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Olson KL, Eccleston C. Reconsidering the Role of Weight Loss in Treatment for Chronic Pain: Knee Osteoarthritis as an Exemplar. THE JOURNAL OF PAIN 2024:104647. [PMID: 39103008 DOI: 10.1016/j.jpain.2024.104647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/07/2024]
Abstract
Chronic pain is prevalent among individuals with higher body weight and associated with greater impairment. As a result, weight loss is a common recommendation for pain management among those with higher body weight. Body weight is an appealing target because it is modifiable and evidence-based treatments to produce weight loss are well-established. In the last 2 decades, there has been a growing line of scientific work investigating the application of weight loss to individuals with chronic pain. This represents an important step to integrate the conceptualization of pain and body weight and there is preliminary work suggesting treatment effects are enhanced when weight loss treatment is combined with pain coping skills. However, weight loss outcomes are variable and difficult to sustain, and access to evidence-based treatment is limited. These concerns are set against the backdrop of growing public and academic concern about the weight-centric approach to health care that dominates western medicine. This is a timely moment to reconsider the conceptualization of weight and pain, and the role of weight loss in chronic pain treatment. Using osteoarthritis as an exemplar, we review the evidence for and clinical uptake of weight loss as a chronic pain management strategy and conclude with key areas for consideration to advance the scientific understanding of these comorbid conditions and how to optimize pain management for individuals of higher body weight. PERSPECTIVE: This focus article critically considers the role of weight loss in management of chronic pain among individuals of higher body. Using knee osteoarthritis as an exemplar, the evidence and clinical uptake of weight loss for pain management is reviewed. Limitations are considered to guide future research and clinical care.
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Affiliation(s)
- KayLoni L Olson
- Weight Control and Diabetes Research Center, Miriam Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island.
| | - Christopher Eccleston
- Research Department for Health, University of Bath, Bath, England; Centre for Pain Research, University of Bath, Bath, England
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Leese C, Gupte D, Christogianni A, Higgins C, Adair P, Dall P, Cameron P, Smith BH, Colvin L. Barriers and facilitators for physical activity in people living with chronic pain: a systematic review and combined analysis. Pain 2024:00006396-990000000-00646. [PMID: 38981051 DOI: 10.1097/j.pain.0000000000003314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/20/2024] [Indexed: 07/11/2024]
Abstract
ABSTRACT Chronic pain is a prevalent and complex health issue associated with physical, emotional, and social consequences. Management of pain is multifactorial and challenging; however, physical activity (PA) has consistently been shown to be beneficial. Despite this, PA levels among people with chronic pain are low. This study aimed to identify facilitators and barriers to PA among adults with chronic pain and analyse these using the structure of a validated behaviour change model: the capability, opportunity, and motivation behaviour change model (COM-B). We performed a systematic review of 6 databases and subsequent combined analysis including peer-reviewed primary research published in English up to November 15, 2023. Search terms consisted of 3 components: pain, PA, and facilitators/barriers. Quality appraisal of studies was conducted using appropriate tools. The systematic search yielded 40 eligible studies with a total of 2164 participants. The studies represented various chronic pain conditions, locations, and study designs. The key barriers to engagement in PA were the impact of pain severity, comorbidities, lack of knowledge about PA benefits, and time constraints. Key facilitators were a personalised approach, social support, and awareness of the benefits. The findings were categorised according to the COM-B model, allowing for the identification of modifiable factors. Person-centred approaches, education, and accessible environments were identified as important aspects to consider for successful PA promotion among people with chronic pain. Utilising the factors identified in the COM-B model is crucial for successful future interventions to increasing PA uptake and adherence in this population.
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Affiliation(s)
- Callum Leese
- Department of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Devashri Gupte
- Department of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | | | - Cassie Higgins
- Department of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Pauline Adair
- Psychology, School of Psychology, Queen's University, Belfast, United Kingdom
| | - Philippa Dall
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Paul Cameron
- Pain Rehabilitation, Cardiff University, Cardiff, United Kingdom
| | - Blair H Smith
- Population Health Science, University of Dundee, Dundee, Scotland
| | - Lesley Colvin
- Population Health Science, University of Dundee, Dundee, Scotland
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Cuomo A, Parascandolo I. Role of Nutrition in the Management of Patients with Chronic Musculoskeletal Pain. J Pain Res 2024; 17:2223-2238. [PMID: 38947129 PMCID: PMC11214565 DOI: 10.2147/jpr.s456202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/13/2024] [Indexed: 07/02/2024] Open
Abstract
Chronic musculoskeletal pain (CMP), defined as persistent discomfort in musculoskeletal tissues persisting for over 3 months, afflicts an estimated 1.71 billion people globally, leading to significant functional impairments and psychological distress, thereby detrimentally affecting individuals' quality of life. The objective of this narrative review is to elucidate the complex relationship among dietary habits, sarcopenia, and gut microbiota composition, with an eye toward enhancing patient management and outcomes. Given the burgeoning interest in the influence of diet on CMP, a detailed examination of the current literature is warranted. Nutritional intake is a critical determinant of the gut microbiota profile, which, in turn, is linked to musculature integrity and performance, potentially leading to sarcopenia. The development of sarcopenia can aggravate CMP owing to diminished muscular strength and functionality. Additionally, disruptions in the gut microbiota may directly modulate nociception, intensifying CMP manifestations. Thus, nutritional optimization emerges as a viable approach to CMP management. Emphasizing a diet conducive to a healthy gut microbiome could forestall or mitigate sarcopenia, thereby attenuating CMP intensity. Nevertheless, the domain calls for further empirical exploration to unravel the nuances of these interactions and to forge efficacious dietary strategies for individuals with CMP. Beyond mere analgesia, comprehensive patient care for CMP requires acknowledgment of the complex and multifactorial nature of pain and its foundational elements. Embracing an integrative treatment model allows healthcare practitioners to promise better patient prognoses, enriched life quality, and a decrease in the sustained healthcare costs associated with CMP.
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Affiliation(s)
- Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS - Fondazione G Pascale, Naples, Italy
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Granviken F, Vasseljen O, Bach K, Jaiswal A, Meisingset I. Decision Support for Managing Common Musculoskeletal Pain Disorders: Development of a Case-Based Reasoning Application. JMIR Form Res 2024; 8:e44805. [PMID: 38728686 PMCID: PMC11127158 DOI: 10.2196/44805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/21/2024] [Accepted: 03/21/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Common interventions for musculoskeletal pain disorders either lack evidence to support their use or have small to modest or short-term effects. Given the heterogeneity of patients with musculoskeletal pain disorders, treatment guidelines and systematic reviews have limited transferability to clinical practice. A problem-solving method in artificial intelligence, case-based reasoning (CBR), where new problems are solved based on experiences from past similar problems, might offer guidance in such situations. OBJECTIVE This study aims to use CBR to build a decision support system for patients with musculoskeletal pain disorders seeking physiotherapy care. This study describes the development of the CBR system SupportPrim PT and demonstrates its ability to identify similar patients. METHODS Data from physiotherapy patients in primary care in Norway were collected to build a case base for SupportPrim PT. We used the local-global principle in CBR to identify similar patients. The global similarity measures are attributes used to identify similar patients and consisted of prognostic attributes. They were weighted in terms of prognostic importance and choice of treatment, where the weighting represents the relevance of the different attributes. For the local similarity measures, the degree of similarity within each attribute was based on minimal clinically important differences and expert knowledge. The SupportPrim PT's ability to identify similar patients was assessed by comparing the similarity scores of all patients in the case base with the scores on an established screening tool (the short form Örebro Musculoskeletal Pain Screening Questionnaire [ÖMSPQ]) and an outcome measure (the Musculoskeletal Health Questionnaire [MSK-HQ]) used in musculoskeletal pain. We also assessed the same in a more extensive case base. RESULTS The original case base contained 105 patients with musculoskeletal pain (mean age 46, SD 15 years; 77/105, 73.3% women). The SupportPrim PT consisted of 29 weighted attributes with local similarities. When comparing the similarity scores for all patients in the case base, one at a time, with the ÖMSPQ and MSK-HQ, the most similar patients had a mean absolute difference from the query patient of 9.3 (95% CI 8.0-10.6) points on the ÖMSPQ and a mean absolute difference of 5.6 (95% CI 4.6-6.6) points on the MSK-HQ. For both ÖMSPQ and MSK-HQ, the absolute score difference increased as the rank of most similar patients decreased. Patients retrieved from a more extensive case base (N=486) had a higher mean similarity score and were slightly more similar to the query patients in ÖMSPQ and MSK-HQ compared with the original smaller case base. CONCLUSIONS This study describes the development of a CBR system, SupportPrim PT, for musculoskeletal pain in primary care. The SupportPrim PT identified similar patients according to an established screening tool and an outcome measure for patients with musculoskeletal pain.
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Affiliation(s)
- Fredrik Granviken
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St Olavs Hospital, Trondheim, Norway
| | - Ottar Vasseljen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kerstin Bach
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Amar Jaiswal
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingebrigt Meisingset
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
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Pyykkö JE, Zwartjes M, Nieuwdorp M, van Olst N, Bruin SC, van de Laar AW, Sanderman R, Hagedoorn M, Gerdes VEA. Differences in Psychological Health and Weight Loss after Bariatric Metabolic Surgery between Patients with and without Pain Syndromes. Obes Surg 2024; 34:1693-1703. [PMID: 38499942 PMCID: PMC11031447 DOI: 10.1007/s11695-024-07171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
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.
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Affiliation(s)
- Johanna E Pyykkö
- Department of Health Psychology, Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, Netherlands.
| | - Max Zwartjes
- Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Max Nieuwdorp
- Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
- Department of Metabolic and Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
| | - Nienke van Olst
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
- Department of Metabolic and Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
| | - Sjoerd C Bruin
- Department of Metabolic and Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
| | - Arnold W van de Laar
- Department of Metabolic and Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology, Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, Netherlands
| | - Victor E A Gerdes
- Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
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Lawford B, Hinman RS, Jones S, Keating C, Brown C, Bennell KL. 'The fact that I know I can do it is quite a motivator now': a qualitative study exploring experiences maintaining weight loss 6 months after completing a weight loss programme for knee osteoarthritis. BMJ Open 2023; 13:e068157. [PMID: 37142310 PMCID: PMC10163509 DOI: 10.1136/bmjopen-2022-068157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE To explore experiences maintaining weight loss 6 months after completing a multicomponent weight loss programme for knee osteoarthritis. DESIGN Qualitative study based on an interpretivist paradigm and a phenomenological approach that was embedded within a randomised controlled trial. SETTING Semistructured interviews were conducted with participants 6 months after completing a 6-month weight loss programme (ACTRN12618000930280) involving a ketogenic very low calorie diet (VLCD), exercise and physical activity programme, videoconferencing consultations with a dietitian and physiotherapist, and provision of educational and behaviour change resources and meal replacement products. Interviews were audio recorded, transcribed verbatim and data were analysed based on the principles of reflexive thematic analysis. PARTICIPANTS 20 people with knee osteoarthritis. RESULTS Three themes were developed: (1) successfully maintained weight loss; (2) empowering self-management of weight (understand importance of exercise; increased knowledge about food and nutrition; resources from programme still useful; knee pain as a motivator; confidence in ability to self-regulate weight) and (3) challenges keeping on track (loss of accountability to dietitian and study; old habits and social situations; stressful life events or changes in health). CONCLUSION Participants had overall positive experiences maintaining their weight loss since completing the weight loss programme and were confident in their ability to self-regulate their weight in the future. Findings suggest a programme incorporating dietitian and physiotherapist consultations, a VLCD, and educational and behaviour change resources supports confidence maintaining weight loss in the medium term. Further research is required to explore strategies to overcome barriers like loss of accountability and returning to old eating habits.
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Affiliation(s)
- Belinda Lawford
- CHESM, University of Melbourne, Parkville, Victoria, Australia
| | - Rana S Hinman
- CHESM, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Jones
- CHESM, University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Kim L Bennell
- CHESM, University of Melbourne, Parkville, Victoria, Australia
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Imhagen A, Karlsson J, Jansson S, Anderzén-Carlsson A. A lifelong struggle for a lighter tomorrow: A qualitative study on experiences of obesity in primary healthcare patients. J Clin Nurs 2023; 32:834-846. [PMID: 35655375 PMCID: PMC10084391 DOI: 10.1111/jocn.16379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
AIM To describe experiences of living with obesity before the start of a group-based lifestyle intervention. BACKGROUND Obesity is a chronic disease that affects a person's physical and psychological health. Increased knowledge of experiences of living with obesity is required. DESIGN A qualitative study with a descriptive design. METHODS Semi-structured individual interviews with 17 participants living with obesity (Body Mass Index 32-49) were conducted between October and November 2019. The interviews were analysed using qualitative content analysis. The COREQ checklist was followed. RESULTS The analysis resulted in one main theme: Struggling for a lighter tomorrow and three subthemes: Suffering, Resilience and Need for support in making changes. For the majority of the participants, living with obesity was a lifelong struggle involving suffering on different levels. Yet despite this, the participants had not given up and hoped for a better life. They showed a degree of resilience and motivation, and a perceived ability to achieve lifestyle changes. However, there was a pronounced need for support to help them achieve this. CONCLUSION Living with obesity is complex and carries a risk of medical complications as well as psychosocial suffering. Healthy lifestyle habits to achieve better health and to lose weight should be encouraged, taking patient resources into account. Patients also need help in handling weight stigmatisation, and both healthcare professionals and society must engage with this. RELEVANCE TO CLINICAL PRACTICE Obesity is a chronic disease, and patients need ongoing support. Therefore, care for patients with obesity in primary health care must be further developed. Patient resources and strengths have to be acknowledged and encouraged in the process of helping them adopt healthy lifestyle habits. The findings of this study can contribute to ending weight stigmatisation by increasing the knowledge of living with obesity.
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Affiliation(s)
- Annika Imhagen
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Jan Karlsson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Stefan Jansson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Agneta Anderzén-Carlsson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
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Vaezipour A, Andrews N, Oviedo-Trespalacios O, Amershi F, Horswill M, Johnston V, Delhomme P. Exploring driving behaviour from the perspectives of individuals with chronic pain and health professionals. APPLIED ERGONOMICS 2022; 102:103755. [PMID: 35381464 DOI: 10.1016/j.apergo.2022.103755] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
Chronic pain affects one in five Australians, and this could impact daily activities such as driving. Driving is a complex task, which requires the cognitive and physical ability to predict, identify, and respond to hazards to avoid crashing. However, research exploring the factors that influence safe driving behaviour for chronic pain individuals is limited. A qualitative study was conducted which involved semi-structured interviews with 23 people who had experienced persistent pain for at least three months and 17 health professionals who had experience working with individuals with chronic pain. The aim of this study was to obtain a deeper understanding of the experiences and challenges that people with chronic pain may have in their day-to-day driving. Participants were also asked about currently available driving assessments and strategies for individuals with chronic pain in the Australian healthcare system. The themes emerging from the interviews highlighted the need for clearer guidelines and educational materials regarding the impact of chronic pain on an individual's ability to drive. These themes included the physical and cognitive challenges resulting from chronic pain, as well as the potential side effects of pain medications. In addition, participants identified a number of self-regulation strategies and driving assessments currently available for monitoring safe driving behaviour in Australia. This study improves our understanding of how chronic pain affects driving behaviour, as reported by individuals experiencing the pain and relevant health professionals. Recommendations for improving the safety of drivers with chronic pain are discussed, including possible technological interventions and better public education.
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Affiliation(s)
- Atiyeh Vaezipour
- RECOVER Injury Research Centre, The University of Queensland, Australia.
| | - Nicole Andrews
- RECOVER Injury Research Centre, The University of Queensland, Australia; Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Queensland, Australia; Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Queensland, Australia
| | | | - Fatima Amershi
- Tess Cramond Pain and Research Centre, Metro North Hospital and Health Service, Queensland, Australia; Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Mark Horswill
- School of Psychology, The University of Queensland, Australia
| | - Venerina Johnston
- RECOVER Injury Research Centre, The University of Queensland, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Australia
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Verdú E, Homs J, Boadas-Vaello P. Physiological Changes and Pathological Pain Associated with Sedentary Lifestyle-Induced Body Systems Fat Accumulation and Their Modulation by Physical Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13333. [PMID: 34948944 PMCID: PMC8705491 DOI: 10.3390/ijerph182413333] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 12/11/2022]
Abstract
A sedentary lifestyle is associated with overweight/obesity, which involves excessive fat body accumulation, triggering structural and functional changes in tissues, organs, and body systems. Research shows that this fat accumulation is responsible for several comorbidities, including cardiovascular, gastrointestinal, and metabolic dysfunctions, as well as pathological pain behaviors. These health concerns are related to the crosstalk between adipose tissue and body systems, leading to pathophysiological changes to the latter. To deal with these health issues, it has been suggested that physical exercise may reverse part of these obesity-related pathologies by modulating the cross talk between the adipose tissue and body systems. In this context, this review was carried out to provide knowledge about (i) the structural and functional changes in tissues, organs, and body systems from accumulation of fat in obesity, emphasizing the crosstalk between fat and body tissues; (ii) the crosstalk between fat and body tissues triggering pain; and (iii) the effects of physical exercise on body tissues and organs in obese and non-obese subjects, and their impact on pathological pain. This information may help one to better understand this crosstalk and the factors involved, and it could be useful in designing more specific training interventions (according to the nature of the comorbidity).
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Affiliation(s)
- Enrique Verdú
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, 17003 Girona, Spain;
| | - Judit Homs
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, 17003 Girona, Spain;
- Department of Physical Therapy, EUSES-University of Girona, 17190 Salt, Spain
| | - Pere Boadas-Vaello
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, 17003 Girona, Spain;
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Merriwether EN, Wittleder S, Cho G, Bogan E, Thomas R, Bostwick N, Wang B, Ravenell J, Jay M. Racial and weight discrimination associations with pain intensity and pain interference in an ethnically diverse sample of adults with obesity: a baseline analysis of the clustered randomized-controlled clinical trial the goals for eating and moving (GEM) study. BMC Public Health 2021; 21:2201. [PMID: 34856961 PMCID: PMC8638106 DOI: 10.1186/s12889-021-12199-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Everyday experiences with racial (RD) and weight discrimination (WD) are risk factors for chronic pain in ethnically diverse adults with obesity. However, the individual or combined effects of RD and WD on pain in adults with obesity is not well understood. There are gender differences and sexual dimorphisms in nociception and pain, but the effect of gender on relationships between RD, WD, and pain outcomes in ethnically diverse adults with obesity is unclear. Thus, the purposes of this study were to: 1) examine whether RD and WD are associated with pain intensity and interference, and 2) explore gender as a moderator of the associations between RD, WD, and pain. METHODS This is a baseline data analysis from a randomized, controlled clinical trial of a lifestyle weight-management intervention. Eligible participants were English or Spanish-speaking (ages 18-69 years) and had either a body mass index of ≥30 kg/m2 or ≥ 25 kg/m2 with weight-related comorbidity. RD and WD were measured using questions derived from the Experiences of Discrimination questionnaire (EOD). Pain interference and intensity were measured using the PROMIS 29 adult profile V2.1. Linear regression models were performed to determine the associations between WD, RD, gender, and pain outcomes. RESULTS Participants (n = 483) reported mild pain interference (T-score: 52.65 ± 10.29) and moderate pain intensity (4.23 ± 3.15). RD was more strongly associated with pain interference in women (b = .47, SE = .08, p < 001), compared to men (b = .14, SE = .07, p = .06). Also, there were no significant interaction effects between RD and gender on pain intensity, or between WD and gender on pain interference or pain intensity. CONCLUSIONS Pain is highly prevalent in adults with obesity, and is impacted by the frequencies of experiences with RD and WD. Further, discrimination against adults with obesity and chronic pain could exacerbate existing racial disparities in pain and weight management. Asking ethnically diverse adults with obesity about their pain and their experiences of RD and WD could help clinicians make culturally informed assessment and intervention decisions that address barriers to pain relief and weight loss. TRIAL REGISTRATION NCT03006328.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Melanie Jay
- NYU Grossman School of Medicine, New York, USA
- New York Harbor VA, New York, USA
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11
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Hamer O, Larkin D, Relph N, Dey P. Fear-related barriers to physical activity among adults with overweight and obesity: A narrative synthesis scoping review. Obes Rev 2021; 22:e13307. [PMID: 34170596 DOI: 10.1111/obr.13307] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/02/2021] [Accepted: 05/29/2021] [Indexed: 12/01/2022]
Abstract
Physical activity is a health behavior contributing to successful weight management. Adults with overweight and obesity find it challenging to meet recommended activity guidelines because of a range of barriers, some of which are not yet fully understood. A barrier receiving limited consideration, compared with other literature within this field, is that of fear. The purpose of this scoping review was to establish the extent of literature on fear-related barriers to physical activity in adults with overweight or obesity and to identify gaps in this literature. The review followed the scoping review framework outlined by Arksey and O'Malley and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The findings of the identified papers were charted thematically using a framework of fears and age group. In total, 34 studies were included that identified nine different fears related to barriers to activity in this population. However, only a small number of studies (n = 5) had explicitly intended to explore fear-related barriers. There were notable knowledge gaps including activity-related fear of pain and movement in adults under 45 years of age. There is a strong rationale to further explore these fears because they may restrict health promoting behavior.
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Affiliation(s)
- Oliver Hamer
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Derek Larkin
- Department of Psychology, Edge Hill University, Ormskirk, UK
| | - Nicola Relph
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Paola Dey
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Peiris WL, Cicuttini FM, Hussain SM, Estee MM, Romero L, Ranger TA, Fairley JL, McLean EC, Urquhart DM. Is adiposity associated with back and lower limb pain? A systematic review. PLoS One 2021; 16:e0256720. [PMID: 34520462 PMCID: PMC8439494 DOI: 10.1371/journal.pone.0256720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/27/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Back and lower limb pain have a major impact on physical function and quality of life. While obesity is a modifiable risk factor for musculoskeletal pain, the role of adiposity is less clear. This systematic review aimed to examine the relationship between both adiposity and its distribution and back and lower limb pain. METHODS A systematic search of electronic databases was conducted to identify studies that examined the association between anthropometric and/or direct measures of adiposity and site specific musculoskeletal pain. Risk of bias was assessed and a best evidence synthesis was performed. RESULTS A total of 56 studies were identified which examined 4 pain regions, including the lower back (36 studies), hip (two studies), knee (13 studies) and foot (eight studies). 31(55%) studies were assessed as having low to moderate risk of bias. 17(30%) studies were cohort in design. The best evidence synthesis provided evidence of a relationship between central adiposity and low back and knee pain, but not hip or foot pain. There was also evidence of a longitudinal relationship between adiposity and the presence of back, knee and foot pain, as well as incident and increasing foot pain. CONCLUSIONS This systematic review provides evidence of an association between both body fat and its central distribution and low back and knee pain, and a longitudinal relationship between adiposity and back, knee and foot pain. These results highlight the potential for targeting adiposity in the development of novel treatments at these sites.
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Affiliation(s)
- Waruna L. Peiris
- Department Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia M. Cicuttini
- Department Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sultana Monira Hussain
- Department Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mahnuma M. Estee
- Department Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Tom A. Ranger
- Department Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica L. Fairley
- Department Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emily C. McLean
- Department Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Donna M. Urquhart
- Department Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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13
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The Role of Pain Catastrophizing and Pain Acceptance in Performance-Based and Self-Reported Physical Functioning in Individuals with Fibromyalgia and Obesity. J Pers Med 2021; 11:jpm11080810. [PMID: 34442454 PMCID: PMC8401554 DOI: 10.3390/jpm11080810] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022] Open
Abstract
Impaired physical functioning is one of the most critical consequences associated with fibromyalgia, especially when there is comorbid obesity. Psychological factors are known to contribute to perceived (i.e., subjective) physical functioning. However, physical function is a multidimensional concept encompassing both subjective and objective functioning. The contribution of psychological factors to performance-based (i.e., objective) functioning is unclear. This study aims to investigate the contribution of pain catastrophizing and pain acceptance to both self-reported and performance-based physical functioning. In this cross-sectional study, 160 participants completed self-report measures of pain catastrophizing, pain acceptance, and pain severity. A self-report measure and a performance-based test were used to assess physical functioning. Higher pain catastrophizing and lower pain acceptance were associated with poorer physical functioning at both self-reported and performance-based levels. Our results are consistent with previous evidence on the association between pain catastrophizing and pain acceptance with self-reported physical functioning. This study contributes to the current literature by providing novel insights into the role of psychological factors in performance-based physical functioning. Multidisciplinary interventions that address pain catastrophizing and pain acceptance are recommended and might be effective to improve both perceived and performance-based functioning in women with FM and obesity.
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14
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Dong HJ, Dragioti E, Rivano Fischer M, Gerdle B. Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry. J Pain Res 2021; 14:1863-1873. [PMID: 34188533 PMCID: PMC8232849 DOI: 10.2147/jpr.s305399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/14/2021] [Indexed: 01/07/2023] Open
Abstract
Background It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight. Objective This study investigated whether obese patients with chronic pain lost weight after completing IMMPR in specialist pain units. The association of pain relief and weight change over time was also examined. Methods Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used (N=224), including baseline and 12-month follow-up after IMMPR from 2016 to 2018. Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviours, psychological distress, and health-related quality of life (HRQoL). A reduction of at least 5% of initial weight indicates clinically significant weight loss. Patients were classified into three groups based on the pain relief levels after IMMPR: pain relief of clinical significance (30% or more reduction of pain intensity); pain relief without clinical significance (less than 30% reduction of pain intensity); and no pain relief. Linear mixed regression models were used to examine the weight changes among the groups with different pain relief levels. Results A significant reduction of pain intensity was found after IMMPR (p < 0.01, effect size Cohen’s d = 0.34). A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss (20.2%~24.3%, p = 0.47). Significant improvements were reported regarding physical activity behaviour, psychological distress, and HRQoL, but weight change was not associated with changes of pain intensity. Conclusion About one-fifth of obese patients achieved significant weight reduction after IMMPR. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.
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Affiliation(s)
- Huan-Ji Dong
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Health Sciences, Research Group Rehabilitation Medicine, Lund University, Lund, Sweden.,Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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15
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Dong HJ, Larsson B, Rivano Fischer M, Gerdle B. Facing obesity in pain rehabilitation clinics: Profiles of physical activity in patients with chronic pain and obesity-A study from the Swedish Quality Registry for Pain Rehabilitation (SQRP). PLoS One 2020; 15:e0239818. [PMID: 32986777 PMCID: PMC7521725 DOI: 10.1371/journal.pone.0239818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background The obesity epidemic has influenced pain rehabilitation clinics. To date, little is known about baseline level of physical activity (PA) in patients referred to pain rehabilitation clinics. We aimed to investigate the PA levels of patients referred to pain rehabilitation clinics and to evaluate the effect of excess weight on PA level. Methods and findings Data were obtained from the Swedish Quality Registry for Pain Rehabilitation between 2016 and 2017. These data included PA time (everyday PA and physical exercise per week), Body Mass Index (BMI), sociodemographic factors, chronic pain and psychological aspects (e.g., pain intensity, depressive and anxiety symptoms and insomnia problems). Insufficient PA was defined as less than 150 minutes per week. We performed logistic regressions as well as orthogonal partial least square regression to estimate the effects of excess weight on PA. Over one-fourth of the patients were classified as obese (BMI ≥30 kg/m2, 871/3110, 25.3%) and nearly one-third of these patients were classified as severely obese (BMI ≥35 kg/m2, 242/871, 27.8%). Time estimations for physical exercise varied among the BMI groups, but patients in the higher BMI category were more likely to spend less time on everyday PA. Compared to normal weight, mild obesity [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.53–0.81] and severe obesity (OR 0.56, 95% CI 0.42–0.74) were associated with less PA. Mild obese patients had an elevated risk of 65% and severe obese patients had an elevated risk of 96% for insufficient PA. Increased pain intensity was positively related to insufficient PA (OR 1.17, 95% CI 1.06–1.29) among the obese patients. Conclusion Having low PA is very common for patients referred to pain rehabilitation clinics, especially for those with comorbid obesity. As a first step to increase PA, obese patients need to be encouraged to increase the intensity and amount of less painful daily PA.
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Affiliation(s)
- Huan-Ji Dong
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- * E-mail:
| | - Britt Larsson
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Health Sciences, Research Group Rehabilitation Medicine, Lund University, Lund, Sweden
- Department of Neurosurgery and Pain Rehabilitation, Skane University Hospital, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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16
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Dong HJ, Larsson B, Rivano Fischer M, Gerdle B. Maintenance of quality of life improvement for patients with chronic pain and obesity after interdisciplinary multimodal pain rehabilitation - A study using the Swedish Quality Registry for Pain Rehabilitation. Eur J Pain 2019; 23:1839-1849. [PMID: 31343806 DOI: 10.1002/ejp.1457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/03/2019] [Accepted: 07/21/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Throughout the world many people have both obesity and chronic pain, comorbidities that decrease Health-Related Quality of Life (HRQoL). It is uncertain whether patients with comorbid obesity can maintain improved HRQoL after Interdisciplinary Multimodal Pain Rehabilitation (IMMPR). METHODS Data from 2016, 2017, and 2018 were obtained from a national pain database for Swedish specialized pain clinics and collected at three time points: Pre-IMMPR; Post- IMMPR; and 12-month follow-up (FU-IMMPR). Participants (N = 872) reported body weight, height, pain aspects, and HRQoL (RAND 36-Item Health Survey). Severe obesity (Body Mass Index, BMI ≥35 kg/m2 ) was defined according to WHO classifications. We used linear mixed regression models to examine BMI group differences in HRQoL over time. RESULTS More than 25% of patients (224/872) were obese and nearly 30% (63/224) of these were severely obese. All BMI groups improved significantly in both physical and mental composites of HRQoL after IMMPR (Pre- vs. Post-IMMPR, p < .001). The improvements were maintained at a 12-month follow-up (Post- vs. FU-IMMPR, p > .05). The severe obesity group had the lowest physical health score and least improvement (pre- vs. FU-IMMPR, Cohen's d = o.422, small effect size). Severe obesity had negative impact on physical health (β = -4.39, p < .05) after controlling for sociodemographic factors and pain aspects. CONCLUSION Improvements in HRQoL after IMMPR were achieved and maintained across all weights, including patients with comorbid obesity. Only severe obesity was negatively associated with physical health aspects of HRQoL. SIGNIFICANCE Patients with chronic pain and comorbid obesity achieve sustained Health-Related Quality of Life (HRQoL) improvements from Interdisciplinary Multimodal Pain Rehabilitation (IMMPR). This finding suggests that rehabilitation professionals should consider using IMMPR for patients with comorbid obesity even though their improvement may not reach the same level as for non-obese patients.
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Affiliation(s)
- Huan-Ji Dong
- Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
| | - Britt Larsson
- Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Health Sciences, Rehabilitation Medicine, Lund University, Lund, Sweden.,Department of Neurosurgery and Pain Rehabilitation, Skane University Hospital, Lund, Sweden
| | - Björn Gerdle
- Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
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17
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Majchrzak M, Brzecka A, Daroszewski C, Błasiak P, Rzechonek A, Tarasov VV, Chubarev VN, Kurinnaya AS, Melnikova TI, Makhmutova A, Klochkov SG, Somasundaram SG, Kirkland CE, Aliev G. Increased Pain Sensitivity in Obese Patients After Lung Cancer Surgery. Front Pharmacol 2019; 10:626. [PMID: 31258474 PMCID: PMC6586739 DOI: 10.3389/fphar.2019.00626] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Obesity and cancer are recognized worldwide health threats. While there is no reported causal relationship, the increasing frequency of both conditions results in a higher incidence of obese patients who are being treated for cancer. Physiological data indicate that there is a relationship between obesity and susceptibility to pain; however, currently, there are no specific pharmacological interventions. Objective: To evaluate the self-reported intensity of postoperative pain in obese and nonobese lung cancer who receive either thoracotomy or video-assisted thoracic surgery (VATS) surgical therapy. Material and Methods: In 50 obese [mean body mass index (BMI) of 34.1 ± 3.2 kg/m2] and 62 nonobese (mean BMI of 24.9 ± 3 kg/m2) lung cancer patients, the intensity of pain was estimated every 4 h using a visual analog scale (VAS, 0 indicating no pain and 10 indicating “worst imaginable pain”) beginning shortly after surgery (Day O) and continuing until the day of discharge (Day D). Results: The self-reported pain was more severe in obese than in nonobese patients, both at the time of the operation [Day O (4.5 ± 1.2 vs 3.4 ± 1.1; p < 0.0001)] and at the day of discharge [Day D (3.9 ± 1.4 vs 2.6 ± 0.9, p < 0.0001)]. This finding was consistent both in the patients after thoracotomy and after video-assisted thoracic surgery (VATS, p < 0.0001). The patients with severe pain shortly after surgery (VAS score >4) had significantly higher BMI (31.8 ± 5.6 kg/m2vs 28.8 ± 5.2 kg/m2, p < 0.01) and were hospitalized longer than the remaining patients (13.0 ± 13.6 days vs 9.5 ± 3.6 days, p < 0.05). Conclusion: The reported perception of pain in obese lung cancer patients is greater than in nonobese patients undergoing the same thoracic surgery. In obese patients, severe pain persisted longer. Pain management is an important consideration in the postoperative care of lung cancer patients, even more so with obese patients.
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Affiliation(s)
- Maciej Majchrzak
- Department of Thoracic Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Cancer, Medical University in Wroclaw, Wroclaw, Poland
| | - Cyryl Daroszewski
- Department of Pulmonology and Lung Cancer, Medical University in Wroclaw, Wroclaw, Poland
| | - Piotr Błasiak
- Department of Thoracic Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Adam Rzechonek
- Department of Thoracic Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Vadim V Tarasov
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vladimir N Chubarev
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasiya S Kurinnaya
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tatiana I Melnikova
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alfiya Makhmutova
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia
| | - Sergey G Klochkov
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia
| | - Siva G Somasundaram
- Department of Biological Sciences, Salem University, Salem, WV, United States
| | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem, WV, United States
| | - Gjumrakch Aliev
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia.,GALLY International Biomedical Research Institute, San Antonio, TX, United States
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18
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Chahal-Kummen M, Blom-Høgestøl IK, Eribe I, Klungsøyr O, Kristinsson J, Mala T. Abdominal pain and symptoms before and after Roux-en-Y gastric bypass. BJS Open 2019; 3:317-326. [PMID: 31183448 PMCID: PMC6551394 DOI: 10.1002/bjs5.50148] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/18/2019] [Indexed: 12/17/2022] Open
Abstract
Background Despite increased emphasis on patient‐reported outcomes, few studies have focused on abdominal pain symptoms before and after Roux‐en‐Y gastric bypass (RYGB). The aim of this study was to quantify chronic abdominal pain (CAP) in relation to RYGB. Methods Patients with morbid obesity planned for RYGB were invited to participate at a tertiary referral centre from February 2014 to June 2015. Participants completed a series of seven questionnaires before and 2 years after RYGB. CAP was defined as patient‐reported presence of long‐term or recurrent abdominal pain lasting for more than 3 months. Results A total of 236 patients were included, of whom 209 (88·6 per cent) attended follow‐up. CAP was reported by 28 patients (11·9 per cent) at baseline and 60 (28·7 per cent) at follow‐up (P < 0·001). Gastrointestinal Symptom Rating Scale (GSRS) scores (except reflux scores) and symptoms of anxiety increased from baseline to follow‐up. Most quality of life (QoL) scores (except role emotional, mental health and mental component scores) also increased. At follow‐up, patients with CAP had higher GSRS scores than those without CAP, with large effect sizes for abdominal pain and indigestion syndrome scores. Patients with CAP had more symptoms of anxiety, higher levels of catastrophizing and lower QoL scores. Baseline CAP seemed to predict CAP at follow‐up. Conclusion The prevalence of CAP is higher 2 years after RYGB compared with baseline values.
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Affiliation(s)
- M Chahal-Kummen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine, University of Oslo Oslo Norway
| | - I K Blom-Høgestøl
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine, University of Oslo Oslo Norway
| | - I Eribe
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Oslo Norway
| | - O Klungsøyr
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo Oslo Norway
| | - J Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Oslo Norway
| | - T Mala
- Department of Gastrointestinal Surgery Oslo University Hospital Oslo Norway
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Dong HJ, Larsson B, Levin LÅ, Bernfort L, Gerdle B. Is excess weight a burden for older adults who suffer chronic pain? BMC Geriatr 2018; 18:270. [PMID: 30409125 PMCID: PMC6225711 DOI: 10.1186/s12877-018-0963-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 10/24/2018] [Indexed: 12/31/2022] Open
Abstract
Background Obesity and chronic pain are common comorbidities and adversely influence each other. Advanced age is associated with more comorbidities and multi-morbidities. In this study, we investigated the burden of overweight/obesity and its comorbidities and their associations with chronic pain in a random population sample of Swedish older adults. Methods The cross-sectional analysis involved a random sample of a population ≥ 65 years in south-eastern Sweden (N = 6243). Data were collected from a postal questionnaire that addressed pain aspects, body mass index (BMI), and health experiences. Chronic pain was defined as pain during the previous three months. According to the 0–10 Numeric Rating Scale, pain scored ≥7 corresponds to severe pain. Binary logistic regression was used to determine the variables associated to pain aspects. Results A total of 2633 (42%) reported chronic pain. More obese older adults (BMI ≥30 kg/m2) experienced chronic pain (58%) than those who were low-normal weight (BMI < 25 kg/m2, 39%) or overweight (25 ≤ BMI < 30 kg/m2, 41%). Obese elderly more frequently had pain in extremities and lower back than their peers. In the multivariate model, obesity (Odds Ratio (OR) 1.59, 95% Confidence Interval (CI) 1.33–1.91) but not overweight (OR 1.08, 95% CI 0.95–1.22) was associated with chronic pain. Obesity (OR 1.53, 95% CI 1.16–2.01) was also significantly related to severe pain. We also found other comorbidities – i.e., traumatic history (OR 2.52, 95% CI 1.99–3.19), rheumatic diseases (OR 5.21, 95% CI 4.54–5.97), age ≥ 85 years (OR 1.66, 95% CI 1.22–2.25), and depression or anxiety diagnosis (OR 1.83, 95% CI 1.32–2.53) – showed stronger associations with pain aspects than weight status. Conclusion: In older adults, excess weight (BMI 30 or above) is a potentially modifiable factor but not the only risk factor that is associated with chronic pain and severe pain. Future studies should investigate the effectiveness of interventions that treat comorbid pain and obesity in older adults.
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Affiliation(s)
- Huan-Ji Dong
- Pain and Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Britt Larsson
- Pain and Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Lars-Åke Levin
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Lars Bernfort
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
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20
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Twomey D, Stuart S, Baker K. Pain in Parkinson's disease: the lived experience. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.6.301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Doireann Twomey
- Senior neurological physiotherapist, Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, Northumbria University, Newcastle Upon Tyne, UK
| | - Samuel Stuart
- Research associate, Institute of Neuroscience/Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne; Newastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Baker
- Senior lecturer in physiotherapy, Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, Northumbria University, Newcastle Upon Tyne, UK
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