Severe obesity effect on low back biomechanical stress of manual load lifting

Singh, Devender; Park, Woojin; Hwang, Dong‐Choon; Levy, Martin S.

doi:10.3233/wor-141945

Cited by 38 publications

(18 citation statements)

References 39 publications

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“…Though much remains to be clarified, an increasing body of evidence illuminates the mechanisms underlying the obesity-pain link such as increased loading on joints and spine ( Okifuji & Hare, 2015 ). Higher levels of BMI are also associated with greater wear-and-tear on knee cartilage ( Ding et al, 2005 ), greater disk compression force while lifting ( Singh et al, 2015 ), higher risk for degenerative disk disorders ( Samartzis et al, 2012 ), and altered body mechanics and postures ( Fabris de Souza et al, 2005 ). In particular, overloading on lower back, hip, and knee joints may contribute to structural damage and lead to osteroarthritis ( McVinnie, 2013 ).…”

Section: Discussionmentioning

confidence: 99%

Increases in BMI and chronic pain for US adults in midlife, 1992 to 2016

Stokes

Xie

Lundberg

et al. 2020

SSM - Population Health

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Recent unprecedented increases in mortality and morbidity during midlife are often ascribed to rising despair in the US population. An alternative and less often examined explanation is that these trends reflect, at least in part, the lagged effects of the obesity epidemic. Adults in midlife today are more likely to live with obesity and have a greater cumulative exposure to excess adiposity during their lifetime than any previous generation. Prior work has demonstrated a link between obesity and mortality risk at midlife, but the mechanisms remain unclear. Pain may represent one important pathway linking obesity to mortality trends. Pain is a debilitating condition that has increased significantly over recent decades and is associated with both morbidity and mortality, including suicide and opioid-related mortality. Evidence suggests obesity and pain may be linked, but there is little evidence of an association at the population level. In this paper, we examine to what extent increases in overweight and obesity explain the rising trends in chronic pain observed among middle-aged adults in the US from 1992 to 2016. We assess trends in both mild/moderate nonlimiting pain and severe and/or limiting pain. In doing so, we draw attention to one mechanism through which overweight/obesity may have contributed to recent population health trends. Our analysis found that increases in BMI from 1992 to 2016 may account for up to 20% of the upward trend in mild/moderate nonlimiting pain and 32% of the trend in severe and/or limiting pain for women, and 10% and 19% of the trends respectively for men.

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Section: Discussionmentioning

confidence: 99%

Increases in BMI and chronic pain for US adults in midlife, 1992 to 2016

Stokes

Xie

Lundberg

et al. 2020

SSM - Population Health

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“…It is possible that there is a threshold of BMI beyond which the development or maintenance of chronic back pain is substantially facilitated. A link between severe obesity and back pain could be explained by a variety of causes including mechanical stresses from excess weight[44], systemic effects from low-grade inflammation from adipose tissue [45], or mediation by other factors such as depression or other chronic conditions. Additional longitudinal studies are still needed to ascertain what component of the obesity-back pain association is due to obesity occurring as a consequence, rather than a cause, of chronic back pain.…”

Section: Discussionmentioning

confidence: 99%

Modifiable risk factors for chronic back pain: insights using the co-twin control design

et al. 2017

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BACKGROUND: Inconsistent associations between modifiable risk factors and chronic back pain (CBP) may be due to the inability of traditional epidemiologic study designs to properly account for an array of potential genetic and environmental confounding factors. The co-twin control research design, comparing modifiable risk factors in twins discordant for CBP, offers a unique way to remove numerous confounding factors. PURPOSE: To examine the association of modifiable lifestyle and psychological factors with lifetime CBP. STUDY DESIGN/SETTING: Cross-sectional co-twin control study in a nationwide sample of male twin members of the Vietnam Era Twin Registry. PATIENT SAMPLE: 7,108 participants including 1,308 monozygotic (MZ) pairs and 793 dizygotic pairs. OUTCOME MEASURE: Self-reported lifetime history of CBP. METHODS: Lifestyle factors included body mass index (BMI), smoking history, alcohol consumption, habitual physical activity, and typical sleep duration. Psychological factors included depression (Patient Health Questionnaire-9 [PHQ9]) and post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist [PCL]). Covariates included age, race, education, and income. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated for the association of risk factors with lifetime CBP when considering twins as individuals, and a within-pair co-twin control analysis that accounted for familial and genetic factors. Funding was through VA grant 5IK2RX001515; there were no study-specific conflicts of interest. RESULTS: The mean age of respondents was 62 years and the prevalence of lifetime CBP was 28%. All lifestyle factors were associated with CBP in the individual level analysis. However none of these persisted in the within-pair analyses, except for severe obesity (BMI≥35.0) which was associated with lifetime CBP in both individual-level (OR = 1.6, 95% CI 1.3–1.9) and within-pair analyses (MZ analysis: OR = 3.7, 95% CI 1.2–11.4). PTSD and depression symptoms were strongly associated with lifetime CBP in both the individual-level (moderate/severe depression: OR = 4.2, 95% CI 3.6–4.9 and severe PTSD: OR = 4.8, 95% CI 4.0–5.7) and within-pair (MZ) analyses (moderate/severe depression: OR = 4.6, 95% CI 2.4–8.7 and severe PTSD: OR = 3.2, 95% CI 1.6–6.5). CONCLUSIONS: Many associations between modifiable lifestyle risk factors and chronic back pain are due to confounding by familial and genetic factors. Severe obesity, depression, and PTSD should be considered in the development of intervention strategies to reduce the prevalence of chronic back pain.

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“…A recent study 72 showed that obese individuals exert significantly greater disk compression force while lifting compared to normal weight individuals, often greatly exceeding the action limit set by the National Institute of Occupational Safety and Health. Thus, it may not be surprising to see that obesity is also related to greater structural damage in the back.…”

Section: Potential Mechanisms Underlying the Obesity–pain Linkmentioning

confidence: 99%

The association between chronic pain and obesity

Okifuji¹,

Hare²

2015

JPR

434

337

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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.

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Severe obesity effect on low back biomechanical stress of manual load lifting

Abstract: In light of previous research on spine, bone and obesity, the study results seem to suggest that severely obese individuals are likely at an increased risk of lifting-related low back pain compared with normal weight individuals.

Cited by 38 publications

References 39 publications

Increases in BMI and chronic pain for US adults in midlife, 1992 to 2016

Increases in BMI and chronic pain for US adults in midlife, 1992 to 2016

Modifiable risk factors for chronic back pain: insights using the co-twin control design

The association between chronic pain and obesity

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