Your Diet May Promote Chronic Pain, Studies Suggest
By Eliza Whitaker, MS, RDN on February 20, 2024 — Medically Reviewed by Kristen Carli, MS, RDN
Research suggests that diet may directly impact chronic pain related to rheumatic diseases.
Photo by Towfiqu barbhuiya @towfiqu999999/Unsplash
Summary
Consuming a diet of anti-inflammatory foods, like those included in the Mediterranean diet, may help lower levels of chronic pain in those with rheumatic disease.
Lack of sleep and chronic pain work together in a vicious cycle to further promote pain.
Gut health, which is influenced by food consumption, may impact chronic pain levels experienced by those with rheumatic disease.
According to the American College of Rheumatology, as of 2022, over 58 million adults and 300,000 juveniles in the US have been diagnosed with rheumatic disease.
Rheumatic disease is a broad term that describes conditions that cause pain, stiffness, and swelling of the joints, tendons, muscles, ligaments, and internal organs. Some of these conditions result from an autoimmune condition in which the body’s immune system incorrectly attacks its healthy tissues.
Examples of rheumatic diseases include arthritis, rheumatoid arthritis, fibromyalgia, scleroderma, and lupus, among others. Many people diagnosed with rheumatic diseases suffer from chronic pain due to tissue damage as a result of the condition.
According to the CDC, 1 in 3 adults diagnosed with arthritis by a physician suffer from severe joint pain. This means an estimated 19 million Americans suffer from chronic pain severe enough to limit their daily function.
Various rheumatic diseases will have different causes and symptoms, but a characteristic they share in common is inflammation. Inflammation may typically be associated with a warm-to-the-touch, red area surrounding an injury or cut on the body, telling us that our immune system is working hard to heal the area.
However, inflammation due to a rheumatic condition may result from the immune system attacking healthy tissues within the body, which may impact gut health. The effects of inflammation in the gut may further contribute to chronic pain.
Many interventions can help manage chronic pain, including medication, personalized exercise programs, and leading a healthy lifestyle – encompassing dietary modifications.
New research has found that an anti-inflammatory, modified Mediterranean Diet may be an intervention to help reduce chronic pain in those with rheumatic diseases, improving overall quality of life.
The Mediterranean diet may reduce chronic pain
Jessica Hinkley, RDN, registered dietitian and owner of Nutrition Unearthed, works with patients with joint, muscle, and nerve pain. She explains that the anti-inflammatory foods included in the Mediterranean diet may aid in managing pain and swelling.
“Generally, anti-inflammatory foods are high in vitamins, minerals, antioxidants, unsaturated fatty acids, or some combination of these. There are different types of unsaturated fatty acids and they play various roles in managing inflammation.”
She continues, “Omega-3s also play an important role in the health of our brain, heart, eyes, and preventing and managing type 2 diabetes.”
Hinkley recommends a variety of dietary sources of omega-3 fatty acids, including fatty fish such as salmon, tuna, sardines, and mackerel, as well as plant-based foods like flaxseed oil and walnuts.
Additional omega-3-rich foods include:
Algae oil
Chia seeds
Cod liver oil
Hemp seeds
Edamame
Caviar
“When it comes to oils, try to choose cold-pressed oils that have been minimally processed to preserve their flavor and health-boosting properties,” says Hinkley.
The National Institute of Health recommends consuming 1.1–1.6 grams of omega-3 fatty acids each day. Another helpful recommendation provided by the American Heart Association is to have a 3–4 ounce serving of fish twice a week to ensure adequate consumption.
Hinkley uses the Mediterranean diet as a starting point for patients looking to reduce their discomfort.
“Focus on making vegetables and fruits the foundation of what you eat and then assure you’re incorporating enough protein, whole grains, and nutritious fats into your diet,” says Hinkley.
What does the research show?
Study participants consumed a diet that encouraged the consumption of anti-inflammatory foods. For four months participants did not consume gluten, cow’s milk, red meat, alcohol, sugar, or unhealthy processed foods.
Participants were given a monthly Curuma Latte supplement, which contains black pepper and curcuma, both of which promote the absorption of curcumin, the active ingredient in turmeric.
In addition to removing pro-inflammatory foods from their diets, participants were encouraged to consume larger quantities of anti-inflammatory foods, including bluefish, extra virgin olive oil, nuts, fruits, vegetables, legumes, plain yogurt, and kefir.
This diet was designed to closely mirror the Mediterranean diet, which promotes the consumption of fruits, vegetables, extra virgin olive oil, nuts, legumes, fish, and unprocessed cereals with moderate consumption of dairy products and meat and minimal consumption of red meat and processed foods.
In addition to tracking participants' food intake, researchers also assessed participants’ physical activity level, pain, depression, stress, and sleep quality.
Study results
Researchers noted those consuming more anti-inflammatory foods had improved physical characteristics, pain, and stress. Participants who reduced their consumption of proinflammatory foods reported better sleep satisfaction.
Participants experiencing less pain had significantly lower stress levels, hyperinsomnia, and insomnia in addition to lower scores on the Health Assessment Questionnaire that determined the level of disability of each participant.
Overall, researchers concluded that following this modified Mediterranean diet may provide relief from chronic pain resulting from rheumatic diseases and may improve quality of life by reducing stress, decreasing depression, and improving sleep quality.
Limitations
This study was conducted as a pilot study with only 45 participants consuming an anti-inflammatory diet for four months. This is a small sample set with a relatively short intervention period, given the chronic aspect of pain and disease experienced by those with rheumatic diseases.
All study participants were over the age of 45, making it difficult to infer that these results would apply to younger populations.
Additionally, 89% of participants in this study were women, likely because the prevalence of rheumatic diseases is higher in women than in men. Further studies need to be conducted on both men and women to make more significant generalizations about the results.
An updated option: the Green Mediterranean Diet
The Green Mediterranean Diet, also known as the green-Med diet, is a newer variation of the traditional Mediterranean diet but includes more plants, green tea, and less red meat and poultry.
The traditional Mediterranean diet is known for reducing the risk of stroke, diabetes, and heart disease, but research has shown that the Green Mediterranean Diet may be even better.
A study published in BMC Medicine showed that those following the Green Mediterranean Diet lost more than double the visceral fat of those following the traditional Mediterranean Diet.
Visceral fat is a fat tissue that covers our internal organs, compared to subcutaneous fat, which is found just below the skin. Excessive amounts of visceral fat increase our risk of developing heart disease, stroke, and diabetes, among other conditions.
The Green Mediterranean Diet may be another way of eating that could promote further health benefits for those with rheumatic disease, but further research is needed to verify this claim.
Additional considerations for chronic pain management
In addition to following a healthy diet, there are other important factors to consider when managing chronic pain related to rheumatic diseases. These considerations can greatly impact the effectiveness of pain management strategies and overall well-being.
Gut health
The mechanisms causing chronic pain are still greatly misunderstood; however, emerging research shows that chronic pain could be influenced by gastrointestinal (GI) health.
The gut microbiome can produce molecules, such as neurotransmitters and neuromodulators, that influence the peripheral and central nervous systems, impacting chronic pain levels.
It is also possible that colonization of the gut with greater levels of unfavorable microorganisms may influence the development of different conditions associated with chronic pain.
Consuming foods that contain prebiotic fiber, which feeds beneficial gut bacteria, may help improve gut health.
Prebiotic-containing foods include onions, garlic, asparagus, and bananas, among others.
Tina Marinaccio, MS, RD, registered dietitian and owner of Health Dynamics, LLC, shared, "The gut makes short-chain fatty acids from the fiber in beans, which in turn can lower the inflammatory markers found in rheumatic diseases.”
Marinaccio recommends bringing more foods included in the Mediterranean diet to your plate by
Incorporating legumes by adding chickpeas to salads or enjoying lentil soup
Using extra virgin olive oil
Swapping unhealthy processed snacks for omega-3 foods like nuts
Sleep quality
Research shows that the relationship between pain and sleep quality is bidirectional. This means that higher pain levels can lead to poorer sleep quality, while poor sleep quality can reduce pain tolerance, leading to higher pain levels.
Lack of sleep is known to affect nociceptive processing — the way the central and peripheral nervous systems receive information about pain and other sensations.
In the case of pain, a lack of sleep may stop the body from activating analgesic systems that aid in pain relief while also activating hyperalgesic systems that promote sensitivity to pain.
In simpler terms, lack of sleep can reduce the body's effort to relieve pain while increasing sensitivity to pain, resulting in a greater sensation of pain. This can create a vicious cycle, further worsening pain and sleep quality.
Knowing the impact that sleep can have on pain levels, adopting food intake habits that optimize sleep may provide further benefits in addition to an anti-inflammatory diet.
A meta-analysis compiling the results of multiple studies on how diet impacts sleep discovered varying results, but overall was able to determine that consuming fruits, veggies, and legumes has been associated with improved sleep. Fatty fish and olive oil consumption were also associated with greater sleep quality.
In comparison, excessive consumption of red meat, added sugars, and saturated fats were associated with decreased sleep quality.
Other practices that may promote sleep quality include:
Waiting at least two hours to go to bed after having a large meal
Discontinuing caffeine intake for at least 6 hours before going to bed
Reducing sugar intake in the evenings
Having balanced meals containing carbohydrates, protein, and fats throughout the day
Limiting or avoiding alcohol intake
Staying off screens before bedtime
Limiting the consumption of stimulating content from movies, shows, and books that could promote evening anxiety
The bottom line
Overall, taking steps to promote improved sleep quality and gut health and adopting an anti-inflammatory way of eating may promote general wellness and impact the pain experienced by those with chronic pain due to rheumatic disease.
Pain, especially chronic pain, can be debilitating for many people. The solutions to chronic pain may be just as complex as the cause.
Further studies are needed to gain a deeper understanding of how diet can influence chronic pain levels, especially in those with rheumatic diseases.
Consult with your doctor or a registered dietitian to determine if any nutritional changes may benefit you.
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Dietitian Insights articles are authored by registered dietitians who utilize only high-quality sources, including peer-reviewed studies and reputable agencies, to provide the most up-to-date, evidence-based insights. Read our editorial process to learn more about how our content is medically reviewed and kept current and credible.
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Sala-Climent M, López de Coca T, Guerrero MD, et al. The effect of an anti-inflammatory diet on chronic pain: a pilot study. Front Nutr. 2023;10:1205526. Published 2023 Jul 13. doi:10.3389/fnut.2023.1205526
Zelicha H, Kloting N, Kaplan A, et al. The effect of high-polyphenol Mediterranean diet on visceral adiposity: the DIRECT PLUS randomized controlled trial. BMC Med. 2022;20(1):327. Published 2022 Sep 30. doi:10.1186/s12916-022-02525-8
Liu L, Wu Q, Chen Y, et al. Gut microbiota in chronic pain: Novel insights into mechanisms and promising therapeutic strategies. Int Immunopharmacol. 2023;115:109685. doi:10.1016/j.intimp.2023.109685
Haack M, Simpson N, Sethna N, Kaur S, Mullington J. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology. 2020;45(1):205-216. doi:10.1038/s41386-019-0439-z
Scoditti E, Tumolo MR, Garbarino S. Mediterranean Diet on Sleep: A Health Alliance. Nutrients. 2022;14(14):2998. Published 2022 Jul 21. doi:10.3390/nu14142998
Practitioner applications
In addition to the challenges they already face, many with rheumatic conditions have difficulty affording prescription medications or battle with insurance companies to receive the treatment they need. In these cases, a greater focus on nutritional health may be beneficial.
Another aspect to consider is the financial status of patients. The Mediterranean diet and other anti-inflammatory diets primarily consist of whole foods. Therefore, limiting factors can be food cost and access, which may require varying recommendations, including:
Referring patients to food pantries offering whole foods
Local food co-ops may offer better prices than grocery stores
Bulk shopping, which may cost more upfront but could help lower overall food costs
Planning meals using more affordable options such as dried, canned, or frozen produce
Consider utilizing a Produce Prescription or other services to support access to foods, including WIC, SNAP, or programs for older adults
It’s important to remember that any steps or efforts towards consuming a diet that promotes an anti-inflammatory state of the body will benefit patients.
Assessing current sleep duration and quality can be another critical component of treatment for those with chronic pain. Promoting sleep hygiene practices may also be beneficial.
Note: All information in this article is for educational purposes only and should not be interpreted as medical advice. The reader should consult with a healthcare provider before using any supplements or making any dietary or lifestyle changes. Read the full medical disclaimer.
