Clinicians Hungry for Education on Diet for Pain Management

Pauline Anderson

November 13, 2018

BOSTON — Clinicians are keen to learn about diet as a way of managing pain, new research shows.

Investigators surveyed participants who had enrolled in a diet and pain management course that was offered at last year's Academy of Integrative Pain Management Global Pain Summit.

The results, presented at this year's meeting, showed that those who took the inaugural course found that it significantly improved their level of confidence in offering nutritional advice to patients.

"Nutritional pain management is something that any clinician, at any stage, can do," program leader Robert Bonakdar, MD, director of pain management, Scripps Center for Integrative Medicine, La Jolla, California, and assistant clinical professor of medicine, University of California, San Diego, School of Medicine, told Medscape Medical News.

It's something a practice with multiple healthcare providers in particular might consider incorporating, because it may reduce time constraints on any single clinician, said Bonakdar.

Although proper nutrition has the potential to reduce pain and inflammation, there are no formal guidelines on nutrition pain management, he noted.

Last year, the inaugural course proved to be "super popular," attracting 115 clinicians, said Bonakdar. This year, more than 300 people registered for the program.

"It goes back to the whole drive to use nonpharmacological pain options, but not everyone will have access to acupuncture or massage, or whatever. What everyone does have access to is food," he said.

Lack of Education

Researchers surveyed clinicians before and after taking the course last year. Survey respondents included MDs, DOs, nurses, acupuncturists, and dieticians.

"You would think that dieticians know a lot about diet, and they do, but not necessarily for treating pain," Bonakdar noted.

Of the survey respondents, 58% had been in practice for more than 15 years.

The survey results showed that most respondents (61.7%) had received minimal or no education on the role of diet/supplements in their professional training.

This lack of education means clinicians are not discussing the importance of nutrition with their patients. About 21% of survey respondents said they rarely or never initiated discussions with patients about diet or supplements for pain management, and 27.8% said they did so only occasionally.

"So less education means less conversation," said Bonakdar.

Respondents who had taken the course reported that it was "absolutely" useful, said Bonakdar.

The survey showed that the course significantly increased the educational knowledge base, familiarity of patient-centered resources, and confidence among healthcare professionals (P >  .05).

"There's strong evidence that the course will improve participants' ability to incorporate dietary approaches and to individualize dietary approaches," Bonakdar told conference delegates.

Survey respondents were asked about elements of the course they found most helpful and for suggestions for additional topics.

Participants praised the program for providing a good foundation on the topic and insights into the link between diet and inflammation.

Some said they would welcome more information on supplement recommendations. Others wanted more handouts on specific conditions, such as fibromyalgia and rheumatoid arthritis, and step-by-step guides to help incorporate the information into a short patient visit.

Rapidly Evolving Field

The popularity of the course is due in part to the fact that "there is not a lot out there" for physicians who want to learn more about nutrition as a pain management tool, said Bonakdar.

The course provides information on the way different dietary approaches, including the elimination diet, the ketogenic diet, the Mediterranean diet, and plant-based diets, may improve pain conditions.

It's a matter of determining what dietary approach helps a particular patient, said Bonakdar.

For example, in the case of migraine, research shows that certain supplements — including magnesium, feverfew, coenzyme Q10, B vitamins, such as riboflavin and folic acid, and a newer supplement derived from pine bark — may be useful.

Participants also learned the importance of dietary logs and how to overcome time constraints and other obstacles to incorporating dietary advice into clinical practice.

Because the field is "rapidly evolving," organizers aim to offer the program twice a year at multiple sites, said Bonakdar.

"The goal is to get more options for clinicians around the country to become nutritionally educated and comfortable and confident in using it as an approach when they talk to patients about pain," he said.

Future sessions may have more information on the use of nutrition to reduce medications, as well as recipe suggestions for dishes that may help control pain, said Bonakdar.

Academy of Integrative Pain Management (AIPM) Inaugural Global Pain Clinician Summit 2018. Abstract 13, presented November 9, 2018.

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