Food pyramid for subjects with chronic pain: foods and dietary constituents as anti-inflammatory and antioxidant agents

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Introduction

A food-specific diet, possibly associated with dietary supplements, can provide helpful support for patients suffering from chronic pain⁽¹⁾. A high number of chronic pain subjects have elevated levels of pro-inflammatory cytokines in blood and tissues⁽²⁾.

Regardless of underlying causes of pain, inflammation is the primary means of alert that calls into action the cells responsible for surveillance and protection, set in motion to limit tissue damage⁽³⁾. It is a normal biological process in response to tissue injury, to a microbial infection, and to a chemical irritation⁽⁴⁾.

Inflammation is caused by the migration of immune cells from the blood vessels and the release of mediators in the damage site⁽⁵⁾. This process is followed by the recruitment of inflammatory cells, release of reactive oxygen species and pro-inflammatory cytokines, in order to eliminate pathogens and repair damaged tissue⁽⁶⁾. In general, normal inflammation is rapid and self-limiting, but prolonged inflammation can cause various chronic painful disorders⁽⁷⁾.

If the acute inflammatory phase does not eliminate the pathogen resolving inflammation, the inflammatory process continues and develops into a chronic condition, associated with chronic pain⁽⁸⁾.

Inflammation represents a cause of nociceptive pain⁽²⁾and osteoarthrosis (OA) is one of the most common syndromes⁽⁹⁾causing limited joint motion, pain and disability. In Europe osteoarthritis affects over 40 million adults, according to the European League Against Rheumatism (EULAR)⁽¹⁰⁾. OA patients often cannot reach an adequate pain relief with drugs (non-steroidal anti-inflammatory drugs (NSAID) and weak opioids) and/or develop severe side effects. Risk of developing OA is largely related to lifestyle factors like diet and physical activity. Weight control and maintaining a BMI within the normal range (between 18·5 and 25 kg/m²) supports the analgesic and anti-inflammatory therapies⁽¹¹⁾. Moreover, adipose tissue releases inflammatory molecules, such as leptin and cytokines, whose release can be reduced or even suppressed by the decrease of fat mass⁽¹²⁾.

Finally, a recent study by Emery et al.⁽¹³