Body mass in adolescents with chronic pain: observational study - Gauntlett-Gilbert, Bhat,Clinch 2019

[Sly Saint]

Abstract
Objective In a paediatric chronic pain population, to determine whether higher body mass was associated with poorer functioning, mood or treatment outcome.

Design Cross-sectional study with examination of treatment outcomes.

Setting Tertiary specialist adolescent pain rehabilitation unit.

Patients 355 adolescents with relatively severe non-malignant chronic pain.

Interventions Intensive 3-week pain rehabilitation programme.

Main outcome measures Objective physical measures (walk, sit-to-stand); self-reported functioning and mood

Results Average body mass index (BMI) in the sample was relatively high (24.2 (SD 5.6)) with 20.5% being classified as obese. However, there were no relationships between body mass and objective physical measures, physical or social functioning, depression or anxiety (all p>0.05). There was a small relationship between higher body mass and greater pain-related fear (r=0.17, p<0.01). Treatment improved all variables (p<0.001) apart from pain intensity. There were no relationships between higher body mass and poorer treatment outcome; in fact, patients with higher BMI showed slightly greater decreases in depression (r=0.12, p<0.05) and pain-specific anxiety (r=0.18, p<0.01) during treatment.

Conclusions Higher body mass does not worsen functioning, mood or treatment response in adolescents with disabling chronic pain. Childhood obesity and chronic pain are both stigmatised conditions; clinicians should avoid implying that high body mass alone is a causal factor in the struggles of a young person with chronic pain.

https://adc.bmj.com/content/early/2019/11/28/archdischild-2019-317843?rss=1

 

[Amw66]

We observe an inverse correlation. Body mass decreases , pain increases.

 

[rvallee]

Well that's another "common wisdom" used in standard practice that seems to be completely made-up. Almost like there's a pattern of some kind, to make claims with zero evidence and never budge. We get it, a lower body mass is healthier overall but, no, it is not a damn magic pill. I have below average BMI. Guess what: still always in pain and sometimes in high levels of pain.

Anyway, do fat cells even have nociception? I'm pretty sure it's been established that the number of fat cells do not change, only their size. So I have no idea how those two things could be connected in any way other than lazy beliefs.

Although this nugget:

Treatment improved all variables (p<0.001) apart from pain intensity

So the "pain treatment" rehabilitation did not reduce pain. That's hitting two birds with 14 lbs if I ever saw one. Can it really be called "pain treatment" if it does not even affect pain?

I do appreciate the conclusion, though. It is rare. Because lost among all this obsession with pathologizing normal behavior as being the cause of all chronic illness is the reality that people with genuine mental illness also do get sick and this obsession is blocking their access to standard medical care by making managing an (as of yet) untreatable and unrelated problem as a condition to that medical care. On that it's the opposite of the two birds: it not only fails to fix the intended problem but actually makes everything worse off. Might want to change the thought process that lead to something this wrong happening in the first place.