Heinberg, Leslie J.

Background: Individuals with obesity frequently contend with pain, but few studies address the clinical impact of comorbidity within this population. This study compared the early weight loss outcomes and complications of bariatric surgery for participants with and without presurgical pain. Methods: A retrospective analysis of data stored in a registry of patients who had undergone bariatric surgery was conducted. Patients completed a routine preoperative psychological and medical evaluation. Participants were grouped based upon the presence of at least one pain condition and/or pain site: pain ( n = 184) or no pain ( n = 30). Participants completed questionnaires regarding 21 psychological and 17 medical complications and reported their weights at their 1- and 3-month postoperative psychological appointments. Results: The majority of the final sample ( n = 214) identified as 69% female and 66% Caucasian. Contrary to the hypothesis, results indicated no significant mean differences in 1- and 3-month postoperative medical and psychological complications, or percentage excess and total weight loss between the groups. Conclusions: In the early postoperative period, participants with preoperative pain and comorbid obesity lose weight and experience complications to a degree comparable with participants without preoperative pain. Implications for clinical interventions and future research are discussed.

Abstract Objective Individuals with obesity frequently contend with chronic pain, but few studies address the clinical impact of coordinated pain services on this population. The current study addresses this topic by comparing the effectiveness of a comprehensive pain rehabilitation program for patients with and without obesity. Methods A retrospective analysis of registry data was conducted. Obesity was considered as one of three weight groups, based on the following body mass index cutoffs: normal weight (18.5 to < 25 kg/m2), overweight (25 to < 30 kg/m2), and obese (> 30 kg/m2). These groups were compared on the Pain Severity Ratings (PSR) Scale, the Pain Disability Index (PDI), and the Depression, Anxiety, Stress Scales—Short Form (DASS-SF). Results Groups differed on baseline pain disability and depression. Patients with obesity had higher scores on both the PDI (P = .028) and the DASS-SF depression subscale (P = .006). Contrary to the hypothesis, after controlling for baseline score and sex there were no significant differences between weight groups with regards to PSR, PDI, or any DASS-SF subscale at discharge. At 1-year follow-up, individuals who were overweight and obese had significantly more anxiety compared to individuals whose weight was in the normal range. Conclusions Multidisciplinary pain rehabilitation programs appear to be an effective treatment intervention for patients who have concomitant chronic pain and obesity, to a degree comparable to patients who have chronic pain but do not contend with obesity. Implications for program development, clinical interventions, and future research are discussed.

Background and Aims: Gastroparesis (GP) patients suffer from recurrent symptoms of nausea, vomiting, early satiety, and abdominal pain. The impact of GP on quality of life (QoL), health care utilization and daily activities is not well understood. Materials and Methods: Part 1: 398 adult patients (≥18 y) with documented GP (symptoms >6 mo) were surveyed to assess QoL and pain using the Short Form 36 and McGill pain questionnaires. Part 2: 491 adult GP patients were surveyed to evaluate employment status, work and daily activities, medication use, physician visits, diagnostic testing, emergency room visits, and hospitalizations related to their GP symptoms. Both protocols received Institutional Review Board approval. Results: Part 1: 250 fully evaluable surveys were returned (63%). The mean age was 46.8 years (range, 18 to 84 y); 78% were women. Mean Short Form 36 scores for mental health (56.9) and social functioning (68.1) were analogous to scores for patients with serious chronic medical disorders and depression. Pain scores were lower in patients with idiopathic GP compared with diabetic GP. Part 2: 228 evaluable surveys were analyzed (58.3% response rate). The mean age was 49.6 (19 to 86 y); 77.2% were women. GP symptoms reduced daily activities in 67.5% and lowered annual income in 28.5%. In total, 11% were disabled due to GP symptoms. Conclusions: GP reduces patients’ QoL and places a significant financial burden on the health care system. Treatment strategies for GP patients should be broad based and incorporate pain management, psychological evaluation and management, and strategies to improve overall well-being with a return to work and daily activities.