*Note: This is a three part series on chronic pain. The first part will address the inflammatory component of chronic pain. The second will address the CNS component and the third will address the childhood factors leading to increased for chronic pain.

What is Chronic Pain?

(If you haven't read Part 1 or Part 2 yet, go back and read those for some more great info!)

Continuous throbbing headaches, stiff and sore joints, aching muscles and a burning low back, sharp shooting pains down the backs of your legs or the side of your face. Arising with the weary thought that you have to face yet another day on little to no sleep, kept awake by the pain that has overtaken your body.

You feel angry at yourself, at your body. Why can't I just be like everyone else? Why does life have to hurt? Maybe it as an old injury that never seemed to fully heal. Perhaps it was something that crept up on you and you have no knowledge of when or how the pain began.

Maybe you were born with a condition that has caused a steady decline in your health and you can't remember a time that you were pain free.

Your own flesh feels foreign,

like a prison that keeps you locked in an unending wheel of exhaustion and agony.

You feel trapped in your own skin.

Your own flesh feels foreign, like a prison that keeps you locked in an unending wheel of exhaustion and agony. You feel trapped in your own skin.

Life with chronic pain is more than debilitating. It is soul crushing. The immense weight those of us who suffer from chronic pain carries cannot be overstated. When it seems all but impossible to get out of bed just to take a shower, you realize that pain has become the unwanted focus and driver of your life.

The far reaching effects of chronic pain can't even begin to be understood by those who don't suffer from this nightmare.

Chronic pain can seem like a hopeless condition to live with, especially when you don't remember the last time you weren't in pain, but there is hope. Research is showing that chronic pain can have both an inflammatory and a central nervous system or CNS component and by using an approach that integrates addressing both aspects, relief may be attainable.

Why does my body ache?

While the reasons why one particular person suffers from chronic pain and another doesn't is not quite clear yet in academic research, inflammation plays a defining role. When you think of inflammation, you usually think of the hot, red, painful swollen knee when you trip or get injured while playing sports.

The inflammation of chronic pain is similar but a bit different. Low grade systemic inflammation is a condition in which there is a long-term release of pro-inflammatory cytokines (chemicals within certain cells in your body) from immune cells. The innate immune system which encompasses such components as the skin, your cough reflex, and mucus production, can be involved as well.

Inflammation, in the normal physiological immune response, plays a positive role. In it's proper form, inflammation helps to isolate any harmful intruders in the body and alert the immune system to destroy them. This helps to keep you from getting sick or dying from a foreign antigen, like the flu or Cholera.

If inflammation is so good, then why do I feel so bad? Inflammation is only a "good" thing when it is done under the proper physiological context. So if you've been exposed to the rhinovirus, which causes the common cold, the immune system will try its best to get rid of that virus to prevent you from becoming sick.

If there is no foreign intruder, then inflammation in the body can cause more harm than good.

Why would my cells

be promoting

inflammation in my body...?

Doesn't that seem like

my body is working against me?

So naturally the question to ask is: why would my cells be promoting inflammation in my body if there is no intruder? Doesn't that seem like my body is working against me?

In a sense, yes... and no. Inflammation in the body isn't just caused by foreign intruders. It is also mediated by certain hormones, your life choices, and unsurprisingly, your diet.

Leptin and Chronic Pain?

Leptin is a hormone produced by the adipocytes, or fat cells, in your body. The more fatty tissue you have the more leptin is produced. Predominantly leptin is thought to play a role in fat storage in the body. It's main role is to allow the brain to help assess the stores of energy that you have available to you.

People who are considered to be overweight or obese usually have more levels of leptin circulating in the blood than people who are normal weight or underweight. The response that leptin invokes on the immune system is basically pro-inflammatory [1].

This means that high amounts of leptin in the blood, as seen in individuals carrying extra weight, equates to higher amounts of inflammation in the body.

More fatty tissue, more adipocytes, secrete more leptin and allow for a cascade of inflammatory cytokines to be released leading to things like insulin resistance and Diabetes mellitus Type II.

This, in turn, leads to more inflammation which leads to more long term organ damage and chronic pain.

Gut Microbiome and Inflammation

Your intestines are the home to trillions of bacteria that not only help to digest food and extract nutrients but also help to influence your immune system. The amount of bacterial cells in the human intestines outnumber your own cells by a factor of 10.

Your gut flora help to reduce inflammation through maintaining the mucosal immune system, protecting from pathogen invasion and maintaining intestinal tract integrity [2]. Clearly, our gut microbiome plays a huge role in our health.

As we age and/or gain more weight, the amount and type of bacteria in our guts lessen and become more uniform. This leads to unintended consequences like an increase in gut permeability and low grade inflammation.

Gut permeability allows particles into the blood stream that have not yet been broken down and used as nutrients. The body recognizes these undigested particles as a threat and releases more inflammatory cytokines to neutralize it.

This scenario repeats itself indefinitely leading to a build up of low grade inflammation in the body. As pro-inflammatory cytokines are released more and more, these chemicals have the ability to directly stimulate nociceptors (or pain receptors) in the body causing chronic pain [3].

So what am I supposed to do to alleviate my chronic pain?

Since, chronic pain is not a simple entity to deal with for patient or practitioner, could it be that a whole lifestyle change is required to find some relief?

"Like eating more berries is going to take away my pain? Yeah right." I can hear you say with the role of your eyes.

While it's not that simple, I'd have to agree that in a sense, you are right! Berries, blackberries, blueberries, all types of berries, are very beneficial in helping to receive pain due to their high amounts of antioxidants and phytonutrients.

Many plants, like cranberries, possess compounds called proanthocyanidins, which have been shown to be a powerful antioxidant.

Free radical damage contributes greatly to pain through tissue and nerve damage. Increasing antioxidants in your diet can help to not only reduce free radical damage but also help decrease inflammation. The ketogenic diet, a low carb high fat diet has also been found to be anti-inflammatory as it decreases pro-inflammatory cytokine levels in the body. Omega-3's, like EPA and DHA, have the power to decrease inflammation in the body by pushing the body's biochemical down a less inflammatory pathway both directly by replacing arachidonic acid (a pro-inflammatory fatty acid) and indirectly through altering the expression of inflammatory genes [4].

Mushrooms, like Grifola frondosa, have immune stabilizing chemicals like phenols and beta-glucans that help lower inflammation thereby reducing inflammation induced chronic pain. G. frondosa, as well as many other species of mushroom, like cordyceps sinensis, have been proven to have a power anti-inflammatory effect by reducing the amount of cytokines produced in the body [5].

What does an Anti-inflammatory Diet look like?

Fruits and vegetables are an integral part of your diet to decrease inflammation. Dark leafy greens like spinach, kale, and chard give your body the nutrients it needs to start down a path to lower inflammation.

Steaming your vegetables allows for optimal digestion and absorption while helping the intestinal mucosa to heal itself. Make sure to choose high fiber, lower carb vegetables like red and green cabbage, mustard greens, cauliflower, and radishes. High fiber helps to improve the digestive and bowel function while lower carbs contribute to lowered amounts of insulin resistance and inflammation.

Avoid high intake of fruits, even if they are fresh, since fruits have a high sugar content and sugar adds to inflammation. Eating a small amount of high fiber low carb whole fruits like whole apples, pears, cantaloupe, blackberries, and cherries will allow you to receive the dense anti-inflammatory nutrients without causing more inflammation with added sugar.

Limit or eliminate red and processed meats. These food items were associated with higher CRP (C-reactive protein) levels in both men and women [6]. CRP is a biomarker for inflammation. The higher your levels, the more inflammation in your body and the more pain.

Incorporate spices like garlic, tumeric, and ginger into your diet for an extra boost of antioxidants. Always stay hydrated making sure to drink a minimum of 6 to 8 glasses of water a day to allow for maximum functioning of your body.

Avoids foods like peanuts, animal milks, caffeine, citrus fruits, dried fruits (because of their high sugar content), fried foods, and wheat products.

Following this diet for a minimum of 4 weeks will help to lower inflammation and pain.

While changing your diet is extremely difficult, it is more difficult to live with inflammation induced chronic pan. Making some serious long-term changes to your diet can have a lasting benefit to your health.

Are you experiencing chronic pain? What have you tried? What worked and what didn't?

References

1. Tian G, Liang J-N, Wang Z-Y, Zhou D. Emerging role of leptin in rheumatoid arthritis. Clinical and Experimental Immunology. 2014;177(3):557-570. doi:10.1111/cei.12372.

2. Minihane AM, Vinoy S, Russell WR, et al. Low-grade inflammation, diet composition and health: current research evidence and its translation. The British Journal of Nutrition. 2015;114(7):999-1012. doi:10.1017/S0007114515002093.

3. Ji R-R, Xu Z-Z, Gao Y-J. Emerging targets in neuroinflammation-driven chronic pain. Nature reviews Drug discovery. 2014;13(7):533-548. doi:10.1038/nrd4334

4. French JA, Koepp M, Naegelin Y, et al. Clinical studies and anti-inflammatory mechanisms of treatments. Epilepsia. 2017;58(Suppl 3):69-82. doi:10.1111/epi.13779.

5. Elsayed EA, El Enshasy H, Wadaan MAM, Aziz R. Mushrooms: A Potential Natural Source of Anti-Inflammatory Compounds for Medical Applications. Mediators of Inflammation. 2014;2014:805841. doi:10.1155/2014/805841.

6.Chai W, Morimoto Y, Cooney RV, et al. Dietary Red and Processed Meat Intake and Markers of Adiposity and Inflammation: The Multiethnic Cohort Study. Journal of the American College of Nutrition. 2017;36(5):378-385. doi:10.1080/07315724.2017.1318317.