Previous research suggests that there’s a link between depression, lower socioeconomic status, and pain, but this is the first study to show a relationship between pain conditions and food insecurity, lead author Teresa Bigand, PhD candidate, College of Nursing, Washington State University Spokane, told Medscape Medical News.
More resources are now needed to address the nutritional needs of people with chronic pain, Bigand added.
Participants completed the Patient Health Questionnaire, which measures depressive symptoms (5 or greater on a 0-24 scale indicates depression), the Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance short form, and the PROMIS pain interference short form.
Scores higher than 50 for both PROMIS scales indicated a greater disturbance than for the general population.
The survey included a question on food insecurity, asking how often in the past 12 months the participants worried that their food would run out before they had money to buy more. Answers could be “never” (0), “rarely” (1), “sometimes” (2), “often” (3), or “always” (4).
The percentage of females was higher in the pain group compared with other participants (72% vs 57%), as was mean body mass index (BMI, 33.7 vs 31.5) and having a college degree (39.5% vs 27.7%).
Respondents had a high level of sleep disturbances, poor heath, and depression. This is in line with other research that has uncovered a strong and complex relationship between chronic pain, poor sleep, and depression, Bigand said.
About 51% of the participants indicated that they had food insecurity “often” or “always.”
“The more depressed you are, the more likely you are to feel that your food will run out before you have money to buy more,” Bigand said.
The study didn’t determine why this might be, but Bigand surmised that “younger people are more likely to have a family at home and children to feed, and more responsibilities than those living on their own.”
Despite the availability of fresh produce, these food bank users “were still not meeting their nutritional needs,” said Bigand. She noted that she aims to carry out further analyses to find out why.
“We want to know if people are really eating those fresh foods, and if so, how often,” she said. “Maybe it’s that they’re eating all their food in the first week, then eating nothing the second week.”
The researchers would also like to look more closely at people with and without chronic pain in terms of BMI differences. Bigand noted that proper nutrition is linked to numerous health benefits in addition to improving pain outcomes.
Commenting on the study for Medscape Medical News, Robert Bonakdar, MD, director of pain management, Scripps Center for Integrative Medicine, La Jolla, California, and assistant clinical professor of medicine at the University of California-San Diego School of Medicine, noted that patients with pain often end up on a poor diet.
However, these patients are also more likely to go on disability, become depressed, and face poverty, added Bonakdar.
“At that point, their choices are narrowed, and that just compounds the problem,” he said. If these patients can only afford certain foods, “they might be headed to nutritional deficiency.”
Marker for Nutritional Deficits?
Also commenting for Medscape Medical News, W. Clayton Jackson, MD, president of the AIPM, said the study findings are important but “probably predictable” if viewed “through the lens” of social determinants of health and chronic illness.
“It would make sense that depression and pain would be correlative to patients who have food insecurity,” Jackson said. But in light of mounting research linking certain elements of poor nutrition to pain, this new study takes on added significance, he noted.
He noted that past studies have shown that fresh foods, antioxidant foods, vegetables with dark skin, and colorful foods tend to have an anti-inflammatory effect, and added that inflammation is a key cause of pain.
There’s a reason people shop at a food bank rather than at a supermarket or farmer’s market, Jackson said, noting that an individual may have lost his or her job and fallen victim to a vicious cycle that ensues, Jackson said.
“Some Pain Summit participants said it’s a common experience of patients in their practice that chronic pain drives decreased functionality, which drives decreased employability, which increases poverty, which drives more pain,” he concluded.
Dr Jackson is a consultant for Otsuka Pharmaceuticals and Aspire Health. Dr Bonakdar receives royalties or honoraria from Oxford University Press, Lippincott, and Elsevier and is a consultant for American Specialty Health, Standard Process, and Metagenics.