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‘Food Insecurity’ Linked to Pain Conditions

BOSTON – Patients who experience chronic pain and who use food banks may be prone to “food insecurity,” the fear of running out of food before being able to buy more.

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.

The study was presented here at the Academy of Integrative Pain Management (AIPM) Inaugural Global Pain Clinician Summit 2018.

Patient-Reported Pain

To locate adult users of a food bank for the study, investigators attended community food drop-off events and mobile markets in low-income apartment housing.

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 researchers collected surveys from 207 food bank users (average age, about 60 years; 53.7% reported having chronic pain).

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%).

It’s not clear why the pain group was more educated, said Bigand. “This was very preliminary work, and we would like to go back and do more research,” she added.

Those in the pain group also had more mental health problems (36.7% vs 22.3%) and were more likely to use food stamps (77.1% vs 52.4%).

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.”

Food Fears

The study showed that three variables independently predicted food insecurity in the previous year.

The presence of chronic pain was significantly associated with increasing frequency of food insecurity (P < .05), as was depression (P < .01).

“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.

Age was inversely related to food insecurity, meaning that younger participants were more worried about food running out.

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.”

The food bank that partnered with the investigators provides fresh and canned fruits and vegetables, as well as staple foods like bread.

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.

‘High-Hit’ Foods

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.

“They go after what I call ‘high-hit’ foods like simple carbs and high-fat foods because these might provide a short-term analgesic,” he said.

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.

Food insecurity may not just be a marker for low socioeconomic status or some of the social determinants of health, but may also be a marker for lack of quality nutrition,” Jackson said.

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.

Highly processed and canned foods that tend to be lower in cost typically have less nutritional value and may contribute to pain, said Jackson.

“It’s fascinating to see a student take that research a step further and show that patients who didn’t have as much access to high-quality food also had negative health outcomes,” he said.

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.

Academy of Integrative Pain Management (AIPM) Inaugural Global Pain Clinician Summit 2018. Abstract 11, presented November 9, 2018.

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