Introduction to obesity and pain

There now appears to be a strong link between obesity and pain. Studies show that obese people are much more likely to feel light to intense pain in many parts of the body. Scientists do not understand exactly how or why obesity causes pain, but it is clear that weight loss can help reduce pain and improve quality of life for obese patients.


Pain

Most people would be familiar with the uncomfortable and unpleasant feeling of pain. This is usually caused by actual damage to the body’s tissues. Pain is a symptom that is seen in many different diseases and can vary in severity. For example, pain may interrupt daily activities or cause severe disability. Acute pain is a response to a negative change in the body, sometimes caused by surgery, trauma or illness. The pain might start suddenly but does not usually last for more than 3 months.

Chronic pain lasts for much longer than would be expected considering the original injury. Some chronic diseases are known to worsen pain symptoms. These include rheumatoid arthritis, migraine headaches, fibromyalgia and diabetic nephropathy. A person’s emotional and psychological well-being may also affect their experience of pain. For example, depression and anxiety may put a person at risk of developing pain and intensify their experience of pain.

Among health care professionals, a holistic model of pain is used for assessment and treatment. Since pain is a complex condition, the physical, emotional, cognitive, social and spiritual aspects of pain should all be considered.


Obesity

A person will be diagnosed with obesity if they have a body mass index (BMI) over 30. The BMI is a calculation that considers a person’s height and weight. Obese patients have excess body fat, which put them at risk of developing type 2 diabetes, heart disease, some cancers, arthritis and sleep disorders. Obesity may also negatively impact a person’s self-esteem and their sexual and social well-being.

Obesity is a serious public health concern because rates of the disease are increasing rapidly. This is the case in Australia as well as many other developed countries. In 2000, about one in five Australians over the age of 25 was obese. Many more are overweight, and risk becoming obese without proper weight management. This is also true for the quarter of Australian children who are either overweight or obese.

Relationship between obesity and pain

Scientists have long thought that obesity increased the experience of pain. However, recent studies have provided evidence of the link between pain and obesity. This means that health care professionals will need to consider pain management when they are treating their patients for obesity.

A study in the US found that moderately obese patients were 76% more likely to feel pain that their underweight or normal weight counterparts. Severely obese patients were at an even greater risk of reporting pain. Both groups of obese patients were more likely to have pain in several areas of the body.
Obesity has been linked to knee pain, osteoarthritis (OA), low back pain (LBP) and general musculoskeletal pain. Carrying excess weight may cause these pain conditions by putting pressure on joints and tissues.


Management of pain in obese individuals

Reducing pain can greatly improve obese patients’ quality of life. However, pain may be difficult and complicated to treat. Often treatment will be long term but may lead only to very gradual improvement.

After an assessment, pain may be managed first through lifestyle changes. These include weight reduction, exercise, cognitive behavioural therapy (CBT) and relaxation. If this is unsuccessful, then drugs or more invasive therapies may also be used.

For more information, please see ‘Treating Chronic Non-Cancer Pain.’


Treatment of obesity

Weight loss is likely to reduce symptoms of pain in obese patients. Obesity may be treated using a number of different approaches. Lifestyle changes may involve healthy eating, reducing alcohol intake and increasing exercise. Meal replacement programs, drugs or therapy may also be prescribed. Weight loss surgery is usually only considered as a last resort, when all other approaches have failed.

More information

Obesity and weight loss
For more information on obesity, health and social issues, and methods of weight loss, as well as some useful tools, see
Obesity and Weight Loss.
Living with obesity
For more information on living with obesity, including discussing obesity with friends or loved ones, bullying and obesity in children, obesity and its cost on the workplace and links between obesity and sexuality, fertility and depression, see Living with Obesity.

 

References

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  2. Carr B, Goudas L.’Acute pain’, Lancet. 1999, vol.353, issue 9169, pg.2051-2058
  3. Loeser JD, Melzack R.’Pain: an overview,’ Lancet. 1999, vol.353, issue.9164, pg.1607-1609.
  4. Hunter New England Area Health Service. Community Information Series: ‘Pain Matters: The Nature of Pain.’ NSW, March 2007
  5. Reproduced from: Obesity: Preventing and Managing the Global Epidemic, 2000, WHO, Geneva
  6. NHMRC, National clinical guidelines on weight control and obesity management, 2002, NHMRC, Canberra
  7. Hitt, H. McMillen, R. Thornton-Neaves, Koch, K & Corby, A. ‘Comorbidity of Obesity and Pain in a General Population: Results from the Southern Pain Prevalence Study’, The Journal of Pain, vol.8, issue 5, May 2007, pg.430-436.
  8. Jinks, C. Jordan, K. Croft, P. ‘Disabling knee pain – another consequence of obesity: Results from a prospective cohort study’, BMC Public Health 2006, vol. 6, pg.258
  9. Janke, E. ‘Pain and Obesity: Where we have been, where we are going’, Journal of Pain, vol.7, issue 4, supplement 1. April 2006, page S88
  10. Wearing, SC. Henning, EM, Byrne, NM, Steele, JR, Hills, AP. ‘Musculoskeletal disorders associated with obesity: a biomechanical perspective’ Obesity Reviews, Aug 2006, vol. 7, issue 3, pg.239-250, 12p, 1 chart