Background & Aims

The prevalence of persons with overweight and obesity in the European region is approximately 60 percent 1 and people with overweight and obesity report a higher risk of chronic low back pain (CLBP) compared to individuals with normal weight (odds ratio > 1.18) 2, 3. Previous research reported promising evidence of a positive association between low back pain (LBP) and overweight or obesity 4-6. However, the severity of pain intensity and its possible association with different body composition measures such as, body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), body fat percentage (BF%) and total body fat mass remains unknown. In this systematic review with meta-analysis, the evidence regarding the association between pain intensity and body composition measures in patients suffering from chronic non-specific low back pain (CNLBP) was critically appraised and synthesized.

Methods

This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement 7. Literature published up to April 2023 was systematically searched on PubMed, Embase, CINAHL, Web of Science and the Cochrane library. Studies providing data on the association between pain intensity and at least one measure of body composition in adults with CNLBP were included. Methodological quality of the included studies was assessed with the Critical Appraisal Skills Programme 8. Meta-analysis employed a random-effects model with inverse-variance approach 9. Correlation coefficients (r) were transformed using Fisher’s Z transformation. Heterogeneity was assessed using the Q statistic and its p-value and Higgins’ I2 9. Publication bias was assessed using funnel plots and Egger’s test. Sensitivity analysis was conducted to observe the robustness of the meta-analysis in relation to different study characteristics. Statistical significance was set at 5%.

Results

Sixteen observational studies out of 11’025 entries were included in this systematic review. Of those, fifteen were pooled in the meta-analysis based on a sample of 4’557 participants with CNLBP. Results indicated a very low, positive and statistically significant association between pain intensity and BMI (r = 0.13, 95% CI: 0.05 to 0.20, p = 0.002), whilst associations with WHR and WC were very low, positive but statistically non-significant (WHR: r = 0.10, 95% CI: -0.14 to 0.34, p = 0.27; WC: r = 0.09, 95% CI: -0.28 to 0.44, p = 0.40). Due to limited number of studies, meta-analyses for other body composition characteristics were not possible. Sensitivity analyses, Q statistics and Higgins I2 assumed robust results. No evidence for publication bias was found. The quality rating of included studies showed substantial limitations and high risk for confounding.

Conclusions

Based on the fifteen pooled studies, a tendency towards a consistently positive but very low association between pain intensity and different measures of body composition in adults with CNLBP and overweight or obesity was found. Only the association between pain intensity and BMI was statistically significant whilst the associations with WHR and WC were similar to BMI, but statistically not significant. As BMI alone does not account for body fat distribution 10, future research should explore other standardized measurements for overweight and obesity, for example BF% or subcutaneous tissue fatness and their possible association with pain. Due to the observational, cross-sectional nature of the included studies no statement regarding causality of the demonstrated correlation can be made.

References

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Presenting Author

Melanie Liechti

Poster Authors

Melanie Liechti

MSc PT

Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Brussels, Belgium

Lead Author

Massimo Menegon

BSc PT

Bern University of Applied Sciences, Department of Physiotherapy, Bern, Switzerland

Lead Author

Alexander Philipp Schurz

MSc PT

Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium

Lead Author

Jan Taeymans

PhD

Bern University of Applied Sciences, Department of Physiotherapy, Bern, Switzerland

Lead Author

Heiner Baur

PhD

Bern University of Applied Sciences, Department of Physiotherapy, Bern, Switzerland

Lead Author

Ron Clijsen

PhD

University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland

Lead Author

Anneleen Malfliet

Pain in Motion research group (PAIN), Vrije Universiteit Brussel

Lead Author

Nathanael Lutz

PhD

Bern University of Applied Sciences, Department of Physiotherapy, Bern, Switzerland

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Low Back Pain