nutrition and eating behavior in patients with chronic pain receiving long-term opioid therapy...
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Nutrition and eating behavior in patients with chronic pain receiving long-term opioid therapy
Joseph Walker III, MDDepartment of Orthopedics
University of Connecticut
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Prevalence of chronic painBa
ckgr
ound
Adapted from Windt et al. J Psychosom Res 2008
Developed countries: 19-37%Developing countries: 41%
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ObjectivesO
bjec
tives
Objectives of this study To assess nutrient intake and eating behavior in a group of patients who werediagnosed with chronic pain and received long-term opioid analgesic therapy
Previous studies suggest a correlation between nutrient intake and chronic pain
However, the lack of clinical research regarding the dietary behavior of patients with chronic pain has been noticeable
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Inclusion criteriaM
etho
ds
Inclusion criteriaAt least 18 years oldIntractable chronic painLong-term opioid analgesic treatment
Exclusion criteria Previous eating disordersPregnancy
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Demographic and clinical data of participantsM
etho
ds
Characteristics Value ± SDSample size, n 53
Men (%) 30 (57)
Women (%) 23 (43)
Age, y 54.7 ± 11.3
White (%) 51 (96)
American Indian (%) 2 (4)
Mental Health Diagnosis (%) 19 (36)
Meleger et al PMR 2014
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Characteristics Value ± SDChronic Pain Diagnoses Low pack pain ±Lumbar Neck pain ± Cervical Neuropathic pain (Peripheral, Central, CRPS) Joint pain (psoriatic, degenerative) Fibromyalgia Poststemotomy pain Perineal pain Post-traumatic jaw pain
309992111
Pain Level 0-10 5.8 ± 2.2
Average Morphine equivalents, mg 226.6 ± 199Duration opioid treatment, y 1.5-14
Met
hods
Demographic and clinical data of participants
Meleger et al PMR 2014
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Met
hods
Parameter Value ± SDBMI, X ± SD 29.3 ± 6.1
Overweight (BMI ≥25 - <30), N (%) 14 (28)
Obesity (BMI ≥ 30), N (%) 22 (44)
Demographic and clinical data of participants
Meleger et al PMR 2014
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Experimental setup M
etho
ds
Meleger et al PMR 2014
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Study instrumentsM
etho
ds
Pain Intensity during 6 months Numeric rating scale and visual faces scale (Wong-Baker Faces Rating Scale)
Biosphychosocial information Short demographic survey
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Study instrumentsM
etho
ds
Nutrient data14-item Food Frequency Questionnaire (FFQ)
-Type of foods they consumed-Quantity of those foods in relation to a medium sized portion
Eating behavior Eating behavior inventory (EBI)
-26-item self-report instrument developed to asses individual behaviors that have been implicated in weight-loss management
Nutrient calculations Nutrient data system for research software (2010)
-Generates multiple datasets from a batch of completed FFQ forms, including the daily nutrient intake dataset
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Weight distribution and caloric intake Re
sults
Meleger et al PMR 2014
Note: 6/30 men and 6/20 women reported a daily caloric intake below 1200 calories per day
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Mean individual daily consumptionRe
sults
Meleger et al PMR 2014
Nutrient Mean ± SD Recommended
Carbohydrates (%) 51 45-65
Protein (%) 16.3 10-35
Fat (%) 34.1 20-35
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Mean individual daily consumptionRe
sults
Meleger et al PMR 2014
Nutrient Mean ± SD Recommended*
Carbohydrates (g) (kcal)
240.6 ± 105.1 962.4 ± 420
Sugar, total (g) 125.6 ± 59.6 130
Sugar, added (g) 74.4 ± 43.0 Restrict Intake
Glycemic Load 117.7 ± 54.7 90
Fiber (g) 17.3 ± 7.5 25
Aspartame (mg) 145.9 ± 300.5
* Recommend/Guidelines from USDA Dietary Reference Intake
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Mean individual daily consumptionRe
sults
Meleger et al PMR 2014
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Mean individual daily consumptionRe
sults
Meleger et al PMR 2014
Nutrient Mean ± SD Recommended*
Cholesterol (mg) 266.5 ± 234 < 300
Saturated fat (g) (%)
25.8 ± 16.812.3
< 16< 7
Omega-3-fatty acids (g) 1.6 ± 0.99 Prevention cardiovascular disease: >0.3 Modulation of RA pain: 2.6 -7.1 (RA)
Total trans-fatty acids (g) (%)
2.7 ± 1.71.3
< 2.0 < 1.0 %
Total monounsaturated fatty acids (g)
25.7 ± 14.6
Total polyunsaturated fatty acids (g)
14.4 ± 8.3 (14-17g /day) men (11-12g /day) women
* Recommend/Guidelines from USDA Dietary Reference Intake
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Mean individual daily consumptionRe
sults
Meleger et al PMR 2014
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Daily consumption of fruit and vegetablesRe
sults
Meleger et al PMR 2014
Daily Serving Mean ± SD Recommended*
Fruit (5-a-day method)
1.5 ± 1.2 4-5
Fruit(summation method)
1.8 ± 1.1 4-5
Vegetables (5-a-day method)
1.9 ± 1.4 4-5
Vegetables (summation method)
1.9 ± 1.5 4-5
* Recommend/Guidelines from USDA Dietary Reference Intake
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Daily consumption of Alcohol and CaffeineRe
sults
Meleger et al PMR 2014
Daily Consumption Mean ± SD Recommended*
Alcohol (g) 1.6 ± 0.5 < 14
Caffeine (mg) 199.9 ± 160.8 < 186
* Recommend/Guidelines from USDA Dietary Reference Intake
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Daily consumption of TryptophanRe
sults
Meleger et al PMR 2014
Daily Consumption Mean ± SD
Tryptophan (g) 0.9 ± 0.4
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Daily consumption of vitaminsRe
sults
Meleger et al PMR 2014
Mean ± SD RDA (Men) RDA (Women
Vitamin A (mg) 1083.8 ± 1483.1 900 700
Vitamin C (mg) 112.7 ± 72.0 90 75
Vitamin D (IU) 244 ± 208 600 600
Vitamin E (mg) 14.3 ± 13.8 15 15
Vitamin B12 (mg) 8.6 ± 10.2 2.4 2.4
Folate (mg) 436.7 ± 222.0 400 400
* Recommend/Guidelines from USDA Dietary Reference Intake
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Daily consumption of vitaminsRe
sults
Meleger et al PMR 2014
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Daily consumption of mineralsRe
sults
Meleger et al PMR 2014
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Daily consumption of mineralsRe
sults
Meleger et al PMR 2014
Mean ± SD RDA (Men) RDA (Women
Calcium (mg) 1111.7 ± 672.1 1000 1000
Magnesium (mg) 293.6 ± 120.4 420 320
Iron (mg) 15.2 ± 8.8 8 18
Sodium (mg) 2868.5 ± 1388.1 <2300 <2300
* Recommend/Guidelines from USDA Dietary Reference Intake
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ConclusionsCo
nclu
sion
s
Calorie intakeOur results suggest a similar percent of fat, protein, carbohydrate calorie intake
However, regarding type of fat intake, the participants reported greater than recommended saturated fat and trans fat consumption compared to guidelines
Clinical conclusion Counsel the patient on reducing saturated fat and transfat intake and to
bring more in line with guidelines
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ConclusionsCo
nclu
sion
s
Clinical conclusion Counsel the patient on raising vegetable intake
Vegetable intakeParticipants consumed an approximate daily average of 2 servings of fruits and vegetables, respectively
This is well below the suggested daily guidelines of 4-5 servings in each category as proposed by the American Heart Association and the Dietary Approaches to Stop Hypertension diet
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ConclusionsCo
nclu
sion
s
Clinical conclusion Counsel the patient on lowering sodium intake
Sodium IntakeSodium intake was found to be significantly higher than the conservative suggestion of 2.3 g per day
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ConclusionsCo
nclu
sion
s
Caffeine IntakeAll but one participant reported a higher regular consumption of caffeine than the average consumption in Vermont
Clinical conclusionCounsel the patient to lower caffeine intake, since there is a possible relationship with poor sleep/insomnia
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ConclusionsCo
nclu
sion
s
Clinical conclusionCounsel patients with RA to increase their daily dosage via fish, nuts, and seeds
Omega-3-Fatty Acid intakeThe majority of participants consumed more than the recommended Cardiovascular protective dose of omega-3-fatty acids, but less than the anti-inflammatory dosing found to be effective in persons with RA
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ConclusionsCo
nclu
sion
s
Vitamin and Mineral intakeResults from the present study indicate suboptimal intake of micronutrients, especially vitamin D and Magnesium
Clinical conclusionCounsel the patient to increase/balance their intake of magnesium and vitamin D
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ConclusionsCo
nclu
sion
s
Clinical Conclusion Physician may wish to direct patients to weight-management
Eating BehavioursOur results demonstrate a pattern in average EBI scores that is very similar to the scores for new patients entering a weight-loss management centre
Explanations-Participants have eating behaviours that promote weight gain-Participants have eating behaviours that do not promote weight loss
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ConclusionsCo
nclu
sion
s
Clinical Conclusion Consult patients with fibromyalgia or headache disorders that minimizing/ stopping this high intake may relieve their symptoms
Artificial Sweetener IntakeParticipants had high intake of artificial sweeteners such as aspartame
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Conc
lusi
ons
Conclusions
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Future PerspectivesFu
ture
Per
spec
tive
Study limitationsSmall sample sizeSampling biasSmall ethnic heterogeneityLong-term opioid analgesic therapy
Future studiesLarge prospective population studies are needed to confirm our resultsin patients with or without opioid analgesics
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Acknowledgements
Dept. of Physical Medicine and RehabilitationHarvard Medical School
Boston, MAand
Spaulding Rehabilitation HospitalMedford, MA
Alec L. Meleger, MD
Supported by:Spaulding Rehabilitation Mini-Grant
Marriage and Family Therapy Program Human Development and Family Studies
University of ConnecticutStorrs, CT
Cameron Kiely Froude, MA
Virginia Czamowski, NP
Spaulding Rehabilitation HospitalMedford, MA
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FINMeleger AL, Froude CK, Walker J. Nutrition and eating behavior in patients with chronic pain receiving long-term opioid therapy. PM&R. 2014 Jan; 6(1):7-12.