Pain is a major public health concern. The National Academy of Medicine estimates that 100 million Americans suffer from chronic pain, more than those who suffer from heart disease, cancer, and diabetes combined.¹ The annual cost of chronic pain is over $600 billion, and in a given year 126 million adults experience some pain with about one-third (40 million adults) experiencing severity.² Pain is one of the most common reasons individuals seek primary medical care, yet pain care is routinely inadequate and without comprehensive assessment or treatment plan.³ Furthermore, pain is associated with poor general health, health-related disability, and increased health care utilization.³ According to national estimates, back pain, joint pain, neck pain, and headaches are among the most common types of pain experienced by US adults (see Table 1-1).^4,5,6

The prevalence of common painful conditions has remained stable despite improved understanding of the mechanisms of pain syndromes and the development of novel medications and medical devices (see Table 1-1). A focus on treatment rather than prevention has contributed to the epidemic of chronic pain. One of the treatments continues to be the use of opioid medications. Morbidity and mortality from opioid-related overdose has increased with the rise in opioid prescriptions. In 2015; 12.5 million people in the United States misused opioid medications, and 33,000 died from complications associated with opioid overdose.^7,8 In fact, at the time of this publication, opioid overdose is now the leading cause of accidental death in the United States.⁸ Therefore, emphasis on pain education, assessment, and knowledge of pain medications is central to improving the health of the person.

Chronic pain management requires treatment strategies tailored to each person and not overly reliant on single modalities. In addition to the various treatments, management also requires patients to be participants in their own care, which often begins with fostering a healthy lifestyle. The cells of our body need nutrients, oxygen, and healthy sleep to recover, repair, and perform activities of daily living. A predominantly plant-based, whole-food diet delivers a balance of vitamins, minerals and antioxidants. Anti-inflammatory diets high in fruits, vegetables, nuts, whole grains, fish, and healthy oils such as the Mediterranean diet or purely plant-based diets, such as a Vegan diet, are associated with decreased pain and improved mood. Decreased pain and improved mood further promote healthy choices.^9,10

Similarly, consistent moderate aerobic exercise promotes healthy weight with associated decreased pain, improved general conditioning, and increased function. Cardiovascular health enhances oxygen and nutrient delivery to the cells supporting tissue function, recovery,
and repair, and the endorphins associated with cardiovascular exercise also improve mood and healthy choices.