Eliminating Pain - Naturopathic Approaches

Pain deteriorates quality of life

Today more people than ever are seeking naturopathic care, especially for long standing conditions including but not limited to anxiety, diabetes, depression and cardiovascular disease. What many people may not realize is that naturopathic doctors are also well trained in treating acute injuries as well as more chronic cases of pain caused by previous injuries or other conditions including osteoarthritis. Dealing with pain, whether from a recent injury or from a long standing condition can be very difficult. The pain from injuries can have a massive impact on activities of daily living. Simple tasks such as reaching up to get a glass out of a cupboard, or bending down to pick up the groceries can be excruciating and sometimes seemingly impossible to perform. Due to these effects on quality of life and activities of daily living, there is always a need to seek out the safest and most effective treatments which will assist in healing damaged tissues, reduce pain and inflammation and increase overall quality of life.

There are a number of treatments that can be used to help with pain management. Diet and lifestyle changes and a number of physical and manual therapies can be of great benefit to many people for a variety of ailments. Sometimes eliminating food triggers can be helpful in reducing inflammation and in allowing the body to focus resources on other areas. Gentle exercises and stretches completed on a routine basis can ameliorate pain, improve range of motion, and help prevent future injuries. Exercise is a healthy part of almost any treatment plan, but it is best individualized depending on your age, demographic, and medical history. This article we will be focusing on a number of supplements with very promising clinical research that can have some profound effects on pain and inflammation. In particular, we will discuss curcumin, boswellia, and bromelain. These three therapies have been used successfully by naturopathic doctors to treat multiple acute and chronic conditions, including everything from athletic injuries to rheumatoid arthritis. Like any natural supplements, they tend to be on the safer side, but every treatment has possible side effects. When it comes to the herbal treatment options, allergy is always a possible side effect that should be assessed beforehand.

Curcumin

Tumeric comes from the plant Curcuma longa. It is a gold-colored spice commonly used in the Indian subcontinent, not only its vast health benefits but also for the preservation of food and as a yellow dye for textiles.^[1] Curcumin, which gives turmeric its deep gold color, was first isolated nearly two hundred years ago, and its immense health benefits are still being studied today. Curcumin has been getting a lot of good press lately as research gets published showing its positive benefits for a large number of conditions including cancer, arthritis, diabetes, cardiovascular disease, osteoporosis, Alzheimer’s disease, and other conditions.^[2] The magic of curcumin comes from its powerful ability to reduce inflammation.^[3] Curcumin has the ability to suppress one the key processes in inflammation, nuclear factor-kappaB (NF-kB). NF-kB controls many of the genes involved in inflammation and it is often seen chronically activated in many chronic diseases such as irritable bowel disease and atherosclerosis.^[4]

The powerful anti-inflammatory effect is especially important when treating injuries and alleviating pain. Many people often reach for an over the counter pain medication, including Tylenol and Advil, when seeking relief. In fact these are some of the most commonly prescribed medications in North America and Europe.^[5] These non-steroidal anti-inflammatory drugs (NSAID) are effective but often have a number of contraindications and side effects, most notably stomach ulcers.^[5] Curcumin seems to be a safe and effective alternative to chronic NSAID use. A recent study looked at the efficacy of curcumin in treating active Rheumatoid Arthritis (RA).^[6] In this study the participants received curcumin at 500mg per day along with their medication, curcumin at 500mg alone, or the medication alone. The findings of the study are extremely compelling. The curcumin-only group improved significantly, with a 44.5% reduction in their disease activity scores by the end of the study (8 weeks) and had a 60% reduction in pain scores as well. Blood test markers of inflammation were also reduced significantly in the groups receiving curcumin. The curcumin-only group had a drop of 52% in the blood marker c-reactive protein (an inflammatory marker) compared with 26.9% in the curcumin plus medication group and an increase of 1.5% in the drug only group.^[6] Curcumin is often standardized to its active constituents and often combined with a carrier. The carrier part of the supplement is usually included to promote absorption of curcumin, as it is otherwise very difficult to absorb. High-quality supplements will identify this on their product labels.

Boswellia

Boswellia serrata, also known as Indian frankinscence is a tree that is found growing in India, northern Africa and in some parts of the Middle East.^[7] When the bark of the tree is peeled away, a sticky resin is found. It is this resin that has been used for it medicinal properties for nearly a millennia.^[7] Similarly to curcumin, the key to boswellia lies in its powerful anti-inflammatory effects. There have been a number of studies looking at boswellia's efficacy in treating conditions including rheumatoid arthritis, crohn's disease, and colitis. Again, like curcumin, many of the diseases that are governed by inflammatory processes show potential to be treated with boswellia. Extracts of boswellia have been demonstrated to be potent inhibitors of 5-lipoxygenase (5-LOX), which is a key enzyme in the biosynthesis of leukotrienes from arachidonic acid in the cellular inflammatory cascade.^[8] By inhibiting this enzyme, boswellia can stop one of the key precursors to inflammation.

Recently a specialized extract of boswellia, 5-Loxin has shown some pretty impressive results in recent clinical trials. A 90 day trail of 5-Loxin in participants with osteoarthritis of the knee had participants take 100 or 200mg of 5-Loxin or placebo and tracked their results.^[8] The most astounding figure to come out of this study is that both 5-Loxin groups saw significant improvements in pain scores and physical ability scores in seven days. These figures continued to improve over the course of the study. Another interesting note to come out of this study is boswellia's effects on an enzyme called metalloproteinase-3. This enzyme is found in the synovial fluid in the knee and can be responsible for some of the cartilage degradation seen in osteoarthritis.^[8] Both 5-Loxin groups saw significant reductions in this enzyme, with a larger reduction seen in the higher dose group. These results are rather impressive, especially the significant reduction of pain and improvement in function within one week of use. When compared to other herbal options, boswellia is one of the absolute safest. It has an extremely long history of use with very limited side effects and virtually no safety concerns affiliated with its use. Typically boswellia will be found in supplements paired with other anti-inflammatory herbs. It can be provided in tablet form (in which case it is usually looking at a dried standardized extract), or in tincture form (in which case it is an alcohol extract of the whole plant). Both forms are effective in clinical encounters.

Bromelain

Bromelain differs a little bit from the curcumin and boswellia which we spoke about earlier as it is what is known as a proteolytic enzyme. Proteolytic enzymes literally chew up proteins which can make it easier for proper tissue healing to take place.^[9] For this exact purpose, proteolytic enzymes have been used in the medical community for quite some time to assist with wound healing and for post-surgical care.^[9] Bromelain itself is an extract that is derived from pineapple, mainly concentrated in the stem.^[10] Bromelain has been shown to have anti-inflammatory effects as well as analgesic or pain reducing effects.^[10] This is interesting as it seems that bromelain can modulate both inflammatory and pain pathways directly.

A study comparing the efficacy of a supplement containing bromelain to the drug diclofenac in managing osteoarthritis of the knee yielded some interesting results. The supplement was found to be better than the drug at reducing pain at rest and equally as good as the drug at reducing pain in general.^[11] The study also found that the supplement improved restricted joint function by 10% while the drug showed no improvements over the course of the study.^[11] Bromelain can also help speed up post-surgical healing as well. A study was conducted in which participant whom had surgery to repair fractured bones received a supplement containing bromelain or a placebo for 2 weeks after the surgery. Participants who received the supplement needed less pain medication, had reduced swelling and overall noted a more rapid and comfortable recovery period.^[12]

Living with pain, whether acute or chronic, can be extremely challenging. Pain can make daily tasks seem excruciating or nearly impossible to accomplish. In many cases, even a small reduction in pain and swelling can have great impacts on a person’s overall quality of life. The supplements we discussed here are powerful and effective treatments for pain management. This article is focused on supplements but there are many other treatments available for the management of pain. Diet and lifestyle are always important but other treatments can include acupuncture, massage, physiotherapy and joint manipulation. A well thought out comprehensive plan is always your best bet to help manage pain and get on living a happy healthy life. As always, talk to your health care provider about these supplements before taking them. They are there to help you come up with a treatment plan tailored specifically for you needs.