Over the counter pain relief is marvellous - when used in moderation. Long term use of any analgesics comes with side effects though. At a recent pain management conference Roman Cregg used the analogy of a plaster on a leaky pipe. You cover one spot just for another to then spout out and need to be treated. This happens with ibuprofen, it causes irritation of the gut and so then a patient needs to take something to prevent stomach ulcers which in turn means that they need laxatives and so on. This blog post lists my five favourite alternative remedies for pain. There is often only poor quality evidence for natural remedies because it is difficult to get research funding and ethical approval to work with vulnerable people (those living with persistent pain). The remedies below have OK to good evidence for their efficacy though. Do remember that this blog post is not an alternative to medical advice. It is more a reminder that we can use more than pills to help our pain. With that out of the way, let’s start with the most obvious remedy:
1.Heat or cold therapy.
Heat therapy is another way of describing a warm bath, hot water bottle or heat pad. Heat dilates blood vessels; increases blood flow, oxygen and nutrients to the area; and speeds up clearance of inflammatory factors. Whereas cold treatment - such as an ice pack, causes local blood vessels to constrict; reduces tissue metabolism and inflammation; and reduces the sensitivity of receptors and nerve conduction velocity. This means that the pain messaging system dials down. This meta analysis asked whether heat or cold therapy was better at preventing muscle soreness after exercise. The researchers concluded that a hot pack proved most effective and stable for pain relief, with contrast water therapy (alternating hot then cold) coming in second within 48 hours of exercise. After 48 hours, cryotherapy, which involves spending 2 minutes in a freezing cold room, provided the best pain relief. How can you apply this knowledge to your unique pain experience? Try both, try alternating, and apply this general approach
2.TENS
My next favourite non-invasive and drug-free pain relief option is a TENS machine. TENS stands for Transcutaneous (through the skin) Electrical Nerve Stimulation and is a nifty little device. I explain its use in the video below so you can skip the next paragraph if you like 😉. Essentially, people aren’t entirely sure how TENS machines work but it might be that they stimulate sensory nerves with electrical currents that override or interfere with pain signals, reducing the perception of pain. This paper concludes that there is not enough good quality research on using TENS machines for pain relief. However, in a lecture about lower back pain we all became converts when a doctor running a pain service showed that when used an hour a day for at least a week, TENS reduced pain in 70% of her sample of hundreds of people. A 7/10 chance that it might work is worth trying. Here’s my 1 minute video
3. Capsaicin
My third favourite remedy is capsaicin After putting on a capsaicin patch there is a gradual sensation of warmth that gets hotter over time. If it feels like burning you may want to take it off. Capsaicin interferes with the transmission of pain signals from the nerves to the brain. This is called “defunctionalisation of nociceptor fibres.” It does this through two main processes. First it turns the switch off at the junction where pain messages should be passed on; and it dials down the activity of sensory nerve endings involved in the perception of pain and temperature. This article outlines the effectiveness of capsaicin prescribed by doctors for neuropathic pain with positive results. The photo here shows a packet of patches that I purchased online:
4.Menthol
Along the same vein as capsaicin is menthol which is a natural compound derived from mint oils. It produces a cooling or tingling sensation when applied to the skin. It is very common, and if you check your pain relief cream it is probably an ingredient. It’s thought to alleviate pain through three main mechanisms. It interacts with kappa-opioid receptors sending safety messages to the brain. It activates cold receptors (called TRPM8) in the spinal cord so that the nerves pass on cooling messages instead of pain signals. It may also desensitise nerve endings in the skin, reducing their sensitivity to pain signals. The cream that I use has arnica, hemp, eucalyptus, boswellia and comfrey in it too, these are long recognised anti inflammatory ingredients. This is what it looks like:
5. Ginger and Turmeric
Another treatment that I love is found in the kitchen. Ginger is marvellous. Turmeric is wonderful. Together they work synergistically to create even greater anti-inflammatory effects.
Ginger is thought to exert its analgesic and anti-inflammatory effects by inhibiting COX2 pathways. These are the defence enzymes that produce inflammatory prostaglandins. Prostaglandins are compounds that contribute to the inflammatory soup that defends the body but also produce pain. This is similar to the way that non steroidal anti inflammatories work. Ginger, however, does not have a negative effect on stomach mucosa. This is thought to be because it doesn’t inhibit COX1 which produces the housekeeper enzymes and compounds that maintain the health of our organs. Ginger also contains antioxidants, such as gingerol and zingerone, which help protect cells from damage caused by oxidative stress which also contributes to inflammation and pain.
The active compound in turmeric is called curcumin. Curcumin modifies proinflammatory cytokines, which are signalling molecules produced by immune cells. It also stops the production of the enzyme (phospholipase A2) that starts the inflammatory cascade that leads to the production of prostaglandins. Put simply both turmeric and ginger are natural anti inflammatories. You can use them in cooking, juice them or have them in a cup of hot water each day. They help.
And those are my five favourite natural pain remedies. One that I have no experience with personally but I’m quite interested in is infrared light therapy. I’ll report back on this one, we’re all a bit too uninjured at the moment and so I can’t test my wearable device on my family. Here’s an infographic from this paper that shows how it may help with pain relief, tissue relaxation and tissue repair.
And those are my top five natural pain remedies. I’m not telling you to avoid over the counter pain relief. In fact when I feel a migraine coming on, I make a ginger turmeric drink; I put menthol on my neck and shoulders; I take paracetamol and ibuprofen and sometimes that’s all I need. If I haven’t caught it on time I take a prescription triptan (which need to be used sparingly) and use my TENS machine. Pain sucks and the more tools we have to beat it - the better.
xx
P
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