When I decided it was time to do some academic study, Covid created the opportunity to return to university. Throughout my postgraduate study in pain management, I was surprised to hear little about what and how we eat if in chronic pain. Exercise and movement, one of the main tenants of health, was well covered, but diet was not!
Diet is an ideal opportunity to include a chronic pain patient in their treatment, however Mendonca (2020) in their review of nutritional interventions found that
"Nutrition has scarcely been given attention, and its effects on pain have been underestimated but may become a key point in pain management." p.11
Diet and Lifestyle - An Important Aspect of Managing Chronic Pain
Diet and lifestyle is in the core DNA of naturopathy, as without looking first at how people live we cannot understand their health issues. However, perhaps more important is listening to our clients. Active listening empowers people to explore their issues, understand them and in doing so they feel enabled to be put changes into action.
Problems After Hip Replacement Surgery - Balance and Anxiety
My specialist area is chronic pain and this article tells the story of one person's chronic ongoing problems following a hip replacement that took place several years before we met. However in treating within any specialist area, it's still important not to lose that holistic viewpoint that I mentioned above, but first, I needed this client to remind me of the healing power of vegetables.
Simon (not his real name) came to me to improve his movement and mobility following hip replacement surgery. His main issues were vertigo and poor balance. These were always an ongoing concern not only throughout his workday, but also impacted his favourite hobby of mountain biking. The problems surrounding his balance were causing anxiety due to his instability; his anxiety was increasing and interfering in all aspects of his life.
One day that fear was realised, he fell off his bike in the bush, luckily he was with a group of friends. There were no major injuries; just cuts, scrapes and bruises and the challenge of getting himself, and his electric mountain bike home. Remember electric bikes are heavy!
At this time, I was seeing Simon fortnightly. But after his fall off the bike each time I saw him his injuries didn't really improve. After one consultation, I re-checked his intake form. Breakfast - cereals, lunch-sandwich, dinner-meat and veg, curry etc. At the time this food record created no "red flags" or concern.
Vitamins And Minerals Improve Healing Time And Reduce Pain
However, poor healing suggests your body is lacking the nutrition needed for self-healing, that is the body repairing itself as it does in any self-limiting illness. Therefore I needed to dig deeper into Simon's diet, so I asked him to keep a food diary. Result? No vegetables, just meat with potatoes, rice or pasta. Is it no wonder his injuries were not healing? Our bodies need the micronutrients from a range of fruit and vegetables.
I learnt this lesson well. Whatever issues your clients are presenting discuss their diet and if in doubt ask for a food diary to be kept. You may only need this for a week. And remember, be understanding if a client doesn't get around to filling in the diary or it gets forgotten.
There is an awful lot of confusion around what we should eat, and the marketing that bombards us each day. As naturopaths, we specialise in food and ways to eat but we may initially be dealing with clients who are very confused and worried about sharing with us details of their actual diet.
Nutritional Advice Not Included In Most Pain Management Programmes
Recently, I completed postgraduate study in pain management at Otago University. Within the global multidisciplinary approach to chronic pain Mendonca et al. (2020) found little or no attention has been given to nutrition, underestimating the impact of vegetables and fruit on pain.
Their multidisciplinary teams rarely include a dietician or naturopath, basically because diet is not an issue considered by most chronic pain specialist. But how can your body handle chronic or persistent pain if it is nutrient deficient? This omission is unfortunate as Elma (2020) stresses that poor diet can be, not just an underlying factor in chronic musculoskeletal pain but also prolong its duration.
A Balanced Diet Is An Important Treatment For Relieving Chronic Pain
My second story is about chronic pain, phantom pain, at times unbearable. However following my experience with Simon, and knowing how little emphasis pain specialists put on diet, this time I'd be checking his veggie intake. There are many people who have no knowledge of what to expect when visiting a naturopath for the first time. They may be quite concerned, thinking we are going to put them on a gluten-free or dairy free diet, so reassurance is often first step.
The following quotes from this client, give credence to this lack of knowledge.
" I had never worked with a natural therapist or even knew what it involved so I was quite curious"
" It would be fair to say some of Jean’s methods seemed a little ‘out there’ to begin with, but to my pleasant surprise they seemed to be working."
My first step with each new chronic pain client is listening and an extended discussion necessary to get a full history, not only about their pain but perhaps the causes of this chronic pain due to what has happened previously in their life.
Time For The 'What do you eat?' Question
Generally, the expectation of someone with chronic pain is they are looking to be pain-free, for you to take away their pain. I decided to wait it would be a good idea to wait until the second appointment to begin the food talk with this client.
Even I was surprised. It seemed his diet was mostly from the local Chinese takeaway, especially when his children came to stay as it provided an easy, quick option. As it was their local Chinese takeaway, he had trained them to his preferences.
His Diet Included No Vegetables
That preference was mostly chicken, and either fried rice or noodles but positively no vegetables. As he had severe phantom pain, this time I didn't mess about but stated categorically 'you have to eat your vegetables.'
One of the reasons he came to me was the actual severity of his pain for which pain specialist could offer nothing to help. So homework, each week, was to add at least one new vegetable to his diet.
It wasn't easy, he wasn't happy but the family came on board sending me pictures of the vegetables he was eating. Months later he and his partner called in on their way to the food market. They had done local research to found the cheapest places in town to buy real vegetables that they cooked at home. Great news!
Therefore if you suffer from chronic pain, even though none of your specialists has talked about the food you eat, it's time for you to assess how and what you eat. Brain et al. (2021) agree with me, start improving your diet by adding vegetables - fresh, frozen or canned depending on your budget and access.
The more colours you can find and put on your plate the better.
This article is the personal opinion of the author, Jean Jordan who is a natural therapist who works online with people who have chronic pain and related stress and anxiety.
Learn more about Jean and discover her philosophy and holistic approach.
References:
Brain, K,. Burrows, T. L., Bruggink, L., Malfliet, A., Hayes, C., Hudson, F. J., Collins, C. E. (2021). Diet and Chronic Non-Cancer Pain: The State of the Art and Future Directions. Journal of Clinical Medicine, 10(21), 5203.
Elma, Ö.,Yilmaz, S. T., Deliens, T.,Clarys, P., Nijs, J., Coppieters, I., Polli, A., Malfliet, A. (2020). Chronic Musculoskeletal Pain and Nutrition: Where Are We and Where Are We Heading? The journal of injury, function, and rehabilitation, 12(12), 1268-1278
Mendonca, C. R., Moll, M., Castro, M.C.R., Silveira, E. A. (2020). Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review. Nutrients, 12(10), 3075.
Jean Jordan
Want to find simple effective ways to reduce your chronic pain and improve your symptoms without increasing your stress and overwhelm? This is where I can help! Ideas can be found in the articles on my website. You can sign-up to regular updates or spend time using some of the collection of self-help techniques. After over 20 years of having my own pain clinics pain I started Natural Pain Solutions online business to reach more people, rather than one person at a time. Therefore when I completed my postgraduate pain management studies I wanted to spread the word about holistic self-help techniques that people can use at home. Learn more about me here.