Is chronic pain a lifestyle problem?

A reader asked for my take on a presentation slide asserting that “chronic pain is a lifestyle problem.” I’ve written tons about this topic from many angles over the years, but I thought it might be helpful to zoom in and answer this specific question concisely…

No! That’s oversimplified to the breaking point. Chronic pain is only partly a lifestyle problem, and the other parts really matter, so it’s a terrible idea to imply that lifestyle is the whole problem.

Pain is never one kind of problem, any more than cancer is one disease.

The statement also obnoxiously implies blame, even if there is a seed of truth to it. Not all lifestyle is about choices and consequences, thanks to vast forces beyond our control, like poverty and prejudice — and the consequences of chronic pain itself, which can be catastrophically enervating.

But if you tell patients that chronic pain is all about lifestyle, you might as well just start shouting, “Your pain is all your fault! You’re the problem, and only you can fix it!” That’s clearly bad bedside manner (if not malpractice), but is it at least technically correct?

Only partly, and it’s also bad biology to ignore the other parts.

Many kinds of pain are caused by sneaky pathologies and injuries that can evade diagnosis for years at a time, if not forever. For instance, viral infections do all kinds of damage that we are still only beginning to understand, let alone diagnose. More conventionally, bone fatigue and stress fractures are notoriously hard to catch, and account for a surprising amount of “mysterious” pain. Most such origins for pain are chronically underestimated compared to many other popular scapegoats for pain, the simplistic and/or obvious possibilities: anxiety, posture, laziness, weakness, stiffness, nutritional or supplement deficiencies, and so on.

That all said… unhealthy people are likelier to do poorly with almost any kind of pain. The severity, chronicity, and impact of pain are all partly a function of overall health and fitness, which is in turn, of course, affected by all kinds of lifestyle factors: smoking, alcohol abuse, insomnia, and sedentariness are all well-known risk factors for pain, for example. Even just eating junk food is probably a pain-booster, and it doesn’t get much more “lifestyle” than a chip binge.

So lifestyle is relevant to chronic pain, but I would never just say that “chronic pain is a lifestyle problem,” because there’s just so much more to it! For more context and details, see the main PainSci library article about non-specific vulnerabilities to pain, and my high-level overview of the great variety of ways that pain can happen to people.

Déjà vu? I did a “first draft” of this post about a year ago. This is a much more polished version.