Many people with obesity have chronic pain due to joint stress and inflammation. Speaking to these patients about modifiable lifestyle factors — like diet and exercise — can help improve their pain severity and quality of life.

In a new study published in the European Journal of Nutrition, patients with overweight or obesity who followed a 3-month weight-loss dietary intervention cut chronic musculoskeletal pain scores in half — independent of adiposity changes.

Specifically:

1. Diet quality improved 22%
2. Presence of chronic musculoskeletal pain dropped from 50% to 24%

You may already recommend weight loss to relieve pain or joint stress, but it is important to emphasize diet quality, rather than focusing only on BMI or a number on the scale.

Clinicians should reinforce that: “It’s not just about how much you eat, but also the types of foods you choose,” Susan J. Ward, PhD, lead researcher of the study and a research coordinator at the University of South Australia, Adelaide, Australia, said in an email.

Study participants increased their intake of fruits, vegetables, whole grains, and lean meats while limiting alcohol, soft drinks, and sweets.

The researchers did not investigate why these dietary changes relieved pain, but Ward offered some possible explanations: a diet rich in vitamins, minerals, and micronutrients may affect pain pathways in the neuroimmune system, improve musculoskeletal health, and reduce inflammation.

“A higher quality diet tends to be rich in anti-inflammatory nutrients, and lower in pro-inflammatory foods, like refined carbohydrates, saturated fats, added sugars, and alcohol,” Ward said. “This shift may help reduce chronic low-grade inflammation that contributes to pain.”

Anti-Inflammatory Foods Help Lower Chronic Pain

Inflammation contributes to both chronic pain and chronic disease, like obesity, type 2 diabetes, and arthritis.

“A diet high in saturated or processed foods, red meat, high-fat dairy products, and high-sugar foods can alter the body’s gut microbiome and immune system, leading to inflammation in the body, which worsens chronic pain,” Meera K. Kirpekar, MD, a clinical associate professor and director of the Section on Women’s Pain in the Department of Anesthesiology, Perioperative Care, and Pain Medicine at NYU Langone, New York City, said in an email.

Healthcare providers should speak to patients about lifestyle modifications to improve overall health and pain scores. However, keep in mind that diet is only one piece of the pain management puzzle, Kirpekar said.

Address Micronutrient Deficiencies

While talking to patients about lifestyle modifications, you may need to screen for nutritional deficiencies. A recent study published in the journal Pain Practice found that some people with severe pain had lower levels of vitamin D, B12, magnesium, and folate than those with moderate or no pain.

Clinicians can screen patients with high-impact chronic pain for these deficiencies when they don’t get the relief they want from other treatments, said Julie Pilitsis, MD, PhD, senior author of the Pain Practice study, head of Department of Neurosurgery College of Medicine — Tucson, The University of Arizona, and a member of the Comprehensive Center for Pain & Addiction.

After screening, you will need to talk to patients about ways to increase their intake of the deficient nutrients through diet or specific supplements. “I wish it were as easy as giving people a multivitamin. But multivitamins give you a little bit of everything, not necessarily the boost where you need it,” said Pilitsis.

Micronutrient supplements or dietary changes can work synergistically with medications and therapies. Think about patients with spinal cord stimulators that modulate the nervous system. Proper nutrition is key to ensuring their neurons and nervous tissues respond to the device properly, said Pilitsis.

Clinicians should also consider that patients with chronic pain might develop nutritional deficiencies since pain can make it harder to shop for groceries and prepare nutritious meals.

To address this with patients, healthcare providers should ask about appetite and changes in eating habits. Short food-frequency questionnaires or conversations about dietary variety can help identify patients who may require more in-depth nutrition evaluation or laboratory testing, Melissa Mroz-Planells, DCN, RDN, a registered dietitian based in Seattle and spokesperson for the Academy of Nutrition and Dietetics, said in an email.

What Is the Best Diet for Chronic Pain?

People who want to eat for pain relief should limit highly processed foods. Diets that have been shown to lower pain typically include fruits, vegetables, whole grains, legumes, and nuts, said Mroz-Planells.

These recommendations align with the Mediterranean diet, an anti-inflammatory dietary pattern often considered the healthiest way to eat. This dietary pattern emphasizes fruits, vegetables, extra virgin olive oil, whole grains, beans, and nuts, and limits consumption of fish, dairy, and meat.

Mroz-Planells said it is often overwhelming for patients to adopt a new eating pattern, so providers should try to remind them that an anti-inflammatory diet may ease pain “even if the scale doesn’t budge.” 

You can empower patients to make small, manageable changes, such as adding fruit to a snack, swapping a refined grain for a whole grain, or trying a seasonal vegetable with dinner. “Over time, these steps collectively lead to significant improvements in pain and overall health,” she added.

Practical Ways to Address Diet Quality

Simply telling patients to adopt a new diet may not work. Patients with chronic pain may feel too overwhelmed or unwell to adhere to the recommendations. Here are a few tips to use when addressing diet quality with these patients:

1. Acknowledge and ask questions. Acknowledging challenges can help patients feel more empowered to make dietary changes. Pilitsis said providers can also ask: “What do you think you could do to add this to your diet?” to help patients feel directly involved in their care plans.
2. Engage their cheerleaders. Patients with chronic pain often come to appointments with spouses, family members, or other “cheerleaders” who want to help, Pilitsis said. “A lot of patients with chronic pain are older people, and it’s hard for them to cook. Get the family members involved,” she added. Talking to the patient’s “cheerleaders” about ways to prepare healthy, anti-inflammatory meals can make it easier for the patient to adopt lifestyle changes.
3. Provide handouts. Patients will likely have questions after you discuss the Mediterranean diet, so consider creating a handout or website to share with them. Giving patients something to refer to after the appointment makes it easier for everyone and “would be really helpful for providers, because you only have so much time,” she added.

Following a healthy diet is important for general wellness and pain relief, but you have to “downsize the ask,” said Pilitsis. Work with patients to determine a small, manageable starting point.