Pain is an all too common sensation. Though unpleasant, pain is a helpful signal which shouldn't be ignored. It is your body's way of alerting you to immediate injury or asking for "help" with potential or underlying problems you may not be aware of.

We are all familiar with what pain can feel like: burning, stinging, sharp and electric, throbbing, dull or deep aching, but what causes this subjective feeling?

Every tissue in the body has special nerve receptors known as nociceptors. They are specially designed to detect unpleasant or noxious stimuli from mechanical, thermal or chemical sources. When alerted to a stimulus the nerve fires an impulse that mainly travels via the spinal cord to different parts of the brain.

Once tissue cells are damaged or injured they release 'inflammatory mediators' such as prostaglandins that stimulate the nociceptors and intensify the effects of histamine. The effect of this may be an increase of blood supply to the area, swelling, and pain.

The immediate response most people have is to take something to get rid of the pain. The conventional, pharmaceutical response is to use non steroidal anti-inflammatory drugs (NSAIDs) and pain killers.

Generally, NSAIDs (e.g. Ibuprofen, Diclofenac, Aspirin and Naproxen) work by blocking the body's inflammatory mediators. This then suppresses the sensation of pain and reduces inflammation.

Though they are effective short term, NSAIDs do have harmful side effects when taken inappropriately or long term (one month to years). Side effects include heartburn, indigestion, stomach ulcers and liver damage.

Though the exact mechanism remains unclear, painkillers such as Paracetamol are thought to work by blocking an enzyme in the brain involved in the transmission of pain. It helps bring down high temperatures and doesn't have the same adverse reactions as NSAIDs.

Non steroidal anti-inflammatory drugs are often the first port of call for patients and general practitioners in the treatment of low back pain. Prescriptions for NSAIDs are thought to cost the NHS approximately £250 million a year. Low back pain accounts for up to 7 million GP visits annually.

Within chiropractic practice, patients are more frequently expressing concerns about the long-term uses of such medication. As Chiropractors, we are frequently asked "should I continue taking this medication?".

The answer: we cannot make the decision for you and of course these NSAIDs have a specific short-term role. Ask yourself - do I know what the underlying cause or irritant is and how can this be addressed? - as this is one of the most important aspects to promote healing. Patients are advised to make themselves aware of the side effects, how to combat them and how to make their own informed decision.

Some Natural Alternatives

	Omega 3 fatty acids Evidence has shown fish oils to be as effective as drugs in alleviating pain and inflammation. A study conducted in 2002 found that 86% of patients with arthritic change who took fish oils prior to knee replacement surgery had no or reduced levels of enzymes which cause cartilage damage compared to 26% who took a placebo (1). Fish oils help reduce pain and inflammation. Simply, it is thought that the omega 3 fatty acids act by stopping inflammatory cells migrating to the site of inflammation and by suppressing the actions and production of the inflammatory mediators. Increasing the dietary intake of oily fish rich in omega 3 is one option; fish oils can be also taken in tablet or oil form. Look for high potency – at least 500mg of omega 3 per 1000mg of fish oil.
	Curcumin Found in the bright yellow pigment of turmeric spice. It’s an active compound holding a variety of anti-inflammatory actions. Trials have shown it to be similarly effective to NSAIDs. A review in the Journal of Clinical Immunology suggested curcumin taken at low doses can enhance antibody responses thus showing an ability to modulate the immune system (2). It can be easily added to food or taken as a supplement – 10,000mg providing 500mg turmeric root extract.
	Bromelain A collection of enzymes found in pineapples. It has a variety of medicinal properties including anti-inflammatory. Like many of the other alternatives it is thought to help by inhibiting the inflammatory mediators and also blocking compounds known as kinins (contributors to causing pain and swelling). It is thought it also helps by breaking down the ‘mesh’ formed around the inflamed area largely made up of a substance called fibrin. This allows the damage tissue to heal effectively allowing restoring good blood supply and tissue drainage. It can be taken as a supplement between meals – 1000 GDU in 500mg Bromelain.
	Antioxidants Apart from having vast health benefits, the nutrients within antioxidants help reduce inflammation. Choose fruit and vegetables rich in colour: peppers, kale, apricots, blueberries to name a few. Quercitin is found abundantly in onions, broccoli, squash, red grapes and cherries and has an anti-inflammatory effect by inhibiting the enzymes that produce pro-inflammatory prostaglandins and associated effect in inhibiting histamine.
	Ginger Frequently used in Indian Ayurvedic medicine, ginger has shown to inhibit the synthesis of pro-inflammatory prostaglandins and other inflammatory mediators. One study showed that using ginger therapeutically reduced the pain and swelling in 75% of the population involved in the study suffering with rheumatoid and osteoarthritis. It can be incorporated into the diet freshly cut or infused in teas or taken as a supplement – 14,400mg provided by 120mg of ginger root.
	Boswelia Boswelia serrata is also known as Indian Frankincense with powerful anti-inflammatory agents. Boswelic acid appears to reduce joint swelling, improves blood supply to inflamed joints, reduces pain and increases mobility. One trial showed patients taking Boswelic acid had a significant reduction in symptoms compared to a placebo. It is available for use as a topical cream or in tablet form.

As with many ailments and conditions, tackling inflammation and pain requires a combination of treatments and remedies.

Noteworthy

Please be aware that the information given is general and intended as guidance and not necessarily appropriate or specific to the individual.

If you are thinking of taking any natural alternative we would advise you to seek professional advice first either at Wickford Chiropractic Clinic or from a nutritional therapist before taking any new supplement.

It is not advisable to cease taking prescribed medication without prior advice and information.

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