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Surgery, pain and physical function

Surgery leads to pain and physical function improvements

At year one, clinically meaningful improvements were shown in 57.6% of participants for bodily pain

A large percentage of patients with severe obesity who underwent bariatric surgery, experienced improvement in pain, physical function, and walking capacity over three years, according to a study, ‘Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity’, published in JAMA. The authors noted that variability and durability of improvements in pain and physical function following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) are not well described, and this study was design to record and report changes in pain and physical function in the first three years following bariatric surgery, and to identify factors associated with improvement.

Dr Wendy C King of the University of Pittsburgh, and colleagues examined changes in pain and physical function in the first three years following bariatric surgery, and factors associated with improvement, among adults with severe obesity. Research assessments were conducted prior to surgery and annually thereafter. The study was conducted at ten hospitals between February 2005 and February 2009.

Wendy King (Credit: Pitt Public Health)

Primary outcomes were clinically meaningful pre-surgery to post-surgery improvements in pain and function using scores from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (ie, improvement of ≥5 points on the norm-based score [range, 0-100]) and 400-meter walk time (ie, improvement of ≥24 seconds) using established thresholds. The secondary outcome was clinically meaningful improvement using the Western Ontario McMaster Osteoarthritis Index (ie, improvement of ≥9.7 pain points and ≥9.3 function points on the transformed score [range, 0-100]).

Of 2,458 participants, 2,221 completed baseline and follow-up assessments; 79 percent were women; median age was 47 years; median BMI was 46; 70 percent underwent RYGB; 25 percent underwent LAGB. Among the primary findings through three years of follow-up: approximately 50 percent to 70 percent of adults experienced clinically significant improvements in perceived bodily pain and physical function and in objectively measured walking capacity; and approximately three-fourths of participants with severe knee and hip pain or disability at baseline experienced improvements in osteoarthritis symptoms. The percentage of patients with improvement in pain and physical function decreased between year one and year three following surgery.

At year one, clinically meaningful improvements were shown in 57.6% (95% CI, 55.3%-59.9%) of participants for bodily pain, 76.5% (95% CI, 74.6%-78.5%) for physical function, and 59.5% (95% CI, 56.4%-62.7%) for walk time.

Additionally, among participants with severe knee or disability (633), or hip pain or disability (500) at baseline, approximately three-fourths experienced joint-specific improvements in knee pain (77.1% [95% CI, 73.5%-80.7%]) and in hip function (79.2% [95% CI, 75.3%-83.1%]).

Between year one and year three, rates of improvement significantly decreased to 48.6% (95% CI, 46.0%-51.1%) for bodily pain and to 70.2% (95% CI, 67.8%-72.5%) for physical function, but improvement rates for walk time, knee and hip pain, and knee and hip function did not (P for all ≥0.05).

Younger age, male sex, higher income, lower BMI, and fewer depressive symptoms pre-surgery; no diabetes and no venous oedema (swelling of the legs) with ulcerations post-surgery (either no history or remission); and pre-surgery-to-post-surgery reductions in weight and depressive symptoms were associated with pre-surgery-to-post-surgery improvements in multiple outcomes at years one, two and three.

“The study's large geographically diverse sample, inclusion of multiple validated measures of pain and physical function, longitudinal design, and follow-up through three years make it one of the most informative studies of pain and function following RYGB and LAGB to date," the authors write. “...Among a cohort of patients with severe obesity undergoing bariatric surgery, a large percentage experienced improvement compared with baseline in pain, physical function, and walk time over three years. However, the percentage with improvement in pain and physical function decreased between year one and year three following surgery.”

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