Background & Aims

Chronic pain is a lifestyle related disease (1). A growing problem on a societal level is that the western lifestyle and diet is spreading (2), including increased sedentariness and less nutritious foods.
Obesity is a common comorbidity to chronic pain (3). Maintaining a healthy lifestyle is harder when living with chronic pain (4, 5). It is yet unknown what patients living with chronic pain and comorbid obesity need to make lifestyle changes in rehabilitation. Also, clinicians find it difficult to address obesity.
The IASP recommendations on nutrition (6) may serve as a vignette to the topic. Also, novel research (7) (8) suggest that a focus on nutrition and capability to a healthy lifestyle may improve patients’ sleep, overall experience of energy throughout the day and their capacity to handle stress.
The aim of this study was to explore the experiences of lifestyle changes due to IPRP among patients living with obesity and chronic pain and their remaining needs and requests.

Methods

Included participants had completed an eight weeklong interdisciplinary pain rehabilitation program (IPRP) involving synchronized multimodal interventions as cognitive behavioral therapy and graded physical activity. The overall purpose of the IPRP was to facilitate return-to-work, through improved physical and psychological function. All eleven included participants (four males, seven females) fulfilled the criteria for obesity (? 30 kg/m2) and chronic pain. Their average age was 46 years, and their average BMI was 36.67 kg/m2.

Data was collected through semi-structured interviews digital or on cite. Verbatim transcripts were analyzed with an inductive approach to get a broad view of participants needs and requests and understand their process of making lifestyle changes. Latent content analysis was chosen to grasp data of sensitive concerns not plainly outspoken. The analysis resulted in one theme, two main categories and eight sub-categories.

Results

The main theme “Hold me back and push me forward” describe the participants’ expressed need for guidance. Two categories emerged under this theme, one overarching the hindrances preventing participants to make lifestyle changes, labeled “An impassible wall”. The other category encompass how participants changed perspectives and found new paths, labeled “Relearning”.

Among the described hindrances, self-blame and shame were especially outlined as devastating for their self-efficacy and limiting their ability to behavior change. Comorbidities as well as repeated unsuccessful attempts to change in the past, also contributed to experiences of being hindered.

Concerning relearning, several of the participants’ ideas on how to act differently, put the light on the balance between control and demand. They acknowledged a need additional knowledge and a long-term plan for maintenance of change. However, the also emphasized the importance of self-affirmation and person-centered demands.

Conclusions

We conclude that motivation is not enough to overcome hindrances for making lifestyle changes. Participants requested individual guidance to overcome their specific composotion of hindrances. They also asked for a tailored intervention based on their needs to be able to change perspectives and learn new ways to cope. Reducing demands and self-blame was found to be key change processes.

The study advocates for the strategic timing of interventions, suggesting that a detailed evaluation of each patient’s specific obstacles could lead to a more effective, customized treatment trajectory. For instance, integrating stress management elements in the IPRP may be beneficial for patients whose emotional eating is stress-induced, while prioritizing treatments for insomnia may be more effective for those for whom sleep disturbances exacerbate sedentary behavior. This tailored approach may enhance the overall efficacy of the IPRP and support patients in achieving sustainable lifestyle changes.

References

1.Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11.
2.Roth J, Qiang X, Marbán SL, Redelt H, Lowell BC. The obesity pandemic: where have we been and where are we going? Obesity research. 2004;12 Suppl 2:88S-101S.
3.Okifuji A, Hare BD. The association between chronic pain and obesity. Journal of Pain Research. 2015;8:399-408.
4.Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain. 2006;10(4):287-333.
5.Cooper L, Ells L, Ryan C, Martin D. Perceptions of adults with overweight/obesity and chronic musculoskeletal pain: An interpretative phenomenological analysis. Journal of Clinical Nursing. 2018;27(5-6):e776-e86.
6.IASP. 2020 Global Year for the Prevention of Pain: Nutrition and Chronic Pain: International Association for the Study of Pain; 2021 [Available from: https://www.iasp-pain.org/resources/fact-sheets/nutrition-and-chronic-pain/.
7.Elma Ö, Brain K, Dong HJ. The Importance of Nutrition as a Lifestyle Factor in Chronic Pain Management: A Narrative Review. Journal of Clinical Medicine. 2022;11(19).
8.Storm E, Bendelin N, Wessman KB, Johansson MM, Björk M, Dong HJ. Lifestyle changes are burdensome with my body broken by pain and obesity: patients’ perspectives after pain rehabilitation. BMC Musculoskeletal Disorders. 2023;24(1).

Presenting Author

Nina Bendelin

Poster Authors

Nina Bendelin

PhD

Pain and Rehabilitation Centre, and Departement of Health, Medicine and Caring Sciences, Linköping U

Lead Author

Mathilda Björk

Pain and Rehabilitation Centre, and Departement of Health, Medicine and Caring Sciences, Linköping U

Lead Author

Tova Resman

Pain and Rehabilitation Centre, and Departement of Health, Medicine and Caring Sciences, Linköping U

Lead Author

Elin Storm

Lead Author

Kim Bergström Wessman

Lead Author

Maria Johansson

PhD

Linköping University Faculty of Health sciences

Lead Author

Huanji Dong

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

Lead Author

Topics

  • Treatment/Management: Pharmacology: Psychological and Rehabilitative Therapies