October 21, 2018

Effectively Treat Chronic Pain by Treating Obesity

By Jenny L. F. Andrus, MD

Obesity is an epidemic in America.  As physicians, no matter if we are PCPs or specialists, we see a steady stream of obese patients., many of whom are obese.  Obesity causes or exacerbates many of the most common pathologies we observe, and chronic pain is no exception.

As an Interventional Pain Management Specialist, I see patients in my practice who suffer from chronic pain and obesity.  I utilize different methods of treating their pain, including interventional procedures, medications, Physical Therapy, and behavioral therapy.   For most patients, these are appropriate treatments.  However, weight loss may provide them with the most effective and long-lasting form of pain relief.  As physicians, we should be more proactive in addressing weight as part of our treatment plan.

Extra weight causing any level of obesity always equals problems for the human body, especially for the musculoskeletal system.  The muscles, joints and ligaments become stressed and sore.  Joint degeneration occurs, leading to less activity, weight gain and chronic musculoskeletal pain.  Back pain, arthritis, fibromyalgia, diabetes, and spinal issues all typically have obesity as a component.

There are several challenges to overcome.  The first is helping our patients understand the connection between obesity, pain and chronic illness. Those patients who have exhausted the easier treatment options and have not found relief may be easier to persuade about the benefits of weight loss.

Second, if losing weight was so easy, we would not have to address obesity with our patients.  Bu we do.  Are we helping our patients by offering resources, reading materials and medical direction on weight loss, or is prescribing a pill easier? Are we offering referrals to nutritionists or behavioral therapists so that they can address the reasons for consuming too much food, or do we look the other way?  Would bariatric surgery be the most expeditious remedy for our morbidly obese patients, or are we afraid to discuss that option in case we hurt someone’s feelings?

The federal government and the Commonwealth of Virginia have issued strict guidelines regarding the use of opioids because of the deleterious or potentially deadly effects they have on the health of those who take them.  However, obesity is a much larger health issue for Americans, affecting millions and costing billions of dollars to treat every year. It is time that we address the epidemic health issue of obesity as diligently as possible.

Many of you have seen the dramatic results that weight loss has on the health of your patients:  hypertension resolves, Type 2 Diabetes ends, GERD goes away, the risk for stroke, heart attack and cancers decrease…the list goes on and on.  Chronic pain patients who overcome obesity often report that their pain goes away completely or decreases substantially… something that might not happen with medication, surgery or other interventions.  Pain medications can be stopped entirely or reduced to a fraction of what the patient once required for analgesia.

Losing weight has so many benefits to the overweight/obese patient that I believe it should be a part of any comprehensive treatment and wellness plan, no matter your specialty.

Jenny L.F. Andrus, MD practices at the Orthopaedic and Spine Center in Newport News. She is Board certified in Physical Medicine and Rehabilitation and Pain Management. www.osc-ortho.com