Nutrition and eating behavior in patients with chronic pain receiving long-term opioid therapy Joseph Walker III, MD Department of Orthopedics University

Nutrition and eating behavior in patients with chronic pain receiving long-term opioid therapy

Joseph Walker III, MDDepartment of Orthopedics

University of Connecticut

Prevalence of chronic painBa

ckgr

ound

Adapted from Windt et al. J Psychosom Res 2008

Developed countries: 19-37%Developing countries: 41%

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

Inclusion criteriaM

etho

ds

Inclusion criteriaAt least 18 years oldIntractable chronic painLong-term opioid analgesic treatment

Exclusion criteria Previous eating disordersPregnancy

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

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


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


Experimental setup M

etho

ds


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

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

Weight distribution and caloric intake Re

sults


Note: 6/30 men and 6/20 women reported a daily caloric intake below 1200 calories per day

Mean individual daily consumptionRe

sults


Nutrient Mean ± SD Recommended

Carbohydrates (%) 51 45-65

Protein (%) 16.3 10-35

Fat (%) 34.1 20-35


sults


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


sults



sults


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



sults


Daily consumption of fruit and vegetablesRe

sults


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


Daily consumption of Alcohol and CaffeineRe

sults


Daily Consumption Mean ± SD Recommended*

Alcohol (g) 1.6 ± 0.5 < 14

Caffeine (mg) 199.9 ± 160.8 < 186


Daily consumption of TryptophanRe

sults


Daily Consumption Mean ± SD

Tryptophan (g) 0.9 ± 0.4

Daily consumption of vitaminsRe

sults


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


Daily consumption of vitaminsRe

sults


Daily consumption of mineralsRe

sults


Daily consumption of mineralsRe

sults


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


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

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

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

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

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

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

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

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

Conc

lusi

ons

Conclusions

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

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

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.

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Nutrition and eating behavior in patients with chronic pain receiving long-term opioid therapy Joseph Walker III, MD Department of Orthopedics University