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. 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.

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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).
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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

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