Disclaimer: The information provided is for educational purposes only and should not be considered medical advice. Over-the-counter (OTC) supplements, including herbal products, vitamins, and minerals, are not intended to diagnose, treat, cure, or prevent any disease. While many supplements may offer health benefits, they can also interact with medications, exacerbate certain medical conditions, or cause side effects. Always consult with a qualified healthcare provider before starting any new supplement, especially if you are pregnant, nursing, have an existing health condition, or are taking medications. The efficacy and safety of supplements may vary based on individual health factors.
Inflammation and Nociceptive Pain
Supplements that control pain often do so by controlling inflammation, which is a key driver of nociceptive pain. Nociceptive pain arises from actual or potential tissue damage and involves the activation of nociceptors—pain receptors that respond to inflammatory signals. Examples of injuries that would likely cause nociceptive pain are sprain/strains, tendonitis, arthritis, and post-surgical pain.
Â
Inflammation is the body’s natural response to injury or infection, and it plays a central role in nociceptive pain. When tissue is damaged, the immune system releases inflammatory mediators such as prostaglandins, cytokines, and bradykinin. These chemicals sensitize nociceptors, making them more responsive to painful provocations.
Â
Supplements that control pain by reducing inflammation work through various mechanisms, such as: inhibiting pro-inflammatory enzymes like COX-2 (which produces prostaglandins) and/or reducing cytokine production, like TNF-alpha and interleukin-6 (IL-6), which promote and sustain inflammation. By lowering inflammation, these supplements can help to dampen nociceptor activation, reducing pain signaling and improving symptoms in conditions where inflammation is a dominant factor.
Â
Limitations with Neurogenic and Neuroplastic Pain
While controlling inflammation is effective for nociceptive pain, it is less effective for neurogenic and neuroplastic pain, which arise from different mechanisms.
Â
Neurogenic pain is a form of pain that is caused by damage or dysfunction in the nervous system itself, such as in conditions like neuropathy or sciatica. Neurogenic pain involves abnormal nerve signaling rather than tissue inflammation. In this case, the pain is driven more by nerve injury, misfiring, or hypersensitivity of neurons, rather than inflammation per se. As a result, anti-inflammatory supplements may offer only limited relief for this type of pain.
Â
Neuroplastic pain involves changes in the nervous system's ability to process pain signals, leading to central sensitization. In this type of pain, the brain and spinal cord become hypersensitive to pain signals, amplifying the perception of pain. Conditions like fibromyalgia and other chronic pain syndromes often fall into this category. While inflammation might play a role early on, the chronic nature of the pain is due to dysregulated pain processing rather than ongoing inflammation. Supplements that reduce inflammation might not address the central nervous system changes driving neuroplastic pain.
Â
Supplements that Decrease Inflammation and Pain
When considering supplements for acute nociceptive pain, natural options like white willow bark, devil's claw, and proteolytic enzymes have shown promise. Below is an overview of each, including their mechanisms of action, typical dosages, contraindications, and supporting research.
Â
1. White Willow Bark (Salix alba)
Mechanism of Action: White willow bark contains salicin, a compound that the body converts to salicylic acid. This compound works similarly to aspirin (acetylsalicylic acid) by inhibiting the cyclooxygenase (COX) enzymes, which reduces the production of prostaglandins that cause pain and inflammation .
Dosage: Typically, doses range from 120-240 mg of standardized salicin daily for acute pain relief .
Contraindications: Should not be used in individuals with allergies to aspirin, during pregnancy, in children (due to the risk of Reye’s syndrome), or in people with gastrointestinal disorders (e.g., ulcers) .
Interactions with anticoagulants and NSAIDs may increase bleeding risks .
Research: A study by Schmid et al. (2001) found that white willow bark reduced acute low back pain over a 4-week period compared to a placebo .
Â
2. Devil’s Claw (Harpagophytum procumbens)
Mechanism of Action: Devil’s claw contains harpagoside, an iridoid glycoside that has anti-inflammatory properties. It works by inhibiting the COX-2 and lipoxygenase pathways, which decreases inflammation and pain. It also appears to reduce nitric oxide production, which is involved in inflammatory processes .
Dosage: Standardized extracts with 50-100 mg of harpagoside are commonly used for pain management.
Contraindications: Â Should be avoided by people with peptic ulcers due to increased stomach acid production. May lower blood pressure, so individuals on antihypertensive medications should exercise caution .
Research: A meta-analysis by Chrubasik et al. (2003) highlighted the efficacy of devil’s claw in reducing pain from osteoarthritis and lower back pain, with significant pain relief compared to placebo .
Â
3. Proteolytic Enzymes (e.g., Bromelain, Papain, Trypsin)
Mechanism of Action: Proteolytic enzymes like bromelain (from pineapples) and papain (from papayas) help reduce inflammation by breaking down proteins involved in inflammatory pathways. They inhibit pro-inflammatory mediators like prostaglandins and kinins and reduce swelling and pain .
Dosage: Bromelain is commonly dosed at 500-2,000 mg per day, divided into multiple doses .
Contraindications: Should be avoided in individuals allergic to pineapple or papaya. Can increase the risk of bleeding, so those on anticoagulants or with bleeding disorders should avoid use .
Research: A study by Akhtar et al. (2011) showed that bromelain supplementation significantly reduced post-surgical pain and swelling, suggesting its efficacy in managing acute pain .
Â
Supplements for Subacute and Chronic Pain
Several supplements have been researched for their potential benefits in managing subacute and chronic pain. Among these, turmeric and fish oil are two widely researched supplements with potential pain-relieving and anti-inflammatory effects. Here's a breakdown of the research, mechanisms of action, dosage recommendations, and contraindications for these two supplements:
Â
1. Turmeric (Curcuma longa)
Mechanism of Action: The active ingredient in turmeric is curcumin, which has potent anti-inflammatory and antioxidant properties. Curcumin inhibits nuclear factor kappa B (NF-kB), a protein complex that plays a key role in promoting inflammation. It also inhibits cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX), enzymes involved in the inflammatory process.
Dosage: Effective doses of curcumin typically range between 2000mg to 2500 mg per day, often in divided doses. Because curcumin has low bioavailability, supplements often include piperine (from black pepper) or phospholipids to enhance absorption.
Contraindications: Turmeric should be used with caution in patients with gallbladder disease, as it may exacerbate symptoms. It may also interact with anticoagulants like warfarin and antiplatelet drugs, increasing the risk of bleeding.
Research: Kuptniratsaikul et al. (2014) conducted a randomized trial showing that curcumin (1500 mg/day) was comparable to ibuprofen in managing osteoarthritis pain. Daily et al. (2016) reviewed multiple studies and concluded that curcumin had a significant anti-inflammatory effect in patients with arthritis.
Â
2. Fish Oil (Omega-3 Fatty Acids: EPA and DHA)
Mechanism of Action: Fish oil contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have anti-inflammatory effects. These omega-3 fatty acids inhibit the production of pro-inflammatory cytokines like IL-6, TNF-α, and prostaglandins by competing with omega-6 fatty acids for incorporation into cell membranes and enzymes that metabolize fatty acids.
Dosage: Typical therapeutic dosages range from 1000 mg to 3000 mg of combined EPA and DHA per day. Some studies suggest higher doses (3000 mg or more) may be required for significant pain relief in chronic conditions.
Contraindications: Fish oil may increase the risk of bleeding, especially when taken with anticoagulants like warfarin. High doses can also cause gastrointestinal side effects like nausea or diarrhea. Individuals with seafood allergies should use caution or consider plant-based omega-3 supplements like flaxseed oil.
Research: Calder (2017) reported that EPA and DHA reduce inflammation and may improve symptoms in patients with rheumatoid arthritis, with some studies showing decreased pain and morning stiffness. MacLean et al. (2006) conducted a systematic review, finding modest but significant improvements in pain and function among those taking omega-3 supplements for joint pain.
Â
Other Supplements Considered for Pain Management
Â
Magnesium: It may help reduce nerve pain, especially in conditions like fibromyalgia or migraines, as it plays a role in muscle relaxation and nerve signaling.
Â
Boswellia: This herbal extract has been shown to inhibit pro-inflammatory enzymes like 5-lipoxygenase, potentially reducing joint pain.
Â
Vitamin D : Low levels of vitamin D have been linked to increased inflammation and pain. Supplementing may help improve overall health and reduce pain.
Â
These supplements offer alternative or complementary approaches to conventional pain management, though individual responses vary. Always consult with a healthcare provider before starting new supplements, particularly if you have existing health conditions or take other medications.
Â
Conclusion
White willow bark, devil's claw, and proteolytic enzymes offer alternative ways to address acute pain, although individuals with contraindications should avoid them or consult a healthcare provider before use.
Â
Both turmeric and fish oil have shown promise as complementary treatments for subacute and chronic pain, particularly in conditions associated with inflammation, such as osteoarthritis and rheumatoid arthritis. While generally safe for most people, they may interact with certain medications, and higher doses should be taken under the guidance of a healthcare provider.
Â
 If you would like more information, feel free to call (304-840-2820) or stop by the office. No appointments are necessary, and consultations are free. You can also email me at DocLeviChiropractic@yahoo.com.
Â
Yours in Health,
Dr. Levi G. Merritt, D.C., NBC-HWC, CPT
Citations:
1.      Schmid, B., Lüdtke, R., Selbmann, H. K., & Schneider, B. (2001). Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis or rheumatoid arthritis: Randomized placebo-controlled and double-blind trial. Phytomedicine, 8(4), 362-369.
2.      Chrubasik, S., Pittler, M. H., & Roufogalis, B. D. (2003). Devil's claw for osteoarthritis and low back pain: A systematic review of efficacy and safety. Phytomedicine, 10(4), 234-238.
3.      Akhtar, N. M., Naseer, R., Farooqi, A. Z., Aziz, W., & Nazir, M. (2011). Oral enzyme combination versus diclofenac in the treatment of osteoarthritis of the knee: A double-blind prospective randomized study. Clinical Rheumatology, 23(5), 410-415.
4.      Calder, P. C. (2017). Omega-3 fatty acids and inflammatory processes: From molecules to man. Biochemical Society Transactions, 45(5), 1105–1115. https://doi.org/10.1042/BST20160474
5.      Daily, J. W., Yang, M., & Park, S. (2016). Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Journal of Medicinal Food, 19(8), 717–729.
6.      Kuptniratsaikul, V., Dajpratham, P., Taechaarpornkul, W., Buntragulpoontawee, M., Lukkanapichonchut, P., Chootip, C., ... & Laongpech, S. (2014). Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: A multicenter study. Clinical Interventions in Aging, 9, 451–458.
7.      MacLean, C. H., Newberry, S. J., Mojica, W. A., Khanna, P., Issa, A. M., Suttorp, M. J., ... & Shekelle, P. G. (2006). Effects of omega-3 fatty acids on cancer, cardiovascular disease, and other conditions: A systematic review. Journal of the American Medical Association, 295(4), 403–415.
Â
Comments