Natural pain modulation

Townsend Letter for Doctors and Patients, Jan, 2005 by Jason Barker, Chris Meletis

Pain, in all of its forms, (mental, emotional and physical) is one of medicine's greatest challenges. Rarely is pain the actual disease process; rather it is almost always a symptom of imbalance in the body. Pain in all of its presentations is often the patient's greatest motivator to seek care and recovery and because of this, pain often takes precedence in expediency of care. Too often pain is treated as just that; a symptom in and of itself and oftentimes the symptom picture becomes mired in treating the patient's pain rather than working simultaneously to resolve the cause. As one of the main tenets of naturopathic medicine is to 'identify and treat the cause,' locating the causative agent(s) in pain is a large part of treatment. Losing focus on the cause of pain can easily occur in patients with overwhelming symptoms.

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Pain management from the naturopathic perspective focuses on several aspects of pain, including attempts to elicit physiologic change in a person's perspective of pain. Undoubtedly, many conventional pain medicines (the majority of which are derived from plant substances, originally) provide strong and rapid treatment. These medicines are quite useful in times of unbearable pain when pain relief transcends all other treatments. In the naturopathic model of disease, pain may result (at the end of a long line) from improper care of the body, overindulgence and excess, and poor diet. Interestingly, early naturopathic doctors prescribed what we still recognize today as healthful outlets; fresh air, sunshine, good diet, 'scientific relaxation' and a positive mental attitude, among other things. Seemingly simplistic recommendations, they provide the basic framework for health, perhaps more than ever today, as the simultaneous pursuit of health while maintaining poor lifestyle habits is counterproductive. Of course, the suggestions mentioned above are far removed from today's modern chemical pain relievers, yet when combined with additional treatments utilizing natural medicines, a much-improved state of health can be achieved.

Furthermore, a focus on relieving pain from a naturopathic perspective may assist a person in avoiding the addictive perils of pharmaceutical prescriptions, including their strong and toxic side effects. What is most important is that in removing the cause, physicians deliver their greatest service by altering one's course of health away from what may be lifelong protracted pain and disability.

Dietary Factors

A primary intervention in removing pain involves creating an environment in which the tissues (referring to physical pain) affected are provided with the best opportunity for health. Techniques for improving tissue health via dietary regulation include optimizing protein intake, limiting refined carbohydrates, and ensuring adequate micronutrient and fatty acid intake. An overabundance of refined carbohydrate intake negates effective insulin metabolism, leading to weight gain and promotion of the inflammatory cascade. Inadequate protein intake limits repair of injured tissue when consumed at less than 30% of the RDA (0.8 g of protein per kg body weight per day). Foods rich in omega 6 fatty acids are known to promote inflammatory processes, cancer, autoimmune conditions, and circulatory issues. (1) Adequate synthesis of protein (and thus tissue repair) may be limited by several conditions; insufficient intake of dietary protein has been associated with immune dysfunction, impaired muscle use, decreased bone mass, decreased cognitive function, delayed healing of wounds (surgical included) and increased morbidity. (2) Additionally, medical conditions such as malabsorption syndromes, gastrointestinal disease, and both chronic and acute infections can lead to deficiencies of micronutrients and increased requirements for protein and energy. Finally, pain patients who strongly rely on prescription pain medications may have further compromised nutrient absorption, loss of appetite and gastrointestinal conditions.

Proteolytic Enzymes

In addition to well-recognized anti-inflammatory and anti-endemic properties, proteolytic enzymes exert analgesic effects as well. Enzyme-induced analgesia is thought to arise by their ability to limit the inflammatory cascade and directly influence nociceptors, the body's pain-sensing apparatus. (3) One such widely used enzyme is bromelain. Bromelain refers to a group of enzymes that are obtained from the fruit and stem of the pineapple (Ananas comosus). (4) Bromelain's anti-inflammatory effects are mediated by its ability to slow leukocyte migration and activation to areas of tissue injury. Other mechanisms include protein degradation at points of inflammation, depletion of kininogen, and inhibition of inflammatory prostaglandins and induction of prostaglandin E1, a prostaglandin with anti-inflammatory properties. Side effects of bromelain are limited to gastrointestinal upset, sometimes with diarrhea. One source mentioned that lg-E mediated allergic reactions are possible when using bromelain yet this has been rarely documented. (5) As for clinical application, one study evaluated bromelain's analgesic and anti-inflammatory effects in osteo- and rheumatoid arthritis patients for 3 months. (6) Bromelain was used at doses of 200 or 400 milligrams per day. Pain evaluation was based on patient symptom scores; these were reduced by 41% (200 milligram group) and by 59% (400 milligram group). Scores for stiffness and physical function decreased significantly in the 400-milligram dose group in comparison to the low dose group. A final note by the study authors revealed that in comparison to baseline, overall psychological well being improved (with a significant dose-response relationship) in both groups after their treatments.