This qualitative study explored the lived experience of eating problems in 16 adults with complex chronic pain (15 women, age 21–69, all White non-Hispanic, cisgender) recruited from a multidisciplinary academic pain clinic; interviews were analyzed using Reflexive Thematic Analysis.
Five core themes emerged: (1) fear-driven unpredictability around food triggers; (2) vicious cycles linking pain, medication side effects, mood, and maladaptive eating; (3) disrupted body image and identity; (4) social isolation tied to dietary restrictions; and (5) practical barriers—financial, physical, and logistical—to obtaining and preparing food. Eating difficulties extended well beyond standard eating disorder criteria.
- Sample was small (n=16), nearly all female, exclusively White non-Hispanic, and English-speaking—severely limiting generalizability. - Treatment-seeking sample from a single specialty pain clinic, not representative of community populations. - Qualitative design does not allow causal inference or prevalence estimates.
Screen chronic pain patients for the full range of eating difficulties—including fear-based restriction, comfort eating, and medication-related appetite changes—not just formal eating disorder diagnoses. Replace weight-centric advice with individualized, biopsychosocial approaches that address fear-avoidance, decision fatigue, social isolation, and practical food-access barriers.
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