In this chapter we will discuss the role of various factors associated with particular lifestyle choices in the management of chronic pain. Lifestyle choices will be grouped into the following four general categories: (1) weight, exercise, and nutrition; (2) common substances of daily living, specifically caffeine, tobacco, and alcohol; (3) sleep, and; (4) other lifestyle factors with variable degrees of choice, including social isolation/social support, employment-related factors, and religiosity/spirituality.
WEIGHT, EXERCISE, AND NUTRITION
There is a solid body of research evidence that confirms a positive correlation between weight and chronic pain. Several studies have found that individuals with high body mass index (BMI) levels report higher levels of pain associated with various chronic pain conditions, including chronic widespread pain,1 chronic low back pain (CLBP),1-4 arthritic pain,5,6 abdominal pain, headaches—both tension and migraines—and fibromyalgia (FMS),1 among others. Moreover, the relationship appears to be incremental; that is, increasingly higher levels of weight lead to incrementally higher levels of pain. Using four target overweight categories, a large-scale study that gathered survey data through telephone interviews with over 1 million subjects found that “overweight” subjects (BMI >25) reported 20% higher rates of pain than subjects in the “low-normal weight group” (BMI = 18.5-24.9); 68% higher for subjects in the “Obese I” group (BMI = 30-34.9), 136% higher for the “Obese II” group (BMI = 35-39.9), and 254% higher for the “Obese III” group (BMI >40)7. Other studies have confirmed the incremental nature of this relationship.
In addition to higher levels of pain intensity, higher levels of BMI are also correlated with a higher prevalence of a number of chronic pain conditions. Moreover, there is evidence that the relationship between excess weight and chronic pain can be bidirectional. Although a chronic pain condition may lead to higher levels of inactivity that may result in weight gain, there is also evidence that excessive weight may lead to the onset and maintenance of chronic pain conditions. A prospective study by Heuch and colleagues4 found that high levels of BMI were associated with subsequent prevalence of low back pain in individuals with no previous history of low back pain at baseline. Moreover, in this study the presence of a history of low back pain at baseline did not predict subsequent higher levels of BMI.
High BMI levels among chronic pain sufferers have also been associated with a negative quality of life, poor physical functioning, greater disability, and greater accident liability.8,9 Psychological factors, mainly anxiety and depression, can also play a significant role in modulating the relationship between weight and pain. This relationship can also be bidirectional; whereas anxiety and depression may lead to significant weight gain, being overweight may reinforce feelings of anxiety and depression. However, regardless of the particular direction of causality, it in turn may exacerbate ...