Dietary Ingredients Requiring Further Research Before Evidence-Based Recommendations Can Be Made for Their Use as an Approach to Mitigating Pain

Abstract

Objective Approximately 55–76% of Service members use dietary supplements for various reasons; although such use has become popular, decisions are often driven by information that is not evidence-based. This work evaluates whether current research on dietary ingredients for chronic musculoskeletal pain provides sufficient evidence 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. Grading of Recommendations, Assessment, Development and Evaluation was used to determine confidence in the effect estimates. The committee used a decision table to make evidence-informed judgments across decision-making factors and recommendations for practice and self-care use. Results Nineteen dietary ingredients were assessed. No recommendations were given for boswellia, ginger, rose hip, or s-adenosyl-L-methionine (SAMe); specifically, although ginger can be obtained via food, no recommendation is provided for use as a supplement due to unclear research. Further, there were insufficient strong research on boswellia and SAMe and possible compliance issues (i.e., high number of capsules required daily) associated with rose hip. Conclusions No recommendations were made when the evidence was low quality or trade-offs were so closely balanced that any recommendation would be too speculative. Research recommendations are provided to enhance the quality and body of evidence for the most promising ingredients. Clinicians and those with chronic pain can rely on evidence-based recommendations to inform their decisions.

Eruca sativa Meal against Diabetic Neuropathic Pain: An H2S-Mediated Effect of Glucoerucin

“…Evidence collected in the last few years supports a diet-based approach in the management of different types of diseases, including chronic pain syndromes [50,51,52]. Among the most largely studied nutraceutical products there are the GSLs, secondary metabolites that can be found in different concentrations among cruciferous vegetables [6,18].…”

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

“…Clearly, this may not necessarily be the case. Considerations for dosing are discussed in subsequent articles within this series [18, 19].…”

Conditional Recommendations for Specific Dietary Ingredients as an Approach to Chronic Musculoskeletal Pain: Evidence-Based Decision Aid for Health Care Providers, Participants, and Policy Makers

“…Whereas no recommendation was provided (37.5% weak, in favor; 37.5% none; 25% weak, against) for the use of ginger as a dietary supplement, members agreed that minimal adverse events have been noted and that the certainty and quality of the evidence for a small yet statistically significant reduction in pain (SMD = –0.30) and disability (SMD = –0.22) were moderate (Supplementary Data: Summary Report) [12,62]. The desirable anticipated effect was not as substantial as the other ingredients reported here; however, members agreed that it is already available in tea and food and, if readily available, could be suggested for use.…”