Gout Pain Relief
I’ve been told by family members that gout is as painful, if not more painful, than breaking a bone. I’ve also seen patients in the midst of a gout flare-up, walking on an affected big toe, brought to tears.
I’ve discovered, from research, professional experience, and familial experience, that treating gout pain is a multifaceted approach. When we think about treating pain, we often think about popping pills – and yes, that works, but that is not the only way we should be treating gout pain.
The Medical Approach
People typically seek treatment from their physicians for gout during an acute attack. At this point, the goal is to decrease pain while also decreasing inflammation.
According to Rebecca Manno, MD, MHS of Johns Hopkins University, we often think of gout and jump to initiating a uric acid lowering medication immediately at diagnosis. Yet, initiating such therapy is not indicated in the midst of a flare-up. However, it should not be discontinued if it is already prescribed.
Instead, medication should be prescribed that reduces pain and inflammation. Examples include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include ibuprofen or indomethacin. Both can be administered three to four times daily and should be discontinued once symptoms resolve.
- Colchicine. Although this medication can be administered via intravenous solution, it is associated with toxicity so is better tolerated as an oral medication. In addition, low doses are associated with fewer side effects. It can be given in conjunction with NSAIDs.
- Corticosteroids. These are often given when patients have a contraindication to NSAIDs. They can be given via injection into the affected joint or as an oral preparation; the oral preparation is typically given initially as a large dose, then tapered to smaller doses in a stepwise fashion.
Once the pain is diminished and the flare-up is gone, if you’re not already on a uric acid reducing medication, now is the time to start! These medications are not pain-relieving, but you can think of them as prophylactic treatment – they’ll help prevent the pain from occurring in the first place. Options include:
- Allopurinol. This medication is typically started at a low dose, then increased to a higher dose. It is increased in a stepwise fashion because it can cause gastric upset initially, but the stomach problems resolve over time, as the body adjusts to the medication.
- Febuxostat. This medication is used for people who do not tolerate allopurinol or whose kidney function is diminished. It is also started at a lower dose and increased over time. Side effects can be muscular pain and nausea.
- Probenecid. This medication works directly on the kidneys to decrease uric acid levels. It is often prescribed in conjunction with antibiotics to increase effectiveness. However, it may be less tolerated than other medications – it has quite a few side effects. Side effects include nausea, stomach upset, rash, headaches, and kidney stones.
- Lesinurad: This medication is often added when allopurinol or febuxostat is not working effectively on its own. It is thought to enhance the effectiveness of these medications. Like probenecid, it has a long list of side effects. If you’re prescribed this medication, you should stay hydrated because side effects are often related to the kidneys – increased creatinine and kidney stones. Other side effects include headache, flu-like symptoms, GERD, and increased risk of cardiovascular events.
- Pegloticase. This medication is used for refractory gout – gout that is unresponsive to all other treatments. It is given via an IV infusion and lowers uric acid levels quickly, but must be given every two weeks. Because the treatment is so strong, there are a lot of side effects associated with this treatment – nausea and vomiting, chest pain, constipation, sore throat, and bruising.
The Nutrition Approach
As you now know, gout can be treated traditionally, with medication. These medications can be used during a flare-up or prophylactically, to prevent the gout flare-ups from occurring in the first place.
You may have heard the quote said by Ann Wigmore, “The food you eat can either be the safest and most powerful form of medicine or the slowest form of poison.” This is especially true if you have gout. You can also think of the foods that you are eating as medicine.
According to Mayo Clinic, gout was historically associated with the wealthy – “Gout has been associated for centuries with overindulgence in meats, seafood, and alcohol. The condition was, in fact, considered a disease of the wealthiest people — those who could afford such eating habits.”
In the past, the “gout diet” was extremely restrictive. We understand that a diet high in purines (which promote uric acid build-up in the body) will worsen gout symptoms, so all foods with moderate to high amounts of purine were avoided. The diet is now simplified – there is now an understanding of what “better” works and that certain foods actually control uric acid levels!
General Guidelines of the “Gout Diet”
Weight loss is recommended
If you have gout and you are overweight or obese, it is recommended that you lose weight. Carrying excess pounds increases the risk of gout, while losing weight decreases the risk of gout. A calorie-restricted diet, even without restricting purines, may reduce gout flare-ups. A bonus – less weight will put less stress on the joints.
Keep hydrated
Unless contraindicated by another health condition, 8 to 16 glasses of water is the recommended goal for people with gout. If you have other conditions that may affect your hydration goals, discuss this with your physician.
Macronutrient intake
- Complex carbohydrates: eat fruits, vegetables, and whole grains as opposed to white breads and desserts that contain high-fructose corn syrup.
- Fats: Reduce the intake of saturated fat in the diet (red meat and high-fat dairy, for example).
- Protein: limit protein from lean meat and fish to four to six ounces per day and increase protein intake from low-fat dairy.
Beverages
Alcohol is thought to increase uric acid production, especially beer and liquor. Wine is currently being studied. Avoid alcohol if possible, especially in the midst of a flare-up. Coffee may actually reduce the risk of gout, if intake is moderate.
Vegetables
Asparagus, peas, cauliflower, and mushrooms are all high-purine vegetables. At one point in time, it was thought that all high-purine vegetables should be avoided. Research now shows that vegetables, regardless of the purine content, do not precipitate a gout exacerbation. A diet rich in fruits and vegetables is recommended. Lentils is also included in this category, although they were traditionally recommended as a “no-no” due to their purine content.
FOODS TO AVOID:
Specific foods to avoid include organ and glandular meats, such as liver, kidney, and sweetbreads. All of these are known to increase uric acid levels in the body. Certain seafood will also increase uric acid levels and these include fish such as tuna, mackerel, trout, haddock, herring, anchovies, and sardines. Other seafood to avoid includes mussels and scallops.
FOODS TO INCLUDE:
Research is still being done but cherries may decrease the risk of gout flare-ups. Research shows that tart cherries, in any form, may be beneficial – try eating 10-20 cherries per day, drinking tart cherry extract, or drinking tart cherry juice (but look at the ingredients – it should be tart cherry juice and nothing else!). In addition, foods that are rich in vitamin C may reduce uric acid levels. A vitamin C supplement (500mg per day) may be beneficial.
