Intermittent Fasting: Potential Utility in the Treatment of Chronic Pain across the Clinical Spectrum
Abstract
:1. Introduction
2. Mechanistic Benefits of Intermittent Fasting
2.1. Metabolic Functioning
2.2. Cardiovascular Functioning
2.3. Immune Functioning
2.4. Neurobiological Functioning
3. Physiology of Pain States
3.1. Mechanical Pain
3.2. Inflammatory Pain
3.3. Neuropathic Pain
3.4. Ischemic Pain
3.5. Visceral Pain
3.6. Central Pain
4. Intermittent Fasting in the Treatment of Chronic Pain
4.1. Non-Invasive Pain Management
4.2. Pre and Post-Invasive Pain Management Interventions
4.3. Prehabilitation
4.4. Post-Procedure and Injury Rehabilitation
5. Considerations and Contraindications
6. Summary
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Fasting Type | Regimen | Description |
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Intermittent Fasting | Complete-alternate-day fasting [7,8] | No energy-containing foods or beverages on fasting days alternating with ad libitum intake on consumption days |
Modified-alternate day fasting [9,10] | 20–40% of energy requirements consumed on fasting days alternating with ad libitum intake on consumption days | |
5:2 [11,12] | Restriction to 25% or less of calorie requirements 2 days per week (consecutive or non-consecutive days) with ad libitum intake the remaining 5 days | |
Time-restricted feeding * [5,13] | Ad libitum energy intake within a 6–12 h period, no energy-containing foods for the remaining 12–18 h in a 24 h period | |
Periodic fasting | Prolonged fasting [14,15] | 2 to 21 days of very little or no energy intake (water-only fast) followed by a period of ad libitum intake |
Fasting-mimicking diet [16,17,18] | Low-calorie, low-sugar, low-protein, high-unsaturated fat diet (30–50% of energy requirements) for 4–7 consecutive days with ad libitum eating the rest of the month. |
Pain State | Definition | Relevant Mechanisms | Examples | Potential Benefits of Fasting |
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Mechanical pain | Pain resulting from abnormal stress on muscles, bones, joints, or soft tissue | Mechanical nociceptors triggered by excess pressure or mechanical deformation on a muscle, bone, joint, or soft tissue due to acute or cumulative trauma. May or may not involve tissue damage [136]. |
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Inflammatory pain | Persistent or recurrent pain due to inappropriate activation of the inflammatory response | The inflammatory cascade includes release of chemical mediators including cytokines and prostaglandins that sensitize nociceptors [54,139,140,141,142]. |
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Neuropathic pain | Pain resulting from a lesion in the somatosensory pathway |
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Ischemic pain | Pain resulting from diminished or absent perfusion to tissues | During ischemic injury, metabolites including ATP and lactic acid accumulate, inflammatory cytokines are released, and group III and IV nociceptive afferents are sensitized. Ischemia-reperfusion injury generates free radicals and ROS, and increased microvascular permeability during reperfusion allows inflammatory cell infiltration and release of pro-algesic cytokines including IL-1 and TNF-alpha [149,150,151,152]. |
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Visceral pain | Pain originating from visceral organs including lower airways, heart, mesentery, and hollow organs of the GI tract | Stimulated by chemical irritants, ischemia, distention, and inflammation. Tissue injury is not required. May be referred to somatically innervated structures corresponding to the spinal level of the affected visceral site [154,155,156]. |
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Central pain | Disturbance in pain processing in the central nervous system resulting in diffuse or regional hyperalgesia | Elevated underlying levels of pronociceptive neurotransmitters (substance P, glutamate) and reduced levels of neurotransmitters that inhibit pain (serotonin, norepinephrine, dopamine). Implication of the endocannabinoid system, but not the endogenous opioid system (which is augmented in fibromyalgia) [134,157]. |
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Caron, J.P.; Kreher, M.A.; Mickle, A.M.; Wu, S.; Przkora, R.; Estores, I.M.; Sibille, K.T. Intermittent Fasting: Potential Utility in the Treatment of Chronic Pain across the Clinical Spectrum. Nutrients 2022, 14, 2536. https://doi.org/10.3390/nu14122536
Caron JP, Kreher MA, Mickle AM, Wu S, Przkora R, Estores IM, Sibille KT. Intermittent Fasting: Potential Utility in the Treatment of Chronic Pain across the Clinical Spectrum. Nutrients. 2022; 14(12):2536. https://doi.org/10.3390/nu14122536
Chicago/Turabian StyleCaron, Jesse P., Margaret Ann Kreher, Angela M. Mickle, Stanley Wu, Rene Przkora, Irene M. Estores, and Kimberly T. Sibille. 2022. "Intermittent Fasting: Potential Utility in the Treatment of Chronic Pain across the Clinical Spectrum" Nutrients 14, no. 12: 2536. https://doi.org/10.3390/nu14122536