Nutrition plays an important role in pain management. Healthy eating patterns are associated with reduced systemic inflammation, as well as lower risk and severity of chronic non-cancer pain and associated comorbidities. The role of nutrition in chronic non-cancer pain management is an emerging field with increasing interest from clinicians and patients. Evidence from a number of recent systematic reviews shows that optimising diet quality and incorporating foods containing anti-inflammatory nutrients such as fruits, vegetables, long chain and monounsaturated fats, antioxidants, and fibre leads to reduction in pain severity and interference. This review describes the current state of the art and highlights why nutrition is critical within a person-centred approach to pain management. Recommendations are made to guide clinicians and highlight areas for future research.

Background Chronic non-cancer pain (CNCP) frequently co-occurs with other chronic conditions, resulting in multimorbidity. Objective The aim of this article is to summarise current approaches to CNCP management and explore areas of specificity and overlap with chronic conditions in general. Discussion The biomedical component of the management of chronic conditions may be condition-specific. However, mindbody, connection, activity and nutrition components entail significant overlap and are helpful across conditions. Effective practice avoids overemphasis on medical treatments at the expense of evidence-based, multidimensional lifestyle approaches. CNCP management illustrates the case for reconceptualising chronic condition management using a generic lifestyle-based approach. This capitalises on overlapping treatments, creates system efficiency and allows patients with multimorbidity to be treated more effectively in primary care, with only a small subgroup referred to condition-specific tertiary services. CHRONIC NON-CANCER PAIN (CNCP) is commonplace and costly. In 2018, 3.24 million Australians were living with CNCP, costing the country $73.2 billion. 1 In planning resource efficiency, it is noteworthy that CNCP often occurs in the midst of multimorbidity (Figure 1). A Scottish primary care study found that 23% of patients had multimorbidity and 46% of those presenting with CNCP had three or more long-term conditions. 2 Metaflammation has been postulated as an underlying mechanism contributing to many chronic conditions. 3 This may partly explain the overlap of effective lifestylebased treatment strategies. For example, increasing physical activity improves multiple chronic conditions. There are potential efficiencies in generic lifestylebased approaches to chronic conditions. Overinvesting in chronic conditionspecific programs may lead to unintended inefficiencies and costs. This article summarises current approaches to CNCP treatment and considers areas of specificity and overlap with generic chronic condition management (Figure 2).

Guidelines for chronic noncancer pain prioritize behavioral treatments. In clinical practice transition from opioids to behavioral treatments is often not endorsed by patients or providers. Feasible interventions to support opioid tapering are needed, particularly in primary care. The objectives of this paper is to review the feasibility of behavioral interventions to support opioid tapering. Electronic databases (MEDLINE, Embase, PsycINFO, and CINAHL) were searched from inception to June 2019 to identify original studies reporting feasibility (consent rates; completion rates; patient-reported acceptability; integration into clinical practice; and adverse events) of opioid tapering and transition to behavioral treatments for adults experiencing chronic noncancer pain. Google scholar and contents tables of key journals were also searched. Two authors independently extracted data and assessed methodological quality using The Quality Assessment Tool for Quantitative Studies. Eleven publications met inclusion criteria, of which three were conducted in primary care. Consent rates ranged from 27% to 98% and completion rates from 6.6% to 100%. Four studies rated at least one component of patient acceptability: helpfulness from 50%–81%; satisfaction 71%–94%, and “recommend to others” 74%–91%. Three studies reported provider perspectives and two studies reported adverse events. Quality assessment indicated all 11 studies were moderate or weak, primarily due to selection bias and lack of assessor blinding. There was also considerable heterogeneity in study design. The limited available data suggest that attempts to translate opioid tapering interventions into practice are likely to encounter substantial feasibility challenges. One possible way to ameliorate this challenge may be a clear policy context, which facilitates and support opioid reduction.