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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.

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Presentation on theme: "Nutrition and eating behavior in patients with chronic pain receiving long-term opioid therapy Joseph Walker III, MD Department of Orthopedics University."— Presentation transcript:

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

2 Prevalence of chronic pain Background Adapted from Windt et al. J Psychosom Res 2008 Developed countries: 19-37% Developing countries: 41%

3 Objectives Objectives of this study To assess nutrient intake and eating behavior in a group of patients who were diagnosed 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

4 Inclusion criteria Methods Inclusion criteria At least 18 years old Intractable chronic pain Long-term opioid analgesic treatment Exclusion criteria Previous eating disorders Pregnancy

5 Demographic and clinical data of participants Methods CharacteristicsValue ± SD Sample size, n53 Men (%)30 (57) Women (%)23 (43) Age, y54.7 ± 11.3 White (%)51 (96) American Indian (%)2 (4) Mental Health Diagnosis (%)19 (36) Meleger et al PMR 2014

6 CharacteristicsValue ± SD Chronic 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 Pain Level ± 2.2 Average Morphine equivalents, mg226.6 ± 199 Duration opioid treatment, y Methods Demographic and clinical data of participants Meleger et al PMR 2014

7 Methods ParameterValue ± SD BMI, X ± SD29.3 ± 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

8 Experimental setup Methods Meleger et al PMR 2014

9 Study instruments Methods Pain Intensity during 6 months Numeric rating scale and visual faces scale (Wong-Baker Faces Rating Scale) Biosphychosocial information Short demographic survey

10 Study instruments Methods Nutrient data 14-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

11 Weight distribution and caloric intake Results Meleger et al PMR 2014 Note: 6/30 men and 6/20 women reported a daily caloric intake below 1200 calories per day

12 Mean individual daily consumption Results Meleger et al PMR 2014 NutrientMean ± SDRecommended Carbohydrates (%) Protein (%) Fat (%)

13 Mean individual daily consumption Results Meleger et al PMR 2014 NutrientMean ± SDRecommended* Carbohydrates (g) (kcal) ± ± 420 Sugar, total (g)125.6 ± Sugar, added (g)74.4 ± 43.0Restrict Intake Glycemic Load117.7 ± Fiber (g)17.3 ± Aspartame (mg)145.9 ± * Recommend/Guidelines from USDA Dietary Reference Intake

14 Mean individual daily consumption Results Meleger et al PMR 2014

15 Mean individual daily consumption Results Meleger et al PMR 2014 NutrientMean ± SDRecommended* Cholesterol (mg)266.5 ± 234< 300 Saturated fat (g) (%) 25.8 ± < 16 < 7 Omega-3-fatty acids (g)1.6 ± 0.99Prevention cardiovascular disease: >0.3 Modulation of RA pain: (RA) Total trans-fatty acids (g) (%) 2.7 ± < 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

16 Mean individual daily consumption Results Meleger et al PMR 2014

17 Daily consumption of fruit and vegetables Results Meleger et al PMR 2014 Daily ServingMean ± SDRecommended* Fruit (5-a-day method) 1.5 ± Fruit (summation method) 1.8 ± Vegetables (5-a-day method) 1.9 ± Vegetables (summation method) 1.9 ± * Recommend/Guidelines from USDA Dietary Reference Intake

18 Daily consumption of Alcohol and Caffeine Results Meleger et al PMR 2014 Daily ConsumptionMean ± SDRecommended* Alcohol (g)1.6 ± 0.5< 14 Caffeine (mg)199.9 ± 160.8< 186 * Recommend/Guidelines from USDA Dietary Reference Intake

19 Daily consumption of Tryptophan Results Meleger et al PMR 2014 Daily ConsumptionMean ± SD Tryptophan (g)0.9 ± 0.4

20 Daily consumption of vitamins Results Meleger et al PMR 2014 Mean ± SDRDA (Men)RDA (Women Vitamin A (  g) ± Vitamin C (mg)112.7 ± Vitamin D (IU)244 ± Vitamin E (mg)14.3 ± Vitamin B12 (  g) 8.6 ± Folate (  g) ± * Recommend/Guidelines from USDA Dietary Reference Intake

21 Daily consumption of vitamins Results Meleger et al PMR 2014

22 Daily consumption of minerals Results Meleger et al PMR 2014

23 Daily consumption of minerals Results Meleger et al PMR 2014 Mean ± SDRDA (Men)RDA (Women Calcium (mg) ± Magnesium (mg)293.6 ± Iron (mg)15.2 ± Sodium (mg) ± <2300 * Recommend/Guidelines from USDA Dietary Reference Intake

24 Conclusions Calorie intake Our 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

25 Conclusions Clinical conclusion Counsel the patient on raising vegetable intake Vegetable intake Participants 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

26 Conclusions Clinical conclusion Counsel the patient on lowering sodium intake Sodium Intake Sodium intake was found to be significantly higher than the conservative suggestion of 2.3 g per day

27 Conclusions Caffeine Intake All but one participant reported a higher regular consumption of caffeine than the average consumption in Vermont Clinical conclusion Counsel the patient to lower caffeine intake, since there is a possible relationship with poor sleep/insomnia

28 Conclusions Clinical conclusion Counsel patients with RA to increase their daily dosage via fish, nuts, and seeds Omega-3-Fatty Acid intake The 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

29 Conclusions Vitamin and Mineral intake Results from the present study indicate suboptimal intake of micronutrients, especially vitamin D and Magnesium Clinical conclusion Counsel the patient to increase/balance their intake of magnesium and vitamin D

30 Conclusions Clinical Conclusion Physician may wish to direct patients to weight-management Eating Behaviours Our 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

31 Conclusions Clinical Conclusion Consult patients with fibromyalgia or headache disorders that minimizing/ stopping this high intake may relieve their symptoms Artificial Sweetener Intake Participants had high intake of artificial sweeteners such as aspartame

32 Conclusions

33 Future Perspectives Future Perspective Study limitations Small sample size Sampling bias Small ethnic heterogeneity Long-term opioid analgesic therapy Future studies Large prospective population studies are needed to confirm our results in patients with or without opioid analgesics

34 Acknowledgements Dept. of Physical Medicine and Rehabilitation Harvard Medical School Boston, MA and Spaulding Rehabilitation Hospital Medford, MA Alec L. Meleger, MD Supported by: Spaulding Rehabilitation Mini-Grant Marriage and Family Therapy Program Human Development and Family Studies University of Connecticut Storrs, CT Cameron Kiely Froude, MA Virginia Czamowski, NP Spaulding Rehabilitation Hospital Medford, MA

35 FIN Meleger AL, Froude CK, Walker J. Nutrition and eating behavior in patients with chronic pain receiving long-term opioid therapy. PM&R Jan; 6(1):7-12.


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