Upper Extremity Pain and ObesityThursday, May 9, 2013
Many patients presenting at our bariatric clinic complain of pain. Much of this is located in the lower back and lower extremities and is most often attributed to the mechanical consequences of carrying excess weight.
However, it is not uncommon to see patients present with pain in “non-weight bearing” joints, including the upper extremities.
This issue was studied by Velmas and colleagues from the Finnish Institute of Occupational Health in a paper published in Pain Medicine.
The data included 177 workers seeking medical advice for upper extremity pain.
Interestingly, all obesity indicators, including BMI, waist and hip circumference, visceral and liver fat as well as markers of metabolic disease were associated with pain intensity and interference with sleep.
In fact, visceral fat thickness was the strongest predictor of upper extremity intensity and interference with sleep.
While this association is of considerable interest, it is not clear whether obesity promotes upper extremity pain (e.g. through pro-inflammatory pathways) or upper extremity pain promotes weight gain (e.g. by impairing sleep or affecting eating behaviour).
Nevertheless, clinicians should be aware of the fact that overweight and obese patients can present with upper extremity pain and that this may be associated with increased cardio metabolic risk.
Vehmas T, Shiri R, Luoma K, & Viikari-Juntura E (2013). The Relations of Obesity Indicators and Early Metabolic Disturbance with Upper Extremity Pain. Pain medicine (Malden, Mass.) PMID: 23647726