Page 362 Guide to Pain Management in Low-Resource Settings

350 Joel Gagnier

function. A diet with regular fruit and vegetable intake with oral glucosamine sulfate at 1500 mg per day to-
would include these vitamins, or alternatively a simple gether with oral chondroitin sulfate at 1200 mg per day;
multivitamin mineral formula would be suffi cient. In oral unsaponifi able fractions of avocado and soybean
patients with diabetic neuropathy, besides adequately oils at 300 mg per day; oral Harpagophytum procum-
controlling blood sugar, vitamin B at 150 mg or vitamin bens (Devil’s claw) 2400 mg per day; and topical creams
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E at 800 IU per day may be eff ective. Th ese supplements containing a combination of camphor, glucosamine
may be used together. A simple dietary intervention to sulfate, and chondroitin sulfate. Mild to moderate OA
aid in blood sugar control is the regular consumption of may respond to a treatment starting with glucosamine
beans and legumes. sulfate (1500 mg/day) and chondroitin sulfate (1200 mg
per day) for 4–6 weeks, and if there is a limited eff ect
What supplements are adding oral unsaponifi able fractions of avocado and soy-
bean oils and Devil’s claw. Rheumatoid arthritis may be
best for chronic pain?
treated with oral borage seed oil at 1–1.5 grams per day,
Chronic unspecifi ed back pain may be treated with oral oral fi sh oil providing eicosapentaenoic acid (EPA) and
Harpagophytum procumbens (Devil’s claw) at 2000– docosahexanoic acid (DHA) at 2 grams/day, oral vita-
3000 mg per day, delivering 50–100 mg of the active min E at 800 IU per day, or oral Tripterygium wilfordii
constituent harpagoside; oral willow bark (Salix alba, (thunder god vine) at 200–600 mg per day.
Salix daphnoides, or Salix purpurea) at 1200 mg per
day, delivering 120–240 mg of the active constituent What supplements are best for
salicin; or topical capsicum cream. Dysmenorrhea may special therapeutic situations?
be treated with oral calcium at 1000–1500 mg per day,
magnesium at 300–400 mg per day, vitamin B6 at 100 Dementia of the Alzheimer’s type may be eff ectively
mg per day, vitamin E at 400–800 IU per day, or Vitex treated with oral Ginkgo biloba (Ginkgo) at 120–240 mg
agnus-castus (chaste berry) at 20–40 mg per day. For per day, oral Melissa offi cinalis (lemon balm) at 60 drops
migraine headaches the following are eff ective: vitamin of a 45% alcohol extract, oral Salvia offi cinalis (sage) at
B 400 mg per day, Tanacetum parthenium (feverfew) 1000 mg per day, or oral vitamin E at 2000 IU per day.
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100 mg per day, magnesium 500 mg per day, or Petasites Th ese supplements may be used in isolation or in com-
hybridus (Butterbur) 150 mg per day. Th ese can be used bination. It may take 3–4 months before any eff ects of
individually or in combination. Rheumatic pain in the these interventions are seen.
form of osteoarthritis (OA) may be successfully treated