Does changing weight change pain? Retrospective data analysis from a national multidisciplinary weight management service

Abstract

Background Musculoskeletal (MSK) pain is common in obese populations. Multidisciplinary Tier 3 weight management services (WMS) are effective in reducing weight; however, MSK pain as an outcome is not routinely reported post‐WMS interventions. Methods Following ethical approval this retrospective design study using anonymized data from a national WMS established changes in anthropometric and pain prevalence and intensity scores as well as establishing variables predictive of achieving clinically significant changes (CSC) in pain scores. Results Of the 806 patients registered to the WMS (January 2011–February 2015), 59% (n = 476; CI = 56–62) attended their reassessments at 6 months. The overall mean age was 45.1 ± 12 years and 62% (n = 294) were female. At baseline 70% (n = 281; CI = 65–75) reported low back pain (LBP) and 59% (n = 234; CI = 54–64) had knee pain. At reassessment 37.3% (n = 177) of patients lost ≥5% body weight, 58.7% (n = 279) were weight stable (5% weight loss or gain) and 4.0% (n = 19) gained ≥5% body weight. Low back and knee pain prevalence reduced significantly for those who lost ≥5% body weight. Variables predictive of a CSC in LBP numerical rating scale (NRS) score included a higher baseline NRS score, weighing more, and rating losing weight as being important (p < 0.05). Higher baseline NRS and being younger resulted in higher odds of a CSC in knee pain NRS (p < 0.05). Conclusions Overall this WMS was effective for clinical weight loss. For those who lost most weight prevalence of knee and LBP reduced. Imbedding pain management strategies within WMS’s may provide a more holistic approach to obesity management. Significance Weight loss can reduce musculoskeletal pain, particularly for those who lose more weight. Imbedding pain management strategies within these services may provide a more holistic approach to obesity management.

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

“…Although obese patients had the least reduced pain intensity Post‐IMMPR, no BMI group reported a reduction large enough to reach the minimal clinically important difference. Consistent with our findings, two other research groups focused on morbidly obese patients receiving weight loss interventions, also reported lack of clinically significant reduction in pain intensity (Cooper, Ryan, et al., ; Dunlevy et al., ). In the normal weight group, the effect size was small, but this must be seen in the perspective that these patients represent a selection of patients with complex chronic pain conditions.…”

“…Both conditions, severe pain and extreme obesity, interfere with patients' attempts to improve in one or the other condition. The complex interwoven relationship suggested here reminds health professionals about the underlying mechanisms (McVinnie, 2013) and the necessity of targeting pain rehabilitation and weight management in an integrated fashion (Dunlevy et al, 2019;Janke et al, 2014).…”

Weight management and musculoskeletal pain: Does sleep mediate the connection?

“…OSA is associated with an increased risk for heart attack, stroke, arrhythmia, high blood pressure and mortality, and is prevalent in obese populations. The study by Dunlevy et al (2019) found that 25% of the obese population sample had OSA. Obesity and sleep disorders are correlated in a bidirectional manner, as short sleep duration is increasingly recognized as a risk factor for obesity, while obesity is recognized as a source for sleep disturbances, increasing the risk of OSA, decreasing deep sleep (stage N3 NREM sleep and stage REM sleep) and sleep efficiency (Naufel et al, 2018).…”

“…In conclusion, we would like to highlight the importance of the study by Dunlevy et al (2019), which provides valuable information on obesity, an important and growing global problem, and its link with MSK pain. Although the relationship between obesity, MSK pain and sleep is complex and multifactorial and not yet fully elucidated, we would like to draw attention to the potential role of sleep as a mediator in this relationship and one which is worthy of further investigation.…”

“…Dear Editor, In a recent issue of the European Journal of Pain, Dunlevy et al (2019) presented the results of a retrospective study using data from a weight management program. We would like to congratulate the authors on this important investigation which showed that weight loss of ≥5% reduced musculoskeletal (MSK) pain, specifically knee pain and low back pain, in patients with severe obesity.…”