**1. Introduction**

Chronic pain, as defined by The International Association for the Study of Pain (IASP), is pain that persists or recurs for more than 3 months [1]. Chronic pain is a serious health issue, affecting approximately 20% of adults worldwide and it is anticipated that this will continue to increase alongside the growing and ageing population [1]. There is also a significant socioeconomic burden associated with chronic pain, including high health care use and costs, high absenteeism, loss of productivity, functional impairment, and disability [2]. Due to the complexity of chronic pain and its comorbidities, both evidence and clinical practice have guided the development of integrative pain management, from monodisciplinary to multidisciplinary treatments and from multidisciplinary treatments to interdisciplinary programs, based on a biopsychosocial approach [3–5].

An accumulating body of evidence suggests that poor nutrition, such as malnutrition, unhealthy dietary behaviors, and a poor dietary intake can play a significant role in the occurrence, prognosis, and maintenance of chronic non-cancer pain, hereafter described as chronic pain [4,6,7]. Unhealthy dietary behaviors and a poor dietary intake is characterized by the limited intake of core nutrient-rich foods and an excessive intake of energy-dense

**Citation:** Elma, Ö.; Brain, K.; Dong, H.-J. The Importance of Nutrition as a Lifestyle Factor in Chronic Pain Management: A Narrative Review. *J. Clin. Med.* **2022**, *11*, 5950. https:// doi.org/10.3390/jcm11195950

Academic Editors: Carmen María Galvez Sánchez, Casandra I. Montoro Aguilar and Markus W. Hollmann

Received: 18 August 2022 Accepted: 5 October 2022 Published: 9 October 2022

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**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

nutrient poor foods [8]. The role of nutrition as an important lifestyle factor in pain management is gaining more attention. Over the past two decades, nutrition has occasionally been acknowledged by pain organizations, health care professionals, and consumers, and the interest in the role of nutrition in pain management has grown significantly. In a submission to the European Parliament in 2001, poor appetite and nutrition were listed, amongst others, as a burden associated with chronic pain [9]. In 2013, a qualitative study conducted by Chronic Pain Australia, an organization representing consumers experiencing pain, reported that individuals wanted more information on nutrition and pain management [10]. In 2015, Australia's Faculty of Pain Management acknowledged that dietitians should provide input into patient care, where necessary [11]. Nutrition was also a major focus in the Consortium Pain Task Force White Paper, in 2018 [12]. More recently, in 2020, the IASP recognized the importance of optimizing one's dietary intake in pain management strategies based on a large body of evidence, which indicated the significant effect of nutrition-based interventions on pain reduction [13,14].

Despite the growing evidence regarding the role and integration of nutrition in chronic pain management, it is still unclear how nutritional factors interact with chronic pain, the exact nature of the underlying mechanisms of this interaction, and how the nutritional care process can be implemented in chronic pain management. Thus, the aim of this narrative review is to summarize the existing evidence regarding (1) the nutrition-related health of people experiencing pain (2) the underlying potential mechanisms that explain the interaction between nutrition and chronic pain, and (3) the role of nutrition screening, assessment and evaluation for people experiencing pain, and the scope of nutrition practice in pain management.
