CF 190: Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment

Today we’re going to talk about obesity in youth and chronic pain, we’ll talk about fibromyalgia and hyperbaric oxygen chambers, and we’ll talk about chronic pain and the healing journey. 

But first, here’s that sweet sweet bumper music

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You have found yourself smack dab in the middle of Episode #190

Now if you missed last week’s episode , we were joined by the amazing Dr. Brett Winchester from the St. Louis area. This doctor is just phenomenal in everything he does and says and we are all fortunate to have him in this profession. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Day 1 of our nurse practitioner starting is today. This morning has, of course, had its hiccups. We have the EHR where we have him set up but he has to have his own login and password and all that good stuff so that’s been one challenge so far. 

Just getting oriented with where all of the stuff is, lidocaine, lab tubes, swabs, blah blah blah. Still waiting on the autoclave and still getting the malpractice policy in place this morning. What a process that’s been. 

But we knew there’d be hiccups, and we’re getting them addressed. Then I have my regular life to contend with. I have patients to treat and a podcast to write so here we go. Short and sweet on this one because my cup is running over this morning. 

Item #1

Our first item today is called “Obesity in Youth with Chronic Pain: Giving It the Seriousness It Deserves” by Hainsworth et. al. (Keri R Hainsworth 2021) and published in Pain Medicine in June of 2021 and day-um…..that’s hot!

Why They Did It

The aim of this commentary is to review the current science on co-occurring chronic pain and obesity in children and adolescents. In so doing, we also highlight some of the current gaps in knowledge. It is our hope that this commentary will draw attention to an overlooked area of research and clinical endeavors within the field of pediatric pain.

The authors note that it is becoming increasingly clear that we should be familiar with this research. Both chronic pain and obesity have been rising in children for some time and studies are showing that obesity exacerbates the negative outcomes associated with chronic pain. 

In addition, accumulating research exists on all facets of the co-occurrence of chronic pain and obesity in adults. Given all this, the paucity of research in this area of pediatric chronic pain and obesity is at a minimum, disheartening, and at a maximum, unconscionable.

Ooooweee! That’s like putting a white glove on and smacking some clown around the room a little bit, isn’t it? I like it. It give me a little tickle. 

Here are their main points:

• On average, it can take 2 years longer for youth with obesity to be referred to a pediatric pain clinic than it does for youth with a normal weight


• Pediatric patients with CPO have health-related quality of life that is more impaired in every domain than patients with chronic pain and a healthy body mass index percentile


• Although systemic inflammation is commonly elevated in youth with obesity, patients with CPO have significantly higher levels of systemic inflammation than those with chronic pain alone or obesity alone 


• Children with CPO are at increased risk of being treated as though they bear more responsibility for their health (and by extension, their pain) than youth without obesity and are at increased risk of pain dismissal and biased medical care


• CPO in children and adolescents is associated with more impaired physical functioning and lower levels of physical activity than youth with chronic pain alone or obesity alone Further, parents report that their children with CPO (particularly girls) have greater functional disability (one of the most important outcomes in our field) than parents of youth with chronic pain and a normal body mass index


• While multidisciplinary pain management programs work well for patients with a healthy weight, this is not true for those with comorbid obesity. Patients with a healthy weight improve in functional disability within 3 months of intake, whereas patients with CPO stagnate

First, even though we as clinicians and researchers need to address obesity in the context of chronic pain, we must be extremely thoughtful about how we move forward. Weight is a very sensitive subject, therefore, the call for more research in this area must strongly consider the need for sensitivity. CPO is the co-occurrence of a typically “invisible,” debilitating condition coupled with a condition so visible that it is sadly associated with victimization from important people in the child’s life, including peers, parents, and teachers

Second, we would do well to closely follow the admonitions and advice of our colleagues whose primary clinical and research focus is