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Changes in back pain scores after bariatric surgery in obese patients: A systematic review and meta-analysis

By Froukje W. Koremans, Xiaolong Chen, Abhirup Das, Ashish D Diwan

Posted 31 Aug 2020
medRxiv DOI: 10.1101/2020.08.25.20182022

Objective: To evaluate if back pain scores in morbidly obese patients change after bariatric surgery. Summary Background Data: Obese patients often complain of low back pain (LBP), however the underlying mechanism is not fully understood. Recent research shows that, next to mechanical loading, the chronic low-grade inflammation that arises in obese patients is contributing to LBP due to intervertebral disc degeneration. Therefore, it is hypothesized that bariatric surgery will have an effect on the LBP in obese patients. Methods: We searched four online databases for randomized controlled trials and observational studies. In obese patients, eligible for bariatric surgery, the changes in pre- and postoperative pain scores, assessed by Numeric Rating Pain Scale (NPS) or Visual Analogue Scale (VAS), were considered as primary outcomes. Effect size (ES) and their 95% confidence intervals (CI) were evaluated. Results: Eight observational studies met the eligibility criteria. All studies showed a reduction of LBP following bariatric surgery, with a mean change of -2.9 points in NPS and of -3.8 cm in VAS. Among the patients undergoing bariatric surgery, based on a fixed effect estimated by pain assessment, the pain score decreased significantly in both groups; in NPS (ES -3.49, 95%CI [-3.86, -3.12]) and in VAS (ES -3.975, 95%CI [-4.45, -3.50]). Conclusions: From this meta-analysis, the data of back pain improvement following bariatric surgery seems encouraging. Substantial weight loss following bariatric surgery might be associated with a reduction in back pain intensity.

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