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. 2025 Dec;57(1):2517816.
doi: 10.1080/07853890.2025.2517816. Epub 2025 Jun 18.

Pain characteristics and psychological factors that mediate the association between obesity and outcomes of interdisciplinary pain rehabilitation: a registry-based cohort study

Huan-Ji Dong  1 , Agnes Genander  1 , Elena Dragioti  1   2
Affiliations

Pain characteristics and psychological factors that mediate the association between obesity and outcomes of interdisciplinary pain rehabilitation: a registry-based cohort study

Huan-Ji Dong et al. Ann Med. 2025 Dec.

Abstract

Background: Obesity is a common comorbidity with chronic pain and is closely related to functional and psychological complications of pain, which are also the main outcomes of interdisciplinary pain rehabilitation programmes (IPRP). How obesity influences IPRP outcomes is poorly understood. This study aims to investigate the role of pain characteristics and psychological factors before IPRP as mediators of the association between obesity and IPRP outcomes (i.e. pain intensity and psychological functioning).

Methods: Sociodemographic variables, pain characteristics and psychological factors were retrieved from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Data at baseline (pre-IPRP) and 1-year follow-up (FU-IPRP) were used in mediation analysis.

Results: Of the 872 patients (mean age 45.8 ± 10.5 years, 80.3% female), 232 (26.6%) were obese (body mass index [BMI] ≥ 30 kg/m2). Patients with obesity reported higher pain intensity (p = 0.02), a higher number of pain locations (p < 0.001), and longer pain duration (p = 0.002) compared to non-obese patients. Significant improvements at FU-IPRP were found in pain intensity and psychological functioning for both obese and non-obese groups. Mediation analysis revealed that pain intensity, pain radiation and depressive symptoms at pre-IPRP reduced the improvement of pain intensity at FU-IPRP among the patients with obesity. Depressive symptoms and pain intensity (or pain radiation) also mediated changes in two psychometric outcomes of IPRP (dysfunctional scale and adaptive coper scale).

Conclusion: At FU-IPRP, patients with obesity experienced improvements in pain and psychological well-being, which were mediated by pain intensity, pain radiation, and depression. The roles of these mediators need to be specifically addressed when designing a tailored IPRP for pain patients with comorbid obesity.

Keywords: Chronic pain; depression; obesity; rehabilitation.

Plain language summary

Patients with chronic pain and comorbid obesity had worse pain characteristics than non-obese peers before participating in a pain rehabilitation program.Pain intensity, pain radiation and depression mediated the improvements of rehabilitation for patients with chronic pain and comorbid obesity.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
Conceptual diagram of a mediation model. In addition, we investigated the effects of moderating factors (age, gender, and education) upon the direct and mediating paths. The total effect is the sum of direct effect and indirect effects. IPRP: Interdisciplinary Pain Rehabilitation Program; Pre-IPRP: start of IPRP; FU-IPRP: one-year follow-up after IPRP.
Figure 2.
Figure 2.
Conceptual diagram of the first mediation model. IPRP: Interdisciplinary Pain Rehabilitation Program; Pre-IPRP: start of IPRP; FU-IPRP: one-year follow-up after IPRP; NRS-7d: average pain intensity previous 7 d; PRI: Pain Region Index; MPI: Multidimensional Pain Inventory; DYS: dysfunctional profile; HADS: Hospital Anxiety and Depression Scale; HADS-D: HADS-depression subscale. *95% CI does not contain zero after bootstrapping.
Figure 3.
Figure 3.
Conceptual diagram of the second mediation model. IPRP: Interdisciplinary Pain Rehabilitation Program; Pre-IPRP: start of IPRP; FU-IPRP: one-year follow-up after IPRP; NRS-7d: average pain intensity previous 7 d; PRI: Pain Region Index; MPI: Multidimensional Pain Inventory; DYS: dysfunctional profile; HADS, Hospital Anxiety and Depression Scale; HADS-D: HADS-depression subscale. * 95% CI does not contain zero after bootstrapping.
Figure 4.
Figure 4.
Conceptual diagram of the third mediation model. IPRP: Interdisciplinary Pain Rehabilitation Program; Pre-IPRP: start of IPRP; FU-IPRP: one-year follow-up after IPRP; NRS-7d: average pain intensity previous 7 d; PRI: Pain Region Index; MPI: Multidimensional Pain Inventory; DYS: dysfunctional profile; AC: adaptive coping profile; HADS: Hospital Anxiety and Depression Scale; HADS-D: HADS-depression subscale. *95% CI does not contain zero after bootstrapping.
Figure 5.
Figure 5.
Moderating effects on the mediating paths. IPRP: Interdisciplinary Pain Rehabilitation Program; Pre-IPRP: start of IPRP; FU-IPRP: one-year follow-up after IPRP; PRI: Pain Region Index; MPI: Multidimensional Pain Inventory; DYS: dysfunctional profile; AC: adaptive coping profile.
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