Excess weight a burden for chronic pain

Excess body weight is one of the factors that most negatively affects chronic pain, the more weight the more pain.

This is not only due to the fact that it is a physical burden, but also because the accumulation of fat in the body causes metabolic alterations that increase generalized chronic inflammation, which worsens pain, as well as other aspects of health.

Overweight and obesity are health problems in themselves, but also factors that worsen chronic pain and also make us more prone to suffer from other pathologies such as diabetes, cardiovascular diseases, metabolic syndrome, depression, gastrointestinal disorders, etc.

The complexity of weight and body composition regulation and the relationship between nutrition and chronic pain makes this issue a priority when helping patients.

Excess body weight is caused by an increase in the accumulation of fat in the body mainly due to an imbalance between calories ingested and calories expended. Obesity occurs when our BMI (ratio between our weight and our height) is higher than 30 or also when the accumulation of fat in the abdomen makes our waist circumference higher than 88cm in women and 102cm in men.

The accumulation of fat in our abdominal area is detrimental to cardiovascular health, favors insulin resistance and also the development of diseases or inflammatory situations. Its relationship with pain has also been observed, the more abdominal perimeter, the more inflammation and pain.

Obesity increases chronic inflammation in the body and this causes us to feel more pain because it enhances central sensitization. central sensitization and the metabolic, endocrine and immune balance is impaired.

There is a close relationship between increased abdominal fat mass and increased pain, i.e., patients who are overweight or obese feel more pain, are in poorer health and have worse physical function and quality of life than those who are of adequate weight.

There are many studies that talk about how obesity (and being overweight) has a very negative effect on the level of pain in patients with diseases such as fibromyalgia, osteoarthritis, chronic low back pain, etc.

All of them show that the greater the weight, the greater the pain and that by reducing the weight, even if it is only 10% of the initial weight, patients notice an improvement.

In addition, there are studies that show a positive relationship between the maintenance of muscle mass and improvement in pain, better physical function and better quality of life. So that, achieving an adequate body weight and striving to maintain muscle mass are basic factors in reducing pain..

But the regulation of body weight is very complex and achieving an adequate weight in people with obesity and pain is a task that requires effort and perseverance. The diet should be balanced and sufficient to take in only the energy we expend each day.

Food intake is affected by factors such as rest and sleep, stress, moods, physical activity, medication, and pain…

Not getting enough rest or too little sleep or poor quality sleep causes us to eat more.

Being under a state of chronic stress, such as being in pain continuously, alters the regulation of satiety signals.

Mood disturbances, depression and anxiety also negatively affect the way we eat….

Lack of physical activity makes us lose muscle mass and therefore feel more tired or less vital, and that can also make us look for extra energy in food.

In addition, it is known that one of the positive effects of physical exercise is that it helps regulate satiety and hunger.

Some drugs can also alter the intake or metabolism making us more susceptible to weight gain. And to top it all, the same pain, when chronic, alters eating behavior as it generates alterations in the nervous system that make patients have less control over their impulses to eat, and unconsciously seek the analgesic-hedonic effect of eating.

While we eat we do not feel pain, and in addition, if we eat something we like, we will have a positive sensation that relieves us, even if only fleetingly. But it is a mechanism that our own body has to maintain its physical and mental integrity, when we feel some kind of tension or stress (in this case chronic pain) the brain itself looks for ways to give itself a reward and get rid of that negative feeling …

In patients with chronic pain this mechanism works against us because the instantaneous relief obtained while eating something appetizing does not compensate for the fact that this will encourage us to ingest more calories and therefore gain weight.

And if we gain weight, we worsen the pain.

For all these reasons, and much more, it is essential to help patients to follow a healthy diet that allows them to maintain their body weight while still enjoying delicious dishes and recipes.

All recommendations have to be tailored to the individual patient, but there are some general guidelines that can be taken into account to improve weight and pain:

Plant-based foods should predominate as they are the ones that, in general, concentrate more nutrients in fewer calories.

Vegetables should be eaten daily as well as fruits, ideally 2 servings of the former and no more than 3 of the latter.

Sugars and foods rich in saturated fats such as red meat, sausages, some dairy products (desserts and cured cheeses), cookies, pastries and other processed foods should be reduced as much as possible.

Seeds and nuts such as walnuts, almonds, hazelnuts and pistachios should be included in the diet in small portions.

It is important to have consistent meal times and try to avoid eating foods rich in carbohydrates at night (vegetables, salads, fish and eggs are ideal for dinner)….