Refractory Chronic Pain and Obesity: Promising Implications for Multidisciplinary Pain Rehabilitation

Abstract

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.

Adults with excess weight or obesity, but not with overweight, report greater pain intensities than individuals with normal weight: a systematic review and meta-analysis

“…The included literature spanned from 2008 ( 48 ) to 2021 ( 49 ). The studies were performed in 13 countries, mostly in the United States (n = 16).…”

“…Sample size ranged from 30 ( 50 ) to 9415 ( 51 ) and 31,210 participants in sum were assessed (mean age [SD]: 53 [13.1] years; 44% were women). It should be noted that 5 studies exclusively recruited women ( 52 – 56 ), in one study only men were included ( 51 ), one study did not provide information on the sex ( 35 ) and in 3 studies the mean age was not provided or specified ( 49 , 55 , 57 ). The youngest average age was 24.1 ( 58 ) and the oldest 80.5 ( 59 ).…”

“…Among the 31 included studies, 29 were observational (15 were cross-sectional ( 12 , 52 , 53 , 55 , 56 , 58 – 67 ), 7 retrospective ( 28 , 35 , 48 , 49 , 68 – 70 ), 6 prospective ( 51 , 57 , 71 – 74 ) and 1 combined analysis of retrospective and prospective occurrences ( 75 ) in cohort studies) and 2 were interventional [clinical trials ( 50 , 54 )]. BMI classification was monitored for all the included studies according to the WHO standards; however, not all the studies made use of a complete subclassification stratified in four classes.…”

“…BMI classification was monitored for all the included studies according to the WHO standards; however, not all the studies made use of a complete subclassification stratified in four classes. Most studies classified the participants in normal range (BMI: 18.5-24.9), overweight or pre-obesity (BMI: 25.0-29.9) and obesity (BMI ≥ 30.0) ( 28 , 48 , 49 , 51 , 52 , 54 , 56 , 63 – 66 , 72 – 74 ). However, 10 articles ( 35 , 51 , 52 , 58 – 60 , 62 , 63 , 68 , 70 ) recruited underweight patients, of which 3 studies ( 52 , 63 , 70 ) added such data to the normal range category, and two ( 51 , 68 ) left them out of their quantitative analysis.…”

“…However, 10 articles ( 35 , 51 , 52 , 58 – 60 , 62 , 63 , 68 , 70 ) recruited underweight patients, of which 3 studies ( 52 , 63 , 70 ) added such data to the normal range category, and two ( 51 , 68 ) left them out of their quantitative analysis. Although a subclassification for obesity was carried out in 11 studies ( 12 , 49 , 55 , 57 , 59 , 60 , 65 – 68 , 70 ), none included the same subgroups in their studies.…”