Chronic pain management increasingly emphasizes patient self-management behaviors such as regular physical activity, restorative sleep, stress regulation, and healthful nutrition. Education is commonly used to support these aims; however, improving knowledge alone rarely produces sustained behavior change. In this Perspective, an argument will be made that effective chronic pain management requires a deliberate shift from education-focused approaches alone toward clinician-supported behavior change. Education may be necessary to reconceptualize pain and reduce perceived threat, though it is insufficient to help patients consistently adopt and sustain health-promoting behaviors in the context of pain. Drawing on pain science, health behavior change theory, and behavioral medicine, behavior change will be distinguished from education, and practical techniques will be outlined that clinicians can use to support patients in translating knowledge into action. Key principles include tailoring interventions to a patient's stage of change, fostering self-efficacy through graded mastery experiences, using motivational interviewing to elicit values-based motivation and address ambivalence, and employing collaborative goal setting and action planning. The role of action planning, graded tasks, and motivational interviewing approaches to sustain behavior change will be emphasized. This paper will provide a clinician-focused roadmap for supporting behavior change in pain care. By moving beyond education toward intentional behavior change support, clinicians can better foster resilience, functional recovery, and sustainable self-management among individuals living with chronic pain.
BackgroundAccelerated global population aging has increased the urgency of identifying effective non-pharmacological strategies to reduce mortality risk among older adults. Although exercise serves as a key protective factor, industrial air pollution may attenuate its health benefits, and this interaction remains unclear. This study aims to investigate whether county-level industrial air pollution indicators modify the association between exercise and all-cause mortality among older adults.MethodsA longitudinal survival analysis was performed using the Chinese Longitudinal Healthy Longevity Survey (2008–2014) with multistage stratified sampling across 23 provinces. The analysis included 16,954 participants aged ≥ 65 years with three follow-up waves spanning 6 years. Self-reported current exercise habits, survival outcomes, health status, sex, smoking status, baseline age, residence, body mass index, functional status, and comorbidity count were extracted. County-level industrial air pollution indicators (annual soot and SO2 emissions, and removals) were matched to individuals according to their residence. All pollution indicators were standardized, and time-varying covariates were updated at each wave. Cox proportional hazards models were constructed sequentially: univariate models for core variables (exercise habits and industrial air pollution indicators), two-way interaction models, and multivariate models with sequential adjustment for covariates (sex, health status, baseline age, smoking status, residence, BMI, functional status, and comorbidity count).ResultsSelf-reported current exercise habits were significantly associated with lower all-cause mortality risk after multivariate adjustment (fully adjusted HR = 0.835, 95% CI: 0.773–0.902, p < 0.001). SO2 emissions showed a weak association with survival risk in univariate analysis (HR = 1.023, 95% CI: 0.942–1.111, p = 0.585). The association estimate was further attenuated after multivariate adjustment (fully adjusted HR = 1.001, 95% CI: 0.874–1.146, p = 0.992). Soot-related indicators showed no significant mortality associations. The interaction between exercise habits and each of the four industrial air pollution indicators was not significant (all p > 0.05).ConclusionSelf-reported current exercise habits were consistently associated with lower all-cause mortality among Chinese older adults, and this association was robust to adjustment for covariates. No statistically significant multiplicative interaction was detected between exercise habits and any of the four pollution indicators. Continued attention to industrial emission control remains warranted, while promoting habitual exercise among older adults may be beneficial in areas with industrial emissions.
