Bariatric surgery significantly improves measures of pain

by Bruce Sylvester: During three years following bariatric surgery, a majority of patients achieved improvement in pain, physical function, and walk time, researchers reported on April 5 2016 in JAMA/Journal of the American Medical Association.

“Our study found that clinically meaningful improvements in bodily pain, specific joint pain and physical function are common following bariatric surgery. In particular, walking is easier, which impacts patients’ ability to adopt a more physically active lifestyle. However, some patients continue to have significant pain and disability,” said lead investigator Wendy King, Ph.D., associate professor in the Department of Epidemiology at the University of Pittsburgh School of Public Health in Pittsburgh, Pennsylvania. “This data can help patients and clinicians develop realistic expectations regarding the impact of bariatric surgery on pain and disability.”

Of 2,458 subjects enrolled for the study, 2,221 completed all assessments, and 1,743 (78.5%) were women. Median age at baseline was 47 years, and median body mass index (BMI) was 45.9.

Of the study completers, 70.4% underwent Roux-en-Y gastric bypass (RYGB) and 25% underwent laparoscopic adjustable gastric banding (LAGB).

Primary outcomes were clinically meaningful improvements in pain and function using scores from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)

At year 1, the investigators noted clinically meaningful improvements in 57.6% of subjects for bodily pain, in 76.5% for physical function and in 59.5% for walk time.

Also, among subjects with severe knee or disability (633), or hip pain or disability (500) at baseline, about three-fourths achieved joint-specific improvements in knee pain (77.1%) and in hip function (79.2%).

From year 1 through year 3, rates of improvement significantly decreased to 48.6%  for bodily pain and to 70.2% for physical function, but improvement rates for walk time, knee and hip pain, and knee and hip function did not regress.

Older age, lower income, more depressive symptoms and pre-existing medical conditions, including cardiovascular disease and diabetes before surgery, were all independently associated with a lower likelihood of improvement in pain and mobility post-surgery.

More weight loss and more reduction in depressive symptoms were associated with greater likelihood of improvement in measures for pain.

At three years post-surgery, the investigators found that 76.3 percent of patients reported no interference at work from leg and back pain, up from 54.1 percent from pre-surgery.

The average physical function score of the participants — ability to walk various distances, climb stairs, perform vigorous and moderate activities, lift and carry groceries, bathe, dress, bend and kneel — improved to a level comparable to that of the general U.S. population.

“Functional status is an extremely important aspect of health that has not been as well-studied as other conditions that change following bariatric surgery, and this study sheds light on specific factors that may affect improvements in individuals with joint pain who undergo these procedures,” said study co-author Anita Courcoulas, M.D., M.P.H., chief of minimally invasive bariatric and general surgery at the University of Pittsburgh School of Medicine.