Musculoskeletal Pain, Self-reported Physical Function, and Quality of Life in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Cohort.
OBJECTIVE
Obesity is associated with chronic musculoskeletal pain and is a risk factor for disability and osteoarthritis.


OBJECTIVE
To describe the prevalence, sites, and intensity of musculoskeletal pain in adolescents with severe obesity; to evaluate associations between musculoskeletal pain and self-reported physical function as well as weight-related quality of life; and to evaluate the association between musculoskeletal pain and high-sensitivity C-reactive protein level.


METHODS
Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a prospective, observational study that collects standardized data on adolescents undergoing weight loss surgery at 5 US centers. We examined baseline data from this cohort between February 28, 2007, and December 30, 2011. We excluded adolescents with Blount disease and slipped capital femoral epiphyses. A total of 233 participants were included in these analyses.


METHODS
We assessed musculoskeletal pain and pain intensity of the lower back, hips, knees, and ankles/feet using the visual analog scale, categorizing musculoskeletal pain into lower back pain, lower extremity (hips, knees, and feet/ankles combined) pain, and no pain. We assessed self-reported physical function status with the Health Assessment Questionnaire Disability Index and assessed weight-related quality of life with the Impact of Weight on Quality of Life-Kids measure. We adjusted for sex, race, age at surgery, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and clinical depressive symptoms in regression analyses.


RESULTS
Among the 233 participants, the mean (SD) age at surgery was 17.1 (1.56) years and the median BMI was 50.4. Participants were predominantly female (77%), white (73%), and non-Hispanic (93%). Among the participants, 49% had poor functional status and 76% had musculoskeletal pain. Lower back pain was prevalent (63%), followed by ankle/foot (53%), knee (49%), and hip (31%) pain; 26% had pain at all 4 sites. In adjusted analyses, compared with pain-free participants, those reporting lower extremity pain had greater odds of having poor physical function according to scores on the Health Assessment Questionnaire Disability Index (odds ratio = 2.82; 95% CI, 1.35 to 5.88; P < .01). Compared with pain-free participants, those reporting lower extremity pain had significantly lower Impact of Weight on Quality of Life-Kids total scores (β = -9.42; 95% CI, -14.15 to -4.69; P < .01) and physical comfort scores (β = -17.29; 95% CI, -23.32 to -11.25; P < .01). After adjustment, no significant relationship was observed between musculoskeletal pain and high-sensitivity C-reactive protein level.


CONCLUSIONS
Adolescents with severe obesity have musculoskeletal pain that limits their physical function and quality of life. Longitudinal follow-up will reveal whether weight loss surgery reverses pain and physical functional limitations and improves quality of life.
Nationwide Children's Hospital, The Ohio State University, Columbus.
Sharon
S
Bout-Tabaku
Nationwide Children's Hospital, The Ohio State University, Columbus.
Marc P
MP
Michalsky
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Todd M
TM
Jenkins
Nationwide Children's Hospital, The Ohio State University, Columbus.
Amy
A
Baughcum
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Meg H
MH
Zeller
Texas Children's Hospital, Baylor College of Medicine, Houston.
Mary L
ML
Brandt
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Anita
A
Courcoulas
University of Cincinnati, Cincinnati, Ohio.
Ralph
R
Buncher
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Michael
M
Helmrath
University of Buffalo, Buffalo, New York.
Carroll M
CM
Harmon
University of Alabama at Birmingham, Birmingham.
Mike K
MK
Chen
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Thomas H
TH
Inge
D000293:Adolescent; D050110:Bariatric Surgery / Q000523:psychology*; D015992:Body Mass Index; D001835:Body Weight; D002097:C-Reactive Protein / Q000378:metabolism; D059350:Chronic Pain / Q000097:blood / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009043:Motor Activity; D059352:Musculoskeletal Pain / Q000097:blood / Q000523:psychology*; D010147:Pain Measurement / Q000523:psychology; D010809:Physical Fitness; D011183:Postoperative Complications / Q000097:blood / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D014481:United States
D002097:C-Reactive Protein