There have been
clinical trials on creatine and chronic pain.

 

$
Average cost for a one-month supply of creatine monohydrate, 5 grams/day

 

If you’ve heard of creatine, it’s likely that you think of it in association with athletes looking for a performance booster or sweaty teenage boys trying to bulk up, bro! But after some positive self-experimentation, I started to wonder whether there were other benefits to creatine supplementation. As it turns out, there probably is. (–Keeli Fricks, Paindatabase maven)

What It Is & How It Works

If you know creatine science, you can skip over to the next section. Creatine is naturally produced by the body from various amino acids, and is mainly found in muscle. Omnivores also get about 1g/day from dietary sources, like muscle meat, organs, and dairy.

Once ingested, creatine can be converted to phosphocreatine (PCr) in a process called phosphorylation. Muscles use adenosine triphosphate (ATP) to give the quick energy needed for an initial contraction, but the problem is that muscle fibers don’t have all that much ATP in reserve. Instead, muscles need a way to quickly generate more ATP. Conveniently, they have stores of the ATP precursor, adenosine diphosphate (ADP). And what ADP needs is another phosphate bond to become ATP. See where this is going? I’ll tell you anyway. PCr transfers that much-needed phosphate bond to ADP and yields more ATP and creatinine, the latter of which is filtered through the kidneys to be excreted in the urine.

keeli kamal

Keeli needs more phosphocreatine to get out of this hold

The body’s PCr stores don’t have to be filled through biosynthesis and dietary consumption alone, though, and that’s where the value of creatine supplementation comes in.

The use of supplemental creatine to enhance athletic performance is, I think, pretty well documented by now. But what about creatine for pain relief?

Creatine and Fibromyalgia

In the last few years there have been several conflicting studies examining the relationship between fibromyalgia and creatine. Interest in the link between creatine and fibromyalgia seems to have piqued after a 2004 study showed that fibromyalgia patients had significantly lower levels of both ATP and phosphocreatine in their quadriceps.

Unfortunately for this particular line of inquiry, a 16-week creatine-in-fibromyalgia study published late last year concluded that, “no general changes were observed in aerobic conditioning, pain, cognitive function, quality of sleep, and quality of life.” But don’t give up hope just yet!

The group given creatine did, predictably, show a dramatic increase in muscle phosphocreatine to the tune of 80.3%, while the placebo group diminished their PCr stores by 2.7%. The creatine group also showed greater muscle strength than the control group in leg press, chest press, and isometric exercises, increasing their capabilities by 9.8%, 1.2% and 6.4% respectively, while the control group actually had worse performances than they did for their baseline (by .5%, 7.4%, and 3.2%, respectively).

I don’t know about you, but increasing muscle strength and performance isn’t anything to sneeze at when you’re unwell and in pain. With increased strength, it’s quite possible that tasks that before might have taxed your muscles and added to pain and fatigue can now be accomplished with relative ease.

A notably less well conducted study of a single patient with fibromyalgia, PTSD and depression reported better fibro symptoms after supplementing with creatine. Can’t discount the experience of n=1, even if it doesn’t carry nearly the same weight as the aforementioned study.

Creatine and Osteoarthritis

A 2011 double-blind, placebo-controlled study on 24 postmenopausal women with knee osteoarthritis shone quite a favorable light on creatine. Both the creatine and placebo groups were placed into a lower-limb exercise program. The primary measure of physical function was determined by a timed stands test, and secondary outcomes were lean mass, quality of life, pain, stiffness, and muscle strength.

While both groups demonstrated improved physical function, the creatine group showed significantly more improvement. The creatine group also showed improvements in their levels of stiffness, lean mass in lower limbs, and quality of life whereas the control group did not. Both groups experienced reduced pain.

A possible joint-related benefit of creatine could come from its exercise-enhancing abilities. It may be that the additional strength that can come as a result of exercising under the influence, as it were, confers some protection, support, and stability for joints. Or at least it does for knees, and I suspect those same principles apply to other joints. In the above study, both groups reported having reduced pain after going through an exercise regimen, and I think that since creatine helps with exercise and strength-building, and exercise and strength-building can help pain, that creatine may contribute to reduced pain via exercise-boosting. But that’s just my conjecture.

Fun fact: creatine is also reported to enhance cognitive capabilities in the elderly and in vegetarians (though not really in omnivores). Since pain can be influenced by a variety of factors outside of the actual joint or muscle, creatine’s emerging role in mental functioning might play a role in its use for chronic pain.

My Experience

My love affair with creatine began almost a year ago. Keeli and creatine, sittin’ in a tree, e-n-e-r-g-i-zing… hah! That almost worked. Sort of.

For real, though, folks. I started taking creatine last summer to assist in building muscle.  Not because creatine itself builds muscle, but because it can help you squeeze out that last rep or, in my case, get up to the next theraband color in physical therapy (on a good day). Gaining strength is a generally good thing to do for just about anybody, and it’s especially important for people with hypermobility. Its affordability and lack of side-effects made it a prime candidate for trial.

Honestly, I didn’t notice any burst in strength or capability. But what I did notice was some relief. Relief from the body-wide muscular aches I’ve had for as long as I can remember. Because of the Ehlers-Danlos, I walk around sore. With the creatine, though, I walk around a less sore. Significantly so. For me, it’s like going from having the body aches of the flu to almost recovered from the flu. Sweet!

Oddly enough, I don’t really notice a huge difference when I stop taking it – maybe because the onset of typical soreness is gradual, and maybe because creatine stores last a while after ceasing supplementation. When I start again, though, it’s pretty darn obvious. It makes me happy.

Do I know why this is? Nope. Do I have rigorous (or even not-so-rigorous) scientific explanations or support for my experience? Nope! Do I care? Hahaha! Don’t be silly, you goose. Of course not. It works for me, and I’m satisfied with that knowledge to continue my daily dose of about ½-1 teaspoon of micronized creatine monohydrate.

Dosage and Recommendations

As with many supplements, more isn’t necessarily merrier. There’s only so much phosphocreatine your body can store, and this limit is known as the saturation point.

There’re two ways you can reach saturation: loading, where you take 10-20 grams spaced throughout the day for 4-7 days, or just taking a normal dose (5g) each day. I’m not telling you anything you wouldn’t see on most labels, though. Go with the label. That’s probably smart. There’s also support for taking it with some carbohydrates to help with uptake and retention. Creatine monohydrate is a common and quality form of creatine, and micronized is even better since the smaller particles mix more easily in water.

In sum, you should think about trying creatine if you have chronic muscular pain, fatigue or joint pain due to osteoarthritis. On the one hand, you shouldn’t expect any miracle cures (though that advice applies to pretty much everything in regards to pain relief). On the flip side, though, it’s dirt cheap, has pretty much no side-effects, and even has evidence for providing mental boosts and fatigue reduction. As an unscientific plus, this author experienced some not unremarkable improvements in muscular pain with creatine supplementation.

Its lack of flavor is noteworthy, too, in light of that fact that so many powdered oral supplements taste like something straight up dirty. Or it’s supposed to be flavorless, that is — I swear it tastes faintly fruity. My opinion? Try it. There’s really not much to lose.




6 Comments

  1. I also found it helped with muscle pain from Ehlers-danlos hypermobility.

    I prefer TRI-CREATINE MALATE:
    It combines creatine monohydrate and malic acid. It has less of a bloating effect, and less gastrointestinal issues. I do think with creatine supplementation you need to cycle it. 2 months on, 1 month off? But that suggestion us usually aimed at people “bulking” I’m not sure how it would effect musculoskeletal pain.

    Have you found you need to increase your dosage over time?

    Either way, I do personally feel muscle bulking and strength training has helped with my muscle pain and faster recovery from Ehlers-danlos pain causes.

    Reply
    • Hey Aly!

      That’s pretty neat that you’ve benefited from taking creatine, too. I do cycle, and haven’t experimented with increasing my doses. You’ve encouraged me to look up Tri-creatine malate, though, and check out the differences. Thanks :)

      Reply
  2. Hi Keeli, i’m a 4th year medical student and nutrition + fitness freak. This website of yours is an absolute gold mine of reliable, evidence based information. I am genuinely sick of seeing made up information (basically broscience) all over the internet. Have you considered making it more available to the public? I’ve never come across this website till today despite having read literally hundreds of articles online. Some of your articles are really good and you write well too! Although your focus is obviously on pain relief, the basic science behind a few of your articles is quite useful for fitness/health.

    Reply
  3. I have had a rod put in my hip as i fractured it,i’m in so much pain and just read about this,wondering id it will do me good to use it,also my husband has bad pain in his leg,he thinks it’s sciatica and would like to know if this will help with the pain

    Reply
  4. Hey I agree that increased strength is nothing to sneeze at. I get that having increased strength may not have addressed the cause of pain for fibromyalgia patients, but as someone who has ankylosing spondylitis, if you count the number of steps from my bed to my bathroom as reps, and if creatine can help me push through those “reps” and more, I would say it would be an improvement in my quality of life. I don’t have the muscle fascia issues that fibromyalgia patients have, though, so I get why added strength may not improve their pain or quality of life, even if they can eek out more reps with creatine.

    Reply
    • I think it really just boils down to the fact that there’s really something there that can help a lot of people; they just need to do more studies on more types of pain populations.

      Reply

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