Drugs, psychotherapy, physiotherapy, meditation. What if we added a healthy diet to these pain-fighting strategies? An increasing number of studies suggest that a diet rich in antioxidant and anti-inflammatory foods could contribute to the reduction of chronic pain, which affects about 16 million people in Italy. On the other hand, a poor diet can contribute to accentuate it.
“When we talk about chronic pain we are referring to a real pathology, which can affect patients of all ages and be very disabling», he explains Giuliano DeCarolis, specialist in anesthesia and pain therapy and medical director at the University Hospital of Pisa. “Pathologies of the spine (classic back pain), for example, particularly affect people of working age, and therefore also have an economic impact, for the individual and for society”.
What diseases can trigger chronic pain?
Chronic pain is often triggered by a pathology: the most frequent are the backachethe diabetic neuropathya painful complication of diabetes mellitus affecting the peripheral nerves, or the post herpetic neuralgiaa frequent consequence of herpes zoster infection, better known as fire of saint Anthonycharacterized by severe neuropathic pain. Even after an operation (on the hip or knee, for example) neuropathic pain can arise, in these cases called post-surgical pain.
“Let’s not forget theobesity, which is also an important risk factor for chronic pain since the accumulation of fat in fat cells leads to an increase in the inflammatory process», notes the expert. Treating pangs that become chronic can be complex. “Pharmacological therapies are mainly used and in some cases psychological support is also required, since chronic pain has a major impact on the quality of life of patients and can cause anxiety and depression,” continues De Carolis. «For years we pain specialists have been paying increasing attention to behavioral interventions and all the habits for a correct lifestyle that can influence the perception of pain».
Intermittent fasting could reduce chronic pain
Nutrition is one of them. Studies on the relationship between chronic pain, lifestyle and diet. Among these is an Italian research, still in progress, on the effect of particular dietary regimens and fasting. The study suggests that, in mice, a molecule produced by the body following prolonged fasting (called beta-hydroxybutyrate) can reduce chronic pain. Researchers are trying to understand whether this also happens in humans and therefore whether patients suffering from neuropathic pain could benefit from periods of fasting.
A food pyramid effective against chronic pain
But what do we know about foods that can reduce or promote pain? What foods are best suited for chronic pain sufferers and how much and how often should they be eaten? To answer these questions Mariangela Rondanellispecialist in food science, professor in applied dietary science and techniques at the University of Pavia, and his colleagues analyzed 172 scientific studies on the relationship between diet and chronic pain and, based on the results, they developed a food pyramid that can serve as a guide for patients.
«In the scientific literature there are many works that demonstrate how a situation of high inflammation, associated with a situation in which the oxidant reality predominates over the antioxidant one in the body, represents a cause of chronic pain. Many foods have demonstrated anti-inflammatory and antioxidant activity, while others have pro-inflammatory and pro-oxidant activity and therefore should be avoided. “A healthy diet can also promote the correct metabolism of painkillers,” continues De Carolis. “This is because if we eat right and avoid alcohol abuse, our liver is not stressed and can easily metabolize drugs.” The resulting food pyramid looks a lot like the mediterranean pyramid which, as the expert points out, remains the point of reference for a healthy diet. Researchers specify the amounts of foods to consume and explain why they can help counteract chronic pain.
Pain relief foods
«At the base of our pyramid we have inserted thewater», underlines Rondanelli. “We should at least drink some two liters a day because a well hydrated patient responds better to physiotherapy and suffers less. Then of course we indicate fruits and vegetableswhich are very rich in antioxidants, and cereals with a low glycemic index, such as whole grain bread, rice or pasta (we recommend three servings a day). This is because it has been studied that, in patients with high levels of inflammation and suffering from chronic pain, the consumption of whole grains, but also of legumes (of which we suggest four servings per week) can reduce inflammation. Furthermore, low glycemic index cereals, legumes, vegetables and fruit, which should preferably be eaten with their skins, contain a high fiber content, which promote intestinal transit and help fight constipation caused by opiates taken for pain”.
The dried fruit has an anti-inflammatory activity and in fact researchers recommend consuming 30 grams of it per day (the amount that roughly fits in one hand), while it yogurt (one jar a day) promotes the well-being of the intestinal flora, therefore of the microorganisms that live in the digestive system and which, by communicating with the brain, can promote the production of neurotransmitters, molecules that mediate communication between neurons, important for pain control .
Yes to vitamin D, vitamin B12, Omega 3 fatty acids and fiber
«Inside the food pyramid we have added a flag that represents the supplements of vitamin D, vitamin B12, Omega 3 fatty acids and fiber» resumes the nutritionist. «Supplementation is naturally recommended for those patients suffering from chronic pain who have low blood levels of these vitamins, who consume little fiber or little fish and therefore do not get enough Omega 3».
Beware of red meats, sweets and refined grains
Red meat, sweets and refined cereals, on the other hand, are found at the top of the pyramid as in the Mediterranean scheme, and therefore should be eaten occasionally, as they are pro-inflammatory and pro-oxidant foods.
Headache: here are the foods that can trigger it
In terms of pain, the one that affects the head is one of the most common. And often what is eaten becomes a scapegoat. Food, by itself, is not a cause, but in genetically predisposed individuals, certain foods can act as a trigger for a single migraine attack. “It happens most commonly with i aged cheesesthe alcoholic beverages (for some wine or beer, for others spirits), the chocolateThe citrus fruits oh foods rich in glutamatewidely used in Asian cuisine, so much so that we talk about Chinese restaurant headaches», explains the neurologist Gianluca Coppolaresearcher at the Polo Pontino of the Sapienza University of Rome.
The role of caffeine in the onset of headache, on the other hand, it is controversial. According to some studies, excess caffeine can cause headaches and contribute to the chronicity of headaches, while according to others, the trigger is not the caffeine itself but a non-constant intake (one cup of coffee one day, four the next day and etc). Still other people experience a caffeine withdrawal, so without the morning espresso they begin to suffer from headaches.
Coppola points out that the nature of the triggering factors is extremely subjective: «In some patients a migraine attack can be triggered by a single brand of beer and no other alcohol, in others by fruit. I had a patient whose trigger was watermelon. The point is that only the patient can identify their triggers, not the doctor, and that often a trigger food only becomes a trigger when taken in certain quantities. Also because the systematic intake of a food that causes headaches could lead to chronic headaches».
Vitamin A and B and coenzyme Q10 protect against headaches
On the other hand, some of the foods that can trigger headaches can also protect against attacks. “Someone vitamins, such as A and B contained in citrus fruits, for example, can contribute to the prevention of migraine. Controlled studies have shown that a surplus of some vitamins, particularly the B2 (also known as riboflavin, found in milk and eggs), and of coenzyme Q10 (a fundamental molecule for the functioning of cells), can become a treatment for the prevention of headaches», concludes Coppola. “But in order for them to be effective in the treatment of migraine, very high doses of these two molecules are needed, which cannot be taken with the diet, but integrated through specific galenic preparations, created by the pharmacist at the request of the specialist”. Coppola concludes by emphasizing that skipping meals and dehydration are also among the triggers of migraine.