___________________________________________________ Pain Assessment and Management, 2nd Edition
Eating Routines Chronic pain is more common in people with an unhealthy weight, whether they are underweight or overweight when compared to those with a healthy weight (Elma et al., 2022). These authors found that those with chronic pain were likely to have suboptimal nutrient intake and/or poor eating behaviors. A common concern shared by clients with pain is the increased effort it takes to obtain and prepare nutritious food. Eating involves not only the effort to get up and make something to eat but also the entire activity of going shopping for food and the physical demands that entails. Therefore, clients will often have an inadequate supply of food and rely on easier (and usually less healthy) choices. As a result of eating less frequently and in smaller amounts, blood sugar drops, which can increase fatigue and cause dizziness. Fatigue, which may already be a concern for a client with pain, is now exacerbated by poor eating habits. Pasdar et al. (2022) found that higher adherence to a high- protein diet was inversely related to chronic low back pain and that following an energy-dense diet was positively associated with chronic low back pain. Unfortunately, weight gain can worsen pain and increase the effort needed to perform physi- cal activities. Stoner et al. (2017) found that obesity hinders improvement in functioning. Obesity can cause mechani- cal disruption, including joint compression and alignment changes that can lead to pain (Antonescu et al., 2020). The practitioner can work with a client to develop strategies, such as planning meals ahead, arranging to have the necessary ingredients, and having a back-up eating plan for flare-up days, such as prepared frozen meals. INSTRUMENTAL ACTIVITIES OF DAILY LIVING After participation in a pain rehabilitation program, individu- als continue have a need to adjust to life with chronic pain (Kallhed & Mårtensson, 2018). Kallhed and Mårtensson (2018) identified several categories in the qualitative analysis of participant experiences that incorporated the meaning behind and the relationship between finding new ways to perform activities, achieving a reasonable balance of activities, and using activities to achieve other purposes. This supports the use of activities, occupations, and strategies with clients who experience chronic pain. Additionally, heavy housework was identified as the occupation that caused the greatest difficulty for older adults (Stamm et al., 2016). Chronic musculoskeletal disease and pain intensity were significant predictors for prob- lems in these areas. Planning time use can be a method that individuals can use to manage activities that are considered meaningful. The goal is for the client to structure their time and give priority to activities that are the most important on a particular day (Kallhed & Mårtensson, 2018). When time is planned effectively, individuals are more likely to be able to participate in another activity later on, and this improves the feeling of accomplishment for them.
WORK Work remains an important occupation for individuals experiencing chronic pain, regardless of the amount of time spent away from a position (Saunders et al., 2018). Bryson- Campbell et al. (2020) identified self-management, goal setting, education, balance, communication and collaboration, and support as key concepts needed to support injured workers. Practitioners often provide interventions that focus on work. Assessment and intervention can be provided either indi- vidually or in groups of workers to promote health and injury prevention (Dorsey et al., 2017). Practitioners design and modify tools, equipment, or behaviors to improve participation and reduce pain for clients. It is important to remember to address not only the physical aspects needed to participate in work but also the psychosocial and cultural aspects. Without consideration of these additional aspects, it is possible that the perceptions of others will cause the client to feel singled out and abandon the adaptations that can limit pain. A systematic review of the literature provides evidence that supports the use of work-oriented interventions, including work hardening, education on work techniques, management strategies in the performance of work tasks, and environmental modification (Wegrzynek et al., 2020). LEISURE Savvakis and Kolokouras (2019) found that limited leisure activities could mediate quality of life in chronic musculo- skeletal illnesses, which supports the use of activities for other purposes and enables the individual to temporarily focus on other things rather than the pain. Clients can use activities to decrease pain for short periods. The activities chosen are frequently identified as joyful and provide a sense of well- being for the individual (Kallhed & Mårtensson, 2018). Using relaxation techniques and other distractors can be a strategy to relieve pain. The interplay between chronic pain and physi- cal activity on the risk of all-cause mortality was examined using National Health and Nutrition Examination Survey data between 1999 and 2004. The findings demonstrate that those with chronic pain who engaged in at least 150 minutes of physical activity a week had a lower risk of mortality when compared to those without chronic pain and no reported leisure time (Youngdeok, 2019). Working with clients who have pain to increase time spent in active leisure occupations can reduce the risk of mortality. SLEEP Disrupted and “unrestful” sleep is a common complaint from clients with chronic pain (McVeigh et al. 2022). Resting can be a source of stress for some due to feeling the need to be more active (Kallhed & Mårtensson, 2018). The prevalence of sleep disturbance is high among individuals suffering from chronic pain (Sun, 2021). Between 72.9% and 92% of par- ticipants with chronic widespread pain experience poor sleep as measured by the Pittsburgh Sleep Quality Index (de Rooij et al., 2020; Sun, 2021). Lindell and Grinby-Ekman (2022)
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