By Robert R. Ballentine
Chronic pain is caused by a wide variety of diseases and syndromes. If you suffer chronic pain and don't know its cause, you should have a complete examination to determine an accurate diagnosis. Fibromyalgia, osteoarthritis, carpal tunnel syndrome and thoracic outlet syndrome are just a few of the diseases and syndromes that cause chronic pain. While chiropractic, acupuncture, physical therapy, medications and surgery are the most commonly prescribed treatments, diet and nutrition may also play an important role in pain management.
The first half of this article deals with the biology of cells and pain. I'll explain how various substances, like white table sugar, coffee, chocolate and saturated fats (fatty acids) greatly impact and increase pain.
The two most common causative chronic pain factors I see in my office are fibromyalgia and osteoarthritis. I will explain the two maladies and share some of the dietary suggestions that have helped my patients control and decrease the debilitating effects of chronic pain. Since certain foods have a specific effect on pain, I will offer some alternate food choices. I will also discuss some of the newer nutritional supplements that have helped my patients, specifically those suffering from fibromyalgia and osteoarthritis pain.
Pain and the Cell
The average human body is composed of approximately 72 trillion cells. Each cell is programmed to perform a specific function. The ability to perform a required task is solely dependent on the health of that cell.

A human cell is much like a small pond and its fragile ecosystem. The cell is a small pool of water surrounded on all sides by a border. The border surrounding the human tissue cell is a protective coating of fats and proteins. The protective coating allows various substances into the cellular pond. Suspended in the cell's fluid (the cellular pond) are numerous small organs called organelles. The organelles rely on the nutrients that cross the protective cell wall to supply the raw materials and energy needed to perform that cell's specific task. The process occurs in much the same way that the fish in the small pond rely on the stream's flow into the pond.
The Polluted Body
If the stream that flows into a pond becomes polluted with toxic substances, the pond will not be able to support life for very long. The human cell is much the same. When toxic or abnormal substances are allowed across the cell wall, the normal functioning of the cell is distracted and slowed. As the cell becomes more and more polluted, its function slows and the cell dies. When a great enough number of the cells that constitute an organ die, then the organ becomes diseased.

When a body part, such as the muscle in fibromyalgia or the cartilage and ligaments in arthritis, becomes diseased, the part struggles to heal and repair itself. Much of the pain experienced during a chronic pain syndrome is generated by tissue damage, inflammation and cellular pollution.
Some Polluting Substances
White Table Sugar:
White table sugar (sucrose) greatly increases pain - this is especially true for sufferers of spinal arthritis and fibromyalgia. Sugar's impact on pain is probably linked to the mineral loss associated with diets high in refined sugar. Human muscle relies on the minerals calcium, magnesium, potassium and sodium for smooth and coordinated contraction and relaxation. A diet high in sugar causes the kidneys to extract calcium, magnesium and potassium from the blood and dump the minerals into the urine. The body then scavenges its bones and muscles to make up the mineral deficiency in the blood. The process results in muscles already less flexible due to fibromyalgia and osteoarthritis becoming even more spastic. Since sugar causes the body to extract minerals from bone and muscle, it's logical that sugar consumption intensifies pain (see section on Magnesium Malate).

Eating sugar also creates another problem for those suffering from arthritis pain: sugar directly increases inflammation. When sugar is eaten, the human body will either use it for blood sugar or convert it into fat for storage. Sugar is readily converted into a bad fat, namely saturated fat. Saturated fat is a problem for arthritis sufferers because it contains the fatty acid arachidonic acid. Arachidonic acid is converted by arthritic joint tissues into an inflammatory substance called a series two prostaglandin. The conversion of sugar to saturated fat increases the amount of arachidonic acid available and results in an increase in inflammation and pain (see section on The Role of Prostaglandins).

Coffee, tea, chocolate and colas all contain substances, called methyixanthines (caffeine, theophylline and theobromine) that cause an increase in pain and inflammation. Methyixanthines are stimulants with the side effect of diuresis, or increased urination. Diuretics increase the body's loss of water and electrolyte minerals into the urine thus disturbing the delicate balance of important minerals in soft tissues, like muscles and ligaments. The result is more stiffness and pain in muscles and ligaments because the body scavenges for the lost minerals, as noted previously.

Coffee and Chocolate:
One of the ways that pain is perceived and relieved in the brain is by the release of substances from the nerve endings that activates the cells in the brain. The action is like supermarket parking lot. The brain has parking spaces in its cells that are called receptor sites. The nerves communicate with the brain by releasing substances that then occupy the brain's cellular parking spaces.

When opiates park in the parking spaces, they stop pain perception by the brain. Opiates are a classification of chemicals that include morphine and endorphins. Endorphins are natural opiates made by the body to block pain. The release of endorphins can be stimulated by many methods including, vigorous exercise, electrical T.E.N.s units and chiropractic manipulation. However, coffee is like the obnoxious person who cuts in front of you at the supermarket and takes your parking space. Coffee contains a chemical that occupies the opiate parking space so that pain-relieving substances cannot block pain - this occurs even if the coffee is decaffeinated. The result is a decrease in pain tolerance; it also results in pain-relieving interventions, like physical therapy, chiropractic manipulation, acupuncture and medications, being less effective.

Instant coffee and chocolate contain another potential problem chemical called oxalic acid. Oxalic acid readily binds or chelates, to calcium, magnesium and potassium. The binding prevents the minerals from being absorbed and creates temporary mineral deficiencies that induce muscle spasms and tightness. It is a major problem for chronic back pain sufferers who already have inflexible spinal muscles. Oxalic acid also contributes to bone spur formations and kidney stones.

An additional problem with the use of chocolate is that it contains a substantial amount of saturated fat. Saturated fat will greatly increase pain, as discussed in the next section.
What Are Fats and Oils?
Scientists refer to fats and oils as lipids. Lipids are made of two types of chemical substances called glycerol and fatty acids. There are three fatty acids attached to one glycerol. It is the fatty acid portion of a lipid that determines a "good fat" from a "bad fat." The type of lipid is determined by the type and length of fatty acids that are attached to the glycerol.

Lipids that are fairly solid at room temperature are saturated fatty acids. Examples of saturated fat include butter, lard, animal fat, and coconut oil. Saturated fats contain arachidonic acid (AA), which increases pain and inflammation. Lipids that are not solid at room temperature contain mostly unsaturated fatty acids. Examples of these lipids are olive oil, corn oil, flax seed oil, and canola oil. Unsaturated fats contain substances that reduce pain and inflammation.
Fatty Acids and Pain
A lipid increases or decreases pain based on its fatty acid composition. The body handles fatty acids differently based on their structure. The process is very interesting: lipids are broken down into their individual fatty acid and glycerol components through a long, complicated digestive process. The fatty acids are then packaged and transported in lecithin to various organs and glands. The organs and glands then manufacture useful substances from the fatty acids, like hormones, cell walls, and hormonelike substances called prostaglandins. Prostaglandins perform a wide variety of functions for the human body including the regulation of pain and inflammation. Without a healthy gall bladder and liver, the normal process of lipid metabolism breaks down.
Omega-3 and Omega-6 Fatty Acids
We will only concern ourselves with two classes of fatty acids, namely omega-3 and omega-6.

High concentrations of omega-3 fatty acids are found in flax seed oil, evening primrose oil, and cold water fish oils like salmon oil. High concentrations of omega-6 fatty acids are found in borage oil, meats, safflower oil and black current seed oil.

Omega-3 and omega-6 fatty acids are used to make a series of three types of prostaglandins (please refer to the provided charts for reference). Series one and series two prostaglandins are made from omega-6 fatty acids. Series three prostaglandins are made from omega-3 fatty acids.
The Fatty Acid Cascade
The Role of Prostaglandins
Series one prostaglandins originate from the fatty acid gamma linolenic acid (GLA). This prostaglandin series DECREASES PAIN AND INFLAMMATION. Series two prostaglandins originate from the fatty acid arachidonic acid (AA). This prostaglandin series INCREASES IMFLAMMATION AND PAIN. AA is manufactured when an enzyme is present, called delta-5 desaturase, in adequate amounts during the series one fatty acid cascade. Series three prostaglandins originate from the fatty acid alpha-linolenic acid (AKA). This prostaglandin series in ANTI-NFLAMMATORY. One other substance of note is the omega-3 fatty acid elcosapentaenoic acid (EPA). I include this fatty acid in our discussion because of its importance in decreasing the manufacture of painful AA. EPA, found in cold water fish, inhibits the manufacture of AA from di-hommo-gamma linolenic acid (DGLA). EPA does this by slowing down the activity of the enzyme delta-5 desaturase which converts DGLA into AA.
Lipid Bottom Line
The bottom line to lipids and their relationship to pain and inflammation is that anyone suffering from chronic pain should DECREASE their dietary intake of the fatty acids that manufacture series two inflammatory prostaglandins. Arachidonic acid, the principal "painful fatty acid," is found in red meats (lamb, pork, beef), bacon, sausages, red meat luncheon slices, lard and chocolate. Saturated fatty acids intake should also be limited. Saturated fatty acids are found in any lipid that is solid at room temperature: examples include butter, coconut oil, lard, animal fat and milk chocolate.

It is also important to INCREASE your intake of lipids that produce series one and three prostaglandins; examples of series one and three include borage oil, evening primrose oil, flax seed oil, black currant seed oil and salmon oil. For arthritis patients, I recommend either borage oil by itself or a combination of borage and flax seed oils. The reason to use the combination is that the omega-e fatty acids in flax seed oil help slow down the manufacture of arachidonic acid; this in turn allows the GLA in borage oil to be used for the manufacture of anti-inflammatory series one prostaglandins.
• I strongly recommend that you consult your physician or some qualified health professional before adding any supplemental oils to your diet. Taking too much flax seed oil causes a deficiency of other fatty acids. You can over do a good thing with any of these oils.
• Supplemental oils should not be heated or used in cooking.
• Buy only flax seed oils with expiration dates on their bottles.
For more reading on the subject of oils I suggest the book entitled "Fats That Heal - Fats that Kill" by Udo Erasmus, Ph.D.
Fibromyalgia is one of the least understood pain syndromes in medicine today. Until recently, patients with this condition were often thought to be hypochondriacs or mentally ill. Fibromyalgia sufferers usually have chronic pain across the shoulders and into the neck, in the lower back, the outside of the arms and in the knees. The pain associated with this syndrome is like the pain experienced from over exercising a group of muscles; the muscles feel achy, stiff and sore. The pain from fibromyalgia never seems to go away. The fibromyalgia sufferer goes to bed with pain and wakes up with pain. The pain may also be accompanied by depression, chronic fatigue, irritable bowel syndrome and insomnia.
Testing for Fibromyalgia
Currently, there are no specific blood tests or other objective testing procedures to diagnose fibromyalgia. The diagnosis is made when depression, insomnia, chronic fatigue or irritable bowel syndrome accompany chronic, painful "trigger points" in the muscles of certain areas for longer than three months. "Trigger points" are areas of muscle with localized points of pain that radiate into the surrounding tissues. By pushing on certain areas of muscle, you can trigger pain in the surrounding area.

The current medical approach is to use antidepressant medications like Elavil for both the pain and depression. Some people get relief from their symptoms by using an antidepressant. The use of nonsteroidal anti-inflammatory medications like ibuprofen and naprosyn or pain relievers like acetaminophen usually offer very little relief to the fibromyaligic patient.
What Causes Fibromyalgia?
The cause of fibromyalgia is not fully understood. Some leading fibromyalgia researchers feel that there is a malfunction in the body's ability to manufacture energy. The muscles burn energy faster than it can be produced, which is compounded by a shortage of the nutrients necessary to make the energy. This may cause the muscles to rely too heavily on the inefficient anaerobic energy cycle for much of their energy production instead of the more efficient aerobic cycle.
Aerobic and Anaerobic Cycles
The aerobic energy cycle results in the production of the energy molecule ATP; carbon, oxygen and water are the resultant wastes; which are then exhaled in our breath, urinated away or reused efficiently. The less efficient anaerobic cycle also produces energy but its not so readily discarded. It is filtered through the liver until the liver can no longer handle the amount produced. When the liver can no longer handle the waste volume, lactic acid backs up into the muscles thus causing the stiff, achiness that plagues fibromyalgia sufferers. You might say that it is a type of lactic acidosis.
Magnesium Malate
Some fibromyalgia patients may be magnesium deficient. A recent article in the Journal of Nutritional Medicine point out that many fibromyalgia patients have responded quite favorably to magnesium malate. Magnesium and malic acid are important substances in the manufacture of energy for the human muscle cell.

I have used magnesium malate on 42 fibromyalgic patients in my clinic and 36 of the patients reported their pain had been significantly reduced.

A word of caution, the malic acid found in this substance is an alpha-hydroxy acid found commonly in apples; alpha-hydroxy acids are used in some cosmetics to exfoliate old skin cells. I have found through clinical experience that patients suffering from irritable bowl syndrome, diverticulitis and Crohn's disease should not take magnesium malate. I found that this substance causes intestinal cramps and diarrhea in those patients who are prone to intestinal problems. The irritation may be due to an irritation of the intestinal lining by the alpha-hydroxy acids.
Additional Supplements
The other nutritional supplements I have found to benefit my patients are pycnogenol, coenzyme Q10 and a multiple vitamin that is high in the B complex vitamins. The supplements are important in the human body's manufacture of energy. The pycnogenol is a powerful antioxidant that has shown considerable promise in the reduction of inflammatory pain. The pycnogenol may help the liver degrade the lactic acid so that it can be excreted by the kidneys. (For more information on pycnogenol, please see my article entitled "What is Pycnogenol?")
The Role of Diet In the Treatment of Fibromyalgia
I have heard some "prominent" rheumatologists say that diet has no effect on fibromyalgia. I disagree. I have found that removing some of the common pain causing substances from the diet has reduced the pain of my fibromyalgic patients by as much as 50%. The items removed were chocolate, coffee, red meat, sugar, saturated fat and, in a few cases, some common food allergens like peanuts, wheat and soy.
Osteoarthritis is the gradual degeneration of cartilage of the joint and is the most common form of arthritis found in the United States. In the later stages, the ligaments and tendons that are associated with the arthritic joint begin to become painful and inflamed. The ongoing inflammation causes calcium to be deposited in the joint structures. The calcium deposits are called bone spurs. The last stage of the disease process occurs when the joint fuses.

The standard medical approach is to use mediations like ibuprofen, fenuprofen and naprosyn to relieve the pain and inflammation. The problem with the medications is that they may relieve the pain but they actually increase the degeneration of the joint tissues. This has been proven in at least six different research studies.
Cartilage Replacement
It has been said by many leading physicians that we cannot replace our cartilage once it begins to wear away. This may no longer be a true statement. We know that the physiology of the joint is similar in some ways to the physiology of the skin. We replace skin cells as they wear out everyday. The cells under the skin move up to replace the ones we slough off. Some leading researchers believe that cartilage does the same thing. In the joint, the cartilage relies on the protein collagen and a sugar/amino acid combination called glycosaminoglycan (GAG) to make a chemical called ground substance. Ground substance is the glue that holds the cartilage cells together and gives the cartilage its spongy ability to absorb shocks.

The ground substance relies on an enzyme called glucosamine synthelase to make the glucosamine necessary for GAG production. As we age, the levels of this enzyme decrease in the body. The result is a decrease in the body's ability to make ground substance. Without glucosamine, cartilage production declines. By supplementing the intake of glucosamine, the enzyme deficiency is no longer a problem. The body now has adequate amounts of raw material to stimulate cartilage manufacture. A new clinical study, scheduled to be started later this year, will use a chicken cartilage extract as an arthritic treatment. The results of this study may further destroy the idea that cartilage cannot be replaced, as it is lost.
Supplements of Osteoarthritis
I recommend glucosamine sulfate or glucosamine HCI to my patients with osteoarthritis. In my experience, these supplements seem to be the most effective forms. Also, glucosamine sulfate is the form used in most of the research studies.

Additionally, I also recommend the antioxidant pycnogenol for any osteoarthritis patients. Research has indicated that this substance may protect the collagen proteins in our joints from being damaged by free radicals - free radical damage leads to more pain and inflammation. Free radicals are damaging substances that are found in heated oils, cigarette smoke and food preservatives, among other things.
Dietary Alternatives for Chronic Pain Sufferers
Fruit juice sweetened cereals, cookies, muffins and energy bars are available in most heath food stores. These are preferable to the sugary cereals, cookies and pastries that many people eat today.

Healthier baking can be done with liquid fruit juice sweeteners, like Wax Orchards, in place of sugar in baking recipes. Sorrel Ridge Fruit Spreads make tasty alternative to high-sugar jams, jellies and syrups. There is a book entitled "Fruit-Sweet and Sugar-Free" by Janice Feuer that I personally have used on many occasions to make tasty baked desserts for my family. The coffee substitute Pero and the tea Roastaroma are pretty good ways to wean yourself off coffee. To cut down on the saturated fat in recipes, I recommend the book "Baking Without Fat" by Health Valley Foods owner George Mateljian. Also, carob makes a good alternative to chocolate when it is prepared properly.
In my clinical experience, diet and nutrition do play a significant role in the management of chronic pain syndromes. Computer engineers always say "garbage in-garbage out" with regard to computer function. The same is true of the human body. Science has shown through radioactive "tagging" that the body replaces about 98% of our cells each year. These cells are made of the substances we eat and drink. If the body has only "garbage" to use as replacement parts, the body will not function optimally. When the human body is not functioning properly, the usual first warning sign is pain. The second warning sign is a diseased body.

Sorry, there is no third warning.