Clinical observations of patients with chronic pain who require opioid treatment support the scientific research and the adverse effects of pain and opioids on the endocrine–nutrition systems.1-9 In order to evaluate a patient’s nutritional status, I use a 72-hour “Food and Drink Recall Diary” form with new patients with chronic pain (see Table 3). Over the 3-day period just prior to admission, new patients almost always report a gross deficiency of protein intake. Protein foods, defined here as food with more than 50% protein by weight, such as fish, beef, poultry, lamb, eggs, or cottage cheese, are rarely eaten. Green vegetables such as beans, broccoli, or brussels sprouts, which contain about 30% protein, also are conspicuously absent from their diet. About the only protein some patients ingest is milk.
