Food, pain, and drugs: does it matter what pain patients eat?

Are orofacial pain and xerostomia associated with differences in diet, sensory perception, appetite and enjoyment of eating?-An explorative study

BACKGROUND

Orofacial function is believed to influence an individual's diet. knowledge on appetite and enjoyment of eating in orofacially impaired individuals is scarce.

OBJECTIVE

We aimed to explore potential associations between impaired orofacial function, that is, orofacial pain, jaw function limitation and xerostomia, respectively, and diet, appetite, taste perception, as well as the enjoyment of eating.

METHODS

An online questionnaire was shared among Aarhus University's dental patients and through social media. A convenience sample of 351 individuals responded (97 men, 254 women, aged 18-86 years). Participants were divided into groups with and without orofacial pain or xerostomia based on responses. Questions about food intake, appetite, meal-related well-being and oral/general health were included. Data were analysed using Mann Whitney U tests, Spearman's correlation, Chi-square tests, and t-tests.

RESULTS

Participants with (n = 123) and without (n = 228) orofacial pain differed significantly regarding age, perceived oral/general health, frequency of consumption of for example cooked vegetables and raw whole fruit, perception of sourness, chewiness, and nausea/pain when eating (p ≤ .031). Participants with (n = 101) and without (n = 250) xerostomia differed significantly regarding perceived oral/general health, intake of prepared fruit, alcohol, ice cream/mousse/pudding, general appetite, intake of breakfast and liquid snacks, nausea/pain when eating, taste and chewiness of food (p ≤ .038).

CONCLUSION

Diet, appetite, taste and sensory perception, as well as enjoyment of eating of individuals reporting orofacial pain and/or xerostomia differed slightly to that of individuals free of such symptoms. However, due to the explorative nature of this study, the results should be interpreted with caution pending further research on potential long-term effects on nutritional status and well-being.

The effects of the size and strength of food on jaw motion and temporomandibular joints

Mastication displays much importance in people's lives. The masticatory mandibular motion associated with dental kinematics also impacts temporomandibular joint (TMJ) kinematics and even TMJ health status. How food properties impact kinematical parameters of TMJs is a meaningful question for the conservative treatment of temporomandibular disorders (TMD) and evidence for the diet recommendation of TMD patients. The aim of this study was to find the primary mechanical properties influencing the masticatory motion. The potato boluses with different boiling times and sizes were chosen. The optical motion tracking system was adopted to record the masticatory trials of chewing boluses with various mechanical properties. The mechanical experiments revealed that increasing boiling time could reduce compressive strength. Moreover, multiple regression models were built to find the primary property of food influencing the TMJ kinematics, including condylar displacement, velocity, acceleration, and crushing time. The results showed that the bolus size had a significant primary influence on condylar displacements. The chewing times had a significantly minor influence on condylar displacements, while bolus strength had only a small impact on condylar displacements. Furthermore, condylar displacements on the non-working side were more affected by bolus size and chewing times than on the working sides. The crushing time of the bolus was significantly influenced by the compressive strength. Meals with small sizes and soft properties were therefore advised to lessen condylar displacements and relax the crushing process, and further reduce the loadings in the TMJ.

Continued persistent facial pain despite several surgical interventions in the temporomandibular joint

This article describes a woman in her forties who spontaneously developed facial pain 19 years after double-jaw orthognathic surgery. The focus of her pain was the left side of the face, including the temporomandibular joint (TMJ). Conservative treatment was initiated, including several occlusal splints, in addition to injections with local anesthesia, botulinum toxin, and corticosteroids, with limited effects. Surgical treatments with arthroscopy and discectomy, and ultimately a TMJ prosthesis, improved the patient's joint function but did not reduce pain. The question is whether the degenerated joint was due to progression of the original disease process or to multiple surgical procedures.

Pain hygiene: A content analysis of student nurses' perspectives

Pain hygiene (PH) is a new concept that has not been well-defined. A qualitative content analysis was conducted to understand this newly developed concept. Based on the responses from 78 students, the perceptions of the meaning of the term "pain hygiene" and differences between the term "pain hygiene" and "sleep hygiene" through their participation in open-ended surveys was described. Using content analysis, four themes emerged to present students' meaning of the term "pain hygiene": prevention of worsening of pain; cleanliness or hygiene practices to manage pain; self-care to manage pain; and physical and psychological management of pain. Two themes emerged illustrating differences between PH and sleep hygiene: practices that contribute to a better quality of life and condition, and better sleep with no pain. As a newly developing concept, PH can be used to make changes in pain assessment, prevention, and pain management strategies for all people with pain, which can enrich their quality of life and bring change in pain care outcomes.

Antioxidative and Analgesic Effects of Naringin through Selective Inhibition of Transient Receptor Potential Vanilloid Member 1

Transient receptor potential vanilloid member 1 (TRPV1) is activated in response to capsaicin, protons, temperature, and free reactive oxygen species (ROS) released from inflammatory molecules after exposure to harmful stimuli. The expression level of TRPV1 is elevated in the dorsal root ganglion, and its activation through capsaicin and ROS mediates neuropathic pain in mice. Its expression is high in peripheral and central nervous systems. Although pain is a response evolved for survival, many studies have been conducted to develop analgesics, but no clear results have been reported. Here, we found that naringin selectively inhibited capsaicin-stimulated inward currents in Xenopus oocytes using a two-electrode voltage clamp. The results of this study showed that naringin has an IC50 value of 33.3 μM on TRPV1. The amino acid residues D471 and N628 of TRPV1 were involved in its binding to naringin. Our study bridged the gap between the pain suppression effect of TRPV1 and the preventive effect of naringin on neuropathic pain and oxidation. Naringin had the same characteristics as a model selective antagonist, which is claimed to be ideal for the development of analgesics targeting TRPV1. Thus, this study suggests the applicability of naringin as a novel analgesic candidate through antioxidative and analgesic effects of naringin.

Temporomandibular disorders and dietary changes: A cross-sectional survey

BACKGROUND

Advice about a 'soft diet' may be useful in the short-term alleviation of temporomandibular disorders (TMD) but may contradict the long-term aims of multi-dimensional approaches if a poor nutritional state is caused or exacerbated. The changes patients with TMD make to their diet, because of their condition or its management, have not previously been explored.

OBJECTIVES

To explore the relationship and trends between TMD, TMD interventions and diet using self-report measures.

METHODS

Registrants of the Temporomandibular Joint Association (TMJA) were invited to participate. After completing a screening questionnaire to check for eligibility, participants completed a questionnaire exploring demographics, TMD interventions and dietary habits, as well as jaw functional limitation scale (JFLS) score, graded chronic pain scale score, self-assessed limitation of opening and patient health questionnaire 4 (PHQ-4). This was followed by a validated 3-day electronic diet diary. Descriptive and inferential statistics were used to explore the data for trends and differences in the dietary intake of those participating according to various strata including demographic variables; experience of surgery; other interventions for TMD; duration of TMD; and limitation of mouth opening.

RESULTS

Eighty-five registrants of the TMJA completed the questionnaire, of which 42 (49%) completed the 3-day diet diary. Most participants (66/85 [77.6%]) reported modifying their diet due to their TMD. The most common modification was to cut food into smaller pieces (61/85 [71.8%]) followed by boiling until soft (36/85 [42.4%]) and mashing (34/85 [40%]). Higher JFLS scores were associated with participants reduced enjoyment of food (t(83) = 2.78, p = .007), limitations in the foods they can eat (t(83) = 2.99, p = .004), necessity for modified food preparation (t(83) = 3.38, p = .001) and self-reported weight change (F(2, 82) = 9.31, p = .0002).

CONCLUSION

This study suggests a significant proportion of patients with TMD make alterations to their diet which may impact the nutritional value of their diet. However, self-reported symptoms and interventions for TMD made little difference to nutritional intake as measured by a 3-day diary. Patients reporting self-assessed limited opening had more pain as measured by validated tools, suggesting patients' self-reporting of opening is a useful proxy for clinical measurement in monitoring TMD.

Polyamines: Functions, Metabolism, and Role in Human Disease Management

Putrescine, spermine, and spermidine are the important polyamines (PAs), found in all living organisms. PAs are formed by the decarboxylation of amino acids, and they facilitate cell growth and development via different cellular responses. PAs are the integrated part of the cellular and genetic metabolism and help in transcription, translation, signaling, and post-translational modifications. At the cellular level, PA concentration may influence the condition of various diseases in the body. For instance, a high PA level is detrimental to patients suffering from aging, cognitive impairment, and cancer. The levels of PAs decline with age in humans, which is associated with different health disorders. On the other hand, PAs reduce the risk of many cardiovascular diseases and increase longevity, when taken in an optimum quantity. Therefore, a controlled diet is an easy way to maintain the level of PAs in the body. Based on the nutritional intake of PAs, healthy cell functioning can be maintained. Moreover, several diseases can also be controlled to a higher extend via maintaining the metabolism of PAs. The present review discusses the types, important functions, and metabolism of PAs in humans. It also highlights the nutritional role of PAs in the prevention of various diseases.

Diet can exert both analgesic and pronociceptive effects in acute and chronic pain models: a systematic review of preclinical studies

BACKGROUND

Although diet is an essential aspect of human health, the link between diet and pain is still not well understood. Preclinical animal research provides information to understand underlying mechanisms that allow identifying the needs for human research.

OBJECTIVES

This study aims to give a systematic overview of the current evidence from preclinical studies regarding the analgesic and pronociceptive effects of various diets in non-neuropathic, non-cancer, or non-visceral acute and chronic pain models.

STUDY DESIGN

A systematic Review.

SETTING

This study examined studies that investigate the analgesic and pronociceptive effects of various diets in non-neuropathic, non-cancer, or non-visceral acute and chronic pain models.

METHODS

This review was conducted following the PRISMA guidelines and was registered in PROSPERO with the registration number CRD42019133473. The certainty of evidence was examined by a modified GRADE approach.

RESULTS

After the screening process twenty-four eligible papers were included in this review. Nineteen studies examined acute pain, nine studies chronic inflammatory pain, and four studies assessed both acute and chronic pain models.

LIMITATIONS

Due to the heterogeneity of the included studies, a meta-analysis was not included in this study.

CONCLUSIONS

In animal models, excessive saturated, monounsaturated or omega-6 polyunsaturated fat ingestion and diets rich in fats and carbohydrates can decrease pain sensitivity in acute nociceptive pain, whereas it can induce mechanical allodynia and heat hyperalgesia in chronic inflammatory pain. Additionally, diets rich in anti-inflammatory ingredients, as well as a calorie-restricted diet can promote recovery from primary mechanical allodynia and heat hyperalgesia in chronic inflammatory pain.

Dietary Patterns and Interventions to Alleviate Chronic Pain

Pain is one of the main problems for modern society and medicine, being the most common symptom described by almost all patients. When pain becomes chronic, the life of the patients is dramatically affected, being associated with significant emotional distress and/or functional disability. A complex biopsychosocial evaluation is necessary to better understand chronic pain, where good results can be obtained through interconnected biological, psychological, and social factors. The aim of this study was to find the most relevant articles existent in the PubMed database, one of the most comprehensive databases for medical literature, comprising dietary patterns to alleviate chronic pain. Through a combined search using the keywords “chronic pain” and “diet” limited to the last 10 years we obtained 272 results containing the types of diets used for chronic pain published in the PubMed database. Besides classical and alternative methods of treatment described in literature, it was observed that different diets are also a valid solution, due to many components with antioxidant and anti-inflammatory qualities capable to influence chronic pain and to improve the quality of life. Thirty-eight clinical studies and randomized controlled trials are analyzed, in an attempt to characterize present-day dietary patterns and interventions to alleviate chronic pain.

Nutritional intervention in chronic pain: an innovative way of targeting central nervous system sensitization?

INTRODUCTION

Few treatment programs for chronic pain nowadays take a dietary pattern or adipose status into account.

AREAS COVERED

An important role of neuroinflammation in chronic pain is now well established, at least in part due to increased central nervous system glial activation. Based on preclinical studies, it is postulated that the interaction between nutrition and central sensitization is mediated via bidirectional gut-brain interactions. This model of diet-induced neuroinflammation and consequent central sensitization generates a rationale for developing innovative treatments for patients with chronic pain. Methods: An umbrella approach to cover the authors' expert opinion within an evidence-based viewpoint.

EXPERT OPINION

A low-saturated fat and low-added sugar dietary pattern potentially decreases oxidative stress, preventing Toll-like receptor activation and subsequent glial activation. A low-saturated fat and low-added sugar diet might also prevent afferent vagal nerve fibers sensing the pro-inflammatory mediators that come along with a high-(saturated) fat or energy-dense dietary pattern, thereby preventing them to signal peripheral inflammatory status to the brain. In addition, the gut microbiota produces polyamines, which hold the capacity to excite N-methyl-D-aspartate receptors, an essential component of the central nervous system sensitization. Hence, a diet reducing polyamine production by the gut microbiota requires exploration as a therapeutic target for cancer-related and non-cancer chronic pain.

Participants with chronic pain do not perceive diet as a contributing factor to their pain: a survey-based study

Aim: To explore the reported diet of Australians with chronic pain and their perceived role of food within their pain experience. Methods: A cross-sectional study of 50 participants reporting chronic pain was undertaken using pain and nutritional questionnaires as well as anthropometric measures. Results: Participants rated their diet between 'good' and 'excellent' (76%) and one that promoted well-being (62%), however 74% were overweight or obese (average BMI 30) with multiple co-morbidities. There was no correlation between measures of dietary adherence and knowledge with reported pain. Conclusion: Participants generally reported their diets to be good, however, this was not reflected in their habitual diet. There was a low perceived role of food altering pain perception.

Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review

Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients’ diet, and chronic musculoskeletal pain remains unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients’ diet and chronic musculoskeletal pain. This review was conducted following the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) guidelines and was registered in PROSPERO with the registration number CRD42018110782. PubMed, Web of Science, and Embase online databases were searched. After screening titles and abstracts of 20,316 articles and full texts of 347 articles, 12 eligible articles were included in this review, consisting of nine experimental and three observational studies. Seven out of nine experimental studies reported a pain-relieving effect of dietary changes. Additionally, protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold. In conclusion, plant-based diets might have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

Chronic pain has a tremendous personal and socioeconomic impact and remains difficult to treat. Therefore, it is important to provide an update on the current understanding regarding lifestyle factors in people with chronic pain across the lifespan. Lifestyle factors such as physical (in)activity, sedentary behavior, stress, poor sleep, unhealthy diet, and smoking are associated with chronic pain severity and sustainment. This applies to all age categories, that is, chronic pain across the lifespan. Yet current treatment options often do not or only partly address the many lifestyle factors associated with chronic pain or attempt to address them in a standard format rather than providing an individually tailored multimodal lifestyle intervention. The evidence regarding lifestyle factors is available in adults, but limited in children and older adults having chronic pain, providing important avenues for future research. In conclusion, it is proposed that treatment approaches for people with chronic pain should address all relevant lifestyle factors concomitantly in an individually-tailored multimodal intervention. Ultimately, this should lead to improved outcomes and decrease the psychological and socioeconomic burden of chronic pain. Level of Evidence: IV.

Broccoli sprouts in analgesia – preclinical in vivo studies

Broccoli sprouts produce significant and dose-dependent antinociceptive activity involving an opioid mechanism without sedative or gastric damage.

Food intake assessment and quality of life in women with fibromyalgia

OBJECTIVE

To compare the food intake of women with and without fibromyalgia and verify if the food intake of patients with fibromyalgia interferes with the pain and quality of life.

METHODS

Study participants were women with fibromyalgia (FM) seen in Fibromyalgia Outpatient Clinic, Hospital das Clínicas/UFPR and a control group (CT) with healthy women. Data collection was conducted from March to October 2012. For the assessment of food intake we used the Food Registration and the analyzed items were total calories, carbohydrates, proteins, lipids, vitamins (A, C, B12, D and E) and minerals (folate, selenium, zinc, iron, calcium and magnesium). The software used was Avanutri Online(®). To evaluate the quality of life, the Fibromyalgia Impact Questionnaire (FIQ) and pain threshold were used.

RESULTS

43 patients with FM and 44 healthy women were evaluated. CT group showed a mean consumption of nutrients greater than FM group except for iron. However, only caloric intake, carbohydrates, proteins and lipids in grams and percentage of lipids, vitamin A, E, B12, folate, selenium and calcium were statistically significant. In FM group, there was a negative correlation between vitamin E and FIQ and a positive correlation between percentage of protein and pain threshold.

CONCLUSION

Women with FM showed a lower qualitative and quantitative intake in comparison with CT group. Only vitamin E correlated with quality of life and percentage of protein in the diet with sensation of pain.

Prevention of oxaliplatin-induced peripheral neuropathy by a polyamine-reduced diet-NEUROXAPOL: protocol of a prospective, randomised, controlled, single-blind and monocentric trial

INTRODUCTION

Oxaliplatin remains the most widely used chemotherapeutic agent for treating advanced colorectal cancer but its efficacy is hampered by dose-limiting neurotoxicity manifested by a painful polyneuropathy. Oxaliplatin-induced peripheral neuropathy (OIPN) is characterised by acute and transient cold hyperaesthesia in the hours and days following oxaliplatin infusion (>90% of patients), but also by retarded chronic neuropathy due to the repetition of chemotherapy cycles (30-50% of patients). OIPN impairs the health-related quality of life (HRQOL) of patients and no preventive or curative strategies have as yet proven effective. A polyamine-reduced diet (PRD) has recently demonstrated its efficacy to prevent OIPN in animals without adverse effects.

METHODS AND ANALYSIS

The NEUROXAPOL trial is a prospective, randomised, controlled, single-blind, monocentric and interventional study. This trial is aimed at evaluating the efficacy and feasibility of a PRD compared to a normal polyamine containing diet to prevent OIPN in patients treated by oxaliplatin-based chemotherapy. Patients (n=40 per group) will be randomly assigned to receive either a PRD or a normal diet before and during the chemotherapy regimen. The main objectives are to improve the cold pain thresholds, neuropathic pain symptoms, comorbidities (anxiety and depression) and HRQOL of patients. The primary end point is the assessment of cold pain thresholds 2 weeks after the third cycle of chemotherapy. The secondary end points are the evaluation of thermal pain thresholds, the grade of neuropathy, neuropathic pain, symptoms of anxiety and depression and HRQOL, until the 12th cycle of chemotherapy.

ETHICS AND DISSEMINATION

The study was approved by an independent medical ethics committee 1 (CPP Sud Est 1, Saint Etienne, France) and registered by the competent French authority (ANSM, Saint Denis, France). The results will be disseminated in a peer-reviewed journal and presented at international congresses.

TRIAL REGISTRATION NUMBER

NCT01775449.

Changes in the content of free and conjugated polyamines during Lettuce (Lactuca sativa) growth

Polyamines (PAs) in plant foods are relevant due to the association of these bioactive nutrients with health and disease. The scope of the present study was to monitor the content of free, conjugated, and total (free + conjugated) putrescine (Put), spermidine (Spd), and spermine (Spm) at five stages of lettuce growth in three different greenhouses. The daily intake of PAs from lettuce consumption was estimated since its consumption represents about 7.2% of vegetables intake. Results showed that the content of free Put, Spd, and Spm decreased during plant growth, while the content of conjugated Put, Spd, and Spm increased. Nevertheless, the total PA content remained fairly constant. Significant differences were observed in the PAs content in lettuces grown in different greenhouses. The conjugated fraction of PAs in mature lettuces has an important contribution to the total PAs and will certainly influence the bioavailability and/or bioactivity of dietary polyamines.

Sensitive quantitation of polyamines in plant foods by ultrasound-assisted benzoylation and dispersive liquid-liquid microextraction with the aid of experimental designs

A new method involving ultrasound-assisted benzoylation and dispersive liquid-liquid microextraction was optimized with the aid of chemometrics for the extraction, cleanup, and determination of polyamines in plant foods. Putrescine, cadaverine, spermidine, and spermine were derivatized with 3,5-dinitrobenzoyl chloride and extracted by dispersive liquid-liquid microextraction using acetonitrile and carbon tetrachloride as dispersive and extraction solvents, respectively. Two-level full factorial design and central composite design were applied to select the most appropriate derivatization and extraction conditions. The developed method was linear in the 0.5-10.0 mg/L range, with a R(2) ≥ 0.9989. Intra- and interday precisions ranged from 0.8 to 6.9% and from 3.0 to 10.3%, respectively, and the limit of detection ranged between 0.018 and 0.042 μg/g of fresh weight. This method was applied to the analyses of six different types of plant foods, presenting recoveries between 81.7 and 114.2%. The method is inexpensive, versatile, simple, and sensitive.

Pain in people with an intellectual disability

PURPOSE OF REVIEW

Pain is a near-universal experience and research suggests that chronic pain, defined as pain lasting longer than 3 months, affects around 20% of the general population. However, there is relatively little awareness of the problem of pain amongst people with an intellectual disability.

RECENT FINDINGS

Recent prevalence studies indicated that chronic pain affects around 15% of people with an intellectual disability. Although prevalence can be estimated based on third-party reports, there are methodological limitations that suggest this way of detecting pain may be unreliable. Other methods, such as structured behavioural observation, offer a reliable and valid alternative. Once pain has been recognized, however, there has been limited research to evaluate pain management interventions for people with an intellectual disability, especially in the area of self-management.

SUMMARY

There is good evidence to support behavioural observation methods for recognition of pain in people with limited ability to communicate about their pain. Psychological interventions for pain management are widely used in the general population and may also have a useful role in assisting people with an intellectual disability who are affected by persistent pain. However, there is an ongoing paucity of research in this area.