Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, Pennsylvania, USA.
Obesity (Silver Spring). 2012 Oct;20(10):2027-34. doi: 10.1038/oby.2012.39. Epub 2012 Feb 15.
Providers frequently report pain as a barrier to weight loss, and initial evidence suggests individuals with chronic pain and obesity experience reduced treatment success. However, scant evidence informs our understanding of how this comorbidity negatively influences treatment outcome. More effective programs might be designed with (i) insight into the patient's experience of comorbid chronic pain and obesity and (ii) improved understanding of the behavioral linkages between the experience of pain, engagement in health behaviors, and obesity treatment outcomes. Thirty adult primary care patients with mean BMI = 36.8 (SD 8.9) and average 0-10 pain intensity = 5.6 (SD 1.9) participated in semistructured, in-depth interviews. Transcriptions were analyzed using the constant comparative method. Five themes emerged indicating that patients with comorbid chronic pain and obesity experience: depression as magnifying the comorbid physical symptoms and complicating treatment; hedonic hunger triggered by physical pain and associated with depression and shame; emotional or "binge" eating in response to pain; altered dietary choices in response to pain; and low self-efficacy for physical activity due to pain. Individuals with chronic pain and obesity may be less responsive to traditional interventions that fail to address the symbiotic relationship between the two conditions. These individuals are at-risk for depressive symptoms and eating and activity patterns that sustain the comorbidity and make treatment problematic, and they may respond to pain with behaviors that promote weight gain, poor health and low mood. Further research is needed to examine behavioral mechanisms that promote comorbid pain and obesity, and to develop targeted treatment modules.
提供者经常报告疼痛是减肥的障碍，初步证据表明患有慢性疼痛和肥胖的个体治疗成功率降低。然而，几乎没有证据表明这种合并症如何对治疗结果产生负面影响。如果能够（i）深入了解患者同时患有慢性疼痛和肥胖的体验，以及（ii）更好地理解疼痛体验、参与健康行为与肥胖治疗结果之间的行为联系，那么可能会设计出更有效的治疗方案。30 名成年初级保健患者的平均 BMI = 36.8（SD 8.9），平均疼痛强度 0-10 = 5.6（SD 1.9），参与了半结构化深入访谈。使用恒定性比较法对转录内容进行了分析。出现了五个主题，表明同时患有慢性疼痛和肥胖的患者：抑郁会放大合并的身体症状并使治疗复杂化；身体疼痛引发的享乐性饥饿，与抑郁和羞耻感有关；对疼痛做出情绪化或“暴食”反应；对疼痛做出饮食选择改变；因疼痛导致对体育锻炼的自我效能感降低。患有慢性疼痛和肥胖症的个体可能对传统干预措施的反应性较差，这些措施未能解决两种病症之间的共生关系。这些个体面临抑郁症状和饮食行为的风险，这些行为会维持合并症并使治疗变得困难，他们可能会以促进体重增加、健康状况不佳和情绪低落的行为来应对疼痛。需要进一步研究以检查促进合并疼痛和肥胖的行为机制，并开发针对性的治疗模块。
