To Your Health

What are the safest non-prescription pain remedies and how do they work compared to the regular pain relievers?

Q. I have gone through the non-prescription pain remedies, but I still have a lot of hip and knee pain. I think I'm ready to try some nutritional remedies. What are the safest remedies and how do they work compared to the regular pain relievers?

A. It should not be necessary to suffer pain once the cause is determined. Pain usually signals tissue damage, and often pain is relieved once the damage is repaired. Tissue damage generates the inflammatory response as part of the tissue repair system, but the symptom relief obtained by cooling off inflammation is only part of the solution.

The most common non-prescription pain relievers today are the NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, acetaminophen, and ibuprofen. These kinds of pain relievers are designed to block the body's production of prostaglandins. Prostaglandins are hormones made from the essential fatty acids. Prostaglandins come in two different families: pro-inflammatory prostaglandins and anti-inflammatory prostaglandins. Our diet is overloaded with the fatty acids that make pro-inflammatory prostaglandins, so stopping the production of prostaglandin synthesis mostly stops inflammation by reducing the pro-inflammatory prostaglandins.

The problem is that both families of prostaglandins play a significant role in normal body processes. When NSAIDs are used to control pain, they have a negative effect on these favorable aspects of the prostaglandins. While they may reduce the pain and inflammation, they can cause some very troublesome side effects including ulcers, irregular heartbeat, and high blood pressure. Perhaps more significantly, there is mounting evidence that using NSAIDs may damage cartilage, so that while you are trying to get some pain relief you are also hastening the progression of the very problem you are trying to control.

Another concern is that NSAIDs reduce the ability of the gut to prevent the absorption of partially digested food fragments into the bloodstream. Such food fragments attract antibodies and form "immune complexes" that may accumulate in joints and increase the inflammation in that joint. Again, the use of NSAIDs may actually increase joint inflammation even though its purpose is to reduce it.

There are some nutritional remedies that appear to be entirely safe:

• Glucosamine and chondroitin supplements can help maintain existing cartilage and even stimulate new cartilage to grow

• Vitamin C may help in much the same way, strengthening cartilage so it can better withstand normal wear and tear

• Omega-3 fatty acids from cold-water fish reduce inflammation by increasing the production of anti-inflammatory prostaglandins in relation to pro-inflammatory prostaglandins

• The trace mineral boron, according to USDA research, through its effects on hormone synthesis, improves the body's control over calcium and magnesium

• S-Adenosyl-methionine may relieve pain just as well as NSAIDs, and with fewer side effects, by promoting production of phosphatidyl choline, which in turn enhances membrane flexibility

• Proteolytic enzymes such as bromelain, by destroying inflammatory substances, are another alternative to the use of NSAIDs.

For pain relief, rather than merely interfering with the production of prostaglandins, it makes sense to both repair the damage and to make more of the anti-inflammatory prostaglandins.

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