Background & Aims
Low back pain (LBP) is a prevalent health problem with a significant impact on quality of life[1, 2]. Obesity is a major risk factor for LBP[3] due to increased spinal load, thoracolumbar musculature weakness, altered spinal curvature[4-6] and chronic inflammation[7]. Moreover, obesity favors intervertebral disc extracellular matrix degeneration, adversely affects nerve endings growth[8], and alters the excitation threshold of peripheral nerves, favoring chronic pain sensitization[9]. Bariatric surgery (BS) is the most effective treatment for severe obesity, reducing excess weight and associated comorbidities including LBP[10, 11]. It has been observed that after bariatric surgery, LBP tends to persist[11, 12]. Due to its clinical significance, it is important to unfold factors that are related to LBP and mechanical hyperalgesia in post-BS patients. We compared post- bariatric surgery patients with or without LBP to determine their characteristics and main differences.
This project is supported by the Research Center in Physical Activity, Health, and Leisure—CIAFEL—Faculty of Sport (FADEUP), University of Porto, Portuguese Foundation for Science and Technology (UIDB/00617/2020: doi: 10.54499/UIDB/00617/2020 and UIDP/00617/2020: doi: 10.54499/UIDP/00617/2020), and the Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal (LA/P/0064/2020) and S. João Academic Hospital Center (HSJ), Portugal. Saira Waqqar and Tiago Montanha are funded by Fundação para a Ciência e Tecnologia (FCT) grants 2023.00444.BD, and 2021.05532.BD respectively
Methods
28 post-BS patients (19F:9M; 18-24 months after surgery) were divided into LBP (n=20; 50.5±5years, BMI:32.6±3.8 kg.m-2) and without LBP (n=8; 52.3±7y, BMI:32.1±2.03 kg.m-2). Low back pain intensity (numeric pain rating scale), and Pressure Pain Threshold (PPT; algometer) at the lumbar region, body mass index (BMI), body composition (total and trunk lean and fat mass; DEXA), spine curve angles of the thoracic, lumbar and pelvic regions measured during neutral standing position (Spinal Mouse; IDIAG M360®), and trunk extensors and flexors muscle strength were assessed (Biodex, Isokinetic dynamometer). Independent t-tests and one-way MANOVA were performed to compare groups. Associations between LBP, PPT and dependent variables were explored with Pearson correlation.
Results
Differences between groups were observed for total fat mass, total lean mass, trunk extensors strength, PPT, and lumbar scoliosis: F (5,22) =2.62, p=0.05; Wilk’s ?=0.63, ?p2 =0.37. There were no statistically significant differences in trunk fat mass, trunk lean mass, thoracic kyphosis, thoracic scoliosis, lumbar lordosis angle (LLA), and pelvic tilt (PT) between groups (p>0.05). Patients with and without LBP had spine alignment imbalances including hyper-kyphosis in 61% vs 21%, flat back in 54% vs 25%, mild lumbar scoliosis, and compensatory PT in 32% vs 4%, with no statistically significant difference (p>0.05). LBP was associated with lower total lean mass (r= -0.41, p=0.03), weaker trunk extensor and flexor strength (r=-0.38, p=0.04: r=-0.48, p=0.01), higher fat mass (r=0.40, p=0.04), and lumbar scoliosis (r=0.45, p=0.02). In contrast, PPT was associated with weaker trunk flexors (r=0.37, p=0.05), changes in spine angle i.e., LLA (r= -0.45, p=0.02), and PT (r=-0.52, p=0.00).
Conclusions
Results indicate that post bariatric surgery patients with low back pain have lower total lean mass and trunk extensors strength. Also, pain sensitivity to pressure at the lumbar region and total fat mass were higher, while scoliosis at lumbar region tended to be more prevalent in patients with LBP compared to those without LBP.
References
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Presenting Author
Saira Waqqar
Poster Authors
Saira Waqqar
BSc-PT, PP-DPT & MHPE
Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP) and Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
Lead Author
Tiago Montanha: Master in Physical Activity and Health
Masters in Physical Activity and Health
Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP) and Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
Lead Author
Nelson Azevedo: PhD in Physiotherapy
PT, BSc, MSc, PhD Physiotherapy
CICS, ISAVE, Rua Castelo de Almourol, nº 13 4720-155 Amares – Braga, CIR, ESS, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida nº 400 4200-072 - Porto
Lead Author
Dr. Eduardo Costa:Master in Molecular Medicine,Medicine degree
Masters in molecular medicine, Medicine degree
Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
Lead Author
Hélder Fonseca: PhD Physical Activity and Health
PhD Physical Activity and Health
Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP) and Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
Lead Author
José carlos Ribeiro: PhD sport sciences
PhD sport sciences
Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP) and Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain