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

Abstract

Objective Approximately 55–76% of Service members use dietary supplements for various reasons; although such use has become popular for a wide range of pain conditions, decisions to use supplements are often driven by information that is not evidence-based. This work evaluates whether the 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. GRADE was used to determine confidence in the effect estimates. A decision table was constructed to make evidence-informed judgments across factors required for decision-making, and recommendations were made for practice and self-care use. Results Nineteen dietary ingredients were included. Conditional evidence-based recommendations were made for the use of avocado soybean unsaponifiables, capsaicin, curcuma, ginger, glucosamine, melatonin, polyunsaturated fatty acids, and vitamin D. In these cases, desirable effects outweighed undesirable effects, but there was uncertainty about the trade-offs, either because the evidence was low quality or because benefits and downsides were closely balanced. Conclusions The evidence showed that certain dietary ingredients, when taken as part of a balanced diet and/or as a supplement (e.g., pill, tablet, capsule, cream), may alleviate musculoskeletal pain with no to minimal risk of harm. This finding emphasizes and reinforces the critical importance of shared decision-making between Operators and their health care providers.

The Importance of Nutrition as a Lifestyle Factor in Chronic Pain Management: A Narrative Review

“…None of the identified articles provided relevant information about the guidelines related to nutrition and pain. One article provided conditional recommendations and an evidence based decision aid for the use of specific dietary ingredients in chronic musculoskeletal pain [ 17 ]. However, the population of interest in this article was the United States military, which limits the generalizability of the findings to the general population.…”

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].…”

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

“…No recommendations were offered for boswellia [25–35], ginger [36–46], rose hip [47–51], or s-adenosyl-L-methionine (SAMe) [52–58]. Note that although ginger is conditionally recommended as a food source [13], use as a supplement was not recommended. Table 2 displays the ingredients where no practice recommendations were made, the graded evidence for efficacy and safety, and other considerations noted when making recommendations.…”