By Kathi Head, ND

According to a report from the National Academy of Medicine (formerly the Institute of Medicine), over 100 million Americans suffer from chronic pain.1 Research conducted over the past decade indicates that patients who undergo low-risk surgical procedures such as carpal tunnel release, gallbladder removal, inguinal hernia repair, knee arthroscopy, and dental extractions are increasingly being given more opioid medications for post-operative pain.2,3 Given the expected intensity and duration of pain in these scenarios, a disproportionately large amount of opioid medications were being prescribed.

What is the Solution?

The solution is two-fold:  First, a patient-centered approach that better appreciates the larger burden of pain; and second, expanded tools to support patient healing while minimizing risk. Non-pharmacological approaches, including mind-body therapies, manual and physical therapies, and nutritional and botanical interventions have all demonstrated improved outcomes, such as reductions in pain, medication requirements and recovery time.

Nutritional supplementation approaches to healing after surgery or injury focus on keeping patients comfortable and being able to sleep well, while still helping accelerate the healing process and decreasing the need for potentially addictive opioid medications. Several nutritional supplement products have been studied in this arena, including curcumin, bromelain and melatonin.

Studies have shown that bromelain supplementation both pre- and post-surgery can reduce post-operative swelling and edema, use of pain medications, and healing time. Two oral surgery studies illustrate this. First, in a study of 80 patients who received surgery for impacted third molars, all patients were prescribed an antibiotic and an analgesic on the day of the surgery. On the following day, half the group received bromelain plus the analgesic, while the other half received only the analgesic. Patients were evaluated at three hours, 48 hours and seven days post-surgery. The group who were supplemented with bromelain experienced significantly less pain, edema,  erythema, and also used less pain medication.4 Second, a randomized, double-blind, placebo-controlled trial of 45 oral surgery patients compared bromelain supplementation (250 mg four times daily) with the analgesic diclofenac (25 mg four times daily) or placebo. Treatment was started one day prior to surgery and continued for four days. Patients in both the bromelain group and the diclofenac group experienced significantly less pain and greater quality of life than the placebo group.5

Curcumin also benefits individuals healing from surgery, trauma or overexertion., In a randomized, double-blind, placebo-controlled trial, patients who recently had a laparoscopic cholecystectomy were given an analgesic plus either curcumin (500 mg every six hours) or placebo upon discharge. The analgesic/curcumin group used 82-percent fewer analgesic tablets than patients in the placebo group (6.96 ± 1.8 versus 39.32 ± 16.5). Pain in weeks 1 and 2 and post-op fatigue scores were also significantly lower in the curcumin group.6 In an additional study, curcumin (complexed with phospholipids for enhanced absorption) at 1,000 mg twice daily or placebo was given to 20 healthy males 48 hours prior to a downhill running test and continued for 24 hours after the test (a total of four days). The curcumin-phospholipid group reported significantly less anterior thigh pain (p<0.05) and demonstrated less muscle damage on MRI (p=0.04) and via a known blood marker of muscle damage and inflammation (IL-8) (p<0.05).7

Because of melatonin’s analgesic, anxiolytic, anti-inflammatory, antioxidant, and chronobiotic effects, melatonin has been researched in numerous pre- and post-surgical settings. In a meta-analysis of 10 studies, nine of the studies showed statistically significant reductions in pre-surgery anxiety. In five studies reduced pain scores and/or decreased opioid use were observed. 8 In a 2008 study, 40 patients scheduled for elective hand surgery with intravenous regional anesthesia were randomized to receive either 10 mg melatonin or placebo pre-surgery. Significant decreases in anxiety, tourniquet tolerance, fentanyl requirement, first post-operative pain request, and post-surgical use of diclofenac were seen in the melatonin group compared to placebo.9

As with any pre- or post-surgical supplementation regimen, it is essential to maintain good communication between the prescribing health-care practitioner and the physician performing the surgical procedure.


 

References 

  1. IOM (Institute of Medicine). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011.
  2. Wunsch H, Wijeysundera DN, Passarella MA, Neuman MD. Opioids prescribed after low-risk surgical procedures in the United States, 2004-2012. JAMA 2016;315(15):1654-1657.
  3. Baker JA, Avorn J, Levin R, Bateman BT. Opioid prescribing after surgical extraction of teeth in Medicaid patients, 2000-2010. JAMA 2016;315(15):1653-1654.
  4. Ordesi P, Pisoni L, Nannei P, et al. Therapeutic efficacy of bromelain in impacted third molar surgery: a randomized controlled clinical study. Quintessence Int 2014;45(8):679-684.
  5. Majid OW, Al-Mashhadani BA. Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg 2014;72(6):1043-1048.
  6. Agarwal KA, Tripathi CD, Agarwal BB, Saluja S. Efficacy of turmeric (curcumin) in pain and postoperative fatigue after laparoscopic cholecystectomy: a double-blind, randomized placebo-controlled study. Surg Endosc 2011;25(12):3805-3810.
  7. Drobnic F, Riera J, Appendino G, et al. Reduction of delayed onset muscle soreness by a novel curcumin delivery system (Meriva®): a randomised, placebo-controlled trial. J Int Soc Sports Nutr 2014;11:31.
  8. Yousaf F, Seet E, Venkatraghavan L, et al. Efficacy and safety of melatonin as an anxiolytic and analgesic in the perioperative period: a qualitative systematic review of randomized trials. Anesthesiology 2010;113(4):968-976.
  9. Mowafi HA, Ismail SA. Melatonin improves tourniquet tolerance and enhances postoperative analgesia in patients receiving intravenous regional anesthesia. Anesth Analg 2008;107(4):1422-1426.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease