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PPIs and Pain

PPIs and Pain

A common but often overlooked cause or exacerbating factor of chronic pain are medications such as Proton Pump Inhibitors (PPIs). Learn more about the effect of PPIs on pain and what you can do in today’s article.

What are PPIs?

Proton pump inhibitors (PPIs) are a type of medication commonly prescribed to relieve symptoms of acid reflux.

Common PPIs include:

  • Omeprazole
  • Esomeprazole
  • Lansoprazole
  • Rabeprazole
  • Pantoprazole

How do PPIs effect pain

PPIs work by reducing the amount of stomach acid made by glands in the lining of your stomach.

Although this can be helpful in reducing heartburn symptoms stomach acid is essential to break down food so that vitamins and mineral can be absorbed. The use of PPIs can therefore have some unintended side effects, such as vitamin deficiency

“Proton Pump Inhibitors (PPIs) have been associated with an increased risk of vitamin and mineral deficiencies impacting vitamin B12, vitamin C, calcium, iron and magnesium metabolism” [Heidelbaugh, 2013]

Deficiencies in B12 and magnesium in particular can lead to a range of muscle and nerve symptoms such as: 

  • Migraine / headaches
  • Muscle pain
  • Muscle tightness, cramps, twitching and restless leg syndrome
  • Numbness / pins and needles
PPIs and pain

As well as other symptoms including:

  • Fatigue
  • Depression/ anxiety
  • Ulcers/ mouth sores
  • PMS
  • Allergy-like symptoms
  • Constipation

You can learn more about the consequences of magnesium and B12 deficiency on pain here:

What Should I do?

Given the risk of nutrient insufficiency/ deficiency with long term PPI use, consider taking a good quality multivitamin and calcium/ magnesium supplement to offset this risk, especially if you have one or more of the symptoms listed above.

If symptomatic, try a 1-month trial of a good quality multivitamin and calcium/magnesium supplement and review your symptoms. You can download the ‘Modified Multiple Symptoms Questionnaire’ and complete it before and after your trial to help you do this.

We recommend supplementing calcium/ magnesium separately because they are “bulky” and therefore most multivitamins do not contain enough.


We recommend:

Available from The Natural Dispensary (use practitioner ‘Steffen Toates’ to register).

Or from Amrita Nutrition  (use code YCMZQD to register)


  • Multivitamin – One per day. Do not take within 5 hours of bedtime as it may interfere with sleep. Do not take if you have a history of anxiety.
  • Magnesium/ Calcium – Start with one capsule, once per day (with food). Increase to one capsule, 3 times per day (with food) if tolerated. If you experience loose stools / diarrhoea reduce the dose.


  • Heidelbaugh, J. J. (2013). Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Therapeutic advances in drug safety, 4(3), 125-133.

This post was written by Steffen Toates. Steffen is a chiropractor at Dynamic Health Chiropractic in Jersey CI. For more information about Steffen click here.

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I first attended due to pain in my lower back that I had had for over a year. It was my last resource, as I had tried a lot of things before but it was definitely the best thing for me. I felt listened to and taken seriously and I’m now more or less pain free. I can now do all the things I like again, like dancing and walking. That’s just great!

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