Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 1;21(10):2563-2572.
doi: 10.1093/pm/pnaa043.

The Relationship Between Body Mass Index and Pain Intensity Among Veterans with Musculoskeletal Disorders: Findings from the MSD Cohort Study

Diana M Higgins  1   2 , Eugenia Buta  3 , Alicia A Heapy  4   5 , Mary A Driscoll  4   5 , Robert D Kerns  4   5 , Robin Masheb  4   5 , William C Becker  4   5 , Leslie R M Hausmann  6   7 , Matthew J Bair  8   9 , Laura Wandner  10 , E Amy Janke  11 , Cynthia A Brandt  4   5 , Joseph L Goulet  4   5
Affiliations

The Relationship Between Body Mass Index and Pain Intensity Among Veterans with Musculoskeletal Disorders: Findings from the MSD Cohort Study

Diana M Higgins et al. Pain Med. .

Abstract

Objective: To examine the relationship between body mass index (BMI) and pain intensity among veterans with musculoskeletal disorder diagnoses (MSDs; nontraumatic joint disorder; osteoarthritis; low back, back, and neck pain).

Setting: Administrative and electronic health record data from the Veterans Health Administration (VHA).

Subjects: A national cohort of US military veterans with MSDs in VHA care during 2001-2012 (N = 1,759,338).

Methods: These cross-sectional data were analyzed using hurdle negative binomial models of pain intensity as a function of BMI, adjusted for comorbidities and demographics.

Results: The sample had a mean age of 59.4, 95% were male, 77% were white/Non-Hispanic, 79% were overweight or obese, and 42% reported no pain at index MSD diagnosis. Overall, there was a J-shaped relationship between BMI and pain (nadir = 27 kg/m2), with the severely obese (BMI ≥ 40 kg/m2) being most likely to report any pain (OR vs normal weight = 1.23, 95% confidence interval = 1.21-1.26). The association between BMI and pain varied by MSD, with a stronger relationship in the osteoarthritis group and a less pronounced relationship in the back and low back pain groups.

Conclusions: There was a high prevalence of overweight/obesity among veterans with MSD. High levels of BMI (>27 kg/m2) were associated with increased odds of pain, most markedly among veterans with osteoarthritis.

Keywords: Chronic Pain; Musculoskeletal; Obesity; Osteoarthritis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Relationship between body mass index (BMI) and any pain. The left plot presents adjusted odds ratios for the association between BMI (kg/m2) and the presence of any pain (i.e., non-0 pain). The reference value is BMI = 23 kg/m2. Estimates were obtained from the logistic part of the hurdle-negative binomial model. BMI was modeled using natural cubic splines with 4 degrees of freedom (three knots). The right plot presents the estimated probability of non-0 pain from the same model for a white male with nontraumatic joint disorder, married, with no comorbidities.
Figure 2
Figure 2
Relationship between body mass index (BMI) and pain intensity among subjects with any pain. The left plot presents the adjusted mean (rate) ratios for the association between BMI (kg/m2) and pain among subjects with non-0 pain. The reference value is BMI = 23 kg/m2. Estimates were obtained from the count part of the hurdle-negative binomial model. BMI was modeled using natural cubic splines with 4 degrees of freedom (three knots). The right plot presents the estimated mean pain of subjects with non-0 pain for a white male with nontraumatic joint disorder, married, with no comorbidities.
Figure 3
Figure 3
Odds ratios and mean ratios between body mass index (BMI) and any non-0 pain. The left plot presents adjusted odds ratios for the association between BMI (kg/m2) and the presence of any pain (i.e., non-0 pain), by musculoskeletal disorder (MSD) group. The right plot presents the adjusted mean ratios for the association between BMI (kg/m2) and pain among subjects with non-0 pain, by MSD group. Estimates were obtained from the hurdle-negative binomial model, which included interactions of the MSD group with all variables in the model. The reference value is BMI = 23 kg/m2. BMI was modeled using natural cubic splines with 4 degrees of freedom (three knots).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Flegal KM. Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010;303(3):235–41. - PubMed
    1. Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67(36):1001–6. - PMC - PubMed
    1. Stone AA, Broderick JE.. Obesity and pain are associated in the United States. Obesity (Silver Spring) 2012;20(7):1491–5. - PubMed
    1. Jinks C, Jordan KP, Blagojevic M, et al. Predictors of onset and progression of knee pain in adults living in the community. A prospective study. Rheumatology (Oxford) 2007;47(3):368–74. - PubMed
    1. Shiri R, Karppinen J, Leino-Arjas P, et al. The association between smoking and low back pain: A meta-analysis. Am J Med 2010;123(1):87.e7–35. - PubMed

Publication types