Can Nutraceuticals Reduce the Burden of Chronic Back Pain?

Nutraceuticals, which include dietary supplements, functional foods and fortified foods, have been part of medical traditions in China, India, and Native American cultures for centuries. They are frequently used to treat various types of infection, inflammation and pain. There is abundant anecdotal evidence for their efficacy along with some clinical trials. Given that prescription pain medications such as opiates and NSAIDs have concerning side effects, particularly if they are used long-term, nutraceuticals certainly deserve consideration.

However, there are some challenges involved in deciding what to try. First, these substances are not approved for use as drugs by the FDA, so formulation and manufacturing are not federally monitored. Therefore, consumers must be more diligent in finding good quality products. The recommendations of a naturopathic physician can be invaluable here. On a similar note, there may be drug-drug interactions between nutraceuticals and prescription medications. Once again, consult a naturopathic physician for additional information.

Some nutraceuticals (e.g., vitamins and minerals) can be obtained through eating a healthy diet. Unfortunately, the typical Western diet lacks adequate amounts of crucial vitamins and minerals such as A, B-complex, C, D, E and K, Omega-3 fatty acids, magnesium, calcium, etc. In addition, the Western diet is high is refined starches, sugars and trans fats, all of which not only contribute to overweight and obesity, but also to systemic inflammation which in turn drives chronic pain. A simple rule of thumb is to make your plate half fruits and vegetables as recommended by the government’s MyPlate food plan. Produce can be expensive, so a good strategy is to visit local farmer’s markets and buy what’s seasonal.

Examples of functional foods include curcumin (found in turmeric); resveratrol found in grapes, grape juice, peanuts and certain types of berries, and Omega-3 fatty acids: all known inhibitors of inflammatory substances in the body. Seeds, nuts, almonds and soybeans are sources of phenylalanine, known to increase the release of enkephalins in the dorsal horn of the spinal cord, to increase the body’s endogenous opiate activity (Casale, Symeonidou et al., 2021). Selenium, found in Brazil nuts, meat, fish and eggs has antioxidant properties, regenerates vitamins C and E in the body and boosts the immune system. Some research in animals also suggests that selenium can have an analgesic effect for systemic pain. Magnesium is an extremely important mineral, available in whole grain products, brown rice, fish, meat and dairy. Magnesium deficiency can result in severe muscle cramps. It has also been used intravenously for the treatment of migraine headache (Don Selvey, NMD, private conversation, March, 2023).

Palmitoylethanolamide or PEA has been used to treat back pain and sciatica for decades. A post hoc analysis of a large controlled clinical trial (Cruccu, Di Stefano et al., 2019) confirmed that PEA was extremely effective on pain and function in the treatment group. Authors of the post hoc study emphasized PEA’s good safety profile on top of its efficacy for treating chronic pain. For more information on nutraceuticals consult Chapter 7 of Chronic Back Pain: A Self-Management Framework, available as a free download on this website.


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