Significant pain relief following gastric bypass surgery

Cleveland researchers study musculoskeletal pain following significant weight loss

Over 18 months, researchers at University Hospitals of Cleveland and Case Western Reserve University studied the frequency and prevalence of musculoskeletal (MSK) complaints in obese patients before and after undergoing gastric bypass surgery. The researchers concluded that the complaints, which involved joint and tendon pain, decreased significantly following surgery and initial weight loss, even in non-weight bearing areas of the body.

The comprehensive review of MSK symptoms (neck, shoulder, spine, hip, knee, foot pain, fibromyalgia syndrome, etc.) before and after weight loss studied 54 patients recruited from University Hospitals of Cleveland’s Bariatric Surgery Program, according to Michele Hooper, MD, the study’s principal investigator and co-director of the Arthritis Translational Research Program at University Hospitals of Cleveland.

Dr. Hooper’s findings, which will be presented in San Antonio at the American College of Rheumatology’s annual meeting on October 21, 2004, demonstrated that there was decrease of 52% in the number of sites of musculoskeletal complaints and a 92% reduction in fibromyalgia syndrome pain (widespread pain and tenderness in muscles and soft tissue) between 6-12 months after surgery. There was significant improvement of function and quality life as well. “This was a highly motivated group of individuals who made major lifestyle changes in addition to their surgery,” says Dr. Hooper “Patients also had to adhere to the extensive multi-disciplinary preoperative evaluation that is required by University Hospital’s Bariatric Surgery Program.”

Gastric bypass surgery involves stapling the upper stomach to create a small pouch that is then attached to the small intestine, reducing the capacity of the stomach, resulting in dramatic weight loss. Of the 54 patients who were studied, there were 52 women and two men ranging in age from 35-53 years. For the female participants, the mean weight before surgery was 292 pounds. Many patients suffered from the following comorbid conditions before surgery: hypertension, sleep apnea, type 2 diabetes, asthma, bladder incontinence and gastroesophageal reflux disease.

Using the Western Ontario and McMaster Universities Arthritis Index (WOMAC), a leading outcome measure of osteoarthritis-related disabilities in the hip and knee; as well as the London Fibromyalgia Epidemiology Study Screening (LFESSQ), an index that test pain and fatigue criteria, Dr. Hooper and colleagues found that there was a dramatic resolution of fibromyalgia pain after surgery, which may be due to a decrease in the above stated comorbid syndromes and an increase in physical activity. As weight loss continues, these benefits may improve further.

“The study clearly showed the benefit of weight loss in terms of pain, function and quality of life. We are now trying to understand why certain conditions such as knee osteoarthritis are so much more common than hip or ankle arthritis in people who are overweight,” says Dr. Hooper.