Most Americans consider medicine the holy grail when it comes to managing everything from occasional achiness and age-related twinges to chronic severe pain. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and more potent prescription opioids (Vicodin, OxyContin) certainly have their place when it comes to treating specific types of pain, but they also carry risks…and they don’t always work.
Recent finding: New research from VA Connecticut Healthcare System and Yale School of Medicine indicates that opioids, often used to treat chronic pain in older adults, may increase risk for cardiovascular disease.
Opioids also are linked with sedation and dizziness as well as increased risks for falls and fractures, according to research from Aarhus University Hospital in Denmark…and they are known to be addictive.
As a holistic-minded physical medicine and rehabilitation physician who treats back, joint and other musculoskeletal pain, Renee Enriquez, MD, RMSK, is happy to see an increased demand from patients for nonpharmacological treatments for pain. Eastern-minded treatments, including supplements, topical therapies and even food, can complement Western medication protocols.
Here are some examples of natural painkillers that have helped Dr. Enriquez’s patients…
Turmeric, the golden-hued spice used liberally in South Asian cooking, does more than infuse food with a peppery zing. Its key ingredient, curcumin, has anti-inflammatory properties that can relieve pain in ways similar to that of NSAIDs. Regularly incorporating turmeric in meals and teas is a time-honored Ayurvedic wellness tradition. Turmeric has antioxidant, anti-cancer, anti-diabetic, anti-allergic and brain-protective properties. But to reap the consistent pain-relieving benefits of curcumin, you need much higher quantities than can be obtained via food.
Best: Turmeric supplements for painful chronic conditions such as osteoarthritis (especially knee arthritis), ulcerative colitis and Crohn’s disease. Unlike over-the-counter NSAIDs—which should not be used continuously over an extended time due to the adverse effects on kidneys, blood pressure and the gastrointestinal system (unless directed by a health-care professional)— you’ll need to take turmeric supplements daily for three to six months before seeing any improvement in pain. Choose a brand that incorporates black pepper (piperine)—look for piperine, black pepper extract or even the trademarked BioPerine on the label—and take the supplement(s) with a meal containing some fat, such as olive oil or avocado, to boost absorption. Start with 500 mg to 1,000 mg daily, and reassess your pain at three months and again at six months. If you notice relief, continue taking the supplements for a year…then stop taking them to see if your pain increases. Note: This strategy—called a wash-out—can be prudent with all supplements to avoid needless supplementation.
Caution: Supplements are not regulated by the FDA, so always look for evidence of third-party validation to ensure safety and quality, such as the US Pharmacopeia (USP) Verified Mark on the label. Consumer Reports testing has identified contaminants like lead and bacteria in some turmeric supplements. The Arthritis Foundation recommends medical-grade curcumin supplements by Thorne or Pure Encapsulations.
Side effects can include gastrointestinal discomfort and, at levels over 1,000 mg to 2,000 mg a day, heart palpitations. If you have discomfort or palpitations, stop taking the supplements. Also, because high doses of turmeric can thin the blood, people taking blood thinners such as warfarin (Coumadin) should not supplement with turmeric, nor should anyone with an upcoming surgery scheduled.
If you’ve undergone bariatric (weight-loss) surgery, especially the Roux-en-Y procedure, you’ve likely been told to avoid NSAIDs due to increased risk for ulcers. Consider curcumin supplements when seeking a nonpharmacological treatment for pain.
Oily fish, such as salmon, trout and sardines, are packed with inflammation-calming omega-3 fatty acids, which have long been studied for their potential to improve inflammatory conditions like heart disease, depression and dementia as well as arthritis and other painful conditions. In the case of rheumatoid arthritis, fish oil has been shown to reduce morning stiffness…ease joint swelling and tenderness…and reduce the need for anti-inflammatory pain medications, according to a review of studies by researchers at Asclepeion Hospital and St. Paul’s Hospital in Greece. Fish oil also is known to offer significant joint pain relief for those suffering from osteoarthritis in the knees and hips.
Besides easing inflammation, omega-3s reduce certain types of pain by improving nerve and blood vessel function. Example: Many individuals with diabetes develop diabetic neuropathy, painful nerve damage caused by chronically elevated blood sugar levels. Omega-3s help slow this nerve damage and fortify the structure of vessels and nerves. They also enhance blood circulation, meaning more oxygen and nutrients can reach cellular structures that need healing.
Best: Aim to eat several servings of omega-3–rich foods a day, including fatty fish, walnuts, flaxseeds and chia seeds, all of which include other vital nutrients that may work synergistically with the fatty acids to quell inflammation.
On days when that’s not possible, you can try a supplement—300 mg twice a day (consider Pure Encapsulations), not exceeding 2,400 mg daily. High doses can trigger atrial fibrillation (irregular heartbeat), especially in older adults with the condition. As with turmeric supplements, give it at least three to six months to see a noticeable difference.
Do an online search for “What is the strongest natural pain reliever?” and you may be surprised to see in the results this topical cream, which contains a compound found in the seeds of hot chili peppers. Using capsaicin to treat pain has been described as “fighting fire with fire,” considering that the same irritating compound that makes your mouth burn while eating spicy foods soothes pain from arthritis, backaches, everyday muscle cramps and strains, as well as postherpetic neuralgia, pain that lingers after a shingles attack. Capsaicin does this by initially activating pain fibers…then, with continued use, desensitizing them so they struggle to transmit pain signals to the brain.
Continued use is key here. Many patients quit capsaicin after a short time because it can be smelly (and can trigger coughing when deeply inhaled), and a thin film must be applied three times a day for at least three weeks before it starts to have any meaningful results. But if you stick with it, it can pay off—up to a 50% reduction in pain with regular use, according to a study by Korea’s National Leading Research Laboratory of Molecular Modeling & Drug Design at Ewha Womans University. Capzasin and Zostrix are well-respected brands. Caution: Always wash your hands after applying capsaicin cream to avoid rubbing chili pepper compounds into your eyes or nose, and don’t use it on broken skin.
Capsaicin patch for certain types of pain: The FDA has approved a prescription capsaicin patch to treat postherpetic neuralgia (post-shingles pain) and diabetic neuropathy of the feet. Worn just once for 60 minutes, the Qutenza capsaicin 8% patch can relieve pain for up to three months. In a European Journal of Pain study conducted by researchers at Finland’s Helsinki University Central Hospital, patients with peripheral neuropathic pain (such as that caused by shingles or diabetes) wore up to four capsaicin 8% patches for 30 to 60 minutes or took oral pregabalin, an anti-epileptic drug also used to treat neuropathic pain, for eight weeks. Not only were the patch users just as likely to report a 30% decrease in pain as those taking pregabalin, they experienced a faster onset of pain relief (in 7.5 days, on average, versus 36 days for pregabalin)…fewer system-wide side effects, such as dizziness and nausea…and improved treatment satisfaction. Capsaicin 8% patches also can treat chronic post-surgical pain, according to a study by researchers at Italy’s University of Campania as well as chemotherapy-induced peripheral neuropathic pain, according to researchers at Hungary’s Semmelweis University. The levels of capsaicin in Qutenza (8% versus 0.025% in over-the-counter capsaicin transdermal offerings like Aspercreme Warming and Salonpas Pain Relieving Hot) require a prescription, and patches must be applied by a health-care professional.
Important: Capsaicin 8% patches cause significant pain and burning, so your doctor likely will pretreat the area with a topical analgesic such as lidocaine, or cool the skin with a cold pack beforehand. The patches also can increase blood pressure during or immediately after treatment.
Ads for copper pain-relief bracelets claim they ease arthritis discomfort. Manufacturers purport that joint inflammation is caused by copper deficiency—a now-debunked 19th century theory known as metallotherapy. Theory: Wearing a copper wristband allows the mineral to transfer into your skin, alleviating pain.
Reality: While copper is critical for health, including the formation of red blood cells and connective tissue, there’s no evidence-based research suggesting that wearing copper jewelry translates to improved pain or stiffness. The same goes for copper-infused compression garments such as socks, gloves, and knee and elbow sleeves. If wearing these garments brings any relief, it’s likely because mild compression, with or without copper threads woven throughout the material, can feel good (it warms up tissue and increases circulation). Or it just may be the placebo effect.
