In the War Against Opioids, We Need Alternatives. Here’s How to Manage Chronic Pain Without Putting Your Life at Risk

“As long as you feel pain, you’re still alive.” 

As a doctor, I’ve listened to many patients tell me that pain is a normal part of life. Some may even call it essential. Even if you disagree with that sentiment, the fact is that many people suffer from chronic pain for various reasons. But while we cannot stop all sources of chronic pain, we can change the way it is managed. 

Painkillers like ibuprofen, acetaminophen, and in increasing numbers, opioids, have become our go-to solutions for pain management. Opioids, in particular, are often hailed as the holy grail in pain relief and management. But they’ve come with significant costs — addiction, abuse, overdose, and death — and without the promised benefits. One 2018 study found that opioids were not more effective at treating moderate to severe chronic pain than non-opioids.1 Furthermore, they may raise risks for serious infections.2 

Non-opioid treatments like NSAIDs also have adverse reactions. So what can you do? Thankfully, there are many alternatives to prescription painkillers, many of which are much safer and gentler on your body. 

Natural Pain Relievers

Many herbs, essential oils, and spices have anti-inflammatory properties that can provide pain relief. We’ll discuss a few options here.

Turmeric for Pain Relief

Turmeric (Curcuma longa) is a commonly used spice in many ethnic cuisines, especially in Southeast Asian countries like India and Pakistan. It gives curry its characteristic yellow color, which is produced by a family of bioactive compounds in turmeric called curcuminoids. 

The most well-known curcuminoid is curcumin, which research has shown to have powerful anti-inflammatory and antioxidant properties. In fact, some studies have indicated that curcumin may be a more potent than some anti-inflammatory drugs like ibuprofen and aspirin.3 The greatest advantage of curcumin is its high tolerability.4 Some clinical studies have shown that high doses (8–12 g) of curcumin cause some side effects like nausea and diarrhea, but it is not necessary to consume such high doses to experience the benefits of curcumin. Results from one 2016 study indicated that osteoarthritis symptoms improved with a dosage of less than 2 g/day of curcumin.5 

In addition to pain relief, turmeric has received much attention from the scientific and medical community for its potential as a therapeutic agent for:

• Wound healing
• Diabetes
• Alzheimer’s disease
• Parkinson’s disease
• Cardiovascular disease
• Pulmonary disease
• Various types of cancer
• Irritable bowel syndrome

Despite having such huge potential, curcumin has poor bioavailability, which refers to the proportion of an unchanged substance that is absorbed into the bloodstream, ready for use by the body. Curcumin degrades into various metabolites within 30 minutes at physiological pH. However, some research studies have shown that these metabolites — which are found in high concentrations in circulation after curcumin consumption — are responsible for the anti-inflammatory and antioxidant activities associated with curcumin.67

Some people recommend taking curcumin with piperine, a compound found in black pepper, to increase bioavailability. But extensive studies have shown that activate curcumin is absorbed earlier and is retained longer than the curcumin-piperine combination.8 For my patients, I recommend Activated Curcumin, which features BCM-95® CG, a formulation that provides optimal bioavailability of curcumin and other curcuminoids. 

Boswellia for Pain Relief

Boswellia is an extract of Boswellia serrata, a moderate to large sized branching tree that grows in mountainous regions of India, Northern Africa, and the Middle East. It is often referred to as Indian frankincense, and is one of the most valued Ayurvedic herbs. In traditional Ayurvedic and Unani texts, Boswellia is named as an effective remedy for a long list of conditions from diarrhea to sore throat to ringworm.9 In Western medicine, this gummy resin is known for its use as an:

• Antiarthritic
• Anti-inflammatory
• Antihyperlipidemic (reduces lipid levels in blood)
• Antiatheroscloertic (prevents or counteracts the buildup of fatty substances in and on artery walls)
• Analgesic (relieves pain)
• Hepatoprotective (protects the liver)

Lab and animal studies have shown that boswellia blocks the synthesis of 5-lipoxygenase (5-LO), an enzyme that generates inflammatory compounds called leukotrienes. Furthermore, while NSAIDs can accelerate arthritic conditions by disrupting glycosaminoglycan synthesis in tissues, boswellic acids reduce glycosaminoglycan degradation.9

A clinical trial conducted in 2008 found that boswellia significantly improved arthritic pain and joint function in as little as seven days.10 Other studies have shown similar results, with some suggesting that the anti-inflammatory effect of boswellia is comparable to that of ibuprofen.1112

In general, boswellia can be taken as an oral supplement. Because products vary greatly, it has been difficult to come to a consensus on the optimal dose for safety and efficacy. The Arthritis Foundation recommends 300 mg to 400 mg three times a day of products that contain 60% boswellic acids. I recommend Boswellia by Pure Encapsulations for my patients. 

White Willow Bark for Pain Relief

The use of willow bark extract dates back to 400 BC13 when people chewed on the bark as an anti-inflammatory, antipyretic, and a pain reliever. It continues to be used today for the treatment of various conditions, such as:

• Low back pain
• Osteoarthritis
• Headache
• Inflammation (ex: bursitis, tendinitis)

Willow bark contains salicin which converts to salicylic acid in the stomach. Salicylic acid is a chemical similar to aspirin or acetylsalicylic acid. For this reason, many refer to willow bark as the “original aspirin.” However, willow species only contain a small amount of salicylic acid, and the dose is insufficient to produce pain relief. Fortunately, there are other components of the willow bark, such as flavonoids and polyphenols, that also contribute to the antioxidant, analgesic, and anti-inflammatory effects. This multi-component active principle allows willow bark to have a much broader mechanism of action and lower risk of adverse effects than aspirin. 

Few research studies have been done on the safety and efficacy of white willow bark. Of those available, results suggest that white willow bark (standardized to 120 mg or 240 mg salicin) produce at least short-term pain relief.14 

One study used a supplement formulated with a combination of white willow bark extract, ginger root concentrate, glucosamine sulfate, methylsulfonylmethane (MSM), boswellia serrata extract, turmeric root extract, cayenne, and hyaluronic acid. In this randomized, double-blind study, this combination significantly reduced joint pain severity of middle-aged and older adults.15

There are several precautions to be aware of before you consume white willow bark supplements. Because salicin is similar to aspirin, it is possible for people who are allergic to aspirin to also be sensitive to salicin. White willow bark can also interact with other medications like blood thinners and beta-blockers. If you take any of these medications, consult your doctor before taking willow bark. Children, adolescents under the age of 16, and pregnant and breastfeeding women are also discouraged from taking willow bark supplements. 

For a high-quality white willow bark supplement, I recommend White Willow Forte from Nutra Biogenesis. This unique formula combines the potent powers of white willow bark, boswellia, turmeric, ginger, enzymes, and other nutritional factors to reduce inflammation and provide antioxidant support. 

Other Herbs for Pain Relief

Another supplement I recommend is ReJoint™, a science-backed herbal formula that works on 9 different pain pathways at once, thereby stopping occasional pain before it even starts. ReJoint™ is a combination of 5 carefully-selected herbs:

• Boswellia serrata extract
• Horsetail leaf powder
• Nettle leaf powder
• Odorless garlic bulb powder
• Celery seed powder

In clinical trials, ReJoint™ was found to deliver an average of 66.67% improvement in pain with little to no side effects. 

Natural Topical Pain Relievers

If you’re reluctant to pop another pill, you can consider a topical pain reliever like CRYODERM. The ingredients in CRYODERM include:

• Menthol (derived from peppermint oil)
• Arnica (a homeopathic remedy for pain)
• Boswellia serrata
• Eucalyptus oil
• Glycerin
• Ilex paraguariensis leaf extract (an herb used in southern Latin American countries for its analgesic properties)16
• MSM

The ingredients in CRYODERM act to restore tissue homeostasis. That is, when tissues are inflamed and blood vessels are over-dilated, CRYODERM makes them contract, reducing swelling, redness, pain, and discomfort. On the other hand, when your muscles are in spasm, your blood vessels are constricted, which reduces the blood flow to the affected tissue. In this case, CRYODERM relaxes and dilates the blood vessels, improving microcirculation and tissue oxygen supply to promote healing.17  

Special Proresolving Mediators for Pain Relief

Inflammation is a host response to an infection or tissue damage and has the purpose of restoring homeostasis to the affected tissue. Inadequate or insufficient resolution of inflammation can lead to: 

• Chronic inflammation
• Severe and irreversible tissue damage
• Dysregulation of tissue healing and fibrosis
• Development of autoimmunity and other disease states

Resolution of acute inflammation was once thought of as a passive process — once the stimulus was removed, proinflammatory proteins like cytokines and other signaling molecules would simply decline over time. We now know that it is not only highly complex, but that it is an active process that requires the synthesis of specialized pro-resolving mediators (SPMs). This collective term refers to a large class of signaling molecules derived from polyunsaturated fatty acids like eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). SPMs have important roles in resolving inflammation, and unlike NSAIDs that compromise the immune response, SPMs allow the inflammation to carry out naturally. Once the immune response has served its purpose, SPMs help promote the return to homeostasis by shutting down the immune response, inhibiting additional inflammation, and aiding tissue remodeling.1819 Once SPMs are done with their jobs, the body naturally breaks them down. 

The production of SPMs in your body is highly dependent on a healthy lifestyle and genetics. There are many factors that limit SPM production, a few of which include:

• Aging
• Exposure to environmental toxins
• Lack of exercise or overexertion
• High intake of processed carbohydrates
• High intake of low-quality dietary fats

Simply changing your lifestyle does not do enough to increase the level of SPMs, and neither does taking fish oil supplements. A better, more direct way is to take SPM supplements like SPM Active, which is made from fractionated fish oils to deliver a concentrated SPM product. Studies have found that SPM supplementation reduced blood markers of inflammation in as little as six weeks and had no obvious side effects. With their active roles in inflammation resolution, I believe that SPM supplements can make a big difference for patients who continue to experience pain and discomfort during the slow process of healing.

Systemic Enzyme Therapy for Pain

Tissue repair is a protective response after injury. It is a dynamic process, involving the recruitment of various inflammatory cells, proliferation of cells, scar deposition, and tissue regeneration. In many cases, proper tissue repair occurs when the injury is transient and the inflammation is resolved quickly. 

However, chronic inflammation due to severe, repetitive, or prolonged injury can lead to pain and fibrosis, an immune response characterized by the development, hardening, and/or scarring of fibrous connective tissue. This simply means that the normal tissue is replaced by permanent scar tissue. In some cases such as liver cirrhosis and cardiovascular fibrosis, extensive tissue remodeling and fibrosis can lead to organ failure and death. 

Therefore, the current standard of care for inflammation is to treat it using anti-inflammatory drugs like NSAIDs. There are several problems with this approach though, one of which is the fact that while preventing inflammation may protect tissues from further injury,20 doing so also hinders recovery.2122 This dilemma suggests that the current treatment options may not be effective or safe. 

There’s a need for a therapeutic option that allows the tissue repair processes to occur naturally. And that’s where systemic enzyme therapy comes in. 

Systemic enzyme therapy involves the use of primarily proteolytic enzymes (also called protease, proteinase, or peptidase) along with the flavonoid rutin. Enzymes are administered orally and are mainly absorbed in the small intestine. Although their mechanism of action is not yet fully understood, it is believed that they act in an anti-inflammatory manner upon absorption into the bloodstream. Specifically, it is known that they act in two main ways:

1. As their name suggests, they break down proteins into smaller units called amino acids. This activity not only helps in digestion, but also acts as markers of cell destruction and inflammation.23
2. The enzymes irreversibly bind to antiproteinases such as ɑ-1-antitrypsin and ɑ-2-macroglobulin. This allows the levels of anti-proteinases to increase, which inactivates other proteinases that are thought to play a role in uncontrolled protein degradation as well as tumor development and metastasis.24  

When the enzymes bind ɑ-2-macroglobulins, they form ɑ-2-macroglobulin-proteinase complexes. These complexes can bind to cytokines, some of which are known for promoting immunosuppression and inflammation. 

These two mechanisms of action suggest that systemic enzymes support immune function and promote tissue healing and muscle recovery. Fortunately, these enzymes are present naturally in certain foods. Some examples of such foods are papaya and pineapples, which contain the enzymes papain and bromelain, respectively. 

However, some people may benefit from taking systemic enzyme supplements. And with over 200 clinical studies and 100 million users25, Wobenzym N may be one of the world’s most well-researched joint-health supplements. It has been the subject of six human clinical studies with over 2,400 participants, and has a long history of safety and efficacy. Its unique blend of proteolytic enzymes have been used over several decades as an alternative treatment for other anti-inflammatory medications.  

Safe, Effective Pain Management is Possible

A good pain management strategy involves a multi-pronged approach that often requires patients to make a commitment to lifestyle changes. Instead of reaching for potentially dangerous and addictive drugs that simply mask pain, employing a holistic mindset to pain management can help you enjoy a pain-free life. 

Of course, we haven’t covered all types of natural pain management strategies in this blog post. While we will certainly discuss other methods in the future, I want to emphasize the importance of thinking long-term for your health. While opioids may be appropriate in certain situations, they are never permanent solutions, and the current opioid crisis in this country is proof of that. 

In my practice, I have seen success with all of the products mentioned in this article. Other products I recommend for my patients can be found here. If you suffer from chronic pain, I also highly recommend consulting a qualified functional medicine physician to help you. 

Now it’s time to hear from you. Do you suffer from chronic pain? What are your strategies for managing pain? Please share your story in the comments below! 

References:

1. https://jamanetwork.com/journals/jama/article-abstract/2673971?redirect=true
2. https://annals.org/aim/article-abstract/2672606/prescription-opioids-infection-risk-research-caution-needed
3. https://www.ncbi.nlm.nih.gov/pubmed/15489888
4. https://www.ncbi.nlm.nih.gov/pubmed/10404539
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003001/
6. https://www.ncbi.nlm.nih.gov/pubmed/24368738/
7. https://www.ncbi.nlm.nih.gov/pubmed/9278892/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792534/#CIT40
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309643/
10. https://www.telegraphindia.com/india/indian-herb-hope-for-arthritis-relief/cid/550821#top,
11. https://link.springer.com/article/10.1007%2Fs10067-017-3603-z
12. https://nutritionj.biomedcentral.com/articles/10.1186/s12937-015-0115-z
13. http://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000281
14. https://www.ncbi.nlm.nih.gov/pubmed/25536022
15. https://www.ncbi.nlm.nih.gov/pubmed/24274358
16. https://www.ncbi.nlm.nih.gov/pubmed/26228736
17. https://www.cryoderm.com/index.php?p=392133
18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845539/
19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315926/
20. https://www.ncbi.nlm.nih.gov/pubmed/23539314
21. https://www.ncbi.nlm.nih.gov/pubmed/17463304
22. https://www.ncbi.nlm.nih.gov/pubmed/19713429
23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569274/
24. https://journals.sagepub.com/doi/pdf/10.1177/1534735408327251
25. https://web.archive.org/web/20160424132745/http://www.wobenzym.com/en/articles-and-tips/science/