Food insecurity, loneliness can increase risk of developing chronic pain after surgery: Study

People who experience food insecurity or loneliness are much more likely to develop chronic pain after surgery, according to new research presented at the ANESTHESIOLOGY® 2025 annual meeting.

Chronic pain-lasting three months or longer-after surgery is common, especially after major procedures such as hip or knee replacement, and affects up to 30%-50% of surgical patients. Social factors such as food insecurity and social isolation can significantly raise this risk, the authors found.

Limited access to nutritious food can slow wound healing and increase inflammation, making pain more likely to last longer. Stress from loneliness can overstimulate the nervous system and make pain feel more severe. Also, a lack of social support can leave patients without help with tasks such as picking up medication or attending physical therapy, which can increase recovery time and the likelihood of pain becoming long-term.

“Our study provides strong evidence that a person’s social situation may be just as important as their physical health when it comes to recovery,” said Louie Rodriguez, M.D., co-author of the study and physician research scholar at the University of California, San Diego. “People who lack basic needs such as food and social connection may face a higher risk of long-term pain after surgery. But patients with strong support systems-whether from family, friends or community resources-are better protected. These findings highlight the importance for health care professionals to look beyond traditional medicine and consider the whole picture of a patient's life, from their dinner table to their support system, to help aid recovery."

Researchers analyzed the data from a National Institutes of Health database of 8,065 patients who had surgery after 2000, had no history of chronic pain before surgery, and completed survey data from any of the 78 social determinants of health questions available in the database. Overall, 641 patients (7.9%) developed chronic pain after surgery, which was defined as having persistent postoperative pain at least one year after surgery.

Food insecurity was the strongest predictor of chronic pain, with affected patients being 83% more likely to develop it, compared to those who had reliable access to food. Other predictors included loneliness and level of social support, measured through eight of the 78 survey questions that asked patients to rate their experiences on a scale of 1 to 4.

For the questions related to loneliness, each additional point on the scale increased the risk of chronic pain after surgery by 2.1%. For the questions related to the level of social support, each additional point (reflecting stronger social support) reduced the risk by 3.7%.

“Patients should know that being open about their social and financial situation may be a crucial part of their recovery success after surgery,” said Rodney Grabriel, M.D., MAS, co-author of the study and associate professor of anesthesiology at the University of California, San Diego. “They should feel empowered to discuss any concerns about food insecurity or a lack of social support with their doctors and nurses, who can help connect them to resources like food assistance programs or support groups, which may make recovery faster and lower their risk of ongoing pain.”

The researchers added that screening patients for these and other social factors before surgery can help clinicians intervene early and personalize pain management strategies. Integrating these factors into care plans can be key steps to improving recovery and reducing the risk of chronic pain for vulnerable patients.