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Articles
by
Geoff M. Lecovin
Applied Kinesiology
Chronic
Pain
Cosmetic
Acupuncture
"Dry
Needling"
Exercise
Nutrition
For Pain
Therapy
for Chronic Pain
and Sports Injuries
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of page
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Clinical
Nutrition for Pain
Using diet and Supplements
to control inflammation and promote healing
The Inflammatory
Process
Inflammation is the biological response that occurs when
tissues are injured (e.g. infections, trauma, chemicals,
immune reactions).
Acute inflammation is part of the healing process. It is
characterized by swelling, heat, altered function, redness
and pain. The outcome of acute inflammation should be the
repair and remodeling of injured tissue. If acute inflammation
does not resolve, then a state of chronic inflammation develops.
Chronic inflammation is destructive to tissue and viewed
as a disease process. When inflammation goes awry, the body
produces chemicals that have been linked to:
Cardiovascular disease, Diabetes, Obesity, Alzheimer's disease,
Cancer, Arthritis, Migraines Allergies, Eczema and other
skin disorders, Chronic pain, inflammatory bowel disease,
Asthma, Food sensitivities, Chronic athletic injuries, Delayed
healing from old injuries e.g. Whiplash, Dental inflammation,
Gastritis and ulcers, Auto immune disease e.g. Lupus Multiple
sclerosis.
Ideally, treatment of inflammation should focus on assisting
the healing process, while limiting tissue damage caused
by inflammatory metabolites.
The following outlines the biochemistry of inflammation
followed by treatment with diet and nutritional supplements.
Nutritional approaches to inflammation are aimed at enhancing
the salutary effects while limiting the destructive sequelae.
The inflammatory
process is a physiological continuum that can be divided
into three phases:
1. Acute inflammation- The first 72 hours
2. Repair- 48 hours to 6 weeks
3. Remodeling
Acute Inflammation
(the first 72 hours):
I. Vascular response
II. Cellular response
The Repair Phase
(48 hours to 6 weeks):
1. Repair- Restoring continuity to interrupted tissues
2. Physiological debridement- "Cleaning of injured
area"
3. Ebb and flow phases of healing- Alternating periods of
hypo and hyper metabolism
4. Additional factors affecting tissue healing- Immobilization,
re-injury of damaged tissue, poor blood supply, temperature,
nutrient deficiency (e.g. vitamin C and A, zinc, protein,
), age, medications (e.g. steroids, NSAIDs, anticoagulants,
antibiotics, female sex hormones, cancer drugs), certain
illnesses, and genetics
5. Angiogenesis- New vessel formation
6. Fibroblasts- Cells responsible for collagen formation,
connective tissue repair and scar tissue
Glycosaminoglycans
and Tissue Healing:
In the repair phase, glycosaminoglycans (GAGS), proteoglycans
and collagen are provided to repair injured tissues and
form healthy connective tissue. Nutritional considerations
include the need for adequate: B1, B2, B3, B5, B6, B12,
folic acid, calcium, magnesium, zinc, manganese, cysteine,
calcium, iron, vitamin C, vitamin E, Vitamin A, silicon
and bioflavonoids. Additional supplementation with Glucosamine
Sulphate and Chondroitin Sulphate can help to regenerate
new tissue. This process is negatively impacted by a pro-inflammatory
diet, glycemic dysregulation (High glycemic index foods)
and NSAIDs.
The Remodeling
Phase (6 weeks -3 months or longer):
During remodeling, tissues realign and normal motion is
restored. An important part of preventing chronic problems
when areas are injured and inflamed is to initiate rehabilitation
along with nutritional intervention in order to ensure proper
remodeling through movement and conditioning.
Rehabilitation
should occur in four phases:
I. Modalities/nutrition to eliminate pain at rest, in conjunction
with pain free range of motion exercises
II. Stretching and range of motion exercises with self-imposed
resistance (once capacity to perform unstressed basic daily
activities is achieved)
III. Isometric strengthening exercises (once capacity to
perform normal activities with minimal restraints is achieved)
IV. Isokinetic/isotonic strengthening exercises (after ability
to perform normal uncontrolled activities is reached)
Summary of Major
Biochemical Causes of Pain:
1. Lactic Acid-increases Bradykinin,
the most potent chemical mediator of inflammation
2 Potassiumions- caused by alterations
in the sodium/potassium pump. Results from: magnesium deficiency,
free radical activity, and essential fatty acid deficiency
3. PGE-2 (Prostaglandins)- promoted
by increased arachadonic acid (e.g. trans fats, meat and
dairy)
4. LTB-4 (Leukotrienes)- promoted
by increased arachadonic acid (e.g. trans fats, meat and
dairy)
5. TXA-2 (Thromboxane A-2)- promoted
by increased arachadonic acid (e.g. trans fats, meat and
dairy)
6. Histamine- causes increased
vascular permeability and activates nociceptors (pain receptors)
7. 5-HT (5-Hydroxytryptamine-serotonin)-
a nociceptive irritant and promoter of platelet aggregation
leading to the production of other chemical irritants
8. Bradykinin- the most potent
nociceptor irritant, responsible for the four cardinal signs
of inflammation (dolor/pain, calor/fever, rubor/redness,
and tumor/swelling)
9. Cytokine ( Interleukins and Tumor
necrosis factor)- play a major role in promoting tissue
damage and chronic inflammation
A Diet-Induced
Pro-InflammatoryState (Excessive amounts of meat, sugar
and refined carbohydrate intake along with deficient quantities
of cold water fish, vegetables and fruits):
1. Increased tissue acidity- activates
bradykinin a potent nociceptor (pain) irritant
2. Inadequate potassium intake-
causes alkalosis, ischemia and hypoxia (reduced blood and
oxygen supply)
3. Inadequate magnesium intake-
causes increased lactic acid, platelet aggregation and free
radicals
4. Free radical production- reactive,
unstable molecules damaging to cellular structures
5. Fatty acid imbalances- all
cell membranes contain phospholipids (fat). Depending upon
the nature of fat intake, cells can be pro-inflammatory
or anti-inflammatory:
PRO-INFLAMMATORY fats- meat, dairy
and trans fats- hydrogenated vegetable oils (increases arachadonic
acid causing the formation of pro-inflammatory metabolites
PGE-2, LTB-4 and TXA-2)
ANTI-INFLAMMATORY fats- cold water
fish and green leafy vegetables (increases eicosapentaenoic
acid causing the formation of anti-inflammatory metabolites
PGI-3, TXA-3, PGE-3 and LTB-5)
 Monounsaturated
fatty acids e.g. olive oil promotes the incorporation of
omega 3 fatty acids into phospholipids membranes and reduces
unwanted immune-driven inflammatory processes.
Glycemic Dysregulation
and
Its Pro-Inflammatory Potential:
Factors:
High carbohydrate
diets increase insulin levels favoring biochemical pathways
that lead to the formation of Arachidonic acid and increased
pro-inflammatory Eicosanoids.
Insulin
Resistance Syndrome:
1. Promotes a prothrombotic and hypofibrinolytic state favoring
inflammation
2. Impairs proteoglycan synthesis
3. Causes hypercortisolemia leading to:
• Decreases protein stores, glucose utilization, REM
sleep, and immunity.
• Increases kidney stress.
• Reduced proliferation of osteoblasts (bone builders)
and reduced collagen and protein synthesis.
• Hypercortisolemia inhibits secretory IgA from the
gut, causing increased absorption of food antigens and the
release of pro-inflammatory prostaglandins.
Pharmacological Therapy
of Pain:
Anti-Inflammatory
Agents (NSAIDs):
1. Aspirin
2. NSAIDs- e.g.Ibuprofen, Feldene, Naprosyn, Anaprox, Indocin
3. Acetominophen- Tylenol (analgesic and anti-inflammatory)
4. Corticosteroids e.g. Prednisone
Mechanisms of
Action:
Inhibition of Prostaglandins, Leukotrienes and Thromboxanes
Side-effects:
• Acceleration of bone destruction
• Interferes with cartilage and bone repair and can
lead to weakened tendons and ligaments
• Loss of intestinal permeability
• Gastritis, ulcers, reflux and gastrointestinal tract
injury
• Asthma, rhinitis, sinusitis and hives in sensitive
individuals
• Liver damage
• Dizziness
• Avascular necrosis (tissue and joint destruction)
• Adverse effects on lipid metabolism
• Osteoporosis, arthritis, bursistis
• Decreased mental status
• Water retention, obesity, cushings syndrome
Muscle Relaxants:
1. Flexeril,
2. Soma
3. Skelaxin
4. Robaxin
Mechanisms of
Action:
Depression of the central nervous system
Side-effects:
• Drowsiness and dizziness
• Nausea,
• Ataxia,
• Vertigo,
• Confusion
• Headaches
Opiate Analgesics:
1. Morphine
2. Demerol
3. Dilaudid
4. Codeine
5. Fentanyl
Mechanisms of
Action:
• Act upon opiate receptors in the brain
• Release neurotransmitters (endorphins, enkephalin,
GABA, dynorphin, seratonin)
• Inhibit nociceptive (pain) receptors
Side-effects:
• Mood changes, sedation, mental clouding
• Nausea, vomiting, decreased G.I. motility and increased
bile duct pressure
• Respiratory depression and cough suppression
• Histamine release
• Pruritis
• Urinary retention
Nutritional Recommendations
for Inflammation:
• Focus on vegetable, fruit, cold water fish and olive
oil consumption
• Total carbohydrate consumption should be less than
50% of calories
• Maintain a 3:1 to 2:1 ratio of carbohydrates to
protein
• Pursue a 1:1 ratio of omega 3 to omega 6 fatty acids
(Omega 3- flax, leafy greens, fish, walnuts; Omega 6- corn,
sunflower, grains, borage, evening primrose)
• Limit meats, dairy fats and shellfish
• Limit/Avoid refined carbohydrates and sugar
• Ensure adequate fiber intake
• Eat small frequent intervals, to ensure proper glycemic
regulation
• Ensure proper digestion
• Optimize bowel habits
• Phytochemicals: whole grains, nuts, , onions, carrots,
green vegetables, broccoli, Brussels sprouts, cabbage, cauliflower,
tomatoes, beets, avocado, peppers, soybeans, squash, cilantro,
parsley, citrus, berries, cranberries, apples, melon, cherries,
pomegranates, green tea, red wine, dark chocolate, turmeric,
garlic, ginger, cinnamon, rosemary, sage, oregano, thyme
• Adequate water intake
• Multiple Vitamin/mineral
• Antioxidants : A, E, C, Selenium, Zinc, CoQ10
• B1, B6, B12, folic acid, Calcium, Iron, Potassium
(Chronic Myofascial Pain)
• Bioflavonoids
• Magnesium
• Fish oil
• Bromelain
• Quercetin
• Boswellia
• Glucosamine Sulphate
• Chondroitin Sulphate
Mechanisms of
Action:
• Decreases platelet aggregation
• Decreases lactic acid
• Balances Potassium ions
• Decreased Eicosanoids (prostaglandins, leukotrienes,
thromboxanes, platelet derived growth factor)
• Decreases Histamine levels
• Decreases Serotonin, Bradykinin and Cytokines
Side-effects: None
Exercise
An exercise program consisting of cardiovascular and
resistance training can:
• Increase metabolism and weight loss, thereby enhancing
physical appearance and well being
• Decrease the risk for heart disease
• Reduce blood pressure and cholesterol
• Reduce certain cancers
• Promotes insulin sensitivity , thereby reducing
insulin resistance
• Improve sleep
• Increase strength and bone density
• Enhance immune function
Lifestyle modification:
1. Quit smoking
2. Ensure adequate sleep hygiene
3. Stress management
4. Weight management
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