Ashley Lucas W, Sutton Kent F, Cabell Grant H, Lentz Trevor A, Lewis Brian D, Olson Steven A, Mather Richard C
Brody School of Medicine at East, Carolina University, 600 Moye Blvd., Greenville, NC, 27834, USA.
Departments of Medicine and Pediatrics, Duke University Medical Center, 10 Medicine Circle, Durham, NC, 27710, USA.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):22. doi: 10.1007/s00402-024-05665-z.
Little research has investigated the relationship between musculoskeletal pain and body mass index (BMI) in the context of pain-associated psychological distress. This study aims to determine if independent associations exist between BMI, obesity, demographic variables, and psychological distress in patients presenting with hip pain.
Using a retrospective cross-sectional study design, 428 patients completed the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) and were categorized into pain-associated psychological distress phenotypes using latent class analysis. Participants were stratified into five BMI categories outlined by the Centers for Disease Control and Prevention (CDC) using descriptive statistics. Multinomial logistic regression was employed to determine a relationship between psychological distress phenotype and BMI (first as a continuous variable, then as a categorical variable), age, gender, race, and veteran status as candidate variables.
Four psychological distress phenotypes were generated: high distress (n = 172, 40.2%), low distress (n = 114, 26.6%), negative pain coping (n = 98, 22.9%), and low self-efficacy and acceptance (n = 44, 10.3%). BMI analyses identified 4 participants (0.9%) as being underweight (BMI < 18.5), 146 participants (34.1%) with recommended weights (18.5 < BMI < 24.9), 133 (31.1%) as overweight (25 < BMI < 29.9), 113 (26.4%) with obesity (30 < BMI < 39.9), and 32 (7.5%) with severe obesity (BMI > 40). Additionally, 54.0% of participants with obesity and 59.4% of participants with severe obesity had high psychological distress. As a continuous and categorical variable, elevated BMI was independently associated with membership in the high distress phenotype (p < 0.001). The overweight (p = 0.043), obesity (p < 0.001), and severe obesity (p = 0.034) subgroups and Black/African American participants (p = 0.020) were also all significantly associated with high distress.
Elevated BMI and obesity are associated with high psychological distress in patients with hip pain. These results may inform operative, nonoperative, and behavioral health treatment pathways for patients with comorbid obesity and hip pain, as well as provide direction for prospective studies to address obesity and psychological distress among patients with musculoskeletal pain.
在疼痛相关心理困扰的背景下，很少有研究调查肌肉骨骼疼痛与体重指数（BMI）之间的关系。本研究旨在确定在出现髋部疼痛的患者中，BMI、肥胖、人口统计学变量和心理困扰之间是否存在独立关联。
采用回顾性横断面研究设计，428名患者完成了转诊和预后黄旗预测的最佳筛查（OSPRO-YF），并使用潜在类别分析将其分类为疼痛相关心理困扰表型。使用描述性统计将参与者分为疾病控制与预防中心（CDC）概述的五个BMI类别。采用多项逻辑回归来确定心理困扰表型与BMI（首先作为连续变量，然后作为分类变量）、年龄、性别、种族和退伍军人身份之间的关系，将这些作为候选变量。
产生了四种心理困扰表型：高困扰（n = 172，40.2%）、低困扰（n = 114，26.6%）、消极疼痛应对（n = 98，22.9%）以及低自我效能感和接受度（n = 44，10.3%）。BMI分析确定4名参与者（0.9%）体重过轻（BMI < 18.5），146名参与者（34.1%）体重正常（18.5 < BMI < 24.9），133名（31.1%）超重（25 < BMI < 29.9），113名（26.4%）肥胖（30 < BMI < 39.9），32名（7.5%）重度肥胖（BMI > 40）。此外，54.0%的肥胖参与者和59.4%的重度肥胖参与者有高心理困扰。作为连续变量和分类变量，BMI升高与高困扰表型的成员身份独立相关（p < 0.001）。超重（p = 0.043）、肥胖（p < 0.001）和重度肥胖（p = 0.034）亚组以及黑人/非裔美国参与者（p = 0.020）也都与高困扰显著相关。
BMI升高和肥胖与髋部疼痛患者的高心理困扰相关。这些结果可为合并肥胖和髋部疼痛患者的手术、非手术及行为健康治疗途径提供参考，也可为前瞻性研究提供方向，以解决肌肉骨骼疼痛患者中的肥胖和心理困扰问题。
