Could my weight be contributing to my pain?

As part of having an osteopathic consultation usually requires the patient to have the affect bit of their body exposed so the osteopath can examine it, a very common (possibly very British) reaction is for the patient to apologise for something about their body.  Sometimes it’s toenails, other times it could be a scar, but most of the time they apologise for their weight or body shape, no matter what that weight or shape is! Once we get past that very British moment, a common question we get asked is ‘could my weight be causing my pain?’ ,it’s a simple question that has some nuanced answers which we explain below.

Is there an association between weight and pain in general?

The answer here is undoubtedly yes, several studies have shown that as a person’s weight goes up into the range of Body Mass Index (BMI) that would classify them as overweight (over 25) or obese (over 30) then their likelihood of having pain is increased (1).  This has been shown to be true over several different groups of people, from US army veterans (2) to adolescents (3).  It has also been shown that a person’s chances of having pain increases incrementally as their BMI score goes up (4).

Why this association occurs might seem obvious in that more weight equals more mechanical strain on the body’s structure.  It is true that people who are obese tend to have a greater incidence observable structural changes associated with vertebral disc degeneration and degenerative change in the knee joints (5, 6), suggesting that the compressive forces of their weight contribute to tissue changes.  However obesity can result in people changing how they walk and move, which may also be contributing to their pain.  It has been observed that obese people with low back pain change their movement pattern in response to the pain, possible leading to further complications (7).  It is tempting to think that this mechanical model is the main reason why obesity and pain are linked, but there are other factors at play too.

The increased amount of fat cells a person has may be contributing to their pain, fat cells are not only for energy storage, they are much more active than that.  One action they perform is the production of chemicals for the endocrine system that are ‘pro-inflammatory’, resulting in a generalised increase in bodily inflammation and therefore pain (8).  Other research has shown that obesity is associated with increased levels of leptin, which is a chemical that is also seen in higher levels in people with advanced osteoarthritis which also causes inflammation, pain and joint damage (9).

There may also be a ‘chicken and egg’ scenario at play, in that the amount of pain a person is in will alter their behaviour and lifestyle.  For example, let’s say a person with a relatively low BMI develops some kind of chronic pain problem, the presence of chronic pain has been shown to alter a person’s activity levels due to fear of worsening the pain (10).   As sedentary people are at greater likelihood of developing pain, when a person then avoids activity and their BMI rises they enter a cycle of pain-inactivity-obesity.  Chronic pain is one of the more common reasons people list for their weight gain (11), and the frustration over the inability to be active can also lead to overeating (12).  Other elements of chronic pain such as poor sleep and certain pain medications can also contribute to a person’s propensity to gain weight (1).

These factors may lead to the observable effect that people with increased BMIs have higher levels of pain, but the causality is not always clear, it may be that the pain arrived first which produces a behaviour change which results in increased weight.  It is thought that obesity and chronic pain are multifactorial in nature, with several physical, emotional, and social elements contributing to the overall picture.

If being heavier increases your chances of having pain, what kind of effect does losing weight have on pain levels?

The good news is there is plenty of evidence to suggest that losing some weight will have a measureable difference on your pain.  Recent research shows that a baseline of 10% of bodyweight lost will result in significant improvements in pain and function in people with knee osteoarthritis (13).  At the more extreme end of this type of research people who underwent gastric band surgery and lost 20% of their bodyweight reported improvements in pain scores of 50% (14).

These effects have also been shown to be true for people with low back pain and hip pain (1), indeed many of the current guidelines for the management of hip, back and knee pain include weight management as a key component of success (15, 16).  Importantly there is a measureable ‘dose response’ with losing weight and improvements in pain, the more weight you lose the less pain you will have (1).

Although obesity and pain have a complex and multifaceted relationship one thing that people can do to help reduce various types of pain in the body is to lose weight, this will not only help with the pain but has many proven benefits to your health in general.

Do you want to know what is causing your pain and if we can help? Why not take advantage of our new patient assessment introductory offer to get you started towards a tailor made recovery plan for only £19.

Are you in a lot of pain and want to get better as soon as possible?  If so then why not book in for a new patient consultation, with treatment on the day, for £72.

References

1 – Okifuji A, Hare BD (2015). The association between chronic pain and obesity. J Pain Res. 2015;8:399-408, doi:10.2147/JPR.S55598.

2 – Higgins DM, Kerns RD, Brandt CA, et al (2014). Persistent pain and comorbidity among operation enduring freedom/operation Iraqi freedom/operation New Dawn veterans. Pain Med; 15(5):782–790.

3 – Deere KC, Clinch J, Holliday K, et al (2012). Obesity is a risk factor for musculoskeletal pain in adolescents: findings from a population-based cohort. Pain; 153(9):1932–1938.

4 – Hitt HC, McMillen RC, Thornton-Neaves T, Koch K, Cosby AG (2014). Comorbidity of obesity and pain in a general population: results from the Southern Pain Prevalence Study. J Pain; 8(5):430–436.

5 – Singh D, Park W, Hwang D, Levy MS (2014). Severe obesity effect on low back biomechanical stress of manual load lifting. Work; Sep 23; Epub.

6 – Cimen OB, Incel NA, Yapici Y, Apaydin D, Erdoğan C (2004).  Ups J Med Sci; 109(2):159-64.

7 – Cimolin V, Vismara L, Galli M, Zaina F, Negrini S, Capodaglio P (2011). Effects of obesity and chronic low back pain on gait. J Neuroeng Rehabil; 8:55.

8 – Bluher M, Fasshauer M, Tonjes A, Kratzsch J, Schon MR, Paschke R (2005). Association of interleukin-6, C-reactive protein, interleukin-10 and adiponectin plasma concentrations with measures of obesity, insulin sensitivity and glucose metabolism. Exp Clin Endocrinol Diabetes; 113(9):534–537.

9 – Considine RV (2005). Human leptin: an adipocyte hormone with weight-regulatory and endocrine functions. Semin Vasc Med, 5(1):15–24.

10 – Koho P, Orenius T, Kautiainen H, Haanpaa M, Pohjolainen T, Hurri H (2011). Association of fear of movement and leisure-time physical activity among patients with chronic pain. J Rehabil Med; 43(9):794–799.

11 – Ferguson S, Al-Rehany L, Tang C, Gougeon L, Warwick K, Madill J (2011). Self-reported causes of weight gain: among prebariatric surgery patients. Can J Diet Pract Res;74(4):189–192.

12 – Janke AE, Kozak AT (2012). “The more pain I have, the more I want to eat”: obesity in the context of chronic pain. Obesity (Silver Spring); 20(10):2027–2034.

13 – Christensen R, Bartels EM, Astrup A, Bliddal H (2007). Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis; 66:433–439.

14 – Richette P, Poitou C, Garnero P, Vicaut E, Bouillot JL, Lacorte JM, et al (2011). Benefits of massive weight loss on symptoms, systemic inflammation and cartilage turnover in obese patients with knee osteoarthritis. Ann Rheum Dis; 70:139–144.

15 – National Institute for Clinical Excellence (2014). Osteoarthritis. Care and management in adults

16 – National Institute for Clinical Excellence (2018). Low back pain and sciatica in over 16’s.  [online] https://pathways.nice.org.uk/pathways/low-back-pain-and-sciatica#path=view%3A/pathways/low-back-pain-and-sciatica.