• Rowena Field, Fereshteh Pourkazemi, and Kieron Rooney.
• Sydney School of Health Sciences, The University of Sydney, Faculty of Medicine and Health, NSW, Australia.
• Pain Med. 2022 Feb 1; 23 (2): 326-338.

BackgroundA low-carbohydrate ketogenic diet has been reported to improve chronic pain by reducing inflammation, oxidative stress, and sensitivity within the nervous system. The main aim of this trial is to evaluate the effects of a ketogenic diet on reported pain, blood biomarkers and quality of life in patients with chronic pain.MethodsParticipants with chronic musculoskeletal pain were recruited for a 12-week diet intervention that commenced with a 3-week run-in diet removing ultra-processed foods, followed by randomization to either a whole-food/well-formulated ketogenic diet (WFKD) or to continue with the minimally processed whole-food diet (WFD). Outcome measures included: average pain (visual analogue scale VAS), blood biomarkers, anthropometrics, adherence, depression, anxiety, sleep, ketones, quality of life, diet satisfaction, and macronutrient intake.ResultsAverage weekly pain improved for both groups. WFKD group VAS reduced by 17.9 ± 5.2 mm (P = .004) and the WFD group VAS reduced 11.0 ± 9.0 mm (P = .006). Both groups also reported improved quality of life (WFKD = 11.5 ± 2.8%, P = .001 and WFD = 11.0 ± 3.5%, P = .014). The WFKD group also demonstrated significant improvements in pain interference (P = 0.013), weight (P < .005), depression (P = .015), anxiety (P = .013), and inflammation (hsCRP) (P = .009). Significant average pain reduction remained at three-month follow-up for both groups (WFKD P = .031, WFD P = .011).ConclusionsThe implementation of a whole-food diet that restricts ultra-processed foods is a valid pain management tool; however, a low-carbohydrate ketogenic diets may have potentially greater pain reduction, weight loss and mood improvements.© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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