Clinicians should screen early for psychosocial and lifestyle barriers and use tailored interventions to support more effective, patient‑centred decision‑making.
Context
To provide a clinical framework for simultaneously incorporating physical activity, stress, sleep and nutrition into a personalised multimodal lifestyle intervention for people with chronic pain.
Methods
- This publication was created using a narrative, expert‑driven synthesis of existing literature.
- The authors selected relevant literature on key lifestyle domains (exercise, sleep, stress, diet, weight management).
They divided the paper into two main methodological components:
- Guidance on how clinicians should design a personalised multimodal lifestyle intervention (assessment + behavioural change considerations).
- A narrative synthesis summarising best‑evidence approaches for each lifestyle factor.
Results
1. Physical Activity & Exercise
- Identify whether activities are being avoided or over‑done and match the strategy accordingly.
- Use graded or cognition‑targeted exercise for avoidance and activity pacing (with stress strategies if needed) for persistent/over‑done tasks.
2. Sleep Management
- Routinely screen for insomnia, as it is a core driver of pain.
- Start with sleep education/hygiene and escalate to CBT‑insomnia when insomnia is significant or persistent.
3. Stress Management
- Recognise stress intolerance as a major amplifier of pain, fatigue and cognitive symptoms.
- Integrate stress education and provide/signpost practical coping techniques (relaxation, breathing, mindfulness, cognitive skills).
4. Nutrition & Weight Management
- Treat nutrition as a core treatment target, promoting whole‑food, anti‑inflammatory diets and addressing deficiencies.
- Support behavioural weight‑management where needed and pair dietary change with physical activity.
5. Smoking, Alcohol & Social Connection
- Screen for smoking and alcohol, addressing them through motivational interviewing/signposting to reduce long‑term harm.
- Assess social connectedness and signpost supportive resources when low support contributes to pain and distress.
Reference
Nijs, J. et al. (2024). Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective. Journal of Clinical Medicine, 13(3), p.644.
