Obesity and Pain

A staggering one out of every three people with obesity lives with pain. This can include pain in joints, muscles, headaches, abdominal pain, pelvic pain, and/or neuropathic (nerve) pain. Chronic pain can interfere with daily functioning, and have a huge impact on quality of life, mood, and well being.

A review published in the International Journal of Obesity summarizes the available literature on this important topic.

Here are some of the key points:

Why are people with obesity at risk of chronic pain?

From a mechanical perspective, some people who carry excess weight have pain due to weight strain on muscles and joints.
The chronic inflammatory state of obesity may contribute to heighten pain. Excess fat tissue produces inflammatory cytokines (chemicals/hormones) that may influence the neuron (nerve) activity in both peripheral and central nervous systems.
Sleep disturbance can increase the perception of pain. Many people with elevated weight have obstructive sleep apnea, which can disturb sleep, especially if untreated. Pain itself can disturb sleep, which can further increase the perception of pain.

People with obesity may have greater sensitivity to pain.

Studies suggest that people with overweight or obesity have lower pain thresholds and lower pain tolerance than people of healthy body weight. Further, the degree of pain sensitivity may be correlated with the degree of overweight.

Pain can also lead to weight gain because of:

restrictions in activity due to pain
fear of activity causing pain, leading to decreased activity
eating to medicate/relieve the sensation of pain

So, the relationship between obesity and pain is a two-way street: not only does obesity increase the risk of pain, but pain increases the risk of weight gain.

Identifying and treating the cause(s) of pain is paramount in any patient, of any weight. Treating the symptom of pain itself is important, for alleviation of the pain, to alleviate pain-induced restrictions on activity, and to avoid eating to relieve the sensation of pain. Weight reduction can improve pain (depending on the cause of the pain), though often does not alleviate it completely.

There is still much to be learned and understood as regards the complex relationship between obesity and pain. As the authors note,

The science of obesity and pain is best described as being in its infancy. Understanding the complexity of the relationships between pain and weight status… is essential to our understanding of the development and treatment of overweight and obesity.

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