Veteran and Military Healthcare

Chronic Pain

Pain is the most frequent reason patients seek physician care in the United States, and more than 50 million Americans suffer from chronic pain. Back pain alone is the leading cause of disability in Americans under 45 years of age. Understanding the biochemical processes involved in pain perception and signaling is critical for the effective management of various pain syndromes. There are a number of pharmaceutical treatments available for pain management, many of which have black box warnings.

NSAIDs for example are a mainstay treatment of pain for a variety of inflammatory and non-inflammatory conditions. NSAIDS are a recommended treatment for a wide variety of disease states such as, rheumatoid arthritis, systemic lupus erythematosis, and osteoarthritis, as well as nonsystemic acute and chronic muscle, joint and ligament discomforts. With more than 100 million prescriptions annually, NSAIDs are the most commonly prescribed drug class1. NSAIDs are associated with significant drug induced morbidity and mortality. In the late 1990's it was estimated that 16,500 people died and over 100,000 were hospitalized from NSAID induced GI bleeds2. This complication accounted for a third of the total cost of arthritis care3-4. Patients over the age of 65, with concomitant medications and disease states are the most likely to suffer serious consequence side effects5.

Opiates are another class of pain medications that are frequently prescribed in the United States for the management of pain. The United States consumes 80% of the world’s opiates, and 99% of the world's hydrocodone, the opiate that is in Vicodin. According to IMS Health, the use of Vicodin has grown dramatically from 112 million doses prescribed in 2006, to 131 million in the U.S. as of 2011. Although opiates are considered an effective medication for pain management that does not carry the same risks of NSAIDs, they are highly addictive and attenuate over time creating the need for drug and dose switching.

Pain is a complex biochemical process with numerous factors involved. One of these key factors are the increased nutritional requirements associated with pain syndromes. Patients suffering from chronic pain have an increased need for nutrient precursors of specific neurotransmitters that modulate pain. The use of medical foods for the dietary management of pain is a commonly used therapeutic tool for pain management that is safe, non-addictive, effective and in accordance with the comprehensive pain management strategy implemented by the Army Surgeon General LTG Eric B Schoomaker in 2009, which focuses providers on the safe and efficacious management of pain that is holistic, multidisciplinary, and multimodal in its approach, utilizing state of the art/science modalities and technologies, and providing optimal quality of life for Soldiers and other patients with acute and chronic pain.

  1. http://www.medscape.com/viewarticle/538039
  2. Wolff M, Lichtenstein D, Singh G. Gastrointestinal toxicity of non-steroidal anti-inflammatory drugs. N Engl J Med. 1999; 340(24):1888-99.
  3. Johnson R, Hornbrook M, Hooker R, et al. Analysis of the costs of NSAID-associated gastropathy. Experience in a US health maintenance organization. Pharmacoeconomics. 1997; 12(1):76-88.
  4. Sheen C, MacDonald T. Gastrointestinal side effects of NSAIDs-pharmacoeconomic implications. Expert Opin Pharmacotherapy. 2002; 3(3):265-9
  5. Burmester G, Lanas A, Biasucci L, et al. The appropriate use of non-steroidal anti-inflammatory drugs in rheumatic disease: opinions of a multidisciplinary European expert panel. Ann Rheum Dis. 2011; 70(5):818-22.