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Olson KL, Eccleston C. Reconsidering the Role of Weight Loss in Treatment for Chronic Pain: Knee Osteoarthritis as an Exemplar. THE JOURNAL OF PAIN 2024:104647. [PMID: 39103008 DOI: 10.1016/j.jpain.2024.104647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/07/2024]
Abstract
Chronic pain is prevalent among individuals with higher body weight and associated with greater impairment. As a result, weight loss is a common recommendation for pain management among those with higher body weight. Body weight is an appealing target because it is modifiable and evidence-based treatments to produce weight loss are well-established. In the last 2 decades, there has been a growing line of scientific work investigating the application of weight loss to individuals with chronic pain. This represents an important step to integrate the conceptualization of pain and body weight and there is preliminary work suggesting treatment effects are enhanced when weight loss treatment is combined with pain coping skills. However, weight loss outcomes are variable and difficult to sustain, and access to evidence-based treatment is limited. These concerns are set against the backdrop of growing public and academic concern about the weight-centric approach to health care that dominates western medicine. This is a timely moment to reconsider the conceptualization of weight and pain, and the role of weight loss in chronic pain treatment. Using osteoarthritis as an exemplar, we review the evidence for and clinical uptake of weight loss as a chronic pain management strategy and conclude with key areas for consideration to advance the scientific understanding of these comorbid conditions and how to optimize pain management for individuals of higher body weight. PERSPECTIVE: This focus article critically considers the role of weight loss in management of chronic pain among individuals of higher body. Using knee osteoarthritis as an exemplar, the evidence and clinical uptake of weight loss for pain management is reviewed. Limitations are considered to guide future research and clinical care.
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Affiliation(s)
- KayLoni L Olson
- Weight Control and Diabetes Research Center, Miriam Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island.
| | - Christopher Eccleston
- Research Department for Health, University of Bath, Bath, England; Centre for Pain Research, University of Bath, Bath, England
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Pyykkö JE, Zwartjes M, Nieuwdorp M, van Olst N, Bruin SC, van de Laar AW, Sanderman R, Hagedoorn M, Gerdes VEA. Differences in Psychological Health and Weight Loss after Bariatric Metabolic Surgery between Patients with and without Pain Syndromes. Obes Surg 2024; 34:1693-1703. [PMID: 38499942 PMCID: PMC11031447 DOI: 10.1007/s11695-024-07171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Chronic pain and obesity often co-occur, negatively affecting one another and psychological wellbeing. Pain and psychological wellbeing improve after bariatric metabolic surgery (BMS), however, it is unknown whether psychological wellbeing improves differently after weight loss between patients with and without chronic pain. We investigated whether weight loss is associated with greater psychological wellbeing and functioning change after BMS, comparing patients with and without preoperative pain syndromes. METHODS Depression, health-related quality of life, self-esteem, self-efficacy to exercise and controlling eating behaviours, physical activity, and food cravings were measured before and 24 months after BMS among 276 patients with obesity. The presence of preoperative chronic pain syndromes was examined as a moderator for the relationship between 24-month weight loss and changes in psychological outcomes. RESULTS Chronic pain syndromes were present among 46% of patients. Weight loss was associated with greater improvement in health-related quality of life, self-efficacy to exercise and controlling eating behaviours, self-esteem and greater amelioration in food cravings. Pain syndromes only moderated negatively the relationship between the postoperative weight loss and change in self-efficacy to control eating behaviours (b = -0.49, CI [-0.88,-0.12]). CONCLUSION Patients with and without chronic pain showed similar improvements in weight and psychological wellbeing and behaviours after BMS. The relationship between weight loss and the improvement of self-efficacy to control eating behaviours was weaker among patients with chronic pain syndrome. Further work, measuring pain severity over time, is needed to shed light on the mechanism underlying pain and postoperative change in psychological wellbeing and weight loss.
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Affiliation(s)
- Johanna E Pyykkö
- Department of Health Psychology, Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, Netherlands.
| | - Max Zwartjes
- Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Max Nieuwdorp
- Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
- Department of Metabolic and Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
| | - Nienke van Olst
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
- Department of Metabolic and Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
| | - Sjoerd C Bruin
- Department of Metabolic and Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
| | - Arnold W van de Laar
- Department of Metabolic and Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology, Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, Netherlands
| | - Victor E A Gerdes
- Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, Netherlands
- Department of Vascular Medicine, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
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Garcia MM, Corrales P, Huerta MÁ, Czachorowski MJ, López-Miranda V, Medina-Gómez G, Cobos EJ, Goicoechea C, Molina-Álvarez M. 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. Front Endocrinol (Lausanne) 2024; 15:1340465. [PMID: 38510698 PMCID: PMC10950917 DOI: 10.3389/fendo.2024.1340465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Context Over 1.9 billion adult people have overweight or obesity. Considered as a chronic disease itself, obesity is associated with several comorbidities. Chronic pain affects approximately 60 million people and its connection with obesity has been displayed in several studies. However, controversial results showing both lower and higher pain thresholds in subjects with obesity compared to individuals with normal weight and the different parameters used to define such association (e.g., pain severity, frequency or duration) make it hard to draw straight forward conclusions in the matter. The objective of this article is to examine the relationship between overweight and obesity (classified with BMI as recommended by WHO) and self-perceived pain intensity in adults. Methods A literature search was conducted following PRISMA guidelines using the databases CINAHL, Cochrane Library, EMBASE, PEDro, PubMed, Scopus and Web of Science to identify original studies that provide BMI values and their associated pain intensity assessed by self-report scales. Self-report pain scores were normalized and pooled within meta-analyses. The Cochrane's Q test and I2 index were used to clarify the amount of heterogeneity; meta-regression was performed to explore the relationship between each outcome and the risk of bias. Results Of 2194 studies, 31 eligible studies were identified and appraised, 22 of which provided data for a quantitative analysis. The results herein suggested that adults with excess weight (BMI ≥ 25.0) or obesity (BMI ≥ 30.0) but not with overweight (pre-obesity) alone (BMI 25.0-29.9), are more likely to report greater intensities of pain than individuals of normal weight (BMI 18.5-24.9). Subgroup analyses regarding the pathology of the patients showed no statistically significant differences between groups. Also, influence of age in the effect size, evaluated by meta-regression, was only observed in one of the four analyses. Furthermore, the robustness of the findings was supported by two different sensitivity analyses. Conclusion Subjects with obesity and excess weight, but not overweight, reported greater pain intensities than individuals with normal weight. This finding encourages treatment of obesity as a component of pain management. More research is required to better understand the mechanisms of these differences and the clinical utility of the findings. Systematic Review Registration https://doi.org/10.17605/OSF.IO/RF2G3, identifier OSF.IO/RF2G3.
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Affiliation(s)
- Miguel M. Garcia
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Universidad Rey Juan Carlos, Unidad Asociada de I+D+i al Instituto de Química Médica (IQM) CSIC-URJC, Alcorcón, Spain
- High Performance Experimental Pharmacology Research Group, Universidad Rey Juan Carlos (PHARMAKOM), Alcorcón, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL), Alcorcón, Spain
| | - Patricia Corrales
- Area of Biochemistry, Department of Basic Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Spain
- High Performance Research Group in the Study of the Molecular Mechanisms of Glucolipotoxicity and Insulin Resistance: Implications in Obesity, Diabetes and Metabolic Syndrome, Universidad Rey Juan Carlos (LIPOBETA), Alcorcón, Spain
- Consolidated Research Group on Obesity and Type 2 Diabetes: Adipose Tissue Biology (BIOFAT), Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Miguel Á. Huerta
- Department of Pharmacology and Neurosciences Institute (Biomedical Research Center), Universidad de Granada, Granada, Spain
- Biosanitary Research Institute ibs.GRANADA, Granada, Spain
| | | | - Visitación López-Miranda
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Universidad Rey Juan Carlos, Unidad Asociada de I+D+i al Instituto de Química Médica (IQM) CSIC-URJC, Alcorcón, Spain
- High Performance Experimental Pharmacology Research Group, Universidad Rey Juan Carlos (PHARMAKOM), Alcorcón, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL), Alcorcón, Spain
| | - Gema Medina-Gómez
- Area of Biochemistry, Department of Basic Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Spain
- High Performance Research Group in the Study of the Molecular Mechanisms of Glucolipotoxicity and Insulin Resistance: Implications in Obesity, Diabetes and Metabolic Syndrome, Universidad Rey Juan Carlos (LIPOBETA), Alcorcón, Spain
| | - Enrique J. Cobos
- Department of Pharmacology and Neurosciences Institute (Biomedical Research Center), Universidad de Granada, Granada, Spain
- Biosanitary Research Institute ibs.GRANADA, Granada, Spain
- Teófilo Hernando Institute for Drug Discovery, Madrid, Spain
| | - Carlos Goicoechea
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Universidad Rey Juan Carlos, Unidad Asociada de I+D+i al Instituto de Química Médica (IQM) CSIC-URJC, Alcorcón, Spain
- High Performance Experimental Pharmacology Research Group, Universidad Rey Juan Carlos (PHARMAKOM), Alcorcón, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL), Alcorcón, Spain
| | - Miguel Molina-Álvarez
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Universidad Rey Juan Carlos, Unidad Asociada de I+D+i al Instituto de Química Médica (IQM) CSIC-URJC, Alcorcón, Spain
- High Performance Experimental Pharmacology Research Group, Universidad Rey Juan Carlos (PHARMAKOM), Alcorcón, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL), Alcorcón, Spain
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Dong HJ, Brain K, Olsson M, Dragioti E, Gerdle B, Ghafouri B. Eating habits and the desire to eat healthier among patients with chronic pain: a registry-based study. Sci Rep 2024; 14:4705. [PMID: 38409442 PMCID: PMC10897138 DOI: 10.1038/s41598-024-55449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/23/2024] [Indexed: 02/28/2024] Open
Abstract
Healthcare professionals often meet pain patients with a poor nutritional status such as obesity, unhealthy dietary behaviors, and a suboptimal dietary intake. A poor nutritional status may play a significant role in the occurrence, development, and prognosis of chronic pain. This study investigated eating habits in a specialized pain rehabilitation center using data (N = 2152) from the Swedish quality registry for pain rehabilitation during the period 2016-2021. Patients answered a lifestyle questionnaire regarding their eating habits and desire to modify their lifestyle. The mean (SD) patient age was 46.1 (14.6) years, with 24.8% classified as obese. Suboptimal eating habits included irregular mealtimes (27.2%), weekly consumption of fast-food (20.3%) and nearly daily consumption of confectionery (33.3%). Approximately 20% (n = 426) reported a desire to eat healthier. Frequent confectionery intake (Odds ratio [OR] 1.23, 95% Confidence Interval (CI) 1.04-1.47) and fast-food consumption (OR 1.58, 95% CI 1.24-2.02) increased the likelihood to desire healthier eating. Younger patients (18-29 years), those classified as obese, and those with more extended spatial pain were more likely to express a desire to eat healthier. Eating habits should be addressed in pain management and interdisciplinary pain rehabilitation teams are encouraged to provide nutritional care tailored to the patient's needs.
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Affiliation(s)
- Huan-Ji Dong
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden.
| | - Katherine Brain
- School of Health Science, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Integrated Pain Service, Newcastle, NSW, 2300, Australia
| | - Max Olsson
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, 45500, Ioannina, Greece
| | - Björn Gerdle
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, 22185, Lund, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, 58185, Linköping, Sweden
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Lamoureux E, Pagé MG. The Importance of Good Measurement: Development and Validation of a Measure of Disordered Eating Among Adults with Chronic Pain. Can J Pain 2024; 8:2284815. [PMID: 38425884 PMCID: PMC10900263 DOI: 10.1080/24740527.2023.2284815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- E. Lamoureux
- Research Center, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, Quebec, Canada
| | - M. G. Pagé
- Research Center, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
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Ward SJ, Coates AM, Baldock KL, Berryman C, Hill AM. Characterising concurrent pain experience and dietary patterns in people with chronic musculoskeletal pain: a feasibility study protocol. Pilot Feasibility Stud 2024; 10:13. [PMID: 38254236 PMCID: PMC10801926 DOI: 10.1186/s40814-023-01438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Nutrition-related factors linked to pain chronicity and disability include weight status and dietary behaviours. Dietary patterns associated with concurrent pain episodes, however, remain poorly characterised. This paper outlines the protocol for a feasibility study that aims to characterise pain-related dietary and lifestyle behaviours in people experiencing chronic musculoskeletal pain. METHODS The study will recruit participants who experience musculoskeletal pain on 5 or more days of the week for at least 3 months. Participants will attend two in-person clinic visits where physical measurements and a series of pain and lifestyle questionnaires will be completed. Visits will be conducted pre and post a 2-week self-monitoring period where participants will self-report concurrent diet, sleep, mood, and pain on four days and will wear a wrist-worn activity monitor (GENEActiv). Key feasibility metrics will evaluate participant recruitment, enrolment and retention rates, and compliance with the study data collection protocol. DISCUSSION There remains a lack of evidence behind dietary advice as an adjunct pain management tool. Upon completion of the protocol, feasibility outcomes will identify challenges to guide the design and delivery of a dietary intervention for chronic musculoskeletal pain.
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Affiliation(s)
- Susan J Ward
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Alison M Coates
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Katherine L Baldock
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Carolyn Berryman
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- Innovation IMPlementation And Clinical Translation (IIMPACT), University of South Australia, Adelaide, Australia
| | - Alison M Hill
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
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Burton AL, O’Loughlin I, Rogers K, Newton-John TRO. Development and validation of the Pain-Induced Comfort Eating Scale in a chronic pain sample. Can J Pain 2023; 8:2288888. [PMID: 38659424 PMCID: PMC11042059 DOI: 10.1080/24740527.2023.2288888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/24/2023] [Indexed: 04/26/2024]
Abstract
Background Chronic pain and higher body weight frequently co-occur. This common comorbidity is thought to be mediated by the use of comfort eating as a strategy for managing both the physical and psychological pain and discomfort associated with flare-ups of chronic pain. Valid and reliable assessment tools are needed to inform the development of effective treatments. Aims This study aimed to assess the psychometric properties of a new brief measure of pain-induced comfort eating in chronic pain, the Pain-Induced Comfort Eating Scale (PICES). Methods A sample of 166 patients with chronic pain completed an online test battery including the PICES along with measures of chronic pain and pain-related symptoms, disordered eating, and related psychological factors. Results Results of exploratory factor analysis revealed a single-factor model for the four-item PICES. Further, the PICES demonstrated evidence of good internal consistency as well as convergent validity with demonstrated correlations with related measures. The results of this study also revealed that comfort eating in chronic pain appears to be related to psychological distress; the PICES correlated more strongly with measures assessing mood and psychological distress compared to interference/intensity of physical pain itself. Scores on the PICES also correlated strongly with measures of uncontrolled and emotional eating. Conclusions Overall, our results indicate that the PICES provides a valid and useful brief measure of comfort eating in chronic pain that might be useful to inform treatments targeting the comorbid disordered eating practices that can lead to higher body weights in patients with chronic pain.
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Affiliation(s)
- Amy L. Burton
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Imogen O’Loughlin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Kris Rogers
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Storm E, Bendelin N, Wessman KB, Johansson MM, Björk M, Dong HJ. Lifestyle changes are burdensome with my body broken by pain and obesity: patients' perspectives after pain rehabilitation. BMC Musculoskelet Disord 2023; 24:840. [PMID: 37880642 PMCID: PMC10599046 DOI: 10.1186/s12891-023-06961-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Despite the existing evidence regarding the interrelated relationship between pain and obesity, knowledge about patients' perspectives of this relationship is scarce, especially from patients with chronic pain and obesity after completing Interdisciplinary Pain Rehabilitation Program (IPRP). AIMS This qualitative study expands the understanding of patients' perspectives on how chronic pain and obesity influence each other and how the two conditions affect the ability to make lifestyle changes. METHOD A purposive sample of patients with Body Mass Index (BMI) ≥ 30 kg/m2 and who had completed an IPRP were recruited for individual semi-structured interviews. The transcribed interviews were analysed using latent content analysis and a pattern of theme and categories was constructed based on the participants' perspectives. RESULTS Sixteen patients (aged 28-63 years, 11 female, BMI 30-43 kg/m2) shared their experiences of chronic pain, obesity and lifestyle changes after IPRP. The analysis revealed one overall theme (lifestyle changes are burdensome with a body broken by both pain and obesity) and four categories (pain disturbing days and nights worsens weight control, pain-related stress makes lifestyle changes harder, a painful and obese body intertwined with negative emotions and the overlooked impact of obesity on chronic pain). Most participants perceived that their pain negatively impacted their obesity, but they were uncertain whether their obesity negatively impacted their pain. Nevertheless, the participants desired and struggled to make lifestyle changes. CONCLUSION After IPRP, patients with chronic pain and obesity perceived difficulties with self-management and struggles with lifestyle changes. They experienced a combined burden of the two conditions. Their perspective on the unilateral relationship between pain and obesity differed from the existing evidence. Future tailored IPRPs should integrate nutritional interventions and address the knowledge gaps as well.
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Affiliation(s)
- Elin Storm
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Nina Bendelin
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kim Bergström Wessman
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria M Johansson
- Department of Activity and Health in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Huan-Ji Dong
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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Edwards SA, Martin SL, Rainey T, Whitaker G, Greenwood DC, Jones A, Sivan M. Influence of acute fasting on pain tolerance in healthy subjects: a randomised crossover study. FRONTIERS IN PAIN RESEARCH 2023; 4:1153107. [PMID: 37753146 PMCID: PMC10518402 DOI: 10.3389/fpain.2023.1153107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
Background Although chronic pain and obesity are global health crises with substantial healthcare costs, little is known about the relationship between pain perception and eating behaviours. Food consumption has been reported to provide an analgesic effect by the release of neurotransmitters modulating the pain network. However, whether short-term (acute) fasting affects pain perception remains unclear. Purpose This study aimed to investigate the effect of acute fasting on pain perception and whether attention and mood changes drove the observed changes. Patients and methods The cold pressor test (CPT) was used to investigate the pain tolerance of 25 healthy participants in both non-fasting and 12-h fasting sessions. They were randomised to either session with a crossover to the other after at least 24 h, with the experimenter blinded to the sessions. The pain tolerance was measured using a Stroop task in both attentive and distracted states. The Profile of Mood States (POMS) questionnaire was used to capture the mood, and a 10-point hunger scale was used to measure hunger. Mixed-effects models were used to investigate the influence of fasting and distraction on pain perception, accounting for the repeated measures. Results Fasting reduced CPT pain tolerance, with fasting participants twice as likely to withdraw their hands early (hazard ratio = 2.4, 95% CI: 1.3-4.5). Though men tolerated CPT pain longer than women, there was no evidence that men responded to fasting differently than women (p = 0.9). In addition, no evidence supporting that fasting affected attention or mood was found. Nonetheless, it increased hunger scores by 2.7 points on a 10-point scale (95% CI: 1.2-4.2) and decreased blood glucose concentration levels by 0.51 mmol/L (95% CI: 0.19-0.84). Conclusion Acute fasting reduces pain tolerance in the healthy participants, and this effect is independent of gender and attention or mood changes.
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Affiliation(s)
- Sophie A. Edwards
- The Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Sarah L. Martin
- The Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
- Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Timothy Rainey
- The Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Grace Whitaker
- Centro de Investigación y Desarrollo en Ingeniería en Salud, Universidad de Valparaiso, Valparaiso, Chile
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Anthony Jones
- The Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Manoj Sivan
- The Human Pain Research Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
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Zhang DH, Fan YH, Zhang YQ, Cao H. Neuroendocrine and neuroimmune mechanisms underlying comorbidity of pain and obesity. Life Sci 2023; 322:121669. [PMID: 37023950 DOI: 10.1016/j.lfs.2023.121669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023]
Abstract
Pain and obesity, as well as their associated impairments, are major health concerns. Understanding the relationship between the two is the focus of a growing body of research. However, early researches attribute increased mechanical stress from excessive weight as the main factor of obesity-related pain, which not only over-simplify the association, but also fail to explain some controversial outcomes arising from clinical investigations. This review focuses on neuroendocrine and neuroimmune modulators importantly involved in both pain and obesity, analyzing nociceptive and anti-nociceptive mechanisms based on neuroendocrine pathways including galanin, ghrelin, leptin and their interactions with other neuropeptides and hormone systems which have been reported to play roles in pain and obesity. Mechanisms of immune activities and metabolic alterations are also discussed, due to their intense interactions with neuroendocrine system and crucial roles in the development and maintenance of inflammatory and neuropathic pain. These findings have implications for health given rising rates of obesity and pain-related diagnoses, by providing novel weight-control and analgesic therapies targeted on specific pathways.
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Affiliation(s)
- Dao-Han Zhang
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Ying-Hui Fan
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yu-Qiu Zhang
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
| | - Hong Cao
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China.
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Salwa A, Zvolensky MJ, Kauffman B. The association between anxiety sensitivity and food cravings among individuals seeking treatment for weight-related behaviors. Eat Behav 2023; 48:101684. [PMID: 36463666 PMCID: PMC9974607 DOI: 10.1016/j.eatbeh.2022.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND A better understanding of risk-factors associated with state-like food cravings may be one clinically relevant component in an effort to better understand obesity. Existing work has shown anxiety sensitivity (AS) to be a significant risk factor for increased cravings across a variety of health behaviors (e.g., smoking, alcohol use). Yet, no work has examined the relationship between AS and state-like food cravings. Therefore, the current study sought to examine the association between AS and a variety of state-like food cravings, including: (1) an intense desire to eat, (2) anticipation of relief from negative states and feelings/improvement in mood that may result from eating, (3) obsessive preoccupation with food or lack of control over eating, and (4) craving as a physiological state. METHODS Participants included 161 (Mage = 31.58, SD = 10.71; 60.9 % female) individuals seeking treatment for weight-related behaviors. RESULTS Results indicated that elevated AS was associated with reinforcement-based and physiological food cravings. CONCLUSION Our findings indicate that there may be clinical utility in screening for AS among individuals seeking treatment for weight-related behaviors in efforts to better understand specific types of food craving.
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Affiliation(s)
- Aniqua Salwa
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; HEALTH Institute, University of Houston, Houston, TX, USA.
| | - Brooke Kauffman
- Department of Psychology, University of Houston, Houston, TX, USA
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12
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Smart KM, Hinwood NS, Dunlevy C, Doody CM, Blake C, Fullen BM, Le Roux CW, O'Connell J, Gilsenan C, Finucane FM, O'Donoghue G. Multidimensional pain profiling in people living with obesity and attending weight management services: a protocol for a longitudinal cohort study. BMJ Open 2022; 12:e065188. [PMID: 36526309 PMCID: PMC9764675 DOI: 10.1136/bmjopen-2022-065188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Pain is prevalent in people living with overweight and obesity. Obesity is associated with increased self-reported pain intensity and pain-related disability, reductions in physical functioning and poorer psychological well-being. People living with obesity tend to respond less well to pain treatments or management compared with people living without obesity. Mechanisms linking obesity and pain are complex and may include contributions from and interactions between physiological, behavioural, psychological, sociocultural, biomechanical and genetic factors. Our aim is to study the multidimensional pain profiles of people living with obesity, over time, in an attempt to better understand the relationship between obesity and pain. METHODS AND ANALYSIS This longitudinal observational cohort study will recruit (n=216) people living with obesity and who are newly attending three weight management services in Ireland. Participants will complete questionnaires that assess their multidimensional biopsychosocial pain experience at baseline and at 3, 6, 12 and 18 months post-recruitment. Quantitative analyses will characterise the multidimensional pain experiences and trajectories of the cohort as a whole and in defined subgroups. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics and Medical Research Committee of St Vincent's Healthcare Group, Dublin, Ireland (reference no: RS21-059) and the University College Dublin Human Research Ethics Committee (reference no: LS-E-22-41-Hinwood-Smart). Findings will be disseminated through peer-reviewed journals, conference presentations, public and patient advocacy groups, and social media. STUDY REGISTRATION Open Science Framework Registration DOI: https://doi.org/10.17605/OSF.IO/QCWUE.
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Affiliation(s)
- Keith M Smart
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Physiotherapy Department, St Vincent's University Hospital, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Natasha S Hinwood
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Colin Dunlevy
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
| | - Catherine M Doody
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Brona M Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Carel W Le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Jean O'Connell
- Weight Management Service, St Columcille's Hospital, Dublin, Ireland
| | - Clare Gilsenan
- Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Francis M Finucane
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
- School of Medicine, College of Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Grainne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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13
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Elma Ö, Brain K, Dong HJ. The Importance of Nutrition as a Lifestyle Factor in Chronic Pain Management: A Narrative Review. J Clin Med 2022; 11:5950. [PMID: 36233817 PMCID: PMC9571356 DOI: 10.3390/jcm11195950] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
In everyday clinical practice, healthcare professionals often meet chronic pain patients with a poor nutritional status. A poor nutritional status such as malnutrition, unhealthy dietary behaviors, and a suboptimal dietary intake can play a significant role in the occurrence, development, and prognosis of chronic pain. The relationship between nutrition and chronic pain is complex and may involve many underlying mechanisms such as oxidative stress, inflammation, and glucose metabolism. As such, pain management requires a comprehensive and interdisciplinary approach that includes nutrition. Nutrition is the top modifiable lifestyle factor for chronic non-communicable diseases including chronic pain. Optimizing one's dietary intake and behavior needs to be considered in pain management. Thus, this narrative review reports and summarizes the existing evidence regarding (1) the nutrition-related health of people experiencing pain (2) the underlying potential mechanisms that explain the interaction between nutrition and chronic pain, and (3) the role of nutrition screening, assessment and evaluation for people experiencing pain and the scope of nutrition practice in pain management. Future directions in the nutrition and chronic pain field are also discussed.
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Affiliation(s)
- Ömer Elma
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| | - Katherine Brain
- School of Health Science, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Integrated Pain Service, Newcastle, NSW 2300, Australia
| | - Huan-Ji Dong
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden
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14
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Koning E, Vorstman J, McIntyre RS, Brietzke E. Characterizing eating behavioral phenotypes in mood disorders: a narrative review. Psychol Med 2022; 52:2885-2898. [PMID: 36004528 PMCID: PMC9693712 DOI: 10.1017/s0033291722002446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023]
Abstract
Mood disorders, including depressive and bipolar disorders, represent a multidimensional and prevalent group of psychiatric illnesses characterized by disturbances in emotion, cognition and metabolism. Maladaptive eating behaviors in mood disorders are diverse and warrant characterization in order to increase the precision of diagnostic criteria, identify subtypes and improve treatment strategies. The current narrative review synthesizes evidence for Eating Behavioral Phenotypes (EBP) in mood disorders as well as advancements in pathophysiological conceptual frameworks relevant to each phenotype. Phenotypes include maladaptive eating behaviors related to appetite, emotion, reward, impulsivity, diet style and circadian rhythm disruption. Potential treatment strategies for each phenotype are also discussed, including psychotherapeutic, pharmacological and nutritional interventions. Maladaptive eating behaviors related to mood disorders are relevant from both clinical and research perspectives, yet have been somewhat overlooked thus far. A better understanding of this aspect of mood disorders holds promise to improve clinical care in this patient group and contribute to the subtyping of these currently subjectively diagnosed and treated disorders.
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Affiliation(s)
- Elena Koning
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Jacob Vorstman
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Elisa Brietzke
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
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15
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Li W, Liu P, Li Z, Meng J. Capsaicin-induced pain increases neural responses to low-calorie non-spicy food cues: An ERP study. Biol Psychol 2022; 174:108408. [PMID: 35973635 DOI: 10.1016/j.biopsycho.2022.108408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/25/2022] [Accepted: 08/10/2022] [Indexed: 11/02/2022]
Abstract
Capsaicin, the main spicy ingredient in chili, can activate pain receptors on the human tongue and skin. Although some studies have determined that pain influenced preference for high-calorie foods, little is known whether pain can modulate the individuals' preference for spicy foods and its neural mechanisms. After 30 participants underwent painful (topical capsaicin cream) and control (hand cream) treatments, an event-related potential (ERP) study was conducted to investigate the modulation of capsaicin-induced pain on food preference with food images. Results showed that both P3 and late positive potential (LPP) amplitudes during the painful treatment were significantly larger than those during the control treatment for low-calorie non-spicy food cues. However, for the other three categories of food cues, there were no significant differences between the two treatments. The present study suggests that capsaicin-induced pain increases individuals' neural processing of low-calorie non-spicy food cues, which provides empirical evidence on the relationship between pain and neural responses to food cues to help optimize dietary interventions for patients experiencing pain.
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Affiliation(s)
- Wanchen Li
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, 401331, China; Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, China
| | - Peiyi Liu
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, 401331, China; Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, China
| | - Zuoshan Li
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, 401331, China; Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, China
| | - Jing Meng
- Key Laboratory of Applied Psychology, Chongqing Normal University, Chongqing, 401331, China; Research Center for Brain and Cognitive Science, Chongqing Normal University, Chongqing, China.
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16
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Chronic Pain: Among Tertiary Care Psychiatric Out-Patients in Singapore—Prevalence and Associations with Psychiatric Disorders. Pain Res Manag 2022; 2022:1825132. [PMID: 35463629 PMCID: PMC9033364 DOI: 10.1155/2022/1825132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
Abstract
Objective The study aimed to determine the prevalence and severity of chronic pain and its associations amongst psychiatric out-patients in a tertiary care hospital in Singapore. Methodology. The cross-sectional study was conducted among 290 psychiatric out-patients aged 21–65 years. Sociodemographic and clinical information, as well as data from Brief Pain Inventory-Short Form (BPI-sf), Beck's Depression Inventory II (BDI-II), and Beck's Anxiety Inventory (BAI) were collected. Cut points (C.P.s) dividing the sample into mild, moderate, and severe groups were created for the ratings of average pain. Eight possible cut-off values for the C.P.s between 3 and 7, representing 8 different categorical variables, were created and their relationships were examined with BPI's set of seven interference items using multivariate analysis of variance. Sociodemographic and clinical correlates of chronic pain were determined using multinomial logistic regression analysis. Analysis of covariance was used to determine the association of BPI with continuous scores of BAI and BDI. Results Based on the C.P. pain severity classification, 38.5% of the sample had mild pain, 22.9% had moderate pain, and 11.8% had severe pain. Patients with severe pain were more likely to be associated with older age (p ≤ 0.006) (versus young age), less likely to be married (p ≤ 0.025) (versus single), and more likely to have high risk for obesity (p ≤ 0.030) (versus low risk for obesity). Participants with mild pain were seen to be significantly associated with older age (p ≤ 0.021), whereas moderate pain (p ≤ 0.002) and severe pain (p ≤ 0.001) (versus no pain) were seen to be significantly associated with higher BAI scores. Conclusion The current study observed high prevalence of pain among patients with psychiatric illness that was determined by optimal C.P.s for mild, moderate, and severe pain. Patients diagnosed with anxiety disorders and those with higher BMI were seen to be associated with pain of moderate to severe intensity. Improving the knowledge of correlates and co-morbidities of physical pain would aid in early identification, use of prophylactic strategies, and the intervention techniques to formulate basic guidelines for pain management among psychiatric population.
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17
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Kauffman BY, Rogers AH, Garey L, Zvolensky MJ. Anxiety and depressive symptoms among adults with obesity and chronic pain: the role of anxiety sensitivity. Cogn Behav Ther 2022; 51:295-308. [PMID: 35001838 DOI: 10.1080/16506073.2021.2011396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Obesity and chronic pain frequently co-occur, and this co-occurrence can have potential negative consequences, particularly as it relates to mental health. As such, there is a need to understand potential risk factors for poor mental health among this co-morbid population. Thus, the current study examined the predictive role of anxiety sensitivity (and its sub-facets) on anxiety and depressive symptoms among adults (82.5% female, Mage = 40.2 years, SD = 10.92) with obesity and chronic pain. Results revealed that greater levels of anxiety sensitivity were associated with greater levels of both anxiety and depressive symptoms, with medium to large effect sizes. Post hoc analyses also indicated that specific sub-facets of anxiety sensitivity (cognitive and social concerns) were significant predictors of the criterion variables. The current study highlights the potential clinical utility in targeting anxiety sensitivity among individuals with co-occurring obesity and chronic pain in the treatment of anxiety and depressive symptoms.
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Affiliation(s)
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Health Institute, University of Houston, Houston, TX, USA
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18
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Field RJ, Field TJ, Pourkazemi F, Rooney KB. Experience of participants with chronic pain in a pilot randomized clinical trial using a ketogenic diet. Pain Manag 2021; 12:313-322. [PMID: 34758629 DOI: 10.2217/pmt-2021-0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: To report the experience of chronic pain participants after a well-formulated ketogenic diet (WFKD) or whole-food diet (WFD). The quantitative outcomes for this trial have been published separately (clinical trial registration number ACTRN12620000946910). Patients & methods: The experience of 24 participants was evaluated after 12 and 24 weeks of dietary intervention using survey responses and open questions. Results & conclusion: Retention rates for the WFKD and WFD groups were 93 and 89%, respectively. Average adherence to the WFKD was 82% and to the WFD was 87%. The WFKD enjoyment was rated at 66 and 81% for the WFD group. The ease of adhering to the diet varied more widely for the WFKD group. Barriers included knowledge integration, time management, navigating social food environments and emotional attachment to eliminated foods. Facilitators included structured support and coaching, and comprehensive learning materials. The WFKD was shown to be a feasible and effective treatment option for chronic pain.
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Affiliation(s)
- Rowena J Field
- Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Tara J Field
- The New South Wales Ministry of Health (NSW Health), Sydney, Australia
| | | | - Kieron B Rooney
- Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
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19
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Brain K, Burrows TL, Bruggink L, Malfliet A, Hayes C, Hodson FJ, Collins CE. Diet and Chronic Non-Cancer Pain: The State of the Art and Future Directions. J Clin Med 2021; 10:5203. [PMID: 34768723 PMCID: PMC8584994 DOI: 10.3390/jcm10215203] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 12/28/2022] Open
Abstract
Nutrition plays an important role in pain management. Healthy eating patterns are associated with reduced systemic inflammation, as well as lower risk and severity of chronic non-cancer pain and associated comorbidities. The role of nutrition in chronic non-cancer pain management is an emerging field with increasing interest from clinicians and patients. Evidence from a number of recent systematic reviews shows that optimising diet quality and incorporating foods containing anti-inflammatory nutrients such as fruits, vegetables, long chain and monounsaturated fats, antioxidants, and fibre leads to reduction in pain severity and interference. This review describes the current state of the art and highlights why nutrition is critical within a person-centred approach to pain management. Recommendations are made to guide clinicians and highlight areas for future research.
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Affiliation(s)
- Katherine Brain
- School of Health Science, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.B.); (T.L.B.)
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Integrated Pain Service, Newcastle, NSW 2300, Australia; (L.B.); (C.H.); (F.J.H.)
| | - Tracy L. Burrows
- School of Health Science, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.B.); (T.L.B.)
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Laura Bruggink
- Hunter Integrated Pain Service, Newcastle, NSW 2300, Australia; (L.B.); (C.H.); (F.J.H.)
| | - Anneleen Malfliet
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
- Pain in Motion International Research Group, 1000 Brussels, Belgium
- Research Foundation Flanders (FWO), 1000 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| | - Chris Hayes
- Hunter Integrated Pain Service, Newcastle, NSW 2300, Australia; (L.B.); (C.H.); (F.J.H.)
| | - Fiona J. Hodson
- Hunter Integrated Pain Service, Newcastle, NSW 2300, Australia; (L.B.); (C.H.); (F.J.H.)
| | - Clare E. Collins
- School of Health Science, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.B.); (T.L.B.)
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
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20
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Kauffman BY, Kroeger R, Rogers AH, Garey L, Ditre JW, Zvolensky MJ. Anxiety sensitivity and modifiable cardiovascular disease risk factors: the role of pain intensity among individuals with chronic pain. J Behav Med 2021; 45:297-305. [PMID: 34739661 PMCID: PMC10062191 DOI: 10.1007/s10865-021-00262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
Chronic pain is often comorbid with modifiable cardiovascular disease risk factors, such as obesity and tobacco use. Among individuals with chronic pain, psychological risk factors may increase pain which, in turn, may increase risk for modifiable cardiovascular disease correlates. Thus, the current study examined the explanatory role of pain intensity in the relationship between anxiety sensitivity and two well-documented modifiable cardiovascular disease risk factors. Participants included 396 adults with chronic pain who completed an online survey from a larger study examining chronic pain-mental health relations. Results revealed that higher levels of anxiety sensitivity were related to higher levels of body mass index (BMI) through greater levels of pain intensity. Bi-directional relations were observed between anxiety sensitivity and pain intensity for tobacco risk. The current study highlights a potential transdiagnostic cognitive vulnerability factor, anxiety sensitivity, which may be an important treatment target to reduce modifiable cardiovascular disease risk factors via reductions in pain intensity.
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Affiliation(s)
- Brooke Y Kauffman
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Ryan Kroeger
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 3695 Cullen Blvd., Room 126, Houston, TX, 77204, USA.
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- HEALTH Institute, University of Houston, Houston, TX, USA.
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21
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Abstract
Facial emotion recognition (FER) is extensively investigated in psychological sciences in healthy individuals and clinical conditions. In this paper, we analyzed those studies in which FER was assessed in the case of obesity or fibromyalgia, in relation to the levels of alexithymia. Crucially, these two conditions frequently co-occur; however, no study has explored FER considering both fibromyalgia and obesity. Studies were identified using the electronic search engine of PubMed. The last research was run on 23 July 2021. Two independent lists were generated for the two clinical conditions. Six records were reviewed about obesity, while three records about fibromyalgia. The evidence relative to FER in obesity was not conclusive, whereas the evidence about an altered FER in fibromyalgia seemed more straightforward. Moreover, the role of alexithymia on FER in these clinical conditions was not extensively investigated. In our discussion, we highlighted those factors that should be carefully addressed in investigating FER in these clinical conditions. Moreover, we underlined methodological criticisms that should be overcome in future research.
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Pudalov LR, Krause SJ, Heinberg LJ, Hogue O. Refractory Chronic Pain and Obesity: Promising Implications for Multidisciplinary Pain Rehabilitation. PAIN MEDICINE 2021; 22:2290-2297. [PMID: 33565599 DOI: 10.1093/pm/pnab055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE 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 1-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.
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Affiliation(s)
| | - Steven J Krause
- Case Western Reserve University, Department of Psychiatry, Cleveland, Ohio
| | - Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, Department of Psychiatry and Psychology, Cleveland, Ohio
| | - Olivia Hogue
- Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, Ohio, USA
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23
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Kerver GA, Bond DS, Crosby RD, Cao L, Engel SG, Mitchell JE, Steffen KJ. Pain is adversely related to weight loss maintenance following bariatric surgery. Surg Obes Relat Dis 2021; 17:2026-2032. [PMID: 34600842 DOI: 10.1016/j.soard.2021.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pain and obesity are frequently co-morbid health conditions; thus, it is unsurprising that pain is commonly experienced by individuals seeking bariatric surgery. While pain is generally reduced in the short-term after surgery, there is also variability in pain outcomes and less is known about how unresolved or recurring pain may relate to long-term weight loss and weight loss maintenance. OBJECTIVES This study evaluated trajectories of pain scores through 7 years following bariatric surgery and whether higher pain levels related to poorer weight loss and greater weight regain. SETTING Data were collected from 3 university hospitals, 1 private not-for-profit research institute, and 1 community hospital. METHODS Self-report measures of pain and weight change data were utilized for 1702 adults seeking Roux-en-Y gastric bypass surgery from the Longitudinal Assessment for Bariatric Surgery (LABS) cohort. A series of linear mixed models examined trajectories of pain scores and the concurrent predictive relationship between pain and weight outcomes from pre-surgery through 7 years post-surgery. RESULTS Overall bodily-, hip-, and knee-pain improved through 2 years, deteriorated from 2-5 years, and then slightly improved from 5-7 years following surgery (P < .001). Greater pain was concurrently associated with less weight loss and greater weight regain over time (P ≤ .006). CONCLUSION Pain is evident in the long-term following bariatric surgery and associated with suboptimal weight outcomes. More research is needed to identify mechanisms underlying this relationship, which may ultimately help develop appropriate pain assessment and treatment strategies to ensure optimal post-surgery outcomes.
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Affiliation(s)
- Gail A Kerver
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota; Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.
| | - Dale S Bond
- Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, Rhode Island
| | - Ross D Crosby
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota; Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Li Cao
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota
| | - Scott G Engel
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota; Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - James E Mitchell
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota; Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Kristine J Steffen
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
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Bigand TL, Dietz J, Gubitz HN, Wilson M. Chronic pain and depressive symptoms are related to food insecurity among urban food bank users. J Public Health (Oxf) 2021; 43:573-580. [PMID: 32567657 DOI: 10.1093/pubmed/fdaa062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/03/2020] [Accepted: 04/30/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Food bank users suffer high food insecurity. Food insecurity increases risk for chronic health conditions. However, chronic pain and its relation to food insecurity among food bank users is unknown. Knowledge about populations with chronic pain is important to direct appropriate public health nutritional strategies. METHODS Participants completed a survey including sleep, pain, depressive symptoms and food insecurity measures. Descriptive statistics characterized the burden of chronic pain among the sample, and a series of chi-square and t-tests assessed for demographic differences between food bank users who reported pain compared to those who did not. Logistic regression tested for variables predicting food insecurity. RESULTS Within the sample (N = 207), 53% reported a chronic pain diagnosis. Adults with pain were more likely to receive food stamps and to have a mental health condition than those without pain. Regression analyses revealed that depressive symptoms and chronic pain significantly predicted food insecurity when controlling for age and gender. CONCLUSIONS Exploring the link between depression, pain and nutritional resources may enhance understanding of causal relationships driving food insecurity. Public health officials should address nutritional needs of adults including those with chronic pain who use food bank services.
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Affiliation(s)
- Teresa L Bigand
- Department of Nursing, Washington State University, Spokane, WA 99202, USA.,Professional Nursing Development Office, Professional Nursing Development Office, Providence Health Care, Spokane, WA 99204, USA
| | - Jeremy Dietz
- Department of Public Health and Health Economics, London School of Hygiene and Tropical Medicine London, London WC1E 7HT, UK
| | - Hannah N Gubitz
- Department of Nursing, Washington State University, Spokane, WA 99202, USA
| | - Marian Wilson
- Department of Nursing, Washington State University, Spokane, WA 99202, USA
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25
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Dong HJ, Dragioti E, Rivano Fischer M, Gerdle B. Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry. J Pain Res 2021; 14:1863-1873. [PMID: 34188533 PMCID: PMC8232849 DOI: 10.2147/jpr.s305399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/14/2021] [Indexed: 01/07/2023] Open
Abstract
Background It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight. Objective This study investigated whether obese patients with chronic pain lost weight after completing IMMPR in specialist pain units. The association of pain relief and weight change over time was also examined. Methods Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used (N=224), including baseline and 12-month follow-up after IMMPR from 2016 to 2018. Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviours, psychological distress, and health-related quality of life (HRQoL). A reduction of at least 5% of initial weight indicates clinically significant weight loss. Patients were classified into three groups based on the pain relief levels after IMMPR: pain relief of clinical significance (30% or more reduction of pain intensity); pain relief without clinical significance (less than 30% reduction of pain intensity); and no pain relief. Linear mixed regression models were used to examine the weight changes among the groups with different pain relief levels. Results A significant reduction of pain intensity was found after IMMPR (p < 0.01, effect size Cohen’s d = 0.34). A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss (20.2%~24.3%, p = 0.47). Significant improvements were reported regarding physical activity behaviour, psychological distress, and HRQoL, but weight change was not associated with changes of pain intensity. Conclusion About one-fifth of obese patients achieved significant weight reduction after IMMPR. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.
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Affiliation(s)
- Huan-Ji Dong
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Health Sciences, Research Group Rehabilitation Medicine, Lund University, Lund, Sweden.,Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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26
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Sturgeon JA, Khan J, Hah JM, Hilmoe H, Hong J, Ware MA, Mackey SC. Clinical Profiles of Concurrent Cannabis Use in Chronic Pain: A CHOIR Study. PAIN MEDICINE 2021; 21:3172-3179. [PMID: 32232476 DOI: 10.1093/pm/pnaa060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Despite evidence of the analgesic benefits of cannabis, there remains a relative scarcity of research on the short- and long-term effects of cannabis use in individuals with chronic pain. DESIGN The current study is a secondary analysis of clinical data from the Collaborative Health Outcomes Information Registry (CHOIR). SETTING Data were drawn from a cohort of patients of a multidisciplinary tertiary care pain clinic. SUBJECTS The study sample consisted of data from 7,026 new patient visits from CHOIR; of these, 1,668 patients with a follow-up time point within 180 days were included in a longitudinal analysis. METHODS Clinical data were analyzed to characterize cross-sectional differences in pain and indicators of psychological and physical function according to self-reported, concurrent cannabis use. Additionally, a propensity score-weighted longitudinal analysis was conducted, examining cannabis use as a predictor of changes in clinical variables across time. RESULTS Cross-sectional analyses suggested significantly poorer sleep and significantly higher intensities of pain, emotional distress, and physical and social dysfunction in patients reporting ongoing cannabis use; however, these differences were relatively small in magnitude. However, no differences between cannabis users and nonusers in terms of longitudinal changes in clinical variables were noted. DISCUSSION Our results are among the first to examine concurrent cannabis use as a prognostic variable regarding trajectories of pain-related variables in tertiary care. Future studies may benefit from examining the effect of cannabis initiation, concurrent medication use, and specific aspects of cannabis use (dose, duration of use, or cannabis type) on clinical outcomes.
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Affiliation(s)
- John A Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - James Khan
- Department of Anesthesia, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer M Hah
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Heather Hilmoe
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Juliette Hong
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Mark A Ware
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Higgins DM, Buta E, Heapy AA, Driscoll MA, Kerns RD, Masheb R, Becker WC, Hausmann LRM, Bair MJ, Wandner L, Janke EA, Brandt CA, Goulet JL. The Relationship Between Body Mass Index and Pain Intensity Among Veterans with Musculoskeletal Disorders: Findings from the MSD Cohort Study. PAIN MEDICINE 2021; 21:2563-2572. [PMID: 32186722 DOI: 10.1093/pm/pnaa043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the relationship between body mass index (BMI) and pain intensity among veterans with musculoskeletal disorder diagnoses (MSDs; nontraumatic joint disorder; osteoarthritis; low back, back, and neck pain). SETTING Administrative and electronic health record data from the Veterans Health Administration (VHA). SUBJECTS A national cohort of US military veterans with MSDs in VHA care during 2001-2012 (N = 1,759,338). METHODS These cross-sectional data were analyzed using hurdle negative binomial models of pain intensity as a function of BMI, adjusted for comorbidities and demographics. RESULTS The sample had a mean age of 59.4, 95% were male, 77% were white/Non-Hispanic, 79% were overweight or obese, and 42% reported no pain at index MSD diagnosis. Overall, there was a J-shaped relationship between BMI and pain (nadir = 27 kg/m2), with the severely obese (BMI ≥ 40 kg/m2) being most likely to report any pain (OR vs normal weight = 1.23, 95% confidence interval = 1.21-1.26). The association between BMI and pain varied by MSD, with a stronger relationship in the osteoarthritis group and a less pronounced relationship in the back and low back pain groups. CONCLUSIONS There was a high prevalence of overweight/obesity among veterans with MSD. High levels of BMI (>27 kg/m2) were associated with increased odds of pain, most markedly among veterans with osteoarthritis.
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Affiliation(s)
- Diana M Higgins
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Eugenia Buta
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Alicia A Heapy
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Mary A Driscoll
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Robert D Kerns
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Robin Masheb
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - William C Becker
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew J Bair
- Center for Health Information and Communication (CHIC), VA Health Services Research and Development, Indianapolis, Indiana.,Indiana University School of Medicine and Regenstrief Institute, Indianapolis, Indiana
| | - Laura Wandner
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland
| | - E Amy Janke
- University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Cynthia A Brandt
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Joseph L Goulet
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
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Goldschmidt AB, Khoury JC, Mitchell JE, Jenkins TM, Bond DS, Zeller MH, Michalsky MP, Inge TH. Loss of Control Eating and Health Indicators Over 6 Years in Adolescents Undergoing Metabolic and Bariatric Surgery. Obesity (Silver Spring) 2021; 29:740-747. [PMID: 33759383 PMCID: PMC8474017 DOI: 10.1002/oby.23126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess associations between loss of control (LOC) eating and health outcomes among adolescents undergoing metabolic and bariatric surgery. METHODS A total of 234 adolescents were studied before and up to 6 years after surgery in a prospective, observational cohort design. Adolescents provided self-reports of LOC eating, pain severity, sleep quality, polycystic ovary syndrome, gastroesophageal reflux disease, and medication usage and objective measures of fasting glucose, serum insulin, glycohemoglobin A1c , cholesterol, triglycerides, and blood pressure. χ2 tests, Wilcoxon rank sums, and generalized linear mixed models were used to assess concurrent and prospective associations between LOC eating and health indicators. RESULTS LOC eating presented in 32.5% of adolescents before surgery and was positively associated with sleep disturbances and psychiatric medication usage. After surgery, LOC eating presented in 7.9% to 14.6% of participants and was correlated with improved low- and high-density lipoprotein cholesterol levels and greater back pain. LOC eating was inversely associated with low-density lipoprotein cholesterol at the next consecutive time point. CONCLUSIONS LOC eating was unexpectedly associated with improved low- and high-density lipoprotein cholesterol in adolescents undergoing metabolic and bariatric surgery. Deleterious effects of LOC eating on obesity-related health conditions, aside from back pain, were not detected. Metabolic and other weight-independent health benefits of surgery may persist postoperatively despite LOC eating and associated weight regain.
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Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Todd M. Jenkins
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dale S. Bond
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Meg H. Zeller
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marc P. Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Thomas H. Inge
- Department of Surgery, University of Colorado, Denver and Children’s Hospital Colorado, Aurora, CO, USA
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Circulating inflammatory biomarkers in adolescents: evidence of interactions between chronic pain and obesity. Pain Rep 2021; 6:e916. [PMID: 33977184 PMCID: PMC8104468 DOI: 10.1097/pr9.0000000000000916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 01/21/2023] Open
Abstract
Introduction The negative effects of chronic pain and obesity are compounded in those with both conditions. Despite this, little research has focused on the pathophysiology in pediatric samples. Objective To examine the effects of comorbid chronic pain and obesity on the concentration of circulating inflammatory biomarkers. Methods We used a multiple-cohort observational design, with 4 groups defined by the presence or absence of obesity and chronic pain: healthy controls, chronic pain alone, obesity alone, as well as chronic pain and obesity. Biomarkers measured were leptin, adiponectin, leptin/adiponectin ratio (primary outcome), tumor necrosis factor-alpha, interleukin 6, and C-reactive protein (CRP). Results Data on 125 adolescents (13-17 years) were analyzed. In females, there was an interaction between chronic pain and obesity such that leptin and CRP were higher in the chronic pain and obesity group than in chronic pain or obesity alone. Within the chronic pain and obesity group, biomarkers were correlated with worsened pain attributes, and females reported worse pain than males. The highest levels of interleukin 6 and CRP were found in youth with elevated weight and functional disability. We conclude that in adolescents, chronic pain and obesity interact to cause dysregulation of the inflammatory system, and this effect is more pronounced in females. Conclusion The augmented levels of inflammatory biomarkers are associated with pain and functional disability, and may be an early marker of future pain and disability.
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30
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Goessl CL, Befort CA, Pathak RD, Ellerbeck EF, VanWormer JJ. Chronic pain and weight regain in a lifestyle modification trial. Obes Sci Pract 2021; 7:192-198. [PMID: 33841888 PMCID: PMC8019281 DOI: 10.1002/osp4.471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 01/02/2023] Open
Abstract
Objective Obesity and chronic pain often co‐occur and exert bidirectional influences on one another. How patients with obesity and chronic pain respond to weight loss treatments, however, remains unclear. This study evaluated body weight, physical activity, and diet outcomes in participants with and without chronic pain in a 2‐year behavioral weight loss trial. Methods An analytical cohort of 397 adults was assembled from a Midwestern healthcare system that participated in the larger trial. Participants with chronic pain 1 year prior to, or during, the trial were identified using a validated medical records algorithm. Mixed models were used to estimate changes in outcomes over 24 months. Results One‐third of participants (n = 130) had chronic pain. After adjustment for age, sex, body mass index, and trial arm, weight loss was similar in both groups at 6‐months (−7.0 ± 0.8 kg with chronic pain vs. −7.7 ± 0.6 kg without). Participants with chronic pain had significantly less weight loss at 24‐months relative to those without (−3.6 ± 0.5 vs. −5.2 ± 0.4 kg; p = 0.007). Physical activity, screen time, dietary fat, fruit/vegetable consumption, and sugar‐sweetened beverage intake improved similarly in both groups over time. Conclusions Participants with chronic pain lost ∼33% less weight over 2 years, which was driven by greater weight regain after the first 6 months. Future research should test tailored weight loss maintenance strategies for individuals with chronic pain.
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Affiliation(s)
- Cody L Goessl
- Center for Clinical Epidemiology & Population Health Marshfield Clinic Research Institute Marshfield Wisconsin USA
| | - Christie A Befort
- Department of Population Health University of Kansas Medical Center Kansas City Kansas USA
| | - Ram D Pathak
- Department of Endocrinology Marshfield Clinic-Marshfield Medical Center Marshfield Wisconsin USA
| | - Edward F Ellerbeck
- Department of Population Health University of Kansas Medical Center Kansas City Kansas USA
| | - Jeffrey J VanWormer
- Center for Clinical Epidemiology & Population Health Marshfield Clinic Research Institute Marshfield Wisconsin USA
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31
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Varallo G, Giusti EM, Scarpina F, Cattivelli R, Capodaglio P, Castelnuovo G. The Association of Kinesiophobia and Pain Catastrophizing with Pain-Related Disability and Pain Intensity in Obesity and Chronic Lower-Back Pain. Brain Sci 2020; 11:brainsci11010011. [PMID: 33374178 PMCID: PMC7823580 DOI: 10.3390/brainsci11010011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 12/21/2022] Open
Abstract
Individuals affected by chronic lower-back pain and obesity have an increased risk of long-lasting disability. In this study, we aimed to explore the contribution of kinesiophobia and pain catastrophizing in explaining pain intensity and pain-related disability in chronic lower-back pain associated to obesity. A cross-sectional study on 106 participants with obesity and chronic lower-back pain was performed. We assessed pain intensity, pain disability, pain catastrophizing, and kinesiophobia levels through self-reporting questionnaire. Hierarchical regressions were performed to assess the role of pain catastrophizing and kinesiophobia on pain intensity and pain disability. According to the results, kinesiophobia, but not pain catastrophing, significantly explained both pain intensity and pain-related disability. Kinesiophobia might play a significant role in enhancing pain-related disability and the pain intensity in individuals with chronic lower-back pain and obesity. We encourage future studies in which beliefs and cognition towards pain might be a therapeutic target in interdisciplinary pain management interventions.
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Affiliation(s)
- Giorgia Varallo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.M.G.); (R.C.); (G.C.)
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy
- Correspondence: ; Tel.: +39-338-94-84-148
| | - Emanuele Maria Giusti
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.M.G.); (R.C.); (G.C.)
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy
| | - Federica Scarpina
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, 10124 Turin, Italy;
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy
| | - Roberto Cattivelli
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.M.G.); (R.C.); (G.C.)
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy
| | - Paolo Capodaglio
- Istituto Auxologico Italiano, U.O. di U.O. Riabilitazione Osteoarticolare, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy;
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, 10121 Turin, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy; (E.M.G.); (R.C.); (G.C.)
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale S. Giuseppe, 28824 Piancavallo (Verbania), Italy
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Gilcharan Singh HK, Chee WSS, Hamdy O, Mechanick JI, Lee VKM, Barua A, Mohd Ali SZ, Hussein Z. Eating self-efficacy changes in individuals with type 2 diabetes following a structured lifestyle intervention based on the transcultural Diabetes Nutrition Algorithm (tDNA): A secondary analysis of a randomized controlled trial. PLoS One 2020; 15:e0242487. [PMID: 33253259 PMCID: PMC7703935 DOI: 10.1371/journal.pone.0242487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Eating self-efficacy behavior is an important predictor of successful lifestyle intervention. This secondary analysis evaluated the changes in eating self-efficacy behavior in patients with type 2 diabetes (T2D) and overweight/obesity following structured lifestyle intervention based on the Malaysian customized transcultural Diabetes Nutrition Algorithm (tDNA). METHODS Patients with T2D and overweight/obesity (n = 230) were randomized either into the tDNA group which included a structured low-calorie meal plan using normal foods, incorporation of diabetes-specific meal replacements, and an exercise prescription or usual T2D care (UC) for 6 months. Patients in the tDNA group also received either counseling with motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice using conventional counseling. Eating self-efficacy was assessed using a locally validated Weight Efficacy Lifestyle (WEL) questionnaire. All patients were followed up for additional 6 months' post-intervention. RESULTS There was a significant change in WEL scores with intervention over one-year [Group X Time effect: F = 51.4, df = (3.4, 318.7), p<0.001]. Compared to baseline, WEL scores improved in both the tDNA groups with significantly higher improvement in the tDNA-MI group compared to the tDNA-CC and UC groups at 6 months (tDNA-MI: 25.4±2.1 vs. tDNA-CC: 12.9±2.8 vs. UC: -6.9±1.9, p<0.001). At 12 months' follow-up, both the tDNA groups maintained improvement in the WEL scores, with significantly higher scores in the tDNA-MI group than tDNA-CC group, and the UC group had decreased WEL scores (tDNA-MI: 28.9±3.1 vs. tDNA-CC: 11.6±3.6 vs. UC: -13.2±2.1, p<0.001). Patients in the tDNA-MI group with greater weight loss and hemoglobin A1C reduction also had a higher eating self-efficacy, with a similar trend observed in comparative groups. CONCLUSION Eating self-efficacy improved in patients with T2D and overweight/obesity who maintained their weight loss and glycemic control following a structured lifestyle intervention based on the Malaysian customized tDNA and the improvement was further enhanced with motivational interviewing. CLINICAL TRIAL This randomized clinical trial was registered under National Medical Research Registry, Ministry of Health Malaysia with registration number: NMRR-14-1042-19455 and also under ClinicalTrials.gov with registration number: NCT03881540.
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Affiliation(s)
- Harvinder Kaur Gilcharan Singh
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| | - Winnie Siew Swee Chee
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia
| | - Osama Hamdy
- Division of Endocrinology, Diabetes and Metabolism, Joslin Diabetes Center, Harvard Medical School, Boston, United States of America
| | - Jeffrey Ian Mechanick
- Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - Verna Kar Mun Lee
- Department of Family Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Ankur Barua
- Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Siti Zubaidah Mohd Ali
- Department of Non-Communicable Diseases, Klinik Kesihatan Seremban, Negeri Sembilan, Malaysia
| | - Zanariah Hussein
- Department of Medicine, Hospital Putrajaya, Pusat Pentadbiran Kerajaan Persekutuan, Putrajaya, Malaysia
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Bigand TL, Dietz J, Gubitz HN, Wilson M. Barriers and Facilitators to Healthy Eating among Adult Food Bank Users. West J Nurs Res 2020; 43:660-667. [PMID: 33138737 DOI: 10.1177/0193945920969689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Healthy eating relates to improved health, yet adult food bank users report difficulty accessing healthy foods. Registered nurses can promote healthy eating for food bank recipients by understanding perceived obstacles and facilitators. Urban food bank users completed a survey, and qualitative content analysis was used to analyze four open-ended questions regarding perceptions of healthy eating. In total, 196 adults were included in analysis. Two main categories were identified as perceived facilitators and barriers to healthy eating. Themes from the facilitator category included internal resources and external resources. Themes from the barrier category were personal challenges and environmental issues. Healthy eating is a complex behavior that requires personal motivation, skills, and social/environmental supports to be successfully executed among food bank recipients. Nurses should advocate to leverage food bank resources for healthier eating by offering nurtition counseling at events, optimizing access to fresh fruits and vegetables, and decreasing unhealthy food options.
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Affiliation(s)
- Teresa L Bigand
- College of Nursing, Washington State University, Spokane, WA, USA.,Professional Nursing Development Office, Providence Health Care, Spokane, WA, USA
| | - Jeremy Dietz
- London School of Hygiene and Tropical Medicine London, England, UK
| | - Hannah N Gubitz
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Marian Wilson
- College of Nursing, Washington State University, Spokane, WA, USA
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Su Y, Rao W, D'Arcy C. Depression risk and body mass index among immigrants and non-immigrants in Canada: results from the Canadian Community Health Surveys, 2010-2014. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1283-1295. [PMID: 32222875 DOI: 10.1007/s00127-020-01861-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/11/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Obesity has been associated with an increased risk of the depression in the general population, but it is unknown whether this relationship applies equally to immigrants as well as non-immigrants. Furthermore, the nature of the relationship is uncertain, is it direct or curvilinear? The aim of this study is to examine the relationship between body mass index and major depressive episode among immigrants and non-immigrants. METHODS To provide more statistically robust data, a series of cross-sectional health surveys of the Canadian population for the 5 years 2010-2014 were pooled to increase the number of immigrants in the study. Restricted cubic splines analysis was used to examine the nature of the association. RESULTS Immigrants had lower 12-month depression and obesity prevalence rates than non-immigrants. In addition, it was found that non-immigrants were more likely to develop depression than immigrants, OR = 1.40 (95% CI, 1.16-1.67). Obese respondents were more likely to develop depression than normal weight respondents in both immigrant (OR = 1.55; 95% CI, 1.03-2.32) and non-immigrant groups (OR = 1.23; 95% CI, 1.15-1.32). A significant nonlinear elongated J-shaped association between obesity and depression was found for both immigrants and non-immigrants with increased risk of depression in obese individuals. CONCLUSION Culture-specific, clinical-based interventions should be developed to improve the early identification, treatment and recovery of individuals with a high BMI particularly among those with BMIs in the obese range.
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Affiliation(s)
- Yingying Su
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Wenwang Rao
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Carl D'Arcy
- School of Public Health, University of Saskatchewan, Saskatoon, Canada. .,Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada.
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Kauffman BY, Rogers AH, Bakhshaie J, Mayorga NA, Garza M, Ochoa-Perez M, Lemaire C, Zvolensky MJ. Examining the Relationship Between Pain Intensity and Emotional Eating Among Latinos in a Federally Qualified Health Center: The Role of Anxiety Sensitivity. J Immigr Minor Health 2020; 21:1217-1223. [PMID: 30701426 DOI: 10.1007/s10903-019-00862-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
There is limited understanding of pain and its relationship to emotional eating among Latinos as well as knowledge about potential mechanisms that may underlie their association. We explored whether anxiety sensitivity (fear of the negative consequences of anxiety) explained the relation between pain intensity and emotional eating among a sample of Latinos. Participants were 79 (87.3% female; Mage = 42.04, SD = 12.01) predominately female Latino attendees of a Federally Qualified Health Center. As hypothesized, results indicated that pain intensity yielded a significant indirect effect through anxiety sensitivity for emotional eating. Alternative models wherein anxiety sensitivity served as the predictor and pain intensity as the indirect effect were also significant. Such novel data highlight the potential bi-directional relationship between pain intensity and anxiety sensitivity in terms of emotional eating. Overall, pain intensity and anxiety sensitivity may serve as mechanisms that underlie emotional eating among Latino adults.
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Affiliation(s)
- Brooke Y Kauffman
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, 77204-5502, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, 77204-5502, USA
| | - Jafar Bakhshaie
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, 77204-5502, USA
| | - Nubia A Mayorga
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, 77204-5502, USA
| | | | | | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, Texas, 77204-5502, USA. .,Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA. .,Health Institute, University of Houston, Houston, Texas, USA.
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Chin SH, Huang WL, Akter S, Binks M. Obesity and pain: a systematic review. Int J Obes (Lond) 2019; 44:969-979. [PMID: 31848456 DOI: 10.1038/s41366-019-0505-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/04/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES The current systematic review considered research published within the 10 years preceding June 2019, dealing with the topic of obesity and pain. Within the context of the complex biological and behavioral interrelationships among these phenomena, we sought to identify gaps in the literature and to highlight key targets for future transdisciplinary research. The overarching inclusion criteria were that the included studies could directly contribute to our understanding of these complex phenomena. METHODS We searched PubMed/Medline/Cochrane databases dating back 10 years, using the primary search terms "obesity" and "pain," and for a secondary search we used the search terms "pain" and "diet quality." RESULTS Included studies (n = 70) are primarily human; however, some animal studies were included to enhance understanding of related basic biological phenomena and/or where human data were absent or significantly limited. CONCLUSIONS Our overall conclusions highlight (1) the mechanisms of obesity-related pain (i.e., mechanical, behavioral, and physiological) and potential biological and behavioral contributors (e.g., gender, distribution of body fat, and dietary factors), (2) the requirement for accurate and reliable objective measurement, (3) the need to integrate biological and behavioral contributors into comprehensive, well-controlled prospective study designs.
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Affiliation(s)
- Shao-Hua Chin
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA
| | - Wei-Lin Huang
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA
| | - Sharmin Akter
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA
| | - Martin Binks
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA.
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Skea ZC, Aceves-Martins M, Robertson C, De Bruin M, Avenell A. Acceptability and feasibility of weight management programmes for adults with severe obesity: a qualitative systematic review. BMJ Open 2019; 9:e029473. [PMID: 31511284 PMCID: PMC6738728 DOI: 10.1136/bmjopen-2019-029473] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To improve our understanding of the acceptability of behavioural weight management programmes (WMPs) for adults with severe obesity. DESIGN A systematic review of qualitative evidence. DATA SOURCES Medline, Embase, PsycINFO, CINAHL, SCI, SSCI and CAB abstracts were searched from 1964 to May 2017. ELIGIBILITY CRITERIA Papers that contained qualitative data from adults with body mass index (BMI) ≥35 kg/m2 (and/or the views of providers involved in their care) and considered issues about weight management. DATA EXTRACTION AND SYNTHESIS Two reviewers read and systematically extracted data from the included papers which were compared, and contrasted according to emerging issues and themes. Papers were appraised for methodological rigour and theoretical relevance using Toye's proposed criteria for quality in relation to meta-ethnography. RESULTS 33 papers met our inclusion criteria from seven countries published 2007-2017. Findings were presented from a total of 644 participants and 153 programme providers. Participants described being attracted to programmes that were perceived to be novel or exciting, as well as being endorsed by their healthcare provider. The sense of belonging to a group who shared similar issues, and who had similar physiques and personalities, was particularly important and seemed to foster a strong group identity and related accountability. Group-based activities were enjoyed by many and participants preferred WMPs with more intensive support. However, some described struggling with physical activities (due to a range of physical comorbidities) and not everyone enjoyed group interaction with others (sometimes due to various mental health comorbidities). Although the mean BMI reported across the papers ranged from 36.8 to 44.7 kg/m2, no quotes from participants in any of the included papers were linked to specific detail regarding BMI status. CONCLUSIONS Although group-based interventions were favoured, people with severe obesity might be especially vulnerable to physical and mental comorbidities which could inhibit engagement with certain intervention components.
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Affiliation(s)
- Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - M De Bruin
- Health Psychology Department, University of Aberdeen, Aberdeen, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Majchrzak M, Brzecka A, Daroszewski C, Błasiak P, Rzechonek A, Tarasov VV, Chubarev VN, Kurinnaya AS, Melnikova TI, Makhmutova A, Klochkov SG, Somasundaram SG, Kirkland CE, Aliev G. Increased Pain Sensitivity in Obese Patients After Lung Cancer Surgery. Front Pharmacol 2019; 10:626. [PMID: 31258474 PMCID: PMC6586739 DOI: 10.3389/fphar.2019.00626] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Obesity and cancer are recognized worldwide health threats. While there is no reported causal relationship, the increasing frequency of both conditions results in a higher incidence of obese patients who are being treated for cancer. Physiological data indicate that there is a relationship between obesity and susceptibility to pain; however, currently, there are no specific pharmacological interventions. Objective: To evaluate the self-reported intensity of postoperative pain in obese and nonobese lung cancer who receive either thoracotomy or video-assisted thoracic surgery (VATS) surgical therapy. Material and Methods: In 50 obese [mean body mass index (BMI) of 34.1 ± 3.2 kg/m2] and 62 nonobese (mean BMI of 24.9 ± 3 kg/m2) lung cancer patients, the intensity of pain was estimated every 4 h using a visual analog scale (VAS, 0 indicating no pain and 10 indicating “worst imaginable pain”) beginning shortly after surgery (Day O) and continuing until the day of discharge (Day D). Results: The self-reported pain was more severe in obese than in nonobese patients, both at the time of the operation [Day O (4.5 ± 1.2 vs 3.4 ± 1.1; p < 0.0001)] and at the day of discharge [Day D (3.9 ± 1.4 vs 2.6 ± 0.9, p < 0.0001)]. This finding was consistent both in the patients after thoracotomy and after video-assisted thoracic surgery (VATS, p < 0.0001). The patients with severe pain shortly after surgery (VAS score >4) had significantly higher BMI (31.8 ± 5.6 kg/m2vs 28.8 ± 5.2 kg/m2, p < 0.01) and were hospitalized longer than the remaining patients (13.0 ± 13.6 days vs 9.5 ± 3.6 days, p < 0.05). Conclusion: The reported perception of pain in obese lung cancer patients is greater than in nonobese patients undergoing the same thoracic surgery. In obese patients, severe pain persisted longer. Pain management is an important consideration in the postoperative care of lung cancer patients, even more so with obese patients.
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Affiliation(s)
- Maciej Majchrzak
- Department of Thoracic Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Cancer, Medical University in Wroclaw, Wroclaw, Poland
| | - Cyryl Daroszewski
- Department of Pulmonology and Lung Cancer, Medical University in Wroclaw, Wroclaw, Poland
| | - Piotr Błasiak
- Department of Thoracic Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Adam Rzechonek
- Department of Thoracic Surgery, Medical University in Wroclaw, Wroclaw, Poland
| | - Vadim V Tarasov
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vladimir N Chubarev
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anastasiya S Kurinnaya
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tatiana I Melnikova
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alfiya Makhmutova
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia
| | - Sergey G Klochkov
- Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia
| | - Siva G Somasundaram
- Department of Biological Sciences, Salem University, Salem, WV, United States
| | - Cecil E Kirkland
- Department of Biological Sciences, Salem University, Salem, WV, United States
| | - Gjumrakch Aliev
- Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Institute of Physiologically Active Compounds, Russian Academy of Sciences, Chernogolovka, Russia.,GALLY International Biomedical Research Institute, San Antonio, TX, United States
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Bigand T, Wilson M. Overeating during painful episodes among adults with chronic pain: A preliminary study. Appetite 2019; 137:99-103. [DOI: 10.1016/j.appet.2019.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/23/2019] [Accepted: 02/23/2019] [Indexed: 12/29/2022]
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O'Loughlin I, Newton-John TRO. 'Dis-comfort eating': An investigation into the use of food as a coping strategy for the management of chronic pain. Appetite 2019; 140:288-297. [PMID: 31145944 DOI: 10.1016/j.appet.2019.05.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/18/2019] [Accepted: 05/21/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Chronic pain and obesity are major public health concerns. Animal and human models have demonstrated that eating high-sugar nutrient-dense foods confers analgesic effects. Moreover, recent research suggests that people with chronic pain may "comfort eat" to cope with their pain. Given the harmful impact of obesity on chronic pain, it is critical to determine whether pain elicits comfort eating amongst individuals with chronic pain to ensure that this potentially maladaptive pain coping strategy is not overlooked in chronic pain treatment. Therefore, this study aimed to: determine whether chronic pain intensity predicts pain-induced comfort eating and identify mediators of this relationship; to determine whether pain-induced comfort eating predicts elevated BMI; and to establish whether BMI predicts chronic pain interference. METHODS This study utilised a cross-sectional online survey design and a sample of 151 adults with chronic pain. RESULTS Over three-quarters of this chronic pain sample reported engaging in pain-induced comfort eating. Chronic pain intensity did not significantly predict pain-induced comfort eating. However, there was a significant indirect effect of chronic pain intensity on pain-induced comfort eating through stress-but not experiential avoidance or pain catastrophising. As predicted, pain-induced comfort eating significantly predicted increased BMI, and BMI in turn significantly predicted greater chronic pain interference. DISCUSSION This study indicates that pain-induced comfort eating is both common and harmful amongst individuals with chronic pain, across the entire BMI spectrum. Pain-induced comfort eating and stress have emerged as promising chronic pain treatment targets. The findings are discussed and interpreted in light of extant research and theory, as well as limitations of the current study. Future research directions and clinical implications are also considered.
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Affiliation(s)
- Imogen O'Loughlin
- Graduate School of Health, University of Technology Sydney, Australia
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41
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Rao WW, Zhang JW, Zong QQ, An FR, Ungvari GS, Balbuena L, Yang FY, Xiang YT. Prevalence of depressive symptoms in overweight and obese children and adolescents in mainland China: A meta-analysis of comparative studies and epidemiological surveys. J Affect Disord 2019; 250:26-34. [PMID: 30826491 DOI: 10.1016/j.jad.2019.02.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/13/2019] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Obesity is associated with a higher risk of depression in children and adolescents. This is a meta-analysis of studies examining depressive symptoms in overweight and obese children and adolescents in China. METHODS A systematic literature search was performed independently in both English (PubMed, EMBASE, Web of Science and Medline Complete) and Chinese (China National Knowledge Internet, WANFANG Data and WeiPu VIP) databases from their commencement date to December 31, 2018. The pooled prevalence of depressive symptoms was calculated using a random-effects model. Data analyses were performed with STATA Version 12.0, R Version 3.3.0 and R Studio Version 0.99.903. RESULTS Twenty-two epidemiological and 18 comparative studies were included in the meta-analysis. The overall prevalence of depressive symptoms was 24.02% (95% CI: 15.92%-33.16%) in obese children and adolescents and 22.61% (95% CI: 14.87%-31.34%) in overweigh children and adolescents. Obese children and adolescents were more likely to suffer from depressive symptoms (OR = 1.877, 95% CI: 1.459-2.415, P < 0.001) than their non-obese counterparts. The use of different screening scales for depressive symptoms was significantly associated with the prevalence of depressive symptoms. CONCLUSIONS Depressive symptoms are common in overweight and obese children and adolescents in China. Obese, but not overweight children and adolescents had higher risk of depressive symptoms. In order to lessen the risk of depressive symptoms, regular screening and effective interventions should be implemented to reduce obesity and overweight in this population.
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Affiliation(s)
- Wen-Wang Rao
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Ji-Wen Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Qian-Qian Zong
- School of Nursing, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Fang-Yu Yang
- School of Nursing, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Bigand T, Wilson M, Bindler R, Daratha K. Examining Risk for Persistent Pain among Adults with Overweight Status. Pain Manag Nurs 2019; 19:549-556. [PMID: 29776874 DOI: 10.1016/j.pmn.2018.02.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/10/2018] [Accepted: 02/17/2018] [Indexed: 12/19/2022]
Abstract
Aims of Investigation: Obesity and persistent pain are public health concerns with associated high costs. Evidence supports an increased risk for reports of persistent pain among adults who are above the recommended body mass index level. However, data have not been clearly synthesized to report the risk for the two co-occurring conditions. Even less is known about how overweight status that does not reach the level of obesity is related to pain. Thus, the aim driving this review was to calculate the risk and odds ratios of chronic pain among adults with an overweight body mass index. METHODS A literature review was completed using CINAHL and PubMed databases. Key words were entered using combinations of several MeSH headers. RESULTS Risk and odds ratios were calculated to determine overweight status among adults with chronic pain. Risk and odds ratios were calculated from nine studies. Overweight adults were between 14% and 71% more likely to report chronic pain than normal-weight adults. IMPLICATIONS FOR PRACTICE Pain management nurses should educate adults about the importance of weight management to reduce risk for persistent pain. Nurses need to be informed about current national physical activity and diet recommendations to ensure proper health information is relayed to patients. CONCLUSIONS There is an elevated risk for persistent pain among adults who are overweight compared with those who are recommended weight status. Future longitudinal research focused on causality can help determine which condition contributes to the other. Weight management may be implied for clinical risk reduction of pain conditions among adults who are above recommended body mass index levels.
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Affiliation(s)
| | | | - Ruth Bindler
- Washington State University, Spokane, Washington
| | - Kenn Daratha
- Washington State University, Spokane, Washington
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The Effect of a Pilot Dietary Intervention on Pain Outcomes in Patients Attending a Tertiary Pain Service. Nutrients 2019; 11:nu11010181. [PMID: 30654479 PMCID: PMC6357136 DOI: 10.3390/nu11010181] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to examine the effect of a six-week 2 × 2 design on pain scores, quality of life, and dietary intake in patients attending an Australian tertiary pain clinic. The two intervention components were (1) personalized dietary consultations or waitlist control, and (2) active or placebo dietary supplement (fruit juice). Sixty participants were randomized into one of four groups at baseline (68% female, mean age 49 ± 15 years) with 42 completing the study (70% retention). All groups had statistically significant improvements in three of five pain outcomes. The personalized dietary consultation groups had clinically important improvements in three of five pain outcomes compared to the waitlist control groups. All groups had a statistically significant improvement in six of eight quality-of-life categories post intervention. All groups increased percentage energy from nutrient-dense foods (+5.2 ± 1.4%, p < 0.001) with a significant group-by-time effect for percentage energy from total fat (p = 0.024), with the personalized dietary consultations plus placebo fruit juice reporting the largest reduction (−5.7 ± 2.3%). This study indicates that dietitian-delivered dietary intervention can improve pain scores, quality of life, and dietary intake of people experiencing chronic pain. Future research should evaluate efficacy in a full-powered randomized control trial.
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Goldschmidt AB, Cotton BP, Mackey S, Laurent J, Bryson WC, Bond DS. Prevalence and Correlates of Loss of Control Eating among Adults Presenting for Methadone Maintenance Treatment. Int J Behav Med 2019; 25:693-697. [PMID: 30259293 DOI: 10.1007/s12529-018-9750-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Research suggests that substance use disorders and disordered eating are often comorbid. In light of the ongoing opioid epidemic, the purpose of the current study was to understand the prevalence and health-related correlates of loss of control (LOC) eating in adults seeking methadone maintenance treatment primarily for addiction to heroin and/or painkillers. METHODS Participants were 447 adults surveyed at presentation for methadone maintenance treatment who responded to survey items on LOC eating. Descriptive statistics were used to investigate the prevalence of engaging in LOC eating in the past 2 weeks. Chi-square tests, t tests, and analyses of covariance were used to compare individuals with (LOC+; n = 164) and without (LOC-; n = 283) recent LOC eating on psychosocial, pain-related, and weight-related characteristics. RESULTS Approximately one third of respondents endorsed LOC eating in the past 2 weeks. These participants reported greater affective symptoms, interpersonal dysfunction, pain intensity, and pain interference than the LOC- group (Cohen's d effect size range = .24-.94). LOC+ was also more likely to have engaged in recent illicit drug use and to report having concurrent overweight/obesity (φ effect size range = .09-.10). CONCLUSION The prevalence of LOC eating in adults seeking methadone maintenance treatment was more than triple what has been reported in previous studies using community samples. Given its associations with other health-related variables, the presence of LOC eating may be a marker for more severe psychopathology in individuals seeking methadone maintenance treatment. Future research is needed to understand mechanisms explaining this comorbidity and to develop novel ways to prevent and treat their co-occurrence.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 02903, USA.
| | - Brandi P Cotton
- College of Nursing, The University of Rhode Island, White Hall, 39 Butterfield Road, Kingston, RI, 02881, USA
| | - Scott Mackey
- Department of Psychiatry, The University of Vermont Larner College of Medicine, 1 South Prospect Street, Burlington, VT, 05401, USA
| | - Jennifer Laurent
- Department of Nursing, The University of Vermont College of Nursing and Health Sciences, 204 Rowell Hall, Burlington, VT, 05405, USA
| | - William C Bryson
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI, 02903, USA
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Tang NKY. Cognitive behavioural therapy in pain and psychological disorders: Towards a hybrid future. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:281-289. [PMID: 28284902 DOI: 10.1016/j.pnpbp.2017.02.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022]
Abstract
Cognitive Behavioural Therapy (CBT) is a form of evidence-based talking therapy that emphasises the importance of behaviour and conscious thoughts in shaping our emotional experiences. As pain becomes increasingly accepted as not only a sensory but also an emotional experience, success in using CBT to treat emotional disorders has resulted in the incorporation of cognitive-behavioural principles into the management of chronic pain. Outcomes of CBT-informed interdisciplinary pain management programmes are modest at best, despite rapid methodological improvements in trial design and implementation. Whilst the field searches for new treatment directions, a hybrid CBT approach that seeks to simultaneously tackle pain and its comorbidities shows promise in optimising treatment effectiveness and flexibility. This article provides a brief description of the core characteristics of CBT and the transformation this therapeutic model has brought to our understanding and management of chronic pain. Current evidence on efficacy of CBT for chronic pain is then reviewed, followed by a critical consideration of the advantages and disadvantages of the new hybrid treatment approach that conceptualises and treats chronic pain in connection with its comorbidities. Recent progress made in the area of pain and insomnia is highlighted as an example to project therapeutic innovations in the near future.
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Affiliation(s)
- Nicole K Y Tang
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom.
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Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2018; 22:1-246. [PMID: 30511918 PMCID: PMC6296173 DOI: 10.3310/hta22680] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). REVIEW METHODS Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000. RESULTS A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. LIMITATIONS Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. CONCLUSIONS Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. FUTURE WORK Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. STUDY REGISTRATION This study is registered as PROSPERO CRD42016040190. FUNDING The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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47
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Brooks JM, Deiches J, Xiang X, Batsis JA, Chan F, DiMilia P, Chiu C, Thompson K, Bartels S. Differences in Self-Reported Physical Activity, Exercise Self-Efficacy and Outcome Expectancies, and Health Status by Body Mass Index Groups in People with Chronic Pain. JOURNAL OF REHABILITATION 2018; 84:46-52. [PMID: 32089565 PMCID: PMC7034931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
The study purpose was to determine how self-reported lifestyle physical activity levels, exercise self-efficacy and outcome expectancies, and health status differ by body mass index for persons with chronic pain. From U.S. clinics and community networks, 209 adults reporting chronic musculoskeletal pain were recruited for the cross-sectional survey. Data were analyzed using analysis of variance. Participants with self-described obesity reported the lowest physical activity, reduced exercise self-efficacy and positive outcome expectancies, and poorer health status. Promoting graded activity while addressing motivational factors from health behavior theory for people with chronic pain and obesity should be encouraged in rehabilitation programs.
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48
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Godfrey KM, Bullock AJ, Dorflinger LM, Min KM, Ruser CB, Masheb RM. Pain and modifiable risk factors among weight loss seeking Veterans with overweight. Appetite 2018; 128:100-105. [PMID: 29885382 DOI: 10.1016/j.appet.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/10/2018] [Accepted: 06/05/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Overweight/obesity and chronic pain frequently co-occur and demonstrate a bidirectional relationship. Modifiable risk factors, such as eating behaviors and mental health symptoms, may be important to understand this relationship and improve interventions in Veterans. DESIGN Cross-sectional. SETTING Veterans Health Administration Medical Center outpatient clinic. SUBJECTS The sample of Veterans (N = 126) was mostly male (89.7%), White (76%), and non-Hispanic (94%) with average age of 61.9 years (SD = 8.5) and average body mass index (BMI) of 38.5 (SD = 7.5). METHODS Veterans referred for weight loss treatment (MOVE!) at VA Connecticut completed self-report questionnaires, and electronic medical records were reviewed. RESULTS Mean self-reported pain rating was 4.5 out of 10 (SD = 2.3). Moderate to severe pain was endorsed by 60% of the sample. Veterans with higher pain intensity and interference reported higher global eating disorder symptoms, emotional overeating, night eating, insomnia severity, and mental health symptoms (all p's < 0.01). However, pain intensity and interference were not associated with BMI. CONCLUSIONS For Veterans seeking behavioral weight loss treatment, higher pain intensity and interference were associated with more severe eating disorder, sleep, and mental health symptoms. A better description of the clinical characteristics of Veterans with pain who participate in MOVE! highlights their unique needs and may improve treatments to address pain in the context of weight loss treatment.
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Affiliation(s)
- Kathryn M Godfrey
- The Drexel University Center for Weight, Eating and Lifestyle Science, Philadelphia, PA, USA
| | | | | | - Kathryn M Min
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher B Ruser
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, USA; Yale School of Medicine, New Haven, CT, USA.
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49
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Hainsworth KR, Liu XC, Simpson PM, Swartz AM, Linneman N, Tran ST, Medrano GR, Mascarenhas B, Zhang L, Weisman SJ. A Pilot Study of Iyengar Yoga for Pediatric Obesity: Effects on Gait and Emotional Functioning. CHILDREN-BASEL 2018; 5:children5070092. [PMID: 29973555 PMCID: PMC6068554 DOI: 10.3390/children5070092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/16/2018] [Accepted: 06/25/2018] [Indexed: 12/28/2022]
Abstract
Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary outcome) in youths with obesity. Secondary outcomes included health-related quality of life (HRQoL), physical activity, and pain. Feasibility and acceptability were also assessed. Nine youths (11⁻17 years) participated in an eight-week Iyengar yoga intervention (bi-weekly 1-h classes). Gait, HRQOL (self and parent-proxy reports), and physical activity were assessed at baseline and post-yoga. Pain was self-reported at the beginning of each class. Significant improvements were found in multiple gait parameters, including hip, knee, and ankle motion and moments. Self-reported and parent-proxy reports of emotional functioning significantly improved. Time spent in physical activity and weight did not change. This study demonstrates that a relatively brief, non-invasive Iyengar yoga intervention can result in improved malalignment of the lower extremities during ambulation, as well as in clinically meaningful improvements in emotional functioning. This study extends current evidence that supports a role for yoga in pediatric obesity.
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Affiliation(s)
- Keri R Hainsworth
- Jane B. Pettit Pain and Headache Center, Department of Anesthesiology and Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Xue Cheng Liu
- Department of Orthopedics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Pippa M Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Ann M Swartz
- Department of Kinesiology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA.
| | - Nina Linneman
- Department of Educational Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA.
| | - Susan T Tran
- Department of Psychology, DePaul University, Chicago, IL 60614, USA.
| | - Gustavo R Medrano
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | | | - Liyun Zhang
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | - Steven J Weisman
- Jane B. Pettit Pain and Headache Center, Department of Anesthesiology and Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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50
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White R. Media: painHEALTH: an evidence-based website for adult consumers experiencing musculoskeletal pain. J Physiother 2018; 64:202-203. [PMID: 29903597 DOI: 10.1016/j.jphys.2018.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 10/14/2022] Open
Affiliation(s)
- Ruth White
- Hunter Integrated Pain Service, Newcastle, Australia
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