Medical Barriers: Chronic Pain Conditions

Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.

This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.


Any condition that leads to chronic pain can contribute to obesity by increasing physiological and psychological stress. Pain also makes exercise more difficult to undertake and enjoy.

Osteoarthritis and Back Pain

Obesity is commonly associated with musculoskeletal pain and osteoarthritis, resulting in functional and motor limitations. Obese patients usually move more slowly, are less flexible and feel pain when performing tasks at floor level. There is a strong association between knee osteoarthritis and obesity. Degenerative arthritis resulting from chronic trauma associated with excess body weight develops primarily in weight-bearing joints such as the knee and ankle. However osteoarthritis can also be seen in non-weight-bearing joints, suggesting a systemic inflammatory response. Excess body weight is also closely related to lower back pain. Both static and compressive loading may damage the integrity of intervertebral discs. Increased biomechanical force can also cause muscle sprain and ligament strain.Sleep disorders are very prevalent among obese people. Obstructive sleep apnea is the most common disorder, but disturbed sleep may also be due to primary insomnia, or insomnia secondary to medications, medical or psychiatric disorders.

The presence of significant pain can promote immobility, leading to loss of muscle mass and reduced cardiopulmonary fitness. This can precipitate psychological and metabolic changes that promote further weight gain.

Patients with painful joints may benefit from water-based (non-weight-bearing) exercise and may require pain management before embarking on a weight-loss program. Obese patients requiring joint-replacement surgery are generally advised to lose weight (often in unrealistic amounts) before surgery, but this is very difficult if they are already partially immobilized by pain.

To complicate matters further, most commercial gyms are ill-equipped to handle the needs of obese clients, many of whom cannot go from lying down on the floor to standing up without assistance. Step classes and aerobics classes are in many cases ill-advised, and exercise machines and weight benches are not usually designed for obese users.


Obesity is often associated with fibromyalgia, a common disorder characterized by fatigue, pain, stiffness in the trunk and extremities and a number of specific tender points. Fibromyalgia is more common in women than in men and is frequently accompanied by sleep disorders. Treatment of fibromyalgia may increase a patient’s ability to be physically active, and exercise has been shown to reduce the severity of fibromyalgia symptoms over time. As with severe osteoarthritis, starting with joint-sparing exercises may be prudent.

© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.

The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.

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