According to the Slone Survey, a study of prescription and nonprescription drug use by Americans from 1998-1999 (published in the Journal of the American Medical Association January 16, 2002), 81% of American adults took medication at least on a weekly basis. Many Americans took more than one medication, and 7% took five or more. Among these medications, the top three drugs were all painkillers – acetaminophen (Tylenol and others), ibuprofen (Advil, Motrin, and others), and aspirin. The majority of these Americans suffer from common and often chronic conditions such as headache, back pain, and arthritis, or musculoskeletal injuries. In 43% of American households, at least one family member suffers from a chronic pain syndrome. The cost of these conditions is staggering, including not only the medications, but also doctors’ visits, diagnostic tests, the cost of therapies such as physical therapy or chiropractic care, as well as the loss of time and productivity associated with chronic pain. Side effects and complications from taking these medications are also substantial. Anti-inflammatory drug use results in more than 100,000 hospitalizations and 10,000 to 20,000 deaths in the United States each year. Twenty percent of long-term anti-inflammatory medication users develop stomach ulcers. The number one over-the-counter drug, acetaminophen (Tylenol, Tempra, Pandadol and others), is one of the chief causes of liver failure requiring liver transplant in Great Britain and the U.S. Newer prescription anti-inflammatories such as Celebrex and Vioxx have been associated with increased rates of high blood pressure and even heart attacks. It seems that people suffering from chronic pain are caught in a bind; either live with the pain, or risk serious complications from taking medications. But new research is providing hope and effective alternatives to chronic medication use. This research is beginning to uncover the basic mechanisms of inflammation and pain in the body, and how we can change this process without medications. The cycle of pain and inflammation in the body is related to many chemicals produced by our cells. These chemicals include certain enzymes and specific fatty acids. Enzymes are complex protein molecules that act as catalysts, or controllers of the chemical reactions in our bodies. Fatty acids come from fat; there are many different types of fatty acids in our bodies. The levels of different fatty acids in our bodies depend largely on our diet. Because fatty acids are directly related to pain and inflammation, our diet can play a substantial role in the amount of pain and inflammation we experience. There are also specific foods that affect the activity of enzymes involved in pain and inflammation. The chief fatty acid responsible for inflammation is one called arachidonic acid. A diet rich in arachidonic acid contributes to the cycle of pain and inflammation. Foods that are rich in arachidonic acid include animal meats, egg yolks, and shellfish. One step in stopping inflammation is reducing dietary intake of these foods. But arachidonic acid (AA) can also be synthesized or produced by our bodies. To reduce the production of AA in our bodies we can increase our intake of “anti-inflammatory fats” such as EPA (eicosapentanoic acid) from fish, and ALA (alpha-linoleic acid) from sources including flax, pumpkin seeds, walnuts and soybeans. Research has also shown that certain foods and spices can block the enzymes that fuel the process of pain and inflammation. These anti-inflammatory foods and spices include ginger, cayenne, turmeric, garlic & onion, rosemary, and herbs such as Boswellia (an Ayurvedic herb), wintergreen, licorice root, and black willow. Additional nutrients including Vitamin E and Quercetin (a natural anti-inflammatory found in foods such as citrus fruits, apples, onions, parsley, tea, and red wine) also inhibit enzymes that trigger inflammation. Just as anti-inflammatory foods can have a profound effect on the cycle of pain and inflammation, so does our immune system. Over one-third of our entire immune system is located in the gastrointestinal tract. Reducing inflammation throughout the body therefore requires a healthy gastrointestinal tract. Inflammatory bowel diseases such as Crohn’s disease and Ulcerative Colitis are also commonly associated with arthritis. We can support the health of our gastrointestinal tracts by eating a healthy diet with adequate fiber intake, avoiding unnecessary antibiotics that upset the balance of bacteria in the gastrointestinal tract, and avoiding foods we may be sensitive or allergic to. Several studies have also suggested that wheat (or gluten, a chief protein in wheat) allergy has been associated with some forms of arthritis including rheumatoid arthritis, and that a gluten-free diet can improve arthritis symptoms in rheumatoid arthritis patients. Wheat allergy is one of the top 6 food allergies along with eggs, milk, nuts, soy, and shellfish. There are many physical therapies that can help tremendously to relieve chronic pain. Studies have repeatedly shown that for chronic knee pain from arthritis, the most beneficial therapy is strengthening of the quadriceps (thigh) muscle. Acupuncture can provide substantial relief of pain from many causes. Regular massage, physical and neuromuscular therapy by trained therapists can also be extremely helpful in reducing chronic musculoskeletal pain. Finally, there is also increasing evidence supporting the benefits of mind-body techniques such as meditation, biofeedback, hypnosis, guided imagery, yoga, relaxation therapy, Tai Chi and Chi Gong in the management of chronic pain. These techniques can be extremely helpful and are free of adverse side effects. Here is a summary of recommendations to help improve pain without pills: Eliminate or reduce your intake of red meats, egg yolks, and shellfish to reduce your arachidonic acid levels; Supplement your diet with healthy sources of the essential omega-3 fatty acids EPA and ALA by increasing your intake of: Fish and fish oils (eicosapentanoic acid) Ground flax seeds or flax oil Pumpkin seeds Walnuts Soybeans Hemp oil Increase your intake of anti-inflammatory foods and spices such as: Turmeric (and it derivative, curcumin) Ginger Garlic & onions Cayenne Rosemary Boswellia Citrus fruits Parsely Increase your fiber intake from foods such as whole grains, fruits & vegetables, nuts, seeds and legumes; Exercise including aerobic and muscle strengthening; Practice mind-body techniques: Biofeedback Meditation Yoga Hypnosis Tai Chi and Chi Gong Use helpful physical therapies: Acupuncture Neuromuscular therapy Regular massage Physical therapy For those persons with persistent pain despite these measures, consider a trial of a food allergy elimination diet under the supervision of your physician or nutritionist.