Dong Huan-Ji, Genander Agnes, Dragioti Elena
Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Department of Nursing, School of Health Sciences, Research Laboratory Psychology of Patients, Families and Health Professionals, University of Ioannina, Ioannina, Greece.
Ann Med. 2025 Dec;57(1):2517816. doi: 10.1080/07853890.2025.2517816. Epub 2025 Jun 18.
Obesity is a common comorbidity with chronic pain and is closely related to functional and psychological complications of pain, which are also the main outcomes of interdisciplinary pain rehabilitation programmes (IPRP). How obesity influences IPRP outcomes is poorly understood. This study aims to investigate the role of pain characteristics and psychological factors before IPRP as mediators of the association between obesity and IPRP outcomes (i.e. pain intensity and psychological functioning).
Sociodemographic variables, pain characteristics and psychological factors were retrieved from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Data at baseline (pre-IPRP) and 1-year follow-up (FU-IPRP) were used in mediation analysis.
Of the 872 patients (mean age 45.8 ± 10.5 years, 80.3% female), 232 (26.6%) were obese (body mass index [BMI] ≥ 30 kg/m). Patients with obesity reported higher pain intensity ( = 0.02), a higher number of pain locations ( < 0.001), and longer pain duration ( = 0.002) compared to non-obese patients. Significant improvements at FU-IPRP were found in pain intensity and psychological functioning for both obese and non-obese groups. Mediation analysis revealed that pain intensity, pain radiation and depressive symptoms at pre-IPRP reduced the improvement of pain intensity at FU-IPRP among the patients with obesity. Depressive symptoms and pain intensity (or pain radiation) also mediated changes in two psychometric outcomes of IPRP (dysfunctional scale and adaptive coper scale).
At FU-IPRP, patients with obesity experienced improvements in pain and psychological well-being, which were mediated by pain intensity, pain radiation, and depression. The roles of these mediators need to be specifically addressed when designing a tailored IPRP for pain patients with comorbid obesity.
肥胖是慢性疼痛常见的合并症，与疼痛的功能和心理并发症密切相关，而这些并发症也是多学科疼痛康复项目（IPRP）的主要结果。目前对肥胖如何影响IPRP结果知之甚少。本研究旨在调查IPRP前的疼痛特征和心理因素作为肥胖与IPRP结果（即疼痛强度和心理功能）之间关联的中介作用。
从瑞典疼痛康复质量登记处（SQRP）获取社会人口统计学变量、疼痛特征和心理因素。在中介分析中使用基线（IPRP前）和1年随访（IPRP随访）的数据。
在872例患者（平均年龄45.8±10.5岁，80.3%为女性）中，232例（26.6%）为肥胖患者（体重指数[BMI]≥30kg/m）。与非肥胖患者相比，肥胖患者报告的疼痛强度更高（P=0.02）、疼痛部位更多（P<0.001）、疼痛持续时间更长（P=0.002）。肥胖组和非肥胖组在IPRP随访时疼痛强度和心理功能均有显著改善。中介分析显示，IPRP前的疼痛强度、疼痛放射和抑郁症状降低了肥胖患者在IPRP随访时疼痛强度的改善程度。抑郁症状和疼痛强度（或疼痛放射）也介导了IPRP的两个心理测量结果（功能障碍量表和适应性应对量表）的变化。
在IPRP随访时，肥胖患者的疼痛和心理健康状况有所改善，这是由疼痛强度、疼痛放射和抑郁介导的。在为合并肥胖的疼痛患者设计量身定制的IPRP时，需要特别关注这些中介因素的作用。
