The Role and Safety of Plant Derived Nutraceuticals as Adjuvant Treatment for Pain Management: A Narrative Review

Chronic pain is a serious concern for the healthcare system, considering the high public expense. Many drugs, such as opioids, non-steroidal anti-inflammatory drugs, amitriptyline, duloxetine, and pregabalin, can be used considering the type of pain (nociceptive, neuropathic, or nociplastic). This is because prescription drugs have a significant negative impact on patient health and the economy, increasing the risk of drug interactions and side effects. Nutraceuticals/supplements may be useful to reduce safety issues, particularly in elderly patients. A new fixed nutraceutical formulation containing lycopene (Solanum lycopersicum), sulforaphane (Brassica oleracea), silymarin (Silybum marianum), reduced glutathione, escin (Aesculus hippocastanum), tryptophan, and green tea (Camellia sinensis) can be used to manage the pain even if its action on pain has not been proved in clinical trials. Nevertheless, the evidence of a strong anti-nociceptive effect by escin and green tea, alongside the antioxidant and anti-neuropathic pain properties of other components, may be useful as adjuvant therapy to reduce drug dosage and prescription. Additionally, patients in polytherapy may benefit from the presence of two hepatoprotective compounds, such as glutathione and silymarin. The aim of this narrative review is to evaluate the data available on both efficacy and safety of the described nutrients in the management of pain.