In research published in the American Journal of Preventive Medicine, scientists highlight the need for better approaches to pain management, including physical therapy and weight reduction. According to the authors, obesity not only exacerbates pain but also increases the likelihood that pain patients are more likely to use opiates for prolonged periods, further reducing the opportunity for participating in physical activity.
Lead author Dr. Andrew Stokes, assistant professor of global health at BUSPH, and colleagues set out to explore the potential association between prolonged use of prescribed opiates and obesity. This study built upon the team’s prior work, which evaluated other conditions and diagnoses that could increase the risk of chronic pain. “Research on the opioid crisis to date has focused heavily on the supply-side factors that increased access to opioids,” Dr. Stokes said, adding “Our studies offer new evidence for policymakers to consider how addressing the roots of this crisis will require attention to the underlying sources of demand for pain relief, including obesity through its association with pain,”
The researchers gathered data from the Medical Expenditure Panel Survey for 15 years (2000-2015) and generated a cohort of 89,629 patients ranging in age from 30 to 84 years, with BMI reported at baseline, who were considered to be prescription opioid–naïve for approximately 9 months. The authors defined long-term prescription opioid use as a reported ongoing use at two of three interviews during a 15-month follow-up.
The researchers found that obesity was strongly associated with long-term prescription opioid use among opioid–naïve adults and that this association increased with greater degrees of obesity (higher BMI). Overweight patients with a BMI of 25 to 29.9 kg/m2 had 24% elevated odds of long-term opioid use (95% CI = 7%, 44%) compared with 158% increased odds (95% CI = 106%, 224%) among those with a greater degree of obesity (40-49.9 kg/m2). The authors concluded that these associations were a result of higher dose opioids for reports of greater pain (and excess use observed) that included back and joint pain, injury, and muscle and nerve pain, all of which contributed the most to the excess use of opioids observed among adults with obesity.
Coauthor of the study, Dielle Lundberg, research fellow in the Department of Global Health at BUSPH, highlighted the importance of their study, writing “Policy efforts are urgently needed to regulate the obesogenic environment in this country.” Dr. Lundberg added, “When people are denied access to affordable, healthy food and to the sort of built environments that promote physical activity and health across the life course, obesity is more likely to occur. The results of both studies suggest that through obesity, such environments can also increase pain and create future demand for prescription opioids.”
The authors concluded that given their findings, which suggest that obesity has contributed to prescription opioid use in the U.S., “Future investments in chronic pain reduction may benefit from increased integration with obesity prevention and treatment.”
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