But as you’ve surely noticed, many patients simply can’t get the restorative sleep they need because of pain from chronic conditions or acute injuries.
Since the dangers of opioids and even over-the-counter medicines are well reported, your patients may feel frustrated trying to find relief that allows them to rest and recover.
The result is that individuals with ongoing pain either put themselves at unnecessary risk hoping that they won’t become a statistic or put up with inadequate sleep each night. Furthermore, a lack of sleep is associated with a host of additional physical and psychological complications that have the potential to severely impact your patients’ health.
Sleep—specifically stage four (deep sleep)—is when the body restores energy levels, heals torn muscles, balances hormones, strengthens the immune system, and quite literally keeps the mind healthy and sane. It is during this stage of sleep that the body produces melatonin. But even without interrupted sleep due to pain, the intrusion of artificial light throws melatonin levels off for just about everyone these days.
As a health care practitioner, you are in a unique position to help.
Natural solutions
Besides relieving your patients’ pain through regular adjustments and mobility regimens, you can recommend nutrients that fight pain quickly and effectively, speed muscle repair and promote restorative, healing sleep.
Curcumin from turmeric (Curcuma longa) is one such nutrient. This botanical compound dramatically reduces inflammation and pain by inhibiting cyclooxygenase-2 (COX-2) enzyme activity, while preventing muscle damage and protecting your patients from free-radical damage overall.1-3
There’s a lot of attention on turmeric and curcumin right now, but also a lot of confusion. What your patients may not realize is that standard curcumin extracts can lack bioavailability, i.e., they can be difficult for the body to absorb and usually require massive doses to be effective.
And unstandardized turmeric powder, another popular option, may only contain about 2 percent curcumin, so it is unlikely to deliver the inflammation relief your patients want. For the most consistent results, a clinically studied curcumin extract (BCM-95) that is blended with turmeric essential oil (a source of turmerones) for improved absorption and blood retention is recommend.4,5
Boswellia (Boswellia serrata) is a perfect partner to curcumin. It blocks inflammation along the 5-lipoxygenase (5-LOX) pathway and has the potential to stop synovial tissue and joint damage due to osteoarthritis and rheumatoid arthritis.6-8
The best boswellia extract is standardized to screen out much of the plant’s naturally-occurring beta-boswellic acid (an inflammatory compound), but retains naturally higher levels of beneficial acetyl-11keto-β-boswellic acid (AKBA).6,8 A combination of bioavailable curcumin and uniquely standardized boswellia was compared to celecoxib (Celebrex) in a clinical study of osteoarthritis.7
The curcumin-boswellia combination outclassed celecoxib in relieving pain, walking distance and joint line tenderness scores. For pain relief, nearly 65 percent in the herbal group versus about 30 percent in the drug group improved dramatically—individuals in the herbal group considered their condition to be alleviated to “mild to moderate arthritis,” versus their previously described “moderate to severe arthritis.”7
DLPA, two forms of the amino acid phenylalanine, can address some of the cognitive aspects of pain and bolster what has been called the “endogenous analgesia system.” The D form of phenylalanine appears to block enkephalinase, which would otherwise break down the brain’s natural analgesic enkaphalins. The L form improves mood-elevating chemicals in the brain, including dopamine, epinephrine and norepinephrine.9-12
Vitamin B6 as pyridoxal-5-phosphate (P-5-P) is, arguably, a preferred form of the vitamin. It doesn’t require conversion by the liver, so it can be active in the body sooner to relax tense and sore muscles. Low plasma concentrations of naturally-occurring P-5-P have been noted in patients with rheumatoid arthritis and may be due to chronic inflammation. Replenishing the supply with a readily used supplemental source as opposed to regular B6 (pyridoxine) could make a marked difference in your patients’ experience of pain.13-17
Of course, as mentioned earlier, a short supply of sleep means a short supply of melatonin. To encourage good sleep, some think that supplemental melatonin is an absolute must. While there are botanicals that naturally provide melatonin (cherry extract is one), the important thing here is ensuring that patients get consistent levels to reset their circadian rhythm.18,19
Helping the body to heal itself with restorative, natural sleep is critical to the management of pain from any cause. In fact, sleep is such an essential element to a healthy life that it is the first concern listed in my SHINE protocol for patients dealing with chronic fatigue syndrome or fibromyalgia.
Aside from therapeutic adjustments and guided physical regimens, safe, effective, non-addictive and relaxing nutrients, can speed your patients’ recovery and let them enjoy a healthy, vibrant and active life again.
Jacob Teitelbaum, MD, is director of the Practitioners Alliance Network, which fosters communication between all health practitioners (vitality101.com/pan). He is also an internationally known expert in the fields of chronic fatigue syndrome, fibromyalgia, sleep and pain. He is the author of many books, including the perennial bestseller From Fatigued to Fantastic; Real Cause, Real Cure; Pain Free 1-2-3; and the free iPhone and Android app Cures A-Z. He can be reached at 410-573-5389 or through endfatigue.com.
References
1 Nicol LM, Rowlands DS, Fazakerly R, Kellett J. Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS). Eur J Appl Physiol. 2015;115(8):1769-77.
2 Drobnic F, Riera J, Appendino G, et al. Reduction of delayed onset muscle soreness by a novel curcumin delivery system (Meriva®): a randomised, placebo-controlled trial. J Int Soc Sports Nutr. 2014;11:31.
3 Chandran B, Goel A. A Randomized, Pilot Study to Assess the Efficacy and Safety of Curcumin in Patients with Active Rheumatoid Arthritis. Phytother Res. 2012;26(11):1719-25.
4 Hatcher H, Planalp R, Cho J, et al. Curcumin: from ancient medicine to current clinical trials. Cell Mol Life Sci. 2008;65:1631-1652.
5 Antony B, Merina B, Iyer VS, et al. A pilot cross-over study to evaluate human oral bioavailability of BCM-95 CG (Biocurcumax™) a novel bioenhanced preparation of curcumin. Ind J Pharm Sci. 2008:445-449.
6 Siddiqui MZ. Boswellia serrata, a potential antiinflammatory agent: an overview. Indian J Pharm Sci. 2011 May;73(3):255-61.
7 Antony B, Kizhakedath R, Benny M, Kuruvilla BT. Clinical evaluation of a herbal product (Rhulief™) in the management of knee osteoarthritis. Abstract 316. Osteoarthritis Cartilage. 2011;19(S1):S145-S146.
8 Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006;72(12):1100-16.
9 Russell AL, McCarty MF. DL-phenylalanine markedly potentiates opiate analgesia—an example of nutrient/pharmaceutical up-regulation of the endogenous analgesia system. Med Hypotheses. 2000;55(4):283-8.
10 Ehrenpreis S. Analgesic properties of enkephalinase inhibitors: animal and human studies. Prog Clin Biol Res. 1985;192:363-70.
11 Ehrenpreis S. D-phenylalanine and other enkephalinase inhibitors as pharmacological agents: implications for some important therapeutic application. Aupunct Electrother Res. 1982;7(2-3):157-72.
12 DLPA. In: Hendler SS, ed. (2008). PDR for Nutritional Supplements. 2nd ed. (pg. 189). Montvale, NJ: Physician’s Desk Reference.
13 Chiang EP, Smith DE, Selhub J, et al. Inflammation causes tissue-specific depletion of vitamin B6. Arthritis Res Ther. 2005;7(6):R1254-62.
