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Proinflammatory Dietary Intake Relates to Pain Sensitivity in Chronic Nonspecific Low Back Pain: A Case-Control Study

PainSci » bibliography » Elma et al 2023
Tags: nutrition, inflam-sys, counter-intuitive, self-treatment, treatment

Two articles on PainSci cite Elma 2023: 1. Chronic, Subtle, Systemic Inflammation2. Vulnerability to Chronic Pain

PainSci commentary on Elma 2023: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Elma et al. compared the diets of healthy people versus folks with unexplained chronic low back pain, about fifty of each. Everyone did a three-day food diary, filled out questionnaires, and had the pleasure of a going through a test for pain sensitivity (thank you for your sacrifice, study participants).

The diets of the back pain group were worse in every way. And they had more fat in their blood. And more inflammation. They also ate less of a few foods “known for their anti-inflammatory and antioxidative properties.”

Three days of a food diary and a few dozen subjects with pain isn’t enough to prove anything (especially “causality”), and there are certainly some reasons why these results might not be quite what they seem. There are always sneaky confounders in diet and pain research, and it’s clear that there must be other variables in this equation — because obviously not everyone with high cholesterol has chronic pain, and not everyone with chronic pain has high cholesterol.

We must never forget that “correlation is not causation,” of course. But we must also not forget correlation “sure is a hint” (Tufte).

The evidence may not be strong and it cannot show causality, but it also isn’t exactly a big break with what we already knew. There is plentiful evidence that dysfunctional eating leads to metabolic syndrome over long periods, which is nearly synonymous with systemic inflammation … and so an obvious long-term risk factor for pain. This new evidence suggests that the danger might be more clear and present: you could be hurting right now because you’ve been eating garbage recently.

See also Bakshi, who reported in 2021 that dietary cholesterol is linked to pain sensitivity — again, not necessarily causally linked, but it’s certainly not a crazy idea.

For more context see the blog post “Pass the bag of pain.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Nonspecific chronic low back pain (nCLBP) has been associated with nutrition. Yet, it is not clear how nutritional factors and nCLBP relate to one another. Therefore, the aim of the present study was to investigate differences in diet quality and dietary intake levels between nCLBP patients and healthy controls (HCs) and explore the association between nutritional factors and pain sensitivity in nCLBP.

In this case-control study, 106 participants (ie, n = 53 nCLBP and n = 53 HCs) were recruited and completed a 3-day food diary to assess their dietary intake, which allowed to generate individual diet quality scores (ie, the Healthy Eating Index-2015 and Dietary Inflammatory Index). Additionally, each participant underwent an experimental pain assessment (quantitative sensory testing) and filled out self-reported pain questionnaires.

Compared to healthy controls, the nonspecific chronic low back pain group showed significantly lower diet quality, higher inflammatory scores, and a lower intake of total protein, total fat, dietary fiber, omega-3 fatty acids, vitamin B6, vitamin A, beta-carotene, vitamin E, and magnesium. Pain sensitivity mainly showed a negative correlation with nutritional intakes known for anti-inflammatory properties (ie, vitamins E, D, A, B6, B12, and zinc). Interestingly, total fat, cholesterol, saturated, and monounsaturated fat intakes were found to be inversely associated with pain sensitivity. Overall, patients with nCLBP have a lower diet quality, eat more proinflammatory, have less intake of nutrients known for their anti-inflammatory and antioxidative properties, and drink less water compared to HCs. Accordingly, pain sensitivity was mainly found to be positively associated with proinflammatory dietary intake.

PERSPECTIVE: This study emphasizes the association between a proinflammatory diet and nCLBP. Among nCLBP patients, positive association between increased pain sensitivity and the proinflammatory potential of a diet, highlighting the potential for individualized pain management strategies and leading to the development of novel therapeutic methods.

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