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Who Has Time for Pain?

Pain and Inflammation Pain and Inflammation
Longevity By Nature

People are stressed but want to enjoy full-plate lifestyles—they simply don’t have time to be timed-out by pain. Here’s how to help.

The old joke about the guy who says to his doctor, “Hey Doc, it hurts when I do this,” to which the doctor advises, “Don’t do that” tends to tickle the funny bone. But when the funny bone aches (along with other things), laughter is not at the forefront.

Pain and inflammation are likely the most common reasons your clients visit. According to a study appearing in the journal Pain in February 2022, using a chronic pain module introduced in the 2019 edition of National Health Interview Survey, researchers found that 50.2 million adults (20.5 percent) in the U.S. reported pain on most days or every day. The most common pain locations were back, hip, knee or foot pain. The researchers, from Brigham and Women’s Hospital and Harvard Medical School, also found that more than one in five Americans report having pain either most days or every day, a statistic that illustrates how prevalent chronic pain is in the United States.

There are many studies investigating a diverse variety of tools for pain and inflammation management.

According Rosia Parrish, ND, of the Naturopathic Wellness Center, Boulder, CO, one recent area of research that shows promise for pain management is the use of omega-3 fatty acids due to their well-established inflammation-management properties. A study published in the journal Pain Medicine in 2021 found that omega-3 supplementation reduced pain and improved function in patients with chronic low back pain.

Andrea Burton, technical advisor, Bio-Kult, also likes recent research into DHA/EPA and alleviating discomfort. “An interesting pre-clinical trial into the efficacy of an omega-3 dietary intervention in alleviating pain and psychoneurological symptoms (depression, fatigue, sleep and stress) in breast cancer survivors was published in February 2023. Results showed that the high omega-3 group had a significant decrease in pain, perceived stress, sleep, depression and fatigue over the course of the intervention. This paves the way for further study but is also useful for developing pain management protocols in clinical practice,” she commented.

Oregon-based practitioner Lexi Loch, ND, who also serves as medical educator, EuroMedica/EuroPharma (Green Bay, WI), also sees more research being published on foundational nutrients, like omega-3s and vitamin D, showing their importance in the resolution of inflammation. And she pointed out, while omega-3s are largely thought of as anti-inflammatory, only in the past several decades research demonstrated their role as precursors to specialized pro-resolving mediators (SPMs). SPMS have been shown to significantly help in resolving an acute inflammatory response and prevent the development of chronic, unresolved inflammation.

Vitamin D is another foundational nutrient that helps manage discomfort, according to Dr. Loch. “Observational studies have found that people with the lowest vitamin D levels tend to have higher pain scores. Other research has found that vitamin D insufficiency or deficiency may play a role in central sensitization and chronic pain issues.”

It is now known that diets influence inflammation, and a poor diet can increase chronic inflammation. And according to Dr. Parrish, several studies suggest that a diet rich in anti-inflammatory foods, such as fruits, vegetables and whole grains, may help to reduce inflammation and therefore manage pain. “One study published in the Journal of Pain Research in 2020 found that a Mediterranean-style diet reduced pain intensity and improved function in patients with fibromyalgia,” she said.

Natural practitioner Stacie J. Stephenson, founder and CEO, VibrantDoc, Phoenix, AZ is interested in research looking at anti-inflammatory action of natural foods such as spices. For example, she provided, a 2018 study in the Journal of Translational Medicine looked at how black pepper, cardamom, cinnamon, clove, cumin, fenugreek, fennel, garlic, ginger, onion, rosemary and turmeric might help reduce inflammation in ways that could create a measurable difference. “In parts of the world where spices are used heavily, such as India, some diseases related to inflammation have a lower incidence,” she noted.

Non-supplemental or diet-related findings include a 2022 study that showed how app-based mindfulness training programs can down-regulate pro-inflammatory gene expression, according to Burton. “This could be helpful for those who can’t or don’t want to join face-to-face meditation groups and the study highlighted the potential of digital stress-reduction programs to have important physical as well as mental health benefits,” she commented.

Other exacerbating factors of chronic inflammation, said Dr. Loch, include adverse childhood events, intestinal permeability and environmental toxins (arsenic, mercury, pesticides, etc.).

Dr. Stephenson is also interested in the exciting area of research exploring how instrumental inflammation may be in the development of just about every common chronic disease that plagues our populations.” For example, she pointed out, a 2019 article in Nature Medicine elucidated the role of inflammation in cardiovascular disease, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease, autoimmune conditions and neurodegenerative disorders like Alzheimer’s and Parkinson’s. There is also evidence that inflammation is linked to arthritis and other joint diseases, allergies and COPD, as well as stroke, asthma, bowel diseases, periodontitis, hepatitis, retinopathy and even intervertebral disc herniation. “All those ‘diseases of aging’ might actually be ‘diseases of inflaming,’” she remarked.

Correcting Pain Myths and Misinformation

Thanks to Google, many clients enter your office with preconceived and often wrong notions about inflammation they may have and about pain management.

Dr. Parrish said, “One common misconception is that all inflammation is bad.” Explaining the difference—inflammation as a physiological response to injury or infection and playing an important role in the body’s immune response is good, but it’s the chronic inflammation that contributes to the development of many diseases.

“Another common misconception is that pain is always a sign of tissue damage,” she added. While pain is often associated with tissue damage, it can also be caused by other factors, such as inflammation, nerve damage or psychological factors.

Burton emphasized the findings of a 2020 study that investigated consumers’ perceptions and experiences of following diets believed to help manage inflammation using data from a specific evidence-based nutrition-focused online course. The students identified avoidance of core food groups, such as dairy and grains, as key in managing inflammation. “However, the researchers concluded that the dietary advice came mainly from the internet, and health professionals who reportedly lacked an appreciation of the learners’ underlying nutrition knowledge, providing oversimplified advice that did not satisfy scientific curiosity,” she said. “It appears that consumers are interested in understanding more about managing pain and inflammation but, due to a lack of safe and accurate online information, they can be easily misled.”

Dr. Loch believes that the word inflammation has a negative connotation. In the past, she recalled, patients have often been told to take an “anti-inflammatory,” which can make inflammation seem like the villain or enemy. In her practice, she said, she educates clients about the role of inflammation, and how it can be life-saving and necessary for survival, but can become chronic without the proper nutrients, diet and other good lifestyle practices. “Like all processes in the body, inflammation is a verb, not a noun, a concept I learned from Dr. Andrew Huberman,” she related. “It seems that patients have more buy-in to treatments when educated about inflammation and the choices they can make to resolve acute or chronic inflammation.”

Dr. Stephenson confirmed that clients/patients are generally much more educated and aware about health, pain, inflammation and diet than ever before because information is much more easily accessible. “The downside is that bad health information, or misinformation, is also all too easy to find, and people fall into the trap of fad diets, fad health “cures,” and false beliefs about things they think will be magic bullets for their problems. A few minutes on TikTok will reveal all kinds of crazy interventions people are trying, often to their detriment.”

Supplement Solutions

Depending upon the source and type of discomfort being experienced by the client, tools to reduce it are wide-ranging.

For more immediate relief, Boiron’s Arnicare topicals, oral pellets and meltaway tablets help reduce muscle pain, stiffness, swelling from injuries and bruises, according to Christophe Merville, DPharm, director of education & pharmacy development, Boiron USA (Newton Square, PA). The single active ingredient in most Arnicare products is Arnica montana, which has been researched for its therapeutic effect on pain and has demonstrated anti-inflammatory, analgesic and bruise-healing properties. In 2014, he reported, Boiron initiated a randomized clinical evaluation of Arnicare Gel on sports-related muscular soreness and pain. Results showed that the overall level of stiffness during the 72 hours following the sports game was significantly less in the group using Arnicare Gel versus placebo.

Newer in Boiron’s Arnicare line is the recently introduced Arnicare Arthritis Cream formulated to provide temporary relief of minor joint pain, muscle pain and stiffness due to arthritis for ages 12 and older. “The goal is to allow the patient to safely manage their pain and avoid or delay as much as possible the use of heavier medications,” he commented. “Arnicare Arthritis Cream contains Arnica montana and harpagophytum extracts to target multiple symptoms of minor arthritis pain; harpagophytum relieves joint discomfort and stiffness associated with arthritis pain.”

Merville elaborated that the combination of harpagophytum and arnica reduces swelling, pain and redness from arthritis pain by acting on several steps of the inflammation cascade. Arnicare Arthritis Cream can be applied to all joints to address minor arthritis pain in the hands, hips, knees, feet and lower back and is free of fragrances, camphor and menthol.

He suggested that practitioners can recommend Arnicare in oral form for general systemic relief or in a topical for localized relief to relieve everyday pain from tasks such as housework and yard work, working out or sports, repetitive motion, musical practice, or stiffness from sitting too long at a computer or while traveling. “Surgeons also recommend it to their patients to reduce swelling and bruising from all types of procedures including cosmetic enhancements,” he said. “The main advantage of homeopathic topical and systemic medicines is to offer patients more flexibility in pain management. They do not interact with other drugs and can be used as soon as the pain flares up, contributing to the delay or decrease of the need for painkillers and their usual side effects.”

Similarly, Ache Action, from Illinois-based Protocol For Life Balance, is a blend of standardized extract of willow bark, ginger and AprèsFlex, a proprietary extract of Boswellia serrata. AprèsFlex has been clinically evaluated and demonstrated to be effective on occasional minor aches and pains due to overexertion, pointed out Celine Torres-Moon, science writer. “During the clinical evaluation of AprèsFlex, volunteers experienced a significant knee pain reduction and improvement of joint function as early as five days after beginning supplementation, and these effects were maintained up to 90 days,” she reported. “This product is ideal for athletes of all levels, as well as ‘weekend warriors’. It is best to start taking the product five days before a scheduled event to enjoy the full benefit of this product.”

For a longer-term support for discomfort and pain, EuroMedica’s Curaphen Extra Strength is a professional formula for pain relief, providing higher levels of effective ingredients in a larger, more concentrated dosage form than regular strength Curaphen, noted Dr. Loch.

“For acute pain and inflammation, I suggest a combination of curcumin and boswellia that are emulsified in black sesame seed oil,” she related. “This combination was shown in a clinical study to be equally as effective and fast-acting as acetaminophen. Interestingly, the herbal combination was eight times better at reducing the affective aspects of pain (feeling fatigue, punished, fearful, etc.). Curaphen supports healthy endorphin/enkephalin activity and healthy circulation. Curaphen contains a combination of ingredients with multiple mechanisms of action to relieve occasional muscle pain due to exercise or overuse.”

In her practice, Dr. Parrish has a suite of go-to recommendations. In cases of chronic inflammation, overall supplements she likes to suggest are omega-3 EFAs, curcumin and resveratrol. In cases of acute inflammation with pain, she recommends magnesium, ginger and boswellia. She explained, “Magnesium has been shown to have muscle-relaxing properties and may help to relieve muscle spasms and cramps. Ginger has been shown to have anti-inflammatory and pain-relieving properties and may be helpful for reducing pain and discomfort associated with conditions such as osteoarthritis or menstrual cramps. Boswellia has been traditionally used in ayurvedic medicine to treat inflammatory conditions and may be helpful in reducing pain and inflammation.

Brands she likes to recommend for inflammation and discomfort control include Seroyal/Genestra, Nordic Naturals, Integrative Theraeutics’ Pure Encapsulations, Quicksilver Scientific and Klaire.

Tackling inflammation may be successful with supplementation. In Burton’s view, the most effective supplements for reducing inflammation are those that help regulate the immune system, which controls the inflammatory response. These include vitamin D, an essential fat-soluble nutrient that plays a key role in immune health and may have considerable anti-inflammatory properties. In several studies, she reported, researchers have seen a link between low vitamin D levels and the presence of inflammation.

Further, she explained that omega-3 EFAs have become a common supplement to help with inflammation, as research suggests that more omega-3 in cell membranes enables the production of more omega-3-derived metabolites, many of which can turn off the inflammatory response and turn on a healing response that helps the tissue or cell repair any damage caused by inflammation.

“Another way omega-3 helps to reduce inflammation could be through changes in the numbers and the diversity of microorganisms that live in the gut microbiome,” she elaborated. “It is now understood that what we eat can influence the bacteria that live in the gut and that these bacteria can influence our health. Studies have shown that consuming omega-3 fatty acids can change the type of microbes in the gut, but it is not yet known exactly how these changes influence inflammation.”

Bio-Kult Original is a live bacteria supplement with 14 different strains of beneficial bacteria, which was used in the largest-ever double-blind randomized controlled trial of probiotics in individuals with IBS-D (associated with high inflammation). The study of 400 participants found that Bio-Kult significantly improved overall symptom severity in those with the condition. Abdominal pain and frequency reduced by an average of 69 percent and 34 percent of participants were reported to be symptom-free at the end of the five-month trial.

Additionally, she noted that a 2021 study showed that live bacteria supplements can help modulate immune and inflammatory mechanisms through improving the gut microbial community, increasing mucus secretion and preventing damage to the gut lining.

Dr. Loch also believes that clients who take a foundation of a multivitamin and mineral formula, vitamin D and omega-3s can help manage pain and inflammation. For those presenting with chronic inflammation, she relies on recommending curcumin enhanced with turmeric essential oil. “There are almost 3,000 published studies on the search terms ‘curcumin & inflammation’ on PubMed,” she emphasized. “Curcumin can modulate numerous inflammatory pathways by downregulating inflammatory cytokines, transcription factors and kinases, while simultaneously upregulating antioxidant defenses and shifting the immune system toward balance.”

In her clients with chronic inflammation, Dr. Stephenson said she has “found that vitamin C, turmeric (curcumin), omega-3 fatty acids and ECGC (which can also be obtained from drinking green tea) are the most potent for inflammation.”

As you can see, there are numerous products you can suggest that are safe, natural and effective for inflammation that is associated with chronic pain. And, suggesting proven therapies such as yoga, meditation and massage can also help tremendously. According to the NIH’s NCCIH (National Institutes of Health, National Center for Complementary and Integrative Health), “Pain is one of the leading reasons Americans turn to complementary health approaches such as yoga, massage and meditation—which may help manage pain and other symptoms that are not consistently addressed by prescription drugs and other conventional treatments.”

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Promoting Fertility by Combating Inflammation

By Rosia Parrish, ND, Natural Fertility Specialist, Naturopathic Wellness Center

There is some evidence to suggest that certain anti-inflammatory supplements may be beneficial in the treatment of infertility, although more research is needed to fully understand their effectiveness and safety in this context. Here are some examples of anti-inflammatory supplements that may be beneficial for infertility:

• Omega-3 Fatty Acids: Omega-3 fatty acids have been shown to have anti-inflammatory effects and may be beneficial in improving fertility. A study published in the journal Fertility and Sterility found that omega-3 supplementation improved sperm motility and morphology in men with infertility.

• Curcumin: Curcumin has been shown to have anti-inflammatory and antioxidant properties, which may be beneficial for improving fertility. A study published in the Journal of Ovarian Research found that curcumin supplementation improved ovulation and reduced ovarian cysts in rats with polycystic ovary syndrome (PCOS).

• N-Acetyl Cysteine (NAC): NAC is an amino acid that has been shown to have antioxidant and anti-inflammatory effects, and may be beneficial for improving fertility. A study published in the Journal of Obstetrics and Gynaecology Research found that NAC supplementation improved ovulation and pregnancy rates in women with PCOS.

• Probiotics: Probiotics may be beneficial for improving fertility by improving gut health and reducing inflammation. A study published in the journal Fertility and Sterility found that probiotic supplementation improved pregnancy rates in women undergoing in vitro fertilization (IVF).

• Magnesium: Magnesium may be beneficial for improving fertility by reducing inflammation and stress. A study published in the Journal of Assisted Reproduction and Genetics found that magnesium supplementation improved fertility outcomes in women undergoing IVF.

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Healthy Take Aways

• Researchers found that 50.2 million adults (20.5 percent) in the U.S. reported pain on most days or every day.
• More than one in five Americans report having pain either most days or every day.
• A study published in the journal Pain Medicine in 2021 found that omega-3 supplementation reduced pain and improved function in patients with chronic low back pain.
• Observational studies have found that people with the lowest vitamin D levels tend to have higher pain scores.
• A study published in the Journal of Pain Research in 2020 found that a Mediterranean-style diet reduced pain intensity and improved function in patients with fibromyalgia.

For More Information:

Bio-Kult, www.bio-kult.com
Boiron USA, www.boironusa.com
EuroMedica/EuroPharma, www.euromedicausa.com
Protocol for Life Balance, protocolforlifebalance.com