Natural Pain Relief: Chronic Pain Supplements

If you’re living with chronic pain, you may have already tried the usual treatments. You may have cycled through the drugs, like NSAIDs and opioids. Maybe you’ve even tried surgery. But you’re still in pain. Could natural pain relief with pain supplements offer an alternative?

Experts say -- depending on what’s causing your pain -- supplements may help.

“I think supplements can be the cornerstone of good pain management,” says David C. Leopold, MD, director of Integrative Medical Education at the Scripps Center for Integrative Medicine in San Diego. “People are also looking to supplements more and more. They have less tolerance for the side effects of traditional pain medications. They want something different.”

Given the heavy toll that chronic pain can take on a person’s life, getting control of your pain is key. For a better understanding of which pain supplements might help with which conditions, WebMD turned to some integrative medicine experts. Whether you’re suffering from an achy knee or nerve pain, here’s what you need to know about natural pain relief.

Understanding Chronic Pain

What sets chronic pain apart from more acute pain is its relentlessness. Acute pain fades away as the body heals from an injury. Chronic pain doesn’t.

The causes of chronic pain vary -- fibromyalgia, arthritis, nerve damage, and back injuries to name a few. But, in a way, the core problem is the same: pain. It’s the pain that sends people to the doctor. It’s the pain that can devastate a person’s life. Pain was once thought of as the side effect of other conditions. Now, many experts see chronic pain as a condition in itself that needs its own treatment.

Still, for the average person, getting the right treatment isn’t easy.

“Unfortunately, the conventional medical treatment of chronic pain still isn’t very good,” says Leopold. Perhaps the treatment doesn’t work well and the pain is still interfering with your life. Or maybe the side effects are too severe. Opioid painkillers can cause sedation, constipation, and a risk of addiction. NSAID painkillers -- from over-the-counter drugs like Advil to prescription medicines like Celebrex -- pose a danger of bleeding, stomach problems, and cardiovascular risks.

Natural Pain Relief: Pain Supplements

Natural pain relief offers an alternative. But given that there are so many pain supplements lining the shelves of your drugstore, it’s hard to know where to start. Here’s a rundown of the chronic pain supplements that our experts thought were most important.

• Anti-inflammatory plants and herbs. For all sorts of painful conditions -- including osteoarthritis and back pain -- chronic inflammation is the real problem. NSAID medicines -- such as aspirin, ibuprofen, and naproxen, and Celebrex -- work so well because they block the enzymes that trigger both swelling and pain.
  But if you don’t like the idea of being on an NSAID forever, there’s good news. “There are natural alternatives to NSAIDs that have a similar mechanism,” says Leopold. They include turmeric, green tea, ginger, rosemary, cat’s claw, devil’s claw, and willow bark.
  Which pain supplement is best? Leopold and other experts single out turmeric. “It works really well,” says Tanya Edwards, MD, medical director of the Center for Integrative Medicine at the Cleveland Clinic. “I’ve had patients with arthritis who start using turmeric and are able to go off their NSAIDs entirely.” Look for turmeric in standardized capsules.
  Because they work in the same way as NSAIDs, these pain supplements do pose some of the same risks, such as bleeding. However, the side effects tend to be less severe. Leopold still suggests that people on blood-thinning drugs check with a doctor before using any of these pain supplements. 
• Fish oil. “Fish oil is the clean-up hitter of supplements,” says David P. Rakel, MD, founder and director of the University of Wisconsin’s Integrative Medicine Program in Madison. There’s strong evidence that it helps with many conditions, ranging from cardiovascular problems to depression to asthma.
  Fish oil can also ease the inflammation and pain caused by many chronic conditions. The dose used in the most convincing research is 2 to 4 grams of DHA + EPA daily. Although beneficial omega-3 fatty acids are available from other sources, experts say that fish oil has the best evidence.
  “I recommend omega-3s to everybody, including those with chronic pain,” says Leopold. He says that they help with headaches, back pain, some nerve pain, and autoimmune conditions like rheumatoid arthritis.
  “The pain relief you get from fish oil alone is not tremendous,” notes Rakel. “It’s probably less than you’d get from ibuprofen and other NSAIDs.” But given that some NSAIDs may actually increase the risk of cardiovascular problems, the fact this pain supplement protects against them is an added bonus, he says.Rakel adds that the painkilling effects of fish oil can also be boosted by combining it with other pain supplements like turmeric or ginger -- provided your doctor says it’s safe.
• Vitamin D. This vitamin, which comes from foods and is also produced in the body as a result of sun exposure, has become a hot topic among pain researchers. A number of studies have linked low levels of vitamin D with increased levels of chronic pain.
  One 2009 study looked at the vitamin D levels of people with chronic pain who were using opioid painkillers. Those who had a deficiency of vitamin D needed almost twice as high a dose of medication to control their pain.
  Edwards now checks vitamin D levels in many of her patients with chronic pain. If they’re lower than 50 to 70 nanograms/milliliter, she might recommend a supplement for natural pain relief.
  “Personally, I’ve seen miracles,” she says. “I’ve found that it can have a huge benefit in the symptoms of people with fibromyalgia.” She reports that it’s helpful with other kinds of chronic pain too, like bone and joint pain.
• Capsaicin. Derived from chili peppers, capsaicin may soothe pain when applied to the skin. “Topical capsaicin seems to be helpful for all sorts of pain,” says Edwards. Studies have found it can help relieve pain from rheumatoid arthritis, osteoarthritis, psoriasis, shingles, and diabetic neuropathy. It may also offer natural pain relief for back pain, fibromyalgia pain, and headaches.
• Glucosamine sulfate. “When it comes to joint pain, I think glucosamine supplements have some of the best data out there,” says Leopold. There’s especially strong evidence that this pain supplement can help relieve osteoarthritis pain in the knee. Glucosamine is often combined with chondroitin, which could have an additional benefit.
  Leopold says that the studies suggest that glucosamine not only eases pain, but also slows the progression of osteoarthritis.
• SAMe. There’s good evidence that SAMe offers natural pain relief to people with osteoarthritis. Some studies have found that it’s about as effective as prescription painkillers like Celebrex. But there’s a catch to this pain supplement: the cost.
  “SAMe can run $80-$120 a month,” says Edwards, “so I tend not to use it very much. I can usually get results that are just as good with less expensive treatments.”
• Magnesium. The evidence is mixed. But some studies have found that magnesium supplements can help with pain caused by conditions like migraines and fibromyalgia. Some experts speculate that magnesium deficiency could be a widespread problem.
  “It’s really easy to be magnesium deficient,” says Edwards, who recommends magnesium supplements for her chronic pain patients. “The foods that are highest in magnesium are things like sunflower seeds and pumpkin seeds. Most of us just don’t eat those very often.” Regularly drinking alcohol can also deplete your magnesium levels.
• Acetyl-L-carnitine. Several studies have found that the nutrient acetyl-L-carnitine can ease nerve pain from diabetes. This pain supplement also seems to regenerate damaged nerves and, over time, restore sensitivity. 
• Alpha-lipoic acid. Like acetyl-L-carnitine, alpha-lipoic acid seems to help with diabetic neuropathy.  “Preliminary but promising evidence shows that it not only reduces pain, but also seems to slow down the progression of the nerve injury,” Rakel tells WebMD. “It may help protect the nerves from further damage.”
  Alpha-lipoic acid may also enhance insulin sensitivity -- another benefit for people with diabetes. There’s evidence that this pain supplement can help with nerve damage caused by cancer treatments, too.
• Bromelain. The enzyme bromelain, which comes from the pineapple plant, appears to reduce inflammation and pain. Some studies have found it helpful in osteoarthritis and knee pain. There’s some uncertainty about how well it gets absorbed in digestion, given that it could be neutralized by stomach acid. More research needs to be done. 
• Riboflavin (vitamin B2.) “There was promising research showing that riboflavin might help reduce the frequency of migraines,” says Rakel, but a recent study did not support the claim. Rakel still thinks it’s safe to try for up to eight weeks, given its high safety rating. There’s some evidence that CoQ10 and standardized extracts of butterbur (petasites) might also help prevent migraines.
• MSM (methylsufonylmethane). This is a naturally occurring compound in some plants and animals, which has been shown in some preliminary research to reduce osteoarthritis pain. More studies are needed to clarify its safety and efficacy.

Chronic Pain Supplements: Combining Approaches

As effective as natural pain relief can be, Leopold urges people to keep an open mind about traditional approaches, too. “NSAIDs like ibuprofen and naproxen work really well,” says Leopold, “and they’re incredibly cheap. The price tag on some supplements can be substantial.”

Natural pain relief and traditional medicine don’t have to stand in opposition. Leopold has some patients who take a daily pain supplement like turmeric for pain. Then during exacerbations, they add on an NSAID.

That said, no one should be mixing pain supplements and medications without seeing a doctor first. It could be risky. So make sure your health care provider knows about all the medicines and supplements you use.

Natural Pain Relief: Other Treatments

If you’re looking at alternatives to pain medication and surgery, there are lots of options besides pain supplements.

“When it comes to pain relief, I actually find supplements less helpful than some other complementary treatments,” says Rakel.  Here’s a rundown of other natural pain relief options.

• Physical activity. When you’re in pain, the prospect of exercising might just seem too difficult -- and painful. But studies have found that exercise helps people with chronic pain. They may feel less pain, have more energy, and have better moods than those who don’t exercise.
• Acupuncture. There’s good evidence that acupuncture is a powerful form of natural pain relief. It soothes osteoarthritis pain, fibromyalgia pain, back pain, pain from sports injuries, and more. “Really for just about any kind of pain, I’d recommend acupuncture,” Edwards says.
• Hypnosis. Various types of hypnosis have been found to help with conditions like repetitive strain injuries, back pain, and cancer pain.
• Guided imagery. With help from an expert, you can learn techniques to direct your thoughts by focusing on specific images. Some studies have found that this type of natural pain relief helps with osteoarthritis, fibromyalgia, cancer pain, and headaches.
• Music therapy. It might seem an odd approach, but music therapy -- which may involve listening to or performing music -- has good evidence behind it. Studies have found a benefit in conditions ranging from cancer pain to osteoarthritis.
• Relaxation therapy. There are different types of relaxation therapy. Some focus on mastering breathing techniques that calm the body. Studies suggest that relaxation therapy could offer natural pain relief for osteoarthritis, fibromyalgia, headache, and other conditions.
• Biofeedback. With this technique, people can train themselves to control normally involuntary bodily functions, like heart rate or blood pressure. Some studies have found that it might help with pain from conditions like fibromyalgia and headache.
• Massage. Studies indicate that massage may offer natural pain relief to people with conditions like rheumatoid arthritis, neck and pain, fibromyalgia, and headaches. 
• Talk therapy. This is in no way to imply that the pain is merely “in your head.” But seeing a therapist really could help. Experts say that anxiety and depression often go along with chronic pain. They may also make it feel more intense. “If someone is depressed and life seems out of control, addressing that mental suffering can often significantly reduce their physical pain as well,” Rakel tells WebMD.

Natural Pain Relief: Working With Your Doctor

While chronic pain supplements can really help, experts also suggest you temper your expectations. Be skeptical of any ads your see for all-natural “cures” to chronic pain. Unfortunately, sure-fire cures don’t exist.

Whatever you do, don’t go it alone. Anyone who is living with chronic pain needs to be working with a health care professional. Try to find a pain specialist. If one is available in your area, seek out a pain clinic.

Don’t settle for half-measures. The costs of poorly controlled chronic pain on your life -- and your family’s -- are just too high.  Get help from a specialist. Together, you can get your pain under control.