In an interview with HT Lifestyle, Dr Raghavendra Ramanjulu, Lead Consultant – Palliative Medicine and Rehabilitation at Aster RV Hospital, shared, “An individual’s lifestyle plays a vital role in determining the recovery from an injury or chronic pain conditions. It’s imperative to analyse chronic pain patients for the coexistent inappropriate lifestyle habits and resultant aberrant behaviour pattern as a coping strategy. Chronic pain can impact a patient’s life not limiting to only physical but inadvertently impacting social interaction, psychological wellbeing, and overall outlook towards life.”

He revealed, “The most evidenced comprehensive modalities of improving chronic pain are healthy lifestyle, balanced diet, sleep hygiene, exercise, and yoga. The aforementioned practice is well known and undoubtably would improve any chronic condition not limiting to chronic pain. The concern raised to incorporate the evidence habits by chronic patients is the substantial effort, rigour, and difficulty at sustaining. The easiest approach a patient initiates to cope with an acute or chronic pain would be to limit physical activity, intake of multiple pain medications and probably resort to substance habituation.”

According to him, alcohol consumption may show an initial improvement in an acute pain condition due to its inhibitory effect on the nerve for pain transmission while on the contrary, when the same pain turns chronic, like persistent low back or fibromyalgia, this can have a deleterious effect of even pain worsening and risks of alcohol addiction/misuse. He highlighted, “They also could carry potential risks of other substance abuse like chronic pain medication overdose or tobacco dependence. There have been some clinical studies on patients with low back pain, opining that smoking has no direct effect on pain perception. The only perception they felt was decreased anxiety levels for a short period of time. There were no demonstrable sustained positive effects of smoking on chronic pain patients but lead to negative impact of heavier smoking and nicotine addiction. Smoking also lead to patient reporting higher pain intensity, lower tolerance to pain with worsening of anxiety.”

Bringing his expertise to the same, Dr Balakrishna GK, Senior Consultant – Internal Medicine at BGS Gleneagles Global Hospital in Bengaluru, listed the risk factors for chronic pain as –

• Genetics: Some chronic pain causes, like migraines, run in the family.

• Obesity: Obesity can worsen pain, such as arthritis, since there is extra pressure on the joints.

• Age : Older people are more likely to experience chronic pain from arthritis and neuropathy.

• Previous injuries: Old traumatic injuries are more likely to cause chronic pain in the future.

• Labour-intensive job: People with strenuous jobs are at a greater risk of developing chronic pain.

• Stress: Chronic pain is connected to both frequent stress and post-traumatic stress disorder.

• Lifestyle: People with alcohol and smoking habits are at an increasing risk of developing chronic pain.

Talking about how alcohol consumption contributes to chronic pain, he said, “Chronic alcohol consumption may make people more sensitive to pain through two different molecular mechanisms: one driven by alcohol intake and the other by alcohol withdrawal. The reality is that alcohol consumption may worsen a pain condition. Although alcohol does not directly alleviate pain symptoms, it can cause alcoholic neuropathy, which is nerve damage that leads to chronic pain and other symptoms. Studies have also found that alcohol use disorder is associated with changes in how the brain processes pain signals, as well as changes to how the immune system activation occurs. It is recommended to avoid alcohol or reduce alcohol consumption to improve chronic pain.”

On being asked whether smoking makes the pain worse, Dr Balakrishna GK answered, “Despite short-term “feel-good” sensations, smoking can lead to more pain and damage in the long run, from cancer to heart disease to degenerative diseases in our bodies. It also impairs the body’s ability to heal itself and is a risk factor for rheumatoid arthritis. Smoking damages the arteries, and it is thought that damaged arteries in the discs and joints in the back may lead to pain and injury. Smoking also increases the risk of osteoporosis and bone fractures. Quitting smoking may be one of the best things one can do to improve health and pain symptoms.”

To conclude, lifestyle factors like alcohol consumption and tobacco have a negative impact on chronic pain improvement with potential addiction behaviour. On the other hand, balanced healthy diets with physical activity have been considered to be beneficial at managing and reducing chronic pains.