Associations between attitudes and beliefs about the role of nutrition and diet quality with pain interference and physical function

Background and purpose: Nutrition likely influences pain, but the role of patient beliefs remains understudied in musculoskeletal conditions. This study examined whether beliefs about the role of nutrition in pain, diet quality, and eating self-efficacy are associated with pain interference and physical function, accounting for symptom acuity. Materials and methods: A longitudinal cohort of patients receiving physical therapy for musculoskeletal conditions between July 15 and December 4, 2024, was analyzed. Baseline measures included the Attitudes and Beliefs About Nutrition and Pain Questionnaire, Healthy Eating Score-7, Weight Efficacy Lifestyle Questionnaire-Short Form, and Patient-Reported Outcomes Measurement Information System (pain interference, physical function). A linear mixed-effects model assessed associations with outcomes, including differences by symptom duration. Models were adjusted for age, body mass index, body region, and sex. Results: Among 438 participants, stronger nutrition–pain beliefs were associated with improved physical function (standardized beta coefficient [β] = 0.05; 95% confidence interval [CI] 0.02–0.08; P = 0.001) and reduced pain interference (β = −0.03; 95% CI –0.06 to −0.003; P = 0.03) at 12 weeks. Diet quality and eating self-efficacy were not associated with outcomes. Participants with chronic symptoms had lower diet quality (mean difference = 20.03; 95% CI: 19.33 to 20.72; P = 0.03). Conclusion: Nutrition–pain beliefs demonstrated modest associations with improved physical function and reduced pain interference. While diet quality and eating self-efficacy were not associated with outcomes, lower diet quality was more common with chronic symptoms. These findings support holistic pain management approaches addressing nutrition beliefs within a person-centered framework.