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Changes in pain following a 6-week weight management in-patient programme

2019-09-07, Asada, Kana, Dunlevy, Colin, O'Malley, Emer, Doody, Catherine, Blake, Catherine, Fullen, Brona M., et al.

Objectives Musculoskeletal (MSK) pain is a commonly reported obesity related co-morbidity. Our Weight Management Service (WMS) is a national Tier 3 referral centre for the treatment of adults with severe obesity. As part of our service we deliver a 6 week weight management in-patient programme (WMIPP). This WMIPP involves a 1,100kcal liquid diet, functional rehabilitation and psychology interventions. This study evaluates the impact of the WMIPP on MSK pain and physical function.

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Does changing weight change pain? Retrospective data analysis from a national multidisciplinary weight management service

2019-09, Dunlevy, Colin, MacLellan, Grace A., O'Malley, Emer, Blake, Catherine, Mehegan, John, Fullen, Brona M., et al.

Background: Musculoskeletal (MSK) pain is common in obese populations. Multidisciplinary Tier 3 weight management services (WMS) are effective in reducing weight; however, MSK pain as an outcome is not routinely reported post-WMS interventions. Methods: Following ethical approval this retrospective design study using anonymized data from a national WMS established changes in anthropometric and pain prevalence and intensity scores as well as establishing variables predictive of achieving clinically significant changes (CSC) in pain scores. Results: Of the 806 patients registered to the WMS (January 2011–February 2015), 59% (n = 476; CI = 56–62) attended their reassessments at 6 months. The overall mean age was 45.1 ± 12 years and 62% (n = 294) were female. At baseline 70% (n = 281; CI = 65–75) reported low back pain (LBP) and 59% (n = 234; CI = 54–64) had knee pain. At reassessment 37.3% (n = 177) of patients lost ≥5% body weight, 58.7% (n = 279) were weight stable (5% weight loss or gain) and 4.0% (n = 19) gained ≥5% body weight. Low back and knee pain prevalence reduced significantly for those who lost ≥5% body weight. Variables predictive of a CSC in LBP numerical rating scale (NRS) score included a higher baseline NRS score, weighing more, and rating losing weight as being important (p < 0.05). Higher baseline NRS and being younger resulted in higher odds of a CSC in knee pain NRS (p < 0.05). Conclusions: Overall this WMS was effective for clinical weight loss. For those who lost most weight prevalence of knee and LBP reduced. Imbedding pain management strategies within WMS’s may provide a more holistic approach to obesity management. Significance: Weight loss can reduce musculoskeletal pain, particularly for those who lose more weight. Imbedding pain management strategies within these services may provide a more holistic approach to obesity management.

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Publication

Musculoskeletal pain profile of obese individuals attending a multidisciplinary weight management service

2017-07, MacLellan, Grace A., Dunlevy, Colin, O'Malley, Emer, Blake, Catherine, Fullen, Brona M., et al.

Obesity is associated with numerous chronic diseases, including musculoskeletal (MSK) pain, which affects on quality of life (QoL). There is, however, limited research providing a comprehensive MSK pain profile of an obese cohort. This retrospective study used a patient database at a national weight management service. After ethical approval, anonymized patient data were statistically analyzed to develop a pain profile, investigate relationships between pain, sleep, and function, and explore variables associated with having low back pain (LBP) and knee pain. Overall, 915 individuals attended the weight management service from January 2011 to September 2015 [male, 35% (n = 318; confidence interval [CI] = 32-38); female, 65% (n = 597; CI = 62-68); mean age 44.6]. Mean body mass index was 50.7 kg/m 2 [class III obese (body mass index ≥40 kg/m 2), 92% (n = 835; CI = 91-94)]. Approximately 91% reported MSK pain: LBP, 69% (n = 539; CI = 65-72) [mean Numeric Rating Scale 7.4]; knee pain, 58% (n = 447; CI = 55-61) [mean Numeric Rating Scale 6.8]. Class III obese and multisite pain patients had lower QoL and physical activity levels, reduced sleep, and poorer physical function than less obese patients and those without pain (P < 0.05). Relationships were found between demographic, pain, self-report, psychological, and functional measures (P < 0.05). Patients who slept fewer hours and had poorer functional outcomes were more likely to have LBP; patients who were divorced, had lower QoL, and more frequent nocturia were more likely to have knee pain (P < 0.05). Multisite MSK pain is prevalent and severe in obese patients and is negatively associated with most self-report and functional outcomes. This high prevalence suggests that pain management strategies must be considered when treating obesity.