As blogged before, overweight and obese patients frequently present with fibromyalgia, characterized by chronic pain, fatigue and depressed mood.

A paper by Akiko Okifuji from the University of Utah, Salt Lake City, just published in the Journal of Pain, examines the relationship between fibromyalgia and obesity in pain, function, mood, and sleep.

The study examines the impact of obesity on hyperalgesia, symptoms, physical abilities, and sleep in 215 fibromyalgia patients, who also underwent tender point examination, physical performance testing, and 7-day home sleep assessment.

Almost 50% of participants were obese and an additional 30% were overweight.

Obesity was positively related to greater tender point sensitivity, reduced physical strength and lower-body flexibility, shorter sleep duration, and greater restlessness during sleep.

The results confirmed that obesity is a prevalent comorbidity of fibromyalgia and the authors suggest that weight management may need to be incorporated into treatments.

In the paper, Okifuji and colleagues also discuss several potential mechanisms linking obesity to fibromyalgia including alterations in the endogenous opioid system, the endocrine system, and systemic inflammation, whereby adipose-tissue derived cytokines may enhance central sensitization.

Clinicians should be aware of the relationship between excess weight and fibromyalgia, which can often pose an important contributor to weight gain and a major barrier to weight management.

AMS
Edmonton, Alberta

Okifuji A, Donaldson GW, Barck L, & Fine PG (2010). Relationship Between Fibromyalgia and Obesity in Pain, Function, Mood, and Sleep. The journal of pain : official journal of the American Pain Society PMID: 20542742

Yesterday, I presented Grand Rounds at the Holy Cross Pain Centre in Calgary. As regular readers will recall, pain is a common consequence and/or cause of weight gain and very often a major barrier to weight management.

Not only is obesity commonly associated with conditions such as fibromyalgia, back pain, osteoarthritis, or plantar fasciitis but also migraines and other forms of headaches.

In the same manner that obesity is a complex syndrome that has a multitude of psychosocial and biological determinants, so is chronic pain. It was therefore not surprising to see that many of the principles of interdisciplinary pain management used at the Holy Cross Pain Centre are not very different from the principles we use in the Weight Wise program.

The team at the Pain Centre is fortunate to have the support of physio- and occupational therapists, nurses, psychologists, pharmacists, dietitians and other allied health professionals as well as a wide range of physician consultants working at their centre.

This complement of health professional is indeed very similar to what we have in our obesity clinic.

There are other important similarities: managing patient expectations, emphasis on self-management, focus on functional goals, attrition rates, and other characteristics of chronic disease management programs.

As I have often blogged, obesity is not really different – it just takes the same approach and resources to manage as other chronic conditions – no more, but also no less!

AMS
Calgary, Alberta

Recently, I blogged about the rather close association between excess weight and fibromyalgia.

A paper by Laura-Isabel Arranz and colleagues from the University of Barcelona, Spain, published in the latest issue of Rheumatology International, reviews the role of nutritional factors in patients with fibromyalgia.

While their analysis of the literature confirms the high prevalence of overweight and obesity in fibromyalgia patients and the rather sparse data suggesting that weight loss may improve symptoms, they also note that many patients with fibromyalgia may have other nutritional deficiencies which may or may not be related to this disorder.

Rather limited evidence supports that notion that vegetarian diets may have some beneficial effects, perhaps due to an increase in antioxidant intake.

They also note that although numerous food supplements have been studied, there is very little data to support their use in improving symptoms in patients with fibromyalgia.

Clearly, the relationship between obesity, nutritional factors, and fibromyalgia warrants further study.

AMS
Edmonton, Alberta

To anyone regularly dealing with overweight and obese patients, the frequent association between excess weight and chronic musculoskeletal pain is no secret.

This association is particularly true for the rather enigmatic syndrome of fibromyalgia, characterised by the presence of generalized pain in muscle and joints, often associated with fatigue, poor sleep, and depression. Patients typically present with exquisite tenderness over discrete anatomical points, commonly referred to as tender points.  While there is still much debate around the exact etiology or even the exact diagnostic criteria (e.g. number of tender points) for fibromyalgia, there is no doubt that the presence of this syndrome can prove a major barrier to weight management.

Indeed, it is not at all clear whether there may in fact be an etiological link between fibromyalgia and obesity. As outlined in a paper by Akiko Okifuji and colleagues from Salt Lake City, UT, published last year in Clinical Rheumatology, 70% of fibromyalgia patients in their study were overweight or obese and presented with elevated levels of IL-6, catecholamines, cortisol, and CRP, all of which are common findings in obese patients. Furthermore, the patients with fibromyalgia, as do obese patients, presented with reduced sleep duration and efficiency. Based on these commonalities, Okifuji and colleagues concluded that excess weight and obesity may well play a role in fibromyalgia and related dysfunction. 

Interestingly, in 2008, Alan Saber and colleagues published an article in Obesity Surgery describing a significant improvement in pain score and points of tenderness in patients with fibromyalgia who underwent laparoscopic Roux-en-Y gastric bypass surgery. Based on these findings, the authors suggested that weight loss may be an important treatment modality for severely obese patients with this syndrome.

Whether or not less drastic approaches to weight management can provide benefits remains to be seen. Nevertheless, there have been reports of limited response to education, exercise, and psychological interventions. Thus, currently accepted non-pharmacological treatments for fibromyalgia remain rather limited.

Recently, a Cochrane review concluded that duloxetine is efficacious for treating pain in fibromyalgia and another systematic review found evidence that gabapentin and pregabalin can also reduce pain in these patients. 

Nevertheless, fibromyalgia continues to be a common but largely undertreated problem in overweight and obese patients and can often pose a significant barrier to increasing physical activity or modifying ingestive behaviour. 

As blogged before, assessment for muskuloskeletal pain should be a regular and essential feature of any assessment for overweight and obesity. 

I very much look forward to comments from any readers struggling with fibromyalgia or from colleagues on how they manage this debilitating syndrome.

AMS
Edmonton, Alberta

Lower back pain is not an uncommon finding in obese and very obese individuals. One surgical treatment option is to create a fusion between two or more vertebrae in an attempt to reduce pain by stopping the motion at the painful vertebral segment(s).

In a paper just published in SPINE, Rahul Vaidya and colleagues from the Detroit Receiving Hospital and University Health Center, Detroit, report on their experience in a case series of 63 patients with a BMI of 30 or higher.

Despite a higher surgical risk and a 45% greater chance of complications, obese and very obese patients showed significant improvement in visual analog scale for back and leg pain with some improvement in disability scores independent of the BMI of the patient.

Thus, despite posing a greater challenge for the surgeon and slightly higher surgical risk, heavier patients stand to benefit as much from surgery as less obese patients.

Incidentally, as with other types of orthopedic surgeries that improve mobility, no “spontaneous” weight loss was found to occur after spinal surgery.

Important questions that remain to be answered include the role for pre-surgical weight loss and whether or not weight management will be made easier following surgery.

AMS
Edmonton, Alberta