Increased Pain Sensitivity in Obese Patients After Lung Cancer Surgery

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Abstract

Background: Obesity and cancer are recognized worldwide health threats. While there is no reported causal relationship, the increasing frequency of both conditions results in a higher incidence of obese patients who are being treated for cancer. Physiological data indicate that there is a relationship between obesity and susceptibility to pain; however, currently, there are no specific pharmacological interventions.

Objective: To evaluate the self-reported intensity of postoperative pain in obese and nonobese lung cancer who receive either thoracotomy or video-assisted thoracic surgery (VATS) surgical therapy.

Material and Methods: In 50 obese [mean body mass index (BMI) of 34.1 ± 3.2 kg/m ²] and 62 nonobese (mean BMI of 24.9 ± 3 kg/m ²) lung cancer patients, the intensity of pain was estimated every 4 h using a visual analog scale (VAS, 0 indicating no pain and 10 indicating “worst imaginable pain”) beginning shortly after surgery (Day O) and continuing until the day of discharge (Day D).

Results: The self-reported pain was more severe in obese than in nonobese patients, both at the time of the operation [Day O (4.5 ± 1.2 vs 3.4 ± 1.1; p < 0.0001)] and at the day of discharge [Day D (3.9 ± 1.4 vs 2.6 ± 0.9, p < 0.0001)]. This finding was consistent both in the patients after thoracotomy and after video-assisted thoracic surgery (VATS, p < 0.0001). The patients with severe pain shortly after surgery (VAS score >4) had significantly higher BMI (31.8 ± 5.6 kg/m ² vs 28.8 ± 5.2 kg/m ², p < 0.01) and were hospitalized longer than the remaining patients (13.0 ± 13.6 days vs 9.5 ± 3.6 days, p < 0.05).

Conclusion: The reported perception of pain in obese lung cancer patients is greater than in nonobese patients undergoing the same thoracic surgery. In obese patients, severe pain persisted longer. Pain management is an important consideration in the postoperative care of lung cancer patients, even more so with obese patients.

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The association between chronic pain and obesity

Akiko Okifuji, Bradford Hare (2015)

Obesity and pain present serious public health concerns in our society. Evidence strongly suggests that comorbid obesity is common in chronic pain conditions, and pain complaints are common in obese individuals. In this paper, we review the association between obesity and pain in the general population as well as chronic pain patients. We also review the relationship between obesity and pain response to noxious stimulation in animals and humans. Based upon the existing research, we present several potential mechanisms that may link the two phenomena, including mechanical/structural factors, chemical mediators, depression, sleep, and lifestyle. We discuss the clinical implications of obesity and pain, focusing on the effect of weight loss, both surgical and noninvasive, on pain. The literature suggests that the two conditions are significant comorbidities, adversely impacting each other. The nature of the relationship however is not likely to be direct, but many interacting factors appear to contribute. Weight loss for obese pain patients appears to be an important aspect of overall pain rehabilitation, although more efforts are needed to determine strategies to maintain long-term benefit.

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Comorbidity of obesity and pain in a general population: results from the Southern Pain Prevalence Study.

Karen Koch, Arthur G Cosby, Isabella McMillen … (2007)

This cross-sectional study examines the relation between obesity and self-reported pain (moderate or severe pain occurring at least monthly) in a general population sample of adults in the southeastern United States (N = 3637). Results of the study suggest that obese adults (body mass index [BMI] >30) are more likely to experience pain than their normal-weight and underweight counterparts. Respondents classified as class I obese (BMI of 30 to 34.9) were 1.762 times as likely as the underweight and normal weight participants to report severe pain. Class II obese respondents (BMI of 35 to 39.9) were 1.888 times as likely to experience severe pain. Those respondents categorized as class III obese were most likely to report severe pain--2.297 times as likely as the underweight and normal-weight respondents. Analyses demonstrated a similar trend for respondents reporting moderate to severe pain. Adults who are obese are also more likely to report experiencing pain in multiple locations. This study complements clinical research that links pain and obesity and extends it into a general population. Because this is a cross-sectional study, further research is needed to discern causal explanations for the relation between self-reported pain and obesity. This article provides a population-level depiction of the positive relation between obesity and self-reported pain, which complements clinical research on the topic. It may prompt future research to shape interventions and treatment for both pain and obesity.

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Obesity and pain are associated in the United States.

Arthur Stone, Joan Broderick (2012)

Recent small-scale studies have shown a positive association between central obesity and self-reported pain levels. This study attempts to replicate the finding in a survey of over 1,000,000 individuals in the United States. The Gallup Organization conducted a proprietary survey between 2008 through 2010 where 1,062,271 randomly selected individuals in the United States participated in a telephone interview. Survey questions included height and weight, from which BMI was computed, questions about pain conditions in the past year, and a question about pain experience yesterday. Only 36.8% [corrected] of the sample was classified as Low-Normal BMI, 38.6 [corrected] were classified as Overweight, and the remainder was in the three categories of Obese. BMI and pain yesterday were reliably associated when demographic variables were controlled: the overweight group reported 20% higher rates of pain than Low-Normal group, 68% higher for Obese I group, 136% higher for Obese II group, and 254% higher for Obese III group. The association held for both men and women and it became stronger in older age groups. Controlling the associations for other pain-related medical conditions substantially reduced the associations, but they remained substantial for the Obese groups. We conclude that BMI and daily pain are positively correlated in the United States: people who are obese are considerably more prone to having daily pain. The association is robust and holds after controlling for several pain conditions and across gender and age. The increasing BMI-pain association with older ages suggests a developmental process that, along with metabolic hypotheses, calls out for investigation.

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Author and article information

Contributors

Anna Brzecka: URI : https://loop.frontiersin.org/people/519243

Vladimir N. Chubarev: URI : https://loop.frontiersin.org/people/561687

Sergey G. Klochkov: URI : https://loop.frontiersin.org/people/655570

Gjumrakch Aliev: URI : https://loop.frontiersin.org/people/150041

Journal

Journal ID (nlm-ta): Front Pharmacol

Journal ID (iso-abbrev): Front Pharmacol

Journal ID (publisher-id): Front. Pharmacol.

Title: Frontiers in Pharmacology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1663-9812

Publication date (Electronic): 14 June 2019

Publication date Collection: 2019

Volume: 10

Electronic Location Identifier: 626

Affiliations

[1] ¹Department of Thoracic Surgery, Medical University in Wroclaw , Wroclaw, Poland

[2] ²Department of Pulmonology and Lung Cancer, Medical University in Wroclaw , Wroclaw, Poland

[3] ³Department of Pharmacology and Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University) , Moscow, Russia

[4] ⁴Institute of Physiologically Active Compounds, Russian Academy of Sciences , Chernogolovka, Russia

[5] ⁵Department of Biological Sciences, Salem University , Salem, WV, United States

[6] ⁶GALLY International Biomedical Research Institute , San Antonio, TX, United States

Author notes

Edited by: Ke-Vin Chang, National Taiwan University Hospital, Taiwan

Reviewed by: Chin Moi Chow, University of Sydney, Australia; Vincenzo Ricci, University of Bologna, Italy

*Correspondence: Gjumrakch Aliev, aliev03@ 123456gmail.com

This article was submitted to Translational Pharmacology, a section of the journal Frontiers in Pharmacology

Article

DOI: 10.3389/fphar.2019.00626

PMC ID: 6586739

PubMed ID: 31258474

SO-VID: 2c11055c-c806-4467-881d-c05988c2de9e

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 21 January 2019

Date accepted : 15 May 2019

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Figures: 0, Tables: 4, Equations: 0, References: 56, Pages: 7, Words: 3746

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Increased Pain Sensitivity in Obese Patients After Lung Cancer Surgery

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Most cited references 43

The association between chronic pain and obesity

Comorbidity of obesity and pain in a general population: results from the Southern Pain Prevalence Study.

Obesity and pain are associated in the United States.

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