207: Metabolic and Microcirculatory Optimization in Low-Energy Phenotypes: Implications for Chronic Pain

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Non-pharmacological treatments, Treatment/management

Background and Aims: Patients presenting with fatigue-dominant, hypoperfusion-associated clinical phenotypes—such as postoperative recovery states or menstrual blood-loss–related weakness—frequently report musculoskeletal pain and reduced functional resilience. Autonomic imbalance, impaired microcirculation, and metabolic stress may contribute to symptom persistence and responsiveness to pain-directed interventions. Emerging evidence links microvascular dysfunction to chronic pain (Coderre, 2023), while nutritional factors appear to modulate inflammatory tone and central sensitization (Elma et al., 2022; Nijs et al.). However, systematic evaluation of metabolic–microcirculatory optimization strategies in pain-relevant clinical populations remains limited.

Methods: We conducted a retrospective service evaluation of consecutive adult patients attending a specialist outpatient clinic who exhibited low-energy phenotypes characterized by cold extremities, fatigue, exercise intolerance, and pain complaints. Patients received a standardized metabolic–microcirculatory optimization
package including hydration guidance, sleep regulation, dietary nitrate-rich foods and polyphenol-containing nutritional products. Clinical records were reviewed for baseline characteristics, pain intensity, functional capacity, and symptom trajectories over a 4-week-period.

Results: Preliminary retrospective analysis of approximately 50 patients suggested consistent improvements in subjective energy levels, peripheral warmth, and physical resilience, accompanied by clinically meaningful reductions in pain intensity in a substantial proportion of cases. Functional recovery appeared to parallel
symptom improvement, in line with prior reports linking dietary interventions to pain outcomes (Brown, 2021; Nijs et al., 2020). No serious adverse effects were recorded. Formal statistical analysis is ongoing.

Conclusions: These preliminary observations support the hypothesis that metabolic and microcirculatory optimization strategies may beneficially modulate pain-relevant physiological states in low-energy clinical phenotypes and represent a scalable form of prehabilitation around chronic pain interventions and regenerative procedures. Additionally, physiological priming strategies prioritising microcirculatory stability and mitochondrial resilience may be particularly relevant in settings with bleeding risk or fragile capillary networks—such as cerebral or retinal microvascular beds—to reduce ischemia–reperfusion injury and secondary tissue damage. Preservation of interstitial homeostasis, extracellular collagen networks, and cytoskeletal integrity may further determine tissue resilience after surgical or inflammatory stress, including electrocautery-related injury. Future prospective studies are warranted.

References: Coderre TJ. Contribution of microvascular dysfunction to chronic pain. Frontiers in Pain Research. 2023;4:1111559.

Elma Ö, Brain K, Dong H-J. The importance of nutrition as a lifestyle factor in chronic pain management: a narrative review. Journal of Clinical Medicine. 2022;11(19):5950.

Brown BI. Pain management and nutritional medicine: review of clinical trials and dietary interventions in chronic pain. Nutritional Medicine Institute Review; 2021.

Nijs J, et al. Nutritional neuro-immune mechanisms linking diet to chronic pain sensitization: umbrella review. Vrije Universiteit Brussel; 2020.

Presenting Author: Dr Attila Jonas
Submitting Author: Dr Attila Jonas

Senior Author: Dr Adel Milad

IASP 2026 Global Year theme of Neuropathic Pain: No

• Dr Adel Milad: Consultant Anaesthetist - Ministry of National Guard King Abdulaziz Medical City Riyadh