Abstract ID: 3889

Primary Topic: Curriculum design and development
Secondary Topic: Interprofessional education
Tertiary Topic: Teaching, learning, and assessment

Nutritional Pain Management: Design, Implementation and Evaluation of a Certification Course for Diverse Pain Providers
Robert A Bonakdar, MD FAAFP FACN, , La Jolla, CA, United States; Nancy A Cotter, MD FACN, Veterans Health Administration, Montclair, NJ, United States; Meg Sweeney, B.S., Western University of Health Sciences; The College of Osteopathic Medicine , Pomona, CA, United States

Commercial product: N/A

Commercial product support: N/A

Category: Education

Late Breaker: No

Overview

Background and Hypothesis: Several recently guidelines have endorsed the use of non-pharmacologic interventions for first line management of pain. As pain can coexist with and result from metabolic dysregulation including obesity, metabolic syndrome and nutrient deficiency, nutritional interventions hold promise for impacting pain in selected populations. Unfortunately, clinicians often have suboptimal education and comfort in introducing and implementing nutritional interventions in the setting of pain. We hypothesize that a certification course will have a positive impact on clinician confidence and implementation of nutritional strategies in the setting of pain.

Intervention: A six hour continuing educational course was created to address key learning areas related to pain.  These areas included the role of diet in promoting pain (i.e. inflammatory, nutrient deplete and obesogenic diets); the role of diet in reducing pain (i.e reduction of inflammation, weight management and nutrient deficiency) as well as how to introduce a health promoting diet and evidence-based nutrients in population associate by systemic inflammation and deficiency (i.e. rheumatoid arthritis, migraine and metabolic neuropathy).

Plan: The initial course will be provided to 100 clinicians of diverse backgrounds as part of a larger pain related continuing education conference in the fall of 2017. In addition to a post intervention knowledge assessment, attendees will have a pre-post evaluation of their level of education, knowledge base and comfort level in discussing and implementing nutritional intervention for those in pain.  They will also be asked about scenarios they find particularly challenging (i.e. pain associated with obesity) with discussion incorporated into the course.  Post intervention, attendees will have longterm monitoring to evaluate the impact of the certification on practice changes related to the course. Post course data will be analyzed to gauge the impact of the course as well as plan future interventions in the content area.

Rationale

Chronic pain and obesity are both significant public health concerns which appear to be increasing. Nutritional factors including deficiency and pro-inflammatory diets appear to be important contributing factors to both epidemics with nutritional counseling and support appearing as potentially helpful interventions in helping to mitigate this scenario. Unfortunately, recent studies demonstrate that less than one third of the time do patients receive adequate nutritional counseling. 

A continuing education program geared  towards diverse pain management clinicians was created with the goal of improving the knowledge base, confidence and degree of counseling regarding nutrition in the setting of pain.

References:

Okifuji A, Hare BD. The association between chronic pain and obesity. Journal of Pain Research. 2015;8:399-408. doi:10.2147/JPR.S55598.

Ahmed NU, Delgado M, Saxena A. Trends and disparities in the prevalence of physicians' counseling on diet and nutrition among the US adult population, 2000–2011. Preventive medicine. 2016 Aug 31;89:70-5.

Objectives

  • Diet is associated with pain in both curative and causative relationships.
  • The great majority of pain syndromes are associated with chronic inflammation.
  • Anti-inflammatory foods and dietary patterns have been used successfully to treat chronic-pain syndromes.
  • Food sensitivities and nutrient deficiencies are associated with common pain syndromes.
  • Clinicians should have a high degree of awareness of the role of diet in the amelioration and exacerbation of pain
  • Stepwise counselling by clinicians of all backgrounds can help to incorporate diet as an important and accessible treatment for pain syndromes.

References:

Cotter, Nancy. “Diet and Pain.” Integrative Pain Management, edited by Robert Alan Bonakdar and Andrew W. Sukiennik, Oxford University Press, 2016, pp. 255–267.

Bonakdar RA. Obesity related pain; time for a new approach that targets systemic inflammation. J Family Prac. 2013 Sep 1;62(9):22-8.

Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. American journal of epidemiology. 2009 Dec 11;171(2):135-54.

Hartz AJ, Fischer ME, Bril G, Kelber S, Rupley D, Oken B, Rimm AA. The association of obesity with joint pain and osteoarthritis in the HANES data. Journal of Chronic Diseases. 1986 Dec 31;39(4):311-9.

Bell RF, Borzan J, Kalso E, Simonnet G. Food, pain, and drugs: does it matter what pain patients eat? Pain. 2012 Oct;153(10):1993-6.