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Diet and pain


We all know that what we eat can affect our health. New research, how­ev­er, shows that there may be a spe­cif­ic link between diet and pain. Pain spe­cial­ist Dr Rae Frances Bell tells us more, and out­lines steps you can take to improve your diet as part of your pain man­age­ment regime

It’s very impor­tant for peo­ple with chron­ic pain to main­tain a healthy, bal­anced diet. There are sev­er­al rea­sons for this. First­ly, the ner­vous sys­tem has the capac­i­ty to damp­en pain. Most peo­ple have heard of the body’s own mor­phine-like sub­stances called endor­phins. In order to be able to func­tion opti­mal­ly, the ner­vous sys­tem requires spe­cif­ic nutri­ents such as essen­tial amino acids. One exam­ple is tryp­to­phan, which is a build­ing block in the syn­the­sis of the neu­ro­trans­mit­ter sero­tonin which is very impor­tant in the body’s own pain-damp­en­ing sys­tems. Food­stuffs such as nuts/seeds, fish, eggs, beans, oats, chick­en and turkey con­tain high lev­els of tryptophan.

On the most basic lev­el, the ner­vous sys­tem needs nutri­ents. Cer­tain vit­a­min defi­cien­cies can cause pain prob­lems. For exam­ple, vit­a­min B12 defi­cien­cy can cause very unpleas­ant periph­er­al polyneu­ropa­thy, which is nerve pain in both feet and also some­times in the hands. Vit­a­min D defi­cien­cy can cause mus­cu­loskele­tal pain, as can vit­a­min C deficiency.

Omega‑3 and Omega‑6

The World Health Organ­i­sa­tion pub­lished a report in 2003 which described how there has been a glob­al shift in diet result­ing from dif­fer­ent fac­tors such as indus­tri­al­i­sa­tion and mar­ket glob­al­i­sa­tion. Our diet has changed from being pre­dom­i­nant­ly plant-based to more high-ener­gy den­si­ty and processed foods, includ­ing a sub­stan­tial increase in the intake of sat­u­rat­ed fats and sug­ars. One fac­tor the report focused on was the bal­ance between dietary intake of omega‑6 fat­ty acids and omega‑3 fat­ty acids. The ‘ide­al’ ratio between these fat­ty acids is thought to be 1:1, while ratios under 5:1 have been asso­ci­at­ed with reduced risk for heart dis­ease, can­cer and auto-immune inflam­ma­to­ry conditions.

How­ev­er, in the aver­age Amer­i­can diet today, the intake of omega‑6 is around 15 to 25 times the intake of omega‑3. Foods con­tain­ing rel­a­tive­ly high lev­els of omega‑3 are cold water oily fish such as mack­er­el, her­ring and salmon, fish oil, flax seed and flax seed oil; while omega‑6 is plen­ti­ful in poul­try, and in many veg­etable oils, espe­cial­ly soy­bean oil. Soy­bean oil is used in the pro­duc­tion of fast food and snacks and I think this wide­spread use has par­tic­u­lar­ly con­tributed to high lev­els of omega‑6 in our diet.

Omega‑6 has been linked to inflam­ma­tion, which is some­thing we need to aid heal­ing in our body. But an exag­ger­at­ed inflam­ma­to­ry response cre­ates its own prob­lems. Omega‑3 has anti-inflam­ma­to­ry effects. Research has found that increased dietary intake of omega‑3 reduces joint pain, morn­ing stiff­ness, num­ber of painful joints and con­sump­tion of non-steroidal anti-inflam­ma­to­ry drugs in patients with rheuma­toid arthri­tis. The bal­ance between these fat­ty acids in our diet is thought to be impor­tant. So one thing for pain patients to pay atten­tion to with regard to diet is to ensure they have a suf­fi­cient intake of omega‑3 while avoid­ing exces­sive intake of omega‑6.

A num­ber of foods con­tain sub­stances which have anti-inflam­ma­to­ry prop­er­ties, just like non-steroidal anti-inflam­ma­to­ry drugs. For exam­ple, in vir­gin olive oil, there’s a com­pound called oleo­can­thal, which has been shown to have anti-inflam­ma­to­ry and pain reliev­ing effects sim­i­lar to ibupro­fen. This is real­ly inter­est­ing because non-steroidal anti-inflam­ma­to­ry drugs can have a lot of side effects. If we can achieve some anti-inflam­ma­to­ry and pain-reliev­ing effects through eat­ing health­ily that would be ideal.

Antiox­i­dants

Antiox­i­dants have anti-inflam­ma­to­ry effects and are found in many food­stuffs. Resver­a­trol is an antiox­i­dant which is formed in cer­tain plants when they’re under attack by bac­te­ria or insects. It’s found in the skin of red grapes, and in red wine and grape juice, and it has pow­er­ful anti-inflam­ma­to­ry and neu­ro­pro­tec­tive effects. Antiox­i­dants called antho­cyanins are found in the red­dish-blue pig­ments in blue­ber­ry skins and cher­ries and in ani­mal stud­ies have been shown to reduce inflam­ma­to­ry pain.

Unfor­tu­nate­ly there is a lot of hype in the media about antiox­i­dants, with mul­ti­ple adver­tise­ments telling us to buy antiox­i­dant prod­ucts. You actu­al­ly don’t need a huge intake and the best way to get antiox­i­dants is through your diet, not through pills.

I think most peo­ple know whether their diet is healthy or not. If we’re busy and just snack­ing instead of eat­ing reg­u­lar meals, it’s not good enough. We need to be get­ting vit­a­mins; we need to be eat­ing more fish, less red meat and lots of fresh veg­eta­bles, espe­cial­ly green leafy and bright­ly coloured veg­eta­bles. It’s the colour pig­ments which con­tain the antiox­i­dants, so if you think of a colour­ful, Mediter­ranean kind of diet then you’re on the right track.

Foods to limit

Some food­stuffs can increase pain. Pro­fes­sor Guy Simon­net and col­leagues in Bor­deaux have done inter­est­ing sci­en­tif­ic research on polyamines. Polyamines are impor­tant for cell growth and we obtain most of our polyamines through the diet. Polyamines upreg­u­late activ­i­ty in a recep­tor in the ner­vous sys­tem which is involved in ampli­fy­ing pain and a polyamine defi­cient diet has been shown in a rat study to reduce pain hyper­sen­si­tiv­i­ty. Oranges and orange juice con­tain very high lev­els of polyamines. That does­n’t mean you should stop drink­ing orange juice, it just means you should prob­a­bly think twice before drink­ing large quan­ti­ties on a dai­ly basis. Peanuts and pota­to crisps also con­tain high lev­els of polyamines.

Some pain-reliev­ing med­ica­tions con­tain caf­feine because it inter­acts with anal­gesic drugs and can increase the effect of parac­eta­mol and aspirin. But caf­feine has oth­er attrib­ut­es that are actu­al­ly harm­ful and reg­u­lar mod­er­ate to high intake of cof­fee or oth­er drinks con­tain­ing caf­feine can cause prob­lems. Caf­feine blocks the effects of the body’s own relax­ato­ry neu­ro­trans­mit­ter adeno­sine. Every­one knows that cof­fee can dis­turb sleep. If you have chron­ic pain and sleep poor­ly, you will feel more pain. If cof­fee is con­sumed on a reg­u­lar basis, it can also increase the risk of devel­op­ing a chron­ic dai­ly headache.

High lev­els of caf­feine are linked to osteo­poro­sis, so if you drink more than four cups of cof­fee a day your risk of devel­op­ing osteo­poro­sis increas­es. This is also the case for oth­er caf­feinat­ed bev­er­ages such as cola and “ener­gy” drinks. In addi­tion to flavour­ing, sug­ar or sug­ar replace­ment and water, cola con­tains phos­phor­ic acid and caf­feine. The taste might be nice, but there is noth­ing else pos­i­tive about cola. A reg­u­lar high intake of cola or “ener­gy” bev­er­ages can cause sleep prob­lems and increase the risk of osteo­poro­sis in the same way as cof­fee due to the high caf­feine levels.

What to eat

At our pain clin­ic we reg­u­lar­ly ask our patients what they eat. We start­ed doing this more than 20 years ago and quick­ly dis­cov­ered that many of them had a poor or sub-opti­mal diet. There can be dif­fer­ent rea­sons for this — some pain patients suf­fer depres­sion and have reduced appetite, or they sim­ply don’t feel up to prepar­ing meals. Most are unaware that diet plays a role in pain and that it is espe­cial­ly impor­tant for chron­ic pain patients to have a healthy, bal­anced diet. By bear­ing in mind some of these sim­ple prin­ci­ples you may find ways to make the food you eat an impor­tant part of your pain man­age­ment plan:

  • Pain patients should include foods rich in omega‑3 in their diet and be care­ful with regard to foods rich in omega‑6. Swap­ping dietary veg­etable oils high in Omega‑6 fat­ty acids (such as soy­bean, saf­flower or sun­flower oils) with oils high in Omega‑3 fat­ty acids (such as rape­seed or flax oils) or monoun­sat­u­rat­ed oils such as olive oil will help opti­mise the Omega‑6/Omega‑3 fat­ty acid ratio, as will eat­ing more fish and less red meat. Think about get­ting antiox­i­dants through eat­ing colour­ful meals with fresh veg­eta­bles, fruit and berries. Cut out all kinds of cola or “ener­gy” bev­er­ages. Reduce your dai­ly con­sump­tion of cof­fee. Don’t drink cof­fee (unless it is decaf­feinat­ed) after mid­day if you have sleep problems.
  • Eat reg­u­lar meals with no more than 4 hours inter­val- For exam­ple, 3 main meals + two light snacks and don’t skip break­fast. Eat­ing reg­u­lar­ly is espe­cial­ly impor­tant for patients with chron­ic headache.
  • If you feel you need to lose weight, ask your GP for a con­sul­ta­tion with a dieti­cian. They will prob­a­bly advise you to cut down on sat­u­rat­ed fats, sug­ars, processed foods and snacks, and to eat more fresh veg­eta­bles and protein.
  • Get enough vit­a­mins through your diet. Vit­a­min B12 or cobal­amin is abun­dant in shell­fish, fish, egg yolks, beef, lamb and cheese.
  • Near­ly a thou­sand peo­ple over 65 took part in a study to see if there was any con­nec­tion between the amount of vit­a­min D they had in their blood stream and their expe­ri­ence of back pain. There was no rela­tion­ship in men, but women who had less than a third the lev­els of vit­a­min D con­sid­ered healthy by most experts expe­ri­enced sig­nif­i­cant back pain, sug­gest­ing that women may be more vul­ner­a­ble to vit­a­min D defi­cien­cy-relat­ed pain. A recent sys­tem­at­ic review found a high preva­lence of Vit­a­min D defi­cien­cy in patients with low back pain. We get vit­a­min D from sun­light, so in the win­ter most of us need a sup­ple­ment in the form of cod liv­er oil or vit­a­min D tablets. Mar­garine and milk prod­ucts are often for­ti­fied with vit­a­min D.
  • Vit­a­min C is an antiox­i­dant with anti-inflam­ma­to­ry effects. As men­tioned above, Vit­a­min C defi­cien­cy can cause mus­cu­loskele­tal pain. In addi­tion, research seems to sug­gest that a defi­cien­cy of Vit­a­min C may be a sig­nif­i­cant fac­tor in the pain expe­ri­enced by peo­ple with post-her­pet­ic neu­ral­gia. If you have post-her­pet­ic neu­ral­gia, main­tain­ing good lev­els of vit­a­min C in your diet could pos­si­bly help you with your pain. Vit­a­min C is found in fruit and veg­eta­bles such as straw­ber­ries, oranges, kiwi, broc­coli, and red peppers.

For dietary advice spe­cif­ic to your needs we rec­om­mend you con­sult your GP, pain spe­cial­ist or a qual­i­fied dietit­ian. For more infor­ma­tion vis­it bda.uk.com/publications/index.html.


Dr Rae Frances Bell is Head of Mul­ti­dis­ci­pli­nary Clin­ic, Hauk­land Uni­ver­si­ty Hos­pi­tal, Bergen, Norway.

Dr Bell also dis­cussed this issue in Air­ing Pain 4: Diet, CBT and Mind­ful­ness.

If you would like to know more about the sources of evi­dence con­sult­ed for this pub­li­ca­tion please click here.

Diet and Pain © Rae Frances Bell. All rights reserved. Revised March 2019. To be reviewed March 2022. First pub­lished August 2013.

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