The effect of obesity on pain and disability in chronic shoulder pain patients

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

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.

Association between the time of physical laboral activities and leisure over shoulder pain in fruitculture workers: A cross-sectional study

BACKGROUND

Fruitculture workers are exposed to shoulder pain disorders due to long working times in overhead activities.

OBJECTIVE

This study aims to analyze the association between the time of physical work and leisure activities over the perception of shoulder pain intensity in fruit growing workers.

METHODS

This is a descriptive and correlational cross-sectional study. The sample consisted of 180 fruit-growing workers. Multivariable logistic regression was used, with an estimate of the Odds Ratio (OR) and 95% confidence intervals. The dependent variable: Numeric Pain Rating Scale (NPRS) (0-10 points), was categorized as low and high, with cutoff points of NPRS > 3 and NPRS > 4, and was associated with the independent variables (level of physical activity, personal, labour and psychosocial).

RESULTS

Workers which are insufficiently active in leisure time are more likely to report high-intensity shoulder pain, NPRS > 3 (OR: 2.39; p = 0.049) and NPRS > 4 (OR: 2.85; p = 0.036). In addition, working time in overhead activities is a risk factor for high-intensity pain for NPRS > 3 and NPRS > 4 (OR = 1.01; p < 0.001). Underweight and normal-weight workers were less likely to report shoulder pain in NPRS > 3 (OR = 0.35; p = 0.020) and in NPRS > 4 (OR = 0.20; p = 0.001).

CONCLUSION

Fruit-growing workers had a high prevalence of severe shoulder pain. In addition, workers who are insufficiently active at leisure, overweight and obese are more likely to report severe pain. It was observed that overhead tasks increase the chances of reporting high-intensity shoulder pain among workers.

Lesão do manguito rotador e obesidade: Uma avaliação demográfica e metabólica

Objective  To analyze the relationship between the presence and severity of rotator cuff (RC) injury with obesity and the time of exposure to obesity. Secondarily, to evaluate the relationship and prevalence of demographic and metabolic factors in obese individuals with RC injury.

Methods  This is a cross-sectional study with 235 obese patients (body mass index [BMI] ≥ 30 kg/m ² ). Demographic data (age and gender), metabolic data (hypertension, diabetes mellitus, lipid profile, and time of exposure to obesity), physical examination (weight, height, waist circumference, and clinical tests), and musculoskeletal ultrasound examination were used to analyze the results.

Results  There was no evidence of an association between RC injury and BMI ( p  = 0.82), time of exposure to obesity ( p  = 0.29), or abdominal circumference ( p  = 0.52). In the subgroup with injury, age ( p  < 0.001), presence of diabetes mellitus ( p  = 0.013), hypertension ( p  < 0.001), level of high-density lipoprotein (HDL) ( p  = 0.026), and time of exposure to obesity ( p  < 0.001) were significantly greater compared to the subgroup without injury. In the search for other parameters independently associated with RC injury, associations were observed with age ( p  = 0.0003) and hypertension ( p  = 0.004).

Conclusion  We did not evidence an association between obesity and the time of exposure to it with the occurrence and severity of RC injury. However, individuals with injury had a longer time of exposure to obesity and prevalence of metabolic disorders than individuals without RC injury. In addition, our findings suggest an association between systemic arterial hypertension (SAH) and advanced age with RC injury.

Causal relationships of obesity on musculoskeletal chronic pain: A two-sample Mendelian randomization study

BACKGROUND

The association between obesity and musculoskeletal chronic pain has attracted much attention these days; however, the causal relationship between them is uncertain. Hence, this study performed a Mendelian randomization (MR) analysis to investigate the causal effects of body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) on knee pain, hip pain, and back pain.

MATERIALS AND METHODS

The summary data for obesity and musculoskeletal chronic pain came from the genome-wide association study datasets. Significant and independent (p < 5 × 10^-8; r² < 0.001, kb = 10,000) single-nucleotide polymorphisms were extracted for MR analysis. The inverse variance weighted (IVW) and other methods were used for MR analysis, while sensitivity analyses were conducted to test the reliability and stability.

RESULTS

The positive causal effects of BMI on knee pain (odds ratio (OR) = 1.049; 95% CI: 1.034 to 1.063; p = 9.88 × 10^-12), hip pain (OR = 1.034; 95% CI: 1.024 to 1.044; p = 1.38 × 10^-12), and back pain (OR = 1.022; 95% CI: 1.007 to 1.038; p = 0.004) were observed. WC and HC were also positively associated with knee pain (WC: OR = 1.057; 95% CI: 1.041 to 1.072; p = 1.54 × 10^-13; HC: OR = 1.034; 95% CI: 1.017 to 1.052; p = 1.32 × 10^-4) and hip pain (WC: OR = 1.031; 95% CI: 1.020 to 1.042; p = 2.61 × 10^-8; HC: OR = 1.027; 95% CI: 1.018 to 1.035; p = 5.48 × 10^-10) but not back pain. No causal relationship was found between WHR and musculoskeletal chronic pain. The results were robust according to sensitivity tests.

CONCLUSIONS

This study revealed that BMI was positively related to knee, hip, and back pain and that WC and HC were positively associated with knee and hip pain, while WHR was not related to any type of musculoskeletal chronic pain.

Physiological Changes and Pathological Pain Associated with Sedentary Lifestyle-Induced Body Systems Fat Accumulation and Their Modulation by Physical Exercise

A sedentary lifestyle is associated with overweight/obesity, which involves excessive fat body accumulation, triggering structural and functional changes in tissues, organs, and body systems. Research shows that this fat accumulation is responsible for several comorbidities, including cardiovascular, gastrointestinal, and metabolic dysfunctions, as well as pathological pain behaviors. These health concerns are related to the crosstalk between adipose tissue and body systems, leading to pathophysiological changes to the latter. To deal with these health issues, it has been suggested that physical exercise may reverse part of these obesity-related pathologies by modulating the cross talk between the adipose tissue and body systems. In this context, this review was carried out to provide knowledge about (i) the structural and functional changes in tissues, organs, and body systems from accumulation of fat in obesity, emphasizing the crosstalk between fat and body tissues; (ii) the crosstalk between fat and body tissues triggering pain; and (iii) the effects of physical exercise on body tissues and organs in obese and non-obese subjects, and their impact on pathological pain. This information may help one to better understand this crosstalk and the factors involved, and it could be useful in designing more specific training interventions (according to the nature of the comorbidity).

Pain sensitivity does not differ between obese and healthy weight individuals

Introduction

There is emerging evidence suggesting a relationship between obesity and chronic pain.

Objectives

The aim of this study was to determine whether pain-free obese individuals display altered pain responses to acute noxious stimuli, thus raising the possibility of greater pain sensitivity and potential susceptibility for chronic pain development.

Methods

Psychophysical and anthropometric data were collected from 38 individuals with an obese body mass index (BMI) classification (BMI ≥ 30) and 41 age/sex-matched individuals of a healthy BMI (BMI < 24.9). Because BMI may be an inaccurate index of obesity, additional anthropometric parameters of central adiposity and percent body fat were examined. Pain responses to suprathreshold noxious heat and cold stimuli were examined. Subjects provided pain intensity and unpleasantness ratings to noxious heat (49°C) applied at varying durations and locations (ventral forearm/lower leg). Cold pain ratings, thresholds, and tolerances were obtained after immersion of the hand in a cold-water bath (0-2°C). Between-group differences in pain responses, as well as relationships between pain responses and obesity parameters, were examined. Importantly, confounds that may influence pain such as anxiety, depression, impulsivity, sleepiness, and quality of life were assessed.

Results

No between-group differences in pain sensitivity to noxious heat and cold stimuli were found. No relationships were found between central adiposity or body fat (percentage or distribution) and pain responses to noxious heat or cold stimuli.

Conclusions

Obesity has minimal influence on pain sensitivity. Accordingly, it is unlikely that obesity alone increases susceptibility for chronic pain development through amplification of nociceptive processes.

Management of recent onset tendon-related pain in a primary contact setting: A survey of practice

BACKGROUND

Tendon-related pain is a common and debilitating condition that affects a wide range of people. To inform future research, it is important to understand healthcare professional's current practice.

OBJECTIVES

To describe the practice of First Contact Practitioners (FCPs) and Other Clinicians (OCs) for recent onset tendon pain in a primary contact setting. The secondary aim was to understand if practice differed between the locations of pain.

DESIGN

Cross-sectional online survey METHOD: The online survey asked for responses relating to one scenario of shoulder pain and one of Achilles pain. Except location of pain, the scenarios were identical. Responses were collected over a four-week period to December 2020. The Chi-Square test was used to analyse the difference in proportion of responses between FCPs and OCs, and between locations of pain.

RESULTS

118 responses were received. Rotator Cuff Related Shoulder Pain (RCRSP) was preferred by 64/118 (54.2%) for the shoulder scenario. Achilles tendinopathy was the preferred term by 86/103 (83.5%) for the Achilles. FCPs were more likely to advise NSAIDs for both shoulder (p = 0.006) and Achilles (p = 0.046) scenarios than OCs. Amended duties were more likely to be advised for manual workers for the shoulder scenario compared to Achilles (p = <0.0001).

CONCLUSION

There were similarities in the management of recent onset tendon-related pain; the majority of respondents recommended against further investigations, steroid injections, and recommended exercise. Understanding whether these approaches are clinically effective requires further investigation.