Diet and Chronic Pain: The Paleo Perspective

Chronic pain (pain that lasts 6 months or more) can be caused by all kinds of problems, from autoimmune diseases to overuse injuries to degenerative diseases like osteoarthritis. Sometimes, it can come without any obvious cause just because it apparently decided to show up one day and make your life harder.

Chronic pain without a visible cause is one of the most mentally difficult chronic health problems to manage, because many people assume that you’re just making it up for attention (especially if you “look healthy” otherwise, as if anyone could tell how healthy someone is by looking at them!). Doctors are sometimes reluctant to prescribe strong painkillers for patients who claim they hurt but don’t have any outer sign to “show for it,” because the doctors are afraid the “pain” could just be an excuse to get prescription drugs. But if you’re like most people suffering from chronic pain, you’re very definitely not making it up, and it doesn’t have to have a visible cause to be “legitimate” pain.

Paleo isn’t a one-size-fits-all solution to chronic pain. If that existed, then chronic pain wouldn’t exist any longer. But there is some evidence to support a Paleo-style diet as a reasonably effective therapy for both pain that isn’t caused by a particular disease and pain secondary to other pathologies, like autoimmune diseases or arthritis.

Pain, Inflammation, and the Gut

Think about what pain actually is - what does it mean to say that you “feel pain”? What’s going on in your body to produce that sensation? Physically, the sensation is being registered in your nerves, so you’re looking for the reason why the nerves in some area of your body are registering a sensation of pain. We can break it down into two options: either there is a physical reason for the pain, or there isn’t:

• Nociceptive Pain: There Is a Physical Reason. It could be something called “nociceptive” pain - that’s when there’s a physical stimulus applied to some part of you. For example, if you have chronic pain caused by an overuse injury in your knees, then there's a physical reason for the pain: the injury to the joint.
• Neuropathic Pain: There Is No (Current) Physical Reason. You can also get “neuropathic pain,” which is when there is no physical stimulus that ought to be painful, but something has gone wrong in the nervous system, and so the nerves are sending your brain the sensation of pain anyway. Multiple sclerosis is a good example of a disease that can cause neuropathy; so can diabetes, cancer, and several others. Sometimes, pain starts as an actual injury, but for some reason the nervous system continues to send the pain signals even after the original physical damage is long gone.

The problems underlying these different kinds of pain and the drugs used to treat them raise three interesting possibilities for diet to be effective: by reducing inflammation, by affecting serotonin production in the gut, and by affecting brain metabolism.

If you’ll look back at that list you’ll notice that all of those diseases have something else in common: inflammation. In the case of nociceptive pain, inflammation can actually be the physical stimulus that causes the pain. Chronic inflammation in your body can both trigger the nociceptors to feel pain and make them more sensitive to other stimuli. An example of this at work is the soreness in your muscles after a hard workout. The actual reason why you feel pain is that the inflammation in the muscle tissue is affecting your nociceptors. If your body is chronically inflamed for some other reason, it could potentially cause a similar response.

Inflammation is tied up with chronic pain whether the pain comes from another disease (e.g. cancer), whether it comes from mechanical stress (e.g. poor posture, abnormal bone structure, back pain from sitting all day, “runner’s knee”), or whether it doesn’t have any identifiable cause at all.

Anti-inflammatory drugs like NSAIDs are effective for chronic pain, but they’re rarely prescribed because they tend to cause problems like intestinal ulcers or kidney failure down the line. But they do work, suggesting that one way for diet to modify chronic pain would be to reduce inflammation in general, in ways that let you keep your other organs intact.

Another fascinating aspect of neuropathic pain in particular is the serotonin connection. One commonly prescribed and reasonably effective treatment for neuropathic pain is antidepressant medication, specifically SSRIs. This suggests that neuropathic pain might be influenced by the gut – the vast majority of your body’s serotonin is actually made in the gut, and there’s an intense connection between gut health and brain health. This raises the possibility that a gut-healing diet might have an effect on chronic pain via serotonin. But this is just an idea; nobody's ever actually tried it in a study and it certainly isn't a definitive "proof" of anything.

Anti-epileptics are also a reasonably effective treatment for neuropathic pain. This raises the question of ketogenic diets for controlling pain: ketosis is also an effective treatment for epilepsy, so would it help with pain as well? A few researchers have actually tested this with interesting results, although all the research is in rats and mice.

Chronic Pain: The Paleo Prescription

No diet can magically get rid of everyone’s chronic pain: it just doesn’t work like that. Obviously, if you have chronic pain secondary to some other disease, Step 1 is to go to a doctor for that disease. But based on the research above, here’s a list of practical ways that you could modify Paleo to potentially be helpful as one aspect of addressing your pain:

• Eat an anti-inflammatory diet. Yes to fish, fresh fruits and vegetables, spices, herbs, and tea. Easy on nuts, seeds, and other Omega-6 fats. Inflammation and inflammatory diseases both contribute to chronic pain, and diet has a strong ability to modify the pain-inflammatory response.
• Live an anti-inflammatory lifestyle. (Yes, inflammation is so important that it gets two bullet points). That means getting enough sleep every night, regular but moderate exercise (walking is fine), and effective stress management.
• Pay attention to your gut. Leaky gut and other gut problems are inflammatory, and don't forget the serotonin connection: your gut affects your brain (and keeping your gut happy is just a good idea in general). The relationship between serotonin, food, and the gut is extremely complicated, so that might also be a good place to explore more on your own, if you're interested.
• Fix your movement, if applicable. Human bodies were not designed to sit down all day and then run for an hour on a treadmill. When we do that to them, they send us a signal that something is wrong: pain. Look into ways to address posture issues, mobility problems, old repetitive stress injuries, or whatever other mechanical or movement issues might be behind your pain.
• Consider autoimmunity. Not everyone who has chronic pain has an autoimmune disorder. Not everyone who has an autoimmune disorder has chronic pain. But autoimmune disorders are exactly the kind of disease that spell “chronic pain that nobody can seem to figure out or give you a diagnosis for,” and there are Paleo ways to manage them.

There’s no one “right answer” to chronic pain. There’s no magic pill that will make it go away, not even Paleo. But considering what diet can do for pain, an anti-inflammatory, gut-healing diet sounds like a good idea, and keto is at least an interesting idea to try if you don’t have any reasons not to.