Journal Article

Dietary Ingredients as an Alternative Approach for Mitigating Chronic Musculoskeletal Pain: Evidence-Based Recommendations for Practice and Research in the Military

Meissner, Karin, Teo, Lynn, Deuster, Patricia, Paat, Charmagne F, Berry, Kevin, Crawford, Cindy, Lentino, Cindy, Boyd, Courtney

2019

Overview

Abstract Objective Approximately 55–76% of Service members use dietary supplements for various reasons, including pain and related outcomes. This work evaluates current research on dietary ingredients for chronic musculoskeletal pain 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. The committee made evidence-informed judgments and recommendations for practice and self-care use. Results Nineteen eligible dietary ingredients were assessed for quality, efficacy, and safety. Avocado soybean unsaponifiables, capsaicin, curcuma, ginger (as a food source), glucosamine, melatonin, polyunsaturated fatty acids, and vitamin D were conditionally recommended as their benefits outweighed risks, but there was still some uncertainty about the trade-offs. No recommendations were made for boswellia, ginger (as a dietary supplement), rose hip, or s-adenosyl-L-methionine. Recommendations were made against the use of collagen, creatine, devil’s claw, l-carnitine, methylsulfonylmethane, pycnogenol, willow bark extract, and vitamin E. Research priorities were developed to address gaps precluding stronger recommendations. Conclusions Currently the scientific evidence is insufficiently robust to establish definitive clinical practice guidelines, but processes could be established to track the impact of these ingredients. Until then, providers have the evidence needed to make informed decisions about the safe use of these dietary ingredients, and future research can address existing gaps.

• Publisher: Oxford University Press
• Subject: Activities of daily living / Alfacalcidol / Analysis / Bark / Calcifediol / Capsaicin / Carnitine / Chronic illnesses / Chronic pain / Clinical decision making / Clinical practice guidelines / Clinical trials / Collagen / Creatine / Decision making / Dietary Supplements / Evidence-based medicine / Evidence-Based Medicine - methods / Evidence-Based Medicine - standards / Fatty acids / Food sources / Glucosamine / Humans / INTEGRATIVE MEDICINE SECTION / Levocarnitine / Melatonin / Meta-analysis / Methionine / Military medicine / Military Medicine - methods / Military Medicine - standards / Military Personnel / Musculoskeletal Pain - diagnosis / Musculoskeletal Pain - diet therapy / Musculoskeletal Pain - epidemiology / Musculoskeletal system / Pain / Pain management / Phytotherapy - methods / Phytotherapy - standards / Plant extracts / Polyunsaturated fatty acids / Practice Guidelines as Topic - standards / Pycnogenol / Randomized Controlled Trials as Topic - methods / Randomized Controlled Trials as Topic - standards / Self-care, Health / Systematic review / Vitamin D / Vitamin E