Hippocrates advised his patients to let their food be their medicine. Increasingly, modern society is recognizing that there are “health foods” and “junk foods.” In discussing what pain patients should eat, clinicians should first recognize that there are two main strategies.
First, there is general healthful eating. This is the sort of diet everyone should adhere to at least most of the time. It promotes general health and well-being. This is a diet that is rich in plant-based foods (fruits and vegetables) and minimizes sugar, salt, and simple carbohydrates (white bread, white flour). Fat is to be consumed sparingly. Depending on the individual, the patient may opt to exclude dairy, red meat, or all meat. On this diet, soft drinks, artificial sweetener, cakes, candy, most fast food, fried foods, salty foods, dressings and sauces are excluded.
The second prong of this attack is the pain-mitigated diet, namely making sure the diet includes the foods that specifically help with pain. If the patient eats a junk food diet and drinks a lot of diet soft drinks, eating these pain-killing foods will not help much. But if the patient eats well most of the time, the pain-mitigated diet can make a big difference.
- Many pain-killing foods contain phytonutrients or plant-based nutritional substances. Probably the best known of these are anthocyanins, which help to block inflammation and are effective against arthritis pain. Look for these in foods like cherries, blueberries, wolf berries, pomegranates, and beets.
- Omega-3 oils are not only healthful, they can help relieve back pain by restoring blood flow. Some good sources are salmon, herring, and sardines. Nuts also contain omega-3, but they also contain omega-6 oils, which are less helpful. In fact, too much omega-6 oil can actually promote inflammation. The nut with the best omega-3 to omega-6 ratio is the walnut.
- Curcumin, the active ingredient found within turmeric, is getting a lot of press in medical journals these days as its ancient pain-relieving powers are being rediscovered. Curcumin is a mainstay of Ayurvedic medicine because of its anti-inflammatory properties. It reportedly works well against arthritis pain. Turmeric can be used in cooking; it is a staple of Indian cooking and other cuisines. It has a strong, distinctive flavor. When used in cooking, turmeric should be accompanied by black pepper, whose piperine helps the body to better utilize the curcumin. Turmeric may also be prepared as a “butter” by mixing it with coconut oil and applying it topically. Finally, many health food stores sell a turmeric-based capsule for oral pain control.
- Coffee has come and gone from the “healthful food” list. The fact is that the caffeine contained in regular coffee helps to narrow dilated blood vessels which can reduce pain (particularly the pain associated with vascular headaches) and it can amplify the effects of pharmacological pain relievers like acetaminophen. However, too much caffeine can cause the jitters and even exacerbate pain. A moderate amount of coffee may be healthful and relieve pain. Individuals may have specific reactions to coffee, and coffee should be avoided if the patient believes it exacerbates their particular pain symptoms.
- In addition to its traditional medical use as an antiemetic, ginger can act as an anti-inflammatory agent to help reduce joint pain. Frequently used in Asian cooking, ginger may be taken as food or by capsules.
- Tofu and edamame (soy foods) can reduce joint pain, but only when they are taken as whole soy and not soy protein isolates (contained in many processed foods). Preferred forms include tofu, tempeh, and edamame beans.
- The capsaicin in hot peppers is known to be an effective pain reliever. In fact, synthetic capsaicin is available as a topical analgesic product. But you can also get pain-fighting benefits from eating hot peppers in food or taking capsaicin orally. When it comes to pain-killing effects, the hotter the pepper, the better it relieves pain. When ingesting these peppers be very careful to slowly build up tolerance and do not ever handle the peppers with bare hands and then touch the eyes or other mucus membranes.
- Methyl salicylate is the active substance in wintergreen leaves (a type of mint) and is a powerful pain fighter. You can add mint to your diet or also get wintergreen oil to apply topically for join pain. Peppermint and other mint teas can have a soothing effect on the stomach and digestive system.
- Magnesium can reduce the frequency of migraine headaches, reduce the risk of osteoporosis, and may relieve leg cramps. Magnesium is plentiful in pumpkin seeds, almonds, cashews, beans, and many dark leafy vegetables such as kale and spinach.
- Resveratrol is a compound that made the news many years ago to help explain the so-called French paradox (i.e., why the French can consume rich fatty foods but still have little cardiovascular disease). Resveratrol is a compound found in the skin of red grapes and present in red wine, which the French drink in abundance. Resveratrol has certain cardioprotective effects but it also can relieve disk swelling that contributes to back pain. Moderate red wine consumption may be helpful against pain, but too much is detrimental. Teetotalers can get their resveratrol from red grapes; they are healthiest when eaten whole (rather than in juice, which is often sweetened with sugar).
- Water may be one of the best pain fighters, because dehydration is associated with myriad symptoms, including headache, joint pain, and generalized malaise. Eating lots of fruits and vegetables will automatically increase water intake, but water should be taken regularly throughout the day with quantities increased when the weather is hot or humid. Exercise should also be accompanied by extra hydration. Although coffee, beer, and wine are all liquids, they have a net dehydrating effect on the body and should be offset by an equal or greater quantity of plain water to maintain hydration equilibrium.
Patients should be encouraged to eat a healthful diet year-round and to indulge in pain-fighting foods as much as possible within that framework. Bear in mind that every patient is unique – not all pain killing foods will work well for all patients – and individuals may have strong preferences for or against specific foods. As a general rule for your patients with pain, instruct them to:
- Eat “single-ingredient” foods as much as possible. An apple is better than apple pie. Baked salmon is better than seafood gumbo.
- Avoid processed foods.
- Go heavy on plant-based foods all of the time.
- Try to get a lot of your nutrition from food rather than supplements.
- Vary your diet as much as you can; this helps you to get more nutrients, plus it may expand your horizons.
- Do not overeat.
- Drink plenty of water.
Food can make a big difference very quickly in how a patient feels, so encourage patients to “test drive” a healthful diet to see if it helps at all. A food diary may be helpful for some patients so they can track how they feel and what they eat to determine if certain foods may cause them pain, discomfort, or other symptoms.
Eating meals is a social activity as much as a nutritional one, so as much as possible, families should be encouraged to embark on the pain-mitigating diet as a group. The more everyone joins in and can share in healthful eating with lots of pain-fighting foods, the more likely the patient will be able to adhere to the diet. Lifestyle modifications can be difficult to implement, so support from the family is very helpful.
Another consideration is that many foods interact with certain medications. For instance, grapefruit can potentiate statin drugs and other drugs. Topical products solve this problem in that no food-drug interactions occur.
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