The Moderating Effect of Obesity on Cognitive–Behavioral Pain Treatment Outcomes

Authors

  • John J. Sellinger PhD,

    Corresponding author
    1. Department of Veterans Affairs—VA Connecticut Healthcare System, West Haven, Connecticut
    2. Department of Psychiatry—Yale University School of Medicine, New Haven, Connecticut
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  • Elizabeth A. Clark MA,

    1. Department of Veterans Affairs—VA Connecticut Healthcare System, West Haven, Connecticut
    2. Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
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  • Marc Shulman PhD,

    1. Department of Veterans Affairs—VA Connecticut Healthcare System, West Haven, Connecticut
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  • Patricia H. Rosenberger PhD,

    1. Department of Veterans Affairs—VA Connecticut Healthcare System, West Haven, Connecticut
    2. Department of Psychiatry—Yale University School of Medicine, New Haven, Connecticut
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  • Alicia A. Heapy PhD,

    1. Department of Veterans Affairs—VA Connecticut Healthcare System, West Haven, Connecticut
    2. Department of Psychiatry—Yale University School of Medicine, New Haven, Connecticut
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  • Robert D. Kerns PhD

    1. Department of Veterans Affairs—VA Connecticut Healthcare System, West Haven, Connecticut
    2. Department of Psychiatry—Yale University School of Medicine, New Haven, Connecticut
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John Sellinger, PhD, VA Connecticut Healthcare System, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT 06516, USA. Tel: 203-932-5711, ext. 3589; Fax: 203-937-3495; E-mail: John.Sellinger1@va.gov.

Abstract

Objective.  To assess the effects of body mass index on cognitive-behavioral pain treatment outcomes for chronic low back pain.

Design.  Retrospective analyses of data from a clinical trial were performed, with body mass index used to divide patients into obese and non-obese groups for comparison.

Setting.  VA medical center outpatient clinic.

Patients.  Veterans (N = 74) receiving outpatient care through the VA.

Interventions.  Delivery of a 10-week cognitive-behavioral pain treatment intervention.

Outcome Measures.  The Numerical Rating Scale (pain intensity), Roland Morris Disability Questionnaire (disability), Veteran's SF-36 (health-related quality of life), and Beck Depression Inventory (emotional functioning) were administered pre- and post-treatment.

Results.  The study included 42 obese and 32 non-obese participants, most of whom were male (89%). The average body mass index was 32.44 kg/m2, with average pain intensity rated as 6.59 out of 10. There were no pre-treatment differences in outcome measures between the groups. Repeated measures ANOVAs revealed main effects of Time on all but one outcome (Mental Component score), indicating that the cognitive-behavioral interventions were largely effective. However, Time–body mass index (BMI) group interactions revealed that non-obese participants showed greater improvement following treatment than did their obese counterparts on measures of disability (P < 0.05), physical aspects of quality of life (P < 0.01), and emotional functioning (P < 0.05).

Conclusions.  Standard cognitive-behavioral pain treatment did not yield comparable outcomes for obese and non-obese participants. Results suggest a potential moderating role of BMI in low back pain outcomes. Future work with other pain conditions, including examination of potential mechanisms through which BMI impacts treatment outcomes, is recommended.

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