Diet and Pain

Shafiee et al. (2021) recognize that repeated use of anti-inflammatory agents, the current treatment for inflammatory bowel disease (IBD), can have adverse effects on the patient. The aim of this review was to outline the current literature regarding the anti-inflammatory diet’s effectiveness in IBD. Recently, diet-related strategies have been formulated to try to improve the clinical activity scores in IBD patients. A promising approach is the modification of microbiota living in the digestive tracts through dietary therapy, which has been reported to improve IBD outcomes. The anti-inflammatory diet has been recommended as it restricts the consumption of carbohydrates that contain modified fatty acids. This diet also contains probiotics and prebiotics that can promote balanced intestinal microbiota composition. However, the authors emphasize that there is not yet clear evidence that supports this type of diet for the maintenance of remission or for prevention of IBD relapse. [NPID: pain, inflammation, IBD, digestion]

This 2021 review covers dietary nutrients that are capable of modifying glucose/lipid metabolism and insulin responses and aims to present the impacts of these nutrients on chronic inflammation and immunity. Katsimbri et al. also discuss how these nutritional regimens may act as potentially therapeutic tools for psoriasis and psoriatic arthritis. Dietary nutrients have been shown to activate the immune system, and their effects may result in the overproduction of proinflammatory cytokines. Psoriasis is a chronic, immune-mediated inflammatory disease that is more prevalent in obese individuals. It is said that weight loss interventions, supplementation, and various dietary regimens such as gluten-free and Mediterranean diet, may lead to improvements in psoriasis' natural course and response to therapy. Because of the low volume of research, further investigation into more sophisticated nutritional patterns, such as ketogenic, very low-carbohydrate or specific macro- and micro-nutrient substitution, are recommended. [NPID: pain, glucose, lipid metabolism, insulin, chronic inflammation, inflammation, immunity, psoriasis, psoriatic arthritis, proinflammatory cytokines, immune disease, gluten, Mediterranean diet, Med diet, keto, low-carb]

In this 2021 animal study, male DBA/1J mice were given a diet high in vitamin D3 (D3), and omega-3-fatty acids (O3FA) along with a highly bioavailable form of curcumin in a collagen-induced arthritis (CIA) murine model. The mice were challenged with bovine collagen II (CII) to induce arthritis. Joint thickness and standardized clinical score were checked regularly to determine the progress of disease in terms of severity. Hemshekhar et al. observed significantly drops in disease severity from curcumin administration alone (around 60%), while the mice eating the enriched diet plus curcumin supplements showed decreased disease severity by > 80% and maximally delayed disease onset and progression. It appeared that curcumin alone was responsible for mediating the suppression of anti-collagen antibodies and decreasing cellular infiltration and MMP abundance in the joints of the collagen-induced arthritis mice. But the daily curcumin supplementation in addition to the vitamin D3 and omega-3-fatty acids- enriched diet resulted in significantly more suppression of inflammatory biomarkers known to be associated with rheumatoid arthritis pathogenesis such as TNF, IFN-γ, and MCP-1. Since the combination of curcumin, vitamin D3 and omega-3-fatty acids have demonstrated their efficacy in delaying CIA severity and development in this animal model, it may be worthwhile assessing the use of these supplements in people at risk of developing rheumatoid arthritis in the future. [NPID: pain, vitamin D3, omega-3s, curcumin, animal, bovine collagen, joints, collagen, rheumatoid arthritis]

Costa et al. (2019) state that while there are studies on the role of nutritional interventions on migraine, there is a lack of research on how diet quality is associated with migraines. In this present intervention study, fifty-two women were given individualized diet meal plans based on their nutritional diagnosis. Their clinical and nutritional data were taken once a month for 90 days. 24-hour dietary recalls allowed the reporting of energy content and macronutrients, while the Brazilian Healthy Eating Index-Revised was used to assess diet quality. In addition, the participants’ migraine severity and depressive symptoms were examined. While the intervention did not appear to affect anthropometric characteristics, energy, macronutrients and fiber intake, there was a rise in diet quality assessment scores after 60 and 90 days of intervention. Furthermore, the subjects’ depression scores dropped after 60 days, and their Headache Impact Test scores decreased also after 90 days. The increase in BHEI-R score (diet quality measure) correlated with the decrease in Headache Impact Test scores (migraine severity) at the end of the intervention. Costa et al. declared diet quality enhancement as a good strategy for improving migraine severity, regardless of the nutritional status and weight change. [NPID: pain, migraine, macronutrients, fiber, diet quality]

This 2020 systematic review looks at the evidence linking dietary patterns, diet-related triggers, and dietary interventions with migraine. Dietary triggers are common causes of migraines, while specific diets have also been reported to reduce the frequency of migraine attacks. Hindiyeh et al. searched for randomized controlled trials and observational studies that assessed the effect of diet, food, and nutrition in people with migraine aged ≥18 years. Of the 43 studies included in this analysis, 11 evaluated dietary patterns, 12 investigated dietary interventions, and 20 examined diet-related triggers of migraines. Since the majority of the studies on dietary patterns and triggers were either cross-sectional studies or patient surveys, the overall quality of the studies were deemed to be of low quality. The review identified alcohol and caffeine consumption as the most common diet-related predictors of more frequent migraine attacks. Whereas, a lot of the interventions including low-fat and elimination diets, were linked with decreases in frequency of migraine attacks. The authors conclude that there is a lack of high-quality randomized controlled trial data on dietary patterns and triggers, while the number of randomized controlled trials on dietary interventions’ efficacy in migraine prevention is also limited. There is a need for further high-quality research on diet’s impact on migraine sufferers. [NPID: pain, migraine, migraine triggers, alcohol, caffeine, elimination diet, low-fat, migraine prevention]

This 2021 review covers dietary nutrients that are capable of modifying glucose/lipid metabolism and insulin responses and aims to present the impacts of these nutrients on chronic inflammation and immunity. Katsimbri et al. also discuss how these nutritional regimens may act as potentially therapeutic tools for psoriasis and psoriatic arthritis. Dietary nutrients have been shown to activate the immune system, and their effects may result in the overproduction of proinflammatory cytokines. Psoriasis is a chronic, immune-mediated inflammatory disease that is more prevalent in obese individuals. It is said that weight loss interventions, supplementation, and various dietary regimens such as gluten-free and Mediterranean diet, may lead to improvements in psoriasis' natural course and response to therapy. Because of the low volume of research, further investigation into more sophisticated nutritional patterns, such as ketogenic, very low-carbohydrate or specific macro- and micro-nutrient substitution, are recommended. [NPID: pain, insulin, inflammation, immunity, psoriasis, psoriatic arthritis, immunity, immune system, psoriasis obesity, keto, low-carb]

Since the Mediterranean diet has been promoted to possess positive effects on chronic diseases, Esposito et al. (2021) analyzed the lifestyle and dietary habits of Southern Italian patients with multiple sclerosis (MS), and examined the impact of the Mediterranean diet (MeDi) on multiple sclerosis clinical outcomes. The 435 participants had attended outpatient clinics for routine follow-up visits. During the experiment, the subjects were given a 29-item self-administered questionnaire on life and dietary habits. The results showed that 75.8% of the respondents were interested in nutrition, while 72.8% were non-smokers, 52.9% performed physical activity, and 45.6% used food supplements. People with multiple sclerosis and normal waist circumferences had higher Med Diet Scores (MDS), which is a measure of their adherence to the MeDi and also of their cardiovascular risk. Increased Med Diet Scores also correlated with lower MS Severity Score and Expanded Disability Status Scale. However, no relationship could be identified between the MDS and the total number of relapses. Metabolic comorbidities were associated with an increased 10-year cardiovascular risk. In conclusion, this data suggests that the Mediterranean diet has a positive impact on waist circumference, multiple sclerosis course and disability. Moreover, the MeDi appears to improve MS long-term disability outcomes. [NPID: pain, Mediterranean diet, Med diet, chronic disease, chronic pain, cardiovascular risk, multiple sclerosis]

Although a healthy diet has been associated with reducing symptoms of multiple sclerosis or slowing its progress, Evers et al. (2021) wanted to find out which diets specifically will lead to improvements in patients with multiple sclerosis (MS). The objective of this study was to analyze the relationship between diet quality, use of diets, and quality of life (QoL) in men and women with MS. Among the 623 women participants with MS, a correlation was discovered between diet quality with physical and mental quality of life (after adjusting for several confounders). There was a similar trend observed among the male sample (105 men). In addition, subjects who followed a specific diet had a higher diet quality and benefited from a higher quality of life, when compared with those who did not follow a particular diet. This study therefore found that people with MS, especially women, who adhered more to the Dutch dietary guidelines were more likely to have better outcomes such as physical and mental quality of life. Also, following an MS-specific diet may help to adhere to these guidelines. [NPID: pain, multiple sclerosis, MS, quality of life, QoL]

This narrative review published in 2020 outlines the current knowledge on the interaction between nutrition and chronic musculoskeletal pain, focusing on different underlying mechanisms such as inflammation, obesity, homeostatic balance, and central sensitization. Elma et al. also informs us how nutritional behavior interventions and dietary assessments can be utilized in clinical practice for patients with chronic musculoskeletal pain. Poor diet can be an underlying factor in chronic musculoskeletal pain and can often predict this type of pain. The current literature suggests that diet quality and dietary behavior can affect pain conditions, although the direction of this effect has not been confirmed. We require supplementary human nutrition studies that analyze specific musculoskeletal pain conditions and the underlying pathologies. [NPID: pain, chronic musculoskeletal pain, chronic pain, inflammation, obesity, homeostatic balance]

This 2018 review discusses the role of bioactive lipids in inflammation, acute and chronic pain, obesity and central nervous system diseases. These lipids are capable of modulating peripheral and central pathologic processes and have been linked with the gut microbiota through various mechanisms. A connection between the gut and the brain has been proposed (named the gut-brain axis) since microbial composition has been shown to influence behavior and cognition. Scientists have started investigating the relationship between this axis and health and disease, including stress-related (depression, anxiety and irritable bowel syndrome) and neurodevelopmental disorders (autism), and neurodegenerative diseases (Parkinson Disease, Alzheimer's Disease). Russo et al. mentions an animal study that discovered the reduction of abdominal pain in rats after systemic administration of bacteria. Other findings include PEA and butyrate, which reduced inflammatory markers in animal models with inflammatory bowel disease (IBD), and reduced inflammation as well as pain in irritable bowel syndrome and IBD, respectively. This review provides a summary of the relationship between inflammation, pain, microbiota and various lipids, focusing on N-acylethanolamines (NAEs) and short chain fatty acids (SCFAs) in the gut-brain axis and their functions in the central nervous system diseases. [NPID: pain, chronic pain, inflammation, obesity, gut-brain axis, IBS, anxiety, depression, neurodevelopmental disorders, autism, neurodegenerative diseases, Parkinson Disease, Alzheimer’s, animal, IBD]

This 2020 review focuses on the current research being conducted regarding the dietary factors that influence multiple pain conditions. Fifi & Holton discuss the positive as well as the negative impact of diet. The study of dietary factors that affect glutamatergic neurotransmission may be considered by some since glutamate is an abundant neurotransmitter that mediates pain transmission. The authors reveal some positive findings for glutamate in cases of fibromyalgia and irritable bowel syndrome. Due to the rise of ketogenic diets being recommended for seizure control, this type of diet is thought to hold potential in pain perception too. Inflammatory pain conditions are also discussed here, including promising dietary strategies currently being investigated. Another section reports the link between body mass index (BMI) and prevalence of chronic pain. With regards to the evidence on diet’s positive influence on pain, various herbal remedies such as curcumin, peppermint oil constituents are mentioned, along with their reported mechanisms of action. The last section is dedicated to the role of micronutrients in promoting optimal neuronal functioning. These summaries can help inform people on how food can have both positive and detrimental effects. Understanding their impacts can benefit people, especially those living with chronic pain. [NPID: pain, chronic pain, glutamatergic neurotransmission, glutamate, pain transmission, fibromyalgia, IBS, keto, ketogenic, inflammation, curcumin, peppermint, neuronal functioning]

Since chronic pain treatment programs rarely consider dietary pattern or adipose status, this 2020 review explores the alternative treatments to the current standard. While neuroinflammation is known to play a role in chronic pain, it is believed that this is partly due to the increased central nervous system glial activation. Preclinical studies have pointed to the possibility that the relationship between nutrition and central sensitization may be mediated via the bidirectional gut-brain interactions. This seems to suggest that neuroinflammation is induced by diet, which is a modifiable factor in people with chronic pain. The expert’s opinion is that a dietary pattern consisting of low quantities of saturated fat and added sugars may have various consequences, and ultimately prevent glial activation as well as prevent the transmission of inflammatory signals to the brain. Furthermore, a diet that reduces polyamine generation in the gut microbiota may help lessen or prevent central nervous system sensitization since polyamines can potentially excite N-methyl-D-aspartate receptors (essential component of the central nervous system sensitization). [NPID: pain, adipose tissue, neuroinflammation, gut-brain, inflammation]

The aim of this 2019 study was to investigate the relationship between dietary inflammatory index (a measure of the inflammatory potential of the diet) and psychosomatic complaints (caused or aggravated by a mental factor such as internal conflict or stress). The sample group consisted of 2818 adults (aged 19 to 69 years) from the Isfahan province in Iran. Food frequency questionnaires were distributed, and the subjects were assessed for psychosomatic complaints using a validated Persian questionnaire. After controlling for potential confounders, the participants who ate the most inflammatory diet (in the top tertile of the dietary inflammatory index) were 44% more likely to have psychological complaints and had 22% higher risk of experiencing gastrointestinal complications. In addition, those in the highest tertile of DII scores were associated with more neuro-skeletal issues. However, pharyngeal-respiratory complaints did not significantly correlate with more inflammatory diets after adjusting the analysis model for stressful life events, medical condition, and anti-psychotropic medicine use. To conclude, a diet with anti-inflammatory potential may be recommended to reduce psychosomatic problems. [NPID: pain, inflammation, stress, internal conflict, psychosomatic complaints, neuroskeletal, anti-inflammation]

Lehrskov et. al (2018) here investigated whether postprandial (post-meal) fatigue is regulated by the cytokine IL-1 (which seems to play a role in the pathogenesis of fatigue associated with some chronic diseases) by testing the effect of an IL-1 receptor antagonist in lean and obese subjects. In this double-blind crossover study, 16 male individuals (8 lean, 8 obese) were randomly assigned to receive either the placebo (saline) or the IL-1 receptor antagonist anakinra, and were given a high-fat, high-carbohydrate meal 30 minutes after the subjects ran. Fatigue was determined using the Stanford Sleepiness Scale and blood samples were drawn at baseline and after the intervention. The results showed a reduction in postprandial fatigue in the individuals who were given the IL-1 antagonist, with the effect more pronounced in the obese group than those lean participants. These researchers have concluded IL-1 is involved in the regulation of postprandial fatigue under physiological conditions in lean and obese individuals. [NPID: pain, fatigue, postprandial fatigue, post-meal fatigue, chronic disease, sleep, obesity]

Costa et. al (2019) investigated whether nutritional interventions focused on enhancing diet quality and healthy weight can promote improvement in clinical parameters of women with migraine. The study involved fifty-two women aged 44.0 ± 13.0 years receiving an individualised diet meal plan and nutritional orientation according to their nutritional diagnosis for 90 days. Anthropometric, clinical and nutritional data were measured once a month while diet energy content and macronutrients were checked using 24-hour dietary recall. Diet quality was assessed through the Brazilian Healthy Eating Index-Revised (BHEI-R), the Migraine Disability Assessment and Headache Impact Test version 6 were used to determine the severity of migraine, and the Beck Depression Inventory evaluated depressive symptoms. The result showed no changes in anthropometric characteristics, energy, macronutrients and fiber intake but the BHEI-R scores improved after 60 and 90 days of intervention, while the Beck Depression Inventory Scores and Headache Impact Test scores decreased after 60 and 90 days, respectively. The change in BHEI-R score was found to be negatively correlated to the migraine severity at the end of the intervention. In conclusion, Costa and the other researchers (2019) find the management of diet quality to be a good strategy for improving migraine severity regardless of nutritional status and weight change. [NPID: pain, women, migraine, females, macros, macronutrients, Brazil, depression, weight gain]

Lim & Kim (2016) claim to have identified food-derived compounds that alleviate neuropathic pain and in this review they explored the natural compounds for neuropathic pain relief, their mechanisms of action, and the potential benefits of natural compounds with antagonistic effects on GPCRs (G-Protein Coupled Receptors) for neuropathic treatment. The authors state that available neuropathic pain medicines have undesired side effects (such as tolerance and physical dependence), do not alleviate the pain, that the mechanisms of neuropathic pain are still not fully understood, and that traditional plant treatments have been used worldwide for treating diseases. During neuropathic pain development, the C-C motif chemokine receptor 2 (CCR2) acts as an important signaling mediator, which is why Lim & Kim (2016) discuss the potential benefits of CCR2 antagonists for treatment for neuropathic pain. [NPID: pain, neuropathic pain, GPCRs]

Wu et. al (2018) reviewed published observational research on 25-hydroxyvitamin D (25(OH)D) concentration and pain-related conditions with the aim of finding an association between mean 25(OH)D concentration on the level of vitamin D deficiency and pain conditions. A meta-analysis was conducted on the eighty-one observational studies included in this review with a total of 50 834 participants. In comparison to the controls, mean 25(OH)D concentration was significantly lower in patients with arthritis (mean difference (MD): -12·34 nmol/l; P<0·001), muscle pain (MD: -8·97 nmol/l; P=0·003) and chronic widespread pain (MD: -7·77 nmol/l; P<0·001), but not in patients with headache or migraine (MD: -2·53 nmol/l; P=0·06). The odds of vitamin D deficiency were higher for arthritis, muscle pain and chronic widespread pain, but not for headache or migraine, compared with controls. Sensitivity analyses revealed similar results. The results of this review suggests that low 25(OH)D concentrations may be associated with pain conditions. [NPID: pain, vitamin D, arthritis, muscle pain, headaches, migraines, 25-hydroxyvitamin D]

This 2020 article analyses the current literature on the beneficial and detrimental effects of medical cannabis in the treatment of pain, and discusses the problems and challenges facing the medical community in this domain and offers a practical approach to deal with these challenges. Vulfsons, Minerbi & Sahar (2020) attempt to answer questions such as “what is cannabis? An abusive substance or a medication? Should it be incorporated into current biomedical practice, and how should it be administered? Finally, what is the evidence for the beneficial and detrimental effects of cannabis?” [NPID: pain, cannabis, THC, CBD]

Dreher, Kosz & Schwarting (2019) gathered data from randomised controlled trials (RCTs), non-RCT studies, reviews and recommendations from professional societies in order to investigate the assumed positive effects of physical activity, physical training, and diet adaptations on inflammatory rheumatic diseases and their potential comorbidities. The review found that nutritional medical approaches provide preventative and rehabilitative beneficial possibilities while physical activity and training have positive influences on rheumatic diseases and its comorbidities. It was also mentioned that the exercise and training recommendations of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) provide recommendations, which were adapted by the European League Against Rheumatism (EULAR) to control intensity, duration and training extent. Although the author believes implementation of increased physical activity, regular physical training and diet adaptation should be an additional component of the treatment of inflammatory rheumatic diseases, further research is required in individual sub-aspects. [NPID: pain, inflammation, rheumatic disease, preventative care]

This 2019 experiment studied the effect of cannabidiol (CBD) - primary non-addictive component of cannabis associated with possessing analgesic and anxiolytic properties - on neuropathic pain using rats. Repeated treatment with CBD (5 mg/kg/day, subcutaneously [s.c.], for 7 days) was shown to increase serotonin (5-HT) neuronal firing through desensitisation of 5-HT1A receptors. Rats subjected to the spared nerve injury model for 24 days showed decreased 5-HT firing activity, mechanical allodynia (condition where pain is caused by a stimulus that does not normally elicit pain), and increased anxiety-like behavior but seven days of CBD treatment reduced mechanical allodynia, decreased anxiety-like behavior and normalised 5-HT activity. De Gregorio and colleagues (2019) discovered that repeated treatment with low-dose CBD induces analgesia predominantly through TRPV1 activation, reduces anxiety through 5-HT1A receptor activation, and rescues impaired 5-HT neurotransmission under neuropathic pain conditions. [NPID: pain, cannabis, CBD, animal, 5-HT1A receptors, serotonin, anxiety, neuropathic pain]

Since low FODMAP (fementable oligo-di-mono-saccarides and polyols) diet has been effective in controlling irritable bowel syndrome symptoms, Marum et. al (2017) investigated the effects of a low FODMAP diet on symptoms of fibromyalgia (comorbidy associated with IBS) and weight status (since being overweight is an aggravating factor for fibromyalgia). The 4-week longitudinal study had a sample size of 38 fibromyalgia patients, 37% of whom were overweight and 34% were obese. Following the FODMAP diet, weight, body mass index and waist circumference all decreased significantly (p < 0.01) but there was no significant effect on body composition. As for the fibromyalgia-related outcomes, symptoms significantly dropped as well as severity as shown by the fibromyalgia survey questionnaire. The “diet adherence” was reported to be 85% as reflected by the significant reduction in FODMAP intake. "Satisfaction with improvement of symptoms" (76%), showed correlating with "diet adherence" (r = 0.65; p < 0.01). Although the intake of essential nutrients (fiber, calcium, magnesium and vitamin D) showed no significant difference, the results were highly encouraging. The researchers found that a low fermentable oligo-di-mono-saccharides and polyols diets as a nutritionally balanced approach contributed to weight loss and reduced the severity of fibromyalgia symptoms. [NPID: pain, FODMAP, IBS, fibromyalgia, obesity, waist circumference, fiber, calcium, magnesium, vitamin D, polyphenols]

This 2020 systematic review conducted a search for published original research on the gastrointestinal microbiota and its biomarkers in adult fibromyalgia sufferers, and summarised its findings. From 4771 studies, 11 met the inclusion criteria and were separated into four main groups: papers reporting Helicobacter pylori; other gut bacterial markers; metabolomics and other biomarkers, which included intestinal permeability and small intestinal bacterial overgrowth. The results indicated the gut microbiota may play a role in fibromyalgia within the emerging field of the gut-musculoskeletal axis and suggested there is a limited amount of quality research in this area. Erdrich et. al (2020) call for more studies on the relationship between the gut microbiota, gut dysfunction and fibromyalgia. [NPID: pain, gastrointestinal microbiota, intestinal permeability, fibromyalgia, gut-musculoskeletal, gut microbiome, gut dysfunction, gut-brain axis]

Rea and colleagues (2017) reviewed the involvement of the gastrointestinal microbiota in visceral pain, focusing on the anatomical and physiological nodes whereby microbiota may be mediating pain response and discussing the potential for manipulating gastrointestinal microbiota as a therapeutic target for visceral pain. The writers explained the consequences of changes to the microbial environment in the gut: drop in gut barrier integrity; altered gut motility; inflammatory mediator release; nociceptive and distension receptor sensitisation while hypothalamic pituitary adrenal (HPA) axis, neuroinflammatory events and neurotransmitter systems are concomitantly altered. The microbiota-gut-brain axis imbalance results in the alteration of the central and peripheral pathways, both of which are associated with pain manifestation and perception. [NPID: pain, microbiota, gut microbiome, pain response, gut motility, HPA axis, gut-brain axis, pain perception]

This 2016 review summarised the latest findings on the role of nutrition and nutraceuticals, microbiome, soy, obesity, omega-3 fatty acids, and curcumin supplementation as key elements in modulating the efficacy of analgesic treatments, including opioids. These main topics were addressed in the first edition of the Study In Multidisciplinary Pain Research workshop: “Feed Your Destiny: Fighting Pain” held in April 2016, which recommended the initiation of nutritional assessment and counseling in patients with chronic pain from the onset of treatment. Since some foods and supplements used in personalized treatment will likely improve clinical outcomes of analgesic therapy and result in considerable improvement of patient compliance and quality of life, De Gregori et. al (2016) believe in the “highly promising” benefit of including nutrition in personalising pain medicine. [NPID: pain, nutraceuticals, microbiome, soy, obesity, omega-3s, curcumin, opioids, personalized nutrition]

This 2020 cross-sectional study examined 95 women diagnosed with fibromyalgia syndrome (FMS) and 98 menopause-status matched controls, to learn about the relationship between an anti-inflammatory diet profile and the pressure pain thresholds (PPTs) of tender point sites and other fibromyalgia-related symptoms in patients with FMS. The study evaluated disease severity, sleep, fatigue, anxiety, central sensitisation, Dietary Inflammatory Index (DII) and the PPTs of tender point sites and self-reported global pain levels (through algometry and visual analog scale). The DII score was associated with the PPTs of tender point sites including the occiput, trapezius, zygapophyseal joint, second rib, gluteus, greater trochanter, and knee using linear regression analysis (after variable adjustments) and using analyses of covariance (significant association between the PPTs of the above tender point sites with the DII score quartiles in patients with FMS). However, no significant differences were found for the cases or controls between the DII score and the remaining clinical symptoms or between the DII score quartiles with other symptoms in patients with FMS. The writers conclude that a pro-inflammatory diet was associated with pain hypersensitivity in patients with FMS. [NPID: pain, inflammation, anti-inflammatory, sleep, fatigue, anxiety, central sensitisation, pain hypersensitivity]

This 2016 review studied the scientific evidence linking headaches to those dietary triggers commonly reported by various headache sufferers (particularly those with migraines) such as chocolate, caffeine, dairy products namely aged cheese, alcohol (especially red wine and beer), food preservatives with nitrates and nitrites, monosodium glutamate (MSG), and artificial sweeteners such as aspartame. Prevalence of these triggers from prior-population-based studies will also be examined. Depending on study population and methodology, the presence of any specific dietary trigger in migraine patients varies from 10-64%. Some foods will trigger headaches within an hour while others develop within 12 hours of ingesting the trigger food. Zaeem, Zhou & DIlli (2016) summarised recent literature surrounding headache related to fasting and weight loss as well as eliminating diets based on serum food antibody testing in order to help physicians in their recommendations of low-risk, non-pharmacological adjunctive therapies for patients with debilitating headaches. [NPID: pain, headaches, migraines, chocolate, caffeine, cheese, alcohol, nitrates, monosodium glutamate, MSG, artificial sweeteners, aspartame]

This 2017 review looks at the potential use of polyunsaturated fatty acids (some of which [n-3s] have anti-inflammatory and pro-resolving properties) in rheumatoid arthritis (RA), a chronic inflammatory arthritis in which many inflammatory pathways contribute to joint and systemic inflammation, disease activity, and structural damage. The reviewers reported that data from animal models suggests supplementation with n-3 polyunsaturated fatty acids (n-3 PUFAs), which is found to be low in Western diets, may be an interesting perspective in future research as much in prevention as in treating RA. Human studies have implicated a diet high in n-3 PUFAs with a protective role for incident RA in subjects at risk. Supplementation with n-3 PUFAs could represent a promising therapeutic option to better control many features of RA as it could improve pain symptoms, the tender joint count, duration of morning stiffness and frequency of NSAID assumption. [NPID: pain, polyunsaturated fatty acids, anti-inflammatory, inflammation, arthritis, omega-3s, NSAIDs]

This 2019 article by Rowin reviewed the available evidence to support the use of complementary and alternative treatments for commonly encountered conditions associated with neuropathy and neuropathic pain. Rowin (2019) believes that diet and lifestyle interventions are becoming important components in the management of neuropathy, as the association between metabolic syndrome and neuropathy is increasingly becoming recognised. There has been progress in the understanding of the gut-immune interaction, highlighting the role the gut microbiome and inflammation plays in the modulation of neuropathy and neuropathic pain, as well as promising evidence for nutritional interventions, exercise, supplements, acupuncture and mindfulness-based practices in the treatment of neuropathic pain. [NPID: pain, neuropathy, metabolic syndrome, gut-immune, gut microbiome, gut-brain axis, acupuncture, mindfulness]

Helde-Frankling and Björkhem-Bergman (2017) review the current evidence for the possible role of vitamin D in nociceptive and inflammatory pain. Observational studies have associated low levels of vitamin D with increased pain and higher opioid doses, while recent interventional studies have shown the promise of supplementation of this vitamin in cancer pain and muscular pain (when vitamin D levels are “insufficient” before intervention). The writers propose possible mechanisms for vitamin D in pain management including the anti-inflammatory effects mediated by cytokine and prostaglandin release. It is also suggested that patients with deficient levels (25-hydroxyvitamin D [25-OHD] levels < 30nmol/L) are most likely to benefit from supplementation while those with levels > 50nmol/L would likely gain little from this vitamin D boost. The conclusion is that vitamin D may constitute a safe, simple and potentially beneficial way to reduce pain among patients with vitamin D deficiency, but that more randomized and placebo-controlled studies are needed before any firm conclusions can be drawn. [NPID: pain, vitamin D, inflammation, vitamin D, muscular pain, anti-inflammatory, cytokine]

In this article Carr & McCall (2017) list evidence for vitamin C administration in the treatment of pain and propose a novel analgesic mechanism for vitamin C supported by studies showing a decrease in need for opioid analgesics in surgical and cancer patients administered with high dose vitamin C. While epidemiological evidence has associated suboptimal vitamin C status and spinal pain, there is also clinical evidence: for example a number of studies have demonstrated that vitamin C administration to patients with chronic regional pain syndrome reduces their symptoms; also acute herpetic and post-herpetic neuralgia (nerve pain following herpes) are also diminished after taking high dose vitamin C; in addition high dose vitamin C has been shown to decrease cancer-related pain and thereby improve patient quality of life. While a number of mechanisms have been proposed for its analgesic properties, Carr and McCall (2017) suggest vitamin C’s role as a cofactor for the biosynthesis of amidated opioid peptides. Even if the mechanism is not very clear yet, vitamin C appears to be a safe and effective adjunctive therapy for acute and chronic pain relief in specific patient groups. [NPID: pain, vitamin C, cancer, spinal pain, herpetic, neuralgia, herpes, nerve function, opioid peptides]