Surgical weight loss reduces pain in Black and Hispanic patients, yielding the greatest benefit for pain reduction within the first three months after surgery and decreasing pain faster among Hispanic patients in the early phases of weight loss, according to a study by researchers at NYU Steinhardt School of Culture, Education, and Human Development, New york. However, despite Black and Hispanic patients having significantly less pain after bariatric surgery, their pain burden is still much higher than the general population.
"Medical providers and researchers tend to underestimate the burden of widespread pain in minoritised populations living with higher body weight, leading to widening disparities and poor management of the symptoms," explained lead author of the study, Dr Ericka N Merriwether, an assistant professor of physical therapy at NYU Steinhardt.
Analysing data for 256 patients who received a sleeve gastrectomy between 2017 and 2020, the researchers looked at differences by racial group in weight loss and pain trajectories three months, one and two years after surgery. Pain was evaluated in terms of intensity, interference (how pain affects functioning) and the number and location of painful sites on the body.
Among the findings, widespread pain burden improved, but remained higher than the general US population estimates. Higher percentages of total weight loss were linked to lower pain intensity and lower pain interference following surgery. The greatest reduction in pain intensity and interference occurred in the first three months after surgery, with the impact levelling off after the first year.
In a comparison of the two groups, Hispanic patients reported a higher number of pain sites before surgery and experienced a faster rate of reduction in the number of pain sites after surgery. Black and Hispanic patients experienced greater widespread pain burdens at different intervals following surgery, but there were no statistically significant differences in pain intensity or interference.
The researchers also found that the lower back, legs and feet were the most frequent pain sites, with the lower back reported the most throughout the observation period.
"Patients who live with chronic pain are often told that their pain will improve if they lose weight," added Merriwether. "This work suggests that there may be pain improvement in the early stages of weight loss that either doesn't improve any further or may regress in instances of weight regain. Our findings also suggest that Black adults with widespread pain are not experiencing the same levels of improvement, despite losing a lot of weight. We recommend that health care providers use simple tools such as a body diagram to see patterns of widespread pain as part of the standard of care for pain and weight management."
The findings were featured in the paper, ‘Changes in widespread pain after surgical weight loss in racialized adults: A secondary analysis from a two-year longitudinal study’, published in The Journal of Pain.
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