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Alpha-lipoic acid. Like acetyl-L-carnitine, alpha-lipoic acid seems to help with diabetic neuropathy. "Preliminary but promising evidence shows that it not only reduces pain, but also seems to slow down the progression of the nerve injury," Rakel tells WebMD. "It may help protect the nerves from further damage."

Alpha-lipoic acid may also enhance insulin sensitivity -- another benefit for people with diabetes. There's evidence that this pain supplement can help with nerve damage caused by cancer treatments, too.

Bromelain. The enzyme bromelain, which comes from the pineapple plant, appears to reduce inflammation and pain. Some studies have found it helpful in osteoarthritis and knee pain. There's some uncertainty about how well it gets absorbed in digestion, given that it could be neutralized by stomach acid. More research needs to be done. 

Riboflavin (vitamin B2). "There was promising research showing that riboflavin might help reduce the frequency of migraines," says Rakel, but a recent study did not support the claim. Rakel still thinks it's safe to try for up to eight weeks, given its high safety rating. There's some evidence that CoQ10 and standardized extracts of butterbur (petasites) might also help prevent migraines.

MSM (methylsulfonylmethane). This is a naturally occurring compound in some plants and animals, which has been shown in some preliminary research to reduce osteoarthritis pain. More studies are needed to clarify its safety and efficacy.

Chronic Pain Supplements: Combining Approaches

As effective as natural pain relief can be, Leopold urges people to keep an open mind about traditional approaches, too. "NSAIDs like ibuprofen and naproxen work really well," says Leopold, "and they're incredibly cheap. The price tag on some supplements can be substantial."

Natural pain relief and traditional medicine don't have to stand in opposition. Leopold has some patients who take a daily pain supplement like turmeric for pain. Then during exacerbations, they add on an NSAID.

That said, no one should be mixing pain supplements and medications without seeing a doctor first. It could be risky. So make sure your health care provider knows about all the medicines and supplements you use.

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