Pain In Obese Patients Research Articles

Comparison of postoperative analgesia effects between subcostal anterior quadratus lumborum block and transversus abdominis plane block in bariatric surgery: a prospective randomized controlled study

BackgroundCurrently, the prevalence of obesity is on the rise annually. Bariatric surgery stands out as the most efficacious approach for addressing obesity. Obese patients are more prone to experience moderate to severe pain after surgery due to lower pain thresholds. Regional block, as an important component of multimodal analgesia in bariatric surgery, is crucial in reducing opioid consumption and alleviating postoperative pain in patients undergoing bariatric surgery.Transversus abdominis plane block (TAPB) has gained widespread utilization in bariatric surgery; however, its limitation of inadequate reduction of visceral pain in obese patients remains a significant concern. Therefore, it is imperative to explore new and more efficient strategies for analgesia. Quadratus lumborum block (QLB) has emerged as a popular nerve block in recent years, frequently utilized in conjunction with general anesthesia for abdominal surgery. In the cadaver study of QLB, it was confirmed that the dye level could reach up to T6 when using the subcostal anterior quadratus lumborum muscle approach, which could effectively reduce the incision pain and visceral pain of bariatric surgery patients during the perioperative period.However, there is currently a lack of research on the use of subcostal anterior QLB in patients undergoing bariatric surgery. Our study aims to investigate whether subcostal anterior QLB can provide superior perioperative analgesic efficacy for bariatric surgery under general anesthesia compared to TAPB, leading to reduced postoperative opioid consumption and a lower incidence of postoperative nausea and vomiting (PONV).Methods and designThis study is a prospective, randomized controlled trial aiming to recruit 66 patients undergoing bariatric surgery. The participants will be randomly allocated into two groups in a 1:1 ratio: subcostal anterior QLB group (n = 33) and TAPB group (n = 33). The study aims to investigate the efficacy of subcostal anterior QLB and TAPB in obese patients who are scheduled to undergo bariatric surgery. Our primary outcome is to observe the amount of opioids used in the two groups 24 h after operation. The secondary outcomes included VAS of pain during rest/activity after operation, the type and dose of additional analgesics, the occurrence and severity of PONV, the type and dose of additional antiemetic drugs, postoperative anesthesia care unit (PACU) time, time of first postoperative exhaust, time to first out of bed activity, time to first liquid diet and postoperative admission days.DiscussionOpioid analgesics are prone to causing adverse reactions such as nausea, vomiting, and respiratory depression, especially in obese patients. Multimodal analgesia, including nerve block, can effectively reduce the dose of opioids and alleviate their adverse effects. Currently, TAPB is the most prevalent nerve block analgesia method for abdominal surgery. Recent studies have indicated that subcostal anterior QLB offers advantages over TAPB, including a wider block plane, faster onset, and longer maintenance time. It is not clear which of the two nerve block analgesia techniques is better for postoperative analgesia in patients undergoing bariatric surgery. Our objective in this investigation is to elucidate the superior method between TAPB and subcostal anterior QLB for postoperative pain management in bariatric surgery.Trial registrationChiCTR ChiCTR2300070556. Registered on 17 April 2023.

Photobiomodulation therapy for chronic knee pain in obese patients in pre-rehabilitation for bariatric surgery: randomised, placebo-controlled, double-blinded, clinical trial protocol

IntroductionObesity has become a worldwide public health problem and is directly linked to loss of quality of life, complications and comorbidities. One of them is chronic pain, especially in the...

SIMULATED WEIGHT REDUCTION WITH AN ANTI-GRAVITY TREADMILL: A PILOT STUDY TO ASSESS PAIN REDUCTION IN FOOT AND ANKLE ARTHRITIS

IntroductionOsteoarthritis in the foot and ankle affects approximately 30,000 patients annually in the UK. Evidence has shown that excess weight exacerbates foot pain, with significant increases in joint forces. However, despite the current trend for Clinical Commissioning Groups to ration surgery for obese patients, studies have not yet determined the effect of weight loss in obese patients with foot and ankle arthritis.AimPilot study to investigate the effect of simulated weight loss on pain scores in obese patients with symptomatic foot and ankle arthritis.MethodsFollowing ethical approval, a prospective study of 17 obese patients (mean BMI 39.2, range 31.2 – 50.3) with foot and ankle arthritis was undertaken (BOFAS funded). Under physiotherapist supervision, patients walked for one minute on an anti-gravity treadmill, which allowed simulated weight reduction. Following baseline assessment, reduced BMI was simulated, starting at 20, rising in increments of 5, until each patient's usual BMI was reached. Pain was assessed using a Visual Analogue Scale (VAS). Repeated measures ANOVA was used to assess for significant changes in pain, comparing baseline with each simulated BMI category (significance set at p< 0.05).ResultsSimulated weight loss caused a significant reduction in pain (p=0.005, power 0.91). Mean VAS pain scores improved by 24% (p=0.003) and 17% (p=0.040) for BMI categories 20 and 25, compared with baseline. Pain scores were not significantly different comparing BMI categories of 25 and 20.ConclusionSimulated weight loss to normal BMI significantly decreased pain in obese patients with foot and ankle arthritis. The use of the anti-gravity treadmill to demonstrate the feeling of normal BMI has also provided motivation to several patients to lose weight. The current study could be used to power future studies to investigate the effects of weight loss in foot and ankle patients.

TO OBSERVE AND ASSESS RELATION BETWEEN PRE-OPERATIVE ANXIETY AND POST-OPERATIVE PAIN IN LAPAROSCOPIC BARIATRIC SURGERY PATIENTS

Background: Pre-operative anxiety in obese patients is expected to be more due to psychological reasons, body habitus, comorbidities, and fear of not waking up from anesthesia. It is associated with emotional and physical problems. Predictive factors are complexity of surgery, the anesthesia, post-operative pain, not being appropriately informed, and psychosocial characteristics of the patient. Not many such studies have been conducted in morbidly obese patients. Objectives: The objective of this study was to determine the correlation between pre-operative anxiety and post-operative pain in obese patients undergoing elective laparoscopic bariatric surgery. Methods: Total 200 patients of the American Society of Anesthesiologists Grade I–III were taken, with BMI >30 kg/m2, who were undergoing elective laparoscopic bariatric surgeries. The amsterdam preoperative anxiety and information scale (APAIS) score was recorded a day prior to surgery. Heart rate, blood pressure, respiratory rate, and SpO2 were recorded pre- and postoperatively. Patients were assessed for pain on the visual analog scale (VAS) in post-operative period at 0-, 1-, 2-, 6-, 12-, and 24-h intervals. All the data were entered in master chart and statistically analyzed (Pearson coefficient of correlation test). Results: There is a positive, weak, statistically significant correlation (r=0.157, p=0.026) between anxiety score (APAIS) and post-operative pain (the highest VAS across all hours). Conclusion: Pre-operative anxiety is directly linked to post-operative pain in obese patients undergoing elective laparoscopic bariatric surgery.

Neuropathic Pain in Obese Patients: Prevalence and Impact on Quality of Life

Obesity is associated with increased sensitivity to pain, including neuropathic pain (DN).The objective of this study is to determine the prevalence of DN in obese patients, to assess its impact on the quality of life and to identify the factors associated with it. This is a prospective and descriptive study conducted over a period of 4 months. All patients with BMI over 30 kg/m2, non-diabetics were included. The evaluation of neuropathic pain was made by the DN4 score. The visual pain scale was calculated. Quality of life was assessed using the SF-12 score. Statistical analysis was performed using SPSS 26. A total of 111 patients were included. The average age was 44.79 years old. The majority were women. The average BMI was 38.69 kg/m2. The prevalence of neuropathic pain was 59.1%. The average VAS was 4.32. Physical quality of life was impaired in 66.7% of patients and 71.4% had an impairment of mental life. In univariate analysis, neuropathic pain was more common in women, in older subjects, in cases of prediabetes, in cases of vitamin D deficiency and in patients with impaired physical and mental quality of life. The Spearman correlation study had shown that the DN4 Score was positively correlated with pain VAS, and negatively correlated with physical quality of life and mental quality of life. DN is common in obese patients. It is responsible for a significant impact on the quality of life, hence the importance of detecting and treating it.

Effects of Dexmedetomidine on Postoperative Pain and Recovery Time in Obese Patients.

Objective The objective of this study is to investigate the effect of dexmedetomidine on postoperative pain and recovery time in obese patients. Methods A total of 100 obese patients with body mass index (BMI) ≥ 30 kg/m2 who underwent laparoscopic sleeve gastrectomy under general anesthesia in our hospital from January 2019 to December 2021 were included and assigned into DEX group (dexmedetomidine group) and NS group (normal saline group). The bariatric surgery patients who were given normal saline pump were the NS group (n = 50), and the bariatric surgery patients who were given the dexmedetomidine pump were the DEX group (n = 50). The patients in the DEX group were given continuous intravenous infusion of dexmedetomidine before, during, and after induction of anesthesia at a dose of 0.4 μg. kg-1. h-1, 0.4 μg·kg-1. h-1, 0.2 μg·kg-1. h-1, respectively. The NS group was infused with the same volume of normal saline for the same time. The two groups of patients were treated with the same anesthesia induction and maintenance program. By comparing the operation, anesthesia, postoperative extubation, and recovery time of the two groups of patients, the effect of dexmedetomidine on the postoperative recovery time of obese patients was analyzed. Visual analogue scale (VAS) and adverse reactions were compared to analyze the effect of dexmedetomidine on postoperative pain in obese patients. Results The operation, anesthesia, postoperative extubation, and recovery time of the DEX group were significantly lower than those of the NS group, whereas the VAS and adverse reactions were significantly lower than those in the NS group (P < 0.05). Conclusion An appropriate dose of dexmedetomidine in bariatric surgery for morbidly obese patients can effectively shorten the recovery time and extubation time of patients, reduce postoperative pain and the incidence of adverse reactions, and is worthy of clinical application. Dexmedetomidine 2 μg/kg has promising anesthesia benefits in bariatric surgery of obese patients, can provide favorable analgesia and quality of recovery, help reduce the degree of stress response of patients, and does not increase the risk of adverse events. However, this study has certain limitations, so physicians should tailor the dosage according to the patient's physical condition in clinical practice.

Does adding ketamine to morphine in a patient-controlled intravenous analgesia pump after orthopedic surgeries help better management of postoperative pain in obese patients? A double-blinded clinical trial

Introduction: Low doses of ketamine can cause an antagonistic effect on NMDA-receptors by blocking the magnesium-gated channels. Several studies demonstrated the effect of ketamine in improving the analgesia using opioids, however, obese people reported different reactions to this problem. Objectives: This study seeks to answer the following question: Does adding ketamine to morphine in a patient-controlled intravenous analgesia pump (PCIA) after orthopedic surgeries help better management of postoperative pain in obese patients? Patient and Methods: This double-blinded clinical trial involved 60 obese (body mass of higher than 30 kg/m²) lower limb orthopedic surgery candidates at Shohada hospital (Tabriz, Iran). The participants were randomly categorized into three groups. In group M, 20 mg morphine sulfate, in group MK1 100 mg ketamine + 20 mg morphine sulfate, and in group MK2 200 mg ketamine+10 mg morphine sulfate was added to the analgesia pump. Pain intensity (VAS), sedation score (Ramsay Scale), as well as nausea and vomiting (N&amp;V score) were compared among different groups at 12, 24, 36, and 48 hours after the operation. Results: Group M manifested a significantly higher pain intensity than two other groups during all examined times, and group MK2 demonstrated a significantly lower pain intensity than other groups. In the course of the research, the amount of opioid consumption in group MK2 was significantly lower than in the other groups. Conclusion: The addition of a low dose of ketamine to morphine in the PCIA pump after orthopedic surgeries in obese patients results in proper postoperative pain management. Trial Registration: The trial protocol was approved in the Iranian registry of clinical trial (identifier: IRCT2017101636822N1, https://www. irct.ir/trial/27429, ethical code; IR.TBZMED.REC.1400.820).

Changes in Back Pain Scores after Bariatric Surgery in Obese Patients: A Systematic Review and Meta-Analysis.

Bariatric surgery produces significant and quantifiable reductions in back pain. However, there is a lack of information on the association of weight changes after bariatric surgery with changes in pain score. We aim to evaluate the impact of bariatric surgery on back pain in obese patients and to address the association between changes in body mass index (BMI) and pain score. In obese patients eligible for bariatric surgery, the changes in pre- and post-operative pain scores, assessed by the Numeric Rating Pain Scale (NPS) or Visual Analogue Scale (VAS), were considered as primary outcomes. Mean difference (MD) and their 95% confidence intervals (CI) were evaluated. Eight cohort studies were included in the analysis of 298 obese patients undergoing bariatric surgery. All studies showed a reduction in back pain, with a mean change of −2.9 points in NPS and of −3.8 cm in VAS. There was a significant reduction in back pain (NPS: (MD = −3.49) (95% CI = −3.86, −3.12); VAS: MD = −3.75, (95% CI = −4.13, −3.37)) and BMI (MD = −12.93, (95% CI = −13.61, −12.24)) following bariatric surgery. No significant relationship between BMI change and decrease in clinical scores could be established. However, it was evident that bariatric surgery had a significant effect on back pain scores in severely obese patients. Ideally, a prospective study including spinal imaging, inflammatory markers, a longer follow-up period, and larger study groups with a randomized control group needs to be performed.

Effect of intraperitoneal bupivacaine on postoperative pain in laparoscopic bariatric surgeries.

Postoperative pain has many adverse effects and, if not properly controlled, it may lead to a wide range of complications. Opioids, as frequently used drugs for pain control, have some serious respiratory and gastrointestinal complications, especially in obese patients. In this study, we planned to evaluate the effect of intraperitoneal bupivacaine lavage on postoperative pain in laparoscopic bariatric surgeries. The study was conducted in Firoozgar Hospital (affiliated to Iran University of Medical Sciences), Tehran, Iran. In this clinical trial, 106 patients scheduled for laparoscopic bariatric surgery, randomly assigned to receive either intraperitoneal lavage with 50 mL of .2% bupivacaine or the same volume of normal saline during the operation. One-gram intravenous paracetamol was infused for all patients at the end of surgery, and all patients received intravenous paracetamol infusion for 1 day after surgery. Pain level, assessed by visual analog scale, was recorded at 1, 4, 8, and 24 hours after surgery. Total additive analgesics administered during the first day after surgery was also recorded. The pain score during the first 24 hours after surgery decreased significantly in both groups, but comparing the groups showed that pain level at 1, 4, 8, and 24 hours after surgery in the bupivacaine group was significantly lower than the normal saline group (P < .05). Also, opioid consumption during 24 hours was significantly lower in the bupivacaine group (P < .001). Intraperitoneal lavage with bupivacaine is an effective approach to control postoperative pain in obese patients undergoing laparoscopic bariatric surgery.

Anti-Gravity Simulated Weight Reduction: A Pilot Study to Assess the Impact Upon Pain for Foot and Ankle Arthritis

Category:Ankle, Ankle Arthritis, Hindfoot, Midfoot/ForefootIntroduction/Purpose:Osteoarthritis in the foot and ankle affects approximately 30,000 patients annually in the UK. Evidence has shown that excess weight exacerbates foot pain, with significant increases in joint forces. However, despite the current UK trend for Clinical Commissioning Groups to ration surgery for obese patients, studies have not yet determined the effect of weight loss in obese patients with foot and ankle arthritis.Methods:Following ethical approval, a prospective study of 19 obese patients (mean BMI 39.2, range 31.2 – 50.3) with foot and ankle arthritis was undertaken with funding from BOFAS. Under physiotherapist supervision, patients walked for one minute on an anti-gravity treadmill, which allowed simulated weight reduction. Following baseline assessment, reduced BMI was simulated, starting at 20, rising in increments of 5, until each patient’s usual BMI was reached. Pain was assessed using a Visual Analogue Scale (VAS). Repeated measures ANOVA was used to assess for significant changes in pain, comparing baseline with each simulated BMI category (significance set at p<0.05).Results:Simulated weight loss to BMI 25 caused a significant reduction in pain (p<0.05, power 0.91). Mean VAS pain scores improved by 46% (22.8 points, p=0.002) and 32% (15.9 points, p=0.04) for BMI categories 20 and 25 respectively, compared with baseline. Pain scores were not significantly different comparing between BMI categories of 25 and 20.Conclusion:Simulated weight loss to normal BMI significantly decreased pain in obese patients with foot and ankle arthritis. The use of the anti-gravity treadmill to demonstrate the feeling of normal BMI has also provided motivation to several patients to lose weight. The current study could be used to power future studies to investigate the effects of weight loss in foot and ankle patients.

Lower tourniquet cuff pressure reduces postoperative thigh pain in obese patients undergoing total knee arthroplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The use of high tourniquet pressures in obese patients undergoing total knee arthroplasty increases the risk of postoperative thromboembolic events and skin complications. Measurement of limb occlusion pressure (LOP) before surgery may lead to the use of lower tourniquet cuff pressure during surgery and thereby reduce the risk of postoperative pain and complications.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Eighty-six obese patients scheduled for total knee arthroplasty were randomized to a control group (n=43) with tourniquet pressures at 300 mmHg or the LOP group (n=43) where a recommended tourniquet pressure was determined based on the patient’s limb occlusion pressure. The primary outcome measure was postoperative thigh pain; the secondary outcome measures were the quality of bloodless field, postoperative drop in haemoglobin, postoperative complications and Oxford knee scores.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The tourniquet cuff pressure was significantly lower in the LOP group than in the control group (p&amp;lt;0.001). Patients in the LOP group showed significantly lower postoperative thigh pain scores till postoperative day 3. Our study did not show any difference in intraoperative quality of bloodless field (p&amp;lt;0.103), postoperative complications and Oxford knee scores (p&amp;lt;0.775) at six months after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our results show that the use of limb occlusion pressure method results in decreased postoperative thigh pain without reducing the quality of the bloodless field. We believe that this method in tourniquet application is safe and beneficial for the subset of obese patients undergoing total knee arthroplasty. &lt;/p&gt;

Back pain and sagittal spine alignment in obese patients eligible for bariatric surgery.

The objective of this research was to evaluate the prevalence of cervical and lumbar pain in obese patients eligible for bariatric surgery and to investigate possible changes in sagittal spine alignment in these patients. The following parameters were compared in 30 obese patients and a control group of 25 non-obese volunteers: body mass index, prevalence of cervical and lumbar pain assessed by visual analog scale (VAS), Neck Disability Index [NDI] and Oswestry Disability Index [ODI], as well as radiographic parameters of the spine and pelvis measured with Surgimap software. The cervical and lumbar VAS and the NDI and ODI were significantly worse in obese patients. Compared with the control group, the cervical sagittal vertical axis (cSVA) of the obese group had higher variance (p value = 0.0025) and the cervical lordosis was diminished (p value = 0.0023). Thoracic kyphosis, lumbar lordosis, and the pelvic parameters were not significantly different between the groups. Obese patients demonstrated lower functional performance compared with their non-obese counterparts, while cervical lordosis was diminished and the cSVA was increased in obese patients. These slides can be retrieved under Electronic Supplementary Material.

Comparison between thoracic epidural and systemic opioid analgesia on lung mechanics in obese patients in major gynecological procedures

Background The study was conducted to compare the effects of thoracic epidural analgesia versus systemic opioid analgesia on lung mechanics in obese patients undergoing major gynecological procedures (abdominal hysterectomy, ovarian cyst, ovarian mass, and abdominal explorations). We evaluated their analgesic efficacy over the first 12 postoperative hours after gynecological surgeries, in a randomized, single-blind, clinical trial in 60 patients divided into two equal groups, with 30 patients in each group. Patients and methods Sixty patients were randomized into two equal groups, with 30 patients in each group: group I received general anesthesia in combination with intravenous opioids, and group II received general anesthesia in combination with thoracic epidural anesthesia. General anesthesia was induced with fentanyl 1–2 μg/kg and propofol 1–3 mg/kg followed by rocuronium 0.6 mg/kg. Each patient was assessed for pulmonary function tests, pethidine consumption, visual analog pain scale at rest and on movement, vital signs and the presence of complications (nausea, vomiting, sedation, and pruritus) postoperatively by a blinded investigator in the postanesthesia care unit and at 1, 3, 6, and 12 h postoperatively. Results Group II patients showed significantly increased postoperative pulmonary function test values compared with group I patients at 1, 3, and 6 h; the postoperative analgesia is more effective with group II than with group I (epidural>systemic opioid), and the postoperative consumption of pethidine in the epidural group is lower than in the opioid group. As regards complications during the study in all groups, complications such as nausea, vomiting, pruritus, and sedation were recorded, which were more in the systemic opioid group than in the epidural group. Conclusion Particularly for obese patients, epidural anesthesia and postoperative epidural analgesia improve the postoperative respiratory functions, compared with general anesthesia and systemic analgesia, and reduce postoperative pain in obese patients undergoing major gynecological procedures.

The association between baseline persistent pain and weight change in patients attending a specialist weight management service.

ObjectiveTo quantify the influence of baseline pain levels on weight change at one-year follow-up in patients attending a National Health Service specialist weight management programme.MethodsWe compared one-year follow-up weight (body mass) change between patient sub-groups of none-to-mild, moderate, and severe pain at baseline. A mean sub-group difference in weight change of ≥5kg was considered clinically relevant.ResultsOf the 141 complete cases, n = 43 (30.5%) reported none-to-mild pain, n = 44 (31.2%) reported moderate pain, and n = 54 (38.3%) reported severe pain. Covariate-adjusted mean weight loss (95%CI) was similar for those with none-to-mild (8.1kg (4.2 to 12.0kg)) and moderate pain (8.3kg (4.9 to 11.7kg). The mean weight loss of 3.0kg (-0.4 to 6.4kg) for the severe pain group was 5.1kg (-0.6 to 10.7, p = 0.08) lower than the none-to-mild pain group and 5.3kg (0.4 to 10.2kg, p = 0.03) lower than the moderate pain group.ConclusionsPatients with severe pain upon entry to a specialist weight management service in England achieve a smaller mean weight loss at one-year follow-up than those with none-to-moderate pain. The magnitude of the difference in mean weight loss was clinically relevant, highlighting the importance of addressing severe persistent pain in obese patients undertaking weight management programmes.

Ursolic acid prevents augmented peripheral inflammation and inflammatory hyperalgesia in high-fat diet-induced obese rats by restoring downregulated spinal PPARα.

Obesity is a risk factor for several pain syndromes and is associated with increased pain sensitivity. Evidence suggests that obesity causes the downregulation of peroxisome proliferator‑activated receptor (PPAR)α in the spinal cord, contributing to augmented peripheral edema and inflammatory hyperalgesia. Ursolic acid (UA), a natural pentacyclic triterpenoid carboxylic acid, has been shown to upregulate PPARα in the peripheral tissues of obese animals. The present study hypothesized that UA prevents augmented peripheral inflammation and inflammatory hyperalgesia in obesity by restoring downregulated spinal PPARα. The present study demonstrated that Sprague‑Dawley rats fed a high‑fat diet (HFD) for 12weeks developed obesity and metabolic disorder. Following carrageenan injection, the HFD rats exhibited increased thermal hyperalgesia and paw edema, compared with the rats fed a low‑fat diet. Molecular investigations revealed that the HFD rats exhibited decreased PPARα activity, and exaggerated expression of inflammatory mediators and nuclear factor‑kB activity in the spinal cord in response to carrageenan. Oral administration of UA ameliorated obesity and metabolic disorder, and prevented increased thermal hyperalgesia and paw edema in the HFD rats. Additionally, UA normalized PPARα activity and inhibited the exaggerated spinal cord inflammatory response to carrageenan. Although the knockdown of spinal PPARα with small interferingRNA following the administration of UA did not alter obesity or metabolic parameters, it eradicated the beneficial effects of UA on thermal hyperalgesia and paw edema, and reversed the spinal cord inflammatory response. These results suggested that the systemic administration of UA inhibited the exaggerated spinal cord inflammatory response to peripheral inflammatory stimulation in HFD‑induced obesity by restoring downregulated spinal PPARα, preventing peripheral inflammation and inflammatory hyperalgesia. UA may be a potential therapeutic option for the prevention of increased inflammatory pain in obese patients.

PAIN IN OBESITY IS NOT OBESITY AND PAIN

The article clarifies that pain in obesity is not obesity and pain. The authors reviewed the literature and surveyed the clinical data about pain in people with abnormal body weight. The conclusion was made that pain in obese patients needs adequate management. Data for pharmacokinetic and pharmacodynamics characteristics of frequently used analgesic drugs are summarized. The authors include useful schemas of pharmacotherapy with nonopioid as well as opioid analgesics and practical guidelines for pain management in clinical ward or outpatient departments.

Obésité, perte de poids et lombalgie

Low back pain and obesity are two important common and public health problems. These two complex entities are associated to biopsychosocial phenomena. It is now admitted that low back pain is frequently associated to obesity but the mechanisms of this association remain unclear. Medically supervised nonsurgical weight loss improved different types of musculoskeletal pain in obese patients. Though, to day, bariatric surgery allows a more rapid weight loss than a caloric diet restriction in association with a daily physical activity. By a bariatric surgery, associated with a pre- and post-surgery educational program, different studies have clearly shown that such a large weight loss is followed by a decrease of the pain intensity and, in parallel, by a rapid decrease of disabilities and an increase of the quality of life. Though, different aspects remain unresolved: by which mechanisms these improvements are obtained? Is there a relationship between the weight reduction, the body composition and different structural and functional abnormalities observed in low back pain and obese patients?

Managing pain in obese patients

Managing pain in obese patients

Managing pain in obese patients: meeting weighty challenges.

Managing pain in obese patients: meeting weighty challenges.

Pain Management for the Obese Sleep Apnea Patient

Currently, one third of the US adult population is considered obese. As such, obese patients are a rapidly growing population of patients being admitted to ICU. The problems in managing pain for these patients, primarily perioperative and hospital-associated respiratory depression, are becoming increasingly apparent. New approaches for pain management are intended to minimize the life-threatening side effects of traditional pain control drugs (opioids) and to increase the therapeutic options with nonopioid agents. This article ( a) reviews the pathophysiology of obstructive sleep apnea and other related sleep apnea syndromes, ( b) describes risk factors for perioperative and hospital-associated respiratory depression, ( c) reviews other significant side effects of opioid analgesic agents, and finally ( d) summarizes the emerging consensus for the use of multimodal analgesia for managing pain in obese patients with obstructive sleep apnea.