title: A systematic review of musculoskeletal pain among bariatric surgery patients: implications for physical activity and exercise.
abstract: BACKGROUND
  Physical activity (PA) can play an integral role in protecting the success of bariatric surgery by promoting weight loss and preventing weight regain. Although engagement in PA before surgery predicts postoperative PA levels, this may be undermined by weight-related co-morbidities. The importance of preoperative and postoperative musculoskeletal pain as a limitation to PA is unknown. The objective of this study was to review evidence on preoperative and postoperative pain in bariatric surgery patients, summarize the relationship between musculoskeletal pain and PA, and discuss areas of future research.
  
  
  METHODS
  The MEDLINE database was searched for published articles on musculoskeletal pain in bariatric surgery patients from January 1946 through December 2012. Outcomes of interest included preoperative pain prevalence, postoperative pain prevalence and incidence, and preoperative to postoperative changes in pain.
  
  
  RESULTS
  Preoperative musculoskeletal pain is highly common among candidates for bariatric surgery. Most individuals with presurgical pain experience significant improvement postoperatively. However, the characteristics of pain sufferers vary and few risk factors have been identified. New pain issues that present postsurgically are limited primarily to neurologic complications and are not common. To date, no study has tested the hypothesis that pain is a barrier to PA levels in bariatric surgery patients.
  
  
  CONCLUSIONS
  Gaps in knowledge regarding pain in bariatric surgery patients may present challenges for clinicians and exercise professionals on how to best advise patients about increasing their PA. Future research should include prospective evaluation of musculoskeletal pain via validated measures at multiple time points. This data will inform the time course of pain resolution, potential onset, and correlation with surgical weight loss.
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: speckr@mail.med.upenn.edu.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Speck
authors.affiliation: Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Philadelphia, Pennsylvania.
authors.forename: Dale S
authors.initials: DS
authors.lastname: Bond
authors.affiliation: Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David B
authors.initials: DB
authors.lastname: Sarwer
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: John T
authors.initials: JT
authors.lastname: Farrar
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects*; D059350:Chronic Pain / Q000209:etiology / Q000503:physiopathology; D004812:Epidemiologic Methods; D015444:Exercise / Q000502:physiology*; D006801:Humans; D059352:Musculoskeletal Pain / Q000209:etiology* / Q000503:physiopathology; D010149:Postoperative Pain / Q000209:etiology* / Q000503:physiopathology
keywords: Bariatric surgery; Exercise; Pain; Physical activity