Lifestyle Factors and Chronic Pain in Older European Adults

Chronic pain, recognized as a complex biopsychosocial condition, is significantly influenced by social, economic, and lifestyle factors, making it a major global public health issue. But limited knowledge exists on the association between lifestyle factors and pain severity in older adults.

A survey evaluated the critical role of modifiable lifestyle factors—such as physical inactivity, sleep disturbances, smoking, and poor diet—in the severity and maintenance of chronic pain, particularly among older adults. This cross-sectional study used data from the ninth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to assess these associations in 27,528 individuals aged 50+ across 27 European countries. 

Key Findings:

1. Physical Inactivity: The most significant lifestyle factor associated with pain severity. Older adults who were physically inactive were more likely to experience severe pain. Physical inactivity is also linked to other risk factors such as obesity, poor sleep, and stress, making it a cornerstone for pain management strategies.
2. Sleep Problems: Sleep disturbances showed a bidirectional relationship with pain, where poor sleep exacerbates pain and vice versa. Addressing sleep quality through interventions like cognitive behavioral therapy for insomnia (CBT-I) can be a crucial component of pain management.
3. Smoking: Although weakly associated, smoking was linked to increased pain severity. Smoking cessation programs should be integrated into pain management plans, as smoking can exacerbate pain sensitivity and interfere with pain relief efforts.
4. Dietary Habits: A diet low in fruits and vegetables was associated with higher pain severity. Encouraging a healthy, anti-inflammatory diet (e.g., Mediterranean diet) may help reduce pain and improve overall health.

Clinical Implications:

• Multimodal Interventions: Therapists should adopt a holistic approach that addresses physical activity, sleep, smoking, and diet. Pain science education and cognitive-behavioral strategies can help reconceptualize pain and reduce barriers to behavioral change, such as fear of movement (kinesiophobia) and catastrophizing.
• Personalized Approaches: Individual responses to lifestyle interventions can vary, particularly in chronic pain populations. Personalized strategies that consider pain flares, physical performance, and adherence are essential for effective pain management.
• Motivational Interviewing: Engaging patients in shared decision-making and using motivational interviewing techniques can enhance adherence to lifestyle changes. This approach helps patients develop autonomous motivation and overcome barriers to change.
• Sleep Hygiene and Smoking Cessation: Basic sleep hygiene education and smoking cessation support should be integrated into routine care. These interventions can significantly improve pain outcomes and overall quality of life.
• Physical Activity Promotion: Encouraging gradual increases in physical activity, tailored to the individual’s pain levels and capabilities, is vital. Addressing fear of movement and providing structured exercise programs can help reduce pain severity and improve functionality.

Conclusion

The study emphasizes the importance of addressing modifiable lifestyle factors in the management of chronic pain among older adults. By focusing on physical inactivity, sleep quality, smoking, and diet, therapists can develop comprehensive, individualized interventions that not only alleviate pain but also enhance overall well-being. Future research should explore the bidirectional relationships between these factors and pain, as well as the long-term effectiveness of lifestyle interventions in diverse populations.