Chronic Pain

-D.S. Culp

Chronic pain is estimated to affect more than 80 million Americans. It is indiscriminate in its targets- affecting the young and the old, the rich and the poor. But few really understand the underlying processes that cause their pain and how those processes can be interrupted to provide pain relief.

What causes the sensation of pain? Arachidonic acid is a fatty acid whose levels in the blood stream fluctuate. The role of Arachidonic acid in pain and inflammation is well documented.  If circulating in the bloodstream it is capable of interacting with enzymes to produce pain causing members of the Eicosanoids family called Prostaglandins (PGE₂) and thromboxanes (TXA).   Please note that some classes of Prostaglandins ((PG1 and EIC3) are actually beneficial in the reduction of pain. Not all prostaglandins are “bad” prostaglandins. The “bad” hormone-like prostaglandin lipids stimulate nociceptors, which results in pain.

What is a nociceptor? Approximately three million pain receptors, called nociceptors, are distributed throughout the body around free nerve endings. Many are located in the skin and in muscle tissue. Nociceptors become increasingly sensitive with continued or repeated stimulation. So chronic pain results in a higher sensitivity to sources of pain and the creation of what can seem to be a never ending cycle without relief. When nociceptors are stimulated a message is sent through the spinal cord to the brain. In the brain these messages are interpreted and we experience the sensation of pain

How do pain relievers work? Most pain relievers work by interfering with the pathway of Arachidonic acid conversion to prostaglandins. Reducing, or stopping, the synthesis of prostaglandins from Arachidonic acid is usually accomplished by inhibiting the enzyme, COX or cyclooxygenase. Traditional Western medicine treats chronic pain with non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, which block all prostaglandin production, both the good and the bad. They may produce unpleasant side effects such as gastrointestinal problems, generalized bleeding, kidney and/ or liver dysfunction, and adverse skin reactions.

What are “Essential” Fatty Acids? The Essential Fatty Acids (EFA's) contain two families: Omega 3 and Omega 6. Omega 3 fatty acids are derived from alpha linolenic acid and Omega 6 fatty acids are derived from linoleic acid. Other fatty acids are derived from these two precursors.These are fats that your body must obtain from your diet because you cannot manufacture or synthesize them. Just like vitamins and minerals, they are essential to body functions, particularly cell membrane health. EFA’s  also play a role in modifiying pain. Essential Fatty Acids such as gamma- linoleic acid, or GLA, are capable of disrupting the production of prostaglandins from Arachidonic acid.  Omega 3 deficiencies manifest neurologically and may result in “tingling” sensations, poor vision, decreased immunity, and elevated cholesterol.   Omega 6 deficiencies may manifest as skin problems such as eczema, scaly skin, or dermatitis. 

How can diet affect pain? The type of fats in our diets can either promote or reduce the formation of pain causing prostaglandins. Protein sources such as red meats, chicken, and even milk, are high in saturated fats that can increase the levels of the prostaglandin precursor Arachidonic acid in our bloodstreams. Chronic pain sufferers can reduce the levels of pain creating chemicals in their bodies by altering their diets to include less saturated fat, more unsaturated fats, and more Essential Fatty Acids. With a change in diet you should also see reduced cholesterol levels. Fish, vegetables, fruits, and beans are excellent dietary sources of Essential Fatty Acids.