Prescription opioid use has increased significantly over the past 25 years due to a number of factors including efforts to help patients struggling to cope with pain, overprescribing by providers and marketing by pharmaceutical companies. However, opioids provide euphoria as well as analgesia. 1 This euphoria coupled with iatrogenic physical dependence and addictive qualities has contributed to an epidemic of opioid abuse, addiction and overdose. 2 The increased use of opioids for treating non-cancer chronic pain and the increased use of higher-dose and higher bioavailability formulations has added to what the Centers for Disease Control and the Department of Health and Human Services have referred to as an'epidemic'. 1 Clinicians struggle to weigh the potential benefits of long-term opioids therapy (i.e., use of legitimately obtained prescribed opioids at least five days per week for 90 days) with the risk of misuse or addiction. 3 Recently, the Centers for Disease Control (CDC) has issued prescribing guidelines to address the issue of opioid over-use. 4 Obesity and Chronic Pain Co-Morbidity Patients with severe obesity are more likely to experience chronic pain and related increased functional and psychosocial complications related to chronic pain conditions. 5 Chronic pain also has quality of life implications in patients with severe obesity and has been the subject of a prior review A large-scale survey of over 1 million US residents demonstrated a linear relationship between Body Mass Index (BMI) and chronic pain prevalence. 6 Compared to individuals with normal BMIs, individuals who were overweight reported 20% greater rates of chronic pain, people with Class I obesity reported 68% greater, those with Class II reported 136% greater, and those with clinically severe Class III obesity reported 254% greater rates of chronic pain. 7 Recent research has indicated that although pain ratings and overall medication use is significantly reduced following bariatric surgeries, opioid use not only continues but

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Objective/Setting Individuals with obesity frequently contend with chronic pain, but few studies address the clinical impact of coordinated pain services on this population. The current study addresses this topic by comparing the effectiveness of a comprehensive pain rehabilitation program for patients with and without obesity. Methods A retrospective analysis of registry data was conducted. Obesity was considered as one of three weight groups, based on the following body mass index cutoffs: normal weight (18.5 to < 25 kg/m2), overweight (25 to < 30 kg/m2), and obese (> 30 kg/m2). These groups were compared on the Pain Severity Ratings (PSR) Scale, the Pain Disability Index (PDI), and the Depression, Anxiety, Stress Scales—Short Form (DASS-SF). Results Groups differed on baseline pain disability and depression. Patients with obesity had higher scores on both the PDI (p = .028) and the DASS-SF depression subscale (p = .006). Contrary to the hypothesis, after controlling for baseline score and sex there were no significant differences between weight groups with regards to PSR, PDI, or any DASS-SF subscale at discharge. At one-year follow-up, individuals who were overweight and obese had significantly more anxiety compared to individuals whose weight was in the normal range. Conclusions Multidisciplinary pain rehabilitation programs appear to be an effective treatment intervention for patients who have concomitant chronic pain and obesity, to a degree comparable to patients who have chronic pain but do not contend with obesity. Implications for program development, clinical interventions, and future research are discussed.