The high cost of chronic pain

Chronic pain is an expensive problem. According to the National Institutes of Health, the cost of healthcare due to pain ranges from $261 to $300 billion per year.

When the value of chronic pain sufferers’ lost productivity is added in, the total financial cost of chronic pain to society ranges from $560 to $635 billion annually.

An estimated 54 million Americans have arthritis or another rheumatic condition.

Approximately 38 million Americans suffer from migraine headaches; Nine out of 10 of those migraine sufferers report they can’t “function normally” during days in which a migraine strikes. Three out of 10 migraine sufferers require bed rest during a migraine.

Drugs are not an ideal solution for chronic pain

Patients tend to think of pain medicine as the only way to treat chronic pain and inflammation, so many people automatically take medication when they have chronic pain and think they are helping their condition.

Prescription drugs are the third leading cause of death after heart disease and cancer in the United States and Europe. Around half of those who die have taken their drugs correctly; the other half die because of errors, such as too high a dose or use of a drug despite contraindications.¹

It’s not just prescribed drugs that are problematic. More than $18 billion is spent each year on over-the-counter pain medications. Americans consume 20,000 tons of aspirin each year. But we all know medication is not a cure for chronic pain, and it can often make matters worse.

The use of non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are the common pain relievers bought over the counter or prescribed. They include drugs like ibuprofen, naproxen and aspirin.

About 40% of NSAIDs users have stomach and intestinal symptoms, the most frequent being gastroesophageal reflux (regurgitation and/or heartburn). Other symptoms include belching, stomach pain or discomfort, bloating and nausea after eating). A systematic review of 17 prospective observational studies found that 11% of preventable drug-related hospital admissions could be attributed to NSAIDs.

Other research links chronic pain medications to high blood pressure,² kidney failure,³ heart failure⁴ and ulceration of the GI tract;⁵ some drugs even interfere with bone repair.⁶

The connection between NSAIDs and kidney disease is an interesting one. On Jan. 29, 2002, the New York Times published an article discussing the prevalence of kidney disease in the National Basketball Association and the players’ tendency to take large amounts of ibuprofen.

Another study found that in 2,000 arthritic patients, NSAID use increased ulcer risk tenfold. Almost 25% of NSAID users have ulcers. There is also a strong correlation between the use of pain medication and the symptoms of irritable bowel syndrome.⁷

NSAIDs perpetuate the very problem they are designed to treat. They actually increase the body’s oxidative stress — leading to further inflammation and chronic pain. Research has demonstrated that NSAIDs interfere with protein synthesis¹¹ and the formation of cartilage.^8-10 People taking NSAIDs for arthritis pain are actually making the situation worse.

Don’t forget opioids

In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers, and healthcare providers began to prescribe them at greater rates. Fast-forward to the present, when each day, according to the U.S. Centers for Disease Control and Prevention, more than 140 Americans die from drug overdoses, 91 specifically due to opioids. In 2017 the U.S. Department of Health and Human Services declared opioid abuse a public health emergency.

Is there a drug-free answer for chronic pain?

Get chiropractic adjustments: Balancing the skeletal and nervous system will take pressure off nerves, facilitate normal movement and relieve chronic pain.

• Take natural anti-inflammatory substances: Over time, chronic inflammation in the body can contribute to serious health problems. Several herbs and nutraceuticals can reduce inflammation. Many of them work even better than prescription medication without the negative side effects.
• Eat your way out of chronic pain: Studies have shown people who are overweight tend to produce more inflammatory chemicals than people who are not overweight.^11-17 Research has also shown that sugar, refined foods and processed foods can all increase chemicals in the body that produce inflammation.^18-23 Insulin insensitivity, the result of eating too many refined carbohydrates like sweets, pasta and white bread, itself can cause inflammation. People can reduce their inflammation by eliminating these harmful foods from their diet.
• Polyphenols and carotenoids: Carotenoids are powerful antioxidants. They are mainly yellow, orange or red fat-soluble pigments, including carotene. They give color to plant parts such as ripe tomatoes, carrots and most vegetables. Many of them are converted to vitamin A. Polyphenols are micronutrients we get through certain plant-based foods. They’re packed with antioxidants and potential health benefits. Polyphenols can improve or help treat digestion issues, weight management difficulties, diabetes, neurodegenerative disease and cardiovascular disease. Studies have shown that carotenoids and polyphenols reduce inflammation.^24-34 
• Bottom line: a diet high in brightly colored fresh produce will help combat chronic pain. Eating a diet that is 75% (by volume) fresh fruits and vegetables will reduce pain and inflammation.
• Fats and oils: The chemicals that create and suppress inflammation are oil-soluble. The type of fat in the diet can either promote or suppress inflammation. Avoid hydrogenated oils, trans fats and highly refined vegetable oils. Use extra-virgin olive oil for cooking and for salads. Studies have shown that consuming vegetable-sourced omega-3 fatty acids, like linolenic acid from flax seeds, will reduce inflammation as well as improve blood sugar control.^35-44
• Pancreatic enzymes: Taking pancreatic enzymes with a meal will help digest the food. Enzymes have been extensively studied and have demonstrated an ability to reduce chronic pain and inflammation when taken on an empty stomach. They also speed healing, and do so with few, if any, side effects. Studies have shown enzymes to be comparable to NSAIDs in relieving pain, easing joint stiffness and improving function.^45-53

Other studies have shown enzymes to be effective for managing arthritis. In some studies, they outperform drugs. Enzymes have also been used to reduce pain and improve healing after surgery. In one study involving patients who had undergone cosmetic surgery, the authors stated, “Systemic enzyme therapy with its pharmacological effects represents a preventive and curative option for inflammatory process including healing. Excellent results were presented, namely, in the treatment of secondary lymphoedema.”

Final thoughts

Naturally anti-inflammatory foods, enzymes and other substances, combined with manual therapy, can go a long way in reducing pain, and along with it people’s need for potentially harmful over-the-counter and prescription pain medications.

Paul Varnas, DC, DACBN, is a graduate of the National College of Chiropractic and has had a functional medicine practice for 34 years. He is the author of several books and has taught nutrition at the National University of Health Sciences. For a free PDF of “Instantly Have a Functional Medicine Practice” or a patient handout on the anti-inflammatory diet, email him at paulgvarnas@gmail.com.

References

1. Goetzsche PC. Our prescription drugs kill us in large numbers. Pol Arch Med Wewn. 2014;124(11):628-34. PubMed. https://pubmed.ncbi.nlm.nih.gov/25355584/. Accessed July 11, 2024.
2. Curhan GC, et al. Frequency of analgesic use and risk of hypertension in younger women. Arch Intern Med. 2002;162(19):2204-2208. PubMed. https://pubmed.ncbi.nlm.nih.gov/12390063/. Accessed July 11, 2024.
3. Fored CM, et al. Acetaminophen, aspirin, and chronic renal failure. N Engl J Med. 2001;345(25):1801-1808. NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa010323. Accessed July 11, 2024.
4. Feenstra J, et al. Association of nonsteroidal anti-inflammatory drugs with first occurrence of heart failure and with relapsing heart failure. Arch Intern Med. 2002;162(3):265-270. PubMed. https://pubmed.ncbi.nlm.nih.gov/11822918/. Accessed July 11, 2024.
5. Singh G, et al. Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis. A prospective observational cohort study. Arch Intern Med. 1996;156(14):1530-1536. PubMed. https://pubmed.ncbi.nlm.nih.gov/8687261/. Accessed July 11, 2024.
6. Simon AM, et al. Cyclo-oxygenase 2 function is essential for bone fracture healing. J Bone Miner Res. 2002;17(6):963-976. PubMed. https://pubmed.ncbi.nlm.nih.gov/12054171/. Accessed July 11, 2024.
7. Locke GR, et al. Risk factors for irritable bowel syndrome: Role of analgesics and food sensitivities. Am J Gastroenterol. 2000;95(1):157-165. PubMed. https://pubmed.ncbi.nlm.nih.gov/10638576/. Accessed July 11, 2024.
8. Ding C, et al. Do NSAIDs affect longitudinal changes in knee cartilage volume and knee cartilage defects in older adults? Am J Med. 2009;122(9):836-842. PubMed. https://pubmed.ncbi.nlm.nih.gov/19699379/. Accessed July 11, 2024.
9. Collier S, Ghosh P. Comparison of the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on proteoglycan synthesis by articular cartilage explant and chondrocyte monolayer cultures. Biochem Pharmacol. 1991;41(9):1375-1384. PubMed. https://pubmed.ncbi.nlm.nih.gov/2018569/. Accessed July 11, 2024.
10. David MJ, et al. Effect of non-steroidal anti-inflammatory drugs (NSAIDS) on glycosyltransferase activity from human osteoarthritic cartilage. Br J Rheumatol. 1992;31 Suppl 1:13-7. PubMed. https://pubmed.ncbi.nlm.nih.gov/1555049/. Accessed July 11, 2024.
11. McLaughlin T, et al. T-cell profile in adipose tissue is associated with insulin resistance and systemic inflammation in humans. Arterioscler Thromb Vasc Biol. 2014;34(12):2637-2643. PubMed. https://pubmed.ncbi.nlm.nih.gov/25341798/. Accessed July 11, 2024.
12. Kong LC, et al. Insulin resistance and inflammation predict kinetic body weight changes in response to dietary weight loss and maintenance in overweight and obese subjects by using a Bayesian network approach. Am J Clin Nutr. 2013;98(6):1385-1394. PubMed. https://pubmed.ncbi.nlm.nih.gov/24172304/. Accessed July 11, 2024.
13. Kelly AS, et al. Inflammation, insulin, and endothelial function in overweight children and adolescents: The role of exercise. J Pediatr. 2004;145(6):731-736. PubMed. https://pubmed.ncbi.nlm.nih.gov/15580192/. Accessed July 11, 2024.
14. Temelkova-Kurktschiev T, et al. Subclinical inflammation is strongly related to insulin resistance but not to impaired insulin secretion in a high risk population for diabetes. Metabolism. 2002;51(6):743-749. Science Direct. https://www.sciencedirect.com/science/article/abs/pii/S002604950242029X. Accessed July 11, 2024.
15. Ho TP, et al. Effects of a 12-month moderate weight loss intervention on insulin sensitivity and inflammation status in nondiabetic overweight and obese subjects. Horm Metab Res. 2015;47(4):289-296. PubMed. https://pubmed.ncbi.nlm.nih.gov/24977656/. Accessed July 11, 2024.
16. Aeberli I, et al. Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: A randomized controlled trial. Am J Clin Nutr. 2011;94(2):479-485. PubMed. https://pubmed.ncbi.nlm.nih.gov/21677052/. Accessed July 11, 2024.
17. Myette-Cote E, et al. The effect of a short-term low-carbohydrate, high-fat diet with or without postmeal walks on glycemic control and inflammation in type 2 diabetes: A randomized trial. Am J Physiol Regul Integr Comp Physiol. 2018;315(6):R1210-R1219. PubMed. https://pubmed.ncbi.nlm.nih.gov/30303707/. Accessed July 11, 2024.
18. Messier SP, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: The IDEA randomized clinical trial. JAMA. 2013;310(12):1263-1273. PubMed. https://pubmed.ncbi.nlm.nih.gov/24065013/. Accessed July 11, 2024.
19. Valentini L, et al. Impact of personalized diet and probiotic supplementation on inflammation, nutritional parameters and intestinal microbiota. The “RISTOMED project.” Randomized controlled trial in healthy older people. Clin Nutr. 2015;34(4):593-602. PubMed. https://pubmed.ncbi.nlm.nih.gov/25453395/. Accessed July 11, 2024.
20. Kovell LC, et al. Healthy diet reduces markers of cardiac injury and inflammation regardless of macronutrients: Results from the OmniHeart trial. Int J Cardiol. 2020;299:282-288. PubMed. https://pubmed.ncbi.nlm.nih.gov/31447226/. Accessed July 11, 2024.
21. Casas R, et al. The effects of the mediterranean diet on biomarkers of vascular wall inflammation and plaque vulnerability in subjects with high risk for cardiovascular disease. A randomized trial. PLoS One. 2014;9(6):e100084. Pub Med. https://pubmed.ncbi.nlm.nih.gov/24925270/. Accessed July 11, 2024.
22. Edirisinghe I, et al. Strawberry anthocyanin and its association with postprandial inflammation and insulin. Br J Nutr. 2011;106(6):913-922. PubMed. https://pubmed.ncbi.nlm.nih.gov/21736853/. Accessed July 11, 2024.
23. Dower JI, et al. Supplementation of the pure flavonoids epicatechin and quercetin affects some biomarkers of endothelial dysfunction and inflammation in (pre)hypertensive adults: A randomized double-blind, placebo-controlled, crossover trial. J Nutr. 2015;145(7):1459-1463. PubMed. https://pubmed.ncbi.nlm.nih.gov/25972527/. Accessed July 11, 2024.
24. Jokioja J, et al. Anthocyanin-rich extract from purple potatoes decreases postprandial glycemic response and affects inflammation markers in healthy men. Food Chem. 2020;310:125797. PubMed. https://pubmed.ncbi.nlm.nih.gov/31818516/. Accessed July 11, 2024.
25. Lloedon TK, et al. Impact of anthocyanin-rich whole fruit consumption on exercise-induced oxidative stress and inflammation: a systematic review and meta-analysis. Nutr Rev. 2019;77(9);630-645. PubMed. https://pubmed.ncbi.nlm.nih.gov/31228241/. Accessed July 11, 2024.
26. Joo HK, et al. Anthocyanin-rich extract from red chinese cabbage alleviates vascular inflammation in endothelial cells and Apo E -/- mice. Int J Mol Sci. 2018;19(3):816. PubMed. https://pubmed.ncbi.nlm.nih.gov/29534512/. Accessed July 11, 2024.
27. Gentile D, et al. The flavonoid compound apigenin prevents colonic inflammation and motor dysfunctions associated with high fat diet-induced obesity. PLoS One. 2018;13(4):e0195502. PubMed. https://pubmed.ncbi.nlm.nih.gov/29641549/. Accessed July 11, 2024.
28. Vernarelli JA, Lambert JD. Flavonoid intake is inversely associated with obesity and C-reactive protein, a marker for inflammation, in US adults. Nutr Diabetes. 2017;7(5):e276. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5518804/. Accessed July 11, 2024.
29. Lim HJ, et al. The root barks of Morus alba and the flavonoid constituents inhibit airway inflammation. J Ethnopharmacol. 2013;149(1):169-175. Science Direct. https://www.sciencedirect.com/science/article/abs/pii/S0378874113004352. Accessed July 11, 2024.
30. Jahns L, et al. A diet high in carotenoid-rich vegetables and fruits favorably impacts inflammation status by increasing plasma concentrations of IFN-α2 and decreasing MIP-1β and TNF-α in healthy individuals during a controlled feeding trial. Nutr Res. 2018;52:98-104. PubMed. https://pubmed.ncbi.nlm.nih.gov/29551222/. Accessed July 11, 2024.
31. Wood AD, et al. Patterns of dietary intake and serum carotenoid and tocopherol status are associated with biomarkers of chronic low-grade systemic inflammation and cardiovascular risk. Br J Nutr. 2014;112(8):1341-1352. Europe PMC. https://europepmc.org/article/MED/25313576. Accessed July 11, 2024.
32. Grant R, et al. Cerebrospinal fluid levels of inflammation, oxidative stress and NAD+ are linked to differences in plasma carotenoid concentrations. J Neuroinflammation. 2014;11:117. PubMed. https://pubmed.ncbi.nlm.nih.gov/24985027/. Accessed July 11, 2024.
33. Gillingham LG, et al. High-oleic rapeseed (canola) and flaxseed oils modulate serum lipids and inflammatory biomarkers in hypercholesterolaemic subjects. Br J Nutr. 2011;105(3):417-427. PubMed. https://pubmed.ncbi.nlm.nih.gov/20875216/. Accessed July 11, 2024.
34. Cetisli NE, et al. The effects of flaxseed on menopausal symptoms and quality of life 140 menopausal women who were divided into 4 groups. The menopausal symptoms decreased and the quality of life increased among the women who used flaxseed for 3 months. Holist Nurs Pract. 2015;29(3):151-157. PubMed. https://pubmed.ncbi.nlm.nih.gov/25882265/. Accessed July 11, 2024.
35. De Lorgeril M, et al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343(8911):1454-1459. PubMed. https://pubmed.ncbi.nlm.nih.gov/7911176/. Accessed July 11, 2024.
36. Bhardwaj K, et al. Flaxseed oil and diabetes: A systemic review. J Med Sci. 2015;15:135-138. Science Alert. https://scialert.net/abstract/?doi=jms.2015.135.138. Accessed July 12, 2024.
37. Hutchins AM, et al. Daily flaxseed consumption improves glycemic control in obese men and women with pre-diabetes: A randomized study. Nutr Res. 2013;33(5):367-375. PubMed. https://pubmed.ncbi.nlm.nih.gov/23684438/. Accessed July 12, 2024.
38. Barre DE, et al. High dose flaxseed oil supplementation may affect fasting blood serum glucose management in human type 2 diabetics. J Oleo Sci. 2008;57(5):269-273. PubMed. https://pubmed.ncbi.nlm.nih.gov/18391475/. Accessed July 12, 2024.
39. Djousse L, et al. Relation between dietary linolenic acid and coronary artery disease in the National Heart, Lung, and Blood Institute Family Heart Study. Am J Clin Nutr. 2001;74(5):612-619. PubMed. https://pubmed.ncbi.nlm.nih.gov/11684529/. Accessed July 12, 2024.
40. Hu FB, et al. Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med. 1997;337(21):1491-1499. PubMed. https://pubmed.ncbi.nlm.nih.gov/9366580/. Accessed July 12, 2024.
41. Djousse L, et al. Dietary linolenic acid is inversely associated with calcified atherosclerotic plaque in the coronary arteries: The National Heart, Lung and Blood Institute Family Heart Study. Circulation. 2005;111(22):2921-2926. PubMed. https://pubmed.ncbi.nlm.nih.gov/15927976/. Accessed July 12, 2024.
42. Kaithwas G, Majumdar DK. Effect of L. usitatissimum (Flaxseed/Linseed) fixed oil against distinct phases of inflammation (animal study). ISRN Inflamm. 2013:735158. PubMed. https://pubmed.ncbi.nlm.nih.gov/24049663/. Accessed July 12, 2024.
43. Khrianin AA, et al. Impact of exogenous proteolytic enzymes on immunogenesis in patients with urogenital infections. Antibiot Khimioter. 2012;57(9-10):25-27,29-31. PubMed. https://pubmed.ncbi.nlm.nih.gov/23477217/. Accessed July 12, 2024.
44. Roberts AD, Hart DM. Polyglycolic acid and catgut sutures, with and without oral proteolytic enzymes, in the healing of episiotomies. Br J Obstet Gynaecol. 1983;90(7):650-653. PubMed. https://pubmed.ncbi.nlm.nih.gov/6307340/. Accessed July 12, 2024.
45. Duskova M, Wald M. Orally administered proteases in aesthetic surgery. Aesthetic Plast Surg. 1999;23(1):41-44. PubMed. https://pubmed.ncbi.nlm.nih.gov/10022937/. Accessed July 12, 2024.
46. Hoernecke R, Doenicke A. Perioperative enzyme therapy. A significant supplement to postoperative pain therapy? Anaesthesist. 1993;42(12):856-861. PubMed. https://pubmed.ncbi.nlm.nih.gov/8304581/. Accessed July 12, 2024.
47. Tilscher H, et al. Results of a double-blind, randomized comparative study of Wobenzym-placebo in patients with cervical syndrome. Wien Med Wochenschr. 1996;146(5):91-95. PubMed. https://pubmed.ncbi.nlm.nih.gov/8686328/. Accessed July 12, 2024.
48. Singer F, Oberleitner H. Drug therapy of activated arthrosis. On the effectiveness of an enzyme mixture versus diclofenac. Wien Med Wochenschr. 1996;146(3):55-58. PubMed. https://pubmed.ncbi.nlm.nih.gov/8867274/. Accessed July 12, 2024.
49. Klein G, Kullich W. Reducing pain by oral enzyme therapy in rheumatic diseases. Wien Med Wochenschr. 1999;149(21-22):577-580. PubMed. https://pubmed.ncbi.nlm.nih.gov/10666820/. Accessed July 12, 2024.
50. Shah D, Mital K. The role of trypsin: Chymotrypsin in tissue repair. Adv Ther. 2018;35(1):31-42. PubMed. https://pubmed.ncbi.nlm.nih.gov/29209994/. Accessed July 12, 2024.
51. Beck TW, et al. Effects of a protease supplement on eccentric exercise-induced markers of delayed-onset muscle soreness and muscle damage. J Strength Cond Res. 2007;21(3):661-667. https://journals.lww.com/nsca-jscr/abstract/2007/08000/effects_of_a_protease_supplement_on_eccentric.3.aspx. Accessed July 12, 2024.
52. Klein G, et al. Efficacy and tolerance of an oral enzyme combination in painful osteoarthritis of the hip. A double-blind, randomised study comparing oral enzymes with non-steroidal anti-inflammatory drugs. Clin Exp Rheumatol. 2006;24(1):25-30. PubMed. https://pubmed.ncbi.nlm.nih.gov/16539815/. Accessed July 12, 2024.
53. Uehleke B, et al. Willow bark extract STW 33-I in the long-term treatment of outpatients with rheumatic pain mainly osteoarthritis or back pain. Phytomedicine. 2013;20(11):980-984. PubMed. https://pubmed.ncbi.nlm.nih.gov/23731658/. Accessed July 12, 2024.