Obesity as a Disruptor of the Pain Inhibition Response in Fibromyalgia: A Pooled Multi-Trial Analysis of 521 Patients

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-10-14 DOI:10.1002/ejp.70145

Wolnei Caumo, Kevin Pacheco-Barrios, Guilherme J. M. Lacerda, Bárbara Regina França, Felipe Fregni

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Abstract

Background

BMI has been strongly associated with poor outcomes in fibromyalgia syndrome (FMS) patients, but no previous studies have examined its role in pain inhibition response. This study examines the influence of high BMI on the pain inhibition response and clinical severity of FMS.

Methods

This pooled cross-sectional analysis of baseline data from nine clinical trials involving 521 adult female FMS patients included the largest mechanistic FMS sample to date. Pain inhibition responses (conditioned pain modulation, CPM) were assessed using a computer-based thermode. Clinical assessments included numeric pain scales and Beck's Depression Inventory. Unadjusted and multivariate analyses were conducted to assess the influence of BMI on FMS symptoms using generalised linear models. Interaction terms for BMI and CPM were also tested. Non-linear effects of BMI were assessed with piecewise-linear models.

Results

A high body mass index (BMI) significantly correlated with a weakened CPM response and increased severity of pain and depression symptoms. The relationship between BMI and pain inhibition was distinctly non-linear, with detrimental effects becoming prominent beyond a BMI of 24 kg/m², marking a critical slope change point. Moreover, patients with a higher BMI did not benefit from pain inhibition on pain and depression scores, unlike their normal-weight counterparts, suggesting a disruption in the endogenous pain modulation mechanisms.

Conclusion

The study confirms that high BMI is detrimental to the clinical profile of FMS patients, adversely affecting pain inhibition and contributing to the severity of pain and depression, suggesting that weight management could be an integral component of FMS treatment.

Significance Statement

This study uniquely explores the relationship between BMI and pain inhibition response in fibromyalgia patients, revealing a non-linear association and highlighting BMI's role as a moderator of CPM. The findings emphasise that obesity disrupts endogenous pain regulation, leading to more severe pain and depression symptoms. This underscores the potential for weight management in FMS treatment and supports developing personalised interventions considering obesity status.

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肥胖作为纤维肌痛疼痛抑制反应的干扰物：521例患者的多试验分析

背景：BMI与纤维肌痛综合征（FMS）患者预后不良密切相关，但此前没有研究证实其在疼痛抑制反应中的作用。本研究探讨高BMI对FMS疼痛抑制反应和临床严重程度的影响。方法：对521名成年女性FMS患者的9项临床试验的基线数据进行汇总横断面分析，其中包括迄今为止最大的机械FMS样本。疼痛抑制反应（条件性疼痛调节，CPM）采用基于计算机的热模法进行评估。临床评估包括数值疼痛量表和贝克抑郁量表。采用广义线性模型进行未调整和多变量分析，以评估BMI对FMS症状的影响。对BMI和CPM的相互作用项也进行了检验。采用分段线性模型评估BMI的非线性效应。结果：高身体质量指数（BMI）与CPM反应减弱、疼痛和抑郁症状严重程度增加显著相关。BMI与疼痛抑制之间的关系呈明显的非线性关系，BMI超过24 kg/m2后，有害影响变得明显，标志着一个临界斜率变化点。此外，与体重正常的患者不同，BMI较高的患者在疼痛和抑郁评分上并没有从疼痛抑制中获益，这表明内源性疼痛调节机制受到了破坏。结论：本研究证实，高BMI对FMS患者的临床表现有害，对疼痛抑制产生不利影响，并导致疼痛和抑郁的严重程度，表明体重管理可能是FMS治疗的一个组成部分。意义声明：本研究独特地探讨了纤维肌痛患者BMI与疼痛抑制反应之间的关系，揭示了一种非线性关联，并强调了BMI在CPM调节中的作用。研究结果强调，肥胖会扰乱内源性疼痛调节，导致更严重的疼痛和抑郁症状。这强调了FMS治疗中体重管理的潜力，并支持针对肥胖状况开发个性化干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.