Nutrition Care in Patients Living With Chronic Pain

NCT ID: NCT06277232

Last Updated: 2026-02-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-08-01

Study Completion Date

2028-12-31

Brief Summary

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The investigators' purpose is to develop and test the feasibility, usability, and satisfaction of the Diet4painrelief app as a platform for implementing nutrition care in a specialist pain rehabilitation clinic. The Diet4painrelief will consist of two components: a) a screening tool for nutrition status b) an individually tailored behavior change program aiming to improve the dietary habits and behaviors of patients living with chronic pain.

Part I: Included 20 patients with complex chronic pain to examine the feasibility and outcomes of evidence-based Interdisciplinary Pain Rehabilitation Program (IPRP) integrated with nutrition care. The Diet4painrelief includes a screening tool to assess basic nutritional status as well as their intake of key unhealthy and healthy foods and drinks (through three 24hour-dietary recordings or food diary). Thereafter, the patients receive a personalized behavior change program for dietary optimization. The investigators will design and adapt 6 modules in the digital platform (Diet4painrelief app) based on the International Association for the Study of Pain (IASP) recommendations (6 aspects about 'nutrition and pain') and Sweden's food culture. Clinical outcomes using patient-reported data on socio-demographics, pain aspects, psychometric data, physical disability, and quality of life will be measured at three occasions: first appointment (Pre-IPRP), immediately after completing the rehabilitation program (Post-IPRP), and at a 12-month follow-up (FU-IPRP). Blood samples will be taken to identify biomarkers at the same occasions that provide objective information on metabolic and nutritional abnormalities and further to evaluate the effect of the dietary intervention on changing of pain rehabilitation outcomes.

Part II: Included 192 patients with complex chronic pain. Half of the participants receive IPRP and nutrition care (described above) and the other half receive standard IPRP.

Detailed Description

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Potential participants are patients referred to a specialized pain and rehabilitation clinic due to complex chronic non-malignant pain conditions. A bio-psycho-social assessment revealed that these patients presented psychological symptoms and other comorbidities, reported large difficulties with their pain, and their condition severely affected their working life and participation in social activities. They often did not respond to routine pharmacological/ physiotherapeutic treatments delivered in a mono-disciplinary fashion. The potential participants received written information about the Swedish Quality Registry for Pain Rehabilitation (SQRP) (www.ucr.uu.se/nrs/) research and gave their written consent. The SQRP is mainly based on patient reported outcome measures (PROM) about socio-demographics, pain aspects, body weight and height, psychometric data, physical disability, and quality of life. Patients will complete the questionnaires of SQRP on three occasions: (1) before assessment on the first visit to the clinic (baseline or Pre-IPRP); (2) immediately after IPRPs (Post-IPRP); and (3) at the 12-month follow-up after IPRP discharge (FU-IPRP). Information on body height and weight were self-reported or measured and registered during the clinical assessment. All patients who respond to SQRP will be asked to participate in the study and may submit blood samples (see below).

After completing the informed consent to participate, the participants will fill out a food diary. For those who fail to complete food diaries, a dietician will book an individual meeting to go through three 24hour-dietary recordings. They will be introduced to get access to Diet4painrelief app by one research assistant. One dietician will make individualized plans of nutrition care in the app based on the information from the screening (through three 24hour-dietary recordings or food diary). The patient will receive dietary recommendations based on each patient's need for nutrition. The investigators will design and adapt 6 modules in the digital platform (Diet4painrelief app) based on the IASP recommendations (6 aspects about 'nutrition and pain') and Sweden's food culture. Overall, the app consists of the several features: weekly, push notifications, self-monitoring and feedback features of pain, diet, and recipe feature. The users will receive a text message prompting a brief weekly screening of the nutrition aspects, followed by feedback on individual screening results in comparison with recommendations they initially have received from the dietician. The feedback will be delivered on a graduated colored scale addressing diet aspects (agreement with recommendations). All users will then access a personal interactive dashboard with pictures representing nutritional behavior.

Through the Diet4painrelief platform, the dietician will follow up the progress of each participant in different timepoints during pain rehabilitation process: 4 weeks before standard pain rehabilitation program, 1-2 meetings integrated in rehabilitation process, and 4 weeks after the rehabilitation (via chat function). Participants' perceptions of using eHealth (digital healthcare applications) will be evaluated through individual interviews with the valid questionnaires (personal feelings, utility, and technical issues).

Blood samples will be collected in P100 tubes for all participants at Pre-IPRP, Post-IPRP and FU-IPRP. The sample will be centrifuged at 2500 g for 20 min at room temperature within 2-4 hours. Plasma will be extracted by carefully removing the upper part of the supernatant in fractions to a 10 mL tube, and after mixing gently will be aliquoted into 200 µl in 0.6 mL eppendorf tubes and stored at -86°C. The cell fraction will be removed to a new tube and stored at -86°C. The samples (marked with a code number) will be sent to the clinic´s research laboratory for centrifugation and storing in -86°C. The omic analysis aims to identify biomarkers that provide objective information on metabolic and nutritional abnormalities that can cause or worsen pain, further to objectively evaluate the effect of the dietary intervention on changing of pain rehabilitation outcomes.

Conditions

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Nutrition Poor Overweight and Obesity Mobile Phone Use Pain, Chronic

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Repeated measures, single-subject withdrawal design. All subjects who enroll in the study will receive the intervention and there is no randomization.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Standard IPRP

The IPRP is delivered in a group format to eight patients by an interdisciplinary team consisting of a rehabilitation physician, physiotherapist, occupational therapist, and psychologist. The program includes an 8 week treatment phase followed by a 4 week implementation period, with interdisciplinary team evaluation at week 12 (T1). Standardized Patient reported outcome measures (PROMs) assessing sociodemographic factors, pain, function, and psychological profiles are collected at baseline (T0), post-IPRP (T1) and at 12-month follow-up (T2).

Group Type ACTIVE_COMPARATOR

Dialogue and education (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

Dialogue and education consists of patient education, training in wellness and healthy living habits, meetings with families, video feedback, and couples therapy and self-training (e.g., home lessons, activity diary, physical self-training, reflection time, and self-analysis. . In addition, lectures in basic pain science and pain management are offered for both patients as well as for relatives, friends, and colleagues.

activity training (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

Activity training includes graded activity training, and exposure training, which are delivered by an interdisciplinary team (i.e., a physiotherapist, an occupational therapist, and a psychologist).

meetings (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

The meetings consist of conferences with patients, rehabilitation team, vocational guidance, rehabilitation coordinator, goal-setting meetings, and meetings to check goal achievement.

Cognitive behavioral therapy (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

Acceptance and Commitment Therapy (ACT, e.g., goal compass, training in ACT principles, and mindfulness) is mainly delivered by psychologist in a group-treatment (e.g., training in coping strategies). The cognitive behavioral principles are also used in physiotherapy, ergonomics, and education in pain management.

Relaxation techniques (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

This group-treatment is mainly format by a physiotherapist and psychologist in an interdisciplinary team.

Physical exercise (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

This group-treatment is mainly format by a physiotherapist in an interdisciplinary team.

IPRP and nutrition care

All patients will go through the screening of nutrition status, dietitian counselling, mhealth installation and test, and interviews after the IPRP intervention. Briefly, the dietitian will make personalized dietary plans together with patients. The dietitian then breaks these areas into small, manageable goals that fit the participant's situation (for example, work schedule, home environment, family needs, or cooking skills) and align with the ongoing IPRP sessions. Diet4painrelief as a digital tool will be used by dietician to follow up the progress of each participant.

Group Type EXPERIMENTAL

Nutrition care

Intervention Type OTHER

Nutrition care is designed to include nutrition assessment (e.g., malnutrition screening, monitoring weight changes, etc.), optimization of individual dietary patterns, and evaluation. Through the Diet4painrelief platform, a dietician will follow up the progress of each participant in different timepoints and also plan meetings with other professionals in IPRP. A dietitian together with a physician in rehabilitation are responsible for the administration of the procedure.

Dialogue and education (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

Dialogue and education consists of patient education, training in wellness and healthy living habits, meetings with families, video feedback, and couples therapy and self-training (e.g., home lessons, activity diary, physical self-training, reflection time, and self-analysis. . In addition, lectures in basic pain science and pain management are offered for both patients as well as for relatives, friends, and colleagues.

activity training (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

Activity training includes graded activity training, and exposure training, which are delivered by an interdisciplinary team (i.e., a physiotherapist, an occupational therapist, and a psychologist).

meetings (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

The meetings consist of conferences with patients, rehabilitation team, vocational guidance, rehabilitation coordinator, goal-setting meetings, and meetings to check goal achievement.

Cognitive behavioral therapy (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

Acceptance and Commitment Therapy (ACT, e.g., goal compass, training in ACT principles, and mindfulness) is mainly delivered by psychologist in a group-treatment (e.g., training in coping strategies). The cognitive behavioral principles are also used in physiotherapy, ergonomics, and education in pain management.

Relaxation techniques (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

This group-treatment is mainly format by a physiotherapist and psychologist in an interdisciplinary team.

Physical exercise (part of Interdisciplinary Pain Rehabilitation Program)

Intervention Type BEHAVIORAL

This group-treatment is mainly format by a physiotherapist in an interdisciplinary team.

Interventions

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Nutrition care

Nutrition care is designed to include nutrition assessment (e.g., malnutrition screening, monitoring weight changes, etc.), optimization of individual dietary patterns, and evaluation. Through the Diet4painrelief platform, a dietician will follow up the progress of each participant in different timepoints and also plan meetings with other professionals in IPRP. A dietitian together with a physician in rehabilitation are responsible for the administration of the procedure.

Intervention Type OTHER

Dialogue and education (part of Interdisciplinary Pain Rehabilitation Program)

Dialogue and education consists of patient education, training in wellness and healthy living habits, meetings with families, video feedback, and couples therapy and self-training (e.g., home lessons, activity diary, physical self-training, reflection time, and self-analysis. . In addition, lectures in basic pain science and pain management are offered for both patients as well as for relatives, friends, and colleagues.

Intervention Type BEHAVIORAL

activity training (part of Interdisciplinary Pain Rehabilitation Program)

Activity training includes graded activity training, and exposure training, which are delivered by an interdisciplinary team (i.e., a physiotherapist, an occupational therapist, and a psychologist).

Intervention Type BEHAVIORAL

meetings (part of Interdisciplinary Pain Rehabilitation Program)

The meetings consist of conferences with patients, rehabilitation team, vocational guidance, rehabilitation coordinator, goal-setting meetings, and meetings to check goal achievement.

Intervention Type BEHAVIORAL

Cognitive behavioral therapy (part of Interdisciplinary Pain Rehabilitation Program)

Acceptance and Commitment Therapy (ACT, e.g., goal compass, training in ACT principles, and mindfulness) is mainly delivered by psychologist in a group-treatment (e.g., training in coping strategies). The cognitive behavioral principles are also used in physiotherapy, ergonomics, and education in pain management.

Intervention Type BEHAVIORAL

Relaxation techniques (part of Interdisciplinary Pain Rehabilitation Program)

This group-treatment is mainly format by a physiotherapist and psychologist in an interdisciplinary team.

Intervention Type BEHAVIORAL

Physical exercise (part of Interdisciplinary Pain Rehabilitation Program)

This group-treatment is mainly format by a physiotherapist in an interdisciplinary team.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Self reported Body Mass Index (BMI)\>=25;
* Written consent to participate and attend to the pain rehabilitation program due to disabling chronic pain (on sick leave or experiencing major interference in daily life due to chronic pain)
* Agreement not to participate in other parallel treatments for weight reduction
* Not currently using medications of weight reduction
* Available to get access to internet via own mobile/cellphone.

Exclusion Criteria

* Health conditions such as pregnancy, active metabolic disease, rheumatoid arthritis, and serious psychiatric disease (investigator's judgement, eg, psychosis or suicidal ideation);
* Coagulation disorders with predisposition to bleeding, medication with anticoagulants (low- dose aspirin is permitted);
* hypersensitivity to anaesthetic
* Difficulties in understanding the Swedish language.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ostergotland County Council, Sweden

OTHER

Sponsor Role collaborator

Linkoeping University

OTHER_GOV

Sponsor Role lead

Responsible Party

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Huan-Ji Dong

MD, PhD, Associate Professor (Docent)

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Pain and Rehabilitation clinic

Linköping, Östergötland County, Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Huan-Ji Dong, PhD, MD

Role: CONTACT

+46730488933 ext. +46101032961

Facility Contacts

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Huan-Ji Dong, MD,PhD

Role: primary

Sverige ext. +46 730488933

Role: backup

Sverige

References

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Gerdle B, Molander P, Stenberg G, Stalnacke BM, Enthoven P. Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain-a practice based evidence study from two SQRP centres. BMC Musculoskelet Disord. 2016 Nov 25;17(1):490. doi: 10.1186/s12891-016-1346-7.

Reference Type RESULT
PMID: 27887616 (View on PubMed)

Related Links

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http://dx.doi.org/10.5772/intechopen.102411

Gerdle B, Rivano Fischer M, Ringqvist A. Interdisciplinary Pain Rehabilitation Programs: Evidence and Clinical Real-World Results. In: Aslanidis T, Nouris C, eds. Pain Management - From Acute to Chronic and Beyond. Rijeka: IntechOpen; 2022: Ch. 2.

Other Identifiers

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2022-05364-02

Identifier Type: OTHER

Identifier Source: secondary_id

2024-06976-01

Identifier Type: OTHER

Identifier Source: secondary_id

HMV-2023-00504

Identifier Type: -

Identifier Source: org_study_id

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