Diet and Chronic Pain
Why is my pain doctor talking to me about my eating? How is food related to pain? Shouldn’t my pain doctor be simply focus on prescribing medications and leave diet issues to other health care professionals?
I sometimes wish the practice of medicine were this easy: I write you a pill that eliminates your pain and also if I could, maybe suggest a weight loss pill so you can shed some pounds. Problem solved.
Pills are essentially single molecules and work on one or several receptor targets. The body, however, is a complex system with thousands and millions of overlapping processes that result in healthy function. Chronic pain is a result of abnormalities in the complex workings of the nervous and musculoskeletal systems. As a result, in order to achieve real lasting results, we have to consider our body as a whole when managing chronic pain, rather than a couple of receptors.
You are what you eat
Food is the foundation of the body. Everything that you eat gets broken down to the most basic chemical properties and eventually becomes the “bricks and mortar” of the body. It becomes the cells, proteins and fuel source. If you had the power to choose, you would never select a house built with decaying, shoddy wood compared to one constructed from top of the line steel.
So let us return to the original questions above- how is pain related to nutrition? The answer is so much!
There are four common conditions that have been shown to contribute to worse chronic pain:
Vitamin and mineral deficiency and insufficiency
In 2011-2012, it was estimated that 69% of Americans were overweight as defined by body mass index (a calculation that divides weight by height). The reason that so many Americans are so overweight is a total result of our modern environment and the resulting behaviors that become ingrained into our day to day. Inexpensive, calorically dense, nutritionally poor food is everywhere. We are bombarded with opportunities to eat poorly and it is a daily struggle to avoid temptations.
Even though we live in a world of excess food, the genetic blueprint of our muscular and skeletal system has not changed. Our spines are designed to carry much less weight than what 2 out of 3 heavy Americans carry around. Think about the effect that these extra pounds have every second of everyday bearing down on the spongy vertebral discs in your spine. Or think about the strain this accumulates on the joints in your hips and knees. More weight equals more wear and tear. The simple impact of weight is one factor of how diet affects pain.
Inflammation is the chemical expression of injury or a disease process in our body. It is a natural process that occurs when the body responds to an infection or trauma. A specific insult occurs (ankle sprain or common cold) and the cells sends inflammatory signals to attract repair or immune cells fix the problem area. After healing occurs, the inflammation is turned off and the body moves to a state of homeostasis or balance.
Yet, inflammation can become unbalanced and last longer than what is necessary for normal healthy function. Stress, environmental hazards and nutrition have been shown to increase the level of inflammation. In particular, foods high in sugar, refined grains (like flour), processed and red meat, trans fat and certain cooking oils are known to be pro-inflammatory. When these foods are taken in excess relative to fruits and vegetables, individuals may be prone to the effects of excess inflammation.
One of the major primary causes of chronic pain is excessive inflammation. This is particularly true in most causes of back pain and arthritis. Poor diet can boost the already existing level of inflammation and can worsen one’s pain experience.
Normal function of the body depends on adequate hormone balance. Hormones are signaling proteins that act to regulate and coordinate almost every single activity in the body. There are many organs that produce hormones such as the adrenal glands, pituitary gland, pancreas and even muscle. These ideally work like a thermostat where a sensor detects low levels of a target hormone or an increased demand for a specific organ function and then this signals an expression of hormones. Abnormal hormone function has been shown to contribute to the development or worsening of chronic pain, particularly when thyroid, sex (testosterone and estrogen), stress (cortisone), growth (hGH) and sugar (insulin) hormones become dysregulated.
External hormone replacement is a possible mechanism to help correct hormonal imbalance, and this should be directed by an endocrinologist. However, a first line approach that avoids the potential risks and side effects of hormone replacement may involve a healthy diet, low in saturated fats and rich in fruits and vegetables.
Vitamin and Mineral Insufficiency
If we already described that Americans have an abundance of food, how can we experience a deficiency in vitamins and minerals? Well if you eat too much from food sources that lack nutritional properties, you miss out on the beneficial effects.
While it is rare to see true deficiencies like scurvy (Vitamin C deficiency) or Rickets (Vitamin D deficiency), studies have shown that many individuals, particularly those with chronic conditions like chronic pain, have lower blood levels of certain vitamins and minerals, but not low enough to have a disease specific process.
Vitamin D and magnesium inefficiencies are strongly linked to worse pain. A 2013 study discovered that 74.3% of patients with lumbar spinal stenosis (a common cause of back pain) had low Vitamin D levels, and lower levels were associated with worse pain scores and function. A study in patients with fibromyalgia (a syndrome categorized by diffuse generalized pain) found a relationship between low magnesium levels and worse symptoms and then the treatment with magnesium supplements improved pain scores.
What to do?
Dietary change is one of the most challenging health pursuits. The term diet is commonly misconstrued with these crash or fad diets that are radical departures from one’s accustomed eating habits. Popular diets like the Atkins or South beach diet (low carb), Weight Watchers, Jenny Craig and others attract approximately 50 million Americans a year. Dieters often shed pounds for the several months they follow the plan, but after two years later, studies have shown that approximately 5% show sustained weight loss.
The yo-yo effect of weight loss and weight gain sends an important message. Long term healthy eating habits need to be sustainable. They cannot be major changes abruptly started because with one little slip up, you will certainly return to your habits from before and often times rebound and eat worse.
The ultimate goal of a healthy diet is to eat more nutritiously. Eating less may be a secondary goal. To achieve this long term goal, you need slow, small incremental changes that become reinforced and automatically ingrained into normal eating patterns.
We have created a free diet plan here at DVPSI that emphasizes behavioral change first. It involves a series of exercises that you can track and uses evidenced based practices that are common features of individuals who have successfully lost weight through diet and kept this off. This should be a starting point to transition to using food as a form of medicine.
Weight Loss Diet Self Management Handout
 Kim TH, et al. Prevalence of vitamin D deficiency in patients with lumbar spinal stenosis and its relationship with pain. Pain Physician. 2013 Mar-Apr;16(2):165-76
 Bagis S, et al. Is magnesium citrate treatment effective on pain, clinical parameters and functional status in patients with fibromyalgia? Rheumatol Int. 2013 Jan;33(1):167-72.
 Mann T, et al. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007 Apr;62(3):220-33.