Steps to Treat Chronic Pain
Steps to reduce or heal chronic pain
If you are in pain don't give up. I believe you are in pain and I want to help. In this website, I try to address the root causes of chronic pain. This advice is designed to help heal the causes of chronic pain over time; including pain without a physical cause.
When pain is present without physical injury you need lifestyle interventions which address brain, neuron, and glia problems. This pain is NOT imaginary but it is treated differently than pain from an injury.
I focus on treating the underlying problems of pain naturally which takes time. This is not an instant cure and you may want to consult a pain management specialist.
*Tayna V. (29 year old woman): "I am in pain all the time. I really do not have a support system. The only person that I have in my corner, besides my doctors, is my aunt. My aunt believes that I'm in pain because she also has chronic pain from fibromyalgia. My parents thinks it is all just in my head because the pain is not visible and they keep telling me to get over it."
Please read our page on Why Do We Feel Pain to find out your type of pain.
How to Heal Pain 101 (works on all pain types)
1) Stop the burn: reduce body and brain inflammation
2) Sooth your restless glia cells
3) Give your brain and neurons some healing
1) Reduce inflammation:
Excess inflammation hinders healing, activates glia cells, and contributes to brain pain reorganization (this is where your brain decides to make a personalized chronic pain play list for you even if you have nothing physically wrong). If you have chronic pain without any clear physical injury reducing inflammation is very important.
Steps to reduce inflammation (choose one or all). Click on the links below to see more about each step. We believe in these methods so much that we have a webpage for each topic.
★ Antiinflammatory diet and lifestyle
Jay L. (29 years old) "... the mental health component of pain management is often underplayed. Pain and mental health are intertwined. When you are depressed chronic pain seems worse. If you believe your life is meaningless, you won't have the will to care for yourself and your life becomes dominated by pain. Emotional pain and physical pain are connected in the brain with one bleeding into the other. This pain cycle traps people in a cycle of mental and physical misery. You need purpose and self care to break the cycle." To break this cycle: be kind to yourself.
2) Sooth glial cells (deactivate glia):
Glial cells (glia), which include microglia and astrocytes, are helpful brain cells that can turn into evil villains which cause chronic pain when they are activated. Brain inflammation, viruses, bacteria, injury, temporary pain and stress can transform glial cells into reactive or activated glial cells. For more on how glia work click here.
To deactivate glia you need to reduce overall inflammation (see #1 above) and reduce brain inflammation (neuroinflammation). One way to do this is through diet (or supplements). Studies have shown that astaxanthin and flavonoids (found in foods and in supplements) can deactivate glia and stop the pain cycle.
Steps (choose one or all). Click on the links below to see more about each step.
★ Reduce overall inflammation (see #1 reduce inflammation)
★ Increase flavonoids (see below for details and Super Foods for how to change your diet)
Flavonoids reduce brain and body inflammation
Flavonoids are polyphenols mostly found in vegetables, fruits, grains, roots, bark, stems, spices, flowers, tea and wine. Plants use flavonoids to protect themselves from different biotic (living) and abiotic (nonliving) stresses; to increase drought and frost resistance; for defence; as signaling molecules; as UV filters; and more. There are over 6000 flavonoids that include anthocyanins, chalcones, flavones, flavanones, flavanols (or catechins), flavonols, flavanonols, and isoflavonoids (discussion Panche et al. 2016).
Flavonoids act as antioxidants and are anti-inflammatory, anti-diabetic, anti-microbial, anti-cancer, neuroprotective. They also help prevent diabetic neuropathy and protect the heart (Panche et al. 2016, Khanna et al. 2025).
Blue Box of Science: Five ways flavonoids fight brain inflammation
1) Flavonoids can calm neuroinflammation (brain inflammation) by deactivating glia. Flavonoids; such as quercetin, epigallocatechin-3-gallate, and myricetin; reduce the number of activated glia and proinflammatory cytokines. Flavonoids are antiinflammatory which protects neurons and glial cells against neurotoxins-induced injury and improves neuroplasticity (the ability of your brain to adjust)(discussion Martnez-Coria et al. 2023)
2) Flavonoids have anti-cholinesterase activity which decreases the enzyme acetylcholinesterase (AChE). Anti-cholinesterase compounds decrease cholinesterase, an enzyme that breaks down acetylcholine. Anti-cholinesterase compounds treat neurodegenerative diseases (discussion Panche et al. 2016).
AChE is an enzyme in the central nervous system (CNS). It is involved in the pathological progression of neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease. It modulates the inflammatory response, oxidative stress, apoptosis (cell death), and aggregation/clumping of pathological proteins (discussion Panche et al. 2016, Walczak-Nowicka and Herbet 2021, Martínez-Coria et al. 2023).
3) By inhibiting AChE, flavonoids indirectly increase neural acetylcholine levels in the brain. Acetylcholine is a neurotransmitter that controls neuronal excitability, promotes the ability of neurons to connect and process information (synaptic plasticity), modulate neuron communication (synaptic transmission), and coordinates the firing of clusters of neurons (Picciotto et al. 2012, Walczak-Nowicka and Herbet 2021). Acetylcholine is involved in muscle control and activation, reasoning, learning, focus, memory formation and wake/sleep cycle.
4) Flavonoids reduce inflammation by inhibiting cytokines. These plant compounds inhibit proinflammatory cytokines including:
• Cyclooxygenase-2 (COX-2), which synthesizes prostaglandins which cause inflammation and pain.
• Tumor necrosis factor (TNF-a) which regulates inflammation and immune responses. When elevated TNF-a causes chronic inflammation, excitotoxity, and breakdown of the blood-brain barrier (BBB). During neuroinflammation, TNF-a is activated and upregulated by microglia (Olmos G, Lladó 2014).
• Interleukin-1 beta (IL-1β) which amplifies the immune response and can ramp up inflammation rapidly.
• Interleukin-6 (IL-6) which triggers production of proteins responsible for acute inflammation. Too much IL-6 and disruption of IL-6 signaling pathways can cause various autoimmune and inflammatory disorders and cancer (discussion Rose-John 2020).
• Inducible nitric oxide synthase (iNOS) which modulates inflammation and immune activation by producing nitric oxide (NO). When it is over produced or dysregulated iNOS can be involved in pain, sepsis, cancer, and neurodegeneration (Cinelli et al. 2020).
5) Flavonoids prevent halt diabetic neuropathy by inhibiting NLRP3 inflammasome activation. Activation of the NLRP3 (NOD-, LRR- and pyrin domain-containing protein 3) inflammasome triggers the immune system causing diabetic peripheral neuropathy (DPN) disease progression.
The NLRP3 inflammasome is a large multi protein complex that helps regulate inflammation and the immune system. Chronic NLRP3 inflammasome activation can contribute to inflammatory diseases such as cancer, autoimmune diseases, diabetes, cardiovascular diseases, and neurological disorders (Alehashemi et al. 2020, Khanna et al. 2025).
Diabetic peripheral neuropathy is the nerve damage often seen in people with diabetes. It is caused by chronic inflammation, high blood glucose and excess oxidative stress. This is why many people with type 2 diabetes either lose feeling in their feet or start getting nerve pain in their feet and hands.
Flavonoids block NLRP3 inflammasome activation by modifying vital signalling pathways; reducing oxidative stress; and blocking NF-κB and caspase-1 which reduce production of secondary inflammatory chemicals (Panche et al. 2016, Khanna et al. 2025).
So where do you get flavonoids?
Here is a partial list: all berries, onions, apples, plums, tomatoes, cherries, broccoli, kale, green and black tea, beans, chocolate (and cocoa), spices, whole cereal grains, carrots, oranges, lemons and limes. See Super Foods.
Astaxanthin may stop chronic pain while protecting the brain
Astaxanthin is a dark red carotenoid pigment extracted from a microalga. It has extremely potent anti-inflammatory, anti-apoptotic, and antioxidant activities.
★ Crosses the blood brain barrier (BBB).
★ Increases neurogenesis (new neuron growth) and brain plasticity in adults.
★ Inhibits inflammation and prevents oxidative damage.
★ Stops microglia (glia) from activating and producing cytotoxic substances such as reactive oxygen species (ROS), reactive nitrogen species (RNS) and cytokines. This is important since activated glia can initiate and continue the chronic pain cycle.
★ Increases cellular resilience.
★ Maintains cognitive function in neurodegenerative diseases and as people age.
Discussions in Morris et al. 2015, Grimmig et al. 2017, Wen et al. 2017, Sorrenti et al. 2020, Zhou et al. 2021, Medoro et al. 2023.
I have a whole page on astaxanthin. Click here to see how astaxanthin sooths glial cells to halt the chronic pain cycle.
Eugène Samuel Grasset- poster for an exhibition of French decorative art at the Grafton Galleries, 1893.
3) Heal the brain and neurons
Steps (choose one or all). Click on the links below to see more about each step.
★ Reduce inflammation (see step #1)
★ See step #2 to calm down your glia cells
★ Decrease the deadly neurotoxic trio: neuronal excitotoxicity, neuroinflammation, and oxidative stress
★ Address emotional trauma which can initiate and propagate inflammation (see PTSD/cPTSD, religious trauma, tips to change your life, fight depression, music heals)
★ Reduce stress (stress busters, reduce stress by unplugging)
Stress increases inflammation
The central nervous system (CNS) activates the innate immune system when it is injured due to trauma, infections, stroke, neurotoxins, viruses and other damage. CNS cells; such as astrocytes, microglia, vascular cells, neutrophils, and macrophages; activate and cause brain inflammation (neuroinflammation) (Galasso et al 2018).
Moving your muscles increases brain growth
Exercise increases axon and dendrite growth in neurons. Muscle fiber movement causes motor neurons to secrete myokines (cytokines). Myokines are biochemical signals that can have different effects. Autocrine signals communicates with the same cell, paracrine signals communicate with nearby cells, and/or endocrine signals communicate throughout the body. These muscle-secreted factors significantly increase neurite (axon and dendrite) outgrowth and migration (Bu et al. 2025).
What is the neurotoxic triad? The troublesome three are neuronal excitotoxicity, neuroinflammation, and oxidative stress: they egg each other on to damage your brain.
Neuronal excitotoxicity is when neurons fire too much due to excess glutamate. Glutamine is a neurotransmitter that increases the rate at which neurons fire. Excess glutamine floods excitatory plasma membrane receptors and damages neurons.
Excitotoxicity is involved in migraines, aging, trauma, ischemia, strokes, epilepsy, and neurodegenerative diseases (such as Alzheimer's disease, Huntington's disease, Parkinson's disease, and Amyotrophic lateral sclerosis).
Here are just some of the neurotoxic triad evil deeds:
Excitotoxity impairs mitochondria so they produce less energy.
Excitotoxity releases excess glutamate which stimulates immune cells; the immune cells release cytokines that increase inflammation and neuroinflammation.
Oxidative stress directly stimulates and increases neuroinflammation.
Oxidative stress increases reactive nitrogen species (RNS) which inhibit glutamate transporters; increasing glutamate and likelihood of excitotoxity.
Excess RNS can cause astrocytic swelling and release of glutamate.
Neuroinflammation; that is originally caused by stress, trauma, stress, or invading peripheral cytokines; can cause excitotoxicity and oxidative stress.
Neuroinflammation increases release of reactive oxygen species (ROS) and RNS, which increases oxidative stress.
Microglia release TNF-α and IL-1β, which increase excitatory neurotransmission via glutamate and therefore, increase excitotoxicity.
Discussion Holton 2021.
Micronutrients can protect you from neuroinflammation, excitotoxicity, and/or oxidative stress.
The brain is extremely vulnerable to reactive oxygen species (ROS) damage. This is due to several factors; its high oxygen usage, less antioxidant defense ability, a ton of mitochondria, and the presence of easily oxidized lipids and metals (discussion Upaganlawar et al. 2021). As mentioned above, oxidative stress can cause neurodegeneration and inflammation and vice versa.
Micronutrients that protect the brain include:
- Vitamin C
- Vitamin E
- Vitamin D
- Riboflavin (B2)
- Vitamin B6
- Folate (I recommend the biologically active form of folate, 5-methyltetrahydrofolate)
- Vitamin B12
- Magnesium
More on the B vitamins
Everyone knows the super stars of the B world. Yes, B6 and B12 get all the popular press, with folate trending for those who are pregnant.
However, taking too much of only one or two B vitamins is unwise. B vitamins should be taken as a complex together: thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin (B7), folate (B9), and cobalamin (B12). This is because they work together and if you take one without the others you can make yourself deficient in one or more B vitamins.
Why are some B vitamins labeled bioavailable?
You can buy most B vitamins in an active (bioavailable) form. Normally, your body will convert regular B vitamins into the active form using special enzymes. Some people ether do not have the enzymes needed to convert one or more of the B vitamins into the active form or their enzymes are not working at 100% due to a genetic variance. They need to use bioavailable B vitamins.
B vitamin: active or bioavailable form
B1 (Thiamin): Benfotiamine
B2 (Riboflavin): Riboflavin 5'-Phosphate Sodium
B3 (Niacin): Niacinamide & Niacin
B5 (Pantothenic Acid): D-Calcium Pantothenate
B6 (Pyridoxine): Pyridoxal 5'-Phosphate
B7 (Biotin): Biotin
B9 (Folate): Methylfolate
B12 (Cobalamin): Methylcobalamin
Note that B vitamins are NOT related. They are co-workers not relatives.
4) Heal the body
If you have pain from actual physical/tissue damage, you need to maximize healing while letting yourself recover. Since this isn't the 1950's we all know that bed rest or a stay in the local sanitarian isn't the correct way to heal for most people. You need to be reasonably active while taking your injury into consideration.
Steps (choose one or all). Click on the links below to see more about each step.
★ Add protein to diet - you need more protein to heal
★ Anti-inflammatory diet and lifestyle
★ Gentle physical therapy (if you have exercise intolerance check here)
★ Add pain management because too much pain hinders healing
Special topic: non-drug treatments for chronic lower back pain
As a person whose lower back went out when I was 21 years old, I know about lower back problems. I was walking hunched over for over a week and had reoccurring episodes until I figured out the secret - exercise.
I don't currently have any back pains as long as I strength train and walk/hike. When I stop they reappear.
What works for lower back pain (evidence based research)
★ My exercise program (antidotal)
Exercise module (discussion in Mauck et al. 2022)
(1) Walking and hiking
(2) General exercise (strength training plus conditioning).
(3) Motor control exercise (MCE). These exercises are designed to enhance spine stability and control by building up core muscles. Think about them as lacing around your middle and building up your back support (a corset for the back).
(4) Directional preference exercise. This is moving in the direction that gives you the most relief from back pain. For example, you may feel better by leaning forwards or feel better by leaning back. This preference is used when deciding on the best back exercises for you.
(5) Motum, a 12-week movement program for chronic non-specific lower back pain had a large positive effect on improving fear avoidance of movement and balance. It had a smaller positive effect on pain and function.
The exercise blocks were designed to focus on movement patterns: 1) core bracing/stabilization, 2) flexion and extension, 3) rotation, and 4) squat patterns. The exercise built on each other so that people could take small steps. For pictures of the movements in this program see Farmer et al. 2025.
Add in one or more of these strategies which are proven to compliment the benefits of exercise:
(1) Cognitive behavior therapy (CBT) or pain reprocessing therapy (PRT)
(2) Manual therapy. This is a hands on technique that uses massage, joint mobilization, and soft tissue manipulation.
(3) Foam rolling. Foam rolling may be just as good as manual therapy in postexercise recovery (Espi-Lopez et al. 2023). Bonus: foam rollers are cheap and you can do them without a partner.
(4) Use decision-making strategies to tailor your treatment to you. Don't just go off the latest TikTok trend. PSA please don't get health advice from TikTok, at least verify it.
Lifestyle and self care
(1) Good bed and supportive chairs. What is a good bed will depend on you. This may be the only thing you need.
Go into a mattress store and try out the beds. Get a knowledgable salesperson to tell you all about the new beds. They even have beds that raise at the head and at the foot to take pressure off your back. Try them out, they feel great. If you cannot afford a new bed you may be able to modify your old bed to help with pain.
(2) Acceptance and commitment therapy (ACT) or pain reprocessing therapy (PRT). ACT improves function and pain by focusing on having people accept their pain vs gaining control over the pain. Pain reprocessing therapy (PRT) reduces or eliminates pain by teaching your brain to see pain as less threatening.
(3) Guided and self-guided pain management programs.
What works for me (it may or may not help you):
Back: standing deadlifts have almost completely alleviated my lower back pain. I added stabilizing core exercises which gives me even more resilience. I also walk everyday.
Knees: walking backwards, retro walking, (on a safe flat track or trail) eliminates knee pain in part by building strength while minimizing knee stress. One study found that backwards walking 3x week for 10 minutes (4 weeks total) reduced pain, improved physical function and improved static stability for people with knee osteoarthritis (KOA) when compared to a control group (Chen et al. 2021).
If I have a random joint or muscle that is sore or stiff I always move it using whole body no-weight exercises such as kick boxing or dancing. Functional large body movements help teach your muscles, nerves and brain to play nicely with each other. It is telling them, "look, you can move without hurting yourself; there is no need for pain."
*Names and some minor identifying details in all stories in this website are changed to protect people's privacy.
I'm not your doctor; I'm just a person who would like to see you happy, pain free and healthy. If you have any questions or doubts about how to reduce chronic pain please consult a professional.
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