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Original Investigation |

Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity

Wendy C. King, PhD1; Jia-Yuh Chen, MS1; Steven H. Belle, PhD1; Anita P. Courcoulas, MD, MPH2; Gregory F. Dakin, MD3; Katherine A. Elder, PhD4,5; David R. Flum, MD, MPH6; Marcelo W. Hinojosa, MD6; James E. Mitchell, MD7; Walter J. Pories, MD8; Bruce M. Wolfe, MD4; Susan Z. Yanovski, MD9
[+] Author Affiliations
1University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
2University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
3Weill Cornell Medical Center, New York, New York
4Oregon Health and Science University, Portland
5Now with Pacific University, Forest Grove, Oregon, and the Oregon Health and Science University, Portland
6University of Washington, Seattle
7Neuropsychiatric Research Institute, Fargo, North Dakota
8Brody School of Medicine, East Carolina University, Greenville, North Carolina
9National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
JAMA. 2016;315(13):1362-1371. doi:10.1001/jama.2016.3010.
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Importance  The variability and durability of improvements in pain and physical function following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) are not well described.

Objectives  To report changes in pain and physical function in the first 3 years following bariatric surgery, and to identify factors associated with improvement.

Design, Setting, and Participants  The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study at 10 US hospitals. Adults with severe obesity undergoing bariatric surgery were recruited between February 2005 and February 2009. Research assessments were conducted prior to surgery and annually thereafter. Three-year follow-up through October 2012 is reported.

Exposures  Bariatric surgery as clinical care.

Main Outcomes and Measures  Primary outcomes were clinically meaningful presurgery to postsurgery improvements in pain and function using scores from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (ie, improvement of ≥5 points on the norm-based score [range, 0-100]) and 400-meter walk time (ie, improvement of ≥24 seconds) using established thresholds. The secondary outcome was clinically meaningful improvement using the Western Ontario McMaster Osteoarthritis Index (ie, improvement of ≥9.7 pain points and ≥9.3 function points on the transformed score [range, 0-100]).

Results  Of 2458 participants, 2221 completed baseline and follow-up assessments (1743 [78.5%] were women; median age was 47 years; median body mass index [BMI] was 45.9; 70.4% underwent RYGB; 25.0% underwent LAGB). At year 1, clinically meaningful improvements were shown in 57.6% (95% CI, 55.3%-59.9%) of participants for bodily pain, 76.5% (95% CI, 74.6%-78.5%) for physical function, and 59.5% (95% CI, 56.4%-62.7%) for walk time. Additionally, among participants with severe knee or disability (633), or hip pain or disability (500) at baseline, approximately three-fourths experienced joint-specific improvements in knee pain (77.1% [95% CI, 73.5%-80.7%]) and in hip function (79.2% [95% CI, 75.3%-83.1%]). Between year 1 and year 3, rates of improvement significantly decreased to 48.6% (95% CI, 46.0%-51.1%) for bodily pain and to 70.2% (95% CI, 67.8%-72.5%) for physical function, but improvement rates for walk time, knee and hip pain, and knee and hip function did not (P for all ≥.05). Younger age, male sex, higher income, lower BMI, and fewer depressive symptoms presurgery; no diabetes and no venous edema with ulcerations postsurgery (either no history or remission); and presurgery-to-postsurgery reductions in weight and depressive symptoms were associated with presurgery-to-postsurgery improvements in multiple outcomes at years 1, 2, and 3.

Conclusions and Relevance  Among a cohort of participants with severe obesity undergoing bariatric surgery, a large percentage experienced improvement, compared with baseline, in pain, physical function, and walk time over 3 years, but the percentage with improvement in pain and physical function decreased between year 1 and year 3.

Trial Registration  clinicaltrials.gov Identifier: NCT00465829

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Figure 1.
Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) Study Flow From Approached Patients to Analysis Sample

aThe number of patients initially screened for eligibility was not recorded.

bIndicates that all pain and function measures may not have been completed.

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Figure 2.
Back and Leg Pain Before and After Bariatric Surgery

Observed data are reported in eTable 2.

aPatients were asked, “In the past 4 weeks, how much did pain interfere with your normal work, including both work outside the home and house work?” Those who reported having no back or leg pain to the preceding question were grouped with those reporting “not at all.”

bSample size of model. Modeled data, adjusted for age and site are shown.

cPatients were asked, “If you had to spend the rest of your life with the symptoms you have right now, how would you feel about it?” Those who reported no back or leg pain to the preceding question were grouped with those reporting “very satisfied.”

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