Kronik Ağrı Yönetiminde Beslenme Tedavisinin Rolü

Abstract

Kronik ağrı, üç aydan uzun süren veya tekrarlayıcı nitelikte olan ağrı olarak tanımlanmakta ve dünya genelinde milyonlarca insanı etkileyen önemli bir halk sağlığı problemi olarak kabul edilmektedir. Günlük yaşam kalitesini önemli ölçüde düşüren, fiziksel, psikolojik ve sosyal sorunlara yol açabilen bu durum, bireylerin yaşamlarını uzun süreli olarak olumsuz etkileyebilmektedir. Kronik ağrının oluşum mekanizmaları henüz tam olarak aydınlatılamamış olsa da, son yıllarda yapılan bilimsel araştırmalar, bazı biyolojik süreçlerin bu durumun gelişiminde rol oynayabileceğini göstermektedir. Bu süreçler arasında oksidatif stres, inflamasyon, artmış vücut ağırlığı ve bağırsak mikrobiyotasında görülen dengesizlik (disbiyozis) öne çıkmaktadır. Dikkat çekici olan nokta ise bu faktörlerin çoğunun doğrudan ya da dolaylı olarak beslenme ile yakından ilişki içinde olmasıdır. Bu nedenle, beslenmenin kronik ağrının oluşumu ve şiddeti üzerindeki etkilerini araştırmak, ağrıyı azaltmaya yönelik beslenme temelli yaklaşımların geliştirilmesini mümkün kılabilir. Bu derlemede, kronik ağrı patogenezinde rol oynayan olası biyolojik mekanizmalar ele alınmakta ve beslenme tedavisinin bu süreçteki yeri ve potansiyel katkıları incelenmektedir. Böylece, kronik ağrının önlenmesi ve yönetiminde tamamlayıcı bir yaklaşım olarak beslenmenin önemi vurgulanmaktadır.

Keywords

• Kronik ağrı
• oksidatif stres
• inflamasyon
• disbiyozis
• beslenme

The Role of Nutrition Therapy in the Management of Chronic Pain

Abstract

Chronic pain is defined as pain lasting longer than three months or recurring in nature and is considered a major public health problem affecting millions of people worldwide. This condition, which significantly reduces quality of daily life and may lead to physical, psychological, and social problems, can negatively affect individuals' lives over the long term. Although the mechanisms underlying the development of chronic pain have not yet been fully understood, recent scientific studies suggest that certain biological processes may play a role in its development. Among these processes, oxidative stress, inflammation, increased body weight, and imbalance in gut microbiota (dysbiosis) are particularly prominent. Notably, most of these factors are closely associated with nutrition either directly or indirectly. Therefore, investigating the effects of nutrition on the development and severity of chronic pain may enable the development of nutrition-based approaches aimed at reducing pain. This review discusses the possible biological mechanisms involved in the pathogenesis of chronic pain and examines the role and potential contributions of nutrition therapy in this process. Thus, the importance of nutrition as a complementary approach in the prevention and management of chronic pain is emphasized.

Keywords

• Chronic pain
• oxidative stress
• inflammation
• dysbiosis
• nutrition

References

1. 1. Treede RD, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: The IASP classification of chronic pain for the international classification of diseases (ICD-11). Pain. 2019;160(1):19–27. doi: 10.1097/j.pain.0000000000001384.
2. 2. Bautista A, Lee J, Delfino S, LaPreze D, Abd-Elsayed A. The impact of nutrition on pain: A narrative review of recent literature. Curr Pain Headache Rep. 2024;28(10):1059–66. doi: 10.1007/s11916-024-01275-x.
3. 3. Zimmer Z, Fraser K, Grol-Prokopczyk H, Zajacova A. A global study of pain prevalence across 52 countries: Examining the role of country-level contextual factors. Pain. 2022;163(9):1740–50. doi: 10.1097/j.pain.0000000000002557.
4. 4. Cohen SP, Vase L, Hooten WM. Chronic pain: An update on burden, best practices, and new advances. Lancet. 2021;397(10289):2082–97. doi: 10.1016/S0140-6736(21)00393-7.
5. 5. Hadi MA, McHugh GA, Closs SJ. Impact of chronic pain on patients’ quality of life: A comparative mixed-methods study. J Patient Exp. 2019;6(2):133–41. doi: 10.1177/2374373518786013.
6. 6. Yong RJ, Mullins PM, Bhattacharyya N. Prevalence of chronic pain among adults in the United States. Pain. 2022;163(2):e328–32. doi: 10.1097/j.pain.0000000000002291.
7. 7. Field R, Pourkazemi F, Hashempur MH, Thiruvengadam M, Rooney K. Editorial: Diet, nutrition, and functional foods for chronic pain. Front Nutr. 2024;11: 1456706. doi: 10.3389/fnut.2024.1456706.
8. 8. Cuomo A, Parascandolo I. Role of nutrition in the management of patients with chronic musculoskeletal pain. J Pain Res.2024;17:2223-2238. doi: 10.2147/JPR.S456202.

9. 9. Brain K, Burrows TL, Rollo ME, et al. A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain. J Hum Nutr Diet. 2019;32(2):198–225. doi: 10.1111/jhn.12601.
10. 10. Xu Lou I, Gil-García E, Cáceres-Matos R, Ali K, Molina E. Nutritional aspects in chronic non-cancer pain: A systematic review. Front Nutr. 2022;9:931090. doi: 10.3389/fnut.2022.931090.
11. 11. Galvez-Sánchez CM, Montoro CI. Chronic pain: Clinical updates and perspectives. J Clin Med. 2022;11(12):3474. doi: 10.3390/jcm11123474.
12. 12. Elma Ö, Tümkaya Yilmaz S, Deliens T, et al. Do nutritional factors interact with chronic musculoskeletal pain?A systematic review. J Clin Med. 2020;9(3):702. doi: 10.3390/jcm9030702.
13. 13. Elma Ö, Brain K, Dong H-J. The importance of nutrition as a lifestyle factor in chronic pain management: A narrative review. J Clin Med. 2022;11(19):5950. doi: 10.3390/jcm11195950.
14. 14. Reddy VP. Oxidative stress in health and disease. Biomedicines, 2023;11(11):2925. doi: 10.3390/biomedicines11112925.
15. 15. Aleksandrova K, Koelman L, Rodrigues CE. Dietary patterns and biomarkers of oxidative stress and inflammation: A systematic review of observational and intervention studies. Redox biol. 2021;42:101869. doi: 10.1016/j.redox.2021.101869.
16. 16. Ho T, Ryan M, Holle J. Redox reactions in chronic pain: Mechanisms and relevance in fibromyalgia. Front Pain Res (Lausanne). 2025;6, 1593908. doi: 10.3389/fpain.2025.1593908.
17. 17. Neyal M, Yimenicioglu F, Aydeniz A, et al. Plasma nitrite levels, total antioxidant status, total oxidant status, and oxidative stress index in patients with tension-type headache and fibromyalgia. Clin Neurol Neurosur. 2013;115(6):736–40. doi: 10.1016/j.clineuro.2012.08.028.
18. 18. Cordero MD, Cotán D, del-Pozo-Martín Y, et al. Oral coenzyme Q10 supplementation improves clinical symptoms and recovers pathologic alterations in blood mononuclear cells in a fibromyalgia patient. Nutrition. 2012;28(11–12):1200–3. doi: 10.1016/j.nut.2012.03.018.
19. 19. Schell J, Hal Scofield R, Barrett JR, et al. Strawberries improve pain and inflammation in obese adults with radiographic evidence of knee osteoarthritis. Nutrients. 2017;9(9):949. doi: 10.3390/nu9090949.
20. 20. Ward SJ, Coates AM, Baldock KL, Stanford TE, Hill AM. Better diet quality is associated with reduced body pain in adults regardless of adiposity: Findings from the Whyalla Intergenerational Study of Health. Nutr Res. 2024;130:22–33. doi: 10.1016/j.nutres.2024.08.002.
21. 21. Macphail K. C-reactive protein, chronic low back pain and, diet and lifestyle. Int Musculoskelet Med. 2015;37(1):29–32. doi: 10.1179/53615415Y.0000000001.
22. 22. Jönsson M, Bäckryd E, Jonasson L, Gerdle B, Ghafouri B. Differences in plasma lipoprotein profiles between patients with chronic peripheral neuropathic pain and healthy controls: An exploratory pilot study. Pain Rep. 2022;7(5):e1036. doi: 10.1097/PR9.0000000000001036.
23. 23. Calcutt NA. Diabetic neuropathy and neuropathic pain: A (CoN) fusion of pathogenic mechanisms? Pain. 2020;161(Suppl 1):S65-S86. doi: 10.1097/j.pain.0000000000001922.
24. 24. Elma Ö, Lebuf E, Marnef AQ, et al. Diet can exert both analgesic and pronociceptive effects in acute and chronic pain models: A systematic review of preclinical studies. Nutr Neurosci. 2022;25(10):2195–2217. doi: 10.1080/1028415X.2021.1934956.
25. 25. Pak R, Cho M, Pride K, Abd-Elsayed A. The gut microbiota and chronic pain. Curr Pain Headache Rep. 2024;28(4):259–69. doi: 10.1007/s11916-024-01221-x.
26. 26. Santoni M, Miccini F, Battelli N. Gut microbiota, immunity and pain. Immunol Lett. 2021;229:44–47. doi: 10.1016/j.imlet.2020.11.010.
27. 27. Nijs J, Tumkaya Yilmaz S, Elma Ö, et al. Nutritional intervention in chronic pain: An innovative way of targeting central nervous system sensitization? Expert Opin Ther Targets. 2020;24(8):793–803. doi: 10.1080/14728222.2020.1784142.
28. 28. Glick-Bauer M, Yeh M-C. The health advantage of a vegan diet: Exploring the gut microbiota connection. Nutrients. 2014;6(11):4822–38. doi: 10.3390/nu6114822.
29. 29. Goudman L, Demuyser T, Pilitsis JG, et al. Gut dysbiosis in patients with chronic pain: A systematic review and meta-analysis. Front Immunol. 2024;15:1342833. doi: 10.3389/fimmu.2024.1342833.
30. 30. Nijs J, Leysen L, Vanlauwe J, et al. Treatment of central sensitization in patients with chronic pain: Time for change? Expert Opin Pharmacother. 2019;20(16):1961-70. doi: 10.1080/14656566.2019.1647166.
31. 31. Cassani E, Privitera G, Pezzoli G, et al. Use of probiotics for the treatment of constipation in Parkinson’s disease patients. Minerva Gastroenterol Dietol. 2011;57(2):117-121.
32. 32. Roman P, Estévez AF, Miras A, et al. A pilot randomized controlled trial to explore cognitive and emotional effects of probiotics in fibromyalgia. Sci Rep. 2018;8(1):10965. doi: 10.1038/s41598-018-29388-5.
33. 33. Okifuji A, Hare BD. The association between chronic pain and obesity. J Pain Res. 2015; 8:399–408. doi: 10.2147/JPR.S55598.
34. 34. Brain K, Burrows TL, Bruggink L, et al. Diet and chronic non-cancer pain: The state of the art and future directions. J Clin Med. 2021;10(21):5203. doi: 10.3390/jcm10215203.
35. 35. Elma Ö, Yilmaz ST, Deliens T, et al. Chronic musculoskeletal pain and nutrition: Where are we and where are we heading? PM R. 2020;12(12):1268–1278. doi: 10.1002/pmrj.12346.
36. 36. Dong H-J, Larsson B, Fischer MR, Gerdle B. Facing obesity in pain rehabilitation clinics: Profiles of physical activity in patients with chronic pain and obesity-A study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). PLoS One. 2020;15(9): e0239818. doi: 10.1371/journal.pone.0239818.
37. 37. Brain K, Burrows T, Rollo ME, Hayes C, Hodson FJ, Collins CE. Population characteristics in a tertiary pain service cohort experiencing chronic non-cancer pain: Weight status, comorbidities, and patient goals. Healthcare (Basel). 2017;5(2):28. doi: 10.3390/healthcare5020028.
38. 38. Gota CE, Kaouk S, Wilke WS. Fibromyalgia and obesity: The association between body mass index and disability, depression, history of abuse, medications, and comorbidities. J Clin Rheumatol. 2015;21(6):289–95. doi: 10.1097/RHU.0000000000000278.
39. 39. Atzeni F, Alciati A, Salaffi F, et al. The association between body mass index and fibromyalgia severity: Data from a cross-sectional survey of 2339 patients. Rheumatol Adv Pract. 2021;5(1):rkab015. doi: 10.1093/rap/rkab015.
40. 40. Robson EK, Hodder RK, Kamper SJ, et al. Effectiveness of weight-loss interventions for reducing pain and disability in people with common musculoskeletal disorders: A systematic review with meta-analysis. J Orhop Sports Phy Ther. 2020;50(6):319-333. doi: 10.2519/jospt.2020.9041.
41. 41. Geha P, deAraujo I, Green B, Small DM. Decreased food pleasure and disrupted satiety signals in chronic low back pain. Pain. 2014;155(4):712–722. doi: 10.1016/j.pain.2013.12.027.
42. 42. Raja SN, Carr DB, Cohen M, et al. The Revised IASP definition of pain: Concepts, challenges, and compromises. Pain. 2021;161(9):1976–82. doi: 10.1097/j.pain.0000000000001939.
43. 43. Yesildemir O, Guldas M, Boqué N, et al. Adherence to the Mediterranean diet among families from four countries in the Mediterranean basin. Nutrients. 2025;17(7):1157.
44. 44. Alaufi NS, Chan YM, Waly MI, Chin YS, Yusof BNM, Ahmad N. Application of mediterranean diet in cardiovascular diseases and type 2 diabetes mellitus: Motivations and challenges. Nutrients. 2022;14(13):2777. doi: 10.3390/nu14132777.
45. 45. Perna S, Alalwan TA, Al-Thawadi S, et al. Evidence-based role of nutrients and antioxidants for chronic pain management in musculoskeletal frailty and sarcopenia in aging. Geriatrics (Basel). 2020;5(1):16. doi: 10.3390/geriatrics5010016.
46. 46. Batista ED, Andretta A, De Miranda RC, Nehring J, Paiva E dos S, Schieferdecker MEM. Food intake assessment and quality of life in women with fibromyalgia. Rev Bras Reumatol Engl Ed. 2016;56(2):105–110. doi: 10.1016/j.rbre.2015.08.015.
47. 47. Santos HO, Macedo RCO. Impact of intermittent fasting on the lipid profile: Assessment associated with diet and weight loss. Clin Nutr ESPEN. 2018;24:14–21. doi: 10.1016/j.clnesp.2018.01.002.
48. 48. Taskinen MR, Packard CJ, Borén J. Dietary fructose and the metabolic syndrome. Nutrients. 2019;11(9):1987. doi: 10.3390/nu11091987.
49. 49. Sanders AE, Weatherspoon ED, Ehrmann BM, et al. Circulating polyunsaturated fatty acids and pain intensity in five chronic pain conditions. J Pain. 2023;24(3):478-489. doi: 10.1016/j.jpain.2022.10.008.
50. 50. Walsh TP, Arnoid JB, Evans AM, Yaxley A, Damarell RA, Shanahan EM. The association between body fat and musculoskeletal pain: A systematic review and meta-analysis. BMC Musculoskelet Disord. 2018;19(1):233. doi: 10.1186/s12891-018-2137-0.
51. 51. Soares A de A, Louçana PMC, Nasi EP, Sousa KM de H, Sá OM de S, Silva-Néto RP. A double- blind, randomized, and placebo-controlled clinical trial with omega-3 polyunsaturated fatty acids (OPFA ɷ-3) for the prevention of migraine in chronic migraine patients using amitriptyline. Nutr Neurosci. 2018;21(3):219–223. doi: 10.1080/1028415X.2016.1266133.
52. 52. Philpot U, Johnson MI. Diet therapy in the management of chronic pain: Better diet less pain? Pain Manag. 2019;9(4):335-338. doi: 10.2217/pmt-2019-0014.
53. 53. von Känel R, Müller-Hartmannsgruber V, Kokinogenis G, Egloff N. Vitamin D and central hypersensitivity in patients with chronic pain. Pain Med. 2014;15(9):1609-1618. doi: 10.1111/pme.12454.
54. 54. Xiaohua G, Dongdong L, Xiaoting N, et al. Severe vitamin D deficiency is associated with increased expression of inflammatory cytokines in painful diabetic peripheral neuropathy. Front Nutr. 2021; 8:612068. doi: 10.3389/fnut.2021.612068.
55. 55. Moini A, Ebrahimi T, Shirzad N, et al. The effect of vitamin D on primary dysmenorrhea with vitamin D deficiency: A randomized double-blind controlled clinical trial. Gynecol Endocrinol. 2016;32(6):502–5. doi: 10.3109/09513590.2015.1136617.
56. 56. Zarei S, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Javadzadeh Y, Effati-Daryani F. Effects of calcium-vitamin D and calcium-alone on pain intensity and menstrual blood loss in women with primary dysmenorrhea: A randomized controlled trial. Pain Med. 2017;18(1):3–13. doi: 10.1093/pm/pnw121.
57. 57. Konarska A, Fabijanski A, Dukacz A, et al. Magnesium in pain control - mechanisms of action in perioperative pain , neuropathic pain and migraine. J Educ Health Sport. 2025; 78: 57571-57571. doi: 10.12775/JEHS.2025.78.57571.
58. 58. Srebro D, Vuckovic S, Milovanovic A, Kosutic J, Vujovic KS, Prostran M. Magnesium in Pain Research: State of the Art. Curr Med Chem. 2017;24(4):424–434. doi: 10.2174/0929867323666161213101744.
59. 59. Oh TK, Chung SH, Park J, et al. Effects of perioperative magnesium sulfate administration on postoperative chronic knee pain in patients undergoing total knee arthroplasty: A retrospective evaluation. J Clin Med. 2019;8(12):2231. doi: 10.3390/jcm8122231.
60. 60. Jiang Y-G, Wang Y-H, Zhang H, Wang Z-Y, Liu Y-Q. Effects of early-life zinc deficiency on learning and memory in offspring and the changes in DNA methylation patterns. Nutr Neurosci. 2022;25(5):1001-1010. doi: 10.1080/1028415X.2020.1831259.
61. 61. Bagianto H. The influence of zinc deficiency on chronic pain in Sprague Dawley rats. Med J Indeones. 2010;19(2):88–95. doi: 10.13181/mji.v19i2.388.
62. 62. Teimoori B, Ghasemi M, Hoseini ZSA, Razavi M. The efficacy of zinc administration in the treatment of primary dysmenorrhea. Oman Med J. 2016;31(2):107–11. doi: 10.5001/omj.2016.21.
63. 63. Mrowicka M, Mrowicki J, Dragan G, Majsterek I. The importance of thiamine (vitamin B1) in humans. Biosci Rep. 2023;43(10): BSR20230374. doi: 10.1042/BSR20230374.
64. 64. Costantini A, Pala MI, Tundo S, Matteucci P. High-dose thiamine improves the symptoms of fibromyalgia. BMJ Case Rep. 2013;bcr2013009019. doi: 10.1136/bcr-2013-009019.
65. 65. Hosseinlou A, Alinejad V, Alinejad M, Aghakhani N. The effects of fish oil capsules and vitamin B1 tablets on duration and severity of dysmenorrhea in students of high school in Urmia-Iran. Glob J Health Sci. 2014;6(7):124-9. doi: 10.5539/gjhs.v6n7p124.
66. 66. Paez-Hurtado AM, Calderon-Ospina CA, Nava-Mesa MO. Mechanisms of action of vitamin B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin) in pain: A narrative review. Nutr Neurosci. 2023;26(3):235-253. doi: 10.1080/1028415X.2022.2034242.
67. 67. Sadeghi O, Nasiri M, Maghsoudi Z, Pahlavani N, Rezaie M, Askari G. Effects of pyridoxine supplementation on severity, frequency and duration of migraine attacks in migraine patients with aura: A double-blind randomized clinical trial study in Iran. Iran J Neurol 2015;14(2):74–80.
68. 68. Ghavidel-Parsa B, Naeimi A, Gharibpoor F, et al. Effect of vitamin B6 on pain, disease severity, and psychological profile of fibromyalgia patients; a randomized, double-blinded clinical trial. BMC Musculoskelet Disord. 2022;23(1):664. doi: 10.1186/s12891-022-05637-7.
69. 69. Suzuki K, Tanaka H, Ebara M, et al. Electrospun nanofiber sheets incorporating methylcobalamin promote nerve regeneration and functional recovery in a rat sciatic nerve crush injury model. Acta Biomat. 2017; 53: 250-259. doi: 10.1016/j.actbio.2017.02.004.
70. 70. Alvarado AM, Navarro SA. Complex B vitamins: Physiology and therapeutic effect on pain. Am J Pharmacol Sci. 2016;4(2):20–7. doi: 10.12691/ajps-4-2-2.
71. 71. Ayanoğlu M, Tuhan H, Komüroğlu A, Tosun A. Is There a relation between vitamin b₁₂ levels and headaches in children and adolescents? J Behcet Uz Child Hosp. 2021;11(1):73–9. doi: 10.5222/buchd.2021.32767.
72. 72. Didangelos T, Karlafti E, Kotzakioulafi E, et al. Vitamin B12 supplementation in diabetic neuropathy: A 1-year, randomized, double-blind, placebo-controlled trial. Nutrients, 2021;13(2), 395. doi: 10.3390/nu13020395.
73. 73. Schloss JM, Colosimo M, Airey C, Masci P, Linnane AW, Vitetta L. A randomised, placebo-controlled trial assessing the efficacy of an oral B group vitamin in preventing the development of chemotherapy-induced peripheral neuropathy (CIPN). Support Care Cancer. 2017;25(1):195–204. doi: 10.1007/s00520-016-3404-y.