Page 112 - JSOM Summer 2018

An Ongoing Series

Dietary Supplements for Musculoskeletal Pain

Science Versus Claims

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Cindy Crawford ; Leila Saldanha, PhD, RD ; Rebecca Costello, PhD ; Patricia Deuster, PhD, MPH *
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ABSTRACT
Special Operations Forces (SOF) face unique challenges that is a high-performance warrior athlete, and the end result of
manifest themselves both mentally and physically. The extremes the extraordinary physical demands, to include his or her
of training and combat can affect the readiness to perform at regular physical strength and conditioning training, is often
peak levels, especially when confronted with musculoskele- acute and chronic musculoskeletal injuries. When injuries do
tal pain. Many SOF Operators turn to dietary supplements in occur, SOF Operators rarely seek treatment for fear of being
hopes of gaining an edge. Although some supplements are now out of the game or letting down a team member. “Vitamin
being marketed for pain, decisions to use these products need M” (Motrin, or ibuprofen) is used frequently and often in
to be driven by information that is evidence based. We describe large doses to mediate pain for any number of injuries or
SOF-specific evidence-based recommendations for the use of ailments.
dietary ingredients for pain that emerged from a rigorous scien-
tific evaluation. These recommendations are compared with the To date, dietary ingredients are marketed as solutions to pre-
label claims made in the commercial market by companies sell- emptively mitigate or combat musculoskeletal pain. Although
ing products to combat musculoskeletal pain. This information some dietary supplements may be a good option, knowing
can be used by the SOF medical community to assist Operators where to go and how to choose the best options can easily
in making informed decisions when considering or selecting di- become a challenging task. Having some knowledge of the sci-
etary supplements for maintaining and optimizing performance. entific evidence available and knowing how to read/interpret
label claims in an objective manner would benefit the medical
Keywords: dietary supplements; military personnel; evi- community and Operators. Evidence-informed decisions for
dence-based medicine; decision aid; musculoskeletal pain what and what not to use as alternative approaches to mitigate
pain are essential for optimizing SOF performance.

Introduction What Does the Scientific Evidence Say?
SOF are always looking for ways to enhance performance. Through the US Special Operations Command’s Preserva-
Because training and missions typically occur under extreme tion of the Force and Family Behavioral Health Program, a
conditions with physically challenging and demanding tasks, project was executed to determine whether current research
many SOF personnel turn to dietary supplements as a way to on dietary ingredients for musculoskeletal pain could provide
sustain their performance. Most believe that taking dietary sufficient evidence to inform decisions for both practice and
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supplements is a low-risk action, so trying them out as a way self-care use. To achieve this, state-of-the-science evidence
to enhance performance seems logical when other options may methodologies were applied to provide clear, comprehensive,
not be available. However, decisions to use dietary supple- and unbiased information to SOF. A panel of experts used
ments are often driven by peers rather than by evidence-based this information to make evidence-based recommendations to
information. What the dietary supplement industry markets inform policy decisions regarding dietary ingredients for im-
through label claims and advertisements may or may not re- proving pain and thus optimizing performance. The evidence
flect the scientific evidence or the “truth” about the benefits showed that certain dietary ingredients, when taken as part of
and/or potential risks. a balanced diet and/or as a supplement, or when applied as a
cream such as in the case of capsaicin as a self-care approach,
In an earlier issue of our Human Performance Optimization may help alleviate musculoskeletal pain for SOF, with no to
series, the burden of pain was discussed. The SOF Operator minimal risk of any harm. 3
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*Correspondence to patricia.deuster@usuhs.edu
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1 Ms Crawford is a senior program manager at the Thought Leadership and Innovation Foundation, McLean, VA. Drs Saldanha and Costello are
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scientific consultants with the Office of Dietary Supplements, National Institutes of Health, Bethesda, MD. Dr Deuster is a professor and direc-
tor of the Consortium for Health and Military Performance: A Defense Center of Excellence, Department of Military and Emergency Medicine,
Uniformed Services University, Bethesda, MD.
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