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Many serious conditions and diseases, including hyperlipidemia, obesity, congestive heart failure, and renal failure, have their own recommended diet.
The fundamental principle of the diet is that patients with chronic pain need a high-protein–intake diet with avoidance of carbohydrate (sugars and starches)-induced episodes of hypoglycemia and weight gain. Chronic, severe pain causes excess adrenal secretion of cortisol and catecholamine, which makes glucose serum levels unstable.7 Levels may vary from hyper- to hypoglycemia.
Opioid treatment also has a profound effect on the endocrine–nutrition system, compounding the necessity of a pain diet.1-4 Patients on opioids commonly gain weight and prefer sweet foods (see Table 2). Clinical observations of patients with chronic pain who require opioid treatment support the scientific research and the adverse effects of pain and opioids on the endocrine–nutrition systems.1-9 In order to evaluate a patient’s nutritional status, I use a 72-hour “Food and Drink Recall Diary” form with new patients with chronic pain (see Table 3).
This recall form is highly recommended because it is not designed to calculate calories, but simply to determine if the patient with pain is eating any protein.
It is highly suggested that pain practitioners take a dietary history for protein intake and examine the patient for muscle loss and weakness. Some patients with pain give a history that about 2 hours after eating a carbohydrate load, such as a doughnut, bagel, or glass of fruit juice, their pain will flare. There are four sound, theoretical reasons why a chronic pain diet should be based on high-protein intake. The universal complaint of weakness by patients with severe pain may have many causes, but a lack of protein has to be one of them.


The major dietary recommendation for patients with chronic pain is to eat protein foods with each meal and to not eat or drink carbohydrates without eating protein at the same time. Considerable scientific information and clinical observation have accumulated in recent years that chronic pain, particularly the debilitating, severe form that requires opioid treatment, needs a “chronic pain” diet.1-6 To date, however, no chronic pain diet has been officially recommended. Pituitary–adrenal exhaustion may occur if severe pain goes uncontrolled for an extended period of time. Over the 3-day period just prior to admission, new patients almost always report a gross deficiency of protein intake.
Prior to good pain control, most patients report their appetites to be so poor that they seldom eat much of anything except sweets and some starches. Although I’ve never tested blood sugar levels during these reported flares, I highly suspect that hypoglycemia causes pain flares in some patients. There are eight essential amino acids that the body cannot make, and therefore must be supplied through one’s diet. The amino acid proline is the major building block of collegen, essential for the development of cartilage and intervertebral discs. Preference for sweet foods and higher body mass index in patients being treated in long-term methadone maintenance.
Course of weight change during naltrexone versus methadone maintenance for opioid-dependent patients. Vertical Health Media, LLC disclaims any liability for damages resulting from the use of any product advertised herein and suggests that readers fully investigate the products and claims prior to purchasing.


The dietary supplements also recommended are intended to assist regeneration of tissue and prevent osteopenia and osteoporosis. Physical examination of these patients often shows loss of muscle mass with weakness, so much so that listing “malnutrition” is warranted as a secondary diagnosis in the patient’s chart. Although no one knows how much protein a patient with pain must take in to provide enough amino acid substrate for the production of these pain-controlling compounds, my dietary histories intuitively tell me it’s often not enough. Eating protein with every meal and every time sugar and starches are eaten will prevent a rapid rise in insulin, storage of any excess glucose as fat, and hypoglycemia that results in carbohydrate cravings and possible pain flares.
I recommend only diet drinks in an effort to restrict carbohydrates and prevent hypoglycemia and weight gain. Green vegetables such as beans, broccoli, or brussels sprouts, which contain about 30% protein, also are conspicuously absent from their diet.
Juice, milk, regular sodas, and energy drinks are prohibited, as they are loaded with carbohydrates and may lead to hypoglycemia. Amino acids enter the blood from the intestine and travel to locations in the liver, glands, and brain, where they are building blocks for compounds critical to pain relief.



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