title: Obesity and general pain in patients utilizing family medicine: should pain standards call for referral of obese patients to weight management programs?
abstract: BACKGROUND
  Accredited medical care organizations are expected to assess pain levels in their patients. Appropriate responses to high pain levels have not been specified.
  
  
  METHODS
  This study was a retrospective analysis of information abstracted from medical records of 673 adult patients utilizing family medicine. Pain was measured using a scale ranging from 0 to 10. Scores of 7 and above were judged to represent high levels of pain. Multiple logistic regression was used to test the relationship between body mass index (BMI) and general pain, after adjustment for co-morbidity, physical limitations, and demographic characteristics.
  
  
  RESULTS
  Multiple logistic regression analysis revealed that, in comparison with patients with normal body mass, patients with BMI greater than 35 had higher odds of experiencing pain scored 7 or over after adjusting for physical limitations, co-morbidity, age, and gender (adjusted odds ratio [AOR] = 1.89, P = .03). Odds ratios also were significant for subjects with any (vs none) physical limitations (AOR = 1.91, P = .01) and for men relative to women (AOR = 0.65, P = .04). co-morbidity, common diagnoses, and moderate BMI scores were not independently related to high pain levels.
  
  
  CONCLUSIONS
  In our sample of patients utilizing family medicine, BMI greater than 35 is a risk factor for elevated pain scores. This relationship appears to be independent of orthopedic consequences of obesity. Referral to weight management programs might be useful as a quality indicator for obese adults reporting high levels of general pain.
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. rohrer.james@mayo.edu
authors.forename: James E
authors.initials: JE
authors.lastname: Rohrer
authors.forename: Steven C
authors.initials: SC
authors.lastname: Adamson
authors.forename: Darryl
authors.initials: D
authors.lastname: Barnes
authors.forename: Ruth
authors.initials: R
authors.lastname: Herman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005194:Family Practice; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity; D010146:Pain; D012017:Referral and Consultation; D012189:Retrospective Studies