Saturday, March 3, 2012

Arthritis Today: More Weight Equals More Fibromyalgia Pain

Those who weigh the most have the worst fibromyalgia symptoms

By Otesa Middleton Miles

(Arthritis Today - 3/2/12) - Excess weight is known to aggravate fibromyalgia symptoms – such as pain sensitivity and sleep disturbances – and reduce quality of life among patients. New research now shows, the more severe the obesity, the more severe the fibromyalgia symptoms, and those who have abody mass index, or BMI, of 35 or higher experience the worst symptoms.

“I’m not surprised,” says study co-author Terry H. Oh, MD, assistant professor of physical medicine and rehabilitation at the Mayo Clinic, in Rochester, Minn. She says that earlier studies have shown that obesity increases fibromyalgia symptoms, but there hadn’t been concrete information before this study about whether different levels of obesity affected fibromyalgia symptoms differently.

In other words, is all obesity the same when it comes to fibromyalgia? The answer is no: Bigger definitely is worse, leading to significantly more severe symptoms. “The severely obese seemed to have the most problems,” says Dr. Oh.

Her study, which was published online in the journal Arthritis Care & Research, divided 888 adults with fibromyalgia into four groups: non-obese (BMI less than 25), overweight (BMI of 25 to 29.9), moderately obese (BMI of 30 to 34.9) and severely obese (BMI equal to or greater than 35). Patients were tracked for three years, underwent a physical evaluation and were asked to fill out health surveys and the Fibromyalgia Impact Questionnaire (a questionnaire used to assess fibromyalgia’s impact on a patient).

The researchers found – for most symptoms, but not all – that as the BMI category increased, so did the severity of the symptoms. Patients in the highest BMI group, for example, missed work more often because of fibromyalgia symptoms and reported more pain, stiffness and fatigue compared with those who were not obese or less obese. Also, the study found that the severely obese patients had more tender points on their bodies and worse physical functioning than the non-obese and less obese.
Trends showed most symptoms worsened with higher BMI category, but for the most part, the difference in the severity of symptoms was statistically significant for the highest BMI group compared with the other groups. “The group comparison showed the difference was primarily seen between the severely obese and the other groups,” Dr. Oh says. “Symptom severity is very pronounced when obesity is more severe.”

Why is there a relationship between BMI and the severity of fibromyalgia symptoms? Dr. Oh and her team write that multiple factors may be at work, including a higher level of pain receptors in fat tissue, elevated levels of pro-inflammatory cytokines, loss of physical fitness and an increase in mechanical loads on the body. And the higher rate of obesity in fibromyalgia patients “may be caused by a vicious circle of pain andphysical inactivity.”

Dr. Oh urges people with fibromyalgia to find a way to stay active despite the chronic pain and fatigue that come with it, and believes doctors should discuss weight-loss strategies with their fibromyalgia patients.

“Those who are severely obese may need more help for weight-loss management,” she says. “The basic message is that they have to stay active and exercise by starting slowly and gradually in terms of duration, intensity and frequency. It’s more than saying ‘lose weight.’ They need specific recommendations or to see a dietitian or endocrinologist or get other treatment options.”

Akiko Okifuji, PhD, a psychologist at the Pain Research and Management Center and professor at the University of Utah, in Salt Lake City, says it makes sense that those carrying around extra weight would experience more symptoms. Okifuji, who was not involved in Dr. Oh’s study, conducted earlier research on fibromyalgia and obesity, which found that obese fibromyalgia patients had more pain, less physical strength and more sleep problems.

“Both obesity and fibromyalgia are very different persistent conditions that impact overall health, physical well-being as well as quality of life,” Okifuji says.

She believes people intuitively know what Dr. Oh’s study showed – that severe obesity is bad for fibromyalgia patients. “But it’s good to show it scientifically,” Okifuji says. “Patients need proper nutritional education. It is difficult when you don’t move much. Sometimes food becomes a comfort. 

They need education on how to deal with that and how to maximize calorie burning while minimizing intake. When dealing with chronic fatigue and chronic pain, it is very difficult to do weight management. The key issue for the scientific and clinical community is to come up with an effective [weight management plan] for people who can’t move that much. It’s a tricky thing.”

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