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Does it hurt to be heavy? Weight and back pain relationship is complex

PainSci » bibliography » Wright et al 2010
Tags: etiology, radiculopathy, pain, mind, structuralism, sciatica, leg, pro, neuropathy, pain problems, spine, buttocks, hip, herniation, back pain, limbs

Two articles on PainSci cite Wright 2010: 1. The Complete Guide to Low Back Pain2. 6 Main Causes of Morning Back Pain

PainSci commentary on Wright 2010: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Does it hurt to be heavy? It seems possible, and in this study “obese twins were more likely to report low back pain.” But it’s not that simple: there are many variables involved. For instance, several other pain problems were also more likely: “migraine headaches, fibromyalgia, abdominal pain, and chronic widespread pain.” Weight is associated with more pain in general, not low back pain specifically, as you’d expect if the problem were simply due to compression of the spine. Clearly that typical assumption is not a safe one, and indeed the apparent connection between weight and pain weakened when the data were adjusted for common denominators like depression, a strongly confirmed risk factor for low back pain. In other words, if you factored out the depressed cases, the remaining subjects were not all that likely to have back pain. Given such complexity, the researchers made it clear that more and different research is needed to figure out what, exactly, is causing what. No kidding!

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Chronic pain and obesity, and their associated impairments, are major health concerns. We estimated the association of overweight and obesity with 5 distinct pain conditions and 3 pain symptoms, and examined whether familial influences explained these relationships. We used data collected from 3,471 twins in the community-based University of Washington Twin Registry.

Twins reported sociodemographic data, current height and weight, chronic pain diagnoses and symptoms, and lifetime depression. Overweight and obese were defined as body mass index of 25.0 to 29.9 kg/m(2) and >or= 30.0 kg/m(2), respectively. Generalized estimating equation regression models, adjusted for age, gender, depression, and familial/genetic factors, were used to examine the relationship between chronic pain, and overweight and obesity.

Overall, overweight and obese twins were more likely to report low back pain, tension-type or migraine headache, fibromyalgia, abdominal pain, and chronic widespread pain than normal-weight twins after adjustment for age, gender, and depression. After further adjusting for familial influences, these associations were diminished. The mechanisms underlying these relationships are likely diverse and multifactorial, yet this study demonstrates that the associations can be partially explained by familial and sociodemographic factors, and depression. Future longitudinal research can help to determine causality and underlying mechanisms.

PERSPECTIVE: This article reports on the familial contribution and the role of psychological factors in the relationship between chronic pain, and overweight and obesity. These findings can increase our understanding of the mechanisms underlying these 2 commonly comorbid sets of conditions.

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