Background & Aims

Chronic pain, accounting for 75% of global years lived with disability1, intersects with poor dietary intake – the leading cause of morbidity and mortality worldwide2 in many ways. Firstly, mechanisms associated with chronic pain such as inflammation and oxidative stress can be modulated by dietary intake3. Secondly, comorbid conditions associated with chronic pain e.g. depression, cardiovascular disease, type 2 diabetes, eating disorders and malnutrition can be managed with nutrition interventions3. Thirdly, chronic pain impacts on mobility and function reducing one’s ability to shop, cook and prepare healthy meals3. Best practice treatment combines a biopsychosocial approach with lifestyle factors e.g. physical activity, sleep, and nutrition4. Many pain services include these factors in their education/treatment. However, there is limited evidence of dietitian involvement in this setting. This abstract explores the role of dietitians and nutrition care in contemporary pain treatment.

Methods

We present a case study, or “recipe”, for developing, building, and implementing evidenced-based nutrition care for people living with chronic pain.

The ingredients needed for this recipe are:
•One systematic review
•One clinical audit
•Two focus group studies
•One pilot study intervention showing clinical meaningful improvements in pain outcomes with a personalized dietary intervention led by a dietitian
•Two enthusiastic dietitians
•Two passionate multidisciplinary teams
•Several national and international collaborations
•A dash of successful advocacy and leadership
•A pinch of determination
•Innovation, to taste

Please see below for the recipe’s methods.

Results

1.Preheat the oven to 180?C.
2.In a bowl, add the first four ingredients. Mix well to create a PhD thesis and build the evidence base.
3.In another bowl, add in likeminded national and global clinicians and researchers and whisk together to share knowledge and foster collaborations.
4.To this bowl, pour in the evidence, two dietitians, two multidisciplinary pain teams embracing new perspectives, a dash of advocacy and leadership to support the integration of nutrition care in pain management. Stir gently and pour into a baking dish.
5.Bake for 9 years and then appreciate the finished product; the establishment of dietetic positions in these two services.
6.Acknowledge the burnt edges; the challenges; limited capacity, lack of specific evidence and change management challenges.
7.Create a garnish with innovations like student placements, stakeholder engagement, service mapping and capacity building.
8.Serve evidenced based nutrition care to people living with chronic pain.

Conclusions

This recipe provides a case study of two dietitians working collaboratively with multidisciplinary pain services to promote and innovate best practice nutrition care for people living with chronic pain.
Recipe notes and variations include:
1.Adapt the recipe to other national and international pain services, considering the regions dietary intake and dietary recommendations.
2.Expand the recipe to advocate for the inclusion of dietary assessment in national pain registries and promote registry-based trials.
3.Expand the recipe to support dietitians working in niche areas and multidisciplinary pain services to advocate and innovate, driving the development into new services.

References

1.GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020 Oct 17;396(10258):1223-1249. doi: 10.1016/S0140-6736(20)30752-2.
2.GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019 May 11;393(10184):1958-1972. doi: 10.1016/S0140-6736(19)30041-8.
3.Elma Ö, Brain K, Dong HJ. The Importance of Nutrition as a Lifestyle Factor in Chronic Pain Management: A Narrative Review. J Clin Med. 2022 Oct 9;11(19):5950. doi: 10.3390/jcm11195950.
4.Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. 2021 May 29;397(10289):2082-2097. doi: 10.1016/S0140-6736(21)00393-7.

Presenting Author

Katherine Brain

Poster Authors

Katherine Brain

PhD, B Nutr&Diet (Hon I)

Hunter Integrated Pain Service; Chronic Pain Australia; University of Newcastle

Lead Author

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Lucy Kocanda

Tamworth Integrated Pain Service & The University of Newcastle Department of Rural Health

Lead Author

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Chris Hayes

Hunter Integrated Pain Service

Lead Author

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Hema Rajappa

Hunter Integrated Pain Service

Lead Author

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Vickie Croker

Tamworth Integrated Pain Service

Lead Author

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Laura Bruggink

Hunter Integrated Pain Service

Lead Author

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Huanji Dong

Department of Pain and Rehabilitations Centre, Region ?sterg?tland & Link?ping Univers

Lead Author

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Topics

  • Access to Care

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