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. CHRONIC PAIN CONDITIONS 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. Fibromyalgia 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… Read More »

Full Post

Would Reducing Obesity Save Thousands of Knees?

On most days, our obesity clinic could easily be confused with an orthopedic clinic given the sheer number of patients who present with severe pains in their backs, knees, hips, and ankles – often to the point of immobility. It turns out (perhaps not surprisingly) that today, obesity and knee osteoarthritis are among the most frequent chronic conditions affecting Americans aged 50 to 84 years – my guess is that these conditions are no less frequent among Canadians. Given the high prevalence of both obesity and knee osteoarthritis and their very significant impact on quality of life, Losina and a team of researchers from Harvard, Boston University, Chapel Hill, Yale and the University of Sydney undertook the rather momentous task of estimating the impact of these conditions on morbidity and mortality in older Americans. Their results were now published in the Annals of Internal Medicine. The researchers based their analyses on U.S. Census and national obesity data with estimated prevalence of symptomatic knee osteoarthritis, whereby they assigned the US population aged 50 to 84 years to four subpopulations: nonobese without knee osteoarthritis (reference group), nonobese with knee osteoarthritis, obese without knee osteoarthritis, and obese with knee osteoarthritis. They then used a computer simulation model (The Osteoarthritis Policy Model) to estimate quality-adjusted life-year losses due to knee osteoarthritis and obesity and to determine health benefits of reducing obesity prevalence to levels observed a decade ago. It turns out that the estimated total losses of per-person quality-adjusted life-years ranged from around 2 years in nonobese persons with knee osteoarthritis to about 3.5 years for persons affected by both conditions. Although these numbers may not sound shocking, they actually represent 10% to 25% of the remaining quality-adjusted survival of persons aged 50 to 84 years. When calculated for the entire US population in that age range, this amounts to a staggering 86 million quality-adjusted lost to these conditions. The researchers also calculate that reversing obesity prevalence to levels seen 10 years ago would avert just over 110,000 total knee replacements – so reducing obesity (even to where it was just 10 years ago) could indeed save a substantial number of knees. What the paper of course does not disclose is how exactly such a reversal in obesity rates could possibly be achieved. Clearly, the impact of weight loss on knee (and other) pain that we see in our clinic is often dramatic, but achieving weight… Read More »

Full Post

Orthopedic Surgery Centre Opens in Edmonton

Yesterday, the first patients moved into the new six-storey Orthopedic Surgery Centre (OSC) on the Royal Alexandra Hospital campus here in Edmonton. This state-of-the-art 56-bed and 4-theatre facility will exclusively provide services to patients requiring hip and knee surgeries from across northern Alberta. At capacity, the OSC will perform more than 4,000 procedures annually, certainly a much needed resource for Albertans. Regular readers of these pages will of course readily appreciate that this increasing demand for hip and knee replacements is primarily driven by one key factor: the increasing prevalence of obesity. Not only are the vast majority of patients receiving new hips and knees overweight or obese but we also know that excess weight is the key factor that is driving down the age of patients requiring such surgeries. While I have no doubt that this centre is necessary and will provide high quality orthopedic care to Albertans, I am also positive that we will likely need many more such centres (in Alberta and elsewhere) unless we put the same resources and efforts into preventing and treating obesity. To put this into perspective: while it is great to see that 4000 Albertans will now receive new hips and knees every year at this centre, let us not forget that less than 400 Albertans will receive bariatric surgery this year, a procedure that could dramatically reduce the need for such joint replacements in the first place (and provide substantial other benefits to patients). Indeed, many of the almost 100,000 Albertans with severe obesity, who may eventually need new hips or knees, will likely not even qualify for such surgery because they are deemed far too heavy for such operations. As I have often said before, not spending money on obesity treatments now, only means spending far more on treating the many complications later. AMS Edmonton, Alberta

Full Post

Obesity Promotes Musculoskeletal Problems in Kids

Not that this study should come as a surprise – indeed, regular readers of this blog will be well aware of the link between excess weight and bone and joint problems. Perhaps, what is surprising about this study is that it comes from The Netherlands, one of the leanest countries in Europe, which is a obviously also starting to have obesity problems of its own. In this study, just published in the Annals of Family Medicine, Marjolein Krul and colleagues from the University of Rotterdam, compared the frequency of musculoskeletal problems in overweight and obese children with that in normal-weight children in a cross-sectional database and face-to-face interview study that included 2,459 children aged 2 to 17 years from Dutch family practices. Overweight and obese children in both age-groups (2 to 11 years and 12 to 17 years) reported significantly more musculoskeletal problems (OR = 1.86 and OR = 1.69, respectively) than normal-weight children. In general children who were overweight or obese were almost twice as likely to report ankle and foot problems than children who were of normal weight. Overweight and obese children aged 12 to 17 years were also twice as likely to consult their family physicians with lower extremity problems than normal-weight children. So much for the notion that “chubbiness” in childhood is something that is cute and just a sign of a “healthy” appetite. What can the poor kids do? More often than not, excess weight is a problem that affects more than one member in the family and may well require family-based interventions. Simply telling the overweight kid to exercise more (especially with already existing musculoskeletal problems) is probably not the solution. AMS Edmonton, Alberta

Full Post

Off-Loading Young Hips

It is no secret that obesity is a substantial driver of any hip and knee replacement program. Although all kinds of factors can promote degenerative joint disease, the excess weight bearing down on a given joint certainly doesn’t help. In adults, this is pretty much accepted and as there is no end to the obesity epidemic in sight, orthopedic surgeons are unlikely to be out of work anytime soon. But now, there is increasing evidence that obesity may be driving an increase in joint problems in kids. Slipped capital femoral epiphysis (SCFE), typically appearing around the time of the early-pubertal growth spurt in adolescents (twice as often in boys than in girls), is of growing concern. In a recent article, Murray and Wilson from the Royal Hospital for Sick Children in Edinburg describe a 2.5-fold increase in SCFE in Scotland over the last two decades, but also that SCFE was now increasingly seen at younger ages. This increase remarkably parallels the substantial increase in childhood obesity in Scotland over this time period. Typically patients present with a history of several weeks or months of hip or knee pain and an intermittent limp. Treatment requires surgical fixation of the femoral head to avoid further slippage. With all the concern about increasing type 2 diabetes, dyslipidemia and hypertension in kids, let’s not forget bone and joint health. Missing the diagnosis can lead to irreversable damage with loss of function. Early recognition and surgical treatment (with or without weight loss) is essential. AMS

Full Post