Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review.

Food consumption has significant positive effects on an individual's health status, including the reduction of symptoms associated with musculoskeletal pain. However, specific food groups indicated for the treatment of pain are not yet determined. Hence, this review aimed to analyze the effects of nutritional interventions with specific diets, oils and/or fatty acids, and foodstuffs in natura in the reduction of musculoskeletal pain. An integrative review was conducted in the following databases: Embase, PubMed, LILACS, and Google Scholar. Clinical trials written in English, Spanish, and Portuguese and published between 2000 and March 2020 were included in this review. Seventeen studies were included. Among these, a reduction of musculoskeletal pain with different types of nutritional interventions, such as vegan and Mediterranean diets and the consumption of blueberry, strawberry, passion fruit peel extract, argan oil, fish oil (omega-3), olive oil, and undenatured type II collagen and vitamin D gel capsules, was observed in 14 studies. Eight studies evaluated the profiles of several inflammatory markers, and of these, decreased interleukin (IL)-6, IL-1ß, and tumor necrosis factor-α levels were observed in two studies. This review suggests that different nutritional interventions with specific diets, oils and/or fatty acids, and foodstuffs in natura reduce musculoskeletal pain, specifically in adults with osteoarthritis. Besides pain improvement, nutritional interventions, including the consumption of strawberry and vitamin D gel capsules, decrease the levels of several inflammatory markers.

Dietary Ingredients as an Alternative Approach for Mitigating Chronic Musculoskeletal Pain: Evidence-Based Recommendations for Practice and Research in the Military.

OBJECTIVE: Approximately 55-76% of Service members use dietary supplements for various reasons, including pain and related outcomes. This work evaluates current research on dietary ingredients for chronic musculoskeletal pain to inform decisions for practice and self-care, specifically for Special Operations Forces personnel. METHODS: A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. GRADE was used to determine confidence in the effect estimates. The committee made evidence-informed judgments and recommendations for practice and self-care use. RESULTS: Nineteen eligible dietary ingredients were assessed for quality, efficacy, and safety. Avocado soybean unsaponifiables, capsaicin, curcuma, ginger (as a food source), glucosamine, melatonin, polyunsaturated fatty acids, and vitamin D were conditionally recommended as their benefits outweighed risks, but there was still some uncertainty about the trade-offs. No recommendations were made for boswellia, ginger (as a dietary supplement), rose hip, or s-adenosyl-L-methionine. Recommendations were made against the use of collagen, creatine, devil's claw, l-carnitine, methylsulfonylmethane, pycnogenol, willow bark extract, and vitamin E. Research priorities were developed to address gaps precluding stronger recommendations. CONCLUSIONS: Currently the scientific evidence is insufficiently robust to establish definitive clinical practice guidelines, but processes could be established to track the impact of these ingredients. Until then, providers have the evidence needed to make informed decisions about the safe use of these dietary ingredients, and future research can address existing gaps.

Chronic musculoskeletal pain and function improve with a plant-based diet.

BACKGROUND: Chronic musculoskeletal pain, often debilitating, affects all genders, ethnicities, and age groups. Research suggests consumption of a plant-based diet may improve the status of persons with chronic pain. A diet rich in fruits, vegetables and whole grains has been shown to reduce chronic pain and disability associated with musculoskeletal conditions. OBJECTIVE: The purpose of this study was to examine the value of a plant-based diet in the management of chronic musculoskeletal pain and functional limitations. METHOD: Fourteen subjects participated in the eight-week study. Baseline evaluation included anthropometric measurements and completion of two self-reported outcome measures: Numeric Pain Rating Scale (NPRS) and the Short Form Health Survey (SF-36). A registered dietitian nutritionist provided a sample menu cycle and education on a plant-based diet. Subjects utilized a phone app to log food intake and receive support from the dietitian. Post data collection included a repeat of the baseline measures and the Patient Global Impression of Change Scale. The sample was small. Twenty subjects began, 14 completed. No comparison group was used. Results should be considered with caution. RESULTS: The diet intervention resulted in decreased pain and improvement in quality of life. Diet adherence by ten of fourteen subjects was 89% based on completion of food intake records and adherence to allowed foods. CONCLUSION: Consumption of a plant-based diet produced positive improvements in chronic pain and function. Interprofessional collaboration between physical therapists and registered dietitian nutritionists, along with other healthcare practitioners, can encourage and promote diet interventions that positively affect chronic pain.

Vitamin D as potential antidepressant in outpatients with musculoskeletal pain
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OBJECTIVE: To determine the incidence of vitamin D deficiency, anxiety, and depression disorders in an outpatient population with musculoskeletal pain (MSP), and to evaluate the effects of correcting a vitamin D deficiency on MSP and psychological symptoms. MATERIALS AND METHODS: A total of 261 outpatients with MSP and 100 controls were involved. The Hospital Anxiety and Depression Scale (HADS) was used to assess psychological symptoms. Serum vitamin D was measured. Outpatients with vitamin D insufficiency and deficiency received oral vitamin D supplementation. Pain severity and psychological symptoms were evaluated before and after vitamin D supplementation plus dairy products. RESULTS: Vitamin D deficiency was found in 88.7% of participants in the MSP group and 69% of controls. Clinical anxiety was reported by 38.3% of participants in the MSP group and 9% of controls, while clinical depression was reported by 31.8% of participants in the MSP group and 2% of controls. Multisite pain was significantly and positively associated with anxiety, depression, and pain severity, and was inversely associated with daily calcium intake. Anxiety was inversely associated with vitamin D level, daily calcium intake, and age. A similar pattern was observed for depression. MSP was the most significant independent predictor of anxiety (OR = 7.84) and depression (OR = 5.89). Relative to baseline, all measured outcome parameters significantly improved after vitamin D supplementation plus increased intake of dairy products. CONCLUSION: Low serum vitamin D is associated with MSP along with low calcium intake, depression, and anxiety. Supplementation with vitamin D improved MSP and associated disorders.
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Dietary Supplements for Musculoskeletal Pain: Science Versus Claims.

Special Operations Forces (SOF) face unique challenges that manifest themselves both mentally and physically. The extremes of training and combat can affect the readiness to perform at peak levels, especially when confronted with musculoskeletal pain. Many SOF Operators turn to dietary supplements in hopes of gaining an edge. Although some supplements are now being marketed for pain, decisions to use these products need to be driven by information that is evidence based. We describe SOF-specific evidence-based recommendations for the use of dietary ingredients for pain that emerged from a rigorous scientific evaluation. These recommendations are compared with the label claims made in the commercial market by companies selling products to combat musculoskeletal pain. This information can be used by the SOF medical community to assist Operators in making informed decisions when considering or selecting dietary supplements for maintaining and optimizing performance.

Randomized placebo-controlled pilot trial of omega 3 fatty acids for prevention of aromatase inhibitor-induced musculoskeletal pain.

PURPOSE: Aromatase inhibitor (AI)-induced joint symptoms negatively impact drug adherence and quality of life in breast cancer survivors. Mechanisms underlying symptoms may include inflammation. It is hypothesized that n - 3 polyunsaturated fatty acids (PUFAs) have anti-inflammatory properties and may reduce symptoms. METHODS: We conducted a randomized, double-blind, placebo-controlled study comparing 4.3 g/day n - 3 PUFA supplements vs placebo for 24 weeks in postmenopausal breast cancer patients starting adjuvant AIs. Primary endpoints were adherence and tolerability; secondary outcomes included inflammatory cytokines and symptoms assessed by the Brief Pain Inventory short form (BPI-SF) and Functional Assessment of Cancer Treatment-Endocrine Symptoms (FACT-ES) at 0, 12, and 24 weeks. RESULTS: Forty-four women were randomized, of which 35 completed the study. Adherence was ≥ 88% based on these 35 patients with pill counts as well as change in red blood cell (RBC) n - 3 PUFAs. Common toxicities included grade 1 flatulence (55% of both groups) and belching (45% of n - 3 group). Mean pain severity scores (BPI-SF) did not change significantly by time or treatment arm. Quality of life, based on FACT-ES scores, significantly decreased within placebo (p = 0.04), but not the n - 3 group (p = 0.58), with a trend toward between-group differences (p = 0.06) at 12 weeks, but no significant differences at 24 weeks. RBC n - 3 levels were strongly positively correlated with FACT-ES at 12 weeks, but attenuated at 24 weeks. CONCLUSION: High-dose n - 3 PUFA supplementation is feasible and well tolerated when administered with AIs. Additional studies are needed to evaluate efficacy in prevention of joint symptoms.

Effect of combined carbohydrate-protein ingestion on markers of recovery after simulated rugby union match-play.

In this study, we investigated the effect of ingesting carbohydrate alone or carbohydrate with protein on functional and metabolic markers of recovery from a rugby union-specific shuttle running protocol. On three occasions, at least one week apart in a counterbalanced order, nine experienced male rugby union forwards ingested placebo, carbohydrate (1.2 g · kg body mass(-1) · h(-1)) or carbohydrate with protein (0.4 g · kg body mass(-1) · h(-1)) before, during, and after a rugby union-specific protocol. Markers of muscle damage (creatine kinase: before, 258 ± 171 U · L(-1) vs. 24 h after, 574 ± 285 U · L(-1); myoglobin: pre, 50 ± 18 vs. immediately after, 210 ± 84 nmol · L(-1); P < 0.05) and muscle soreness (1, 2, and 3 [maximum soreness = 8] for before, immediately after, and 24 h after exercise, respectively) increased. Leg strength and repeated 6-s cycle sprint mean power were slightly reduced after exercise (93% and 95% of pre-exercise values, respectively; P < 0.05), but were almost fully recovered after 24 h (97% and 99% of pre-exercise values, respectively). There were no differences between trials for any measure. These results indicate that in experienced rugby players, the small degree of muscle damage and reduction in function induced by the exercise protocol were not attenuated by the ingestion of carbohydrate and protein.