Quite rightly, the first port of call for most people suffering chronic pain in any of its many guises are mainstream treatments and medications. However, many sufferers, particularly those whose chronic pain condition has become well-established and possibly resistant to therapy, turn for some symptomatic relief to certain vitamins and other supplements. This is usually as an adjunct (add-on) therapy rather than as a primary treament. Although viewed with a healthy degree of scepticism in some quarters, there is in fact scientific evidence supporting the benefit of some supplements.
Those set out below do not form a complete list and the benefit or otherwise of some is the matter of (in some instances considerable) scientific debate.
If you are considering taking any vitamins or supplements you are strongly recommended to discuss their possible efficacy or otherwise with your doctor before taking them. This is particularly important as even seemingly innocuous supplements may in fact interfere negatively with the action of your prescription and/or other mainstream medication.
Vitamins B9 (Folic Acid) and B12
Folic acid, which is also known as vitamin B9 or folate, is most commonly associated with pregnant women, who take it as a supplement during pregnancy to reduce the risk of birth defects in the developing child.
Vitamin B12 plays an important role in ensuring the normal function of the brain and the nervous system.
It has long been known that folic acid and vitamin B12 can boost the function of our immune system and are important for our overall health. However, research has shown that taking folic acid in conjunction with vitamin B12 can improve the symptoms of those suffering Fibromyalgia (FM) and Chronic Fatigue Syndrome (CFS or ME).
The vast majority of people diagnosed with ME suffer widespread and persistent pain. Similarly, people suffering FM have many symptoms common to those suffering ME and it is not uncommon to be diagnosed with both conditions concurrently. For this reason, much of the more recent research into FM has explored the role of central sensitisation, which may underlie a host of chronic pain conditions and suggests that ME and FM are simply different manifestations of the same underlying problem.
In fact, research has demonstrated that the benefits of taking folic acid in conjunction with vitamin B12 were particularly beneficial to those diagnosed as suffering both ME and FM. It was also found that higher doses of these supplements led to a greater reduction in symptoms.
It was also found that those who took folic acid and vitamin B12 in addition to daily doses of certain medications such as Duloxetine, Pregabalin and opiate-based painkillers, benefitted less from taking the supplements. Despite that, doctors treating both ME and FM are increasingly exploring with their patients ways of incorporating these supplements into their daily medication regime.
Vitamin B complex
Research has shown the potential role of vitamin B complex as an additional therapy for those taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, Naproxen and Aspirin for low back pain.
Vitamin B complex is a cocktail of B vitamins defined as 1 mg of vitamin B12, 50 to 100 mg of vitamin B1 and 50 to 100 mg of vitamin B6. Its addition to an NSAID drug regime seems to intensify the pain-relieving effect of the NSAID(s), although the exact reason for this is the subject of some debate.
We have considered in an earlier article the role that vitamin C, also known as ascorbic acid, may play as a Complex Regional Pain Syndrome (CRPS)-preventative following limb fractures or limb surgery. As a result of a considerable amount of research, it is now widely accepted among the medical profession that there is at least some correlation between taking vitamin C and the chance of developing CRPS following limb fractures or limb surgery. In one study, 2.4% of the group taking vitamin C developed CRPS compared to 10.1% taking a placebo.
These results were replicated in another study where 1.7% of the group taking vitamin C developed CRPS compared to 9.6% of the placebo group.
Whilst a subsequent analysis of these results has cast some doubt over their reliability of both studies, as vitamin C is both inexpensive and safe, the advice received by most people following limb fracture or surgery is to take 500 mg of vitamin C daily for at least 50 days.
There are also conflicting studies as to whether vitamin C can help to reduce levels of pain in people suffering other chronic pain conditions such as arthritis.
Whilst there is no conclusive evidence that taking vitamin D supplements can help to relieve chronic pain, it has been established that for reasons which are not fully understood, levels of vitamin D in people suffering a variety of chronic pain conditions are lower than in those not suffering chronic pain. For this reason, as maintaining levels of levels of vitamin D is vital to our health, supplements have been recommended to some people suffering chronic pain.
Back in 2009, research published into the use of intravenous magnesium as a treatment for CRPS Type 1, concluded that “The results of this pilot study show significant benefits of intravenous magnesium treatment on complaints and quality of life in CRPS 1 patients. Pain reported by patients was significantly decreased.”
For most participants in that study the reported reduction in pain seemed startling, occurring within 20 to 30 minutes, with levels of pain remaining “significantly reduced” for up to 12 weeks. Participants also reported reductions in levels of hyperalgesia and allodynia. Researchers thought that magnesium was acting as a NMDA receptor antagonist, in a very similar way to intravenous ketamine.
Despite those promising results, a further study published in 2013 concluded that “Administration of the…[NMDA] receptor antagonist magnesium in chronic CRPS provides insufficient benefit over placebo.”
This trial did not write off magnesium entirely, but recommended that any further research on magnesium for CRPS Type 1 should be limited to the acute phase only.
A classic example of hope to despondency following one research paper. Or is it?
Certainly in the UK magnesium, intravenous or otherwise, does not form part of the mainstream treatment portfolio for CRPS Type 1. There are, however, numerous anecdotal accounts to be found online of people with CRPS embracing magnesium in a variety of forms – intravenous, supplement tablets, topically-applied oil and magnesium flakes for foot baths.
Of course, the scientists will say that any benefit experienced may be down to chance or even the placebo effect and they may well be correct. However, what magnesium does have in its favour is that, in whatever form it’s taken, not only is it relatively inexpensive but, if the recommended dose is not exceeded, it is reasonably safe – certainly a lot safer than Ketamine!
There is evidence that certain types of chronic pain can be eased by consuming omega-3 essential fatty acids. Omega-3s, are often referred to as ‘fish oil’ as this is their main source.
The two most important types of omega-3 fatty acids found in fish oil are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which convert into compounds that reduce inflammation within the body. It is this anti-inflammatory action that is responsible for reducing pain. In one study, people dependant on NSAIDs for pain relief for chronic non-specific neck or back pain were able to reduce or even dispense entirely with those drugs after taking 1,200 to 2,400 milligrams of omega-3 daily as a supplement. This is very roughly the same amount of omega-3 found in a 125 gram serving of salmon, but of course supplements work out considerably cheaper!
Bromelain is an enzyme which comes from the pineapple plant. It appears to have anti-inflammatory and pain relieving properties, particularly in osteoarthritis and knee pain. However, considerably more research is required.
As the name makes clear, ‘supplements’ should only be consumed in addition to, not in place of, a healthy and well-balanced diet, including our proverbial 5-a-day. Over and above that it is apparent that some vitamins and other supplements can have a role to play in the long-term management of a variety of chronic pain conditions, particularly if they can help to reduce a person’s overall medication intake.
Fortunately, in recent years the medical profession have become a little more open-minded than once they were to the possibility of using certain supplements as an adjunct therapy to more mainstream treatment. That has been helped by the publication of a steady trickle of research papers on this subject.
Of course, a judgement must be made on a case-by-case basis but, if their doctor is happy for them to give a supplement a go, there may be little to lose and possibly much to gain.