Bariatric surgery produces significant and quantifiable reductions in back pain. However, there is a lack of information on the association of weight changes after bariatric surgery with changes in pain score. We aim to evaluate the impact of bariatric surgery on back pain in obese patients and to address the association between changes in body mass index (BMI) and pain score. In obese patients eligible for bariatric surgery, the changes in pre- and post-operative pain scores, assessed by the Numeric Rating Pain Scale (NPS) or Visual Analogue Scale (VAS), were considered as primary outcomes. Mean difference (MD) and their 95% confidence intervals (CI) were evaluated. Eight cohort studies were included in the analysis of 298 obese patients undergoing bariatric surgery. All studies showed a reduction in back pain, with a mean change of −2.9 points in NPS and of −3.8 cm in VAS. There was a significant reduction in back pain (NPS: (MD = −3.49) (95% CI = −3.86, −3.12); VAS: MD = −3.75, (95% CI = −4.13, −3.37)) and BMI (MD = −12.93, (95% CI = −13.61, −12.24)) following bariatric surgery. No significant relationship between BMI change and decrease in clinical scores could be established. However, it was evident that bariatric surgery had a significant effect on back pain scores in severely obese patients. Ideally, a prospective study including spinal imaging, inflammatory markers, a longer follow-up period, and larger study groups with a randomized control group needs to be performed.
Objective: To evaluate if back pain scores in morbidly obese patients change after bariatric surgery. Summary Background Data: Obese patients often complain of low back pain (LBP), however the underlying mechanism is not fully understood. Recent research shows that, next to mechanical loading, the chronic low-grade inflammation that arises in obese patients is contributing to LBP due to intervertebral disc degeneration. Therefore, it is hypothesized that bariatric surgery will have an effect on the LBP in obese patients. Methods: We searched four online databases for randomized controlled trials and observational studies. In obese patients, eligible for bariatric surgery, the changes in pre- and postoperative pain scores, assessed by Numeric Rating Pain Scale (NPS) or Visual Analogue Scale (VAS), were considered as primary outcomes. Effect size (ES) and their 95% confidence intervals (CI) were evaluated. Results: Eight observational studies met the eligibility criteria. All studies showed a reduction of LBP following bariatric surgery, with a mean change of -2.9 points in NPS and of -3.8 cm in VAS. Among the patients undergoing bariatric surgery, based on a fixed effect estimated by pain assessment, the pain score decreased significantly in both groups; in NPS (ES -3.49, 95%CI [-3.86, -3.12]) and in VAS (ES -3.975, 95%CI [-4.45, -3.50]). Conclusions: From this meta-analysis, the data of back pain improvement following bariatric surgery seems encouraging. Substantial weight loss following bariatric surgery might be associated with a reduction in back pain intensity.
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