Normally, inflammation plays an important defensive and healing role in our bodies. Inflammation can be thought of as being caused by three different events:
Injury – When there is injury to an area, chemical mediators are released which attract cells from the blood stream and surrounding tissues to the area. Blood vessels dilate, allowing these cells to enter the injured area, where they start the process of cleaning up injured tissue and dead cells, and fighting off any bacteria that may have entered an open wound. As this process is completed, the body then turns to more of a remodeling and rebuilding phase, both reducing the local inflammation and activating cells to grow new tissue. This is the process that occurs with the formation of scabs and scar tissue to help close the wound and then transitions to remodeling of tissue towards normal. Leading into and during this time of rebuilding, cells also release and respond to chemicals that reduce inflammation.
Infection – Infection stimulates the body to activate the cells to first fight off the invading virus or bacteria by releasing toxic chemicals in the area, creating inflammation to help with this process, and attract immune cells. These cells attack and clear invading pathogens and the process by which they do this involves inflammation. When the infection is cleared, signals are circulated to start reversing the inflammatory process and bring the body back to normal, or homeostasis.
Toxins – Toxins can also induce inflammation, causing destruction of peripheral tissue, peripheral nerves, and cells within the central nervous system. Common examples would be alcohol or exposure to chemotherapy agents.
When there is a local injury, whether it is a traumatic injury to your body or internal injury such as a neck or back problem, the local nerves in the area become sensitized by the inflammation that develops as a result of the injury. The response caused by the injury, infection or toxin creates changes in the cells of the spinal cord and brain (central nervous system or CNS). This increases inflammation within the CNS, which is called neuroinflammation. Normally this neuroinflammation helps protect our bodies by making us more aware of the sensitive area of injury, or creates a sense of depression to promote rest to allow for the inflammation to carry out its purpose and healing to begin.
As the inflammation subsides, the nerves usually return to their normal state of sensitivity and function. Occasionally, however, this return to normal does not occur and the nerves remain hypersensitive. This can cause you to feel normal movement, touch, or other sensations as painful sensations. When this persists long term, it can become a chronic problem, called neuropathic pain.
Similarly, problems arise when neuroinflammation persists, leading to sensitivity and chronic pain. If the neuroinflammation remains, and the brain does not return to its normal uninflamed state, chronic pain develops, as well as chronic depression, anxiety, insomnia and other pain and psychological problems. These components can negatively impact your quality of life and mood, and because of this, neuroinflammation is an important target in the treatment and management of pain.
It has been shown that psychological stress in the way of trauma, social isolation, and other stressors can also cause inflammation within the brain. This neuroinflammation sensitizes you to pain and leads to deepening of depression, problems with anxiety and insomnia and compounds the problem of pain and the treatment of pain. It is thus important to address the “Psychology of Pain” along with other influences of neuroinflammation.
Treatment of Neuroinflammation
We can address and help manage neuroinflammation and the associated problems including chronic pain, through the use of:
Medications and supplements
Diet, Neuroinflammation, and Pain
As science advances, we are learning more about ways to control our pain by controlling our diets. There are many ways to approach your pain management through healthy dietary changes and habits. Diets such as the Anti-inflammatory Diet, the Mediterranean Diet and intermittent fasting have been shown to be excellent for all-around health promotion, as well as helping with neuroinflammation and pain.
These diets have certain common dietary principles and themes. We now know that healthy diets, which reduce neuroinflammation and general body inflammation, prevent neurodegenerative diseases such as Alzheimer’s Disease, promote cardiovascular health, help prevent cancer and certain chronic diseases, and have a huge impact on our mental health and cognitive function.
Caloric intake – We need adequate carbohydrates, protein, and healthy fats in our diet. Excessive eating, however, produces oxidative stress and promotes inflammation in our bodies. Combining health choices of what we eat with moderation of amounts leads to very positive health benefits, above and beyond weight control.
Carbohydrates – Those food items that are converted by the body into sugars for energy for our cells are called carbohydrates. It is important that we consume adequate carbohydrates, but the choice of our carbohydrate sources can play a huge role in controlling our level of inflammation. Foods that are too quickly converted into sugar, including the obvious sweets, but also starchy vegetables such as potatoes, as well as refined and processed flours lead to sugar spikes in the blood stream and the release of insulin. Too strong and frequent a release of insulin, leads to increased inflammation, including neuroinflammation. This in turn worsens pain. Healthy carbohydrate choices include whole grains (which release carbohydrates and sugars very slowly), high fiber and leafy vegetables, and fruits in moderation combined with meals. Watching both the selection of good carbohydrate choices and total amounts provide a means for pain management.
Proteins – The building blocks of our cells and tissues, blood and even antibodies are called proteins, and are needed for healing and health. It is important to choose healthy protein sources as a part of your overall dietary efforts. Protein sources that also come with increased amounts of saturated fats, are not wise choices in this context. Examples include chicken with the fatty skin, fatty red meats, or cold cuts, as the combination with saturated fats makes these unhealthy sources. Lean meats, fish, eggs, and plant-based protein sources make excellent choices and promote health in many ways. Healthy plant-based sources of protein include whole grains such as oatmeal, quinoa, beans, peas, nuts, seeds and others.
Healthy fats – Our choices of fats and oils in our diet is very important. Certain oil sources not only provide healthy mono and poly unsaturated fats, but may also have additional compounds such as polyphenols (extra virgin olive oil) that have a direct anti-inflammatory effect. The balance between saturated and unsaturated fats is one determinate of our level of inflammation, unsaturated fats being very good. Omega 3 fatty acids are excellent at directly reducing inflammation. The best oils for your health include olive oil, canola oil, flaxseed oil, avocado oil, walnut oil, sesame oil, grapeseed oil and sunflower oil. Three oils to limit or avoid would be coconut, partially hydrogenated and palm oils. Good natural sources of omega 3 fatty acids include oily fish such as salmon, flax seed and walnuts, to name a few. The use of healthy oils, for cooking, on salads and for flavoring of foods, and considering supplementation with additional omega 3 fatty acids can go a long way towards reducing neuroinflammation.
Intermittent fasting – Research has shown that intermittent fasting can provide multiple health benefits, including your cardiovascular health, cancer prevention, and other medical positives, and our context, can have a beneficial effect on depression, anxiety, and pain. Intermittent fasting is not as hard as it sounds and can be entered into gradually. One target goal would be to limit eating to an eight-hour window, with fasting for the remaining 16 hours. This may look like having a healthy lunch and healthy dinner, but not snacking and eating breakfast until the following day’s lunch. If you are a coffee drinker, you would avoid putting sugar or creamer in your coffee, but you can have black coffee. You may feel a little grumpy or goofy the first couple of days, but your body does adapt, and you should eventually feel good during your fast. You will have a general sense of improvement in mood and energy level over the first few weeks of starting intermittent fasting. You can still benefit if you do this a few or several times a week, even if it is not every day. Some people narrow the window towards six hours or less, limit calories during their feeding, and add in full fasting days (with plenty of hydration). You can make this fit your needs and receive some degree of benefit no matter how far you dive into the intermittent fasting lifestyle. This will reduce neuroinflammation and thus improve pain, mood, reduce anxiety, and have other quality of life benefits.
Sleep – Sleep has long been a mystery, but we are learning more and more about not only the importance of sleep, but beginning to understand some of the mechanisms for why sleep is so restorative to our mind, cognition, and energy levels. Sleep allows for various brain functions to change patterns during the night, and although we do not fully understand this process is restorative, we are learning that there is also a washing away of toxins, lactic acid and other chemicals that is helpful for restoring normal brain function on a day-to-day basis. We are also learning that adequate and good quality sleep can have a positive preventative effect for Alzheimer’s disease and other neurodegenerative diseases, as well as other long-term benefits which are important for pain management. On the flip side, we also know that pain interferes with sleep by disrupting sleep during the night. The more that this occurs and the lower the quality of sleep, the lower your tolerance for pain becomes. This is a vicious cycle. There are many ways with which we promote good sleep, and thus good control of neuroinflammation, noted on our Sleep page.
Exercise – Regular exercise has many positive effects on our health and well-being, including decreasing neuroinflammation and normalizing immune function in general. It is recommended that you exercise to your level of tolerance and seek guidance from your medical provider and physical therapist for strategies with which to maximize your ability to exercise. The American College of Sports Medicine has recommended 2.5 hours of moderate intensity exercise per week. This ideally involves a combination of aerobic high intensity cardiovascular exercise and weight training. The intensity should be high enough to elevate your heart rate and sense of effort. This can be broken down into 5 30-minute sessions or a few longer sessions.
Nonsteroidal anti-inflammatory medications (NSAIDs) can act to decrease inflammation and pain. There are known risks such as gastrointestinal (GI) bleeding or effects on the kidney or liver. NSAIDs are an effective first line treatment for pain and inflammation. They generally are used on a time-limited fashion, taken with food, and you should observe for any signs of stomach pain, dark stools, swelling, or other possible signs of side effects. Oral corticosteroids are sometimes used when the pain has worsened substantially, and these are used in an attempt to bring down the level of pain severity back towards a baseline level. They tend not to alleviate the problem long-term, but are often helpful in providing a quick benefit when pain is severe. Oral corticosteroids can also cause GI bleeding, swelling and occasional agitation.
Our core recommendations for supplements include omega 3 fatty acids and vitamin D3 on a regular basis. Natural anti-inflammatories include:
Omega 3 fatty acids (fish oil), which is a very powerful anti-inflammatory fatty acid and the recommended dose is at least 1.5g (1500 mg) of EPA and DHA per day, taken with meals.
Curcumin (turmeric) is a naturally occurring yellow pigment that also has demonstrated anti-inflammatory effect. The usual dose is 400-600mg taken three times per day. Caution should be used if you are also taking anticoagulant medications or nonsteroidal medications.
Vitamin D3 has many positive functions. Not only is it important for bone and other health parameters, it also has an anti-inflammatory effect.
White willow bark is effective and contains salicin, which is converted to salicylic acid by the liver. It is considered to have fewer side effects that aspirin although with similar effect.
Alpha lipoic acid at a dose of 600mg once or twice a day is helpful in reducing neuropathic pain (for example, painful diabetic peripheral neuropathy).
Green tea extracts with a typical dose of 300-400mg.
Capsaicin (chili pepper)
Keep in mind that supplements can have interactions with medications you may already be taken, so please discuss the addition of any supplement with your pain care provider prior to starting it.
Pain Psychology and Neuroinflammation
We know that injury, infection, and toxins can cause neuroinflammation, which in turn can cause or aggravate depression, anxiety or symptoms of PTSD. On the other hand, extremely stressful events, chronic stress, or new events such as losses or isolation, can also cause neuroinflammation. This results in an increase in pain levels. This can have a strong negative influence on quality of life. It is important to address neuroinflammation through the power of the mind. A pain psychologist can help in many ways, including relaxation training, mindfulness, and stress and pain management, cognitive behavioral therapy, or other techniques. Therapeutic yoga, art, the use of music, service to others, and a host of other creative ways to retrain the brain to reduce physiologic stress and neuroinflammation can be discussed and explored with a trained pain psychologist.
Neuroinflammation, Pain and Quality of Life
The providers at The Denver Spine and Pain Institute know we must attend to neuroinflammation in order to be successful in treating pain, in promoting better function and a better sense of well-being, which in turn enhances quality of life. This can be done through attention to diet, sleep, exercise, and mental health and is a motivating feature of our Connected Care Approach™. As part of this approach, you can expect to receive:
A full spectrum of treatment options, including behavioral health services, diet and lifestyle education, physician interventions, physical therapy, massage, and research.
Care plans designed specifically for you, to address your specific inflammation control goals.
Therapeutic and caring relationships with a trusted team to ensure you receive the best possible treatment.
A detailed review of options and shared decision-making to help you make an informed choice.
Schedule an Appointment
Please contact us today to schedule an appointment. The Denver Spine and Pain Institute serves patients in Denver and the surrounding areas of Colorado.