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What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain?

Debate

Elizabeth Dean12* and Anne Söderlund2

Author Affiliations

1 Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver V6T 1Z3, Canada

2 School of Health, Care and Social Welfare, Mälardalen University, Västerås SE- 721 23, Sweden

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BMC Musculoskeletal Disorders 2015, 16:87 
doi:10.1186/s12891-015-0545-y

Published: 13 April 2015

Abstract (provisional)

Background Other than activity and exercise, lifestyle practices such as not smoking
and healthy nutrition, well established for preventing and managing lifestyle-related
non-communicable diseases (i.e., heart disease, cancer, hypertension, stroke, obstructive
lung disease, diabetes, and obesity), are less emphasized in the physical therapy
guidelines for addressing chronic pain, e.g., back pain. This state-of-the-art review
examines the relationships between lifestyle behaviours and musculoskeletal health,
with special reference to chronic pain, and their clinical and research implications.
Discussion A state-of-the-art review was conducted to synthesize evidence related
to lifestyle factors (not smoking, healthy diet, healthy weight, optimal sleep and
manageable stress, as well as physical activity) and musculoskeletal health, with
special reference to chronic pain. The findings support that health behaviour change
competencies (examination/assessment and intervention/treatment) may warrant being
included in first-line management of chronic pain, either independently or in conjunction
with conventional physical therapy interventions. To address knowledge gaps in the
literature however three lines of clinical trial research are indicated: 1) to establish
the degree to which traditional physical therapy interventions prescribed for chronic
pain augment the benefits of lifestyle behaviour change; 2) to establish the degree
to which adopting healthier lifestyle practices, avoids or reduces the need for conventional
physical therapy; and 3) to establish whether patients/clients with healthier lifestyles
and who have chronic pain, respond more favourably to conventional physical therapy
interventions than those who have less healthy lifestyles. Summary Lifestyle behaviour
change is well accepted in addressing lifestyle-related non-communicable diseases.
Compelling evidence exists however supporting the need for elucidation of the role
of negative lifestyle behaviours on the incidence of chronic pain, and the role of
positive lifestyle behaviours on its incidence and effective management. Addressing
lifestyle behaviour change in patients/clients with chronic pain, e.g., back pain,
as a first-line intervention might not only constitute a novel approach, but also
reduce the socioeconomic burden related to chronic pain as well as non-communicable
diseases.