Optimizing Chronic Pain Treatment with Enhanced Neuroplastic Responsiveness: A Pilot Randomized Controlled Trial

Abstract

Chronic pain affects mental and physical health and alters brain structure and function. Interventions that reduce chronic pain are also associated with changes in the brain. A number of non-invasive strategies can promote improved learning and memory and increase neuroplasticity in older adults. Intermittent fasting and glucose administration represent two such strategies with the potential to optimize the neurobiological environment to increase responsiveness to recognized pain treatments. The purpose of the pilot study was to test the feasibility and acceptability of intermittent fasting and glucose administration paired with a recognized pain treatment activity, relaxation and guided imagery. A total of 32 adults (44%W, 56%M), 50 to 85 years of age, with chronic knee pain for three months or greater participated in the study. Four sessions were completed over an approximate two-week period. Findings indicate the ability to recruit, randomize, and retain participants in the protocol. The procedures and measures were reasonable and completed without incident. Participant adherence was high and exit interview feedback positive. In summary, the pilot study was feasible and acceptable, providing the evidence necessary to move forward with a larger clinical trial.

Trehalose Reduces Nerve Injury Induced Nociception in Mice but Negatively Affects Alertness

“…Intermittent fasting is a popular approach to stimulate autophagy in the brain and thereby reduce the accumulation of pathological proteins [ 57 , 58 , 59 ]. Intermittent fasting has also been suggested to support the current pain treatments [ 60 ]. A continuous trehalose administration over an extended period may mimic long-term nutrient deficiency for neurons, and one may speculate that neurons will try to save energy and reduce their activity.…”

Intermittent Fasting: Potential Utility in the Treatment of Chronic Pain across the Clinical Spectrum

“…Specific to chronic pain, an IF pilot study was completed on middle and older adults with chronic knee pain. Based on three 16 h fasts over a ten-day period, study findings indicated that the regimen was feasible, acceptable, and without adverse events [174]. Given the consistent body of evidence regarding neuroplastic benefits, IF may also be effective as an adjuvant treatment [49,175].…”

“…Although the sample sizes were small and improvements in fecal flora were not indicated, patterns of clinical improvements were observed in both groups with significance for the individuals with rheumatoid arthritis only [190]. Additionally, a pilot study demonstrated the feasibility and acceptability of three times a week 16 h fast in individuals with chronic musculoskeletal pain [174]. Further, limited fasting trials have been conducted in health conditions associated with chronic pain.…”

Allostatic Mechanism of Mind-Body Medicine for Neuroinflammation

“…Neuroinflammation may represent a form of neuroplasticity that can theoretically be reversed by neuroplastic interventions. For example, accruing evidence suggests significant cross-correlation between the neuroimmune system and neuroplastic mechanisms in responsiveness to chronic pain [30,31], neuronal adaptation in mood disorders [32], neuroimmune plasticity factors involved in central nervous system injury such as traumatic brain injury, spinal cord injury, and/or stroke [14,33], and immune macroenvironment plasticity in cancer models [34], to name a few. Neuroinflammation manifested by prolonged cytokine signalling amplified through the central nervous system cytokine network, causes detrimental effects to neurotransmitter activity, synaptic plasticity, neuroendocrine function, and resultant behaviors/symptoms [31].…”