Diet and Pain

In this post I will be focusing on dietary changes to manage pain. This is a very common thing that patients ask me about, as it is something they can take charge of at home.

The relationship of diet and pain is a very complicated subject that ultimately depends on the individual specifics of the patient’s case. I’m going to try to provide an overview of some evidence-based ways that diet can be used to improve pain, but I’m also going to touch a little bit on obesity first.

For me, the most obvious way that diet can and should be used to assist with pain management is a focus on weight loss/management if a patient is overweight or obese. Unfortunately, although we all like to think that if we just exercise more, we can eat what we want, newer research is coming out to suggest that the majority of weight loss starts with what we are eating.

I think I am doing my patients a disservice if I don’t discuss with them how their obesity is affecting their pain, even though sometimes these conversations can be difficult to have. We can all understand how mechanically, it is not good for the spine and the joints to be subjected to the additional daily stress of extra weight. There is also emerging research that suggests that fat itself may have inflammatory mediators that can cause pain. It is very important for patients with pain to address their weight if it is over a healthy amount. I am fortunate that my practice has a nutritionist, and so I refer patients for an evaluation and treatment plan. Losing weight requires major lifestyle changes, and so I feel it is very important that I remain an active partner with my patients in moving gradually towards their goals.

Aside from weight management in general, there are specific diets that are getting interest in pain management research. The first diet I will touch upon is called a low FODMAP diet. A FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, which are chemicals in foods that are poorly absorbed and fermented by bacteria in our guts. There is good evidence to support the use of a low FODMAP diet in patients with irritable bowel syndrome- about 70% of patients experience an improvement in both abdominal pain and bloating with this type of diet.

Patients ask me a lot about low carbohydrate high fat (LCHF) diets, and ketogenic diets for pain management. The evidence is in its very early stages and appears to be somewhat mixed at this point. There are some, mainly animal studies, which suggest that a high fat diet may cause increased sensitivity to pain. However, a different animal study, which looked at a ketogenic diet, (high fat but also very restrictive in carbohydrates), found that these mice did not develop the same pain sensitivity. Additionally a study of migraine patients found that a low glycemic index diet (more in keeping with a ketogenic diet) reduced the frequency and severity of attacks. So, it is possible that while a high fat diet may not be good for pain, high fat intake as part of a ketogenic diet may be helpful.

Another diet that patients ask me often about with regard to pain is a plant based diet. Again, higher quality studies are needed, but there is some evidence to suggest that a plant based diet may be beneficial for chronic musculoskeletal pain. This type of diet may also be beneficial for pelvic pain resulting from endometriosis, as one study examining women with endometriosis found that red meat intake was correlated with risk of endometriosis, and another larger study supported this and also found that vegetable intake was negatively correlated with risk of endometriosis. A different study looking at a plant based diet for patients with diabetic neuropathy found an improvement in pain, but it is hard to say if this is related to better control of the diabetes with this diet or a unique mechanism for pain.

Many of my patients also ask about an “anti-inflammatory” diet for pain. The problem with this, and the studies on this, is that we haven’t yet agreed upon what an anti-inflammatory diet is! Does it mean just incorporating more herbs/compounds that help with pain/inflammation, like turmeric/curcumin? (See my prior post on herbs for pain here) Does it mean cutting out gluten, which can be pro-inflammatory for certain people, or dairy? Is this really a plant-based diet since meat may cause inflammation? A lot more research is needed into this topic!

Overall, I try to steer people in the direction of what is supported by the existing evidence and what makes sense for their individual symptoms, while focusing on healthy weight loss if that is what is needed. If people want to try elimination diets to see if certain foods are triggers for pain, I also try to support that as well, with the caveat that the more restrictive a diet is, the less likely it is for the diet to become a long-term habit.

As you can see, the relationship of diet to pain is very complex and needs a lot more investigation! If you’re wondering if you should change your diet to help with your pain, the best place to start is by seeing a pain management doctor in person. Don’t forget to subscribe so you never miss a new post!