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Merriwether EN, Vanegas SM, Curado S, Zhou B, Mun CJ, Younger OS, Elbel B, Parikh M, Jay M. Changes in widespread pain after surgical weight loss in racialized adults: A secondary analysis from a two-year longitudinal study. THE JOURNAL OF PAIN 2024:104625. [PMID: 39002743 DOI: 10.1016/j.jpain.2024.104625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/23/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024]
Abstract
Widespread pain is associated with reduced function and disability. Importantly, three-fourths of the approximately 42% of U.S. adults with obesity have widespread pain. Moreover, rates of adult obesity are higher and widespread outcomes are worse in racialized non-Hispanic Black and Hispanic/Latino/a/X groups, potentially exacerbating existing pain disparities. Bariatric surgery significantly reduces weight and improves pain. However, recurrent or unresolved pain after bariatric surgery can hinder weight loss or facilitate weight regain. The current study conducted a secondary analysis of a longitudinal study of predictors and mechanisms of weight loss after bariatric surgery to examine the point prevalence of widespread pain and pain trajectories 24 months post-surgery. Our secondary aim was to examine the association between weight loss and pain characteristics. Our exploratory aim was to longitudinally examine racial differences in pain trajectories after bariatric surgery. Our results showed that point prevalence decreased after bariatric surgery. Additionally, significant improvements in pain trajectories occurred within the first 3 months post-surgery with a pattern of pain reemergence beginning at 12 months post-surgery. Hispanic/Latino/a/X participants reported a higher number of painful anatomical sites before bariatric surgery, and the rate of change in this domain for this group was faster compared to the racialized non-Hispanic Black participants. These findings suggest that pain improvements are most evident during the early stages of surgical weight loss in racialized populations of adults with widespread pain. Thus, clinicians should routinely monitor patients' weight changes after bariatric surgery as they are likely to correspond to changes in their pain experiences. PERSPECTIVE: This article presents the prevalence and pain trajectories of racialized adults with widespread pain (WP) after surgical weight loss. Clinicians should evaluate changes in the magnitude and spatial distribution of pain after significant weight change in these populations so pain interventions can be prescribed with greater precision.
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Affiliation(s)
- Ericka N Merriwether
- Department of Physical Therapy, NYU Steinhardt School of Education, Culture, and Human Development, New York University, New York, NY, USA; Department of Medicine, NYU Grossman School of Medicine, New York University, New York, NY, USA.
| | - Sally M Vanegas
- Department of Medicine, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Silvia Curado
- Department of Pathology, NYU Grossman School of Medicine, New York University, New York, NY, USA; Department of Cell Biology, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Boyan Zhou
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA
| | - Chung Jung Mun
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Olivia S Younger
- Department of Physical Therapy, NYU Steinhardt School of Education, Culture, and Human Development, New York University, New York, NY, USA
| | - Brian Elbel
- Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA; NYU Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Manish Parikh
- Department of Surgery, NYU Grossman School of Medicine, New York University, New York, NY, USA; New York City Health and Hospitals/Bellevue Hospital Center, New York, NY, USA
| | - Melanie Jay
- Department of Medicine, NYU Grossman School of Medicine, New York University, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY, USA; New York Harbor Veterans Affairs, New York, NY, USA
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Chen JH, Chen PJ, Kantha P, Tsai YC, Lai DM, Hsu WL. Examining the influence of body fat distribution on standing balance and functional performance in overweight female patients with degenerative lumbar disease. Front Bioeng Biotechnol 2024; 12:1375627. [PMID: 38974656 PMCID: PMC11224472 DOI: 10.3389/fbioe.2024.1375627] [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: 01/24/2024] [Accepted: 05/23/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction: Degenerative lumbar disease (DLD) is a prevalent disorder that predominantly affects the elderly population, especially female. Extensive research has demonstrated that overweight individuals (categorized by body fat distribution) have a higher susceptibility to developing DLD and an increased risk of falling. However, there is limited research available on the standing balance and functional performance of overweight females with DLD. Aims: To determine the impact of body fat distribution on standing balance and functional performance in overweight females with DLD. Methods: This cross-sectional study evaluated thirty females with DLD were categorized into three types of body fat distribution based on body mass index (BMI) and waist-hip ratio, specifically as android-type, gynoid-type, and normal weight groups. In addition, a control group of ten age-matched females with normal weight was recruited. The Visual Analogue Scale, Roland Morris Disability Questionnaire, Cobb angle (Determined using x-ray), and body composition (Determined using the InBody S10), were conducted only on the DLD groups. All participants were assessed standing balance in the anteroposterior and mediolateral directions. The functional assessments included timed-up-and-go and 5-times-sit-to-stand tests. Results: There were 10 people in each group. Android-type (Age = 65.00 ± 6.34 years; BMI = 26.87 ± 2.05 kg/m2), Gynoid-type (Age = 65.60 ± 4.99 years; BMI = 26.60 ± 1.75 kg/m2), Normal weight (Age = 65.70 ± 5.92 years; BMI = 22.35 ± 1.26 kg/m2), and Control (Age = 65.00 ± 5.23 years; BMI = 22.60 ± 1.12 kg/m2). The android-type group had higher body fat, visceral fat, and lower muscle mass (p < 0.05), along with an increased Cobb angle (p < 0.05). They showed greater ellipse area, total excursion, and mean distance in the anteroposterior direction (p < 0.05). During the functional performance assessments, the android-type group had longer durations in both the 5-times-sit-to-stand and timed-up-and-go tasks (p < 0.05). Conclusion: Our study found that android-type overweight individuals showed postural instability, reduced functional performance, and insufficient lower limb muscle strength and mass. These findings might help physical therapists in planning interventions, as they imply that patients with DLD may require specific types of standing balance training and lower extremities muscle-strengthening based on their body fat distribution. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT05375201.
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Affiliation(s)
- Jung-Hsuan Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Jung Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Yi-Ching Tsai
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Physical Therapy Centre, National Taiwan University Hospital, Taipei, Taiwan
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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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Singh NK, Singh NK, Verma R, Diwan AD. Validation and Estimation of Obesity-Induced Intervertebral Disc Degeneration through Subject-Specific Finite Element Modelling of Functional Spinal Units. Bioengineering (Basel) 2024; 11:344. [PMID: 38671766 PMCID: PMC11048157 DOI: 10.3390/bioengineering11040344] [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: 02/07/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Intervertebral disc degeneration has been linked to obesity; its potential mechanical effects on the intervertebral disc remain unknown. This study aimed to develop and validate a patient-specific model of L3-L4 vertebrae and then use the model to estimate the impact of increasing body weight on disc degeneration. (2) Methods: A three-dimensional model of the functional spinal unit of L3-L4 vertebrae and its components were developed and validated. Validation was achieved by comparing the range of motions (RoM) and intradiscal pressures with the previous literature. Subsequently, the validated model was loaded according to the body mass index and estimated stress, deformation, and RoM to assess disc degeneration. (3) Results: During validation, L3-L4 RoM and intradiscal pressures: flexion 5.17° and 1.04 MPa, extension 1.54° and 0.22 MPa, lateral bending 3.36° and 0.54 MPa, axial rotation 1.14° and 0.52 MPa, respectively. When investigating the impact of weight on disc degeneration, escalating from normal weight to obesity reveals an increased RoM, by 3.44% during flexion, 22.7% during extension, 29.71% during lateral bending, and 33.2% during axial rotation, respectively. Also, stress and disc deformation elevated with increasing weight across all RoM. (4) Conclusions: The predicted mechanical responses of the developed model closely matched the validation dataset. The validated model predicts disc degeneration under increased weight and could lay the foundation for future recommendations aimed at identifying predictors of lower back pain due to disc degeneration.
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Affiliation(s)
- Nitesh Kumar Singh
- Computational Biomechanics Lab, Department of Biomedical Engineering, National Institute of Technology, Raipur 492010, India;
| | - Nishant K. Singh
- Computational Biomechanics Lab, Department of Biomedical Engineering, National Institute of Technology, Raipur 492010, India;
| | - Rati Verma
- Biomechanics Lab, School of Biomedical Engineering, Indian Institute of Technology (BHU), Varanasi 221005, India;
| | - Ashish D. Diwan
- Spine Labs & Spine Service, St George & Sutherland Campus, Clinical School of Faculty of Health & Medicine, University of New South Wales, Sydney, NSW 2502, Australia;
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Evans L, O'Donohoe T, Morokoff A, Drummond K. The role of spinal surgery in the treatment of low back pain. Med J Aust 2023; 218:40-45. [PMID: 36502448 PMCID: PMC10107811 DOI: 10.5694/mja2.51788] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
Low back pain (LBP) is common and a leading cause of disability and lost productivity worldwide. Acute LBP is frequently self-resolving, but recurrence is common, and a significant proportion of patients will develop chronic pain. This transition is perpetuated by anatomical, biological, psychological and social factors. Chronic LBP should be managed with a holistic biopsychosocial approach of generally non-surgical measures. Spinal surgery has a role in alleviating radicular pain and disability resulting from neural compression, or where back pain relates to cancer, infection, or gross instability. Spinal surgery for all other forms of back pain is unsupported by clinical data, and the broader evidence base for spinal surgery in the management of LBP is poor and suggests it is ineffective. Emerging areas of interest include selection of a minority of patients who may benefit from surgery based on spinal sagittal alignment and/or nuclear medicine scans, but an evidence base is absent. Spinal surgery for back pain has increased substantially over recent decades, and disproportionately among privately insured patients, thus the contribution of industry and third-party payers to this increase, and their involvement in published research, requires careful consideration.
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Affiliation(s)
| | | | - Andrew Morokoff
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Katharine Drummond
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
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Alsalamah NM, Bartel L. Management of severe low back pain with a focused vibro‐percussion wave treatment: A case report. Clin Case Rep 2022; 10:e6054. [PMID: 35898760 PMCID: PMC9307888 DOI: 10.1002/ccr3.6054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 05/10/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022] Open
Abstract
A 49‐year‐old male with severe low back pain (LBP) showed multilevel disc bulges with spinal stenosis. After 18 novel low‐frequency sound wave treatments, initial VAS pain score of 9.5 reduced to 2.5 and the Rolland‐Morris score of 13 reduced to 3. MRI showed some resolution of L3–L4 and L4–L5.
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Affiliation(s)
| | - Lee Bartel
- Neuro Spinal Innovations Research Department Mississauga ON Canada
- University of Toronto Toronto ON Canada
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Castro-Méndez A, Requelo-Rodríguez I, Pabón-Carrasco M, González-Elena ML, Ponce-Blandón JA, Palomo-Toucedo IC. A Case-Control Study of the Effects of Chronic Low Back Pain in Spatiotemporal Gait Parameters. SENSORS 2021; 21:s21155247. [PMID: 34372484 PMCID: PMC8347914 DOI: 10.3390/s21155247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 12/12/2022]
Abstract
Chronic low back pain and biomechanical walking imbalances are closely related. It is relevant to identify if there are alterations in spatiotemporal gait patterns in subjects with CLBP (cases) versus healthy subjects (controls) to plan training interventions of motor control gait patterns, and thus allowing normal physical activity of the individual. This study is intended to identify if spatiotemporal alterations occur in the gait cycle in CLBP subjects (cases) compared with a control group (healthy patients) analyzed with an OptoGait LED sensors gait program. Method: A total of n = 147 participants: n = 75 cases (CLBP) and n = 72 healthy controls subjects were studied with OptoGait gait program. Results: Significant differences were found between the two groups and both feet in foot stride, for the differences of the total stride and contact, for gait cadence and total stride length of the gait cycle (p < 0.05). Conclusions: CLBP may alter some normal gait patterns measured by OptoGait; this finding presents imbalances in gait cycle as an underlying factor. The gait is part of daily life of any individual and it is an important physical activity in relation to the maintenance of an optimal state of health. In addition, future studies are deemed necessary.
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Affiliation(s)
- Aurora Castro-Méndez
- Podiatry Department, University of Seville, 41009 Seville, Spain; (M.L.G.-E.); (I.C.P.-T.)
- Correspondence:
| | | | - Manuel Pabón-Carrasco
- Spanish Red Cross Nursing School, University of Seville, 41009 Seville, Spain; (M.P.-C.); (J.A.P.-B.)
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