Effects of weight loss through dietary intervention on pain characteristics, functional mobility, and inflammation in adults with elevated adiposity

Background

The relationship between adiposity and pain is complex. Excess weight increases the risk for chronic musculoskeletal pain (CMP), driven by increased biomechanical load and low-grade systemic inflammation. Pain limits physical function, impacting energy balance contributing to weight gain. The primary aims of this study were to profile pain characteristics in participants with overweight or obesity and determine if weight loss through dietary-induced energy restriction, and presence of CMP, or magnitude of weight loss, was associated with changes in adiposity, pain, functional mobility, and inflammation.

Methods

This was a secondary analysis of data from adults (25-65 years) with overweight or obesity (BMI 27.5-34.9 kg/m2) enrolled in a 3-month, 30% energy-restricted dietary intervention to induce weight loss (January 2019-March 2021). Anthropometric measures (weight, waist circumference and fat mass), pain prevalence, pain severity (McGill Pain Questionnaire, MPQ), pain intensity (Visual Analog Scale, VAS), functional mobility (timed up and go, TUG) and inflammation (high sensitivity C-Reactive Protein, hsCRP) were assessed at baseline and 3-months.

Results

One hundred and ten participants completed the intervention and had weight and pain assessed at both baseline and 3-months. Participants lost 7.0 ± 0.3 kg, representing 7.9% ± 3.7% of body mass. At 3-months, functional mobility improved (TUG -0.2 ± 0.1 s, 95% CI -0.3, -0.1), but there was no change in hsCRP. Compared to baseline, fewer participants reported CMP at 3-months (n = 56, 51% to n = 27, 25%, p < 0.001) and presence of multisite pain decreased from 22.7% to 10.9% (p < 0.001). Improvements in anthropometric measures and functional mobility did not differ between those presenting with or without CMP at baseline. Improvements in pain were not related to the magnitude of weight loss.

Conclusion

Weight loss was effective in reducing pain prevalence and improving functional mobility, emphasizing the importance of considering weight-loss as a key component of pain management.

Clinical trial registration

identifier, ACTRN12618001861246.

Differences in Psychological Health and Weight Loss after Bariatric Metabolic Surgery between Patients with and without Pain Syndromes

PURPOSE

Chronic pain and obesity often co-occur, negatively affecting one another and psychological wellbeing. Pain and psychological wellbeing improve after bariatric metabolic surgery (BMS), however, it is unknown whether psychological wellbeing improves differently after weight loss between patients with and without chronic pain. We investigated whether weight loss is associated with greater psychological wellbeing and functioning change after BMS, comparing patients with and without preoperative pain syndromes.

METHODS

Depression, health-related quality of life, self-esteem, self-efficacy to exercise and controlling eating behaviours, physical activity, and food cravings were measured before and 24 months after BMS among 276 patients with obesity. The presence of preoperative chronic pain syndromes was examined as a moderator for the relationship between 24-month weight loss and changes in psychological outcomes.

RESULTS

Chronic pain syndromes were present among 46% of patients. Weight loss was associated with greater improvement in health-related quality of life, self-efficacy to exercise and controlling eating behaviours, self-esteem and greater amelioration in food cravings. Pain syndromes only moderated negatively the relationship between the postoperative weight loss and change in self-efficacy to control eating behaviours (b = -0.49, CI [-0.88,-0.12]).

CONCLUSION

Patients with and without chronic pain showed similar improvements in weight and psychological wellbeing and behaviours after BMS. The relationship between weight loss and the improvement of self-efficacy to control eating behaviours was weaker among patients with chronic pain syndrome. Further work, measuring pain severity over time, is needed to shed light on the mechanism underlying pain and postoperative change in psychological wellbeing and weight loss.

Adults with excess weight or obesity, but not with overweight, report greater pain intensities than individuals with normal weight: a systematic review and meta-analysis

Context

Over 1.9 billion adult people have overweight or obesity. Considered as a chronic disease itself, obesity is associated with several comorbidities. Chronic pain affects approximately 60 million people and its connection with obesity has been displayed in several studies. However, controversial results showing both lower and higher pain thresholds in subjects with obesity compared to individuals with normal weight and the different parameters used to define such association (e.g., pain severity, frequency or duration) make it hard to draw straight forward conclusions in the matter. The objective of this article is to examine the relationship between overweight and obesity (classified with BMI as recommended by WHO) and self-perceived pain intensity in adults.

Methods

A literature search was conducted following PRISMA guidelines using the databases CINAHL, Cochrane Library, EMBASE, PEDro, PubMed, Scopus and Web of Science to identify original studies that provide BMI values and their associated pain intensity assessed by self-report scales. Self-report pain scores were normalized and pooled within meta-analyses. The Cochrane's Q test and I2 index were used to clarify the amount of heterogeneity; meta-regression was performed to explore the relationship between each outcome and the risk of bias.

Results

Of 2194 studies, 31 eligible studies were identified and appraised, 22 of which provided data for a quantitative analysis. The results herein suggested that adults with excess weight (BMI ≥ 25.0) or obesity (BMI ≥ 30.0) but not with overweight (pre-obesity) alone (BMI 25.0-29.9), are more likely to report greater intensities of pain than individuals of normal weight (BMI 18.5-24.9). Subgroup analyses regarding the pathology of the patients showed no statistically significant differences between groups. Also, influence of age in the effect size, evaluated by meta-regression, was only observed in one of the four analyses. Furthermore, the robustness of the findings was supported by two different sensitivity analyses.

Conclusion

Subjects with obesity and excess weight, but not overweight, reported greater pain intensities than individuals with normal weight. This finding encourages treatment of obesity as a component of pain management. More research is required to better understand the mechanisms of these differences and the clinical utility of the findings.

Systematic Review Registration

https://doi.org/10.17605/OSF.IO/RF2G3, identifier OSF.IO/RF2G3.

Sedentary behavior and neck pain in adults: A systematic review and meta-analysis

Sedentary lifestyle is an imperative risk for musculoskeletal pain. We sought to investigate the association between different types of sedentary behaviors (SBs) and neck pain (NP) among adults. A systematic search was conducted in PubMed, Web of Science, Embase, Scopus, and Google Scholar up to the end of April 2023. The odds ratio (95% CI) was considered as the desired effect size for the association between SBs and the NP. Among 1881 records found by primary search, 46, and 27 reports were included in the qualitative and quantitative analysis respectively. All included studies qualified as good or fair. Our results indicated that SB is a risk factor for NP among adults (OR = 1.5, [1.29, 1.76]). Computer and mobile phone use were also found to be considerable risk factors for NP (OR = 1.3, [1.12, 1.53], and OR = 2.11, [1.32, 3.42] respectively). However, sitting time showed an insignificant association with NP (OR = 1.33, [0.86, 2.07]). Subgroup analysis revealed that SBs are a significant risk factor for NP among university students (OR = 1.58, [1.27, 1.97]), but the association among office workers was marginally insignificant (OR = 1.36, [0.98, 1.89]). According to the meta-regression results, the male gender was found to increase the risk of NP. Meanwhile, Egger's test revealed the presence of publication bias (p-value <0.0001). A sedentary lifestyle as well as computer and mobile phone use is associated with a considerable risk of NP among adults, especially university students. Further, longitudinal studies are needed to better clarify the causality relationships.

A common variant rs2054564 in ADAMST17 is associated with susceptibility to lumbar spondylosis

The molecular pathophysiology underlying lumbar spondylosis development remains unclear. To identify genetic factors associated with lumbar spondylosis, we conducted a genome-wide association study using 83 severe lumbar spondylosis cases and 182 healthy controls and identified 65 candidate disease-associated single nucleotide polymorphisms (SNPs). Replication analysis in 510 case and 911 control subjects from five independent Japanese cohorts identified rs2054564, located in intron 7 of ADAMTS17, as a disease-associated SNP with a genome-wide significance threshold (P = 1.17 × 10-11, odds ratio = 1.92). This association was significant even after adjustment of age, sex, and body mass index (P = 7.52 × 10-11). A replication study in a Korean cohort, including 123 case and 319 control subjects, also verified the significant association of this SNP with severe lumbar spondylosis. Immunohistochemistry revealed that fibrillin-1 (FBN1) and ADAMTS17 were co-expressed in the annulus fibrosus of intervertebral discs (IVDs). ADAMTS17 overexpression in MG63 cells promoted extracellular microfibrils biogenesis, suggesting the potential role of ADAMTS17 in IVD function through interaction with fibrillin fibers. Finally, we provided evidence of FBN1 involvement in IVD function by showing that lumbar IVDs in patients with Marfan syndrome, caused by heterozygous FBN1 gene mutation, were significantly more degenerated. We identified a common SNP variant, located in ADAMTS17, associated with susceptibility to lumbar spondylosis and demonstrated the potential role of the ADAMTS17-fibrillin network in IVDs in lumbar spondylosis development.

Overweight and obesity in young adults with patellofemoral pain: Impact on functional capacity and strength

PURPOSE

This study aimed to (a) investigate the proportion of overweight/obesity in a cohort of young adults with patellofemoral pain (PFP) and (b) explore the association of body mass index (BMI), body fat, and lean mass with functional capacity and hip and knee strength in people with PFP.

METHODS

We included a mixed-sex sample of young adults (18-35 years old) with PFP (n = 100). Measurements for BMI, percentage of body fat, and lean mass (assessed by bioelectrical impedance) were obtained. Functional capacity was assessed by the Anterior Knee Pain Scale, plank test, and single-leg hop test. Strength of the knee extensors, knee flexors, and hip abductors was evaluated isometrically using an isokinetic dynamometer. The proportion of overweight/obesity was calculated based on BMI. The association between BMI, body fat, and lean mass and functional capacity and strength was investigated using partial correlations, followed by hierarchical regression analysis, adjusted for covariates (sex, bilateral pain, and current pain level).

RESULTS

A total of 38% of our cohort had their BMI categorized as overweight/obese. Higher BMI was associated with poor functional capacity (ΔR² = 0.06-0.12, p ≤ 0.001) and with knee flexion strength only (ΔR² = 0.04, p = 0.030). Higher body fat was associated with poor functional capacity (ΔR² = 0.05-0.15, p ≤ 0.015) and reduced strength (ΔR² = 0.15-0.23, p < 0.001). Lower lean mass was associated with poor functional capacity (ΔR² = 0.04-0.13, p ≤ 0.032) and reduced strength (ΔR² = 0.29- 0.31, p < 0.001).

CONCLUSION

BMI, body fat, and lean mass should be considered in the assessment and management of young people with PFP because it may be detrimental to function and strength.

Epigenetic aging, knee pain and physical performance in community-dwelling middle-to-older age adults

Knee pain is a leading cause of disability in the aging population and may indirectly accelerate biological aging processes. Chronological aging increases the risk of developing of knee pain and knee pain reduces physical function; however, limited data exist on how epigenetic aging, a known hallmark of biological aging shown to predict health span and mortality, may influence this relationship. The purpose of this study was to examine whether decreased physical performance associated with knee pain is mediated by markers of epigenetic aging. Participants (57.91 ± 8.04 years) with low impact knee pain (n = 95), high impact knee pain (n = 53) and pain-free controls (n = 26) completed self-reported pain, a blood draw and a short physical performance battery (SPPB) that included balance, walking, and sit to stand tasks. We employed an epigenetic clock previously associated with knee pain and shown to predict overall mortality risk (DNAmGrimAge). Bootstrapped-mediation analyses were used to determine associations of DNAmGrimAge and SPPB between pain groups. Those with high impact and low impact pain had a biologically older epigenetic age (5.14y ± 5.66 and 1.32y ± 5.41, respectively). However, while there were direct effects of pain on overall physical performance, these were not explained by epigenetic aging. Epigenetic aging only mediated the effect of pain on balance performance. Future work is needed to examine pain's impact on biological aging processes including epigenetic aging and its ultimate effect on physical function measures known to predict health span and mortality.

Body fat and skeletal muscle mass, but not body mass index, are associated with pressure hyperalgesia in young adults with patellofemoral pain

BACKGROUND

Young adults with patellofemoral pain (PFP) have a high prevalence of being overweight or obese, which is associated with impaired lower limb function and muscle weakness. However, the impact of being overweight or obese on pain sensitivity has not been explored.

OBJECTIVES

We investigated the association between body fat, skeletal muscle mass, and body mass index (BMI) with pressure hyperalgesia and self-reported pain in young adults with PFP.

METHODS

114 adults with PFP (24 ± 5 years old, 62% women) were recruited. Demographics and self-reported pain (current and worst knee pain intensity in the previous month - 0-100 mm visual analog scale) were recorded. Body fat and skeletal muscle mass were measured using bioelectrical impedance. Pressure hyperalgesia was measured using a handheld algometer (pressure pain threshold) at three sites: center of patella of the painful knee, ipsilateral tibialis anterior, and contralateral upper limb. The association between body fat, skeletal muscle mass, and BMI with pressure hyperalgesia and self-reported pain were investigated using partial correlations and hierarchical regression models (adjusted for sex, bilateral pain, and symptoms duration).

RESULTS

Higher body fat and lower skeletal muscle mass were associated with local, spread, and widespread pressure hyperalgesia (ΔR²=0.09 to 0.17, p ≤ 0.001; ΔR²=0.14 to 0.26, p<0.001, respectively), and higher current self-reported pain (ΔR²=0.10, p<0.001; ΔR²=0.06, p = 0.007, respectively). Higher BMI was associated with higher current self-reported pain (ΔR²=0.10, p = 0.001), but not with any measures of pressure hyperalgesia (p>0.05).

CONCLUSION

Higher body fat and lower skeletal muscle mass help to explain local, spread, and widespread pressure hyperalgesia, and self-reported pain in people with PFP. BMI only helps to explain self-reported pain. These factors should be considered when assessing people with PFP and developing their management plan, but caution should be taken as the strength of association was generally low.

The Pathological Links between Adiposity and the Carpal Tunnel Syndrome

An association between obesity and carpal tunnel syndrome is found in many epidemiological studies. Therefore, there is a need to evaluate the physiopathological links that could explain the association between these two entities. Ectopic adipose tissue is responsible for metabolic syndrome and inflammation, and is a major risk factor for diabetes and cardiovascular diseases. Taking these elements into consideration, we conducted an extensive literature revision of the subject, considering as ectopic fat-related mechanisms the following: (a) the direct compression and the association with the metabolic syndrome of the fat deposition around the wrist, (b) the insulin resistance, dyslipidemia, inflammatory, and oxidative mechanisms related to the central deposition of the fat, (c) the impaired muscle contraction and metabolism related to myosteatosis. Each section presents the cellular pathways which are modified by the ectopic deposition of the adipose tissue and the impact in the pathogeny of the carpal tunnel syndrome. In conclusion, the experimental and clinical data support the epidemiological findings. Efforts to reduce the obesity epidemics will improve not only cardio-metabolic health but will reduce the burden of the disability-free life expectancy due to the carpal tunnel syndrome.

Metabolic obesity and the risk of knee osteoarthritis progression in elderly community residents: A 3-year longitudinal cohort study

OBJECTIVE

Metabolic syndrome is a major health problem worldwide associated with obesity, thus drawing attention to its relation to osteoarthritis (OA). However, it is still uncertain whether metabolic syndrome or body fat distribution is associated with knee OA. The aim of this longitudinal study was to elucidate the association between metabolic obesity and adverse structural changes of knee OA assessed by magnetic resonance imaging (MRI).

METHODS

Participants were recruited from the Hallym Aging Study cohort in Korea. Knee MRI scans, along with dual-energy X-ray absorptiometry, were assessed in 226 participants at baseline and after 3 years. The structural progression in the tibiofemoral joint was evaluated using the semi-quantitative Whole-Organ MRI Score (WORMS) for cartilage morphology and bone marrow lesions (BML). Logistic regression with generalized estimating equation was performed for associations of metabolic risk factors with worsening of WORMS scores at the subregional level.

RESULTS

In the medial compartment, fat mass in women was associated with cartilage loss, but the statistical significance disappeared after adjusting for body mass index. Metabolic syndrome and each of its components were not associated with cartilage loss or increase of BML. On the other hand, the interaction effects of metabolic syndrome on the association between obesity and knee OA progression were not significant.

CONCLUSION

In this cohort, metabolic effects of obesity on knee cartilage damage and BML were not demonstrated. Further large-scale studies are required to prove the causal relationship between metabolic obesity and knee OA.

Metabolic Syndrome, Disease Activity, and Adipokines in Patients With Newly Diagnosed Inflammatory Joint Diseases

OBJECTIVE

To investigate metabolic syndrome (MetS), disease activity, and adipokine levels among patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and undifferentiated arthritis (UA) at the time of diagnosis and after 1 year of follow-up.

METHODS

Patients with inflammatory joint diseases participating in the Northern Savo 2010 population-based longitudinal epidemiological study were evaluated for components of MetS (by National Cholesterol Education Program's Adult Treatment Panel III) and clinical parameters of disease activity. The adipokines adiponectin, adipsin, resistin, and leptin were measured at baseline and after 1 year of treatment with disease-modifying antirheumatic drugs.

RESULTS

Among 176 patients, MetS was detected in 42% of RA, 36% of SpA, and 51% of UA patients. Metabolic syndrome was associated with higher disease activity as measured by patient global assessment in RA and UA patients and increased pain in RA patients. Leptin levels were increased in patients with MetS, showing a linearly increasing trend with the number of components of MetS in SpA and UA, but not in RA. In RA patients, decrease in disease activity correlated with decrease in leptin levels. Resistin did not associate with MetS, but a decrease in resistin correlated with decrease in disease activity in RA and UA. In SpA, increased adiponectin level correlated with relief in disease activity, but not with MetS.

CONCLUSIONS

Metabolic syndrome was common in patients with newly diagnosed arthritides and associated with higher disease activity and increased leptin levels. Resistin responded to treatment of arthritis in RA and UA, leptin in RA, and adiponectin in SpA.

Are Cardiometabolic Markers of Allostatic Load Associated With Pronociceptive Processes in Native Americans?: A Structural Equation Modeling Analysis From the Oklahoma Study of Native American Pain Risk

Native Americans (NAs) experience higher rates of chronic pain than the general U.S. population, but the risk factors for this pain disparity are unknown. NAs also experience high rates of stressors and cardiovascular and metabolic health disparities (eg, diabetes, cardiovascular disease) consistent with allostatic load (stress-related wear-and-tear on homeostatic systems). Given that allostatic load is associated with chronic pain, then allostatic load may contribute to their pain disparity. Data from 302 healthy, pain-free men and women (153 NAs, 149 non-Hispanic Whites [NHW]) were analyzed using structural equation modeling to determine whether cardiometabolic allostatic load (body mass index, blood pressure, heart rate variability) mediated the relationship between NA ethnicity and experimental measures of pronociceptive processes: temporal summation of pain (TS-pain) and the nociceptive flexion reflex (TS-NFR), conditioned pain modulation of pain (CPM-pain) and NFR (CPM-NFR), and pain tolerance. Results indicated that NAs experienced greater cardiometabolic allostatic load that was related to enhanced TS-NFR and impaired CPM-NFR. Cardiometabolic allostatic load was unrelated to measures of pain perception (CPM-pain, TS-pain, pain sensitivity). This suggests cardiometabolic allostatic load may promote spinal sensitization in healthy NAs, that is not concomitant with pain sensitization, perhaps representing a unique pain risk phenotype in NAs. PERSPECTIVE: Healthy, pain-free Native Americans experienced greater cardiometabolic allostatic load that was associated with a pronociceptive pain phenotype indicative of latent spinal sensitization (ie, spinal sensitization not associated with hyperalgesia). This latent spinal sensitization could represent a pain risk phenotype for this population.

An association between chronic widespread pain and the gut microbiome

OBJECTIVES

Chronic widespread musculoskeletal pain (CWP) is a characteristic symptom of fibromyalgia, which has been shown to be associated with an altered gut microbiome. Microbiome studies to date have not examined the milder CWP phenotype specifically nor have they explored the role of raised BMI. The aim of this study was to investigate whether the microbiome is abnormal in CWP.

METHODS

CWP was assessed using a standardized screening questionnaire in female volunteers from the TwinsUK cohort including 113 CWP cases and 1623 controls. The stool microbiome was characterized using 16S rRNA amplicon sequencing and amplicon sequence variants, and associations with CWP examined using linear mixed-effects models adjusting for BMI, age, diet, family relatedness and technical factors.

RESULTS

Alpha diversity was significantly lower in CWP cases than controls (Mann-Whitney test, P-values 2.3e-04 and 1.2e-02, for Shannon and Simpson indices respectively). The species Coprococcus comes was significantly depleted in CWP cases (Padj = 3.04e-03). A genome-wide association study (GWAS) performed for C. comes in TwinsUK followed by meta-analysis with three Dutch cohorts (total n = 3521) resulted in nine suggestive regions, with the most convincing on chromosome 4 near the TRAM1L1 gene (rs76957229, P = 7.4e-8). A Mendelian randomization study based on the results of the GWAS did not support a causal role for C. comes on the development of CWP.

CONCLUSIONS

We have demonstrated reduced diversity in the microbiome in CWP, indicating an involvement of the gut microbiota in CWP; prospectively the microbiome may offer therapeutic opportunities for this condition.

Body composition associations with muscle strength in older adults living in Auckland, New Zealand

BACKGROUND

Aging is associated with decreases in muscle strength and simultaneous changes in body composition, including decreases in muscle mass, muscle quality and increases in adiposity.

METHODS

Adults (n = 369; 236 females) aged 65-74 years living independently were recruited from the cross-sectional Researching Eating Activity and Cognitive Health (REACH) study. Body fat percentage and appendicular skeletal muscle mass (ASM) (sum of lean mass in the arms and legs) were assessed using Dual-energy X-ray Absorptiometry (Hologic, QDR Discovery A). The ASM index was calculated by ASM (kilograms) divided by height (meters) squared. Isometric grip strength was measured using a hand grip strength dynamometer (JAMAR HAND).

RESULTS

Linear regression analyses revealed that muscle strength was positively associated with the ASM index (R2 = 0.431, p < 0.001). When exploring associations between muscle strength and muscle mass according to obesity classifications (obesity ≥30% males; ≥40% females), muscle mass was a significant predictor of muscle strength in non-obese participants. However, in participants with obesity, muscle mass was no longer a significant predictor of muscle strength.

CONCLUSIONS

Body fat percentage should be considered when measuring associations between muscle mass and muscle strength in older adults.

Smartphone addiction and its association with upper body musculoskeletal symptoms among university students classified by age and gender

[Purpose] The purposes of this study were to: 1) survey smartphone addiction among university students, 2) survey the prevalence of upper body musculoskeletal symptoms in relation to the respondents’ sitting posture, and 3) determine the association between smartphone addiction and upper body musculoskeletal symptoms, classified by age and gender. [Participants and Methods] Two self-report questionnaires were employed to collect data from 2,645 university students in Chiang Mai, Thailand. [Results] Of 2,027 respondents (860 males and 1,167 females), the participants’ ages ranged from 18 to 26 years with a mean age of 20.5 ± 1.38 years. The prevalence of smartphone addiction and upper body musculoskeletal symptoms among participants were 15.9% and 30%, respectively. Overall, the mean value of pain severity was 3.66 ± 1.67 out of 10 on the visual analog scale. Multivariate logistic regression analysis revealed that smartphone addiction (OR=6.05, 95% CI: 4.68–7.84), was significantly associated with upper-body musculoskeletal symptoms when adjusted by age and gender. [Conclusion] The prevalence of upper body musculoskeletal symptoms was relatively high, especially for female smartphone users and students aged over 20 years. These results suggest that smartphone addiction may be a potential risk factor for upper body musculoskeletal symptoms in university students.

Brain-Derived Neurotrophic Factor and Immune Cells in Osteoarthritis, Chronic Low Back Pain, and Chronic Widespread Pain Patients: Association with Anxiety and Depression

Background and Objectives: Musculoskeletal dysfunction can induce several types of chronic pain syndromes. It is of particular interest to elucidate the pathomechanism of different forms of chronic pain. It is possible that patients who have developed chronic widespread pain (CWP) may endure different pathomechanisms as compared to those who suffer from local pain (osteoarthritis, OA) and regional pain (chronic low back pain, cLBP), especially with regard to pain regulation and its related biomediators. The aim of this study was to determine the differences in pathomechanisms among these patients by measuring pain-related biomediators, particularly brain-derived neurotrophic factor (BDNF). Additionally, subpopulations of immune cells were determined in parallel. Materials and Methods: Patients and healthy subjects (HSs) were recruited (age and gender-matched). BDNF was measured from serum samples of patients and HSs and the data of body composition parameters were recorded. Additionally, both patients and HSs were asked to fill in questionnaires related to pain intensity, anxiety, and depression. Results: Our results highlight that the levels of both free and total BDNF are significantly lower in pain patients compared to HSs, with p values of 0.041 and 0.024, respectively. The number of CD3- CD56bright natural killer (NK) cells shows significant differences between the groups. Comparing all chronic pain patients with HSs reveals a significantly lower number of CD4+ CD8+ T cells (p = 0.031), CD3- CD56bright NK cells (p = 0.049) and CD20+ CD3- cells (p = 0.007). Conclusions: To conclude, it seems that a general conformity between the pathomechanisms of different chronic pain diseases exists, although there are unique findings only in specific chronic pain patients.

Body Mass Index and Musculoskeletal Pain: A Cross-Sectional Study

Introduction

With obesity reaching pandemic proportions, its detrimental influence on many health-related conditions has recently become a focus of research. Musculoskeletal (MSK) pain is one of several disorders associated with obesity.

Materials and methods

This study was designed to identify MSK pain in individuals with severe obesity, recruited from a specialized obesity clinic, and to evaluate the correlation between the MSK symptoms and some individual criteria.

Results

In 466 patients (342 females and 124 males), with a mean BMI of 42,77 ± 5.64 kg/m², 90,3% reported MSK pain. Severe pain was reported by 57,8% of female vs 26,6% of male patients. Female patients showed higher mean pain level when compared with males. Body sites with a higher prevalence of pain were: knee (63.5%), lumbar region (46.8%), hip (29%) and ankle (23%), with a predominance of severe pain. BMI have shown a positive correlation to numeric rating scale score in female participants in three body regions: shoulder (P = 0.010), knee (P = 0.042) and ankle (P = 0.024). Body sites with higher pain prevalence were especially in areas of increased mechanical load.

Conclusions

Understanding the relationship between obesity and pain may provide insights into preventive measures and therapeutic strategies for MSK pain. Persistent MSK pain is a significant problem in obese patients that can have a negative relationship with quality of life and function. This fact highlights the importance that patients with obesity may have access to interdisciplinary care, for the prevention and rehabilitation of MSK disorders. To further understand this association, more robust studies are needed.

The relationship between body mass index, disease activity, and exercise in ankylosing spondylitis

BACKGROUND

Ankylosing spondylitis (AS) is associated with elevated cardiovascular (CV) risk and obesity is a common, modifiable risk factor. Our aims were 1) to assess the relationship of BMI with disease activity in AS patients, and 2) to assess the extent to which the effect is mediated through exercise.

METHODS

We used data from a prospective AS cohort with a median follow-up of 7 years. To determine the association of BMI (kg/m² ) with disease activity as measured by the Ankylosing Spondylitis Disease Activity Score (ASDAS), we used generalized estimating equations with inverse probability weighting to account for repeated measures per subject and time-varying confounding. To estimate the direct effect of overweight/obese BMI on disease activity, and the indirect effect through exercise, we performed a mediation analysis.

RESULTS

There were 183 subjects with available BMI and disease activity data (77% male, 70% white, mean age 40.8 ± 13.3 years). Higher BMI was significantly associated with higher disease activity over time; on average, for a 1 kg/m² higher BMI, the ASDAS was 0.06 units higher (95% CI 0.04 - 0.08) after adjustment for important confounders. The direct effect of an overweight/obese BMI accounted for most of the total effect on disease activity, with a smaller indirect effect mediated by exercise (7%).

CONCLUSION

Higher BMI was associated with higher disease activity in a prospective AS cohort. We found that being overweight/obese largely influenced disease activity directly, rather than indirectly through exercise. Other mechanisms such as increased inflammation may better explain the obesity-disease activity association.

Association of body composition with disease activity and disability in rheumatoid arthritis

BACKGROUND/AIMS

To explore the associations between body composition and pain, disease activity, and disability in rheumatoid arthritis (RA).

METHODS

The study enrolled 335 patients with RA and underwent body composition measurement with an InBody analyzer. The associations of body mass index (BMI), body fat mass, and skeletal muscle mass with disease activity score in 28 joints (DAS28), an index derived to measure the subjective component of DAS28 (DAS28-P), a pain visual analogue scale (VAS), and disability measured with the health assessment questionnaire (HAQ) were explored. Obesity was defined as BMI ≥ 25 kg/m2.

RESULTS

The median (interquartile range) disease duration was 6 years (3.5 to 9) and the mean DAS28 score was 3.6 ± 1.1. The mean BMI was 23.6 ± 3.6 kg/m2 and 109 patients (32.5%) were obese. Compared with non-obese patients, obese patients had a higher C-reactive protein (1.68 mg/dL vs. < 0.1 mg/dL, p = 0.013), higher pain VAS score (40 vs. 35, p = 0.031), and higher DAS28-erythrocyte sedimentation rate score (3.75 ± 1.18 vs. 3.46 ± 1.11, p = 0.031). In multivariate regression analysis, the DAS28 score in females was positively associated with the current steroid dose, body fat mass, and HAQ score, while the HAQ score in females was associated with older age, DAS28, lower skeletal muscle mass, and higher body fat/skeletal muscle ratio. In the multivariate regression analysis, the DAS28-P score in females was positively associated with body fat/skeletal muscle ratio and HAQ.

CONCLUSION

Body composition, such as the body fat mass and body fat/skeletal muscle ratio, is significantly associated with disease activity and disability in female RA patients.

Molecular Mechanisms of Sex-Related Differences in Arthritis and Associated Pain

Clinical conditions leading to chronic pain show important sex-related differences in the prevalence, severity, and degree of functional disability. Decades of epidemiological and clinical studies have demonstrated that women are more sensitive to pain than men. Arthritis, including rheumatoid arthritis (RA) and osteoarthritis (OA), is much more prevalent in females and accounts for the majority of pain arising from musculoskeletal conditions. It is therefore important to understand the mechanisms governing sex-dependent differences in chronic pain, including arthritis pain. However, research into the mechanisms underlying the sex-related differences in arthritis-induced pain is still in its infancy due to the bias in biomedical research performed largely in male subjects and animals. In this review, we discuss current advances in both clinical and preclinical research regarding sex-related differences in the development or severity of arthritis and associated pain. In addition, sex-related differences in biological and molecular mechanisms underlying the pathogenesis of arthritis pain, elucidated based on clinical and preclinical findings, are reviewed.

High prevalence of musculoskeletal pain in individuals with severe obesity: sites, intensity, and associated factors

Background

Musculoskeletal pain is associated with obesity; however, information on factors associated with pain in adults with obesity and severe obesity is limited. The purpose of this study was to assess the prevalence of musculoskeletal pain by site and intensity of pain and associated factors in individuals with severe obesity (body mass index ≥ 35.0 kg/m²).

Methods

Baseline data from the DieTBra Trial study evaluating pain symptoms in nine body regions over the last seven days using the Nordic Questionnaire on Musculoskeletal Symptoms and Numerical Pain Scale. The variables analyzed using multiple Poisson regression with hierarchical analysis were: sociodemographic, lifestyle, food consumption, clinical, and anthropometric, and the outcome was moderate and intense pain.

Results

In 150 participants, there was a high prevalence of ankle and foot pain (68.7%), lower back pain (62.7%), pain in the knees (53.3%) and upper back pain (52.0%), with a predominance of intense pain. Factors associated with pain according to specific sites were: type 2 diabetes with hand/wrist pain; sedentary time with hip pain; insomnia with pain in the hip and knee; edema in the lower limbs with pain in the lower back and ankles/feet; degree of obesity with ankle/foot pain; and percentage of total fat with ankle/foot pain.

Conclusions

There was a high prevalence of pain and intense pain in individuals with severe obesity and an association with clinical variables, the degree of obesity, and sedentary lifestyle.

Association of body mass index on disease activity in axial spondyloarthritis: systematic review and meta-analysis

OBJECTIVES

In axial spondyloarthritis (axSpA), higher body mass index (BMI) is associated with worse outcomes including response to biologics. Further clarity is needed on whether BMI is associated with disease activity overall, independent of treatment response. We performed a systematic review and meta-analysis to assess the association between BMI and disease activity as reported by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) or Ankylosing Spondylitis Disease Activity Score (ASDAS) in axSpA.

METHODS

We systematically searched for studies evaluating BMI and disease activity as the exposure and outcome of interest, respectively, in axSpA. Using random effects models, we estimated summary standardised mean differences (SMDs) and 95% CIs of BASDAI or ASDAS, comparing obese (BMI>30 kg/m²) or overweight/obese (BMI>25 kg/m²) individuals to those with normal BMI (18.5-24.9 kg/m²).

RESULTS

Twelve studies were included in the meta-analysis. Among all studies reporting the BASDAI at baseline, the pooled SMD of the BASDAI for those with an obese or overweight/obese BMI compared to a normal BMI was 0.38 (95% CI 0.21 to 0.55, I² =75.2%), indicating a significant association of higher BMI with higher BASDAI score. The pooled SMD of the ASDAS for those with an obese or overweight/obese BMI compared to a normal BMI was 0.40 (95% CI 0.27 to 0.54, I²=0%). Findings were robust across subgroup analyses.

CONCLUSION

These results demonstrate an association between an overweight/obese BMI and higher disease activity in studies of axSpA. Future longitudinal studies of BMI and disease activity should assess how this association changes over time.

Musculoskeletal problems in academicians and related factors in Turkey

BACKGROUND AND OBJECTIVE

Musculoskeletal problems are a common health problem with professional and ergonomic features. This study's purpose was to investigate the musculoskeletal problems distribution and related factors among academicians.

METHODS

This study was performed by using a personal and professional information questionnaire, the Extended Nordic Musculoskeletal Questionnaire and International Physical Activity Questionnaire Short Form.

RESULTS

The study was completed with 142 academicians (89 female, 53 male). Mean age was 39.91 ± 8.90 years, physical activity level was 1067.31 ± 1866.95 MET-minute/week, and work time was 13.73 ± 9.15 years. Neck and lower back pain were mostly seen in academicians and their incidence was equal (63.4%). The most experienced pain the previous year was neck pain (39.4%), and upper back pain is the most experienced pain today (19%). The body part that mostly caused the use of medication is neck pain (23%), and mostly caused limitation and sick-leave was low back in the past 12 months (respectively 19.7% and 9.2%). Gender, body mass index, weekly workload, physical activity level, and marital status have been determined to have an effect on musculoskeletal problems in academicians (p< 0.05).

CONCLUSION

The most common musculoskeletal problems reported by academicians were in the upper back and neck regions, which have low level physical activity.

Obesity and pain: a systematic review

BACKGROUND/OBJECTIVES

The current systematic review considered research published within the 10 years preceding June 2019, dealing with the topic of obesity and pain. Within the context of the complex biological and behavioral interrelationships among these phenomena, we sought to identify gaps in the literature and to highlight key targets for future transdisciplinary research. The overarching inclusion criteria were that the included studies could directly contribute to our understanding of these complex phenomena.

METHODS

We searched PubMed/Medline/Cochrane databases dating back 10 years, using the primary search terms "obesity" and "pain," and for a secondary search we used the search terms "pain" and "diet quality."

RESULTS

Included studies (n = 70) are primarily human; however, some animal studies were included to enhance understanding of related basic biological phenomena and/or where human data were absent or significantly limited.

CONCLUSIONS

Our overall conclusions highlight (1) the mechanisms of obesity-related pain (i.e., mechanical, behavioral, and physiological) and potential biological and behavioral contributors (e.g., gender, distribution of body fat, and dietary factors), (2) the requirement for accurate and reliable objective measurement, (3) the need to integrate biological and behavioral contributors into comprehensive, well-controlled prospective study designs.

Association of Body Fat With Health-Related Quality of Life and Depression in Nonagenarians: The Mugello Study

OBJECTIVES

The association of body fat with health status and depression in the oldest old is still debated. The aim of this cross-sectional study is to investigate the association of body fat with health-related quality of life and depression in a sample of nonagenarians.

DESIGN

Data are from the Mugello study, a community-based project conducted in Italian older adults aged 90 years.

SETTING AND PARTICIPANTS

Total body fat was assessed by body impedance assessment. Participants were divided into 3 groups according to gender-specific tertiles of body fat percentage (BF%). Self-perceived mental and physical health status were assessed by the Mental Component Summary (MCS) and the Physical Component Summary (PCS) subscales derived from the 12-item Short Form Health Survey. Lower scores of MCS and PCS indicated poorer mental health and physical health status, respectively. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale, and a score ≥5 was used to identify participants with depression.

RESULTS

The mean age of 251 study participants was 92.5 years, and 173 (68.9%) were women. Participants were included in the low (n = 83), medium (n = 83), and high (n = 85) BF% groups. In the whole sample, mean scores at PCS progressively declined with the increasing BF% group (P = .004). This association was stronger in women, although no significant interaction was observed between the gender and BF% group (P = .63). No significant association between BF% and MCS was documented. Medium and high BF% were associated with a significantly higher probability of depression as compared with low BF% [odds ratio (OR) 2.15, 95% confidence interval (CI) 1.04-4.44, and OR 2.15, 95% CI 1.06-4.34, respectively]. This association was stronger in women, although no significant interaction was observed between gender and BF% group (P = .70).

CONCLUSIONS AND IMPLICATIONS

High BF% is significantly positively associated with poor health-related quality of life and depression, underpinning the clinical relevance to test BF% in older adults. These associations appear to be stronger in women than in men, highlighting the need to investigate deep inside this gender discrepancy.

Does low and heavy load resistance training affect musculoskeletal pain in overweight and obese women? Secondary analysis of a randomized controlled trial

BACKGROUND

Overweight and obesity are associated with musculoskeletal pain, particularly in the female population. However, regular resistance training may positively affect these complaints.

OBJECTIVE

The present study aimed to investigate between group differences in musculoskeletal pain in previously inactive women, allocated to three different resistance-training modalities available in health- and fitness clubs.

METHODS

This is secondary analysis from a single-blinded randomized controlled trial, including healthy women (aged 18-65) with a BMI (kg/m²) ≥25. The participants were allocated to 12 weeks (3 times/weekly) of either BodyPump (high-repetition low-load group session) (n=24), heavy load resistance training with a personal trainer (n=28), non-supervised heavy load resistance training (n=19) or non-exercising controls (n=21). Primary outcome was self-reported musculoskeletal pain in ten different body parts, measured with the Standardized Nordic Pain Questionnaire, at baseline and post-test. In addition, the study included sub-analyses of the participants when they were divided into high (≥28 of 36 sessions, n=38) and low (≤27 of 36 sessions, n=22) exercise adherence.

RESULTS

The analysis revealed no between group differences in musculoskeletal pain in any of the ten body parts. The results did not change when the participants were divided into high versus low adherence.

CONCLUSIONS

Twelve weeks of BodyPump, heavy load resistance training with a personal trainer and non-supervised heavy load resistance training did not show any effect on self-reported musculoskeletal pain in overweight women.

CLINICAL TRIAL REGISTRATION NUMBER

NCT01993953. (https://clinicaltrials.gov/ct2/show/NCT01993953).

Effects of High-Intensity Interval Training Under Normobaric Hypoxia on Cardiometabolic Risk Markers in Overweight/Obese Women

Promising benefits on cardiometabolic risk factors have been reported with prolonged programs of cyclic hypoxia. The aim of this study was to examine whether cyclic hypoxia exposure while exercising through two protocols of high-intensity interval training in overweight/obese women is more effective to improve cardiometabolic risk markers than exercising in normoxia. Participants included 86 overweight/obese women, who started a 12-week program of 36 sessions, and were randomly divided into four groups: (1) interval training in hypoxia (IHT; FIO₂ = 17.2%; n = 13), (2) interval training in normoxia (INT; n = 15), which included 3-minute high-intensity exercise (90% Wmax) followed by 3 minutes of active recovery (55%-65% Wmax), (3) repeated-sprint training in hypoxia (RSH; FIO₂ = 17.2%; n = 15), and (4) repeated-sprint training in normoxia (RSN; n = 18), which included 30 seconds of all-out effort (130% Wmax) followed by 3 minutes of active recovery (55%-65% Wmax). Body composition, anthropometric, biochemical, and clinical parameters were assessed at baseline (A), after 18 training sessions (B), and during the 7 days after the last session (C). IHT and RSH showed a significant (p < 0.001 and p = 0.016, respectively) decrease in the waist circumference at both B and C assessments compared with A. Hypoxia groups presented a significant reduction in the percentage of trunk fat with a moderate effect size (IHT: d = 0.56; RSH: d = 0.93). In the normoxia groups, total cholesterol (CHOL) tended to decrease (INT: -4.21% and RSN: -5.18%), whereas it tended to increase in the hypoxia groups (IHT: +2.91% and RSH +4.07%). An interaction effect between conditions (through pooled data) on waist circumference (p = 0.01), percentage of trunk fat mass (p < 0.001), and CHOL (p = 0.019) was observed. Both training regimens under normobaric cyclic hypoxia were more effective at causing decreased abdominal fat in overweight/obese women than the same protocols in normoxia.

The association between body fat and musculoskeletal pain: a systematic review and meta-analysis

BACKGROUND

Obesity and musculoskeletal pain are strongly related, but there is emerging evidence that body fat, not body weight, may be a better indicator of risk. There is, therefore, a need to determine if body fat is associated with musculoskeletal pain as it may improve management strategies. The aim of this systematic review was to investigate the association between body fat and musculoskeletal pain.

METHODS

Seven electronic databases were searched from inception to 8th January 2018. Cross-sectional and longitudinal studies investigating the association between measures of body fat and musculoskeletal pain were included. All included articles were assessed for methodological rigour using the Epidemiology Appraisal Instrument. Standardised mean differences (SMDs) and effect estimates were pooled for meta-analysis.

RESULTS

A total of 10,221 citations were identified through the database searching, which after abstract and full-text review, yielded 28 unique articles. Fourteen studies were included in the meta-analyses, which found significant cross-sectional associations between total body fat mass and widespread pain (SMD 0.49, 95% CI 0.37-0.61, p < 0.001). Individuals with low-back pain and knee pain had a higher body fat percentage than asymptomatic controls (SMD 0.34, 95% CI 0.17-0.52, p < 0.001 and SMD 0.18, 95% CI 0.05-0.32, p = 0.009, respectively). Fat mass index was significantly, albeit weakly, associated with foot pain (SMD 0.05, 95% CI 0.03-0.06, p < 0.001). Longitudinal studies (n = 8) were unsuitable for meta-analysis, but were largely indicative of elevated body fat increasing the risk of incident and worsening joint pain. There was conflicting evidence for an association between body fat percentage and incident low-back pain (3 studies, follow-up 4-20 years). Increasing knee pain (1 study) and incident foot pain (2 studies) were positively associated with body fat percentage and fat mass index. The percentage of items in the EAI graded as 'yes' for each study ranged from 23 to 85%, indicating variable methodological quality of the included studies.

CONCLUSIONS

This systematic review and meta-analysis identified positive cross-sectional associations between increased body fat and widespread and single-site joint pain in the low-back, knee and foot. Longitudinal studies suggest elevated body fat may infer increased risk of incident and worsening joint pain, although further high-quality studies are required.

Gender-specific associations between fat mass, metabolic syndrome and musculoskeletal pain in community residents: A three-year longitudinal study

Increase in fat mass is correlated with musculoskeletal pain. The aim of this study was to examine the relationship between fat mass and the musculoskeletal pain prospectively in Korean community residents. In the Korean Health and Genome Study, participants (mean age 60.2 years, 56.2% women) completed pain questionnaires and underwent dual x-ray absorptiometry to calculate body composition. Three-year follow-up data on pain was available for 1,325 participants. Pain was categorized according to number of pain regions. At three years of follow-up, participants were classified as follows: 1) no pain both at baseline and at three years (no pain), 2) any pain (one, two or more, or widespread regions) at baseline and no pain at three years (transient pain), 3) no pain at baseline and any pain at three years (new pain) 4) any pain both at baseline and at 3 years (persistent pain). 1) and 2) were grouped as no/transient pain group (no pain) and 3) and 4) as new/persistent pain group (pain). Female gender and obesity were two significant factors associated with the persistence or development of pain. Total fat mass and fat:muscle mass ratio were associated with pain among female participants only, and the odds ratios for pain were significantly increased in female participants in the highest quartile of total fat mass and fat muscle ratio after adjustment. In conclusion, both female gender and obesity were two significant factors associated with pain. Fat mass parameters and pain were significantly associated only among females.

Musculoskeletal pain profile of obese individuals attending a multidisciplinary weight management service

Obesity is associated with numerous chronic diseases, including musculoskeletal (MSK) pain, which affects on quality of life (QoL). There is, however, limited research providing a comprehensive MSK pain profile of an obese cohort. This retrospective study used a patient database at a national weight management service. After ethical approval, anonymized patient data were statistically analyzed to develop a pain profile, investigate relationships between pain, sleep, and function, and explore variables associated with having low back pain (LBP) and knee pain. Overall, 915 individuals attended the weight management service from January 2011 to September 2015 [male, 35% (n = 318; confidence interval [CI] = 32-38); female, 65% (n = 597; CI = 62-68); mean age 44.6]. Mean body mass index was 50.7 kg/m [class III obese (body mass index ≥40 kg/m), 92% (n = 835; CI = 91-94)]. Approximately 91% reported MSK pain: LBP, 69% (n = 539; CI = 65-72) [mean Numeric Rating Scale 7.4]; knee pain, 58% (n = 447; CI = 55-61) [mean Numeric Rating Scale 6.8]. Class III obese and multisite pain patients had lower QoL and physical activity levels, reduced sleep, and poorer physical function than less obese patients and those without pain (P < 0.05). Relationships were found between demographic, pain, self-report, psychological, and functional measures (P < 0.05). Patients who slept fewer hours and had poorer functional outcomes were more likely to have LBP; patients who were divorced, had lower QoL, and more frequent nocturia were more likely to have knee pain (P < 0.05). Multisite MSK pain is prevalent and severe in obese patients and is negatively associated with most self-report and functional outcomes. This high prevalence suggests that pain management strategies must be considered when treating obesity.

Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis

INTRODUCTION

Intra-articular corticosteroid injections are often used for short-term pain relief in patients with knee osteoarthritis (OA). This study investigates the efficacy of intra-articular corticosteroid injections in patients with symptomatic knee OA and factors that affect treatment response.

METHODS

This prospective, multicentered cohort study had 100 participants with radiographic evidence of knee OA enrolled. Participants received one corticosteroid injection into the affected knee and were evaluated before the injection (baseline) and at 3 weeks, 6 weeks, 3 months, and 6 months after the injection.

RESULTS

Participants' Visual Numeric Scale and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores improved at all time points except for the Visual Numeric Scale score at 6 months, compared with baseline scores (P < 0.001). Participants with Kellgren-Lawrence grade 1 or 2 OA saw clinical improvement in the WOMAC scores at all time points, compared with the baseline score (P < 0.01). Compared with all other subgroups, obese patients with Kellgren-Lawrence grade 3 or 4 OA had significantly worse WOMAC scores at baseline, 6 weeks, and 3 months (P < 0.01 and P < 0.01, respectively).

DISCUSSION

Our findings validate previously established guidelines for nonsurgical management of knee OA and suggest that intra-articular corticosteroid injections may be an acceptable short-term management option in patients unwilling or unable to undergo surgical treatment. Obesity and OA severity affect the efficacy of intra-articular corticosteroid injections.

CONCLUSION

Patients receiving intra-articular corticosteroid injections had improved pain and function. Clinicians should expect less improvement in patients with obesity and/or advanced arthritis. Clinical benefits of intra-articular injections in these patients are less predictable.

Improvements in Health-Related Quality of Life and Pain: A Cohort Study in Obese Patients After Laparoscopic Sleeve Gastrectomy

OBJECTIVE

The principal aim of the study was to investigate the effect of the sleeve gastrectomy (SG) in the quality of life (QoL) and pain in a population of morbidly obese patients.

METHODS

Seventy-two SG patients were assessed in this descriptive observational study, before the surgery and 6 months after that. We evaluated health-related QoL (Gastrointestinal Quality of Life Index [GIQLI]) and pain (spontaneous low back pain by Numerical Point Rate Scale [NPRS] and pressure pain thresholds [PPTs]).

RESULTS

The results of the analysis of variance (ANOVA) revealed significant improvements in nearly all of the subscales of GIQLI questionnaire after 6 months: gastrointestinal symptoms (P = .01), physical well-being (P < .001), social well-being (P = .03), and total GIQLI score (P < .001), but not for the emotional condition (P = .20). Patients also had improvements in spontaneous low back pain (P = .002), but not in the PPTs in all the body areas explored, including the cervical area, low back, and hands (P > .05).

CONCLUSION

Patients receiving SG improved their health-related QoL and low back pain 6 months after the intervention, but this improvement was not so important for pressure pain thresholds in different body areas.

Obesity is associated with a higher prevalence of musculoskeletal pain in middle-aged women

Musculoskeletal pain (MSP) has been recently linked with high plasma leptin levels. Our objective was to study if obese women, who have higher leptin levels, could have a higher frequency of MSP. We studied 6079 Latin-American women, 40-59 years old. Their epidemiological data were recorded and the Menopause Rating Scale (MRS), Golberg Anxiety and Depression Scale and Insomnia Scale were applied. MSP was defined as a score ≥2 on MRS11. Women with MSP were slightly older, had fewer years of schooling and were more sedentary. They also complained of more severe menopausal symptoms (29.2% versus. 4.4%, p < 0.0001). Furthermore, they had a higher abdominal perimeter (87.2 ± 12.0 cm versus 84.6 ± 11.6 cm, p < 0.0001) and a higher prevalence of obesity (23.1% versus 15.2%, p < 0.0001). Compared to normal weight women, those with low body weight (IMC <18.5) showed a lower risk of MSP (OR 0.71; 95%CI, 0.42-1.17), overweight women had a higher risk (OR 1.64; 95%CI, 1.44-1.87) and obese women the highest risk (OR 2.06; 95%CI, 1.76-2.40). Logistic regression analysis showed that obesity is independently associated to MSP (OR 1.34; 95%CI, 1.16-1.55). We conclude that obesity is one identifiable risk factor for MSP in middle-aged women.

The Rituximab Biosimilar CT-P10 in Rheumatology and Cancer: A Budget Impact Analysis in 28 European Countries

Introduction

New biosimilars of monoclonal antibodies are anticipated to bring significant cost savings and increase access to treatment. The rituximab biosimilar CT-P10 has recently been approved in Europe in all indications held by reference rituximab (RTX), including rheumatoid arthritis, non-Hodgkin’s lymphoma, and chronic lymphocytic leukemia. We analyzed the budgetary impact of the introduction of CT-P10 into the European Union (EU) for use in patients with rheumatoid arthritis and cancer diagnoses, using a budget impact analysis model.

Methods

The model used a base case scenario in which the 1-year uptake of CT-P10 was estimated at 30%, and the cost of CT-P10 was assumed to be 70% of the cost of RTX. A second 1-year scenario was also modeled, in which the market share of CT-P10 was assumed to be 50% (scenario 2). Finally, 3-year time horizon outcomes were calculated, in which the market share of CT-P10 was assumed to be 30%, 40%, and 50% in the first, second, and third years, respectively.

Results

In the base case scenario, the introduction of CT-P10 was associated with projected savings of €90.04 million in the first year, which would allow 7531 additional patients to access rituximab treatment. This was equivalent to a 6.4% increase in the number of rituximab-treated patients. In scenario 2, budget savings were €150.10 million, with a total of 12,551 additional patients able to access rituximab, equivalent to a 10.7% increase. Over a 3-year time horizon, projected budget savings were approximately €570 million, equating to 47,695 additional patients able to access rituximab.

Conclusions

The model predicted that the introduction of CT-P10 in the EU will be associated with significant budget savings, the reallocation of which will enable many more patients to access rituximab treatment. This is likely to have a significant impact on health gains at patient and societal levels.

Funding: CELLTRION Healthcare Co., Ltd. sponsored the development and analysis of the budget impact analysis model.

Electronic supplementary material

The online version of this article (doi:10.1007/s12325-017-0522-y) contains supplementary material, which is available to authorized users.

Demographic and Life Styles Determinants of Somatic Complaints' Structures: A Cross-sectional Study on a Large Sample of Iranian Adults Using Factor Mixture Model

Background:

To identify somatic complaints dimensions, classify studied population and study the association of demographic and lifestyle factors with somatic complaints dimensions.

Methods:

In a cross-sectional study conducted on 4763 Iranian adults, somatic complaints were assessed using a comprehensive 30-item questionnaire. Self-administered standard questionnaires were used to assess demographic and lifestyle factors. Factor mixture modeling (FMM) was used to identify somatic complaints dimensions and classify studied population.

Results:

The mean age of participants was 36.58 ± 0.13 years, 55.8% were females, 81.2% were married, and 57.2% had college education. About 9.4% of individuals were obese, and 34.8% of participants had regular physical activity. Four domains of somatic complaints were extracted, including “psychological,” “gastrointestinal,” “neuro-skeletal,” and “pharyngeal-respiratory.” Females, obese and inactive participants, and those in low educations had significantly greater scores in terms of four domains than the others (P < 0.05). A two-class, four-factor structure fitted to the somatic complaints based on FMM. Two classes were labeled “high psychological complaints” (519 individuals (11%) and “low psychological complaints” (4243 individuals (89%). There were no significant differences between two classes in terms of demographic and lifestyle factors, except in educational level.

Conclusions:

This study suggested that somatic complaints had a dimensional-categorical structure within studied population so that it could be useful for dealing with diagnostic and therapeutic approaches. The results did not show any association between somatic complaints dimensions and demographic, lifestyle factors, except in educational level.

Pain Severity in Relation to the Final Menstrual Period in a Prospective Multiethnic Observational Cohort: Results From the Study of Women's Health Across the Nation

The development of pain is common in midlife, resulting in increased health care utilization and costs. The aim of this study was to determine the longitudinal trajectory of overall bodily pain among women during the transition between the reproductive years and menopause. We conducted analyses on a community-based, longitudinal cohort of women enrolled in the Study of Women's Health Across the Nation. One thousand four hundred ninety-five women met inclusion criteria, including: 1) defined date of the final menstrual period (FMP), and 2) complete data on Short Form-36 bodily pain. The primary exposure was time to/from the FMP. The primary outcome was the rate of change in Short Form-36 bodily pain, measured on a scale of 0 to 100 with 100 being the most severe pain. We performed within-person trajectory analyses using piecewise regression following nonparametric modeling of functional forms. Mean bodily pain score at the time of the FMP was 29. Mean bodily pain increased at a rate of .26 per year during the transmenopause (the interval spanning 4.5 years before the FMP through .5 years after the FMP), and decreased at a rate of .23 per year after that. Depression and sleep problems were associated with greater increases in pain during the late reproductive years, whereas abdominal cramps at baseline predicted greater decreases in pain during the late reproductive years.

PERSPECTIVE

This article shows that bodily pain increases during the transmenopause and then diminishes during postmenopause. These differences may reflect differences in underlying mechanisms of pain in the 2 periods. Although mean changes were small and unlikely to be clinically meaningful, the magnitude of change varied across subgroups of women.

Two colliding epidemics - obesity is independently associated with chronic pain interfering with activities of daily living in adults 18 years and over; a cross-sectional, population-based study

BACKGROUND

Chronic pain interfering with activities of daily living is highly prevalent in the community. More than 600 million people worldwide are obese. The aim of this paper is to assess if such chronic pain is associated independently with obesity across the adult population, having controlled for other key factors.

METHODS

The South Australian Health Omnibus is an annual, population-based, cross-sectional study. Data on 2616 participants were analysed for episodes of daily pain for three of the preceding six months. Obesity was derived from self-reported height and weight. Multivariable logistic regression analysed the associations between chronic pain interfering with activities of daily living, body mass index (BMI) and key socio-demographic factors.

RESULTS

Chronic pain interfering with activities of daily living peaks in people ≥75 years of age while obesity peaks in the 45-54 age group. Pain and obesity together peak in the 55-74 year age group. In the adjusted multinominal logistic regression model, compared to those with no pain, there was a strong association between obesity and pain that interfered moderately or extremely with day-to-day activities (OR 2.25; 95 % CI 1.57-3.23; p < 0.001) having controlled for respondents' age, gender, rurality, country of birth and highest educational attainment. People over 65 years of age and those with lower educational levels were more likely to experience such chronic pain related to obesity.

CONCLUSION

This study demonstrates a strong association between chronic pain and obesity/morbid obesity in the South Australian population. Prospective, longitudinal data are needed to understand the dynamic interaction between these two prevalent conditions.

The Association Between Obesity and Low Back Pain and Disability Is Affected by Mood Disorders: A Population-Based, Cross-Sectional Study of Men

Low back pain (LBP) and obesity are major public health problems; however, the relationship between body composition and low back pain in men is unknown. This study aims to examine the association between body composition and LBP and disability in a population-based sample of men, as well as the factors that may affect this relationship. Nine hundred seventy-eight male participants from the Geelong Osteoporosis Study were invited to participate in a follow-up study in 2006. Participants completed questionnaires on sociodemographics and health status. Low back pain was determined using the validated Chronic Back Pain Grade Questionnaire and the presence of an emotional disorder was assessed using the Hospital Anxiety Depression Scale. Body composition was measured using dual energy x-ray absorptiometry. Of the 820 respondents (84% response rate), 124 (15%) had high-intensity low back pain and/or disability (back pain). Low back pain was associated with higher body mass index (28.7 ± 0.4 vs 27.3 ± 0.2 kg/m2, P = 0.02) and waist-hip ratio (0.97 ± 0.006 vs 0.96 ± 0.006, P = 0.04), with increased tendency toward having a higher fat mass index (8.0 vs 7.6 kg/m2, P = 0.08), but not fat-free mass index (P = 0.68). The associations between back pain and measures of obesity were stronger in those with an emotional disorder, particularly for waist-hip ratio (P = 0.05 for interaction) and fat mass index (P = 0.06 for interaction).In a population-based sample of men, high-intensity LBP and/or disability were associated with increased levels of obesity, particularly in those with an emotional disorder. This provides evidence to support a biopsychosocial interaction between emotional disorders and obesity with low back pain.

Individual and joint effects of risk factors for onset widespread pain and obesity - a population-based prospective cohort study

BACKGROUND

Widespread musculoskeletal pain (WSP) and obesity frequently co-occur and may have shared risk factors. We aimed to investigate whether four dichotomized risk factors individually or jointly increase the risk for the onset of WSP and onset of obesity.

METHODS

Persons aged 34-76 years in 2004 living in Ullensaker municipality, Norway, responded to questionnaires in 2004 and 2010 (n = 1553). Using causal interaction analyses, we examined whether baseline obesity and WSP, poor sleep quality, mental distress and poor physical fitness jointly increased the risk of new onset WSP (≥3 pain sites leading to disability the last year) and new onset obesity (self-reported BMI ≥30 kg/m(2) ) in persons without WSP (n = 1270) or without obesity (n = 1300) at baseline respectively.

RESULTS

The mean (SD) age was 51 (12.1) years and 56% were female. The incidence of WSP and obesity were 9.1% and 5.4%. Mental distress and poor sleep quality individually and jointly with poor physical fitness increased WSP onset risk (relative excess risk due to interaction [RERI] = 1.90, 95% CI, 0.39-3.42 and RERI = 1.43, 95% CI, 0.10-2.76). Poor physical fitness individually increased the risk for new onset obesity, and baseline WSP and poor sleep quality jointly (RERI = 1.87, 95% CI, 0.49-3.24). The presence of more risk factors was dose-dependently associated with onset WSP and to a lesser extent with onset obesity.

CONCLUSION

The onset of WSP and the onset of obesity were results of joint effects of exposures. Poor physical fitness was a key covariate in increasing the risk for both conditions. WHAT DOES THIS STUDY ADD?: In a general population, the new onset of widespread pain and new onset of obesity were results of joint effects of risk factors and particularly poor physical fitness. The study may aid in the identification of patients at risk of future disability.

Obesity and chronic pain: systematic review of prevalence and implications for pain practice

The combination of obesity and pain may worsen a patient's functional status and quality of life more than each condition in isolation. We systematically searched PubMed/MEDLINE and the Cochrane databases for all reports published on obesity and pain. The prevalence of combined obesity and pain was substantial. Good evidence shows that weight reduction can alleviate pain and diminish pain-related functional impairment. However, inadequate pain control can be a barrier to effective lifestyle modification and rehabilitation. This article examines specific pain management approaches for obese patients and reviews novel interventional techniques for treatment of obesity. The infrastructure for simultaneous treatment of obesity and pain already exists in pain medicine (eg, patient education, behavioral medicine approaches, physical rehabilitation, medications, and interventional treatment). Screening for obesity, pain-related disability, and behavioral disorders as well as monitoring of functional performance should become routine in pain medicine practices. Such an approach requires additional physician and staff training. Further research should focus on better understanding the interplay between these 2 very common conditions and the development of effective treatment strategies.

The association between chronic pain and obesity

Obesity and pain present serious public health concerns in our society. Evidence strongly suggests that comorbid obesity is common in chronic pain conditions, and pain complaints are common in obese individuals. In this paper, we review the association between obesity and pain in the general population as well as chronic pain patients. We also review the relationship between obesity and pain response to noxious stimulation in animals and humans. Based upon the existing research, we present several potential mechanisms that may link the two phenomena, including mechanical/structural factors, chemical mediators, depression, sleep, and lifestyle. We discuss the clinical implications of obesity and pain, focusing on the effect of weight loss, both surgical and noninvasive, on pain. The literature suggests that the two conditions are significant comorbidities, adversely impacting each other. The nature of the relationship however is not likely to be direct, but many interacting factors appear to contribute. Weight loss for obese pain patients appears to be an important aspect of overall pain rehabilitation, although more efforts are needed to determine strategies to maintain long-term benefit.

Inflammation, psychiatric symptoms, and opioid use are associated with pain and disability in patients with cirrhosis

BACKGROUND & AIMS

Cirrhosis is associated with significant pain and disability, the etiologies of which are poorly understood. We investigated whether the pain and disability in patients with cirrhosis are associated with systemic inflammation and psychiatric symptoms.

METHODS

In a prospective study, we recruited 193 patients with cirrhosis caused by hepatitis C virus infection, nonalcoholic steatohepatitis, or alcohol from the hepatology clinic at the University of Pittsburgh. Patients were assessed using the McGill Pain Questionnaire, the Hospital Anxiety and Depression Scale, the Pittsburgh Sleep Quality Index, and the Pain Disability Index. Serum samples were collected and markers of inflammation were measured using standardized Luminex assays (Milipore, St. Charles, MO). We evaluated factors associated with pain, pain-related disability, and chronic opioid use by using multivariable regression models.

RESULTS

Pain was reported by 79% of patients, pain-related disability was reported by 75%, and depression and/or anxiety was reported by 47%; the average Model for End-Stage Liver Disease score was 12 ± 5. Serum samples from 58% percent of patients had increased levels of C-reactive protein. Opioids were prescribed for 30% of patients with pain. In multivariate analysis, factors significantly associated with pain included younger age (odds ratio [OR]/y, 0.93; 95% confidence interval [CI], 0.90-0.99), serum level of interleukin 6 (OR per pg/L, 1.63; 95% CI, 1.09-2.58), Hospital Anxiety and Depression Scale score (OR/point, 1.14; 95% CI, 1.07-1.24), and etiology (hepatitis C virus infection vs alcohol: OR, 3.70; 95% CI, 1.27-11.11). Disability scores were related significantly to psychiatric symptoms (incidence rate ratio [IRR]/point, 1.04; 95% CI, 1.02-1.05), prescription opioid use (IRR, 1.49; 95% CI, 1.14-1.94), Model for End-Stage Liver Disease score (IRR/point, 1.02; 95% CI, 1.0001-1.05), level of C-reactive protein (IRR per mg/dL, 1.13; 95% CI, 1.02-1.24), and pain severity (IRR/point, 1.19; 95% CI, 1.08-1.32).

CONCLUSIONS

Pain and disability are common among patients with cirrhosis, and are associated with inflammation, psychiatric symptoms, and opioid use, which potentially are modifiable. Although opioids are used commonly to treat pain, psychiatric symptoms and inflammation also might be treatment targets in this population.

Chronic pain management in the obese patient: a focused review of key challenges and potential exercise solutions

In obese persons, general and specific musculoskeletal pain is common. Emerging evidence suggests that obesity modulates pain via several mechanisms such as mechanical loading, inflammation, and psychological status. Pain in obesity contributes to deterioration of physical ability, health-related quality of life, and functional dependence. We present the accumulating evidence showing the interrelationships of mechanical stress, inflammation, and psychological characteristics on pain. While acute exercise may transiently exacerbate pain symptoms, regular participation in exercise can lower pain severity or prevalence. Aerobic exercise, resistance exercise, or multimodal exercise programs (combination of the two types) can reduce joint pain in young and older obese adults in the range of 14%-71.4% depending on the study design and intervention used. While published attrition rates with regular exercise are high (∼50%), adherence to exercise may be enhanced with modification to exercise including the accumulation of several exercise bouts rather than one long session, reducing joint range of motion, and replacing impact with nonimpact activity. This field would benefit from rigorous comparative efficacy studies of exercise intensity, frequency, and mode on specific and general musculoskeletal pain in young and older obese persons.