Wednesday, 21 March 2018

Just How Promising Is Medical Marijuana For Older Patients With Nerve Pain?

Today's post from (see link below) is an extremely practical and reader-friendly examination of the potential benefits of medical marijuana for older patients with a variety of complaints including neuropathy. I realise that we're being swamped by medical marijuana articles at the moment but that's because it may just be a genuine contender as an alternative treatment for nerve pain that doesn't involve strong pain killers - it's a hot topic! Selecting appropriate articles for review by this blog's readers then, is a bit of a minefield but this one ticks all the boxes as far as approachability is concerned and is unbiased when it comes to evaluating the herb's effectiveness. This is precisely what we need, as patients suffering from chronic pain conditions and for that reason is well worth a read.

Medical Marijuana for Older Adults By Lisa Esposito, Staff Writer |March 16, 2018, 
Marijuana has changed since back in the day, and your body has changed as well.


Medical Marijuana for Older Adults

"As people get older, the way their body processes medication, including marijuana, is different than it was in their 20s." (Getty Images)

Back when baby boomers were in high school or college, marijuana was mostly about youthful experimentation. Now, medical marijuana gives cannabis new meaning for some older adults. In a growing number of states, people can use marijuana products to treat conditions such as chemotherapy side effects or certain types of pain.

[See: 8 Medications That Treat Multiple Conditions.]

Fibromyalgia has been a source of pain and disruption for Teri Robnett, 59, of Colorado. For 30 years, she's coped with fatigue, anxiety, insomnia and irritable bowel issues. Over the years, she's tried almost every treatment that traditional medicine has to offer, from ibuprofen to prescribed antidepressants and opioid painkillers like OxyContin. None really helped. Instead, alternative measures such as massage, acupuncture and herbal medicines provided some relief.

In 2009, Robnett began working in a marijuana dispensary. Although she had tried marijuana while much younger, she could take it or leave it for recreational use. Now, as she saw others turning to medical marijuana for conditions like hers, she received authorization to try it herself. "I feel so much better," was her almost immediate reaction.

Pain Relief and Appetite Boost

As early as the 1970s, marijuana was considered as a possible therapy for glaucoma, a common eye disease related to aging. However, it's not practical as a glaucoma treatment, according to the American Academy of Ophthalmology.

Pain treatment is the most promising medical use for marijuana supported by data so far, says Margaret Haney, a professor of neurobiology in psychiatry at Columbia University Medical Center in New York City who conducts cannabis research.

Neuropathic Pain

"There really is evidence that cannabis and cannabinoids, including synthetic cannabinoids, reduce pain," Haney says. "What's very exciting is there's some suggestion that cannabinoids can be useful for a type of pain that isn't well-treated by other drugs – neuropathic pain."

Neuropathic pain is caused by nerve damage, also known as neuropathy. Neuropathy can occur with diabetes, HIV infection or medications, and cancer chemotherapy.

Marinol capsules and Syndros oral solution, which contain synthetic cannabis, or dronabinol, are approved by the Food and Drug Administration for treating anorexia associated with weight loss in patients with AIDS, and nausea and vomiting associated with cancer chemotherapy. Cesamet, also approved, contains nabilone, another synthetic form.

Marijuana could also be helpful for other older adults with poor appetite and nausea who are at risk for unwanted weight loss and malnutrition.

"If [marijuana] is legal in your state, it's certainly reasonable to try it for appetite," Haney says. "Just be cautious, and particularly cautious with edibles, because they really are hard to titrate to the effect you want."

Medical Marijuana Uncertainties

Epidiolex, a cannabidiol-based prescription drug, is under review for FDA approval. Studies suggest the drug reduces seizures in two forms of epilepsy.

Anxiety relief is one reason people turn to marijuana, although that can backfire. While marijuana is relaxing and enjoyable for a subset of users, Haney says, "Many others find it enhances anxiety tremendously."

Cannabinoid oil, or CBD oil, is generating a lot of buzz for its potential therapeutic properties. CBD oil does not cause intoxication. Instead, early evidence suggests CBD might help people cope with social anxiety or post-traumatic stress disorder symptoms, among other problems. However, many questions exist about quality and effectiveness of consumer CBD products and there's still a legal gray area around its use.

Marijuana remains a Schedule 1 restricted drug under federal law, classifying it on a par with heroin and above other dangerous and addictive opioid drugs like OxyContin. That makes it much more difficult for researchers like Haney to conduct larger, more conclusive studies.

"We just published a lab study showing that a low dose of opioids in combination with marijuana produces a nice [pain-relieving] effect," Haney notes. "The dose of opioids alone was low enough that it didn't do anything. But when you combined it with cannabis, it did."

[See: 4 Opioid Drugs Parents Should Have on Their Radar.]

Pot Precautions


How to Talk to Your Doctor About Medical Cannabis

If you're considering medical marijuana, there's a lot to think about. Marijuana comes in a much wider assortment of smoking, vaping, topical, oral, spray and edible products than it used to.

Meanwhile, your body has evolved with age. Your health status, balance and drug tolerance have probably changed. Prescription drugs you currently take may interact with marijuana in a variety of ways.

Driving under the influence of marijuana is unsafe at any age. "People often make the comparison to alcohol, and it's definitely less risky than alcohol in terms of driving," Haney says. "But it still doubles the risk of accidents."

Just as with any FDA-approved prescription drugs, you should discuss possible marijuana side effects and drug interactions with your pharmacist or health provider.

"As people get older, the way their body processes medication, including marijuana, is different than it was in their 20s," says Laura Borgelt, an associate dean and professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, in Aurora. "Not only is the drug more potent, or the dose stronger, but their body is metabolizing the drug differently."

With conditions such as diabetes or chronic obstructive pulmonary disease, the impact of marijuana isn't yet known, Borgelt says. However, fall risk is an obvious concern for older adults. "We know that marijuana can create cognitive impairment and slow cognitive processes," she says. "It has also shown some [short-term] memory impairment."

In a 2016 Colorado report evaluating state health trends since marijuana legalizations, the findings include an increase in marijuana-related ER visits and hospitalizations.

Edible marijuana products pose the most risk for interactions with prescription medications, Borgelt says, because both may be broken down, or metabolized, in the liver.

With sedating drugs, including benzodiazepines like Valium or certain sleep medications, there could be an additive effect with marijuana, Borgelt says. The same holds true if combining alcohol and marijuana.

Medical Marijuana: the Myths and Realities

Drug reactions could potentially occur with blood-thinner or anti-clotting medications, oral or injectable diabetes drugs, blood pressure medications and other drugs frequently prescribed to older patients for common medical conditions.

"Using FDA-approved therapies as a first-, second- or third-line [treatment] is the most appropriate way to medicate a condition at this point," Borgelt emphasizes. However, she sees potential for new marijuana-treatment targets and discoveries as researchers learn more about the body's endocannabinoid system.

Obtaining Legal Marijuana

Depending on your medical condition and where you live, you can obtain marijuana in official dispensaries with authorization from your doctor.

Medical marijuana and cannabis programs are legal in 29 states, the District of Columbia, Guam and Puerto Rico as of early 2018, according to the National Conference of State Legislatures. (Recreational marijuana is legal in eight states.)

Borgelt recommends seeking out a cannabis health care professional for people who live in states with medical marijuana laws. These physicians make recommendations for cannabis based on a qualifying condition, which varies from state to state.

The cannabis physician verifies that the condition exists and marijuana is a viable option. The patient can then get paperwork to send to the state for a medical marijuana card. State health department websites provide specific instructions.

[See: 13 Ways to Solve Sleep Problems in Seniors.]

As Robnett continues using medical marijuana, she's learned to combine different strains and forms of cannabis and tailor them to her needs. She might smoke or vape small amounts throughout the day, and then use edibles at night for longer-lasting results. On days when she feels most fatigued, CDB products help her feel more clear and present. No longer needing prescription drugs such as antidepressants or opioid pills is another plus.

Tuesday, 20 March 2018

Removing The Myths And Fables About Medical Marijuana For Pain Relief

Today's post from (see link below) is unapologetically, yet another post about the benefits of medical marijuana for chronic pain relief but because the subject is so hot on the internet at the moment, it's important to get as many facts as we can before deciding whether to use it or not. When you have a painful disease without a cure, such as neuropathy, it's natural to look for alternatives to standard medications that have been proved to be largely ineffective. The danger is that we as patients, latch on to what seems to be a viable alternative to strong painkillers before properly exploring the facts to ensure we're not doing more harm than good. The official jury is still out on medical marijuana but there's no doubt that the evidence suggests that it can be a very effective treatment for chronic pain. Then we have the whole legal issue in some areas and the whirlwind hysteria around opioids and drug abuse. If we can be sure about medical marijuana and be sure of the best way to use it as a treatment, then it seems to me that it ticks many of the boxes when trying to avoid addiction to opioids and the like. However, there are still powerful media and political lobbies that would prevent us from using both as treatments and would prefer that we suffer in silence. The time for the passive patient is long gone but we need the facts! This article helps fill in more of the gaps about the components of medical marijuana and as such, is an invaluable tool in the search for effective treatments.

Medical marijuana: dispelling myths and fallacies behind cannabidiol and tetrahydrocannabinol 
March 18, 2018 Virginia Thornley, M.D. Neurologist, Epileptologist


The endocannabinoid system is found naturally in the brain. It is responsible for the sense of well-being one gets after running a 5-mile course. It does not work through endorphins or adrenaline, as some people may think. It works at the level of the endocannabinoid system. There is a community of CBD producers and consumers and it is in this mysterious world that it is well-known to be used in many medical conditions, still shunned by the majority of the medical community, Congress and even patients in general. The 2 most commonly known are cannabidiol and tetrahydrocannabinol. Cannabidiol has medical properties and has a weak affinity to the CB1 receptor which is predominantly found throughout the central nervous system, which is likely why it is found to work in numerous neurological conditions. Tetrahydrocannabinol (THC) is a well-known cannabinoid most notoriously known for the euphoria of kingpins seen on movies propagated by pop culture. Unfortunately, these connotations overshadow the well-known medicinal benefits. Cannabinoids have been used for centuries even in the B.C. period. It was part of the American pharmacopeia in the 1980’s until it was banned in the 1930’s. Slowly, these products are gaining popularity as a treatment for many medical conditions, primarily neurological because the CB1 receptor is so abundant in the nervous system, due to patients becoming more and more frustrated with the adverse effects and ineffectiveness of conventional treatments. In Europe, a combination of THC and CBD have been used in multiple sclerosis patients since 2010. Animal studies and cell line culture studies demonstrate many potential mechanisms in which CB1 receptors, CBD and THC may be beneficial at the cellular level in many diseases, mechanisms are still being elucidated. It is most commonly used for chronic pain and epilepsy. As with any medication, it may or not be effective for everybody.

How it works–the nitty gritty

Cannabidiol has none of the psychoactive properties as THC. One needs 100 times the amount of CBD to have the same intoxication as THC. Therefore, it works well for those who are reluctant to go this route but who have found conventional medications which do not provide effectiveness, they are simply not cutting it. Because very little is know about its titration, medical marijuana can seem like entering into the world of an apothecary, or such as that found in the medieval days when potions are concocted. Physicians who use it in their treat it similar to a medication and the guidelines are similar start low and go slowly. Tetrahydrocannabinol is more potent and at higher doses works more effectively for pain control and seizures. THC is used at relatively low concentrations in order to effect its medical properties, at higher concentrations one may run into side effects which offsets its medical value. There are different ratios of CBD:THC, different ratios correspond to different symptoms treated. CBD is required in conjunction with THC in order to offset the potential side effects of THC. Tolerance does not build in the system such as that seen with opioids, although if one is medical marijuana naive, the lowest dose possible is ideal. There are no side effects of respiratory depression such as that seen with other medications for pain such as opioids.Consult with your treating physician.

Current legal state of affairs

Currently, there are many states that recognize the medical value of medical marijuana with medical marijuana laws allowing the opening of licensed dispensaries. However, the same cannot be said for the federal law. In some states, the carrying of THC on your person can result in fines and imprisonment. Despite marijuana laws enacted, qualified physicians are at risk for being questioned by authorities, its recommendation and use is not for the faint of heart on the part of physicians and patients. Cannabidiol comes from hemp oil and is not considered illegal. However, anyone who even has 1% hemp oil in their product can still label that product as cannabidiol, which may be the reason why some patients are not getting the full medical effects when bought from the flea market or a vitamin store.

 Tetrahydrocannabidiol which is more well-known for its recreational use and concomitant psychoactive properties at very high doses is federally illegal in many states. Many states often have registries so patients who require this may obtain an ID and verify they are under the care of a qualified physician. It can take a few months to obtain an ID because many patients are often at the end of their ropes in terms of effectiveness of medications. Many patients wish to come off opioids or do not like the idea of needing higher and higher pain medications for their chronic illnesses. It may serve as a great antidote for the current opioid crisis that is well-documented in the news or overdocumented in the news. Many mothers order products online from other countries to counteract the illegalities of their states in order to help their child who may be using 4 potent anti-epileptic agents and is now like a zombie because of the number of medications. While physicians are leery suggesting anything that is in category 1, its medical value cannot be disputed. There is too much evidence tipping it towards the other side of the scale. As tPA was in its infancy of use and physicians were hesitant using it due to its hemorrhagic adverse effect and is now the standard of care for stroke protocols, medical marijuana will likely find its way back into the pharmacopeia, the amount of medical evidence is far too compelling to ignore.

In conclusion

In short, when used wisely, cannabidiol is a non-intoxicating effective treatment for many medical conditions especially neurologic, as evidenced by thousands of years of history of its use and current animal models, clinical trials and wider clinical experience in Europe. When cannabidiol is combined with low concentrations of THC, the medical effect is even greater with the entourage effect without the stigmatized psychoactive effects that are usually associated with THC.


Monday, 19 March 2018

What Causes Your Nerve Pain? (Vid)

Today's video and transcript from (see link below) is an excellent use of 5 minutes to explain the causes of neuropathic pain. The doctor explains what's happening to your nerves and why, in a straightforward and easy to understand manner. The transcript is also shown below to help absorb the information better. Well worth your time, even if you think you already understand the subject quite well.

Causes of Neuropathic Pain Video
Video presented by Zinovy Meyler, DO

Video Transcript 

 Neuropathic pain differs from other types of pains and in order to start talking about neuropathic pain, it's important to remember what pain actually is. So, nociceptive pain or pain that we sense usually is nerves transmitting an impulse and letting us know that there is a damage or injury to part of our body. Neuropathic pain is an actual pathology of the nerve itself. Nerve consists of its body, which is the axon, which is the part that usually gets injured and when that axon is injured what happens is abnormal transmission of impulses. It's important to remember that it's not nerves communicating an injury elsewhere, but the process in the nerves themselves. Neuropathic pain itself presents differently from other types of pain. So, neuropathic pain is likely to be severe. It is usually sharp. It is electric shock-like sensation that people usually describe. It is lightning or lancinating type of pain that most people talk about when they describe neuropathic type of pain. Accompanying that, it can be a deep burning or, at the same time, it can also present as coldness in the limbs or distribution of that nerve. It also comes, at times, with persistent numbness, tingling, or weakness of the muscles that nerve supplies. Neuropathic pain usually travels along the path of the nerve itself. Because the nerves have different function - some nerves are motor nerves, some nerves are sensory nerves - if the sensory part of the nerve is affected, it can alter sensation. Now, it can actually decrease sensation - in other words, create numbness - or it can heighten sensation where normal stimuli are now painful or altered - so something that would usually be a normal muscle sensation, such as light touch, can become a painful sensation. There are many causes for neuropathy or neuropathic pain affecting the nerves. Some of those are compression of the nerve. Now, compression of the nerve can occur anywhere along the path of the nerve. It can be as it exits the spine and travels onward, as in radiculopathy - or in other words, pain arising from compression of the spinal nerve before it exits the spinal column - or it can be peripheral nerve compression. And many of us know what it feels like when we cross our legs and the leg goes numb - that is compression of the peripheral nerve and usually that recovers by itself, but if that compression remains for a longer period of time, then that can become not necessarily permanent, but the recovery from that can take months and sometimes even a whole year. Other sources of the neuropathy can be systemic processes, such as diabetes. Diabetes is a microvascular process decreasing the supply of nutrients to tissues as well as nerves and that tends to be what's called a "length-dependant process," in other words, nerves that are longer tend to be affected first and that's why people with diabetic neuropathy tend to feel their feet being affected first because the nerves are that much longer, so those nerves tend to be affected first, then the hands follow that because they are the next longest nerves in the body. That being said, any process that can damage tissue can also damage nerve tissue. So, what I mean is treatments like chemotherapy - there are different chemotherapy agents that can alter different processes that the nerves depend on and some are actually neurotoxic - in other words, they are damaging the nerves directly. Now, chemotherapy affecting the nerves can appear at the time of the treatment, but it can also be a delayed presentation of that neuropathy. Also, radiation; a process that radiation causes, in the long run, can come up as post-radiation fibrosis. In other words, tissues fibrose and contract and can affect the nerves and that can cause neuropathy as well.

Sunday, 18 March 2018

Which Side Of The Pain-Killer Fence Do You Sit On? (Vid)

Today's video from Jon Gold (see link below) is short, simple and to the point. It asks for common sense on the part of law-makers, doctors and patients regarding pain killers - nothing more, nothing less. However, it's simplicity takes nothing away from the fact that it's highly controversial in this day and age. The truth is that people living in chronic pain would give anything to have their pain removed but equally would do anything to avoid having to take the strength of pain killers required to do just that - they live daily between a rock and a hard place but until there is a suitable and efficient alternative in place, they have no choice if they want to live anything remotely close to a normal life. Public opinion, law-makers and the media want to remove their only remaining option at a stroke but it's clear to all, that those people are not living with the consequences of chronic pain caused by illness. The media is never patient when it comes to bandwagon jumping but that creates a total lack of empathy with the patient. Watch the video and draw your own conclusions because the current situation where stigma and even hate dominate medical prescription cannot be allowed to continue.

Pain Killers Help People

Jon Gold Saturday, June 3, 2017

Don't allow people that truly need them to suffer.

Pain Killers Help People from Jon Gold on Vimeo.

Saturday, 17 March 2018

Acute Versus Chronic Pain: What's The Difference?

Today's post from (see link below) looks at the differences between acute and chronic pain and how they can affect your daily lives. Many people are not sure what sort of pain they have but luckily, if the pain goes away after a while, the brain has the ability to forget what it was like. If that pain persists, so that they have to learn to live with an unending daily cycle of pain, then the picture is very different. The outside world tends to see pain as pain and not be able to discern a difference but however unpleasant acute pain can be, it's nothing in comparison to chronic relentless pain that you are forced to learn to live with. This article addresses the issue and hopefully clears up the doubts in people's minds. It sounds depressing but if you have acute pain, you have hope because you know it will go away eventually. Chronic pain, as with neuropathy for instance, is a bit like having a life sentence and requires a mind set adjustment that for many people is extremely difficult and certainly life-changing.

Chronic vs Acute: Similar But Not The Same
hillaryrobyn 11/30/2017

Since my journey with pain started a few years ago, I’ve heard a lot of opinions about the subject. I’ve touched on this issue before, but today I’d like to go a bit further in depth about it.

Although they seem similar, chronic illness/pain is much, much different from acute illness/pain.

Acute Pain

In medical terminology, acute means an injury or illness that comes on quickly but lasts temporarily. For instance, if you break your arm, your pain is probably going to be terrible, but it won’t last. If you wake up one morning with cold symptoms, you might have an acute upper respiratory infection. It’s going to suck, but it’ll pass. 

Chronic Pain

The term chronic is applied to any health issue that will last longer than three months. For instance, high blood pressure and diabetes are generally chronic. Autoimmune disorders and diseases like MS are chronic and generally progressive in nature, meaning they’ll continue to worsen over time. 

The Difference

Acute and chronic pain affect everyone differently. Acute pain or illness is no fun, that’s for sure, but it’s so much better than chronic pain or illness because it goes away. Anyone can handle a few days or even a week or more of an illness, but dealing with it for years and possibly the rest of your life is a different matter entirely.

For example, most people have woken up with a crick in their neck after sleeping wrong at some point in their life. And it sucks. The discomfort is under the surface and you can’t turn your neck without sharp pain. You take over the counter medications but nothing seems to touch it. For a couple of days you’re just miserable. But then, you wake up and it’s worked itself out and you’re back to normal.

Imagine, though, if that last bit never happened. That you never wake up “normal” again. That day in, day out you’ve got this crick in your neck that won’t go away and that won’t subside no matter how much ibuprofen or Tylenol or Aleve you take. It’s absolutely exhausting.

Then, on top of that, add in the pain that radiates from your neck. Many chronic neck problems cause issues with the nerves that run through the rest of the body. When a nerve is impinged in the neck, it causes problems all throughout the body. Depending on the location of the problem, you can have pain down one or both extremities and/or up into the head. And it’s constant. The location and type of pain may vary, but it doesn’t stop.

Depending upon the cause of the pain, there may or may not be a way to fix it. You might be able to have a surgical procedure, but there’s no guarantee that will work. As a matter of fact, it’s likely to make things worse. You can try alternative treatments like essential oils and chiropractic adjustments, but those will either do nothing or help momentarily. You can buy new pillows, you can change your bed, you can use ice or heat, but all of those things are just temporary solutions to a chronic problem.

This doesn’t just apply to pain, either. There is a difference between being tired because you stayed up all night and being fatigued because you’re sick. To know the difference, think about how you feel after a night’s sleep. If you go to bed exhausted and wake up refreshed, that’s not fatigue. If you’re sleepy but functional, that’s not fatigue.

Fatigue is the constant feeling that you’re walking through molasses. Your brain may want to do things but your body will not comply under any circumstances. Fatigue doesn’t go away with rest or sleep. It’s not a comfortable sleepy feeling, it’s an uncomfortable exhausted feeling. You feel as if all of the earth’s gravity has found you and is pushing you to the ground. 

Final Thoughts

Basically what I am trying to say here is that there is no comparison between acute medical issues and chronic. If you’ve only ever had acute pain, you cannot know what a person with chronic pain is dealing with. Just the same, if you’ve only ever been tired, you can’t know what a person with fatigue is dealing with.

If you’ve had pain that was helped by over the counter medications, that’s wonderful! If you’ve overexerted yourself and it only took one night of sleep (or even a couple) to get better, awesome! But just imagine that the pain never stopped and the tiredness never lifted.

If you’re talking to someone and they mention that they have a chronic health issue, try to empathize with them instead of drawing solely from your experiences. They are not weak because they need pain medications and you don’t. They’re not broken because they need anti-depressants and you don’t. They’re human, just like you. The difference is that they are dealing with a lifetime of sickness and you aren’t.

Friday, 16 March 2018

Chronic Pain And Anxiety: The Chicken And Egg Conundrum: Which Comes First?

Today's long post from (see link below) addresses the 'chicken and egg' problem of which comes first:- anxiety or pain and whether either have a significant effect on the other. It may be lengthy but you won't be bored reading it because it's so accessible and can teach you so much about how your body and mind respond to pain (especially nerve pain). I defy anybody suffering from neuropathy to deny that they have periods of extreme anxiety and worry that their problems are getting (or are going to get) worse. With any disease for which there is no cure and only sticking plaster treatments, the mind will play tricks on you, if only out of frustration but also from the relentless symptoms. The question is; can we use those brain processes to help alleviate the pain instead of letting them take over and make the problem worse? This article looks at what's going on and what you may be able to do about it. Because it's simply explained and discussed, you won't start yawning half way through. It's an article that seems to apply to your own particular case (whatever your situation and level of discomfort) and for that reason is absolutely worth a read - maybe not all in one go but it certainly provides food for thought.

Anxiety & Chronic Pain
A self-help guide for people who have both anxiety and chronic pain
updated Mar 5, 2018 (first published 2006)
by Paul Ingraham, Vancouver, Canada bio


Conversations about chronic painful problems routinely turn into conversations about anxiety. It begins with a statement like “I hold a lot of tension in my back” or “This pain is always the worst when I’m under a lot of stress.” And it often ends up at the chicken and the egg question: did anxiety cause the pain, or is the pain causing the anxiety? (Hint: it’s both.)

Excessive and chronic anxiety is a potent root cause for an awful lot of back pain, probably neck pain,1 as well as virtually any other kind of chronic pain,2 and even a bizarre array of other physical symptoms3 (WebMD has a good complete list). It almost certainly amplifies pain perception and suffering across the board, but it gets worse: it may also actually cause pain we wouldn’t otherwise have, by actually making us more prone to inflammation.4 Although the treatment of anxiety is outside my own expertise, as a “pain guy” it feels like familiar territory to me: anxiety is the other side of the chronic pain coin.
Anxiety is a feeling of worry, nervousness, or unease. Generalized anxiety disorder (GAD) occurs when that feeling gets chronic, excessive, uncontrollable, irrational, and associated with surprisingly diverse symptoms. At least 3 symptoms must drive you nuts for 6 months for a formal GAD diagnosis.5

Some anxiety is essential for our survival — a prehistoric human that didn’t worry wouldn’t live long — but it probably evolved as a strategy for anticipating and neutralizing threats that we no longer face. Anxiety disorders are a frustrating glitch in the modern human condition. Treating them can be like like fighting smoke. The basics of therapy for anxiety are obviously insufficient for many people. Exercise is valuable, but most people can’t beat anxiety just by working out, especially if they are in pain. This article zooms in on some practical, creative, and efficient strategies for calming down and “hacking” anxiety — extra tools for an “everything but the kitchen sink” approach.6

There’s also some whimsy. Because anxious people need some of that. 

Medical causes of anxiety: anxiety as a symptom

Anxiety is rarely just about biology or psychology. Except when it is.

We humans are chemistry, and nothing could make this clearer than the chilling story of an old family friend who suffered lifelong anxiety and panic attacks. Some patients will find that pain is only one of many ways that they are haunted by their anxiety demons. After decades of living with this curse, he was diagnosed with a rare genetic disorder. One of the consequences of this genetic disorder are small tumours on the adrenal glands that cause spikes in adrenalin production. He had one on his adrenal gland. The gland was excised, and he was cured — or perhaps “set free” would be a better description.

That’s an exceptionally rare cause of anxiety, of course. But don’t neglect the possibility of a medical explanation or complication. Some of them are much, much more common. For instance, we know that insomnia is a major risk factor for anxiety disorders,7 so anything that interferes with sleep — practical or pathological — is obviously an important consideration.

Or pain: pain is extremely common, and can be both the cause and consequence of anxiety — sometimes equally, sometimes slanted much more one way than the other, but each always influencing the other to some degree. For many people with both anxiety and pain, solving the pain is the best possible treatment for the anxiety. Others must solve both at once. And a few will find that pain is just one of many ways that they are haunted by anxiety demons.

Anxiety can be magnificently destructive, but when combined with chronic pain it becomes paralyzing.

How I learned to cope with chronic pain, Ettenberg (

Another interesting example, and a bit chilling, with a strong tie-in to chronic pain: some people may be anxious because they have irritated spinal cords, which occurs in some arthritic necks and can cause the body to react as if it were stressed.8 It’s also been found that many people with fibromyalgia also have erratic spinal cord compression,9 which has profound implications: fibromyalgia might not only associated with stress, but also with “artificial” stress brought on by a mechanical spinal cord irritation.

Never in the history of calming down has anyone ever calmed down by being told to calm down

That’s not strictly correct, but it is funny because it’s true in a sense. Being told to calm down in the right way, or telling ourselves, can be effective. But that “right way” is maddeningly elusive. Most people feel like being “persuaded” out of anxiety is a tall order; it’s hard to outsmart it, or suppress it by force of will. We don’t feel good at calming down. Here are some of the typical ways that people reflexively try to calm down (AKA “cope with anxiety”):

We tell ourselves to “get over it,” and that really doesn’t work. (But it can.)
We apply logic and reason, telling ourselves that it doesn’t make sense to be so anxious, and that doesn’t work either. (But sometimes it does.)
We seek out the logic and reason of others, of friends with perspective and experts with authority, and that usually doesn’t work. We still worry, we still feel jittery. (But, again, sometimes it works.)
We try to distract ourselves, and sometimes that sort of works — but only temporarily.
We try to sweat it out with exercise, and that may be the best solution that many people use. But it can still be unsatisfying. It takes a good chunk of time and energy, it doesn’t always work, and you can’t exercise all the time.

These aren’t “best practices,” just the easiest and most obvious things that worried people tend to try. That doesn’t mean they are are useless, and if you haven’t tried them, you should.

But most of them are just variations on telling ourselves to calm down, and they are hardly a magic bullet. Although they work some of the time for easier cases, many people with anxiety disorders have had little luck with these strategies, and we probably wouldn’t have an anxiety epidemic if they were highly effective. By nature, we can’t easily think our way out of anxiety. It’s like telling a depressed person to “think positively” — if they could do that, they wouldn’t be depressed!

But there are are other, better ways to calm down. And what if you had professional help with that?

Never in the history of calming down has anyone ever calmed down by being told to calm down.

~ unknown

It’s as if people expected us to will it away. If only we had thought about being more positive! How silly of us.

How I learned to cope with chronic pain, Ettenberg (
Can a psychologist help you think your way out of anxiety? The state of the evidence about cognitive behavioural therapy for anxiety

Cognitive behavioural therapy (CBT) [Wikipedia] is a dominant force in psychotherapy and the most common treatment approach for anxiety. It’s how most psychologists will try to help you “think your way out.” And behave your way out.

CBT is widely considered to be a proven therapy for anxiety, and some specific types have especially firm foundations.10 It seems to work fairly well in a primary care setting,11 and it seems to be great for kids.12 But the benefits compared to placebo are underwhelming, and a technically positive 2018 review showed results that were less than impressive, and concluded that “better treatments are needed.”13 The benefits are especially less clear for older adults,14 and it’s definitely underwhelming when there’s pain and strange symptoms involved.15 In other words, CBT is may be the least effective when it matters the most (when anxiety is driving the most intense symptoms). 🙁

Overall I’d call the evidence for CBT promising, but from from settled science or “proven.” As an excellent example of the deep, scary complexity, there’s fascinating evidence that CBT may fail to treat chronic pain in some people because they are too inflamed, not because the inflammation is directly painful, but because the inflammation modifies mental state and behaviour and that makes the pain harder to treat!16

There’s some decent evidence that cheaper iCBT is “here to stay.”17 iCBT is Internet-delivered CBT — isn’t that cute? So maybe you’re even getting less anxious right now, reading this charming and reassuring article. You should probably keep reading!
Theory vs practice: you’re not always going to get ideal CBT

It’s easy enough to get optimistic about CBT in the abstract (the scientific evidence), but in my personal experience with several psychologists over the years, and based on a lot of communication with readers… well, let’s just say not all CBT is created equal. There’s a great range of quality and creativity in its application, a big gap between the best possible CBT and the kind that many people will actually encounter in “the wild” — being sold for a bare minimum of $100/hour. (Which is why a more accessible iCBT option is intriguing.)

Good CBT probably gives you a better chance than winging it on your own, but it’s still not an easy road. And its most common weakness in practice seems to be an unfortunate overemphasis of the thinking part — using conscious thought as leverage. Which I cynically assume is an issue simply because that’s what is easiest to do in a therapy session.18

Thinking may be what gets us anxious in the first place, and it may be hard to fight fire with fire, hard to use calming thoughts to subdue or replace worried thoughts. Or, worse, worried thoughts may over time become embodied, so entrenched in our behaviour and biology that they are no longer just thoughts — and fresh attempts to think less worried thoughts may have little impact, especially at first.

Fighting, flighting, tending, and befriending

The famous fight-or-flight response is a biological response to acute stress, and is more common in anxious people but not synonymous with anxiety. Someone suffering from chronic and excessive feelings of worry, nervousness, or unease is not necessarily in a panic. The anxious person is more likely to spend more time in this mode, either because they actually face more threats, or because they perceive more threats than there actually are. But we can worry about threats without ever actually experiencing one. Or reacting as if there’s one. My own childhood was a textbook case of that.19

There are other ways to respond to acute stress. We aren’t limited to fighting and flighting. There is also the much less famous tend-and-befriend response, for instance, a different behavioural strategy in which threats are dealt with more socially: tending to children, or seeking out the safety of the group and befriending people.

Stress pushes us to perform, and so anxiety can be helpful — to a point, after which we get a bit messy.20 “Panic” is the breakdown of performance during extremes of arousal (acute stress reaction, AKA “shock”). And if that reaction is delayed/chronic after exposure to traumatic events? That’s PTSD.

All of these things are linked to anxiety, but do not necessarily go together. 

Does stress wreck us?

Many people have heard of “adrenal fatigue” (or adrenal insufficiency, or adrenal dysfunction). It is supposedly caused by chronics stress and “burnout” of the adrenal glands. And yet it probably doesn’t exist.21

And yet we do know that post-traumatic stress disorder and childhood adversity are strong risk factors for developing chronic widespread pain.2223 So how does that work?

No, stress is not your friend This is the big idea of an extremely popular 2013 TED talk by Kelly McGonigal, and the book that inevitably followed it. Supposedly you are insulated from the health consequences of stress if you just reframe it as a healthy response to a challenge. It’s nonsense on many levels, basically extravagant overinterpretation of a research artifact, as many critics have explained, but “a lie gets halfway around the world before truth puts on its boots.” McGonigal’s talk has become one of the classic examples of the empty sensationalism of so many TED talks.

It’s a common assumption that stress and anxiety have biological consequences, like adrenal fatigue, that drive up the risk of pain later in life, but a 2015 study of 2000 Dutch citizens over six years “could not confirm” those biological consequences.24 Their data did affirm the link between having a rough time in life and chronic pain — people who struggle emotionally are definitely at risk of starting to hurt more — but this occurs independently of any obvious, measurable biological changes, like adrenal fatigue.

If the study results are reproduced by others, it’s kind of a big deal; it implies that there is some other mechanism by which stress makes us vulnerable to pain, and the authors suggest that “psychosocial factors play a role in triggering the development of this condition.” This could be as simple as just saying that stress is directly sensitizing, that it cause a long-term or even permanent increase in the sensitivity of our brain’s threat-o-meter. Or it could be much more complex: people who suffer severe stress are probably more likely to do poorly in their next phase of life, losing income, status, security, friendships and romances, which opens up many possible paths to illness and pain.25

Or the study might have gotten it wrong. 😉 What if the changes causes by stress just aren’t “obvious”? That seems likely: this research was at odds with a fairly large body of evidence that stress is indeed hard on the body in a variety of ways, just not adrenal fatigue, and perhaps not in “obvious” ways that would turn up years later.26
Anxiety has a biological signature (and it’s sneaky)

Many anxious people are not obviously anxious. Anxiety can be “sneaky.”

It’s a common human pattern to control and hide anxiety from others and from ourselves by minimizing its expression, and especially by embodying it — by getting more still and tight. The British “stiff upper lip” is common around the world, and the tip of an iceberg of physical stoicism.

When people dismiss anxiety as a factor in their health, it’s often because they don’t think of themselves as a “nervous person.” But that doesn’t rule out anxiety: we can be anxious without being prone to anxious. Anxiety can be a recent and sometimes surprisingly subtle development in life, at odds with a much older self-image. Anxiety can be a recent & sometimes surprisingly subtle development in life — at odds with an established self-image.

The anxious state is heady. Without thinking, there is no anxiety. It’s a mental state, characterised by the persistence of ideas about problems and dangers. People who lose their ability to think clearly due to stroke report an “ignorance is bliss” state (see below). When we are anxious, we are “in our heads,” as opposed to being “in your body” or “comfortable in your skin.” The more acute the worry, the busier the mind becomes, your brain switching to spin cycle, scanning more vigilantly for dangers — most of them imaginary.

But as heady as it is, anxiety is also physical. Whether it is obvious or not, anxiety involves a distinctive set of changes in behavior and biology.

Adrenalin and cortisol — the stress hormones — may flow too freely and for too long. Of course, this has many adverse effects, and constitutes a genuine medical hazard.27

And many of of us try to hide it. We clamp down on it, try to suffocate its expression. We use muscular tension, stillness, and a lack of breath — like a rabbit freezing to avoid predator detection — to try to manage the churning and sinking sensations in the belly that come with worry, to hide them from ourselves and our friends and family.

These processes are so physical and habitual that they are difficult or impossible to interrupt by force of will. Once it starts, most of us are doomed to a few hours of whirling thoughts, and the physical consequences: back pain or neck pain, a throbbing headache, or insomnia28 are all common embodiments of stress (but there’s much more).

Anxiety and language are closely related. When Lauren Marks had a stroke, she woke up days later in the hospital without her words… and without anxiety, either. Aphasia is a bizarre loss of language due to brain injury.

Lauren had no internal monologue, and a vocabulary of only about forty strangely random words, but rather than being panicked by this state of affairs, she was blissfully ignorant of all her problems, because she did not have labels for them anymore. She felt calm and content. She did not have the vocabulary to worry.

I couldn't have been any more peaceful and satisfied. … Some people lose their inner monologue and some people do not. I did. So I didn't have that little voice chiming in saying, ‘Oh, you're in a world of trouble, Miss Marks. You are in a world of trouble…’ I didn't receive that message.”

Listen to this brilliant short podcast about her case of aphasia: “You learn a lot about language when you lose it.” Fascinating! Now if only there was a way to harmlessly and temporarily induce aphasia! 

Make it more difficult to worry

An anxious mind cannot exist in a relaxed body.

Edmund Jacobson, founder of progressive muscle relaxation and of biofeedback

You can treat anxiety by making it harder to remain anxious.

In practicing the martial art of aikido, you don’t throw a person with brute force, or even with clever leveraging (as in Judo) — you simply position yourself in such a way that your practice partner finds it difficult to keep his balance.

Similarly, in some postures it is difficult to keep your worry. For instance, it is almost impossible to worry intensely if you adopt a confident posture, draw your attention downward into your trunk, and restore vitality and movement and breath to the belly. If you “contradict” the physical patterns of anxious state.

This can be called “grounding.” A lack of grounding is the mind-body pattern at the heart of anxiety. You probably can’t “get over” anxiety without some kind of grounding.

Once you are grounded, you won’t necessarily stop worrying! However, it will be harder to worry, and logic and reason might start to have some influence again. Many other responses to anxiety become easier. Once you are grounded, maybe then you have a shot at outsmarting your anxiety.

But grounding comes first. 

Efficient grounding when it counts

Some well-chosen, specific grounding exercises can be done in two minutes in the office washroom, right after that incredibly irritating meeting with your boss.

They can be done quickly in the middle of the night when you have insomnia and don’t have the will to do anything challenging. You don’t have to get up for an hour and do yoga, or run up and down the apartment building stairs.

Unfortunately, most people don’t know that grounding exercises can be this quick and relevant to a crisis — assuming they know what grounding is in the first place!

Grounding is associated with all those flaky eastern spiritual disciplines and calisthenics: yoga, taijiquan, qigong, meditation and so on. Most people treat these things as slow and preventative medicine for stress, instead of a source of efficient and curative responses to episodes of anxiety.

People who are devoted practitioners in the preventative spirit may get paralyzed when anxiety strikes, forgetting everything they ever learned about yoga. It’s easy enough to do calming and grounding exercises when you are already calm. The challenge is doing them when you are not!

To beat anxiety, you need to do efficient grounding exercises as a direct response to anxiety. An hour of yoga is not efficient. Neither is a run on the sea wall, or a game of squash, or sitting meditation.

What is?
Move happy moves

For more about the relationship between mood and posture, see my huge posture article.

Posture and movement might be able to create and reinforce emotional states.29 And, if posture can change emotions, it’s no surprise that it might also change pain sensitivity — and there is science that suggests it can.30 So, here’s an easy science-y anxiety and pain relief tip: Stand tall! Bold posture. Or, as a mentor of mine liked to put it, “Tits up!” Or as Todd Hargove of Better Movement put it:

It is usually quite obvious to people that changing their thoughts might be a good way to change their mood. For example, people might try to combat sadness or depression by “thinking happy thoughts.” Another possible approach would be to “move happy moves.”

“Move happy moves.” What a fun phrase. What fun advice.

So, when you are anxious or depressed, try combatting simply by standing like a master and commander. Do it like a drama class exercise: make it big and silly, have fun with it. (Subtle is good, too — depending on the circumstances.) It’s certainly not guaranteed to work, but no harm in trying.

To pretend to be calm is to be calm, in a way.

Gillian Flynn, Gone Girl 

Change the beat: the metronome trick

Anxiety often involves racing thoughts, which are even more obvious when you attempt a meditative exercise such as focus on your breathing. If you lie down in a quiet room and try to simply count to 100 in your head, you might notice that your natural counting pace is set to “ridiculously fast.” Counting out loud might help to slow you down a little, but your brain still wants to rush ahead. Sometimes it’s almost impossible to rein it in with willpower.

So use metronome to first match and then tame your mental tempo. (Thanks to smart phones, almost anyone can conveniently download a free metronome app — no need to actually go shopping for a metronome.) Basically, count to 100 several times, a little slower each time, using a metronome instead of willpower. By all means tap your foot or a finger or some other gesture as well. Make it musical. This is called “entrainment.”31
Set the metronome to a pace that matches the speed your brain wants to go. Try 100 beats per minute, for example. The idea is not to fight your natural impulse. Go with it for at least a minute.
Slow the metronome down: drop it 10 beats per minute lower, to 90bpm, and count to 90. (Notice that each step will take a minute if you do it this way. You could also keep counting to 100 at a slower and slower pace, but I like the symmetry of one-minute steps.)
Now set the metronome to 80bpm and count to 80…
And now 70bpm and count to 70…
And so on…

Obviously you can fiddle with the variables here: for instance, you could take smaller steps, or spend longer at each tempo. But if you systematically match a slower and slower metronome pace, your racing thoughts are likely to stop racing. At least for a while.
Change the beat: box breathing

Here’s another way of “changing the beat,” a minor tip but a good one, which is handy for managing anxiety in public situations, when you need to calm yourself discreetly. When your mind and heart and breath are racing, it can be difficult to switch to a measured, slower, deeper breathing pattern. So find a box to put it in.

Look for a rectangle like the side of a building, or a doorway. It may help your focus to anchor the breathing pattern to something you can see. Each side of the box represents a breath in or out, or a pause: breath "up" the left side, hold across the top, breath down the right side, hold across the bottom, and so on.

Set a comfortable pace and depth, as long as it's at least a little bit more slow, regular, and deep.

Now that’s a door! Any old rectangle in your field of view will do. 

Get a massage

Getting a massage isn’t exactly efficient or cheap, but it may be an extremely effective method of grounding and relaxation. Literally all non-human primates groom each other — “social grooming” — and this is clearly a behaviour used for stress management. It is a near certainty that humans can benefit from the same kind of interaction, and massage is basically just ritualized, formal social grooming, without the parasite eating. Or you could pay for a cuddling service. Yes, that’s a real thing these days. Or, ahem, certain other services. The common denominator here is touch. Massage is basically just ritualized, formal primate social grooming, without the parasite eating.

There’s no denying that massage is pleasant — for most people — but its medical benefits are much less clear and proven than you might think. Myths about massage abound. For instance, massage does not flush lactic acid out of cells, or meaningfully increase circulation, or reduce inflammation. Maybe it reduces cortisol levels, but even that popular notion is far from proven, and there is actually evidence that it’s wrong.32 Even in the unlikely event that massage actually does reduce cortisol levels, the phsyiology of stress is much too complex to assume cortisol reduction is in itself a meaningful, good thing.33 There’s just too much going on.

While many benefits of massage are still disconcertingly uncertain and hotly debated (by some), there are two truly proven ones. Dr. Christopher Moyer explains that the only truly confirmed benefits of massage are its effects on mood (“affect”),34 specifically:
massage reduces depression
massage reduces anxiety

And more massage is probably even better. Dr. Moyer:

We made an interesting discovery concerning the effect of the treatment on state anxiety. When a series of massage therapy sessions was administered, the first session in the series provided significant reductions in anxiety, but the last session in the same series provided reductions that were almost twice as large. This pattern was consistent across every study we were able to examine, which strongly suggests that experience with massage therapy is an important predictor of its success, at least where anxiety is concerned. To put it another way, it is possible that the greatest benefits come about only when a person has learned how to receive massage therapy.

So this should be a no-brainer: getting a massage is a better idea than taking meds in almost every possible way. It’s probably not cheaper. But it’s definitely better.
The abdominal lift

Yoga, taiqi, qigong, meditation are all full of exercises that can be done individually with great effect, if one has a clear, specific goal such as “efficient grounding when freaked out.” Here is the single best example, in my opinion, effective for most people, most of the time:

The abdominal lift is a classic yogic exercise, best known as a longevity exercise for its stimulating effect on the internal organs. It is also a powerful abdominal strengthener (including the rarely exercised transversus abdominis), is vital for mastering many breathing techniques, and makes all other breathing exercises easier.
Stand with your upper body supported on your knees.
Take at least three, oxygenating deep breaths to prepare yourself for the first lift.
When you feel you have oxygenated sufficiently, blow all of your air out. Completely flush your lungs, and then hold your breath.
Suck your belly in hard against your spine. Particularly focus on your low belly, below the navel. Hold the position and your breath for several seconds (go as long as you can), and then relax the belly — before breathing again (if you try to breathe before relaxing, it can hurt a bit).

Resume breathing.

One abdominal lift takes about one minute, and three of them is a good dose of grounding, although I recommend five for tough cases.

After an abdominal lift, the physiological pattern of anxiety has not just been disturbed but reversed, and now you are ready to “get over it.” 

More examples

Other great examples of efficient grounding exercises from qigong include:

Lightning bolts. Leap into the air with a big breath, and as you come crashing and stamping down, blow out hard and flick your arms and hands straight downwards, as though throwing lightning bolts into the ground. Ten of these, followed by some stillness, is wonderfully grounding.

Crane Spreads Wings Stand with your feet together, hands folded across your chest, hunched over. Breathe in and “spread your wings” — not just spreading your arms, but leaning back a little as well, opening way up, chin high, a strong line of tension through the chest and the belly. Close up again. Repeat several times.

And it’s not just the eastern spiritual disciplines that can be mined for useful grounding exercises. The anxiety pattern can also be broken by exercises drawn from many western traditions, such as Reichian body work or cognitive therapy. Here are two more examples:

Mental Propaganda. Worrying is a mental rut. Cognitive therapy suggests building new pathways with specific, deliberate mental alternatives. Write down a positive set of thoughts that are a specific alternative to the worrying pattern. Read them out loud in your head five times. (Why is this a grounding exercise? Because your mind and body are one system. It doesn’t matter whether you change the anxiety pattern in the head or the body first, just so long as you change it.)

For example, I survived a bad, scary year — in the aftermath of a terrible accident my wife had — by constantly writing and re-reading a document I called, heartbreakingly, “some notes on dealing with despair.” It was basically a series of the most reassuring things I could think of: elaborate blessing counting. It was quite carefully crafted, and it reassured me to craft it. Simply working on it was as much a part of the self-therapy as re-reading it. The challenge of thinking about and expressing good and reassuring thoughts was quite helpful. There were many nights I don’t know how I could have gotten back to sleep without that exercise.

Round Breathing. Twenty-five fast, deep clear breaths, without pausing at the top or the bottom, can ground you more completely — bring you back into your body — than most people will feel after any amount of meditation. This is hyperventilation, yes, and you may feel dizzy and that’s fine. For much more information, see The Art of Bioenergetic Breathing.

The examples I’ve offered you here are the tip of the iceberg, but you now possess the essential principles: anything you can come up with that disrupts the mental and physical patterns of anxiety will make it difficult to stay there. 

Change your environment (a.k.a. get away from assholes)

Before you diagnose yourself with depression or low self esteem, first make sure you are not, in fact, just surrounded by assholes.

not Freud or Gibson, but Notorious d.e.b. (@debihope), Jan 24, 2010 (see

More formally stated, as psychologist Dr. James Coyne put it, “depression is actually often actually misdiagnosed IED (Inappropriate Environment Disorder).”35 This applies equally to anxiety, I have no doubt. For instance, we know that macaques with low social status are treated very harshly and it has measurable effects on their immune systems: they are inflamed, they get more infections.36 Fascinating. And clearly their problem is that they are just surrounded by asshole macacques.

This is the kind of thing I mean when I cautiously counsel people to do their best to solve problems in their lives as a very basic defense against both anxiety and pain. I would never want to minimize the seriousness of mood disorders, but sometimes what looks like a mood disorder really is “just” a disheartening, stressful situation — and many crappy situations can be changed, sooner or later. Not that it’s easy. In fact, it’s often dazzlingly difficult in the short term. Consider the tragic example of domestic violence: surrounded by one asshole in particular.

But the worse it is, the greater the need. 

Nutritional supplements for anxiety: pre-biotics

The first human test of prebiotics — not the much more familiar probiotics — for anxiety and stress was conducted in 2015.37 The results were promising, and so they’ve been widely reported as good news.

Prebiotics are basically food for the bacteria in your guts, which have a strange-but-true relationship with your nervous system.3839

There are many caveats about this evidence, of course. A detailed analysis of the paper by (ERD #6, April 2015) explains that it’s not clear that the observed effects are clinically relevant:

especially since only one out of the many emotion-related variables tested was affected by a prebiotic. Assuming that prebiotic fibers could be used to “treat” anxiety or depression is a premature conclusion. sensibly notes the “bewildering array” of products available and concludes “there is much work to be done before specific clinical guidelines and recommendations can be made.” Understatement!

But we still have “promising,” and these products are likely extremely safe to experiment with in moderation. 

Nutritional supplements for anxiety: curcumin

Curcumin is the active ingredient in the bright yellow southwest Indian spice, turmeric. Curcumin has a larger evidence base [] than most other supplements, is considered very safe, and there are reasons to think it may be useful in the treatment of both anxiety and pain — making it a perfect supplement to bring up here.

For anxiety: A 2015 study of rats found that curcumin increases the synthesis of docosahexaenoic acid (DHA), which “is linked to the neuropathology of several cognitive disorders, including anxiety.”40 The increases in DHA were accompanied by decreased anxiety. Crucially, one human trial also concluded that “curcumin has a potential anti-anxiety effect.”41

For pain: In another 2015 study, “curcumin caused moderate to large reductions in pain” in 17 men with very sore leg muscles.42 It also helped some aspects of strength loss. The effect size here passes the “impress me” test. These results constitute the only really good science news about any kind of treatment for delayed onset muscle soreness — there is no other treatment for it but the passage of time. Now it just needs to be replicated! It’s completely unknown whether this effect, if it’s real, would have any effect on any other kind of pain, but it is possible.

Supplements generally have a shabby track record, and I don’t recommend many of them.43 These shreds of evidence for curcumin are promising but definitely preliminary. They are probably not sufficient for most patients to justify the cost and hassle of supplementation. However, if you have anxiety and pain and you don’t mind the expense of a supplementation gamble, curcumin is about as good as it gets.

One minor complication drives up the cost and risk of wasting your money: plain curcumin is widely available, but unfortunately it’s poorly absorbed on its own. Most bottles advertise one method or another of enhancing absorption, and some of them use it to justify a much higher price point, but it’s hard to know (maybe impossible) how well any of them actually work. Just be aware that straight curcumin may not be effective.
Consider quitting coffee

Caffeine is one of those rare pleasures in life that doesn’t seem to have much of a downside, and even has some clear benefits, mostly actual performance enhancement.44 It doesn’t even matter how much of it you drink normally: you’ll get a boost from it whether you guzzle the stuff every day, or never touch it.45 And caffeine doesn’t dehydrate you. That’s a silly myth.46 

So, for most people, caffeine is just a good thing. Sadly, people suffering from pain and/or anxiety may be exceptions. And, ironically, this may be true even though caffeine is also a mild pain-killer!47

It’s all about context and the difference between use and abuse. There’s a huge difference between a healthy athlete downing a Redbull half an hour before competition and an exhausted workaholic slamming back their third grande Americano of the day at 7pm.

Caffeine makes us hyper, and that can be somewhat exhausting. We pump more adrenalin, wear ourselves out, and lose sleep: risk factors for pain. Chronic, excessive caffeine abuse — perhaps a vicious cycle of self-medication, caffeine every morning, alcohol every night? — is likely to be an aggravating factor for anxiety and chronic pain. People in chronic pain are often already anxious and sensitized; regardless of why, artificial stimulation may be the last thing they need. Caffeine abuse — which is “common” or “practically universal,” depending on how you define it — is a plausible risk factor for chronic pain.

Casting coffee as a villain is pure speculation and seems to fly in the face of the hard evidence that it’s actually a performance aid, but actually there’s no conflict between what we know about the short term positive effects and what I fear about the long term effects. It can be “all of the above”! Caffeine can be good for pain in the short term and bad for it in the long term. (Booze has similar issues.48)

Bottom line: caffeine is a known mild analgesic and ergogenic aid, but caffeine abuse — which is probably anything from “common” to “practically universal,” depending on how you define it — is a plausible risk factor for chronic pain. Reader Kira Stoops sent me this interesting anecdote about her experience with quitting caffeine:

This is just one person’s story, but I feel quitting my morning Americano had a huge effect on my chronic pain. I’m not sure it’s so much the Americano but the chain of events…

I’ll start by saying I was prescribed Adderal, not for ADD, but because chronic pain turned me into a slug. I took one pill, the smallest dose, and shot through the roof. It was an uncomfortable amount of energy, and I started crying when it kicked in. To me, that was a sign my nervous system was already stimulated plenty, and I needed to start finding ways to wind it down more.

I’ve been drinking coffee since age 14, and figured my one-shot Americano habit was actually a healthy routine: I had to leave the house to get it, it created some social connection in the coffee shop, and the little jolt of caffeine gave me energy for the day.

Quitting was hard. But I started sleeping better right away. Many fibromyalgia patients have disturbed 4th wave sleep, and I think cutting out coffee-caffeine allowed me to sleep more deeply, and get more sleep in a shorter period of time. With more sleep, I had more clarity. Being off coffee gave me a good barometer for what my actual energy and anxiety levels were, once it was out of my system. Being able to “hear” what my body was trying to tell me helped too, so I could respond better.

I’d been plateaued at the same level of pain and exhaustion for about 6 months. Within a month of quitting caffeine, I was sleeping better, having energy longer, feeling more clear, taking on more work projects, hanging out with friends more, attending more events, and just generally finally seeing the needle move. All of these things had their own pain-lowering, positive effects. I’m still in pain (in a flare right this second) but I credit quitting that cup of coffee as the tipping point towards something better.

I just cut my afternoon green tea a few days ago, and will soon start reducing the two cups of black tea I drink daily.

I don’t think it’s for everyone. But my pain seems to come from clenching and tension, and my nervous system seems stimulated enough already. Letting coffee go helps me relax a little more. Plus, not having the morning habit forced me into even healthier morning habits. I would not have said coffee was a problem for me before. I didn’t feel especially stressed or anything by it. I thought it was a good routine. But I’m really glad I gave quitting it a shot.

And how’s it going now? Kira’s update several months later:

These cold cloudy days had me reaching for the brew…within a week of half-caf Americanos I was sleeping like crap, and within about 10 days my pain was steadily and unmistakably worse. Quit again a few days ago and started sleeping harder by the third night. Seems silly for a half-caffeine shot of espresso, but…sensitive nervous systems are just that, I guess.

It’s so delicious I miss it terribly, but less pain is worth the sacrifice.

About Paul Ingraham

I am a science writer, former massage therapist, and I was the assistant editor at for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

What’s new in this article?

Thirteen updates have been logged for this article since publication (2006). All updates are logged to show a long term commitment to quality, accuracy, and currency. more

March — Added sidebar debunking the over-hyped idea that “stress is your friend,” which came from a wildly popular TED talk.

February — Science update, based on Carpenter et al on the efficacy of cognitive behavioural therapy: “more effective treatments needed.”

2017 — New section: “Does stress wreck us?”

2017 — New section: “Consider quitting coffee.”

2017 — New section: “Fighting, flighting, tending, and befriending.” And significant revision of another: “Anxiety has a biological signature (and it’s sneaky).”

2017 — Added an sidebar about the absence of anxiety in aphasia patients — not useful, but fascinating.

2017 — Added another important example of a possible medical cause of anxiety (positional cervical cord compression).

2017 — New section: “Change your environment (a.k.a. get away from assholes).” Added a fascinating citation to the cognitive behavioural therapy section.

2017 — A significant infusion of the science of cognitive behavioural therapy, with several related clarifications and elaborations.

2016 — Revision of the first three sections: more careful use of terminology, more clarity about what this article is about, and more nuance about the idea that it’s hard to “outsmart” anxiety. Added an important citation about insomnia as a risk factor for anxiety.

2016 — Added a more formal and complete definition of anxiety to the introduction.

2016 — Added connection between anxiety and inflammation to the introduction.

2016 — Added footnote about the discovery of GABA-eating gut bacteria.

2006 — Publication. 


Shahidi B, Curran-Everett D, Maluf KS. Psychosocial, Physical, and Neurophysiological Risk Factors for Chronic Neck Pain: A Prospective Inception Cohort Study. J Pain. 2015 Dec;16(12):1288–99. PubMed #26400680.

In 2012, Paksaichol et al convincingly concluded that there was still an absence of evidence that neck pain is caused by any psychological factor. Three years later, this study was published: the first direct and reasonably high quality evidence that depression does cause neck pain. It is not perfect — it’s not a very powerful experiment (a bit small) — but at least it was the right type of study, looking at the right things. 171 healthy office workers were quizzed for a year, identifying three risk factors: depression, poor neck muscle endurance, and low pain tolerance.

Depression isn’t anxiety, of course, but there’s a lot of overlap between the two. BACK TO TEXT
Science says the broader your smile and the deeper the creases around your eyes when you grin, the longer you are likely to live. Doubtless the opposite is also true: frowning and its associated moods are almost certainly harmful over time, by many mechanisms, such as insomnia. Chronic insomnia is known to be painful. BACK TO TEXT
There’s the obvious stuff: insomnia, fatigue, mental fog, irritability, pain, sweating, nausea, diarrhea. But it gets weirder and worse: would you believe tingling and numb face, hands, and feet? Icy cold sweaty feet? Rashes? Trembling and twitching? Dizziness and shortness of breath? And these things may come out of the blue, without any apparent connection to stress or panic. (“Free-floating” anxiety is common.) Sometimes it seems like there’s not much anxiety disorders can’t do to us, especially when complicated by sleep deprivation. BACK TO TEXT
Prolonged chronic stress may contribute to metabolic syndrome (Gohil et al) by messing with the hormonal balance of the hypothalamic-pituitary-adrenal axis (HPA-axis). Metabolic syndrome in turn is strongly associated with a number of markers of systemic inflammation and musculoskeletal conditions, such as more overt examples like Frozen Shoulder Guide and less obvious ones like neck pain (MÀntyselkÀ 2010). Oversimplifying down to a few words (probably too much): chronic stress may be inflammatory. BACK TO TEXT
Association, American Psychiatric (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association. p. 222. BACK TO TEXT
“If the causes of anxiety disorders are so varied, then an adequate approach to recovery needs to be too. It is the basic philosophy of this workbook that the most effective for treatment panic, phobias, or any other problem with anxiety is one that addresses the full range of factors contributing to these conditions. This type of approach can be called quote ‘comprehensive.’ It assumes that you can’t just give someone the ‘right’ medication and expect panic or generalized anxiety to go away.” Bourne EJ. The anxiety & phobia workbook. 5th ed. Oakland (CA): New Harbinger Publications; 2010. p. 162. BACK TO TEXT
Neckelmann D, Mykletun A, Dahl AA. Chronic insomnia as a risk factor for developing anxiety and depression. Sleep. 2007;30(7):873–880.

The results of this large and well-conducted survey are “consistent with insomnia being a risk factor for the development of anxiety disorders.” BACK TO TEXT
There are strong clues that “minor” irritation of the upper spinal cord may simulate stress, firing up the same branch of our nervous system that handles emergencies (sympathetic arousal, see Holman). This would mostly occur due in spines arthritic enough to deprive the spinal cord of a nice wide, stable vertebral canal to live in (cervical spondylitic myelopathy). Although CSM is old pathology news, a low-grade crazy-making effect is new and still uncertain. And yet it’s nicely consistent with the much firmer, recent discovery that the autonomic nervous system is very disturbed in the aftermath of major spinal cord injuries, causing organ failure (see Sezer, Hagen, Hou, Stein) — this fact has been historically overshadowed by paralysis. Dysautonomia has other causes too, but tends to be associated with neurological diseases. What’s interesting here is the accumulating evidence that dysautonomia can be cause by a mechanical disturbance of the spinal cord. BACK TO TEXT
Holman AJ. Positional cervical spinal cord compression and fibromyalgia: a novel comorbidity with important diagnostic and treatment implications. J Pain. 2008 Jul;9(7):613–22. PubMed #18499527.

This study found that 71% of fibromyalgia patients and 85% with chronic widespread pain showed position cervical spinal cord compression on MRI — basically, light pinching of their spinal cord during neck extension. And so “recognition of unsuspected, comorbid cervical cord compression may provide new insight into [fibromyalgia’s] variable presentation.” Hoo boy, no kidding it would. BACK TO TEXT
Like exposure therapy, which is relevant to the phobic anxieties, and not at all to other types of anxiety. An agoraphobic, for instance, can gradually increase exposure to what they fear with longer and longer expeditions out into the world. But what does a patient with pain-dominated anxiety do? Expose themselves to more pain? The usefulness of exposure therapy depends. BACK TO TEXT
Twomey C, O'Reilly G, Byrne M. Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Fam Pract. 2015 Feb;32(1):3–15. PubMed #25248976. BACK TO TEXT
Warwick H, Reardon T, Cooper P, et al. Complete recovery from anxiety disorders following Cognitive Behavior Therapy in children and adolescents: A meta-analysis. Clin Psychol Rev. 2016 Dec;52:77–91. PubMed #28040627. BACK TO TEXT
Carpenter JK, Andrews LA, Witcraft SM, et al. Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depress Anxiety. 2018 Feb. PubMed #29451967. BACK TO TEXT
Hall J, Kellett S, Berrios R, Bains MK, Scott S. Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression. Am J Geriatr Psychiatry. 2016 Nov;24(11):1063–1073. PubMed #27687212. BACK TO TEXT
van Dessel N, den Boeft M, van der Wouden JC, et al. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev. 2014 Nov;(11):CD011142. PubMed #25362239.

This metanalysis of trials of non-drug treatments for somatoform disorders and medically unexplained symptoms (which are closely related to anxiety disorders). It’s mostly about cognitive behavioural therapy, and it largely damns CBT with faint praise. Although “CBT reduced somatic symptoms” compared to doing nothing, the benefits were small and highly variable, as measured in too few studies of only low to moderate quality. BACK TO TEXT
Lasselin J, Kemani MK, Kanstrup M, et al. Low-grade inflammation may moderate the effect of behavioral treatment for chronic pain in adults. J Behav Med. 2016 Oct;39(5):916–24. PubMed #27469518. PainSci #53548.

Forty-one patients with chronic pain (at least six months, many much longer) were tested for signs of systemic inflammation. They all had stable medications, and no major complications. Then they were provided with two kinds of behavioural treatments for several weeks, measuring their progress in several ways.

Unfortunately, no one did well: “No substantial overall effect of behavioral treatment on pain intensity and pain-related variables was found in the present study.” So that’s a sad result for these behavioural therapies.

However, there is a scrap of backwards good news here: the patients with more inflammation “were more resistant to the improvement in pain intensity and in psychological variables contributing to pain.” Note that the mechanism of that effect is probably not that inflammation directly makes pain harder to treat, but actually modifies mental state and behaviour and that makes the pain harder to treat.

The authors believe that this data tentatively “suggests that the inflammatory state may be one of the mechanisms of the persisting behavioral alterations in patients who do not respond to treatment, corresponding to previous studies on treatment resistant depression.” BACK TO TEXT
Andrews G, Newby JM, Williams AD. Internet-delivered cognitive behavior therapy for anxiety disorders is here to stay. Curr Psychiatry Rep. 2015 Jan;17(1):533. PubMed #25413639. BACK TO TEXT
For instance, in one of my most direct experiences with real-world CBT, the therapist labelled her work as “CBT” but was completely fixated on just talking about my personal history, like a classic psychoanalyst. When gently challenged, it became clear that she had only hand-wavey explanations for how this constituted CBT, and there was no end in site: she was going to indefinitely take my money while listening (expertly I’m sure!) to me talk about my past. “CBT” for $180/hour, ladies and gentlemen! BACK TO TEXT
I was small and definitely at risk of being bullied, but I was also very good at avoiding it and rarely faced a real threat. So I worried plenty, but in my entire childhood only faced a violent situation a couple times — less than some people who never worried about it! BACK TO TEXT
This relationship is formally described by the Yerkes-Dodson law, which states that performance initially increases with physiological or mental arousal, but then starts to degrade for most tasks. BACK TO TEXT
Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016 Aug;16(1):48. PubMed #27557747. PainSci #52878.


To our knowledge, this is the first systematic review made by endocrinologists to examine a possible correlation between the HPA axis and a purported “adrenal fatigue” and other conditions associated with fatigue, exhaustion or burnout. So far, there is no proof or demonstration of the existence of “AF”. While a significant number of the reported studies showed differences between the healthy and fatigued groups, important methodological issues and confounding factors were apparent. [Translation: biased, sloppy science! ~ Paul] Two concluding remarks emerge from this systematic review: (1) the results of previous studies were contradictory using all the methods for assessing fatigue and the HPA axis, and (2) the most appropriate methods to assess the HPA axis were not used to evaluate fatigue. Therefore, “AF” requires further investigation by those who claim for its existence. BACK TO TEXT
Burke NN, Finn DP, McGuire BE, Roche M. Psychological stress in early life as a predisposing factor for the development of chronic pain: Clinical and preclinical evidence and neurobiological mechanisms. J Neurosci Res. 2016 Jul. PubMed #27402412. BACK TO TEXT
Coppens E, Van Wambeke P, Morlion B, et al. Prevalence and impact of childhood adversities and post-traumatic stress disorder in women with fibromyalgia and chronic widespread pain. Eur J Pain. 2017 May. PubMed #28543929. BACK TO TEXT
Generaal E, Vogelzangs N, Macfarlane GJ, et al. Biological stress systems, adverse life events and the onset of chronic multisite musculoskeletal pain: a 6-year cohort study. Ann Rheum Dis. 2015 Apr. PubMed #25902791. BACK TO TEXT
Maté G. When the body says no: the cost of hidden stress. Alfred A. Knopf Canada; 2003. With clarity and passion, Vancouver physician Gabor Maté tells the stories of people whose pain and illnesses emerged from lives filled with stress, anxiety and depression, illuminating the next frontier in medicine: the elusive mind-body connection. BACK TO TEXT
Sapolsky RM. Why Zebras Don’t Get Ulcers. 3rd ed ed. New York: Times Books; 2004. In contrast to Gabor MatĂ©’s book, just cited, which is much more about way that stress and illness gets all tangled up, psychologist Robert Sapolsky’s book explores the biology of stress in great detail — especially the way chronic stress is fundamentally at odds with health. BACK TO TEXT
Kakiashvili T, Leszek J, Rutkowski K. The medical perspective on burnout. Int J Occup Med Environ Health. 2013 Jun;26(3):401–12. PubMed #24018996.
Burnout was found to be a risk factor for myocardial infarction and coronary heart disease. It was also related to reduced fibrinolytic capacity, decreased capacity to cope with stress and hypothalamic-pituitary-adrenal (HPA) axis hypoactivity. Severe burnout symptoms are associated with a lower level or smaller increase of the cortisol awakening response (CAR), higher dehydroepiandrosterone-sulphate (DHEAS) levels, lower cortisol/DHEAS ratios and stronger suppression as measured by the dexamethasone suppression test (DST). More and more literature works suggest that the evaluation of the HPA axis should be brought to the attention of primary care physicians.… Chronic stress-related disorders often fall outside the category of a true disease and are often treated as depression or not treated at all. BACK TO TEXT
Knutson KL, Van Cauter E, Rathouz PJ, et al. Association Between Sleep and Blood Pressure in Midlife: The CARDIA Sleep Study. Arch Intern Med. 2009 Jun 18;169(11):1055–1061. PubMed #19506175. PainSci #55440.

Bad sleeps — quantity and quality, probably especially if caused by stress — are associated with elevated blood pressure, according to a side project of the big CARDIA study of coronary artery disease. They used wrist gadgets to monitor sleep and blood pressure in more than 500 adults in their 30s and 40s. The authors say the sleep-BP link is supported by previous research and “laboratory evidence of increased sympathetic nervous activity as a likely mechanism underlying the increase in BP after sleep loss.” BACK TO TEXT
Carney DR, Cuddy AJ, Yap AJ. Power posing: brief nonverbal displays affect neuroendocrine levels and risk tolerance. Psychol Sci. 2010 Oct;21(10):1363–8. PubMed #20855902.

This experiment supposedly shows that adopting a “powerful” (confident) pose changes people’s hormonal levels and increases their willingness to take risks as if they actually had more power. “A person can, by assuming two simple 1-min poses, embody power and instantly become more powerful.” This is plausible and interesting, but melodramatically stated, and probably over-stated. There’s a very popular TED talk about this paper, and so (unsurprisingly) the authors have been accused of reaching beyond what their data can support:
Power Posing: Reassessing The Evidence Behind The Most Popular TED Talk
The Power of the “Power Pose”: Amy Cuddy’s famous finding is the latest example of scientific overreach.

So, take this idea with a grain of salt.

See also Bohns, which presents evidence that power postures can also reduce pain sensitivity. BACK TO TEXT
Bohns V, Wiltermuth S. It hurts when I do this (or you do that): Posture and pain tolerance. Journal of Experimental Social Psychology. 2012 Jan;48(1):341–345. PainSci #54508. BACK TO TEXT
Entrainment refers to a bunch of this, but in the context of “biomusiscology”: internal synchronization to an external rhythm. The science of why a fun tune gets our heads nodding or feet tapping. BACK TO TEXT
I discuss the myths of massage in great detail in Does Massage Therapy Work? BACK TO TEXT
Cortisol levels after a massage do not give a meaningful picture of the organism, and there is no direct relationship between a temporary cortisol reduction and any health benefit. What matters is cortisol levels over time, but even that isn’t exactly straightforward: stress and cortisol have a complex and chaotic relationship regulated by many variables out of our control. BACK TO TEXT
Moyer CA. Affective massage therapy. Int J Ther Massage Bodywork. 2008;1(2):3–5. PubMed #21589715. PainSci #54758.

Dr. Christopher Moyer explains that the only confirmed benefits of massage are its effects on mood (“affect”), specifically depression and anxiety. “Together, these effects on anxiety and depression are the most well-established effects in the MT research literature. They are especially important for us to understand not only for their own sake, but also because anxiety and depression exacerbate many other specific health problem.” He proposes that “the time is right to name a new subfield for massage therapy research and practice: affective massage therapy.” BACK TO TEXT
Not a real thing: a whimsical, imaginary diagnosis. But not entirely silly either. Maybe there should be such a diagnosis. BACK TO TEXT
Snyder-Mackler N, Sanz J, Kohn JN, et al. Social status alters immune regulation and response to infection in macaques. Science. 2016 Nov;354(6315):1041–1045. PubMed #27885030. BACK TO TEXT
Schmidt K, Cowen PJ, Harmer CJ, et al. Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers. Psychopharmacology (Berl). 2015 May;232(10):1793–801. PubMed #25449699. PainSci #54164. In the test, the prebiotic product Bimuno®-galactooligosaccharides (B-GOS) appeared to be effective (while another product did not). Specifically, “The salivary cortisol awakening response was significantly lower after B-GOS intake compared with placebo. Participants also showed decreased attentional vigilance to negative versus positive information in a dot-probe task after B-GOS compared to placebo intake.” But caution: please note that this product is one of a class of sugars that may cause bowel irritation. If you experiment with it, do be alert for symptoms of irritable bowel syndrome. BACK TO TEXT
Schmidt et al: “There is now compelling evidence for a link between enteric microbiota and brain function.” Strange but true. Wikipedia: “The gut–brain axis refers to the biochemical signaling taking place between the gastrointestinal tract and the nervous system, often involving intestinal microbiota, which have been shown to play an important role in healthy brain function.” BACK TO TEXT
Speaking of things bacteria eat: in 2016, scientists discovered a species of gut bacteria that has a GABA-only diet. Gamma-Aminobutyric acid is an important neurotransmitter which has a critical role in keeping our cool, which is an understatement: it’s the most widely used inhibitory neurotransmitter in human physiology, the body’s own tranquilizer. Drugs like Valium (the most famous of the benzodiazepenes) work by enhacing GABA’s effects. The discovery of a gut bacteria that feeds exclusively on GABA may be one the first clear, direct explanations of the “gut-brain connection,” of how the contents of the poop chute can affect moods. An overpopulation of these wee beasties could potentially suppress GABA levels…which would be bad. Intriguing stuff. BACK TO TEXT
Wu A, Noble EE, Tyagi E, et al. Curcumin boosts DHA in the brain: Implications for the prevention of anxiety disorders. Biochim Biophys Acta. 2015 May;1852(5):951–61. PubMed #25550171. BACK TO TEXT
Esmaily H, Sahebkar A, Iranshahi M, et al. An investigation of the effects of curcumin on anxiety and depression in obese individuals: A randomized controlled trial. Chin J Integr Med. 2015 May;21(5):332–8. PubMed #25776839. BACK TO TEXT
Nicol LM, Rowlands DS, Fazakerly R, Kellett J. Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS). Eur J Appl Physiol. 2015 Mar. PubMed #25795285. BACK TO TEXT
PS Ingraham. Can Supplements Help Arthritis and Other Aches and Pains? Debunkery and analysis of supplements and food-like medicines (nutraceuticals), especially glucosamine, chondroitin, and creatine, mostly as they relate to pain. 7814 words. BACK TO TEXT
Hogervorst E, Bandelow S, Schmitt J, et al. Caffeine Improves Physical and Cognitive Performance during Exhaustive Exercise. Medicine & Science in Sports & Exercise. 2008 Oct;40(10):1841–1851. PainSci #56104. Caffeine will “significantly improve” not only endurance performance, but “complex cognitive ability during and after exercise.” The researchers studied 24 well-trained cyclists, giving them either 100mg of caffeine or a placebo and then testing their endurance and their mental function during and after workouts. The signal was loud and clear: caffeine consumption boosted their performance. BACK TO TEXT
Gonçalves Ld, Painelli Vd, Yamaguchi G, et al. Dispelling the myth that habitual caffeine consumption influences the performance response to acute caffeine supplementation. J Appl Physiol (1985). 2017 May:jap.00260.2017. PubMed #28495846.

This trial demonstrated that caffeine supplementation boosts athletic performance even if you are used to its effects. Forty endurance cyclists were divided into groups of low, moderate, and highly daily caffeine intake. They all did three cycling tests after drinking caffeine, a placebo, or nothing at all. Performance on caffeine was clearly best across the board for all participants, regardless of typical caffeine intake. BACK TO TEXT
Killer SC, Blannin AK, Jeukendrup AE. No evidence of dehydration with moderate daily coffee intake: a counterbalanced cross-over study in a free-living population. PLoS One. 2014;9(1):e84154. PubMed #24416202. PainSci #53892.

Many people believe that coffee is dehydrating. To test this popular idea, 50 men drank four cups (200ml) of either coffee or water each day for three days while their diet and activity were controlled. There were no differences in their body mass, urine volume, and signs of hydration in the blood and urine (pee clarity, basically). If you can drink almost a litre of coffee a day and have no measurable effect on hydration, then it is not “dehydrating” to any meaningful degree. The authors reasonably concluded that coffee “provides similar hydrating qualities to water.” BACK TO TEXT

Derry CJ, Derry S, Moore RA. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database Syst Rev. 2014 Dec;(12):CD009281. PubMed #25502052. “The addition of caffeine (≥ 100 mg) to a standard dose of commonly used analgesics provides a small but important increase in the proportion of participants who experience a good level of pain relief.” BACK TO TEXT
We can draw a strong analogy to alcohol, which definitely relieves pain in a meaningful way ... for as long as you’re drunk! It’s the original anaesthetic. But at the same time, we know with extremely high confidence that the stuff is a nasty poison and downright terrible for you when habitually abused long term.) BACK TO TEXT