Obesity affects musculoskeletal pain score in adolescents

By Piriya Mahendra

Obese adolescents are significantly more likely to report musculoskeletal pain than their nonobese counterparts, researchers report.

This finding represents the first reported association between obesity and musculoskeletal pain in adolescents, and suggests that obesity may represent an important risk factor, say Jon Tobias (Southmead Hospital, Bristol, UK) and colleagues in Pain.

They found that adolescents who were obese (>95th percentile for body mass index) had a significant 33% higher risk for reporting any pain, and an 87% higher risk for knee pain, than their nonobese counterparts.

Obese adolescents also had a more than doubled risk for chronic regional pain (CRP), defined as either moderately, very, or extremely troublesome pain lasting longer than 3 months affecting the knee, hip, shoulder, lower back, or a combination of these sites.

Among those individuals who reported pain, obese participants reported higher pain scores for average pain according to the Chronic Pain Grade Questionnaire, at 6.26 versus 5.65.

Among those with knee pain specifically, scores for present pain, worse pain, and average pain were significantly higher in obese than nonobese participants. Indeed, obese patients rated their average pain, at 7.14 compared with 5.96 points in nonobese patients.

Average pain was also significantly higher in obese than nonobese individuals who reported CRP, at 7.75 versus 6.32 points.

There was no significant association between obesity and pain score in individuals with chronic widespread pain (CWP), defined as pain on both sides of the body, above and below the waist and in axial skeleton, present for at least 3 months.

The study included 3376 participants, 1424 of whom were boys, with a mean age of 17.8 years. Overall, 44.7% of participants reported any pain within the past month lasting 1 day or more; 7.0% reported knee pain lasting at least a day, 4.7% CRP, and 4.3% CWP. In addition, 7.0% of participants were obese.

The authors say that obesity may cause pain through increased strain on the joints during weight bearing. They also suggest that an increase in body mass index secondary to reduced physical activity may exacerbate existing musculoskeletal pain.

Tobias et al point out that they observed a link between obesity and increased risk for headaches, conceivably reflecting a link with depression, which is associated with obesity.

"Further studies are justified to evaluate the clinical relevance of these relationships, for example by determining whether obesity predicts persistence of musculoskeletal symptoms and reduced function over the longer term," they conclude.

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