Welcome to episode 482 of The Whole View! This week, Stacy and Dr. Sarah break down Sarah’s top 3 natural strategies for pain management and how each can be used in addition to or even in place of a prescribed pain plan.
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The Whole View, Episode 482: Natural Pain Management Strategies
Today’s listener question comes from Nicole- a long-time listener and Dr. Sarah’s Social Media Manager! (1:20)
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Hi Dr. Sarah and Stacy. My question is – how to begin the AIP without NSAIDs? I understand why removing them is critical – to recognize what foods and lifestyle components may drive inflammation. However, osteoarthritis is in both knees with the right one being bone on bone and in the cervical area, again with the right side being worse.
Generally, I use aleve for pain and if I don’t have to travel or go in the office, I either don’t use it or use one instead. But with job sites reopening, I have had to use them more frequently and I have a bit of travel for my job. Oh, I’ll also mention that at one point, my CRP level was 41 and at last test a couple of years ago, it was down to 19. So I’m open to any suggestions on how to better manage the health challenges so I can begin AIP properly. Thanks so much!
I take supplements including vitamins c and d, both of which are to reduce C-reactive protein. I strive for 8 hours of sleep though it’s mostly interrupted and have year round allergies for which I currently receive allergy shots. I also manage PCOS and osteoarthritis.
Avoiding NSAIDs on the AIP
Nonsteroidal anti-inflammatory drugs (NSAIDs) include many common over-the-counter medications, the three most common of which are acetylsalicylic acid (aspirin), ibuprofen (Advil, Motrin, Nurofen, etc.), and naproxen (Aleve, Midol, etc.) (3:59)
These are routinely prescribed in higher doses to manage pain and reduce inflammation.
However, they have a high incidence of gastrointestinal side effects. The reason for this is that NSAIDs cause damage to the intestinal barrier, and their chronic use carries significant risks of ulcers, hemorrhage, and perforation (a rip or tear in the intestine).
There are several ways NSAIDs harm gut health.
- The enzyme that OTC NSAIDs inhibit cyclooxygenase-1 is important for maintaining the integrity of the gut’s mucous layer. (This is why prescription COX-2 inhibitors have fewer gut side effects)
- NSAIDs activate mast cells which downregulate tight junctions proteins (ZO-1, claudin-1, occludin) and cytoskeletal proteins (tubulin and keratin)
- NSAIDs have a direct effect on tight junction proteins, increasing intestinal permeability.
- They also cause changes in blood flow in the capillaries that supply blood to the tissues of and surrounding the gut, weakening the gut barrier.
- NSAIDs seem to increase the production of leukotrienes, causing the activation and recruitment of neutrophils from the blood, which may contribute to the gastrointestinal damage caused by NSAIDs.
However, medication does not mean admitting failure, and there is still a time and a place for NSAIDs, for example when used as blood thinners.
In some autoimmune diseases, like antiphospholipid syndrome, daily baby aspirin is often suggested to prevent blood clots which can be life-threatening.
It is exceptionally important to work with your doctor if you want to wean off aspirin in this case because removing blood thinners that are treating a clotting disorder can be dangerous.
As a reminder, Stacy and Dr. Sarah are not medical professionals! So, be sure to involve your primary care doctor in all of your medical decisions.
The Role Sleep Has in Pain Management
Sleep restriction increases pain sensation in something called a hyperalgesic effect. (12:31)
Getting more sleep reduces pain sensitivity and was first studied in humans in 2012!
Researchers randomized healthy volunteers (n = 18) into 4 nights of extended 10-hr bedtimes (EXT) or 4 nights of diary-reported habitual bedtimes (HAB).
On day 1 and day 4 they received a standard MSLT (10:00, 12:00, 14:00, and 16:00 hr) and finger withdrawal latency pain testing to a radiant heat stimulus (10:30 and 14:30 hr).
During the four experimental nights, the EXT group slept 1.8 hours per night more than the HAB group, and the average daily sleep latency on the MSLT increased in the EXT group, but not the HAB group.
Similarly, finger withdrawal latency was increased (reduced pain sensitivity) in the EXT group but not the HAB group. The nightly increase in sleep time during the four experimental nights correlated with the improvement in MSLT, which correlated with reduced pain sensitivity.
This was the first data to show that an extended bedtime in mildly sleepy healthy adults resulted in increased sleep time and reduced sleepiness and pain sensitivity.
More Science for Sleep and Pain Management
A 2020 systematic review showed the commonly accepted 8 hours a night isn’t enough.
In human studies, researchers found a normalization of pain processing following one or two nights of unrestricted recovery sleep (as in sleeping as long as you want).
But, when they restricted recovery sleep to 8 hours per night, they discovered two nights were not sufficient to reset hyperalgesic pain changes.
Why? Well, deep sleep is important! Studies show that slow-wave sleep impacts the overnight normalization of pain processing.
One pathway is likely opioid receptors, and studies show that opioids are more effective at mitigating pain when patients get enough sleep.
Altogether, a reset of hyperalgesia during RS (produced by extended phases of wakefulness before RS) seems to be mainly driven by the recovery of sleep continuity. Additionally, rebounds of SWS, chronobiological stabilization, and enhanced serotonergic transmission may play a role.
Stacy and Dr. Sarah covered all the ways to improve sleep on the podcast before, but they suggest listening to episodes:
- Practical Tips for the Sleep Stress Cycle
- What’s the Deal with Those Funny Amber Glasses?
- Is Melatonin Safe?
However, it’s important to note pain can disrupt sleep. So, sometimes the first step to the snowball of badness is proper pain management!
Dr. Sarah has three strategies to suggest for pain management: CBD, turmeric, and red light therapy. They work through different mechanisms and can also be combined.
CBD for Pain Management
There’s quite a lot of science showing that CBD (without THC) is very effective at reducing pain in addition to its anti-inflammatory properties. (23:18)
This works because the endocannabinoid system is the interface between pain sensation and emotional and physiological responses to that pain. In addition, maladaptations to chronic pain (such as depression, anxiety, gastrointestinal issues, and insomnia) are also mediated by this system.
CBD binds with endocannabinoid receptors to modulate this system, which directly reduces pain sensation through a secondary influence via anti-inflammatory and immune-modulatory effects.
So far, CBD (without THC) has been shown to reduce pain in sclerosis, spinal cord injury, brachial plexus injury, limb amputation, pain associated with kidney transplantation, fibromyalgia, and non-cancer chronic pain.
The dose is probably individualized, but a good place to start is 10 to 15 mg twice daily.
In a 2020 study, researchers gave 97 patients using opioids for chronic pain for at least one year 15 mg of CBD twice daily. Over half of the patients (53%) reduced or eliminated their opioids within 8 weeks after adding CBD to their regimens.
In addition, almost all (94%) reported quality of life improvements, including better sleep, with some being able to eliminate anxiety and sleep medications too.
What Stacy and Dr. Sarah Recommend
Stacy and Dr. Sarah covered this in-depth in Episode 420: CBD for Pain Management.
As for a specific recommendation, their go-to is One Farm CBD products because their USDA organic hemp oil is top quality. Flavored with organic essential oils like peppermint oil and cinnamon oil, there are no wonky ingredients (like Stevia!).
It’s so high quality (it has no harsh hemp aftertaste, is light in color, and it never contains any particulates) that unflavored is my preference!
- Link: onefarm.com/thewholeview/
- Deal: 15% off with WHOLEVIEW
Turmeric for Pain Management
Turmeric is rich in a phenol called curcumin, which has potent anti-inflammatory effects via inhibiting cyclooxygenase (COX)-2 that make it comparable to pharmaceutical NSAIDs. (38:10)
For example, Celebrex is a COX-2 inhibitor, while all OTC NSAIDs inhibit both COX-1 and COX-2.
Studies have compared curcumin to phenylbutazone in rheumatoid arthritis patients and people healing from hernia surgery and found the curcumin was just as effective as the NSAID treatment.
By inhibiting COX-2 regulates several transcription factors, protein kinases, adhesion molecules, cytokines, and enzymes involved in inflammatory processes.
- The analgesic effect is via inhibiting COX-2, thus preventing the production of prostaglandins that sensitize the afferent nociceptors at peripheral sites of inflammation.
- There may also be a central mechanism of analgesia (why NSAIDS are synergistic with opioids).
BUT, there are benefits beyond COX-2 inhibition. Curcumin is also a powerful antioxidant. It can reduce lipid peroxidation by supporting antioxidant enzymes (superoxide dismutase, catalase, and glutathione peroxidase), which play an important role in regulating lipid peroxidation.
There’s also some in-vitro evidence that curcumin can scavenge oxygen-free radicals (like superoxide anions and hydroxyl radicals) and nitric oxide involved in the initiation of lipid peroxidation.
And, while NSAIDs can increase intestinal permeability (at least COX-1 inhibitors), curcumin can help restore the gut’s epithelial structure and reduce intestinal permeability, especially after an intestinal injury. In addition, some studies suggest it can counteract changes in the barrier function induced by a Western Standard Diet.
Why Tumeric Over Curcumin?
The reason why it’s better to take turmeric as a supplement rather than curcumin is because it’s rich in other antioxidant polyphenols, and too much curcumin can be harmful. Several clinical studies using 3.6 to 8 grams of curcumin supplements each day resulted in nausea and diarrhea in some participants.
Turmeric is typically about 3% curcumin by weight, which translates to 120 grams of turmeric, or about 13 tablespoons!!!
Also, ginger, black pepper, and fats increase the absorption of turmeric phytonutrients, including curcumin. So while black pepper isn’t technically AIP, this is a situation where the tradeoff is a good one (unless you’re overtly intolerant to black pepper).
Other Anti-Inflammatory Superfoods
Stacy asks: if we extrapolate this to other anti-inflammatory superfoods, like cinnamon? What else may be dietary supports?
Curcuminoids are a class of non-flavonoid polyphenols found in turmeric (the main ones are curcumin, demethoxycurcumin, and bisdemethoxycurcumin). They’re pretty special in the phytonutrient world.
Cinnamon contains coumarins, a class of non-flavonoid polyphenol with analgesic properties. Some coumarins work by inhibiting COX-2, but other mechanisms too, like inhibiting NOS, TNF-alpha, IL-1beta, and an increase in SOD.
There are some other phytonutrients with pain-relieving properties:
- Beta-caryophyllene is a sesquiterpene found in black pepper, cloves, hops, caraway, lavender, cinnamon, oregano, basil, ylang-ylang, rosemary, and cannabis.
- Anthocyanidins and Anthocyanins are the main class of flavonoid polyphenols that give purple fruits and vegetables their color, which has pain-relieving properties due to an affinity for certain “pain-sensation” cell membrane receptors in the brain.
- Dillapiole is a natural monophenol found in dill weed and fennel that possesses anti-inflammatory and pain-relieving properties.
- Thymol is a monoterpene with analgesic properties found in thyme, star anise, oregano, bee balm, and marjoram.
What Stacy and Dr. Sarah Recommend
For Stacy and Dr. Sarah’s specific recommendation, try Paleovalley Turmeric Complex, which delivers a moderate (but not too-high) dose of high-quality whole organic turmeric. It’s combined with black pepper, ginger, and coconut oil to aid absorption, and rosemary and cloves as additional sources of anti-inflammatory phytonutrients.
- Use code “thewholeview” at checkout to receive 15% off your first order!
Joovv & Red Light Therapy for Pain Management
And finally, Joovv red and near-infrared light therapy. (46:30)
Specific wavelengths of light cause a photochemical reaction within our cells; chromophores (which are responsible for a molecule’s color) in our mitochondria absorb photons from red and infrared light, causing electrons in those chromophores to get excited and jump into a higher-energy orbit.
As a result, our body can use this new stored energy for various cellular tasks, which then have wide-ranging benefits for our health.
In fact, the increased cellular metabolism (from an up to 200% increase in ATP production!) means that beneficial proteins can be synthesized, beneficial genes can be turned on, and cellular health, in general, can be improved!
Among the proven benefits are various skin benefits, weight loss, oral health improvement, improved muscle recovery, better sleep quality, better mental health, regulated stress response, enhanced thyroid health, reduced joint pain and reduced inflammation, speedy wound recovery, and more!
Studies are showing red, and near-infrared light therapy can reduce pain caused by fibromyalgia, chronic back and neck pain, joint pain including from injury and arthritis (rheumatoid arthritis and osteoarthritis), orthodontic procedures, cancer, temporomandibular disorders, systemic sclerosis, sciatica, diabetic neuropathy, and burning mouth syndrome!
And, there are clinical trials in the works for other painful chronic conditions, like multiple sclerosis.
Why Red Light Research Is Important
However, for red light therapy to effectively reduce pain, several variables (including power density, wavelength, dosage, and pulse structure) must be in an optimal “sweet spot” that delivers the therapeutic benefit.
The best absorption by our tissues peaks in the ranges of 660-670 nm and 830-850 nm.
Also important, if the light being used doesn’t have enough irradiance (or the time it’s applied for is too short), there won’t be any therapeutic response. In other words, dialing all these factors to the sweet spot is pretty critical!
Studies that evaluate wavelengths outside of the sweet spot show mixed results, and studies with low irradiance also show mixed results.
What Stacy and Dr. Sarah Recommend
Currently, Joovv is the main consumer product on the market that optimizes all the variables needed to hit that therapeutic window.
Dr. Sarah also appreciates the fact that Joovv’s product development is rooted in up-to-date science. Each generation iterate to improve both the experience of using their device and the therapeutic benefits.
Many other products out there use dosages and power outputs that are too low to achieve benefits, don’t use the right wavelengths, or target large enough areas of our bodies.
For more, see Joovv Red Light Therapy for Pain Management and Episode 315: The Scoop on Red Light and Infrared Therapy
- Code WHOLEVIEW for $50 off your first purchase
Honorable Mention: Collagen
It’s not on Dr. Sarah’s top 3 list, but as someone with joint issues and a history of arthritis in her family, collagen is HUGE in her pain reduction.
When she first started adding it as a supplement years ago, she noticed her knees stopped “popping” when she walked. She wasn’t even 30 at the time and had had “snap, crackle, pop” joints since her teen.
She even saw a chiropractor for scoliosis in middle and high school. It’s why she became the “Bone Broth Lady,” she couldn’t get enough! So in Stacy’s book, collagen deserves an “honorable mention.”
She and Dr. Sarah both use and love PaleoValley Bone Broth Powder!
Final Thoughts on Pain Management
The great thing is that they work through different mechanisms so the benefits can be layered.
Stacy reiterates that if you’re doing all these things and still in pain – TAKE MEDICINE.
The stress of chronic pain on the body can have exponential negative repercussions. Stacy struggled with debilitating back pain, trying to avoid medication but in too much pain to do physical therapy or the things she needed to get healthy.
For more on chronic stress, see TWV Podcast Episode 479: Stress, Coffee, Breakfast, and Walking.
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