Natural pain management: The request could not be satisfied
6 Cheap, Natural, and Quick Chronic Pain Remedies
Chronic pain affects about 1 in 5 people in the U.S., making it difficult if not impossible to work and enjoy family and social time.
If you have chronic pain — typically defined as longer than three months and not responding to treatment — your body hasn’t turned off the pain messages to the brain, even though the original source of the pain may be gone.
The pain may be linked with a condition such as arthritis, to a sprain or other injury, or to any number of more elusive causes.
While medications abound, some prefer more natural or holistic methods to quell the pain. Others find that medication doesn’t quite give them enough relief, and are looking for natural treatments to add on to their standard treatments, or replace them.
Complicating the picture is that doctors still don’t understand chronic pain, but they do know that what works for one person may not work for another. So, in this case, try, try again is good advice.
RELATED: How You Can Eat to Beat Back Pain
Next time chronic pain is dragging you down, consider trying a more natural route to relief. And, because pain is individual, ask your doctor for specifics about these treatments, such as doses and time to continue trying them.
1. Exercise. “People who exercise and maintain a good aerobic condition will improve most pain conditions,” says Charles Kim, MD, assistant professor of rehabilitation medicine and anesthesiology and a certified medical acupuncturist at Rusk Rehabilitation at NYU Langone Medical Center.
When we work out, he says, the body produces its own version of painkillers, such as endorphins, hormones that actually increase your pain threshold. Endorphins interact with brain receptors and can change our perception of pain.
When patients tell Dr. Kim they are in too much pain to exercise, he suggests they start slowly, and do even a little burst of walking or other activity — then build up.
In one review of non-pharmacologic treatments for chronic pain, researchers concluded that exercise was moderately effective.
2. Fish Oil. Fish oil is known for its anti-inflammatory properties, and inflammation plays a large role in pain, says Michael Cronin, ND, a naturopathic physician in Scottsdale, Az., and immediate past president of the American Association of Naturopathic Physicians.
In one study, researchers instructed patients with neck or back pain to take 1200 milligrams a day of fish oil supplements with eicosapentaenoic and decosahexanoic acid. After 75 days on fish oil, more than half of the 125 patients who reported back said they had stopped their prescription painkillers.
3. Turmeric. Also called Curcuma longa, turmeric is basically a root, Kim says. “It’s often found in spicy foods, very much in Indian cooking. Studies have shown it has definite anti-inflammatory properties.”
Researchers who tested a combination of turmeric with two other substances, Devil’s claw and bromelain, on patients with pain from osteoarthritis found the mixture gave noticeable pain relief. Patients took two 650-milligram capsules either two or three times a day.
4. Resveratrol. Found in red wine, grapes and berries, resveratrol is known to have many beneficial effects, including anti-cancer, brain protective and even life-prolonging benefits.
Recently, researchers reported that the substance works on a cellular level for pain regulation.
5. Heat Therapy. Using heat as well as cold therapy are time-honored ways to quell pain, Dr. Cronin and Kim agree.
“Hot Epsom salt baths relax the mind and change the nervous input from the body to the brain,” Cronin says. “Using ice is a well-accepted modality that decreases inflammation locally.”
The key is to know when to use which.
“When you have an acute injury, put ice on it right away,” Kim says. For instance, you twist your ankle and it’s painful and swollen. Using heat in this situation will increase blood flow and increase the swelling, he says.
“If you have lingering back spasms, heat would be the best for that,” Kim says. He suggests taking a warm shower and massaging your neck or back (or whatever body part hurts) under the warm water.
6. Meditation. Meditation can quell pain, Kim says. While some people get anxious, thinking they have to do meditation a certain way, Kim tells them it’s just not true.
“Meditation is not scripted,” he says. While you can get instruction, you can also look up approaches and follow instructions, such as this information on the approach known as mindfulness meditation.
Researchers who assigned 109 patients with chronic pain to either a mindfulness meditation program or a wait list found that those who did the meditation reported more pain relief, as well as lower anxiety and depression and a better mental quality of life, than those who did not.
Kratom: What Research Tells Us about This Controversial Supplement for Pain Relief
MSK experts say we don’t yet have enough information about kratom to know whether it is safe and effective for people with cancer.
In the past few years, a number of companies in the United States have begun selling an herbal product called kratom, mostly online. The product, sold as dried leaves or a powder in capsules, comes from a tropical tree that grows in Southeast Asia.
Proponents of kratom say that it acts as a painkiller and a sedative, among other effects. Some people believe it can treat opioid or alcohol addiction. But none of these benefits have been demonstrated in rigorous clinical trials.
Negative events associated with consuming products that contain kratom have been reported. Many of these cases were caused by long-term abuse. In addition, kratom products have been connected to recent outbreaks of salmonella that sickened about 200 people in several states.
Memorial Sloan Kettering neurologist and pharmacologist Gavril Pasternak is studying the active components of kratom to figure out what the herb does in the body. He’s collaborating on this work with medicinal chemist Susruta Majumdar, who was an assistant attending chemist at MSK and is now an associate professor at the Center for Clinical Pharmacology at the St. Louis College of Pharmacy and the Washington University School of Medicine.
Scientists believe that some of the ingredients naturally found in kratom may hold promise for developing new and better painkillers. These drugs could potentially have fewer side effects than those currently on the market.
How can a natural product become a medicine?
It’s not a crazy notion to think that a new drug could come from a tree. In fact, about half of all drugs sold today originated in living things, including plants, fungi, and bacteria found in the soil. These natural products include the heart drug digoxin, which is isolated from a flower called foxglove; the antibiotic penicillin, which comes from mold; and painkillers like morphine, which is made from poppies. Many cancer drugs are made from natural products too.
Natural products that are developed and sold as drugs may come directly from their source. They may also be created in the lab using chemical synthesis. Chemicals taken from living things may become the starting materials for making similar compounds. Chemists may alter naturally occurring molecules to come up with drugs that are more effective or have fewer side effects.
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Can kratom block pain with less risk?
Like most herbal products that come from plants, kratom contains a mixture of many different chemical compounds. In 2016, Dr. Majumdar published a study in collaboration with Columbia University researcher Dalibor Sames showing that among the natural products found in kratom, two compounds activate opioid receptors in human cells — the same receptors activated by drugs like morphine and oxycodone, which are clinically used in the treatment of pain.
Later in the year, in collaboration with Jay McLaughlin of the University of Florida and MSK researchers Ying Xian Pan and Dr. Pasternak, Dr. Majumdar published another study, which reported that two compounds in kratom were more effective than morphine at blocking pain in mice. Their effectiveness was tested using what is called a tail-flick assay. In this assessment, a mouse’s tail is put next to something hot. The efficacy of the pain medication is determined by how many seconds it takes for the mouse to feel pain and flick away its tail.
Further investigations done in cells and mice determined how these molecules provided pain-blocking effects. “We found that these compounds are structurally different from drugs like morphine or fentanyl,” Dr. Majumdar says. “They bind to pain receptors in a different way.” Specifically, they act on the pathways that allow pain to be suppressed without acting on the pathways that suppress breathing. The addictive potential of the natural products found in kratom is presently being investigated and will soon be reported.
“This is a crucial safety issue since respiratory depression is responsible for overdose deaths from opioids,” adds Dr. Pasternak. He and Dr. Majumdar are continuing to work together to design novel drugs based on components in kratom that will be even more effective and safe.
The US Food and Drug Administration and US Drug Enforcement Administration are considering banning kratom. Scientists who study kratom say that such an action would effectively end their research because it would become exceedingly difficult to obtain and work with the compounds. Potentially promising leads for new drugs could be lost.
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Can people with cancer take kratom now?
The type of kratom-derived drugs being developed by Drs. Pasternak and Majumdar are at least several years from being evaluated in clinical trials. But the experts in MSK’s Integrative Medicine Service who manage the About Herbs database frequently receive questions from people with cancer — as well as their doctors — about whether kratom as it is now sold is a safe and effective way to manage cancer pain. The database provides information about herbs and other complementary therapies that is based on scientific literature.
“A lot of people are interested in taking kratom for their cancer pain because they’re concerned about the addiction potential of traditional opioid drugs,” says pharmacist K. Simon Yeung, who manages About Herbs. “But right now, we don’t have enough information to know whether it is safe and effective for this purpose.”
People with cancer receive more effective and reliable pain relief with established painkillers.
Gavril W. Pasternak
neurologist and pharmacologist
“One problem with kratom is that it is a mixture of many different compounds whose levels can vary from preparation to preparation, making it quite difficult to determine what dose should be used,” Dr. Pasternak says. “People with cancer receive more effective and reliable pain relief with established painkillers.”
Dr. Yeung notes that concern about salmonella contamination makes it even more important to avoid kratom products. “One FDA analysis found that half of all kratom products evaluated were contaminated,” he says. “Because chemotherapy and other cancer treatments can weaken a person’s immune system, getting one of these infections could be very serious.”
MSK doctors stress that people with cancer should not take any herbal substances without first discussing it with their healthcare team.
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Natural Pain Relief | Beebe Healthcare
Pain relief doesn’t always come in a pill bottle. There are better solutions, many found in your refrigerator, spice rack, and garden. The right mix of foods, herbs, and supplements has proven to be extraordinarily effective in managing chronic inflammation and pain – no prescription required.
Here are some of the latest findings on a nutritional approach to healthy, pain-free living.
Doctor, What Should I Eat?
Follow the Mediterranean diet. Evidence abounds to show that people who choose lean proteins like fish and poultry, plant-based foods like beans, fresh fruits, and vegetables, and olive oil, enjoy longer, healthier lives. These food choices have proved beneficial for people with rheumatoid arthritis (RA), according to recent studies that show a decrease in joint tenderness and an improvement in a sense of well-being as a result of following the Mediterranean diet.
Garlic’s myriad benefits include curing toothaches, reducing the aches and pains of arthritis, aiding digestion, treating coughs and preventing hypertension.
Onions, one of the richest sources of flavonoids (antioxidants), has been shown to inhibit inflammation in patients with osteoarthritis and rheumatoid arthritis.
Consult Your Spice Cabinet
Turmeric is recognized as a potent anti-inflammatory agent, mainly through the spice’s active ingredients, curcuminoids. Turmeric should be from a quality source and is most bioavailable when heated, making it ideal for stirring into a cup of hot tea or warm milk, for sprinkling on roasted cauliflower, or in a variety of Indian dishes.
Ginger reduces inflammation, lowers blood pressure and is of great value as a digestive aid. Other uses include: relief from arthritis or muscle soreness, menstrual pain, chest, lower back and stomach pain, upper respiratory tract infections, cough, and bronchitis.
Willow bark is used as a fever reducer, mild pain reliever, and an anti-inflammatory agent.
Comfrey-containing creams have been found to significantly reduce inflammation and pain associated with sprains and muscle injuries.
Essential Oils to Relieve Pain
Clove essential oil, commonly used as a dental pain reliever, may also be effective for treating dry socket when combined with a zinc oxide paste.
Peppermint Oil is one of the most popular remedies for alleviating intestinal gas and abdominal cramps. In addition, a dab or two on your temples provides welcome relief from a migraine headache.
Start Slowly with Supplements
Before starting on a supplement regimen, take note of these safety precautions:
- Check with your physician to ensure the supplement will not interfere or react badly with any current medications you are taking.
- Only choose tested, standardized, single-name supplements from a high quality company.
- Read the label carefully and understand what you’re taking.
Consider these supplements with proven benefits:
Magnesium glycinate can help reduce frequency of migraines and eliminate menstrual cramping. Taken at night, this supplement can also help you fall quickly and easily to sleep.
Vitamin D is frequently seen at insufficient levels in Americans, and is important in regulating blood pressure, immune function and regulating cell growth.
Fish oil supplements appear to be a safer alternative to ibuprofen for reducing arthritic neck and back pain.
While there are a number of foods, plants and herbs with medicinal qualities, there is no single one that serves as a magic bullet for pain relief. Instead, a synergistic effect often occurs with a blend of different compounds. The wisest, safest route is following a well-balanced healthy diet and choosing supplements and herbs in consultation with your physician.
Uday Jani, MD, is a Board Certified Internal Medicine physician at Shore View Personalized Medical Care. He is Fellowship Trained in Integrative Medicine. If you are looking for a physician within the Beebe network, use the Find a Doctor database at www.beebehealthcare.org/find-a-doc or call the Physician Referral Service at (302) 645-3332.
Natural anti-inflammatory agents for pain relief
The use of both over-the-counter and prescription nonsteroidal medications is frequently recommended in a typical neurosurgical practice. But persistent long-term use safety concerns must be considered when prescribing these medications for chronic and degenerative pain conditions. This article is a literature review of the biochemical pathways of inflammatory pain, the potentially serious side effects of nonsteroidal drugs and commonly used and clinically studied natural alternative anti-inflammatory supplements. Although nonsteroidal medications can be effective, herbs and dietary supplements may offer a safer, and often an effective, alternative treatment for pain relief, especially for long-term use.
Keywords: Alternative treatments, inflammation, natural anti-inflammatories, pain
Pain, heat, redness, and swelling (dolor, calor, rubor, tumor) are the classic manifestations of the inflammatory process. Abnormalities of the joints of the spine, associated muscles, tendons, ligaments and bone structural abnormalities can all result in pain and need for neurosurgical consultations. Typically, patients will not require immediate surgical intervention, and therefore require treatments to reduce pain and enhance quality of life activities.
In most cases, the genesis of pain is inflammatory, regardless of the etiology. With the elucidation of the role of inflammatory cytokines, there is now a clear understanding of the pathways by which many anti-inflammatory drugs can alleviate inflammation and relieve pain.
The use of non-steroidal anti-inflammatory drug (NSAID) medication is still the mainstay of most classically taught clinicians for joint and spine related inflammatory pain, despite their commonly known side effects . NSAID mechanisms are primarily through interaction with proinflammatory cytokines interleukin (IL)-1a, IL-1b, IL-6 and tumor necrosis factor (TNF-α). Increased concentrations of TNF-α are believed to cause the cardinal signs of inflammation to occur.
The commonly known and documented side effects of steroid-based medications
|Side effects of steroid-based medications|
|Increased risk of infection||Impaired wound healing|
|Fluid retention edema||Weight gain|
|Fat deposits in face, chest, upper back and stomach||Worsening of previously acquired medical conditions|
|Cushingoid-like state||Adrenal suppression and crisis|
These proinflammatory cytokines result in chemoattractant for neutrophils and help them to stick to the endothelial cells for migration. They also stimulate white cell phagocytosis and the production of inflammatory lipid prostaglandin E2 (PGE2). NSAIDs’ ability to interfere with the production of prostaglandin during the inflammatory cascade is the major mechanism cited for the anti-inflammatory success of these medications .
Schematic showing that when a cell membrane is injured the arachidonic acid pathway is activated to initiate the local inflammatory response through the production of prostaglandins, thromboxanes, and leukotrienes. Their activation requires the enzymes COX and LOX. The NSAIDs can block COX action and thereby prevent the formation of the COX-derived inflammatory mediators. 5-HPETE = 5-hydroperoxyeicosatetraenoic acid; LTC4 = leukotriene C4; PGE2 = prostaglandin E2; PGF2 = prostaglandin F2; PGI2 = prostacyclin; TXA2 = thromboxane.
Prostaglandins act as short-lived localized hormones that can be released by any cell of the body during tissue, chemical, or traumatic injury, and can induce fever, inflammation, and pain, once they are present in the intercellular space. Thromboxanes, which are also hormone activators, can regulate blood vessel tone, platelet aggregation, and clot formation to increase the inflammatory response.[92,82] The inflammatory pathway is a complex biochemical pathway which, once stimulated by injury, leads to the production of these and other inflammatory mediators whose initial effect is pain and tissue destruction, followed by healing and recovery.[34,51] A major component of the inflammatory pathway is called the arachidonic acid pathway because arachidonic acid is immediately released from traumatized cellular membranes. Membrane-based arachidonic acid is transformed into prostaglandins and thromboxanes partly through the enzymatic action of cyclooxygenase (COX)[34,57]. There are two types of COX enzymes, COX-1 and COX-2. Both the enzymes act similarly, but selective inhibition (as accomplished by selective COX-2 inhibiting NSAIDs) can make a difference in terms of side effects.
Acetylsalicylic acid works by irreversibly disabling the COX enzymes to block the cascade . NSAIDs have evolved from blocking both COX-1 and COX-2 to selectively only blocking COX-2 in order to inhibit the inflammatory response and reduce the production of inflammatory prostaglandins and thromboxanes. The major push to develop the selective COX-2 inhibitors has been the recognition of significant complications associated with the nonselective COX-1 and COX-2 NSAIDs. Nonselective NSAIDs’ major side effects include significant gastrointestinal upset, gastritis, ulceration, hemorrhage, and even death. By locking COX-1, which also normally acts to protect the gastrointestinal mucosa, nonselective NSAIDs and aspirin can cause significant gastric tissue damage.[34,51,78,91,3,101,115]
Various studies have also shown that NSAIDs can delay muscle regeneration and may reduce ligament, tendon, and cartilage healing.[4,13,77] Specifically, NSAIDs are believed to wipe out the entire inflammatory mediated proliferative phase of healing associated with WBC actions (days 0–4). A study of the effects of NSAIDs on acute hamstring injuries was done in humans by Reynolds et al., and these investigators concluded that patients who used NSAIDs did not experience a greater reduction of pain and soft-tissue swelling when compared with the placebo group. Interestingly enough, the authors noted that the NSAIDs’ group had worse pain associated with severe injuries compared with the placebo group.
The NSAIDs are also known to have adverse effects on kidney function. Dehydration or preexisting chronic renal failure or disease, resulting in stimulation of the renin–angiotensin system, may predispose certain populations to acute renal failure through inhibition of prostaglandin synthesis, which can occur when taking NSAIDs. The National Kidney Foundation asserts that approximately 10% of kidney failures per year are directly correlated to substantial overuse of NSAIDs.
Life-threatening side effects of selective COX-2 NSAIDs
in December 1998, celecoxib (Celebrex) was approved by the Food and Drug Administration (FDA) as the first selective COX-2 inhibitor for treatment of arthritis pain.[92,13,22] Rofecoxib (Vioxx) was approved several months later, followed by valdecoxib (Bextra).[92,28,67,79] These NSAIDs were designed to allow continued production of the gastrointestinally protective prostaglandins produced through the COX-1 enzyme system while blocking the COX-2 enzyme that produces the inflammatory prostaglandins.[34,45,51,89]
Celebrex, Vioxx, and Bextra quickly became the mainstay for the treatment of chronic pain conditions related to inflammation. Within a few years, an estimated 15–20 million people in the US were using selective COX-2–inhibiting NSAIDs on a long-term basis. These drugs became the most commonly used pharmaceutical agent with more than 70 million NSAID prescriptions written each year and 30 billion over-the-counter NSAID tablets sold annually. It was estimated that 5–10% of the adult population used NSAIDs, and among the elderly (a group at higher risk of nonselective NSAID-induced gastrointestinal complications), the use of these drugs was as high as 15%. The general acceptance of these drugs was due to the perceived lack of serious gastrointestinal side effects that had been associated with the nonselective class of NSAIDs.[26,119]
On September 30, 2004, Merck Research Laboratories announced the global withdrawal of rofecoxib (Vioxx), its primary selective COX-2–inhibiting NSAID.[52,90,122] Analysis of the results of the Adenomatous Polyps Prevention on Vioxx study (known as the APPROVe study) showed that there was double the risk of serious thromboembolic events, including myocardial infarction, which became apparent after 18 months of Vioxx treatment. Selective COX-2 NSAID’s thrombotic mechanism of action is based on COX-1’s unopposed action to continued platelet synthesis of thromboxane. Thromboxane is a thrombogenic and atherogenic eicosanoid. Prostacyclin prevents formation of platelet clotting. By inhibiting COX-2 that blocks production of prostacyclin (PGI2) there is unopposed thromboxane which will increase the clotting risk. Thus, inhibiting prostacyclin led to the increased risk of thrombotic cardiovascular and cerebrovascular events.[5,26,73,123]
Natural compounds for inflammation
Because of the significant side effect profiles of steroidal and NSAID medications, there is a greater interest in natural compounds, such as dietary supplement and herbal remedies, which have been used for centuries to reduce pain and inflammation. Many of these natural compounds also work by inhibiting the inflammatory pathways in a similar manner as NSAIDs. In addition to the COX pathway, many natural compounds act to inhibit nuclear factor-kB (NF-kB) inflammatory pathways.
NF-kB inflammatory pathways and cytokines
The NF-kB molecule is a transcription factor that controls the transcription of DNA for the perpetuation of the inflammatory immune response. It acts as a switch to turn inflammation on and off in the body. NF-kB has the ability to detect noxious stimuli, such as infectious agents, free radicals, and other cellular injuries, and then directs DNA to produce inflammatory cytokines. The NF-kB proteins are localized in the cytoplasm of the cell and are associated with a family of inhibitory proteins known as inhibitor of kB (IkB).[43,119] The TNF-α, and especially IL-1b, can also directly stimulate enzymes known as matrix metalloproteinases, which break down extracellular collagen matrix, a hallmark of inflammatory joint disease.[32,76,77] The IkB proteins are normally bound to NF-kB and block their nuclear localization signal. A variety of provoking stimuli can degrade the IkB and result in the nuclear translocation of NF-kB to be free to activate DNA synthesis of inflammatory cytokines .
Schematic showing another inflammatory pathway that is activated by tissue injury. This is the NF-kB activation, in which once the protein is free as a result of tissue injury, it can enter the cell nucleus and activate the DNA to enhance the inflammatory response further by the production of additional cytokines, chemokines, and adhesion molecules (IKKB = IkB kinase)
Aspirin is now believed to target both the NF-kB and COX pathways. These agents inhibit the NF-kB pathway in endothelial cells and block NF-kB activation to inhibit leukocyte recruitment.[114,115,116] NSAIDs have also been found to inhibit both the COX system and the NF-kB pathway. Immunosuppressant drugs also reduce nuclear expression of NF-kB.[39,70,75] Research now indicates that blocking the activation of NF-kB along with other inflammation mediators  is the major mechanism for reducing inflammation by natural compounds.
Several examples of inflammation triggering factors, pathway mediators and conditions modulated by natural compounds
|Natural compounds and inflammatory pathway modulation|
|Radiation||Allergic immune response|
|COX-1 and -2||TNF-α|
|Thromboxanes||Reactive oxygen species (ROS)|
|Insulin resistance||Autoimmune response|
Examples of natural anti-inflammatory
Plant- and animal-derived nutraceutical preparations have been used for hundreds and even thousands of years to obtain effective pain relief. Herbal medications are becoming increasingly popular because of their relatively few side effects. Nevertheless, there are problems associated with these dietary supplements, and their use requires knowledge of their biological action, clinical studies (both affirmative and negative), and potential interactions with other nutraceutical products and prescription medications.
The evaluation of nutraceutical preparations with appropriately designed controlled studies has exploded in recent years. There is now a greater degree of confidence based on controlled study design and improved quality of the investigators that has strengthened positive findings found using natural compounds to treat diseases. It is important for healthcare practitioners to learn about these scientific studies to counsel patients who are taking various dietary supplements, herbs minerals and vitamins for both disease treatment and prevention.
The processes used to prepare herb-derived compounds pose complications when it comes to determining the quantity and concentration of the products.[30,63,102] The preparation processes are not standardized, and therefore, the extraction process and the type of plant used may affect the true concentration of the product. In addition, there is a lack of uniformity within and between manufacturers. Although dietary supplements are not held to the same rigorous testing and standards as pharmaceutically derived medications in the US, there are many regulations that still control their manufacture because these are food products.
The US governmental agencies, through the FDA and others, routinely inspect the manufacture of vitamins or supplements made in this country, as they do for any other food product.[30,63,74] Contaminants, such as the recently discovered high lead content found in various Ayurvedic preparations that were made by an Indian manufacturer and imported into the US,[30,61,63,74,102] are generally thought to be uncommon, but can be a concern when purchasing imported supplements.
Some manufacturers inflate nutraceutical products’ claims and may not cite possible side effects and potential drug interactions. Bleeding complications are associated with white willow bark, ginger, garlic, and others. Therefore, such medicinal preparations are not without risk. Products such as omega-3 essential fatty acids (EFAs) (O3) do have strong scientific support to be considered as an alternative and/or complementary agent to NSAIDs. Published studies have shown the effectiveness of O3 to successfully treat spine-related pain. Capsaicin, oil of camphor, and other natural topical preparations are commonly used for muscle soreness and local application for painful traumatic injuries.[12,16,80] The subsequent sections will review many of these products and discuss both their efficacy and safety issues. As with any drug or natural compounds, additional caution should be used when considering these treatments for children, pregnant or lactating mothers or any other clinical or disease condition that could increase possible risk of side effect or complication.
Omega-3 EFAs (fish oil)
The use of fish oil (in the form of cod liver oil), an omega-3 EFA, for the treatment of muscular, skeletal, and discogenic diseases, can be traced back to the late 18th century as detailed by Curtis et al.,[24,25] Unfortunately, because of the rapid onset of rancidity of this polyunsaturated oil when exposed to air, and hence its disconcerting odor, cod liver oil fell out of favor. With improved extraction techniques, such as using a protective nitrogen blanket and enhanced oxygen-free encapsulation methods, there is less chance of oxidation during the manufacturing process. The therapeutic benefits of fish oil can now be realized without the regurgitation and odor of previous products caused by peroxides and rancid tasting fish oil.
Research has shown that the omega-3 polyunsaturated fatty acids are some of the most effective natural anti-inflammatory agents available.[12,23–25,27,50,85] With the discovery that vascular inflammation is the underlying cause of coronary artery disease, fish and fish oil supplements are now recommended by the American Heart Association for the prevention of this disease.[12,23–25,27,50,85] Countries that have the highest fish consumption also have a lower incidence of neurodegenerative disease and depression.[12,23–25,27,50,85] The biological basis for the effectiveness of fish oil in treating arthritis has been well documented with many positive clinical studies, when compared to traditional pharmaceutical anti-inflammatory agents.[12,23–25,27,50,85]
The active ingredients in fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), enhance the conversion of COX to prostaglandin E3. A natural anti-inflammatory agent, prostaglandin E3 competitively inhibits the effects of the arachidonic acid conversion to prostaglandin E2, a highly inflammatory substance. Prostaglandin E3 also inhibits the synthesis of TNF-α and IL-1b, both of which are inflammatory cytokines. The EPA and DHA can inhibit the 5-LOX pathway, which converts arachidonic acid to inflammatory leukotrienes, by competitive inhibition as well. When EPA and DHA are incorporated into articular cartridge chondrocyte cell membranes, there is a dose-dependent decrease in the expression and activity of the proteoglycan-degrading aggrecanase enzymes.[12,23–25,27,50,85]
Omega-3 EFA, found in fish oil, can directly reduce the degenerative enzymes, aggrecanase and matrix metalloproteinase, as well as IL-1, TNF-α, and COX-2, to reduce the inflammation in synovial cartilage. A recent study of 250 patients with cervical and lumbar disc disease, who were taking NSAIDs, revealed that 59% could substitute fish oil supplements as a natural anti-inflammatory agent for the NSAIDs. The recommended dosage is a total of 1.5–5g of EPA and DHA per day, taken with meals.
Rare side effects include steatorrhea and occasional belching if the supplements are not taken with meals. Typically, persons on a regimen of anticoagulant medications should not take omega-3 EFAs because of the possibility of increasing the bleeding potential.
White willow bark
Bark from the white willow tree is one of the oldest herbal remedies for pain and inflammation, dating back to ancient Egyptian, Roman, Greek, and Indian civilizations, as an analgesic and antipyretic agent. Because of the gastric side effects of aspirin, there has been a resurgence in the use of white willow bark for the treatment of inflammatory syndromes. The mechanism of action of white willow bark is similar to that of aspirin which is a nonselective inhibitor of COX-1 and COX-2, used to block inflammatory prostaglandins.
Various randomized, placebo-controlled studies comparing white willow bark with nonsteroidal agents have shown an efficacy comparable to these agents and aspirin. Salicin from white willow bark is converted to salicylic acid by the liver and is considered to have fewer side effects than aspirin. However, it is costlier than aspirin, and should not be used in children (to avoid the risk of Reye’s syndrome), or in patients with peptic ulcer disease, poorly controlled diabetes, hepatic or renal disorders, or other conditions in which aspirin would be contraindicated. The usual dose of white willow bark is 240 mg/day.[18,19,33,41,64,69,99,100]
Curcumin is a naturally occurring yellow pigment derived from turmeric (Curcuma longa), a flowering plant of the ginger family. It has traditionally been used as a coloring and flavoring spice in food products. Curcumin has long been used in both Ayurvedic and Chinese medicines as an anti-inflammatory agent, a treatment for digestive disorders, and to enhance wound healing. Several clinical trials have demonstrated curcumin’s antioxidant, anti-inflammatory, and antineoplastic effects. Results of a study by Zandi and Karin suggested that curcumin might be efficacious in the treatment of cystic fibrosis because of its anti-inflammatory effect. Curcumin is known to inhibit inflammation by suppressing NF-kB, restricting various activators of NF-kB as well as stemming its expression.
Curcumin has also been suggested as a treatment for colitis, chronic neurodegenerative diseases, arthritis, and cancer. In addition, it regulates the activity of several enzymes and cytokines by inhibiting both COX-1 and COX-2. Most studies to date have been performed in animals, but given the centuries of use of curcumin, as well as its now demonstrated activity in the NF-kB, COX-1, and COX-2 inflammatory pathways, it may be considered a viable natural alternative to nonsteroidal agents for the treatment of inflammation.
The usual dosage of standardized turmeric powder is 400–600 mg taken three times per day. Side effects are few, but with extended use, this agent can cause stomach upset, and in extreme cases gastric ulcers may occur at very high doses. Caution should be used if the patient is taking anticoagulant medications or high doses of nonsteroidal drugs. Studies have shown that curcumin may be used in combination with lower doses of nonsteroidal medications.[7–9,11,21,40,87,111,121]
Green tea has long been recognized to have cardiovascular and cancer preventative characteristics due to its antioxidant properties. Its use in the treatment of arthritic disease as an anti-inflammatory agent has been recognized more recently. The constituents of green tea are polyphenolic compounds called catechins, and epigallocatechin-3 galate is the most abundant catechin in green tea.
Epigallocatechin-3 galate inhibits IL-1–induced proteoglycan release and type 2 collagen degradation in cartilage explants. In human in vitro models, it also suppresses IL-1b and attenuates activation of the transcription factor NF-kB. Green tea also inhibits the aggrecanases which degrade cartilage.
Green tea research now demonstrates both anti-inflammatory and chondroprotective effects. Additionally, green tea research includes the “Asian paradox”, which theorizes that increased green tea consumption in Asia may lead to significant cardiovascular, neuroprotective and cancer prevention properties. The usual recommendation is 3–4 cups of tea a day. Green tea extract has a typical dosage of 300–400 mg. Green tea can cause stomach irritation in some, and because of its caffeine content, a decaffeinated variety is also available; but the polyphenol content is currently unknown.[2,49,53,108,112,117,120]
Pycnogenol (maritime pine bark)
Pycnogenol, like white willow bark, is a nutraceutical material that has been used since ancient times. Pycnogenol is derived from the bark of the maritime pine tree (Pinus maritima) and has been used for more than 2000 years. It has been considered helpful for wound healing, treating scurvy, healing of ulcers, and reducing vascular inflammation. It contains a potent blend of active polyphenols, which includes catechin, taxifolin, procyanidins, and phenolic acids. It is one of the most potent antioxidant compounds currently known.[17,118]
Pycnogenol inhibits TNF-α–induced NF-kB activation as well as adhesion molecule expression in the endothelium. Grimm et al, recently reported that oral intake of pycnogenol inhibited NF-kB activation in lipopolysaccharide-stimulated monocytes as well, thus decreasing the inflammatory response. It also statistically significantly inhibited matrix metalloproteinase-9. This matrix-degrading enzyme is highly expressed at sites of inflammation, and contributes to the pathogenesis of various chronic inflammatory diseases.
Studies have shown that pycnogenol is 50–100 times more potent than vitamin E in neutralizing free radicals and that it helps to recycle and prolong the activity of vitamins C and E. Studies have shown pycnogenol to be effective in reducing blood pressure and reducing the risk of venous thrombosis by its effect on vascular endothelium. The usual dosage is 100–200 mg daily. Few side effects from the use of pine bark extracts have been reported, the most frequent being mild gastrointestinal effects such as diarrhea and upset stomach. Pycnogenol should not be taken by patients who are being treated with immunosuppressants or by those receiving corticosteroid drugs because it can enhance immune system function and interact with drugs that suppress the immune system.[46–84]
The Boswellia species are trees located in India, Ethiopia, Somalia, and the Arabian Peninsula, and they produce a gum resin called olibanum, better known in the western world as frankincense. This resin possesses anti-inflammatory, anti-arthritic, and analgesic properties. Boswellia can inhibit the leukotriene biosynthesis in neutrophilic granulocytes by inhibiting 5-LOX, thus affecting various inflammatory diseases that are perpetuated by leukotrienes. Clinically, the substance is used in the treatment of degenerative and inflammatory joint disorders. It reduces the total white blood cell count in joint fluid, and it also inhibits leukocyte elastase, which is released in rheumatoid arthritis. In one recent study, a statistically significant improvement in arthritis of the knee was shown after 8 weeks of treatment with 333 mg B. serrata extract taken three times a day. The treatment improved function, but radiographically there was no change in the affected joints.
A combination of Boswellia and curcumin showed superior efficacy and tolerability compared with nonsteroidal diclofenac for treating active osteoarthritis. Boswellia typically is given as an extract standardized to contain 30-40% boswellic acids (300-500 mg two or three times/day). Boswellia has been well tolerated in most studies, although some people may experience stomach discomfort, including nausea, acid reflux, or diarrhea.[1–10,42,48,56,62,103,104]
Resveratrol is a plant-based polyphenol molecule that is found in various concentrations of many different plant sources. The plant is called Japanese Knot weed or Polygonum cuspidatum, and the skins of red wine grapes are believe to have the most concentrated amounts of resveratrol. In plants, resveratrol is generally found in the plant skin and acts as a phytoalexin to protect the plant from infection, excessive UV radiation and aide in general plant defense. Resveratrol has also been found to have significant anti-mutation, anti-inflammatory, antoxidant and DNA protective actions, when consumed by animals and humans.
Most of the active research with resveratrol has been done in neuro and cardioprotection, but several studies are being reported on resveratrol’s use for arthritic joint pain. Elmali et al, reported in 2007 using animals that intra-articular injection of resveratrol protects cartilage and reduces the inflammatory reaction in simulated knee osteoarthritis. The anti-inflammatory properties of resveratrol have also been observed in experimental animal models with paw edema, which is attributed to suppression of inflammatory prostaglandin synthesis. Resveratrol is also a potent and specific inhibitor of TNF-α- and IL-1b-induced NF-kB activation. Resveratrol shows the anti-inflammatory properties as it suppresses COX-2 by blocking NF-kB activation.
Resveratrol is available commercially as a dietary supplement capsule, generally from the P. cuspidatum source. The trans-resveratrol is the active form, and although there is not an established dosing range, the typical dose is from 50 to 500 mg daily. Any significant side effect or safety issues with resveratrol have not been established, but due to an experimentally shown anti-platelet effect, caution should be exercised when taking other prescription or herbal anti-platelet or coagulation altering products.[29,54,59,68,72,107,109]
Uncaria tomentosa and Uncaria guianensis are Peruvian herbs derived from woody vines with small claw-like thorns (hence the vernacular name, cat’s claw) at the base of the leaf, which allow the plant to climb to heights of up to 100 ft. Traditionally, the bark of cat’s claw is used to treat arthritis, bursitis, and intestinal disorders. The active ingredients appear to be polyphenols (flavonoids, proanthocyanidins, and tannins), alkaloids, and sterols. Various studies indicate that this Peruvian herb induces a generalized reduction in proinflammatory mediators.
This herb has been shown to prevent the activation of the transcriptional factor NF-kB and it directly inhibits TNF-α production by up to 65-85%. It inhibits the expression of inducible genes associated with inflammation, specifically negating the expression of inducible nitric oxide synthase, and hence attenuates nitrous oxide production. Side effects may include nausea, although it has shown an impressive protective effect on indomethacin-induced enteritis in laboratory studies.
In general, toxicity and side effects are considered minimal. Two case reports of acute renal failure in a patient with lupus erythematosus have been recorded. Cat’s claw can be consumed as a tea (1000 mg root bark to 8 oz water), or as a dry, standardized extract in a capsule (20-60 mg daily).[37–39,76,86,97,98]
Capsaicin (chili pepper)
Capsicum annum is a small spreading shrub which was originally cultivated in the tropical regions of the Americas but is now grown throughout the world, including the US. The small red fruit commonly used to accentuate chili owes its stinging pungency to the chemical, capsaicin. This was isolated by chemists more than a century ago and constitutes approximately 12% of the chili pepper. This fruit has been used for various medicinal purposes by the native peoples of the American tropics for hundreds of years.
Capsaicin produces highly selective regional anesthesia by causing degeneration of capsaicin-sensitive nociceptive nerve endings which can produce significant and long-lasting increases in nociceptive thresholds. Capsaicin potently activates transient receptor potential vanilloid 1, which is a main receptor underlying nociception. It also inhibits NF-kB, thus producing an anti-inflammatory effect. Capsaicin can cause a burning sensation when it comes in contact with human flesh, and also in the digestive tract. This herb is rarely used alone but is generally mixed into other natural anti-arthritic preparations. There are topical capsaicin formulations now available to treat post-herpetic neuralgia. Other uses have been studied for peripheral neuropathies and chronic musculoskeletal pain.[15,20,35,55,58,88,110]
|The Clinical Journal of Pain
|Prospective, open-label, observational study||306 patients, repeat treatments and follow up over 52 weeks||Patients with posttraumatic or postsurgical nerve injury, postherpetic neuralgia, human immunodeficiency virus (HIV) associated distal sensory polyneuropathy, or other peripheral neuropathic pain receiving </= 6 capsaicin 8% patch with retreatment at 9 to 12 week intervals||Capsaicin 8% patch is well-tolerated with a variable alteration in sensory function and nominal risk for complete sensory loss .|
|BMC Neurology 2017||Cohort, open-label, observational, multicenter, European
|429 (420 patients received at least one treatment),
</= 52 weeks treatment and followup
|Patients with non-diabetes-related peripheral neuropathy (PNP) received up to 4 capsaicin 8% patch (179 mg of capsaicin) per treatment (at least 90 days interval)||Capsaicin 8% patch is effective, generally
well-tolerated, and can result in sustained pain relief, significant improvement in overall health status and quality of life .
|Pain Physician 2016||Prospective
|90 patients, single treatment and follow up at 2, 8, and 12 weeks||Patients with lumbosacral pain received capsaicin 8% patch||Treatment with capsaicin 8% patch resulted in substantial neuropathic pain relief and improved quality of life. The results should be further evaluated in a prospective randomized placebo-controlled study .|
|Campbell, C. M.
|Randomized double-blind placebo-controlled study||58 patients, single treatment, 4 weeks follow up||A single capsaicin 0.1 mg dose (n = 30) versus placebo (n = 28) injected into the region of the Morton’s neuroma||A trend toward significance was found in the second and third week. In the capsaicin-treated group, there was a reduction in oral analgesics and improvement in functional interference scores. Based on the findings, injection of capsaicin in painful intermetatarsal neuroma is an effective treatment .|
|European Journal of Pain (London, England)
|Open-label, randomized, multicenter, non-inferiority trial.||629 (559 patients received study medication),
8 weeks follow up
|Patients received either the capsaicin 8% patch (1 to 4 patches, n = 282) or an optimized dose of oral pregabalin (75 mg/day up to 600 mg/day, n = 277)||Capsaicin 8% patch resulted in a faster onset of action, fewer systematic adverse events, greater treatment satisfaction, and non-inferior pain relief compared to an optimized dose of pregabalin in patients with PNP .|
|Raber, J. M.
|Acta Neurologica Belgica
|Clinical trial||37 patients received single treatment,
observed 4 weeks prior to 12 weeks post administration
|Patients suffering from painful, distal symmetric polyneuropathy for an average of 5 years. Single application of the capsaicin 8% cutaneous patch (Qutenza™)||The capsaicin 8% cutaneous patch resulted in a substantial relief of neuropathic pain, a prolongation of sleep mainly in patients with HIV infection, decreased oral pain medication consumption, and a resumption of social activities .|
|Maihofner, C. G.
|European Journal of Pain (London, England)
|1063 (1044 patients evaluated for effectiveness),
12 weeks follow up
|Non-diabetic patients with peripheral neuropathic pain. single application of capsaicin 8% cutaneous patch||The highest treatment response was observed with the capsaicin 8% cutaneous patch in patients suffering from peripheral neuropathic pain of fewer than 6 months. This shows early initiation of topical treatment is recommended .|
|Bischoff, J. M.
|Randomized, double-blind, placebo-controlled trial||46 patients,
3 months follow up
|Patients suffering from inguinal post-herniorrhaphy pain received either an inactive placebo patch (n = 22) or a capsaicin 8% patch (n = 24)||A trend toward pain improvement was observed in patients treated with capsaicin 8% patch after 1 month, but there were no significant differences in pain relief between the capsaicin and placebo group .|
|Current Medical Research and Opinion
|Prospective non-interventional trial||1044 patients (822 patients completed the pain-DETECT questionaire at baseline, 571 completed questionaire at baseline and week 12),
12 weeks follow-up
|Patients with peripheral neuropathic pain treated with capsaicin 8% cutaneous patch. Single application of up to 4 patches, applied 30 min for feet or 60 min other body parts.||Applying topical capsaicin 8% in patients with peripheral neuropathic pain effectively reduced sensory abnormalities. Completion of the pain-DETECT questionnaire was optional and therefore the data was incomplete and not available for all patients. Further studies are needed to confirm these results .|
|Current Medical Research and Opinion
|Prospective, non-interventional study||1040 patients,
single application, 12 weeks follow up
|Patients with peripheral neuropathic pain received single capsaicin 8% patch application of up to 4 patches||Application of capsaicin 8% patch is safe and effective. Because there was no control group, a comparison of the study results with that of therapeutic alternatives is not justified .|
|The Clinical Journal of Pain
randomized controlled studies
single 60 min treatment,
12 weeks follow up
|Patients suffering from postherpetic neuralgia on at least 1 systemic neuropathic pain medication: 302 patients received capsaicin 8% patch and 250 control (capsaicin, 0.04%). Patients not on systemic neuropathic pain medication: 295 received capsaicin 8% patch and 280 control||A single capsaicin 8% patch for 60-min reduces postherpetic neuralgia
for up to 12-weeks regardless of concomitant use of systemic neuropathic pain medication .
|Webster, L. R.
|Diabetes Research and Clinical Practice
|Open-label, randomized, uncontrolled clinical trial||117 patients,
12 weeks follow up
|Patients were pre-treated with one of three 4% lidocaine topical anesthetics (Topicaine Gel, or Betacaine Enhanced Gel 4, or L.M.X.4,) followed by single capsaicin 8% patch application for 60- or 90- min||Applying capsaicin 8% patch with any of the three topical anesthetics was well-tolerated, generally safe, and reduced pain over 12 weeks in patients with postherpetic neuralgia and painful diabetic neuropathy .|
|Hartrick, C. T.
|Clinical Drug Investigation 2011||Randomized, placebo-controlled, parallel-group, double-blind study||14 patients,
42 days follow up
|Patients received direct instillation of capsaicin 15 mg (Anesiva 4975, n = 7) or placebo (n = 7) into the surgical site immediately prior to total knee arthroplasty wound closure, postoperative IV morphine for 24 hr and oral oxycodone as rescue medication were provided||While patients receiving capsaicin had higher BMIs, they had comparable or better pain scores, longer-lasting effect, improved active range of motion at 14 days, less opioid use in the first 3 postoperative days, and less pruritis which likely is related to the opioid-sparing effect .|
|Phytotherapy Research: PTR
|Randomized double-blind multicenter study||281 patients treated (only 130 included in analysis),
3 weeks of treatment and follow up
|Patients receiving capsaicin 0.05% cream (Finalgon ®
CPDWarmecreme, n = 140) or placebo (n = 141)
|Capsaicin cream is effective and well-tolerated in patients with chronic soft tissue pain and patients with chronic back pain compared to the placebo group .|
|Cianchetti, C||International Journal of Clinical Practice 2010||Single-blinded placebo-controlled cross-over study||23 patients,
30 min follow up after application of treatment
|20 females and 3 males with painful arteries in absence of migraine attack receiving topical capsaicin 0.1% or vaseline jelly||While the number of patients was small, results show topical capsaicin is effective in relieving arterial pain during and in the absence of migraine attacks .|
|Aasvang, E. K.
|Anesthesia and Analgesia
double-blind, placebo-controlled study
Single treatment, 4 weeks follow up
|Adult male patients receiving wound instillation of 1000 mcg of ultra-purified capsaicin (ALGRX 4975, n = 20) after open mesh groin hernia repair versus placebo (water, n = 21)||The study analysis showed during the first 3–4 days after inguinal hernia repair, capsaicin has superior analgesia compared to placebo .|
|Predel, H.-G. et al.||Pain and Therapy
|Randomized, double-blind, controlled, multicenter, parallel group trial||746 patients,
treated twice daily for 5 days, 6 days follow up
|Patients with acute back or neck pain were treated with topical diclofenac 2% + capsaicin 0.075% (n = 225), diclofenac 2% (n = 223), capsaicin 0.075% (n = 223) or placebo (n = 75)||Capsaicin alone and capsaicin + diclofenac showed superior benefit compared with placebo. However, diclofenac alone demonstrated efficacy comparable with placebo, and therefore its addition to capsaicin added no increased pain relief over capsaicin alone .|
|Journal of Orofacial Pain
double-blind, placebo-controlled study
4 weeks topical application 4 times daily with follow up at end of each week
|Patients with unilateral pain in the temporomandibular joint (TMJ) area received capsaicin 0.025% cream (n = 17) or its vehicle (placebo, n = 13) to the painful TMJ area||There was no statistically significant difference between the experimental and placebo groups. The factor of time had a major effect on the non-specific improvement of the assessed parameters and the placebo effect had an important role in treating the patients with TMJ pain .|
|McCleane, G.||British Journal of Clinical Pharmacology
double-blind, placebo-controlled study
|200 (151 patients provided results),
4 weeks treatment and follow up
|Patients applied topical 3.3% doxepin (n = 41), 0.025% capsaicin (n = 33), placebo (aqueous cream, n = 41), or 3.3% doxepin/ 0.025% capsaicin cream (n = 36) thrice daily||Overall pain was substantially reduced by 0.025% capsaicin, 3.3% doxepin and also their combination. The combination of doxepin, and capsaicin resulted in more rapid onset and analgesia. Capsaicin substantially decreased sensitivity and shooting pain .|
|Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
|Placebo-controlled trial||99 patients,
four times daily treatment for 16 weeks,
weekly questionnaires as follow up
|All patients with postsurgical neuropathic pain receiving 8 weeks of the placebo cream versus 8 weeks of 0.075% capsaicin cream||Topical capsaicin cream significantly reduces postsurgical neuropathic pain after the first 8 weeks. It was preferred over placebo by a three-to-one margin .|
|The Journal of Urology
|Prospective randomized trial||36 patients,
twice weekly treatment for 1 month,
6 months follow up
|Patients receiving 10 microM intravesical capsaicin (n = 18) or placebo (n = 18)||While intravesical instillation of capsaicin was effective on frequency and nocturia in patients with the hypersensitive disorder, its effect on pain score compared to placebo was not confirmed. Possibly higher doses of capsaicin can be effective in pain control and neurological bladder disease .|
|Journal of Pain and Symptom Management
|Pilot study||11 patients,
4–6 candies over 2–4 days, 20 min follow ups after each treatment
|6 women and five men with oral mucositis pain caused by cancer therapy received oral capsaicin (0.002–0.003 g) in a candy (taffy) vehicle||Oral capsaicin in a candy vehicle resulted in significant pain reduction. The pain relief for most patients was not complete and temporary .|
|Open-label trial||21 (19 evaluable patients),
3 times daily treatment for 2 months,
3 months follow up
|Patients with post-mastectomy pain syndrome
receiving topical 0.025% capsaicin treatment
|Topical capsaicin 0.025% resulted in the disappearance of all symptoms in 2 patients and a significant reduction in 11 patients. Further experimental and clinical research is recommended .|
|The Cochrane Database of Systematic Reviews
|Systematic review of randomized,
double-blind, placebo-controlled studies
|2488||Patients with neuropathic pain receiving high-concentration (5% or more) topical capsaicin versus placebo control or 0.04% topical capsaicin as an ‘active’ placebo to help maintain blinding||Patients with HIV neuropathy, postherpetic neuralgia, and painful diabetic neuropathy experienced moderate or substantial pain relief from high-concentration topical capsaicin compared to the control group. High-concentration capsaicin for chronic pain has similar effects to other therapies. These results should be reviewed with caution as the quality of the evidence was moderate or very low .|
|The Clinical Journal of Pain
|Meta-analysis of randomized,
double-blind, controlled studies
|1313||Patients received 8% capsaicin patch (Qutenza) or a control 0.04% capsaicin patch.||Capsaicin 8% patch is effective in a high number of patients suffering from various neuropathic indications, such as postherpetic neuralgia and HIV neuropathy.
Its analgesic effect starts within a few days and lasts for an average of 5 months .
|Laslett, L. L.
|Progress in Drug Research
|Systematic review of five double-blind RCTs and one case-crossover trial of topical capsaicin||–||Topical capsaicin
treatment (0.025 to 0.075% formulations) in patients with osteoarthritis versus placebo
|Topical capsaicin applied four times daily in patients with clinical or radiologically diagnosed osteoarthritis and at least moderate pain results in moderately effective pain relief up to 20 weeks regardless of the application site and dosage. Topical capsaicin was well tolerated .|
|BMJ (Clinical Research Ed.)
|Systematic review, meta-analysis of RCTs||1024||Adults with chronic pain from neuropathic or musculoskeletal
conditions receiving topical capsaicin (0.025 to 0.075% formulations) with placebo or another treatment
|Topical capsaicin has poor to moderate efficacy in treating musculoskeletal or neuropathic chronic pain. However, it can be used as a sole therapy or an adjunct in patients who are intolerant or unresponsive to other treatments .|
7 Natural Pain Relievers That Really Work
Pain of any kind can be extremely troubling. Whether it’s dull and chronic or sharp and newly induced, it’s reasonable to want relief as soon as possible. Considering that pain can escalate over time and can be caused by virtually anything, it’s important to find a tailored solution that works for you. For many people, that means utilizing an over the counter (OTC) medication like ibuprofen or acetaminophen. Overuse of these drugs, however, can have serious consequences. Last year, the FDA warned that nonsteroidal anti-inflammatory drugs (NSAIDS) like these can increase the risk of heart attack and stroke. That’s why many have turned to alternative medicine to help soothe their aches and pains.
If you haven’t tried any kind of alternative treatment or medicine before, you might be skeptical. It’s worth exploring, though, if you have a serious OTC habit. In fact, 38 percent of American adults use some kind of complementary alternative medicine according to the National Center For Complementary and Integrative Health. Janet Zand, O.M.D., notes that once people figure out the alternative remedy that’s best for them and their specific type of pain, it’s sometimes possible over time “to move for example to half the dose of conventional OTC pain reliever after adding in a natural one.” Ideally, after awhile you might even be able to skip your OTC medicine altogether. Plus, there are often positive side effects from natural pain relievers, since many of them have more than one use. Before starting any new pain relief regimen (natural or otherwise), Zand recommends checking in with your health practitioner first about appropriate substances for your symptoms, potential drug interactions and correct dosage.
Here are some natural remedies that will help soothe your pain that are both tried-and-true by health practitioners and scientific studies.
1. Ice and Heat
Best for: Muscle and joint pain, cramping pain
Why it works: While this might not be the most surprising treatment, ice and heat are nature’s most intrinsic treatments for pain. Heat is ideal for chronic pain, while ice is better for inflammation or a relatively recent injury. This is because heat increases blood flow to the painful area, which relaxes tight muscles and joints, and ice constricts blood vessels which numbs pain. Check out this handy infographic from the Cleveland Clinic, which explains when to use heat versus ice.
How to use it: Apply an ice pack, damp cloth, heating pad or heat wrap for 20 minutes on, 20 minutes off.
Best for: Any kind of inflammation, especially arthritis
Why it works: Found in turmeric, curcumin is one of the more well-researched natural pain relievers. While larger-scale studies are still needed to completely understand all of its uses, it’s been confirmed that it does help alleviate inflammation and some pain. A 2016 study found that the supplement was effective in combatting exercise-induced muscle soreness, and a 2012 study found it effective as part of treatment for patients with rheumatoid arthritis. Curcumin is also currently being studied for several other purposes, notably as part of treatment for and prevention of colorectal cancer.
How to use it: Some people wonder whether eating food with turmeric is enough to get curcurmin’s benefits. According to Zand, “food seasoned with turmeric is healthy but is most likely not a therapeutic dose. It is a good healthy habit to eat it, but if you are experiencing pain don’t expect a bowl of curry to make your pain go away.” She recommends looking for a pill supplement that contains 95 percent curcuminoids. “Generally, the products are standardized,” she notes, and it’s easy to tell from the label exactly how much you’re supposed to take. It should also be added that you should not take more than the recommended dose of this (or any) supplement, as it can cause digestive issues like nausea and diarrhea.
Best for: Bruising, swelling, and inflammation
Why it works: While arnica is one of the most well-known homeopathic methods, there is conflicting research on its effectiveness. Despite this, many people continue to use it. Zand explains that while most of the evidence around arnica’s effectiveness is anecdotal, if it works for you there’s no reason to rule it out. It’s relatively inexpensive and easy to use, so it’s worth a shot — especially for bruising and light swelling.
How to use it: Arnica generally comes in an ointment form, but can also be taken as an oral supplement.
4. Proteolytic Enzymes
Best for: Inflammation, digestive issues
Why it works: These enzymes are naturally made by your pancreas to help digest food, but they can also be ingested as a supplement for additional benefits. Though they’re generally thought of as supplement used to treat inflammation, they are true multi-taskers. In addition to treating pain caused by inflammation in joints they can also help lessen the symptoms of Irritable Bowel Syndrome and other digestive issues.
How to use it: These are taken as an oral supplement. Zand particularly recommends a supplement called Wobenzym. “It works best when taken between meals,” she says, “and you should definitely consult your healthcare practitioner before you start taking it.” Certain types of enzymes are not appropriate for everyone.
5. Willow Bark Extract
Best for: Musculoskeletal pain, back pain
Why it works: Willow bark extract contains salicylic acid, which Zand likes to call “the original aspirin,” since the chemical makeup of the extract is similar to the active ingredients in the OTC drug. This substance has been proven effective in long-term treatment of musculoskeletal disorders as well as back pain, both with and without the aid of OTC pain relievers and other pain management medications. In fact, many people prefer willow bark extract to aspirin because of aspirin’s digestive side effects.
How to use it: Just like aspirin, willow bark comes in pill form, and you should follow the dosage instructions on the packaging.
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Related: A Closer Look at How Acupuncture Works
Best for: All kinds of pain
Why it works: A recent study conducted in the emergency department of a hospital showed promising results of the ancient practice of pricking needles into the skin at specific pressure points. The researchers showed that acupuncture treatments reduced both the pain and anxiety of patients in the emergency room. Additionally, acupuncture boasts the advantage of being one of the most versatile natural pain treatments, as it can help alleviate many different types of pain.
How to use it: The first step to getting pain relief from acupuncture is finding an experienced practitioner. Zand recommends the National Certification Commission for Acupuncture and Oriental Medicine’s database as an amazing resource to find someone highly qualified.
7. Corydalis yanhusuo
Best for: Acute pain, inflammation and nerve pain
Why it works: Corydalis yanhuso is rooted in traditional Chinese medicine. In 2014, it was discovered that the plant, traditionally used for pain relief, contains an analgesic called DHCB. The study calls this discovery a “promising lead in pain management” and more research is being done on exactly how to harness this ancient herb’s powers.
How to use it: This pain reliever can be taken in oral supplement form.
Body’s Natural Pain Killers Can Be Enhanced
Fentanyl, oxycodone, morphine—these substances are familiar to many as a source of both pain relief and the cause of a painful epidemic of addiction and death.
Scientists have attempted for years to balance the potent pain-relieving properties of opioids with their numerous negative side effects—with mostly mixed results.
Work by John Traynor, Ph.D., and Andrew Alt, Ph.D., and their team at the University of Michigan Edward F. Domino Research Center, funded by the National Institute on Drug Abuse, seeks to side-step these problems by harnessing the body’s own ability to block pain.
All opioid drugs—from poppy-derived opium to heroin—work on receptors that are naturally present in the brain and elsewhere in the body. One such receptor, the mu-opioid receptor, binds to natural pain-killers in the body called endogenous endorphins and enkephalins. Drugs acting on the mu-opioid receptor can cause addiction as well as unwanted side effects like drowsiness, problems with breathing, constipation and nausea.
“Normally, when you are in pain, you are releasing endogenous opioids, but they’re just not strong enough or long lasting enough,” says Traynor. The team had long hypothesized that substances called positive allosteric modulators could be used to enhance the body’s own endorphins and enkephalins. In a new paper published in PNAS, they demonstrate that a positive allosteric modulator known as BMS-986122 can boost enkephalins’ ability to activate the mu-opioid receptor.
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What’s more, unlike opioid drugs, positive allosteric modulators only work in the presence of endorphins or enkephalins, meaning they would only kick in when needed for pain relief. They do not bind to the receptor in the way that opioids do instead binding in a different location that enhances its ability to respond to the body’s pain-relieving compounds.
“When you need enkephalins, you release them in a pulsatile fashion in specific regions of the body, then they are metabolized quickly,” explains Traynor. “In contrast, a drug like morphine floods the body and brain and sticks around for several hours.”
The team demonstrated the modulator’s ability to stimulate the mu-opioid receptor by isolating the purified receptor and measuring how it responds to enkephalins. “If you add the positive allosteric modulator, you need a lot less enkephalin to get the response.”
Additional electrophysiology and mouse experiments confirmed that the opioid receptor was more strongly activated by the body’s pain-relieving molecules leading to pain relief. In contrast the modulator showed much reduced side effects of depression of breathing, constipation and addiction liability.
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Their next goal is to measure their ability to enhance activation of endogenous opioids under conditions of stress or chronic pain, explains Traynor, to ensure that they are effective but don’t lead to more dangerous responses like depression of breathing.
“While these molecules won’t solve the opioid crisis,” says Traynor, “they could slow it and prevent it from happening again because patients in pain could take this type of a drug instead of a traditional opioid drug.”
Paper Cited: “Positive allosteric modulation of the mu-opioid receptor produces analgesia with reduced side effects,” Proceedings of the National Academy of Sciences. DOI: 10.1073/pnas.2000017118
Methods of Natural Pain Relief in Childbirth | GBU RO “OTSOZS and R”
Every woman who is waiting for the birth of her baby experiences fear along with bright, joyful experiences. Fear of the unknown, fear of pain during childbirth. How strong this pain will be, how long will it last, is it possible to withstand it. And she is also possessed by approximately the following thoughts: how I will look and how I will behave, whether I will fall into hysterics, whether I will curse the medical staff.
In response to these fears and worries, very effective methods of pain relief have appeared in obstetric practice in recent years. The most popular of these is epidural anesthesia , which completely relieves pain during the first stage of labor (the period when the cervix opens, which is often long and painful). And at the same time, there are many doctors and women in labor who believe that the process of childbirth should proceed as naturally as possible, and pain, since it is conceived by nature, has a right to exist.
To understand these conflicting points of view, let’s turn to scientific research on what pain is and what affects its tolerance.
To date, there are a number of studies in medical science on pain and how people experience pain in different circumstances, what affects pain tolerance and how it can be used in medical practice.
To investigate this issue, scientists turned to the experience of people who not only do not avoid pain in their lives, but, on the contrary, deliberately seek it.These were people engaged in oriental martial arts, representatives of some religious movements, people striving for an ascetic lifestyle.
Investigating extraordinary cases of pain resistance of these people, scientists have deduced some patterns of pain management.
So, the intensity of pain depends on the following factors:
The purpose for which the pain is experienced.
Pain is much easier to experience if the goal is self-improvement or the religious idea of saving the soul.Scientists believe that labor pain is also characterized by great positive force, since its goal is to have a child, as opposed to, for example, pain experienced by a seriously ill person. Thus, it is very important where the thoughts of a person experiencing severe pain are directed – whether he expects as a result of personal spiritual growth, the birth of a new life, or, on the contrary, his own death. Based on this, it can be assumed that it is much more difficult to experience labor pain for those women who, during childbirth, experience fear of their own death or loss of a child.
The intensity of pain is influenced by the environment.
For example, if it is pain that a person encourages himself for the sake of religious convictions, it is much easier for him to experience this pain in the presence of other believers who empathize with him and believe that this pain is necessary for the realization of a high goal. So during the birth of a child surrounded by close people, it is much easier for a woman in labor to experience pain, because close people empathize with her and share her condition.
In Africa and Brazil, the ‘sledgehammer phenomenon’ is widely known: when the time comes for a woman to give birth, the man goes to bed, screams and complains.Ethnologists have found that this relieves a significant part of the mental and even physical stress of the woman in labor, and childbirth is easier.
The degree of pain depends on the state of consciousness of a person.
Pain is transferred much easier when a person is not completely immersed in it, but is in a state of trance, meditation or prayer. It is known that women who are able to pray during childbirth experience them more easily.
Another factor influencing the experience of pain is the psychological readiness for its onset.
In other words, unexpected pain is always experienced as more intense. Some people – for example, martial arts masters – are able to change their physiological state before the impact of pain factors – their blood pressure rises in advance and their pulse quickens, and at the moment of a strong blow to the pain point, the pressure increased by this moment begins to decrease, and not sharply jump , as happens in the case of an unexpected blow.
In case of labor pain, those women are also in an advantageous position who prepare themselves for pain in advance, study various methods of pain relief at special cruises.And even if they don’t have to put what they have learned into practice, the very confidence that they are ready and know how to behave during childbirth greatly relieves the pain. Conversely, the most painful, painful memories of childbirth remain in women who were completely unprepared for them.
There are countries, and these are by no means third world countries, where women give birth in conditions close to natural ones – for example, Holland, where childbirth is fundamentally not anesthetized, and epidural anesthesia is used only in the case of caesarean section.And this does not mean at all that a woman is forced to suffer – no, it is just that certain conditions are created for her: the clan environment is close to home, the presence of close people of the woman in labor is encouraged, the midwife who observed the woman during pregnancy, which means that the woman trusts. In addition, the woman in labor is encouraged to use natural methods of pain relief (breathing and voice techniques, relaxation method), for the same purposes water is widely used (showers, bathrooms, pools).
As for Russia (and Novosibirsk as well), today a different approach to anesthesia is very common: for a certain amount, a woman in labor in any maternity hospital can receive an epidural anesthesia.
If a woman wants to give birth naturally, she needs to worry in advance, during pregnancy, sign up for courses where she (and her husband) will be taught natural methods of pain relief. Unfortunately, now it is not necessary to expect that a midwife or doctor in the maternity hospital will give the woman an anesthetic massage or breathe with her during labor, so the presence of a husband or another close person (mother, sister or close friend) at childbirth is becoming more and more important.The fact is that even the most prepared woman in a stressful situation can forget everything that she studied during pregnancy, and in this case, a loved one who was preparing for childbirth with her will help her remember what is needed.
What methods of natural (non-drug) pain relief are offered to a woman in labor today?
This method was proposed back in the thirties of the last century by the famous English obstetrician Grantley Dick-Reed.His wife Jessica helped G. Dick-Reed to bring the idea of painless, natural childbirth to life by organizing prenatal classes where expectant mothers in small groups could prepare for childbirth. One of the main skills taught in these courses was relaxation technique, as Dick-Reed believed relaxation was the key to peace of mind in childbirth.
Relaxation is a state of the body when the muscle tone of the whole body is reduced to a minimum. A woman’s ability to relax during labor is an invaluable service to her, because the pain always increases with tension and decreases significantly with a decrease in muscle tone.
There are many different ways of relaxation, which you can learn about in courses or in the literature. A description of the method used by Dick-Reed himself can be found in his book Childbirth Without Fear.
Respiratory methods of pain relief.
In principle, all breathing practices used in childbirth result in the same decrease in muscle tone and relaxation.
The first method of pain relief offers to train the ability to breathe.So, if a person normally makes 16 breaths and exhalations per minute, women are encouraged to learn how to take only 8 breaths and exhalations, and the breaths should be small, and the exhalations should be long. During childbirth, a woman will breathe like this only during the contraction, after it ends – normal breathing.
The second method of pain relief suggests the following: imagine that you have a feather in front of your lips, and you need to make a series of short exhalations of such force that the feather does not fly away.After exhaling, you take a small breath and repeat the series again (there may be 4, 6, or 8 exhalations). This breathing also helps to stay relaxed during the contraction and not focus on the pain.
The third method of pain relief is suitable for well-trained women – it suggests not breathing at all during the contraction, and after its end, switch to normal breathing.
Typically, such practices are taught in courses for pregnant women.If we try to describe this method in words, then we can say that a woman is invited to sing her pain, sending a sound to the place of her greatest concentration. The sound should be continuous, while exhaling, while chanting, you do not need to inhale often. I would like to point out that chanting pain has nothing to do with cries for help.
Acupressure or general massage of the sacrum, buttocks and thighs often reduces the intensity of pain.
Anesthesia with warm water.
It is very good if during the contractions a woman will have the opportunity to spend some time in a warm bath, or at least stand or sit in the shower, directing a stream of warm water to the sacrum area during the contractions. The conditions necessary for this have already been created in many Russian maternity hospitals.
A number of experts believe that a woman does not need to relax or breathe in a special way, but during a contraction she needs to concentrate on certain images that contribute to the connection between her and her child in a single process of birth.For example, a woman is asked to imagine the cervix of the uterus with a thousand-petalled bud and open this flower by a petal during each contraction. Another trance technique suggests to a woman in labor during a contraction to imagine herself emerging from a very deep lake with a baby in her arms. Specialists who prepare women for such childbirth have noted significant pain relief.
In conclusion, I would like to wish every woman who will have a baby in the near future to make her choice in relation to labor pain in advance.But even if before giving birth you decided to give birth naturally, and during them you faced unbearable pain, use medication, and vice versa, if you definitely decided that you will give birth under epidural anesthesia, give yourself at least a little experience the sensations that you have prepared for nature. In any case, I wish you and your baby a happy birthday!
PAINSALIZATION DURING CHILDBIRTH: METHODS AND CONSEQUENCES
Despite its naturalness, childbirth is a painful process.At the same time, pain is perceived differently by each woman. And if one woman in labor does not ask the medical staff for appropriate help, then the other may need it. In special cases, doctors resort to pain relief methods.
Indications for pain relief of the labor process
Relief of labor pains for women is shown in the presence of the following deviations:
– cervical dystocia;
– diabetes mellitus;
– high blood pressure;
– young age of the expectant mother;
– disorders of cardiovascular activity.
Anesthesia should be carried out with the gluteal position of the fetus and its large size. The event relieves pain and relieves a woman of fear and emotional stress.
As for the methods of pain relief, their totality is:
non-drug methods – deep breathing, physiotherapy procedures, acupuncture, the use of psychological techniques that distract from pain;
drug methods – the use of drugs that reduce the degree of pain;
Epidural anesthesia is the most effective method of pain relief.Drug injections are administered between the 3rd and 4th lumbar vertebrae. In another way, the method is called regional analgesia.
Should delivery be anaesthetized?
The benefits of pain relief as a medical manipulation are obvious – it reduces pain, relieves stress in the female body and prevents fetal hypoxia. But like any interference with the natural process, pain relief can cause some side effects in the condition of the mother and child. Although they are temporary, their appearance still negatively affects the psyche of a woman.Therefore, it is necessary to anesthetize childbirth only according to indications.
When the fetus suffers from hypoxia or the woman has a hard time tolerating labor pains, the benefits of pain relief far outweigh the risks of developing side effects. But in the normal course of the process, it is better to do without facilitating manipulations. When deciding on their need, the specialist must compare the possible risks, and then choose an option in which the adverse consequences will be minimal for both parties.
Drug pain relief in some newborns provokes respiratory depression, drowsiness, weakness, unwillingness to breastfeed.The occurrence of these consequences is associated with the penetration of drugs through the placenta. All adverse changes quickly disappear without any intervention.
The number of transient effects of epidural anesthesia for women is:
– back pain;
– an unreasonable increase in body temperature for several weeks after childbirth.
Some women have difficulty urinating due to hypotension of the bladder.The problem is resolved on its own within the first day after childbirth.
Epidural anesthesia – pros, cons, reviews
Medical pain relief for childbirth is becoming more and more popular: more and more expectant mothers and their doctors prefer epidural (epidural) anesthesia. According to a number of experts, this is the most modern and safe method for mothers and children, which is also widely used due to its high efficiency and convenience. Gynecologists very often cite multiple positive reviews about epidural anesthesia, and a woman, confronted with a known fact of painful labor, agrees to avoid pain.
Indeed, epidurals are often received rave reviews. But in order to make a decision on the use or refusal of anesthesia, the expectant mother should have the full range of information about the effect of this type of anesthesia on the process of childbirth, as well as aspects of psychological interaction in childbirth between the mother and her baby.
What is the epidural anesthesia method?
The name of the method is due to the method of administration of the anesthetic drug: the anesthetic is injected directly into the space surrounding the dura mater of the spinal cord (from lat.peri – “around”, epi – “above”, dura mater – “dura mater”). Essentially, the anesthetic blocks the impulses that the lower body sends to the pain centers in the brain (analgesia) or all signals, including motor impulses (anesthesia). For epidural (epidural) anesthesia, an anesthesiologist performs a puncture at the height of 3 or 4 vertebrae of the lumbar spine, introducing a special flexible catheter through a needle with a stylet. It is through the catheter that an anesthetic drug will be supplied to the woman’s body every half hour.After anesthesia, the lower body of the woman in labor remains insensitive and immobile; after analgesia, the woman does not feel pain, but retains the ability to move (sit, stand, roll over).
The advantages of epidural anesthesia include the following features of this method of anesthesia:
- the woman remains fully conscious, does not feel pain in labor, her kidneys and uterus are well supplied with blood;
- the anesthetic does not act directly on the fetus without getting into the child’s blood;
- The effect of the anesthetic is usually not harmful to the woman.
It would seem that a panacea has been found. Many women are so afraid of labor pain that the temptation to agree to pain relief after numerous positive reviews about epidural anesthesia is very strong. This is practically a guarantee of an easy and painless delivery!
However, despite all the obvious advantages of epidural anesthesia, we must not forget about the effect that any anesthesia has on the most important area of the birth process – the interaction between mother and baby.Epidural anesthesia can be a real salvation if labor disorders occur, which are accompanied by severe pain (not at all characteristic of normal physiological childbirth). But at the same time, this pain relief can become an obstacle to deep interaction between mother and child, if used in advance, only out of fear of possible pain.
Perception of pain is purely individual and depends primarily on the psychological mood of the woman and her ability to relax.The really real cause of labor pain is muscle tension, which interferes with the normal physiological changes that occur in a woman’s body during childbirth. If a woman feels fear of childbirth, anxiety and anxiety, muscle tension increases. A vicious circle appears: fear causes muscle tension, tension causes pain, pain causes fear. To get rid of pain, you need to learn how to relax. Actually, epidural anesthesia solves the same problem – it relaxes the muscles.But this is far from the only and not the most harmless way to get rid of stress. Relaxation of your body is achieved through a relaxed state of your mind. That is why during childbirth, a feeling of calmness, self-confidence, trust in others, and a comfortable environment are very important for a woman.
Nature has taken care of providing the woman with the pain relievers she needs for childbirth. Among the hormones that regulate labor, the woman’s body secretes a large amount of hormones of joy and pleasure – endorphins, which are able to reduce unpleasant physical sensations and create a special psycho-emotional state, somewhat reminiscent of a state of light intoxication.These hormones have a beneficial effect on the course of childbirth, help a woman to relax, relieve pain, and give a feeling of emotional uplift. However, the mechanism for the production of these hormones is very fragile, it directly depends on the general emotional state of the woman during childbirth. Feelings of anxiety, anxiety, fear can suppress the production of endorphins, and then the strength of this natural pain-relieving mechanism is significantly reduced.
When a woman is not internally ready for childbirth, does not know how to control her body, does not know how to relax, it seems to her that the easiest way is to just pick up and disconnect from unpleasant sensations.But at the same time, she disconnects from her child, who so much needs empathy and support at this moment. Now his birth will not bring any inconvenience to her. What will the child feel? Most likely, he will be very lonely. The world in which he lived for nine months, so tender and loving, understanding and sensitive to any movement, this world in an instant turned into a cold and indifferent, not feeling and not understanding the child’s signals. Mom seemed to have stopped “hearing” her baby.
But birth is not only and not so much a physiological process, it is a joint spiritual experience of two people – a mother and a baby. How well they understand each other depends not only on the safe birth of a child, but also on his further relationship with his mother, loved ones, and the whole world. A woman whose body is devoid of sensitivity ceases to feel the child along with the pain, cannot help him in the birth, does not empathize with his feelings. The greatest feeling of maternal love is surprising in that only a mother is able to subtly feel her baby, as if he is a part of her.If, knowingly or not, this relationship is disturbed, childbirth becomes unnatural. While alleviating the physical inconvenience of childbirth, think about possible emotional experiences, regret about the missed opportunity to give birth to your baby naturally.
The use of anesthesia turns a woman from a mother into a patient, and the miracle of the birth of a person into the act of removing a fetus from the body of a woman in labor. Even when the child was born, the woman still has to recover from anesthesia for some time.Natural childbirth allows a woman to fully communicate with the baby from the first seconds of his birth. This moment is very important for a person, this is the first experience of his communication with the world. What awaits the little man at the moment of birth? Warm, loving maternal hands or a set of medical procedures performed by a doctor?
Many women who have deprived themselves of the opportunity to feel like their baby was born regret it very much. Together with pain sensitivity, they lost the greatest joy of empathy, that indescribable feeling of delight from meeting their child, which occurs only after natural childbirth.A woman whose childbirth was anesthetized often wonders why the baby does not cause love feelings in her. Without experiencing the maximum stress of not only physical, but also mental strength, it is impossible to fully experience the happiness of meeting a baby. This isolation from the child during childbirth interferes with their further deep emotional contact. Mom easily stops breastfeeding, easily delegates him to grandmothers or nannies, does not feel his emotional needs. This happens when anesthesia has been applied for no serious reason.
If there are such reasons, and you cannot do without pain relief, do not forget how much depends on your attention to the child’s experiences. Your warm thoughts about him, your ability to empathize, your desire to support your baby at such an important moment will help to overcome all the negative moments of epidural anesthesia, and then nothing will prevent you from establishing a deep connection with your baby. It is unwise to give up modern scientific advances, but it is even more unwise to give up on ourselves.Remember, the most effective pain reliever is love.
D. Streltsova, S. Abramova
Natural pain relief of childbirth – mama.ru
Natural pain relief system helps to cope with labor pain without drugs and anesthesia. Its main task is to relieve any stress during childbirth, both physical and psychological, which increases the pain.
Fear, tension, followed by an adrenaline rush – these factors can make quite bearable sensations into unbearable pain.The unpreparedness of the expectant mother for childbirth, ignorance of elementary things and the lack of an experienced assistant (as often during contractions a woman is left to lie alone in maternity hospitals) complete the matter, and now the cry “epidural to me!” Is already heard.
At the same time, it is enough to be well prepared and follow simple rules in order to endure childbirth without “hellish torment”. And if there is an experienced midwife nearby, your assistant and a bath with warm water, childbirth will turn from a kind of torture into a completely tolerable and even joyful process.
Psychology of Pain
It is such that the more we are afraid of pain, the stronger it is. Remember at least a child who needs to be injected. The pain is small, but fearful … The situation is approximately the same with childbirth.
From an early age, the expectant mother is used to hearing that childbirth is very painful. During pregnancy, this fear is further intensified by the stories of friends about unsuccessful childbirth, from the screams of women in the birth block, heard even from the street, and often from their own bad experiences.Fear and a mood for pain are firmly in my head.
Fear, which by the time of labor pains turns into panic, causes a response protest, strong tension and stiffness of the mind and body. It is simply impossible for an untrained person to relax in such a situation.
It is fear and the stress that follows it that multiplies the quite bearable pain in labor. And it is the unpreparedness of the woman that does not allow her to overcome this tension.
Attending childbirth preparation classes under the guidance of an experienced professional can help you get rid of your fear of childbirth and thereby greatly alleviate your suffering.The pain during childbirth is bearable, and it should be, just you were told the opposite all the time. The pain of childbirth should not drown out the joy of having a baby, and this is achievable for any woman.
The most disadvantageous position for childbirth is lying on your back. This also applies to contractions and attempts. The fact is that when supine, the uterus compresses large blood vessels and nerve plexuses that run along the inner surface of the sacrum.
In addition, in the supine position, the uterus is forced to do all the work of pushing the baby out, while in the upright position it is helped by the force of gravity.
Possible delivery positions for transferring contractions
- Lying on its side. On the side of the back of the child, it enhances labor, on the side of the abdomen, it slows down.
- On all fours with your chest supported on a pillow, bed or large ball. If you remove the support and lower your head, this posture slows down too vigorous labor activity.
- Squatting holding hands with a partner. Allows you to accelerate the dilatation of the cervix with weak labor.
- Walking around the room has a more positive effect on many than lying in bed.You can walk during contractions, but for the period of attempts you will have to find a more acceptable position.
It is necessary to get acquainted with all the poses in detail at the stage of preparation for childbirth, because it is impossible to understand in advance which one will suit you.
It is possible that you choose one or two for yourself and do not want to change them. But in order to choose, you need to know what to choose from! In addition, on the advice of the midwife, you can adopt a position to speed up or slow down the labor.
Correct breathing during contractions and pushing can not only reduce pain, but also affect the speed of labor. Shortness of breath during contractions increases tension, deep and even breathing relaxes and reduces pain.
If the onset of pushing starts too early and the cervix does not open enough, proper breathing will help you not to push, relax and wait for the time when the cervix opens enough to pass the head without rupture.
Warm water helps a lot to ease contractions. It could be just a shower or a warm bath. The larger the bathtub, the more comfortable it is. In addition, in it, you can take positions that are comfortable for yourself, for example, squatting or on all fours.
The labor process under the influence of warm water slows down somewhat, so you should not abuse it with weak labor: listen to the advice of your midwife.
You can spend the entire period of labor in the water, right up to attempts, but there are different opinions about whether to get out of the water when the baby appears.Many reputable obstetricians-gynecologists believe that pushing, the birth of a baby and the afterbirth should take place on land.
Acupressure massage of the lower back and sacrum is very helpful in relieving pain during labor. It should be done by your birthing partner, such as your husband. To do this correctly, it is imperative that you practice in advance under the supervision of an experienced instructor. Only the precise application of force will help relieve pain, and the “working” points can be different for everyone.
In case you did not have time to prepare, you can take a crash course in pictures, but this will be less effective. You also need mutual understanding and consistency – without them, you can only do harm.
Music for childbirth
Slow quiet music helps to relax, which means relieve tension and relieve pain during childbirth. Nowadays, there are almost no technical restrictions for this.
Many maternity hospitals are allowed to carry a mobile phone, which means that you can write something on it.It is best to choose the music in advance. Here are some tips:
- Do not use fast dynamic compositions. The music should be slow;
- Give preference to instrumental things, without vocals. The voice distracts and interferes with focusing on the process;
- the simpler the melody, the better;
- it is good if the melody has a natural background, for example, the sound of the surf, a stream, or the singing of birds;
- Avoid sad melodies, light should emanate from the music;
- The last criterion is loudness.The music should be quiet and not annoying.
Proprietary pain relief system
Collect all of the tips we have given together, choose what works best for you and what the conditions allow. Realistically assess your capabilities and take action.
Write your birth plan on a piece of paper. Add to it all types of pain relief that you decide to use and start preparing.
90,000 what is it, why is it needed and is it possible to do without it
11 Apr2019 03:07 PM
Anesthesia has long been used for pain relief both during caesarean section and during natural childbirth. But, as before, one of the main fears of pregnant women is related to this topic. “Side effects of anesthesia”, “Complications after anesthesia during childbirth”, “If the anesthesia did not work” – these queries are very popular on the Web and are especially troubling for women who decide to give birth under the compulsory medical insurance. Expectant mothers, already alarmed by the approach of childbirth, do not fully understand the principle of action of different types of anesthesia, do not know what awaits them after the “injection” and, of course, are worried.
What types of anesthesia are there? In what cases is the refusal of the doctor or patient from the “epidural” justified, and in which – not? What are the contraindications? We talked about this with the head of the department of anesthesiology and resuscitation for adults at the maternity hospital at City Clinical Hospital No. 40 in Moscow, anesthesiologist-resuscitator of the highest category, candidate of medical sciences Vladimir Andreevich Sokolov.
– Different types of anesthesia are used during childbirth, right? What options are there?
It all depends on what happens to a woman in childbirth.Does she give birth naturally, is she undergoing a caesarean section, or is it about minor obstetric interventions, which sometimes also require pain relief. Such, for example, as manual examination of the uterus, stitching.
– If we are talking about the so-called physiological childbirth, which of the methods of pain relief is the most reliable?
If physiological childbirth takes place, that is, a woman gives birth naturally, the most reliable method of pain relief is epidural analgesia.At first, a woman may not feel pain at all or may feel something remotely, but, of course, it becomes much easier for her. She can rest, sleep, read.
With this type of anesthesia, the doctor gives the woman an injection, first anesthetizing the skin in the lumbar region, and then inserting a catheter through which the analgesic is injected. As a rule, we use a dispenser, a syringe pump, which constantly delivers the medicine until the cervix is fully dilated. Used ropivacaine, naropine – modern drugs that are considered the safest for women and children.
– That is, until the very moment of the birth of a child, a woman does not feel anything, not even her own legs?
This type of anesthesia does not imply complete immobility. It should not be confused with spinal anesthesia, which is performed during a caesarean section. At the very beginning, when a test dose enters the woman’s body, pain relief may be stronger. Then the dosage of the anesthetic is reduced, the woman can get out of bed, although it is not recommended to actively move at this time.
The action of the drug lasts another hour after the cessation of its delivery. With full disclosure, a woman already feels what is happening to her. The concentration of the drug is calculated in such a way that the normal labor activity does not stop. If the drug is administered at a higher concentration, the woman will not feel pain, legs, or childbirth, and the period of perspiration will be lengthened. So some soreness with a large opening of the cervix will appear, but these sensations are much weaker than those that a woman would experience without anesthesia.
– Are there any contraindications to epidural anesthesia?
Yes. For example, an allergy to amide anesthetics, which are used for this type of pain relief. Also among the contraindications: the use of anticoagulants, blood thinners. The blood clotting disorders revealed in the patient are an absolute contraindication.
A tattoo on the lower back at the puncture site may also be a contraindication.In this case, we carefully look to see if there is a place on the skin that is clear of the pattern. If not, everything is in ink, then the epidural will be denied.
– Epidural anesthesia is offered to everyone in your hospital. Can a woman refuse her?
Yes, there is a small percentage of patients who refuse this type of pain relief in order to survive the so-called “natural” birth. This is their right. There are many psychological relaxation practices, techniques for correct breathing during childbirth.A positive attitude plays an important role. And yet, as a rule, when the cervical dilatation increases and the woman realizes that she does not want to endure pain, she can ask for an epidural analgesia.
– And the woman’s wish will be fulfilled at any moment, even if the “process” is in full swing?
Anesthesia is carried out with different dilatation of the cervix, from 2 cm or more, up to full. But with repeated births, disclosure of 8 cm, it may no longer be advisable to do anesthesia and the staff does not insist on it.In this case, we understand that a woman will give birth within 10-15 minutes. Anesthesia simply does not have time to work, well, except that it is useful for examination after childbirth.
If the opening is less than 8 cm, then the doctors, of course, suggest pain relief.
– What other types of anesthesia are used in childbirth in general and in your maternity hospital in particular?
Intravenous anesthesia. It is required during a postpartum examination if the sensitivity persists, and the woman reacts painfully to the doctor’s manipulations, for example, during stitching.In this case, the woman is immersed in a short medication sleep, which lasts no more than 20 minutes.
– Is vertical delivery possible under epidural anesthesia?
Yes, quite. The effect of the drug gradually weakens during childbirth, relaxation in the muscles decreases, a woman can stand up, move. In any case, she is within the bed, even if she is giving birth vertically, so that epidural anesthesia will not prevent the woman from taking any position that is convenient for her during childbirth.
– Is the same anesthesia used during caesarean section?
When performing a caesarean section, we are talking about spinal anesthesia. This is also an injection in the back, in the same place where the epidural catheter is placed, only the anesthetic is more concentrated and it is injected once.
After the injection very quickly, within 5 minutes, relaxation of the abdomen and legs occurs, the woman can no longer move her legs, the anterior abdominal wall completely relaxes.The woman in labor is conscious during the operation, which lasts no more than 40-60 minutes. Many do not believe that everything ended so quickly. We have to believe, of course, because the child is immediately applied to the breast, warmed, and then the work of children’s doctors begins. After 3 hours, the woman begins to feel her legs and stomach, after 4-6 hours she can sit down. After she is firmly on her feet, if everything is fine with the mother and the baby, after 8-12 hours they are transferred together to the postpartum department.
There are contraindications, it is necessary to consult a specialist.
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90,000 Labor pain relief
How does a woman feel during childbirth?
At the end of pregnancy, you may feel periodic contractions of the uterus.With the onset of labor, contractions become more regular and severe, and can be painful. In the beginning, this is a severe intermittent pain, which, as a rule, increases significantly with the course of labor. The pain is not the same in intensity. More than 90% of women in labor require some form of pain relief.
What methods of pain relief are currently available?
There are several ways to help you manage your pain. An attentive spouse and partner provide invaluable support.It is important to be able to relax, sometimes, on the contrary, walking helps. Warm baths and massages, especially back rubbing, can help relax muscles and relieve pain at specific points. Music you love can be helpful as it distracts and relieves stress.
It is difficult to predict which type of pain relief will work best for you. Below is some information about the methods of pain relief that may be offered to you.
Methods of pain relief in labor
There are several options for managing pain, especially early in labor.Despite the ambiguity of many of the following methods, some find them very useful. You can find out which of them are usually used in our clinic:
- Injectables (narcotic analgesics, non-steroidal anti-inflammatory drugs)
- Epidural analgesia
It is carried out through a very thin tube (catheter), which is inserted between the vertebrae in the lumbar spine.This is the most difficult of the methods performed by an anesthesiologist. It has almost no effect on the child. Sometimes it causes a headache. May cause a drop in blood pressure. The method is one of the most effective methods of pain relief.
Who can get epidural analgesia?
It can be done for most women, but some pregnancy complications and blood clotting disorders may be contraindications. In the absence of contraindications, it will be useful for you and your child.
How is it done?
First of all, install a dropper. This means that the solution will be injected into your vein. A drip is often necessary during childbirth for several reasons. You will then be asked to roll onto your side or sit down while leaning forward. The back will be treated with an antiseptic and a local anesthetic will be injected subcutaneously, which is quite painful. Once the skin has been numbed, performing the actual epidural puncture is rarely painful. A thin tube (catheter) is placed in the back and led to the nerves that conduct pain impulses from the uterus.