EFFECTIVENESS OF LIFESTYLE INTERVENTIONS IN MANAGING CHRONIC MUSCULOSKELETAL PAIN

Kamil Rajczyk; Klaudia Jasik-Zawadka; Barbara Kujawa; Dominika Kozłowska; Paweł Jankowski; Antoni Dondajewski; Zuzanna Muszkiet; Wiktoria Musyt; Anna-Maria Grzeczka; Szymon Dudziński

doi:10.31435/ijitss.4(48).2025.4455

Authors

Kamil Rajczyk Department of Medicine, Faculty of Medicine, Poznań University of Medical Sciences, Poznan, Poland https://orcid.org/0009-0002-3603-0706
Klaudia Jasik-Zawadka Department of Medicine, Faculty of Medicine, Poznań University of Medical Sciences, Poznan, Poland https://orcid.org/0009-0006-9225-9547
Barbara Kujawa Department of Medicine, Faculty of Medicine, Poznań University of Medical Sciences, Poznan, Poland https://orcid.org/0009-0000-3951-965X
Dominika Kozłowska Department of Medicine, Faculty of Medicine, Poznań University of Medical Sciences, Poznan, Poland https://orcid.org/0009-0002-3541-6076
Paweł Jankowski Department of Medicine, Faculty of Medicine, Poznań University of Medical Sciences, Poznan, Poland https://orcid.org/0009-0002-2003-5801
Antoni Dondajewski Department of Medicine, Faculty of Medicine, Poznań University of Medical Sciences, Poznan, Poland https://orcid.org/0009-0000-0081-5857
Zuzanna Muszkiet NZOZ “Bredent”, Bytom, Poland; NZOZ “Gabinety Stomatologiczne Dentus”, Zabrze, Poland https://orcid.org/0009-0001-2968-8668
Wiktoria Musyt University Center for Dentistry and Specialized Medicine, Poznan, Poland https://orcid.org/0009-0006-1650-7430
Anna-Maria Grzeczka Department of Medicine, Faculty of Medicine, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland https://orcid.org/0009-0009-7623-3007
Szymon Dudziński University Center for Dentistry and Specialized Medicine, Poznan, Poland https://orcid.org/0009-0000-1505-4800

DOI:

https://doi.org/10.31435/ijitss.4(48).2025.4455

Keywords:

Chronic Pain, Pain Management, Non-Pharmacological Treatment, Physical Activity, Lifestyle Medicine

Abstract

Introduction: Chronic musculoskeletal pain, particularly low back pain (LBP), is a major global health issue, leading to reduced quality of life, disability, and a significant economic burden on healthcare systems. Increasing evidence suggests that lifestyle-related factors—including physical inactivity, poor sleep, obesity, and psychosocial stress—play a key role in the persistence and severity of chronic pain. Lifestyle medicine, emphasizing behavioral and non-pharmacological interventions, may offer promising therapeutic alternatives.

Aim of the study: The aim of this review was to analyze the effectiveness of lifestyle-based interventions in the management of chronic musculoskeletal pain, focusing on non-pharmacological strategies and their clinical relevance in long-term pain modulation.

Materials and methods: A systematic literature review was conducted using PubMed, Web of Science, and Google Scholar databases. The search included original studies published in English or Polish after 2013, focusing on adult populations and lifestyle-related interventions for chronic musculoskeletal pain. Studies were selected based on methodological quality and clinical relevance, following PRISMA guidelines.

Results and conclusions: The analysis revealed that interventions such as cognitive functional therapy (CFT), occupational therapy, core stabilization exercises, aquatic therapy, abdominal drawing-in maneuver (ADIM), and telerehabilitation show positive effects on pain reduction, functional improvement, and patient engagement. Moreover, integrated healthy lifestyle behaviors—including physical activity, sleep hygiene, balanced diet, and weight management—were associated with reduced healthcare utilization and improved self-efficacy in pain management. Although current evidence supports the use of lifestyle interventions, further high-quality, long-term studies are needed to establish standardized clinical recommendations.

References

Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736–747. https://doi.org/10.1016/S0140-6736(16)30970-9

Hoy, D., March, L., Brooks, P., Woolf, A., Blyth, F., Vos, T., Buchbinder, R., & Murray, C. (2014). The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases, 73(6), 968–974. https://doi.org/10.1136/annrheumdis-2013-204428

Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. (2011). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. National Academies Press.

Vujcic, I., Milicevic, N., Milin-Lazovic, J., Radulovic, O., & Miljkovic, S. (2018). Low back pain in medical students in Belgrade (Serbia): A cross-sectional study. Pain Research and Management, 2018, Article 8317906. https://doi.org/10.1155/2018/8317906

Hoy, D., Bain, C., Williams, G., March, L., Brooks, P., Blyth, F., Woolf, A., Vos, T., & Buchbinder, R. (2012). A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism, 64(6), 2028–2037. https://doi.org/10.1002/art.34347

Casser, H. R., Förster, C., & Germann, C. M. (2016). Rückenleiden – Diagnostik und Therapie. Deutsches Ärzteblatt International, 113(51–52), 883–890. https://doi.org/10.3238/arztebl.2016.0883

Hides, J. A., Richardson, C. A., & Jull, G. A. (1996). Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine, 21(23), 2763–2769. https://doi.org/10.1097/00007632-199612010-00011

Citko, A., Górski, S., Marcinowicz, L., & Górska, A. (2018). Sedentary lifestyle and nonspecific low back pain in medical personnel in North-East Poland. BioMed Research International, 2018, Article 1965807. https://doi.org/10.1155/2018/1965807

Corlett, E. N. (2006). Background to ergonomics. In J. R. Wilson & E. N. Corlett (Eds.), Evaluation of human work (3rd ed.). CRC Press.

Kingma, I., & van Dieën, J. H. (2009). Static and dynamic postural loadings during computer work in females: Sitting on an office chair versus sitting on an exercise ball. Applied Ergonomics, 40(2), 199–205. https://doi.org/10.1016/j.apergo.2008.04.004

Danneels, L. A., Vanderstraeten, G. G., Cambier, D. C., Witvrouw, E. E., & De Cuyper, H. J. (2000). CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. European Spine Journal, 9(4), 266–272. https://doi.org/10.1007/s005860000190

Hayden, J. A., van Tulder, M. W., Malmivaara, A. V., & Koes, B. W. (2005). Meta-analysis: Exercise therapy for nonspecific low back pain. Annals of Internal Medicine, 142(9), 765–775. https://doi.org/10.7326/0003-4819-142-9-200505030-00013

Hodges, P. W., & Moseley, G. L. (2003). Pain and motor control of the lumbopelvic region: Effect and possible mechanisms. Journal of Electromyography and Kinesiology, 13(4), 361–370. https://doi.org/10.1016/S1050-6411(03)00042-7

Walker, B. F., Muller, R., & Grant, W. D. (2004). Low back pain in Australian adults: Prevalence and associated disability. Journal of Manipulative and Physiological Therapeutics, 27(4), 238–244. https://doi.org/10.1016/j.jmpt.2004.02.002

Maniadakis, N., & Gray, A. (2000). The economic burden of back pain in the UK. Pain, 84(1), 95–103. https://doi.org/10.1016/S0304-3959(99)00187-6

Luo, X., Pietrobon, R., Sun, S. X., Liu, G. G., & Hey, L. (2004). Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine, 29(1), 79–86. https://doi.org/10.1097/01.BRS.0000105527.13866.0F

Dagenais, S., Caro, J., & Haldeman, S. (2008). A systematic review of low back pain cost of illness studies in the United States and internationally. The Spine Journal, 8(1), 8–20. https://doi.org/10.1016/j.spinee.2007.10.005

Manchikanti, L., Singh, V., Falco, F. J. E., Benyamin, R. M., & Hirsch, J. A. (2014). Epidemiology of low back pain in adults. Neuromodulation, 17(Suppl. 2), 3–10. https://doi.org/10.1111/ner.12018

Zakład Ubezpieczeń Społecznych. (2017). Absencja chorobowa w 2016 roku. https://www.zus.pl/documents/10182/167971/absencja+chorobowa+w+2016+roku.pdf

Shiri, R., Karppinen, J., Leino-Arjas, P., Solovieva, S., & Viikari-Juntura, E. (2010). The association between obesity and low back pain: A meta-analysis. American Journal of Epidemiology, 171(2), 135–154. https://doi.org/10.1093/aje/kwp356

Skarpsno, E. S., Mork, P. J., Nilsen, T. I. L., & Holtermann, A. (2021). The effect of long-term poor sleep quality on risk of back-related disability and the modifying role of physical activity. Sleep, 44(9), Article zsab112. https://doi.org/10.1038/s41598-021-94845-7

Guan, J., Liu, T., Gao, G., Yang, K., & Liang, H. (2021). Associations between lifestyle-related risk factors and back pain: A systematic review and meta-analysis of Mendelian randomization studies. Scientific Reports, 11(1), 16058. https://doi.org/10.1186/s12891-024-07727-0

O’Sullivan, P. (2012). It’s time for change with the management of non-specific chronic low back pain. British Journal of Sports Medicine, 46(4), 224–227. https://doi.org/10.1136/bjsm.2010.081638

Fersum, K. V., O’Sullivan, P. B., Skouen, J. S., Smith, A., & Kvale, A. (2013). Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: A randomized controlled trial. European Journal of Pain, 17(6), 916–928. https://doi.org/10.1002/j.1532-2149.2012.00252.x

Fersum, K. V., Smith, A., Kvale, A., Skouen, J. S., & O’Sullivan, P. B. (2019). Cognitive functional therapy in patients with non-specific chronic low back pain: 3-year follow-up of a randomized controlled trial. European Journal of Pain, 23(9), 1660–1670. https://doi.org/10.1002/ejp.1399

Khodadad, B., Letafatkar, A., Hadadnezhad, M., & Shojaedin, S. (2020). Comparing the effectiveness of cognitive functional treatment and lumbar stabilization treatment on pain and movement control in patients with low back pain: A randomized controlled trial. Sports Health, 12(3), 289–295. https://doi.org/10.1177/1941738119886854

Zhang, Z. J., Lee, K. K., Leung, F. Y., & Wong, K. K. (2023). Cognitive functional therapy for chronic non-specific low back pain: A systematic review and meta-analysis of randomized controlled trials. Pain Physician, 26(1), E29–E42. https://doi.org/10.1016/j.ijnurstu.2023.104679

Nielsen, S. S., Christensen, J. R., Søndergaard, J., Jensen, J. N., & Petersen, K. S. (2021). Feasibility assessment of an occupational therapy lifestyle intervention added to multidisciplinary chronic pain treatment at a Danish pain centre: A qualitative evaluation from the perspectives of patients and clinicians. International Journal of Qualitative Studies on Health and Well-Being, 16(1), 1949900. https://doi.org/10.1080/17482631.2021.1949900

Persson, E., Lexell, J., Rivano-Fischer, M., & Eklund, M. (2014). Occupational performance and factors associated with outcomes in patients participating in a musculoskeletal pain rehabilitation programme. Journal of Rehabilitation Medicine, 46(7), 698–704. https://doi.org/10.2340/16501977-1810

Slee, R., Warren, A., Noonan, M., & Henderson, T. (2023). Occupational therapy in pain management: An exploration and description of current UK practice. British Journal of Occupational Therapy. https://doi.org/10.1177/03080226241300837

Brendbekken, R., Harris, A., Ursin, H., Eriksen, H. R., & Tangen, T. (2017). Return to work in patients with chronic musculoskeletal pain: Multidisciplinary intervention versus brief intervention: A randomized clinical trial. Journal of Occupational Rehabilitation, 27(1), 82–91. https://doi.org/10.1007/s10926-016-9634-5

de Vries, H. J., Reneman, M. F., Groothoff, J. W., Geertzen, J. H. B., & Brouwer, S. (2011). Staying at work with chronic nonspecific musculoskeletal pain: A qualitative study of workers’ experiences. BMC Musculoskeletal Disorders, 12, Article 126. https://doi.org/10.1186/1471-2474-12-126

Sipavičienė, S., & Klizienė, I. (2020). Effects of different exercise programs on non-specific chronic low back pain and disability in people who perform sedentary work. Clinical Interventions in Aging, 15, 2113–2121. https://doi.org/10.1016/j.clinbiomech.2019.12.028

Akhtar, M. W., Karimi, H., & Gilani, S. A. (2017). Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial. Pakistan Journal of Medical Sciences, 33(4), 1002–1006. https://doi.org/10.12669/pjms.334.12664

Areeudomwong, P., & Buttagat, V. (2019). Comparison of core stabilisation exercise and proprioceptive neuromuscular facilitation training on pain-related and neuromuscular response outcomes for chronic low back pain: A randomised controlled trial. Journal of Bodywork and Movement Therapies, 23(4), 827–833. https://doi.org/10.21315/mjms2019.26.6.8

Akuthota, V., Ferreiro, A., Moore, T., & Fredericson, M. (2008). Core stability exercise principles. Current Sports Medicine Reports, 7(1), 39–44. https://doi.org/10.1097/01.CSMR.0000308663.13278.69

Heo, M.-Y., Kim, K., Hur, B.-Y., & Nam, C.-W. (2015). The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients. Journal of Physical Therapy Science, 27(12), 3843–3846. https://doi.org/10.1589/jpts.27.3843

Baena-Beato, P. Á., Artero, E. G., Arroyo-Morales, M., Robles-Fuentes, A., Gatto-Cardia, M. C., & Delgado-Fernández, M. (2014). Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain: A controlled clinical trial. Clinical Rehabilitation, 28(4), 350–360. https://doi.org/10.1177/0269215513504943

Baena-Beato, P. A., Arroyo-Morales, M., Delgado-Fernández, M., & Gatto-Cardia, M. C. (2013). Effects of different frequencies (2–3 days/week) of aquatic therapy program in adults with chronic low back pain: A non-randomized comparison trial. Pain Medicine, 14(11), 1793–1801. https://doi.org/10.1111/pme.12002

Kihlstrand, M., Stenman, B., Nilsson, S., & Axelsson, O. (1999). Water gymnastics reduced the intensity of back/low back pain in pregnant women. Acta Obstetricia et Gynecologica Scandinavica, 78(3), 180–185. https://doi.org/10.1034/j.1600-0412.1999.780302.x

Ferreira, P. H., Ferreira, M. L., & Hodges, P. W. (2004). Changes in recruitment of the abdominal muscles in people with low back pain: Ultrasound measurement of muscle activity. Spine, 29(22), 2560–2566. https://doi.org/10.1097/01.brs.0000144410.89182.f9

Saiklang, P., Puntumetakul, R., Swangnetr, M., & Boucaut, R. (2020). The immediate effect of the abdominal drawing-in maneuver technique on stature change in seated sedentary workers with chronic low back pain. Ergonomics, 64(1), 55–68. https://doi.org/10.1080/00140139.2020.1810326

Park, S.-D., & Yu, S.-H. (2013). The effects of abdominal draw-in maneuver and core exercise on abdominal muscle thickness and Oswestry disability index in subjects with chronic low back pain. Journal of Exercise Rehabilitation, 9(2), 286–291. https://doi.org/10.12965/jer.130012

Kim, T., Woo, Y., & Kim, Y. (2014). Effect of abdominal drawing-in maneuver during hip extension on the muscle onset time of gluteus maximus, hamstring, and lumbar erector spinae in subjects with hyperlordotic lumbar angle. Journal of Physiological Anthropology, 33(1), Article 34. https://doi.org/10.1186/1880-6805-33-34

Fatoye, F., Gebrye, T., Fatoye, C., Mbada, C. E., Olaoye, M. I., & Odole, A. C. (2020). The clinical and cost-effectiveness of telerehabilitation for people with nonspecific chronic low back pain: Randomized controlled trial. JMIR mHealth and uHealth, 8(6), e15375. https://doi.org/10.2196/15375

Villatoro-Luque, F. J., Rodríguez-Almagro, D., Aibar-Almazán, A., et al. (2023). In non-specific low back pain, is an exercise program carried out through telerehabilitation as effective as one carried out in a physiotherapy center? A controlled randomized trial. Musculoskeletal Science and Practice, 64, 102765. https://doi.org/10.1016/j.msksp.2023.102765

Akodu, A. K., Adedeji, A. R., Zibiri, R. A., & Bakre, A. T. (2024). Effect of telerehabilitation-based core-stability exercise on pain-related disability, pain self-efficacy, and psychological factors in individuals with non-specific chronic low back pain: A randomized controlled study. Bulletin of Faculty of Physical Therapy, 29(1), Article 6. https://doi.org/10.1186/s43161-024-00193-8

Timurtas, E., Polat, M. G., & Karagoz, A. (2025). Clinical outcomes of asynchronous telerehabilitation through a mobile app are equivalent to synchronous telerehabilitation in patients with fibromyalgia: A randomized control study. BMC Musculoskeletal Disorders, 26, Article 377. https://doi.org/10.1186/s12891-025-08377-6

Roberts, K. E., Beckenkamp, P. R., Ferreira, M. L., et al. (2023). The impact of aggregate positive lifestyle behaviors on low back pain resilience and care seeking. The Spine Journal, 23(10), 1563–1571. https://doi.org/10.1016/j.spinee.2023.06.388

Huijbers, J. C. J., Coenen, P., Burchell, G. L. B., et al. (2023). The (cost-)effectiveness of combined lifestyle interventions for people with persistent low-back pain who are overweight or obese: A systematic review. JOSPT Open, 2(3), 146–156. https://doi.org/10.1016/j.msksp.2023.102770

Vincent, H. K., Heywood, K., Connelly, J., & Hurley, R. W. (2012). Obesity and weight loss in the treatment and prevention of osteoarthritis. PM&R, 4(5 Suppl.), S59–S67. https://doi.org/10.1016/j.pmrj.2012.01.005

Asensi, M. T., Napoletano, A., Sofi, F., & Dinu, M. (2023). Low-grade inflammation and ultra-processed foods consumption: A review. Nutrients, 15(6), 1546. https://doi.org/10.3390/nu15061546

Li, C., Huang, H., Xia, Q., & Zhang, L. (2024). Association between sleep duration and chronic musculoskeletal pain in US adults: A cross-sectional study. Frontiers in Medicine, 11, 1461785. https://doi.org/10.3389/fmed.2024.1461785

Herrero Babiloni, A., Thomas, D. C., Alessandri Bonetti, A., & Sangalli, L. (2025). Musculoskeletal pain is associated with poor sleep quality and increased daytime sleepiness in dental students: A cross-sectional pilot study. Journal of Dental Education, 89(1), 45–52. https://doi.org/10.3290/j.qi.b5826634

Edinger, J. D., Wohlgemuth, W. K., Krystal, A. D., & Rice, J. R. (2015). Behavioral insomnia therapy for fibromyalgia patients: A randomized clinical trial. Sleep, 38(3), 341–349. https://doi.org/10.1001/archinte.165.21.2527

McCrae, C. S., Williams, J., Roditi, D., et al. (2019). Cognitive behavioral treatments for insomnia and pain in fibromyalgia: A randomized controlled trial. Sleep, 42(3), Article zsy234. https://doi.org/10.1093/sleep/zsy234

Vinaya, K., Sharma, P., & Rao, S. (2024). Influence of meditative technique on musculoskeletal pain, sleep quality, stress, and state anxiety in geriatric participants: A randomized controlled trial. Journal of Geriatric Mental Health, 11(2), 123–134. https://doi.org/10.1016/j.osep.2024.06.001