Footstep 8

Food, relationships and work

Healthy eating and social connectedness are activities that people with chronic pain can do to help themselves and their bodies. Half of chronic pain patients are overweight or obese and this places increased strain on joints and muscles and makes increasing activity more difficult. Social isolation, also common amongst people with chronic pain, can contribute to low mood, which can then exacerbate the pain experience.

Many people with pain have low Vitamin D levels linked to their reduced exposure to sunlight and low Vitamin D intake and unfortunately, vitamin supplements do not have an evidenced impact on pain levels. Osteoporosis, a common problem, is aggravated by living in low sunlight exposure areas, such as the north of the UK. Cultural behaviours, lifestyle factors and long term use of strong opioids also contribute to the condition. Spotting such risks earlier can mean some patients avoid full blown osteoporosis and its risks.

Underlying all these complications is the importance of helping patient to build their fitness and weight bearing activities which in turn helps their brain to manage pain better.

Being socially engaged improves self esteem and reduces depression. Therefore, being able to work or retrain or study can help mental well being. This is not always an easy path given the lack of flexibility in the benefits system.

In practical terms, showing an empathic understanding of these issues and factoring them into consultations is your best role here.

You should also consider referral into relevant psychological or relationship issues, if these block progress to the patient being a confident and independent self carer.

Action to take

Here are some techniques and resources that you could share with the patient:

Healthy eating

  • Losing weight is likely to be helpful but ‘diets’ may be psychologically unhelpful – focus on health eating with greater levels of activity for more positive outcomes
  • Focus on high quality nutrition e.g. a Mediterranean type diet as suggested in NHS Eat Well
  • Public Health England recommend a vitamin D supplement daily for all and a dose of 10 micrograms/day to limit emergence of osteoporosis, especially in autumn/winter
  • If you have access to local weight loss support services, consider referral – this group support may also help with social connectedness

Managing relationships

  • Seek motivation and support from friends and family by talking about pain experiences, goals and plans
  • Look out for ‘collusion’ or ‘overprotectiveness’ in spousal relationships. Consider naming this and raising it explicitly explaining how it can be unhelpful in recovery

Staying at or returning to work

  • This is beneficial for patients with chronic pain. All the other skills in the ten footsteps will help move towards these goals.
  • For those out of work, discuss: – volunteering – retraining/education – phased returns and part time working
  • Involve occupational health to look at adaptations e.g. standing desks (you can suggest an occupational health assessment on Med3s).

Identify local resources

These can be difficult things to impact on so it is a good idea to see if there are local resources you can access to support patients to explore these areas further. Examples include weight loss programmes or getting active programmes.


Resources for your patient

Healthy eating

Healthy eating is something positive people can do that will help their health and weight and so in turn is part of their self care.

Relationship support

Overcoming Chronic Pain CBT Self Help book – with a useful chapter on managing relationships and intimacy in chronic pain.

Coping with work and study


Extra resources for you

Vitamin D and health

Food, relationships and work

Summary of key points

  • Life issues have a significant impact on ability to manage chronic pain
  • Unhealthy relationships can contribute to more emotional pain
  • Difficulties at work such as an unsupportive employercan mean people will struggle to return or stay at work
  • Healthy eating is something positive people can do that will help their health and weight and so in turn is part of their self care

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