Aches & Pains
Pain is a sensation that is transmitted from an area of tissue damage or stress along the sensory nerves to the brain. The brain interprets the information as the sensation of pain.
Substances that decrease pain either interfere with the ability of nerves to conduct messages, or alter the brain’s capacity to receive sensations.
Pain may be a symptom of an underlying pathological condition, such as inflammation. It may also be due to other causes, such as bruising, infection, burns, headaches, and sprains and strains. Use caution when treating pain without understanding its cause— this may delay diagnosis of conditions that could continue to worsen without medical attention.
What are the symptoms of pain?
Symptoms of pain include discomfort that is often worsened by movement or pressure and may be associated with irritability, problems sleeping, and fatigue. People with pain may have uncomfortable sensations described as burning, sharp, stabbing, aching, throbbing, tingling, shooting, dull, heavy, and tight.
Lifestyle changes that may be helpful
Body weight may be related to pain tolerance. One study indicated women who are more than 30% above the ideal weight for their age experience pain more quickly and more intensely than do women of ideal weight. No research has investigated the effect of weight loss on pain tolerance.
Exercise increases pain tolerance in some situations, in part because exercise may raise levels of naturally occurring painkillers (endorphins and enkephalins). Many types of chronic pain are helped by exercise, though some types of physical activity may aggravate certain painful conditions. People who want to initiate an exercise program for increasing pain tolerance should first consult a qualified health professional.
Nutritional supplements that may be helpful
Certain amino acids have been found to raise pain thresholds and increase tolerance to pain. One of these, a synthetic amino acid called D-phenylalanine (DPA), decreases pain by blocking the enzymes that break down endorphins and enkephalins, the body’s natural pain-killing chemicals. DPA may also produce pain relief by other mechanisms, which are not well understood.
In animal studies, DPA decreased chronic pain within 15 minutes of administration and the effects lasted up to six days. It also decreased responses to acute pain. These findings have been independently verified in at least five other studies. Clinical studies on humans suggest DPA may inhibit some types of chronic pain, but it has little effect on most types of acute pain.
Most human research has tested the pain-relieving effects of 750 to 1,000 mg per day of DPA taken for several weeks of continuous or intermittent use. The results of this research have been mixed, with some trials reporting efficacy, others reporting no difference from placebo, and some reporting equivocal results. It appears that DPA may only work for some people, but a trial period of supplementation seems worthwhile for many types of chronic pain until more is known. If DPA is not available, a related product, D, L-phenylalanine (DLPA), may be substituted at amounts of 1,500 to 2,000 mg per day.
As early as 1981, preliminary human research showed that DPA made the pain-inhibiting effects of acupuncture stronger. One controlled animal study and two controlled trials in humans showed that DPA taken the day before acupuncture increased the effectiveness of acupuncture in reducing both acute dental and chronic low back pain.
Other amino acids may be beneficial in reducing pain. In the central nervous system, L- tryptophan serves as a precursor to serotonin. Serotonin participates in the regulation of mood and may alter responses to pain. In a preliminary trial, 2,750 mg per day of L- tryptophan decreased pain sensitivity. Another preliminary trial found that L-tryptophan (500 mg every four hours) taken the day before a dental procedure significantly decreased the postoperative pain experienced by patients. In another preliminary trial, 3 grams of L-tryptophan taken daily for four weeks significantly decreased pain in a group of people with chronic jaw pain. No research has been published investigating the pain control potential of 5-hydroxytryptophan (5-HTP), another serotonin precursor that, unlike L-tryptophan, is currently available without a prescription.
Vitamin B12 has exhibited pain-killing properties in animal studies. In humans with vertebral pain syndromes, injections of massive amounts of vitamin B12 (5,000 to 10,000 mcg per day) have reportedly provided pain relief. Further studies are needed to confirm the efficacy of this treatment.
Herbs that may be helpful
Capsaicin is an extract of cayenne pepper that may ease many types of chronic pain when applied regularly to the skin. In animal studies, capsaicin was consistently effective at reducing pain when given by mouth, by injection, or when applied topically. A controlled trial in humans found that application of a solution of capsaicin (0.075%) decreased sensitivity of skin to all noxious stimuli. One review article deemed the research on capsaicin’s pain-relieving properties “inconclusive.” However, in several uncontrolled and at least five controlled clinical trials, capsaicin has been consistently shown to decrease the pain of many disorders, including trigeminal neuralgia, shingles, diabetic neuropathy, osteoarthritis, and cluster headaches. For treatment of chronic pain, capsaicin ointment or cream (standardized to 0.025 to 0.075% capsaicin) is typically applied to the painful area four times per day. It is common to experience stinging and burning at the site of application, especially for the first week of treatment; avoid getting it in the eyes, mouth, or open sores.
Preliminary reports from Chinese researchers also note that 75 mg per day of THP (an alkaloid from the plant corydalis) was effective in reducing nerve pain in 78% of those tested.
As early as 1763, use of willow bark to decrease pain and inflammation was reported. Its constituents are chemically related to aspirin. These constituents may decrease pain by two methods: by interfering with the process of inflammation, and by interfering with pain-producing nerves in the spinal cord. No human studies have investigated the pain- relieving potential of willow bark, and questions have been raised as to the actual absorption of willow bark’s pain-relieving constituents. The potential pain-reducing action of willow is typically slower than that of aspirin.
In animal research, alcohol/water extracts of plants from the genus phyllanthus (25 to 200 mg per 2.2 pounds body weight) have shown a marked ability to decrease pain. This family includes the plants Phyllanthus urinaria, P. caroliniensis, P. amarus, and P. niruri. Like aspirin, phyllanthus extracts appear to reduce pain by decreasing inflammation. Although they are six to seven times more potent than aspirin or acetaminophen in test tube studies, extracts of these plants also demonstrate liver-protective properties, suggesting they may be safer than drugs such as acetaminophen, which has well- documented toxicity to the liver. The usefulness of phyllanthus extracts for treating pain in humans is unknown.
Other herbs that have been historically used to relieve pain (although there are no modern scientific studies yet available) include valerian, passion flower, American skullcap, Piscidia erythrina, and crampbark (Viburnum opulus).
Holistic approaches that may be helpful
Transcutaneous electrical nerve stimulation (TENS) is a form of electrical physical therapy that has been used in the treatment of pain since the early 1970s. Pads are placed on the skin and a mild electrical current is sent through to block pain sensations.
Many TENS units are small, portable, and may be hidden under clothing. A review of the first ten years of research on TENS described success rates in treating chronic pain varying from 12.5% to 92% after one year of treatment. Variations in success rates were attributed to differences in the type of pain the TENS was treating. More current research identifies specific conditions that consistently respond well to TENS therapy: rheumatoid arthritis, osteoarthritis, low back pain, phantom limb pain, and post-herpetic nerve pain (shingles). Pain caused by pinched nerves in the spine responds poorly to TENS therapy. While a small number of controlled trials have reported no benefit, most evidence suggests TENS is an effective form of therapy for many types of pain.
Relaxation exercises may decrease the perception of pain. Pain increases as anxiety increases; using methods to decrease anxiety may help reduce pain. In one controlled hospital study, people who were taught mind-body relaxation techniques reported less pain, less difficulty sleeping, and fewer symptoms of depression or anxiety than did people who were not taught the techniques.
Acupuncture has been shown to decrease pain by acting on the enkephalin-based, pain- killing pathways. In 1997, the National Institutes of Health (NIH) stated that acupuncture is useful for muscular, skeletal, and generalized pain, as well as for anaesthesia and post-operative pain. The NIH statement was based on a critical review of over 67 controlled trials of acupuncture for pain control.
Practitioners of manipulation report that it often produces immediate pain relief either in the area manipulated or elsewhere. Controlled trials have found that people given spinal manipulation may experience reduction in pain sensitivity of the skin in related areas, a reduction in joint and muscle tenderness in the area manipulated, and a decrease in elbow tenderness when the neck was manipulated. One study showed no effect of lower spine manipulation on sensitivity to deep pressure over low back muscles and ligaments. Some researchers have speculated that joint manipulation affects pain by enhancing the effects of endorphins. However, only one of three controlled studies has shown an effect of manipulation on endorphin levels.
Hypnosis has been shown to significantly reduce pain associated with office surgical procedures that are performed while the patient is conscious (i.e., without general anaesthesia). People undergoing office surgical procedures received standard care, structured attention or self-hypnotic relaxation in one study. Those using self-hypnosis had no increases in pain during the procedures, compared to those in the other groups. Hypnosis also appeared to stabilize bleeding, decrease the requirement for narcotic pain drugs during the procedure, and shorten procedure time.
Acne Vulgaris
Acne vulgaris, also known as common acne, is an inflammatory condition of the sebaceous glands of the skin. It consists of red, elevated areas on the skin that may develop into pustules and even further into cysts that can cause scarring.
Acne vulgaris occurs mostly on the face, neck, and back of most commonly teenagers and to a lesser extent of young adults. The condition results in part from excessive stimulation of the skin by androgens (male hormones). Bacterial infection of the skin also appears to play a role.
What are the symptoms of acne?
Acne is a skin condition characterized by pimples, which may be closed (sometimes called pustules or “white heads”) or open (blackheads), on the face, neck, chest, back, and shoulders. Most acne is mild, although some people experience inflammation with larger cysts, which may result in scarring.
Dietary changes that may be helpful
Many people assume certain aspects of diet are linked to acne, but there is not much evidence to support this idea. Preliminary research found, for example, that chocolate was not implicated. Similarly, though a diet high in iodine can create an acne-like rash in a few people; this is rarely the cause of acne. In a preliminary study, foods that patients believed triggered their acne failed to cause problems when tested in a clinical setting. Some doctors of natural medicine have observed that food allergy plays a role in some cases of acne, particularly adult acne. However, that observation has not been supported by scientific studies.
Nutritional supplements that may be helpful
In a double-blind trial, topical application of a 4% Niacinamide gel twice daily for two months resulted in significant in improvement in people with acne. However, there is little reason to believe this vitamin would have similar actions if taken orally.
Several double-blind trials indicate that zinc supplements reduce the severity of acne. In one double-blind trial, though not in another, zinc was found to be as effective as oral antibiotic therapy. Doctors sometimes suggest that people with acne take 30 mg of zinc two or three times per day for a few months, then 30 mg per day thereafter. It often takes 12 weeks before any improvement is seen. Long-term zinc supplementation requires 1– 2 mg of copper per day to prevent copper deficiency.
Large quantities of vitamin A—such as 300,000 IU per day for females and 400,000– 500,000 IU per day for males—have been used successfully to treat severe acne. However, unlike the long-lasting benefits of the synthetic prescription version of vitamin A (isotretinoin as Accutane®), the acne typically returns several months after natural vitamin A is discontinued. In addition, the large amounts of vitamin A needed to control acne can be toxic and should be used only under careful medical supervision.
In a preliminary trial, people with acne were given 2.5 grams of pantothenic acid orally four times per day, for a total of 10 grams per day—a remarkably high amount. A cream containing 20% pantothenic acid was also applied topically four to six times per day. With moderate acne, near-complete relief was seen within two months, while severe conditions took at least six months to respond. Eventually, the intake of pantothenic acid was reduced to 1 to 5 grams per day—still a very high amount.
A preliminary report suggested that vitamin B6 at 50 mg per day may alleviate premenstrual flare-ups of acne experienced by some women. While no controlled research has evaluated this possibility, an older controlled trial of resistant adolescent acne found that 50–250 mg per day decreased skin oiliness and improved acne in 75% of the participants. However, another preliminary report suggested that vitamin B6 supplements might exacerbate acne vulgaris.
Herbs that may be helpful
A clinical trial compared the topical use of 5% tea tree oil to 5% benzyl peroxide for common acne. Although the tea tree oil was slower and less potent in its action, it had far fewer side effects and was thus considered more effective overall.
One controlled trial found that guggul (Commiphora mukul) compared favourably to tetracycline in the treatment of cystic acne. The amount of guggul extract taken in the trial was 500 mg twice per day.
Historically, tonic herbs, such as burdock, have been used in the treatment of skin conditions. These herbs are believed to have a cleansing action when taken internally. Burdock root tincture may be taken in the amount of 2 to 4 ml per day. Dried root preparations in a capsule or tablet can be used at 1 to 2 grams three times per day. Many herbal preparations combine burdock root with other alterative herbs, such as yellow dock, red clover, or cleavers. In the treatment of acne, none of these herbs has been studied in scientific research.
Some older, preliminary German research suggests that vitex might contribute to clearing of premenstrual acne, possibly by regulating hormonal influences on acne.1Women in these studies used 40 drops of a concentrated liquid product once daily.
AIDS
Acquired immunodeficiency syndrome (AIDS) is a condition in which the immune system becomes severely weakened and loses its ability to fight infections.
Although some scientists have questioned whether or not the human immunodeficiency virus (HIV) has actually been proven to cause AIDS, most researchers do believe that HIV causes AIDS.
AIDS is an extremely complex disorder, and no cure is currently available. Certain drugs appear to be capable of slowing the progression of the disease. In addition, various nutritional factors may be helpful. However, because of the complicated nature of this disorder, medical supervision is strongly recommended with regard to dietary changes and nutritional supplements. People who have been infected with HIV are hereafter referred to as “HIV-positive.”
What are the symptoms of HIV and AIDS?
HIV causes a broad spectrum of clinical problems, which often mimic other diseases. Within a few weeks of infection, some people may experience flu-like signs and symptoms, including fever, malaise, rash, joint pain, and generalized swelling of the lymph nodes. These acute manifestations usually disappear, and many people remain asymptomatic for long periods. AIDS, the clinical syndrome associated with HIV infection, produces symptoms throughout the body related to opportunistic infections, tumours, and other immune-deficiency complications.
Dietary changes that may be helpful
People with AIDS often lose significant amounts of weight or suffer from recurrent diarrhoea. A diet high in protein and total calories may help a person maintain his or her body weight. In addition, whole foods are preferable to refined and processed foods. Whole foods contain larger amounts of many vitamins and minerals, and people with HIV infection tend to suffer from multiple nutritional deficiencies.
Nonetheless, no evidence currently suggests that dietary changes are curative for people with AIDS, or even that they significantly influence the course of the disease. In fact, a controlled trial comparing the efficacy of three nutritional regimens in the prevention of weight loss in HIV-positive people found no benefit from increasing caloric intake. A 500-calorie per day caloric supplement with fatty acids plus a multivitamin and minerals did not promote increases in body weight beyond that offered by a multivitamin- mineral supplement alone.
AIDS-related weight loss and chronic diarrhoea are sometimes the result of abnormal intestinal function in the absence of an infectious organism. This condition, called “HIV enteropathy” (pronounced “en-ter-OP-a-thee”), may respond to a gluten-free diet. In a preliminary trial, men with HIV enteropathy were given a gluten-free diet for one week. During that week, the number of episodes of diarrhoea decreased by nearly 40%. When gluten-containing foods were re-introduced for a week, the diarrhoea returned. When they were eliminated a second time, again for one week, the episodes of diarrhoea were again reduced. Participants in the study also experienced significant weight gain during the gluten-free periods.
Lifestyle changes that may be helpful
Loss of strength and lean body mass are frequent complications in people with AIDS. Drug therapy with anabolic steroids is sometimes used to counteract these losses. Preliminary trials suggest that progressive resistance training (i.e., weight training) may be used as an alternative or adjunct to steroids in this disease. In a preliminary trial, people with HIV who did progressive resistance training three times per week for eight weeks had significant increases in their lean body mass. Exercise of any type three to four times per week or more has been associated with slower progression to AIDS at one year and with a slower progression to death from AIDS at one year in men.
Nutritional supplements that may be helpful
Because people with HIV infection or AIDS often have multiple nutritional deficiencies, a broad-spectrum nutritional supplement may be beneficial. In one trial, HIV-positive men who took a multivitamin-mineral supplement had slower onset of AIDS, compared with men who did not take a supplement. Use of a multivitamin by pregnant and breast- feeding Tanzanian women with HIV did not affect the risk of transmission of HIV from mother to child, either in utero, during birth, or from breast-feeding.
Selenium deficiency is an independent factor associated with high mortality among HIV- positive people. HIV-positive people who took selenium supplements experienced fewer infections, better intestinal function, improved appetite, and improved heart function (which had been impaired by the disease) than those who did not take the supplements. The usual amount of selenium taken was 400 mcg per day.
Selenium deficiency has been found more often in people with HIV-related cardiomyopathy (heart abnormalities) than in those with HIV and normal heart function. People with HIV-related cardiomyopathy may benefit from selenium supplementation. In a small preliminary trial, people with AIDS and cardiomyopathy, 80% of who were found to be deficient in selenium, were given 800 mcg of selenium per day for 15 days, followed by 400 mcg per day for eight days. Improvements in heart function were noted after selenium supplementation. People wishing to supplement with more than 200 mcg of selenium per day should be monitored by a doctor.
The amino acid, N-acetyl cysteine (NAC), has been shown to inhibit the replication of HIV in test tube studies. In a double-blind trial, supplementing with 800 mg per day of NAC slowed the rate of decline in immune function in people with HIV infection. NAC also promotes the synthesis of glutathione, a naturally-occurring antioxidant that is believed to be protective in people with HIV infection and AIDS.
The combination of glutamine, Arginine, and the amino acid derivative, hydroxymethylbutyrate (HMB), may prevent loss of lean body mass in people with AIDS- associated wasting. In a double-blind trial, AIDS patients who had lost 5% of their body weight in the previous three months received either placebo or a nutrient mixture containing 1.5 grams of HMB, 7 grams of L-glutamine, and 7 grams of L-Arginine twice daily for eight weeks. Those supplemented with placebo gained an average of 0.37 pounds; mostly fat, but lost lean body mass. Those taking the nutrient mixture gained an average of 3 pounds, 85% of which was lean body weight.
In a double-blind trial, the non-disease-causing yeast Saccharomyces boulardii (1 gram three times per day) helped stop diarrhoea in HIV-positive people.17 However, people with severely compromised immune function have been reported to develop yeast infections in the bloodstream after consuming some yeast organisms that are benign for healthy people. For that reason, people with HIV infection who wish to take Saccharomyces boulardii, brewer’s yeast (Saccharomyces cerevisiae), or other live organisms should first consult a doctor.
A deficient level of dehydroepiandrosterone sulphate (DHEAS) in the blood is associated with poor outcomes in people with HIV. Large amounts of supplemental dehydroepiandrosterone (DHEA) may alleviate fatigue and depression in HIV-positive men and women. In a preliminary trial, men and women with HIV infection took 200–500 mg of DHEA per day for eight weeks.21 All participants initially had both low mood and low energy. After eight weeks of DHEA supplementation, 72% of the participants reported their mood to be “much improved” or “very much improved,” and 81% reported having significant improvements in energy level. DHEA supplementation had no effect on CD4 cell (helper T-cell) counts or testosterone levels.
Vitamin A deficiency appears to be very common in people with HIV infection. Low blood levels of vitamin A are associated with greater disease severity and increased transmission of the virus from a pregnant mother to her infant. However, in preliminary and double-blind trials, supplementation with vitamin A failed to reduce the overall mother-to-child transmission of HIV. HIV-positive women who took 5,000 IU per day of vitamin A (as retinyl palmitate) and 50,000 IU per day of beta-carotene during the third trimester (13 weeks) of pregnancy, plus an additional single amount of 200,000 IU of vitamin A at delivery, had the same rate of transmission of HIV to their infants as those who did not take the supplement. However, lower rates of illness have been observed in the children of HIV-positive mothers when the children were supplemented with 50,000– 200,000 IU of vitamin A every two to three months.
Little research has explored whether vitamin A supplements are helpful at halting disease progression. HIV-positive children given two consecutive oral supplements of vitamin A (200,000 IU in a gelcap) in the two days following influenza vaccinations had a modest but significant decrease in viral load. In one trial, giving people an extremely high (300,000 IU) amount of vitamin A one time only did not improve short-term measures of immunity in women with HIV.
Beta-carotene levels have been found to be low in HIV-positive people, even in those without symptoms. However, trials on the effect of beta-carotene supplements have produced conflicting results. In one double-blind trial, supplementing with 300,000 IU per day of beta-carotene significantly increased the number of CD4+ cells in people with HIV infection. In another trial, the same amount of beta-carotene had no effect on CD4+ cell counts or various other measures of immune function in HIV-infected people.
In HIV-positive people with B-vitamin deficiency, the use of B-complex vitamin supplements appears to delay progression to and death from AIDS. Thiamine (vitamin B1) deficiency has been identified in nearly one-quarter of people with AIDS. It has been suggested that a thiamine deficiency may contribute to some of the neurological abnormalities that are associated with AIDS. Vitamin B6 deficiency was found in more than one-third of HIV-positive men; vitamin B6 deficiency was associated with decreased immune function in this group. In a population study of HIV-positive people, intake of vitamin B6 at more than twice the recommended dietary allowance (RDA is 2 mg per day for men and 1.6 mg per day for women) was associated with improved survival. Low blood levels of folic acid and vitamin B12 are also common in HIV-positive people.
Preliminary observations suggest a possible role for vitamin B3 in HIV prevention and treatment. A form of vitamin B3 (Niacinamide) has been shown to inhibit HIV in test tube studies. However, no published data have shown vitamin B3 to inhibit HIV in animals or in people. One study did show that HIV-positive people who consume more than 64 mg of vitamin B3 per day have a decreased risk of progression to AIDS or AIDS-related death. Clinical trials in humans are required to validate these preliminary observations.
Vitamin C has been shown to inhibit HIV replication in test tubes. Intake of vitamin C by HIV-positive persons may be associated with a reduced risk of progression to AIDS. Some doctors recommend large amounts of vitamin C for people with AIDS. Reported benefits in preliminary research include greater resistance against infection and an improvement in overall well-being. The amount of vitamin C used in that study ranged from 40 to 185 grams per day. Supplementation with such large amounts of vitamin C must be monitored by a doctor. This same researcher also reports some success in using