxiety and depression, and poor perceived health or reduced quality of life.”
• Between the years 2015-2018, 10.7 percent of U.S. adults reported using one or more prescription pain medications in the past 30 days.