Pain Prevention (2020 European year against pain) Impact of lifestyle factors

  • Brona Fullen

    European Pain Federation EFIC President - Associate Professor, School of Public Health, Physiotherapy and Sports Science, University College Dublin (UCD), Ireland
  • Elizabeth Dean

    Professor Emeritus, Department of Physical Therapy, University of British Columbia, Canada
  • Joe Tatta

    Founder of the Integrative Pain Science Institute, United States
  • Anne Söderlund

    Professor in Physiotherapy, School of Health, Care and Welfare, Mälardalen University, Västerås, Sweden

Chair: Brona Fullen, Ireland
Role of nutrition in pain prevention
Elizabeth Dean, Canada
Chronic low-grade systemic inflammation (CLGSI) plays a role in many major diseases including the non-communicable diseases (NCDs) and more recently has been implicated in the experience of pain. The role of nutrition has been underexploited not only in terms of its role in preventing, reversing as well as managing NCDs but also as a chronic pain control intervention. Pain is a consequence of tissue injury or pathological insult. Both acute and chronic causes of pain stimulate an immune response. With respect to chronic pain, CLGSI is a common clinical correlate and commonly associated with adverse lifestyle practices including unhealthy diet, as well as smoking, inactivity, chronic sleep deprivation and stress. An anti-inflammatory diet can help mitigate pain and flare-ups, which in turn can improve quality of life. This presentation introduces the role of nutrition in pain prevention and mitigation for health professionals. This relatively novel evidence-based approach to pain prevention and its management is fundamental to a person-centered approach in a comprehensive model of health care. The objectives of this learning module are threefold. First, the role of the immune system and CLGSI as an underlying contributor to pain is described. The immune system is responsible for a cascade of reactions in response to local inflammation as well as persisting CLGSI. Second, the western diet consumed by the majority of people in North American and increasingly in other parts of the world is described. The wester diet has been well documented to be pro-inflammatory and a primary contributor to CLGSI, whereas a whole-food plant-based (WFPB) diet is anti-inflammatory. The western diet is largely opposite to the WFPB diet in that it is high in fat, sugar and salt, and processed food. These qualities are pro-inflammatory compared with a WFPB diet that is high in macro and micro nutrients and low in refined processed foods. Third, how health care professionals can assess an individual’s diet expediently with a view to shift an individual’s diet to being more anti-inflammatory and less pro-inflammatory based on Dean Ornish’s Spectrum approach is outlined. A mini-dietary assessment and outcome evaluation tool can be used as an education tool as well. This clinical tool is described. As a consequence, by following a WFPB diet, chronic pain can be prevented or mitigated as well as risk factors for NCDs reduced. This is consistent with a comprehensive person-centered approach.
Role of physical activity in pain prevention
Joe Tatta, United States 
Public health recommendations for lifestyle interventions have been widely publicized for the promotion of health and prevention of disease. This includes the use of regular physical activity, anti-inflammatory dietary patterns, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for the treatment and reversal of chronic disease. As a lifestyle-related chronic health condition, persistent pain has a deep personal impact on one’s ability to live a full and active life. Yet current research investigations and clinical approaches to the evaluation and management of pain only partly address lifestyle-related factors. One critical lifestyle factor, physical (in)activity and sedentary behaviors, are associated with chronic pain severity, poor functional outcomes, and its persistence across the lifespan. It has also been associated with pain-related psychological distress, including kinesiophobia, catastrophizing, anxiety, depression, and a general pain-avoidance mindset where one is unwilling to participate in normal daily activity or health promoting physical activity. Regular physical activity has increasingly come under the spotlight over recent years, not just for its positive impact on the epigenetic, physical, emotional, and societal outcomes of pain, but also for its potential impact to diminish the parallel pandemic of noncommunicable disease. The objectives of this learning activity will be to 1) describe how physical activity impacts pain neurobiology and mechanisms of pain modulation 2) explain the
relationships between noncommunicable diseases and chronic pain, 3) examine the associations between regular physical activity, sedentary lifestyles, and the incidence of chronic pain, 4) identify which type of physical activity is beneficial for prevention and treatment of pain, and 5) describe how healthcare professionals can utilize behavioral health strategies and support people to M.O.V.E while willingly engaging in meaningful physical activity, even if pain is present.
Role of sleep hygiene and stress management in pain prevention
Anne Söderlund, Sweden
Lifestyle related problems such as poor sleep and increased perceived stress are common in persons suffering of musculoskeletal pain. Stress can be defined as “external and/or internal demands that are appraised as taxing or exceeding the resources of the person”. Pain-related stressors have been described to include aspects in person’s occupation, physical symptoms, feelings and cognitions related to pain problems, family and home responsibilities and recreation. Poor recovery in e.g. whiplash associated disorders and acute stress have shown to highly correlate and stress reduction was seen as a mediator of the intervention effects. This imply that stress management in pain conditions could function as preventive factor for worsening pain. Behavior change techniques, e.g. self-monitoring, goal-setting, relaxation, changing negative thinking, and applying time management can support positive development in stress-related problems such as physical, emotional, cognitive or sleep disturbances.

Chronic insomnia can be defined by having recurrent difficulties in falling asleep, continuous sleep and early awakening, all causing decreased daily functioning and participation. Insomnia and its comorbidity with chronic pain has been shown in about 50% of patients and can lead to deterioration of chronic pain condition. Also, poor sleep might be a better predictor of chronic pain than the reverse is. The interventions usually target chronic pain related health problems and not specifically poor sleep, leading to no improvement of sleeping problems. Interventions such as cognitive behavioral therapy in chronic pain conditions should include specific poor sleep targeted components, e.g. sleep education, self-monitoring of sleep and sleep-related thoughts in a diary, changes in sleep hygiene and sleep restriction, but also techniques for maintenance of the new sleeping behavior. Maintenance of behavior change regarding sleep and stress self-management is as important as initiating the change.

Show Resources
Show Resources