11

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Chronic Pain and Inflammation: Are Drugs Ever a Good Idea?

Answered on August 19, 2014
Created June 22, 2011 at 1:20 PM

Trying to reconcile the complexities of both paleo science and my own individual health. I'm starting to understand that an underlying state of chronic inflammation is a source of many problems and disease states. I've also experienced the power of a paleo approach in reducing inflammation, but I'm wondering what to do if diet, supplementation, and movement are unable to calm it completely. In other words, if you've done everything "right" (or at least don't know what else to try) and you still live with a certain level of pain and inflammation, do the anti-inflammatory benefits of taking, say, a low-dose NSAID, outweigh the damage they can potentially do? What would you do if you had to choose between chronic inflammation and medication? If that's a false dichotomy, what are other options?

Back Story: I'm a 40-year-old male diagnosed with ankylosing spondylitis at 14. Off and on NSAIDS and DMARDS since about 18. Have done well with Celebrex for 8 years, but a low-starch paleo diet has cut my required dose by 75%. Also have MAJOR heart disease in my family (none in me yet) so am scared shitless of the inflammation-heart disease relationship. I'm sure there's something I'm missing paleo-wise, but I can't seem to figure it out (the permutations and combinations of diet, supplementation, and exercise are overwhelming). I've gone without Celebrex for the past two months, but my level of pain and inflammation is creeping back up and limiting my activity level.

Medium avatar

(3259)

on June 23, 2011
at 11:50 PM

I had to Google both curcumin and FWIW - tell me more...

7e746be2f0e550a8cd7df881322ae705

(18701)

on June 23, 2011
at 01:17 AM

I was waiting for your response, Kamal. Great points.

Af1d286f0fd5c3949f59b4edf4d892f5

(18452)

on June 22, 2011
at 05:47 PM

i agree. a quality post that addresses an important issue that many people struggle with.

Medium avatar

(3259)

on June 22, 2011
at 04:56 PM

I used to take 400mg per day Celebrex but now take 100mg only when things are bad - maybe 3 times in past month. I, too, will give it more time and hope those occasional flares disappear.

1ec4e7ca085b7f8d5821529653e1e35a

(5506)

on June 22, 2011
at 01:49 PM

good succint answer

1ec4e7ca085b7f8d5821529653e1e35a

(5506)

on June 22, 2011
at 01:48 PM

I think that if intervention through a reduction in all outside sources is not taking it far enough then you may have to get some medication in. If you just do what you're doing and try to rely on it as little as possible then you'll be good. Since it's a genetic issue there's only so far paleo can take you right?

Medium avatar

(3259)

on June 22, 2011
at 01:39 PM

Yeah...I contributed to that thread. I get the protocol, I'm just wondering if reducing inflammation with meds is a good idea if paleo doesn't take you all the way. Problem is, it's very hard to know if the protocol you're on is the right one or could be tweaked in some really specific way. Thanks for the input, though.

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on June 22, 2011
at 01:32 PM

great question.

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11 Answers

11
D3ff004d4a0c42b67cc2c49a5ee9c0f3

(5801)

on June 22, 2011
at 01:43 PM

My opinion is that medication should not be the first choice for an ailment (unless it is immediately life threatening). However, medication is not evil and quality of life is more important to me than paleo.

I will do what I can with diet, exercise, and "grin-and-bear-it," but if pain were too much that it affected quality of life, I would not hesitate to take it.

1ec4e7ca085b7f8d5821529653e1e35a

(5506)

on June 22, 2011
at 01:49 PM

good succint answer

6
21fd060d0796fdb8a4a990441e08eae7

(24543)

on June 22, 2011
at 09:17 PM

Yes, I think drugs are a good idea sometimes. Here are a couple reasons.

First, the notion that inflammation is at the root of all pain is incorrect (not saying that you implied this). Central sensitization of the nervous system can exist without any inflammation at all in the joint or near the tendon/ligament.

Second, pain can get in the way of healing pain. Very very easily! While a person is exploring what the root cause of their pain is, many months or even years can pass. If pain levels are uncontrolled or creeping up, medication can be very helpful to keep you going and not stuck in a rut.

Third reason-- it is possible to try topical NSAIDs to reduce gastric problems. It is also possible to titrate NSAID dosage up or down, and they are not addictive in the general sense. Some drugs related to pain management have significant downsides. NSAIDs can fall in that category (as they also may reduce healing responses, although this appears to be controversial), but they have relatively low downsides.

7e746be2f0e550a8cd7df881322ae705

(18701)

on June 23, 2011
at 01:17 AM

I was waiting for your response, Kamal. Great points.

2
6277d3befe67137bc537d0fc50dd3993

on June 23, 2011
at 04:02 PM

My interest in the Paleo diet was sparked from an inflammatory angle as well. The researchers are still finding components of our diets that contribute to an exaggerated autoimmune response in our bodies (saponins, anyone?).

Quite a few people have had success really cutting back their food options (Paleo, minus nightshades, minus others) and have found the problematic food in their diet. The hard part is that you might be eating it unknowingly, or you may think it's fine because it's a paleo diet staple. I think the answer is there for you, you just haven't found it yet.

Check out http://paleoautoimmunerecipes.blogspot.com/ . It's the best resource I've found for the strictest form of the paleo diet for people concerned with autoimmune diseases. This is like the Marines of the paleo diet (her own words). If you can keep on a diet like she recommends for a while, I think you'll find a pretty good baseline of whether you really need these NSAIDS or not.

That's my goal...hit her level of commitment for a while, then add back things slowly so I get an idea what foods the offenders are for me. I haven't quite made it yet...still learning.

2
7d0c3ea9bf8be00b93e6433d8f125ac3

(7540)

on June 22, 2011
at 05:43 PM

If I was in pain every day such that it limited my activity level and I had done as much as I could with regards to dietary intervention, I would take pain meds without any hesitation. I know a lot of people here seem to be 100% against any pharmaceuticals of any kind but if they're the difference between chronic pain/suffering or being able to enjoy a normal quality of life, what's the shame in taking them? Paleo isn't a panacea, no matter how much we want it to be.

1
11dff0119e8ca2babb4acf40a5ef6ac4

(233)

on June 23, 2011
at 03:38 PM

I have facet joint arthritis in both my lower lumbar spine and cervical spine. I did the "take this pill and call me when you need more" thing for a few years. It took a while to find a combination of NSAIDS, muscle relaxants, and pain killers that covered my needs. But by the time we got there, I was so fed up with the whole thing that I just wanted some control back. So I started with curcumin (cox2 inhibitor among other things), boswellia (5-lox inhibitor), grape seed extract, and bromelain. And I took that combination, along with ginger tea for over a year. It was as effective as mobic, flexeril, and the occasional darvocet that I was taking previously.

Then I changed my diet and started seeing a chiropractor, and I've been able to reduce and/or discontinue all of the above. (Still take the curcumin and grape seed extracts whenever I know I'm going to be doing things that are going to make me hurt.)

I don't think it's wrong to take something for pain. To me, at least, it's better than lying around in bed because it hurts to be up and around. It's better than sweeping up a broken glass in the kitchen and knowing you can't bend over to pick it up. But I do think that curcumin and the rest are less likely to cause the heart damage that other NSAIDS can cause, so when I need something, I tend to go that direction.

BTW, you can find a lot of information on curcumin and the rest in a PubMed search. Just be prepared to do a bit of reading.

1
3c6b4eed18dc57f746755b698426e7c8

on June 22, 2011
at 04:25 PM

My gout (or RA) occasionally flares up and I do take NSAID (prescription level Naproxen) occasionally. I've gone gluten-, dairy-, and nightshade-free but I still get gout/RA attacks.

Then my only option is to take about 380-750mg of Naproxen or suffer through a gout/RA attack. My inflammation level as measured by CRP is 0.3, the lowest detectable level. My West sed rate is 1, also the lowest level. And I'm 5-10/157 lbs with about 15% body fat.

So I think I've done all I can on the inflammation front but I still get these autoimmune type attacks. I will give it more time to see if my anti-inflammatory diet completely remits my autoimmunity. But until then, what option do you have but take NSAIDs?

Medium avatar

(3259)

on June 22, 2011
at 04:56 PM

I used to take 400mg per day Celebrex but now take 100mg only when things are bad - maybe 3 times in past month. I, too, will give it more time and hope those occasional flares disappear.

1
1ec4e7ca085b7f8d5821529653e1e35a

(5506)

on June 22, 2011
at 01:28 PM

I would make sure to follow a strict anti-inflammatory protocol via Robb Wolf which is talked about in a thread here: http://paleohacks.com/questions/29067/has-anyone-tried-robb-wolfs-autoimmune-gut-irritation-protocol#axzz1PwAjkCAq

Getting rid of anything that could cause inflammation for you is a good idea.

Medium avatar

(3259)

on June 22, 2011
at 01:39 PM

Yeah...I contributed to that thread. I get the protocol, I'm just wondering if reducing inflammation with meds is a good idea if paleo doesn't take you all the way. Problem is, it's very hard to know if the protocol you're on is the right one or could be tweaked in some really specific way. Thanks for the input, though.

1ec4e7ca085b7f8d5821529653e1e35a

(5506)

on June 22, 2011
at 01:48 PM

I think that if intervention through a reduction in all outside sources is not taking it far enough then you may have to get some medication in. If you just do what you're doing and try to rely on it as little as possible then you'll be good. Since it's a genetic issue there's only so far paleo can take you right?

0
1f8384be58052b6b96f476e475abdc74

(2231)

on June 23, 2011
at 03:33 PM

curcumin......FWIW

Medium avatar

(3259)

on June 23, 2011
at 11:50 PM

I had to Google both curcumin and FWIW - tell me more...

0
417ac0e162dc468b8ca61a574e5cd3c0

on June 23, 2011
at 12:29 AM

Hopefully some questions for you to think about may help you.

-What is inflammation? ans.= An absolutely-necessary, genetically-programmed response to cell and-or tissue trauma/damage/breakdown/decay...intended to stem further damage and cause repair.

-What caused this cell and/or tissue damage? ans.= Acutely-inappropriate, sub-acutely-inappropriate and/or chronically-inappropriate cellular environment (physically, chemically), etc.

-Is the body "wrong" for invoking the inflammatory response? ans.= Likely, no. The preponderance of evidence shows that the body does not really 'inappropriately' bring on inflammation. In other words, the inflammation is there due to the presence of the cell damage/breakdown. if inflammation is chronic, then the cell damage continues and cell repair is (or has been) inadequate.

Is inflammation 100% necessary for repair and restoration of proper cell and tissue function ? ans. Yes.

Are there any drugs that assist aid or improve the inflammatory response? ans. No.

Are there any drugs that suppress/disturb/change/alter the inflammatory response in such a way that they make you "feel" better in the short term? ans.=Yes.

0
C074eec3b3c0325ef3018a128111823a

(1012)

on June 22, 2011
at 10:07 PM

A lot of things in the body work in cycles of cause and effect, with progressive buildup and severity of results. Inflammation and auto-immune responses are a clear and classic example. What's necessary is to break the cycle.

Just as using the drugs alone to suppress the symptoms isn't a good long-term strategy, without addressing the underlying cause via diet and similar "paleo lifestyle" means, it can also be the case that using just the diet alone is a poor strategy, particularly in the short term.

You may need to tackle it from both sides of the cycle, to reduce the cause and dampen the effect, for best results - especially initially, to get the body to calm down enough that it is not just reacting to its own existing inflammation.

0
03db20f160e58814827ae5a05a5c8792

on June 22, 2011
at 05:19 PM

I would do everything to avoid drugs. They are always toxic, disturbing your bodies own healing capacities. Painkillers and anti-inflammatory drugs actually destroy your gut health, joints and connective tissue. And if you have those problems they will cause inflammation or autoimmune issuies anyway. So the choice is not inflammation or medication but inflammation and medication. So I would continue to look for other solutions.

http://www.kneepaintreatment.com/knee-pain/why-joint-destroying-anti-inflammatory-drugs-make-your-knee-arthritis-worse.html

They are ok for short term use (after acute trauma). But long-term use would be not an option for me. It's like drinking alcohol when your liver is sick.

Dr. Seaman's website Deflame.com is helpful to get an idea what is going on.

http://www.deflame.com/Home/tabid/36/Default.aspx http://www.deflame.com/InflammatoryDiseases/tabid/81/Default.aspx

A success story (terrible back pain ) from the website http://www.deflame.com/BackPainSuccess/tabid/109/Default.aspx

If I were in your situation I would contact Dr. Seaman personally and ask for help. Maybe Dr. Kruse (The Quilt) could be helpful too. And I would take acupuncture sessions. It always helped me at least in reducing sympoms without nasty side effects. Good luck

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