Chronic pain management in the obese patient: a focused review of key challenges and potential exercise solutions

Abstract

In obese persons, general and specific musculoskeletal pain is common. Emerging evidence suggests that obesity modulates pain via several mechanisms such as mechanical loading, inflammation, and psychological status. Pain in obesity contributes to deterioration of physical ability, health-related quality of life, and functional dependence. We present the accumulating evidence showing the interrelationships of mechanical stress, inflammation, and psychological characteristics on pain. While acute exercise may transiently exacerbate pain symptoms, regular participation in exercise can lower pain severity or prevalence. Aerobic exercise, resistance exercise, or multimodal exercise programs (combination of the two types) can reduce joint pain in young and older obese adults in the range of 14%–71.4% depending on the study design and intervention used. While published attrition rates with regular exercise are high (∼50%), adherence to exercise may be enhanced with modification to exercise including the accumulation of several exercise bouts rather than one long session, reducing joint range of motion, and replacing impact with nonimpact activity. This field would benefit from rigorous comparative efficacy studies of exercise intensity, frequency, and mode on specific and general musculoskeletal pain in young and older obese persons.

Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

“…Surgical procedure type and amount of weight loss were not associated with risk of post-surgery continued or initiated opioid use, whereas severity of pain was. In the context of the Center for Disease Control and Prevention’s recent evidence-based conclusion that opioids should not be routinely used to manage chronic pain(42), these findings highlight the need for alternative long-term pain management approaches following bariatric surgery, which may include nonopioid analgesic and nonpharmacological options(43;44). …”

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 the causal obesity-pain relationship has not been fully explored, evidence suggests that obesity and pain adversely affect one another as they share underlying mechanical, physiological, psychological and behavioural mechanisms (McVinnie, 2013;Okifuji & Hare, 2015;Zdziarski, Wasser, & Vincent, 2015).…”

Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity

“…3 Obesity can also contribute to pain and physical limitations through factors such as impaired cardiorespiratory function, 4 systematic inflammation, 5 reduced flexibility of movement, 6 low strength per body mass, 5 and depression. 7 …”