***This 3 part article series is from a deep-dive video I made on chronic pain, inflammation, common pain meds and curcumin. Click here to watch the DEEP DIVE video (49 min) or click here to watch the shorter (6 min) video***
“Hey all, Drew here, owner and health coach at Agape Health Solution, coming at you with a video on chronic pain, inflammation, common pain medications and a turmeric extract called curcumin. I wanted to do this video for 3 reasons.
First, because so many Americans are dealing with chronic pain on a regular basis. More than 100 million Americans suffer with chronic pain, and forecasts show that the number and percentage of people dealing with chronic pain is going to increase in the United States.
Second, because there are serious adverse health effects associated with common pain relieving medication.
And third, we have 70 years of clinical data supporting the safe use of turmeric and curcumin for reducing systemic inflammation and pain.
By the end of this video you’ll know more about…
1.The problem of pain in America
2.Why a smart holistic, integrative, natural-leaning approach leads to the best health outcomes
3.The adverse side effects of common pain relieving meds
4.How America became a pharmaceutical drug-saturated culture
5.The science and clinical data behind turmeric and curcumin for reducing inflammation and pain, including how it works on a cellular level (as well as its positive effects on conditions like cancer and Alzheimer’s)
6.What the bible says about inflammation and disease (yes, it’s in there!)
7.What to look for in a curcumin supplement, including brands I like and dosage guidelines
8.Lab tests you or your provider can order that show the non-specific levels of inflammation in your body
9.What a smart holistic approach looks like regarding sleep, exercise and activity, nutrition and healthcare choices
So without further ado, let’s get into today’s topic…
Image Source: www.healthline.com/health-news/america-is-losing-the-war-on-chronic-pain
So chronic and acute pain is a widespread problem in the U.S., and some of the most common sources of pain include lower back pain, neck pain and headaches (including migraines). I can relate; when I was diagnosed with psoriatic arthritis in 2008 (at only 27 years old!), one of my symptoms was pain throughout my body.
According to data from 2008-2012 more than 100 million Americans live with some type of daily pain, and 125 million Americans (or nearly 1 in 2 adults) are adversely affected by a musculoskeletal condition of some type. Data from 2018 found that more than 90 million US adults have some form of arthritis. Nearly 20% of ALL healthcare visits in the U.S. are for musculoskeletal conditions, with a price tag totaling over $600 billion a year, or roughly $4,800 annually for each American adult living with musculoskeletal pain and/or dysfunction. [1-3]
When we look at disabilities in the U.S., we continue to see the impact of widespread pain and musculoskeletal dysfunction. The Census Bureau’s definition of disability is “serious difficulty with hearing, vision, cognition, walking or climbing stairs, as well as difficulty with self-care and independent living.” Using this definition, more than 60 million Americans (~26% of U.S. adults) are disabled. Included in musculoskeletal disabilities are conditions like arthritis, fibromyalgia, lupus, chronic gout and other forms of joint pain. 
Image Source: www.cdc.gov/vitalsigns/arthritis/infographic.html
The number of Americans dealing with chronic pain is projected to increase significantly, in part due to population increases and increases in the number of senior citizens, but also due to increases in the prevalence of inflammatory and pain conditions. For example, the worldwide prevalence of knee osteoarthritis increased more than 25% from 1990 to 2010. 
So the problem of chronic pain is widespread, and there’s an enormous need for safe, effective pain relieving interventions. But before diving into the data on pain medications, turmeric, curcumin and lab tests for inflammation, I first want to share some basics of my approach to health, because it influences the interventions I prefer and also the ones I discourage…
There are 7 basic pillars of the Agape Health Approach...
The first principle is a holistic approach, which means we consider all of the areas that can affect health, including psychological factors, social factors, sleep, exercise, physical activity, nutrition, stress, and medical and dental factors, as well as other factors.
The second is integrative approach, which means we choose the best diagnostic and interventional tools from both conventional and alternative approaches.
The third principle is a natural leaning approach, which means we recognize that the human body tends to interact more positively with certain substances found in nature than it does with synthetic isolates.
The fourth is a personalized approach, which means recognizing that each person’s body is in a unique physiological state, and that the specific interventions needed to improve health may look a little different for each person.
The fifth is a root-cause-focused approach; there is a place for symptom management (as with acute pain) but if we’re not identifying and then safely and effectively addressing the root issue driving pain and disease then we’re just kicking the can down the road.
The sixth pillar is an evidence-based approach; perhaps surprisingly not all common lifestyle and healthcare tests and interventions have a robust amount of clinical evidence to support their use, but we make an effort to prioritize those lifestyle and healthcare tests and interventions that have solid clinical and scientific evidence to support their use.
And finally the Agape approach is a bible-based approach that recognizes the positive impact that spiritual attributes like faith, wisdom, discipline and patience can have on health outcomes.
…but back to today’s topic of pain and inflammation…
Image Source: www.ofirmev.com/why-ofirmev/pain-management.aspx
What is mainstream medicine’s first-line treatment for most pain? Well, pain medication of course! And the most common drugs used include acetaminophen (Tylenol), NSAIDs and opioids if the pain is severe enough (or if the doctor is unethical enough).
After sharing some info with you on the problem of chronic pain in the U.S., the second reason wanted to do this video was because of serious issues associated with common pain meds. Let’s start with the most popular pain drug in America, acetaminophen…
Image Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC4913076/
This screenshot is of a 2016 scientific journal article on the side effects associated with acetaminophen. Acetaminophen is known as paracetamol in Europe; you might know it by the brand name Tylenol. Acetaminophen is consumed by more than 60 million Americans on a weekly basis, making it the most widely utilized pain killer in the United States. The primary danger with acetaminophen and Tylenol is liver damage. 
Acetaminophen induced liver toxicity is common in the U.S. and accounts for more than 50% of overdose-related acute liver failure cases and approximately 20% of liver transplant cases. More than 60% of unintentional overdoses of acetaminophen occur with use of the opioid/acetaminophen combination (ex. Vicodin, Norco, etc.). Acetaminophen-induced hepatotoxicity first emerged in the United States in the mid-1980s, and even though the risk has been known for decades, all signs point towards a growing incidence of the phenomenon. 
On a cellular level, acetaminophen hepatotoxicity occurs through the formation of the noxious NAPQI metabolite, which is present in excessive quantities, its damaging effect exacerbated by glutathione (GSH) depletion (glutathione being the master antioxidant), excess free radical production, oxidative stress, and mitochondrial dysfunction leading to depletion in adenosine triphosphate (ATP) stores. Acetaminophen-induced cell death of hepatocytes takes on the characteristic changes of liver necrosis (i.e. liver tissue death). 
All told, acetaminophen is responsible for >50,000 emergency department visits and 500 deaths a year in the United States; 50% of these are unintentional overdoses. Part of the problem here too is that it’s not uncommon for patients to confuse acetaminophen with non-steroidal anti-inflammatory (NSAIDs) medications. Strictly speaking, acetaminophen is not an NSAID. 
Image Source: www.caymanchem.com/news/research-tools-for-fatty-liver-diseases
So the risk with acetaminophen/Tylenol is associated with liver damage. This is especially problematic in the U.S. since there is already a liver disease epidemic with NAFLD, which affects 100 million Americans or ~40% of all US adults.
…but enough about Tylenol and liver damage, let’s look at NSAIDs…
Image Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC3045681/
When talking about NSAIDs we’re talking about drugs like Celebrex (usually prescription only) and OTC drugs like ibuprofen (which includes products like Advil and Motrin), as well as naproxen and aspirin (like those made by Bayer). As a class of drugs, non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for arthritis, joint pain and inflammation. However, it’s well established that they cause gastrointestinal complications such as ulcers, erosions and small intestinal mucosal injury. 
The pathophysiology of these complications can be ascribed, in part, to the drugs action on the mitochondria. NSAIDs tend to uncouple cellular mitochondria, which decreases intracellular ATP concentration, increases leakage of Ca2+ (calcium ions) out of mitochondria, causes osmotic imbalance at the cellular level and results in a loss of control over intracellular junctions. The latter leads to increased intestinal permeability (more commonly known as leaky gut) and subsequent mucosal damages. When leaky gut is present, there’s often an increase in the proliferation of disease and inflammation-causing microbes. 
Image Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC3890944/
While acetaminophen is the most popular individual pain medication, NSAIDs as a class of drugs account for 60% of the over-the-counter analgesic market in the United States. We’ve already discussed that NSAIDs are associated with adverse gastrointestinal (GI) effects. They’re also associated with adverse cardiovascular (CV) events, including increased blood pressure and deterioration of congestive heart failure, as well as renal toxicity. 
The development of mucosal inflammation and increased gut permeability are the most frequent abnormalities in NSAID users, and increased gut permeability can be seen as soon as 12 hours after the ingestion of single doses of most NSAIDs. Tests have shown that intestinal inflammation is present in 60-70% of patients taking NSAIDs and that, once established, it may be detected up to 1 to 3 years after long-term NSAID use has been stopped. About 30-50% of NSAID users develop endoscopic lesions (such as hemorrhages, erosions, and ulcerations), mainly located in the gastric antrum (lower section of stomach). The risk of developing serious GI complications is 3-5 times greater among NSAIDs user than among nonusers. 
So the risk with NSAIDs is primarily associated with stomach and intestinal damage. Again, this is especially problematic in the U.S., since we already have >70% of American adults (or ~180 MILLION people) dealing with digestive system discomfort on a regular basis. 
…but enough about NSAIDs and GI damage, let’s look at opioids…
Image Source: https://ndcrc.org/opioid-use-disorder-resources/
Opioid medications include hydrocodone-acetaminophen combinations (ex. Vicodin, Norco), tramadol (a weak opioid), oxycodone (ex. OxyContin, Percocet), methadone, the incredibly dangerous fentanyl, morphine and codeine. Most are aware that we’re in the middle of an opioid-related crisis, particularly as it relates to overdose-related deaths where opioids are involved. In 2002 a little more than 10,000 opioid-related deaths occurred in the United States. By 2017 that number was almost 50,000, with the most dramatic year over year increases seen since 2012. 
Deaths from fentanyl alone more than doubled IN JUST ONE YEAR, from over 9,000 deaths in 2015 to more than 19,000 deaths in 2016. While some of this is a substance abuse and addiction issue -- opioids being highly addictive -- much of this is a chronic pain issue. 
Image Source: https://catalyst.nejm.org/quandary-opioids-chronic-pain-addiction/
The above image was generated using data from the New England Journal of Medicine. During 2017 and 2018, its estimated that there were between 80-120 opioid-related deaths a day in the United States. 
And it’s not just addiction, abuse, overdose and death that’s a problem with opioids…
Image Source: www.ncbi.nlm.nih.gov/pmc/articles/PMC3990131/
The above image is of a 2013 scientific journal article that reviewed clinical data on opioids and their adverse effects on the GI tract, and found that…
*Opioid-induced constipation (OIC) is the most common and debilitating side effect of opioids
*Other common side effects include nausea, vomiting and itching
*Although constipation and nausea are considered the two main complications of opioids, other less common side effects include increased sensitivity to pain (which is ironic), adverse immune system effects and hormonal dysfunction
*Narcotic bowel syndrome (NBS) is a subset of opioid–induced bowel dysfunctions, accompanied by chronic and frequent abdominal pain that worsens by taking or escalating the dose of opioids. 
… so we see from the clinical data that there are serious adverse side effects associated with pain medications like acetaminophen, NSAIDs and opioids. And I don’t want to deep dive into the reasons for our opioid crisis and excessive use of pharmaceutical meds but I do think it’s important people understand some of the basics of how we got into this mess…
[CLICK HERE TO READ PART 2 OF 3]
1 www.pharmacytoday.org/article/S1042-0991(15)30173-0/fulltext (>125 million Americans experienced pain in last 3 months)
2 www.memorialphysicianpractices.com/our-practices/memorial-arthritis-osteoporosis-center (>90 million Americans have an arthritic condition)
3 www.webmd.com/pain-management/news/20110629/100-million-americans-have-chronic-pain#1 (chronic pain costs U.S. $600 billion/yr)
4 www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html (>60 million Americans have a disability)
5 www.arthritis.org/Documents/Sections/About-Arthritis/arthritis-facts-stats-figures.pdf (>25% increase in knee OA from 1990 to 2010)
6 www.ncbi.nlm.nih.gov/pmc/articles/PMC4913076/ (2016 scientific article on acetaminophen-induced liver damage)
7 www.ncbi.nlm.nih.gov/books/NBK441917/ (2018 scientific book on acetaminophen-induced liver damage)
8 www.ncbi.nlm.nih.gov/pmc/articles/PMC3045681/ (2011 scientific article on NSAIDs and gastrointestinal damage)
9 www.ncbi.nlm.nih.gov/pmc/articles/PMC3890944/ (2013 scientific journal article on NSAIDs and upper & lower GI damage)
10 www.foxnews.com/health/survey-shows-74-percent-of-americans-living-with-gi-discomfort (74% of Americans live with digestive discomfort on regular basis)
11 https://ndcrc.org/opioid-use-disorder-resources/ (Opioid-related deaths jumped from 10k/yr in 2002 to ~50k/yr in 2017)
12 https://catalyst.nejm.org/quandary-opioids-chronic-pain-addiction/ (2018 article from NEJM on 115 opioid overdose deaths/day in US)
13 www.ncbi.nlm.nih.gov/pmc/articles/PMC3990131/ (2013 scientific article on opioids and their adverse effects on GI system)