A new study published in the open-access journal Regional Anesthesia & Pain Medicine has found that excess abdominal fat is strongly associated with chronic musculoskeletal pain, particularly in women. This study is the first to establish a link between fat tissue and chronic pain across multiple body sites, highlighting the importance of fat distribution in pain management.
Obesity, which has nearly tripled since 1975, is a major public health concern. It is associated with chronic diseases like cardiovascular disease and diabetes, contributing to reduced life expectancy. Chronic musculoskeletal pain is also widespread, with an estimated 1.71 billion people worldwide affected, according to the Global Burden of Disease 2019 report.
The study by Kifle and colleagues indicated that reducing abdominal fat may help alleviate chronic musculoskeletal pain, especially in individuals with pain at multiple body sites. Previous research has linked obesity to musculoskeletal pain, but the specific contribution of excess fat tissue to chronic pain across different areas was unclear. The study analyzed data from 32,409 UK Biobank participants, with an average age of 55 years. MRI scans measured visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and participants reported chronic pain in areas such as the neck, shoulder, back, and hips. Follow-up MRI scans and pain assessments were conducted after two years.
The analysis revealed a clear dose-response relationship between the number of chronic pain sites and the levels of VAT, SAT, the VAT-to-SAT ratio, and body mass index (BMI). This association was particularly pronounced in women, where the odds of experiencing pain at multiple sites were twice as high with increased VAT, and 60% greater with both increased SAT and a higher VAT-to-SAT ratio. In men, the odds ratios were also elevated, though to a lesser degree: 34%, 39%, and 13% higher, respectively.
A systematic review and meta-analysis by Walsh et al. identified positive cross-sectional associations between increased body fat and widespread and single-site joint pain in the lower back, knee, and foot. Longitudinal studies suggest that elevated body fat may increase the risk of incident and worsening joint pain, although further high-quality studies are required.
Higher levels of fat tissue were linked to greater odds of reporting chronic pain across both genders, but the association remained stronger in women. The researchers suggest that this may be due to differences in fat distribution and hormonal influences between men and women. Significantly, these associations persisted even after controlling for a range of potential confounding factors, including age, height, ethnicity, income, education level, alcohol use, smoking, physical activity, sleep duration, mental health, and coexisting medical conditions.
Although the study found a significant link between abdominal fat and chronic pain, it was observational and cannot establish a direct cause-and-effect relationship. However, the research suggests that abdominal fat, particularly ectopic fat deposits, may contribute to widespread chronic musculoskeletal pain, especially in women due to differences in fat distribution and hormonal influences. Clinically, this highlights the importance of weight management as a potential strategy for alleviating chronic, multisite pain, with targeted interventions for reducing abdominal fat. Physicians could consider incorporating lifestyle modifications, such as diet and exercise, as part of pain management plans, particularly for women at higher risk.
References
- Kifle ZD, Tian J, Aitken D, Melton PE, Cicuttini F, Jones G, et al. MRI-derived abdominal adipose tissue is associated with multisite and widespread chronic pain. Reg Anesth Pain Med [Internet]. 2024 Aug 6 [cited 2024 Sep 12]; Available from: https://rapm.bmj.com/content/early/2024/08/06/rapm-2024-105535
- Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. 2020 Dec 19;396(10267):2006–17.
- Walsh TP, Arnold JB, Evans AM, Yaxley A, Damarell RA, Shanahan EM. The association between body fat and musculoskeletal pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2018 Jul 18;19(1):233.