Family physician Dr James Lee Kok Yew tells us more about the complications of being trapped in an obesity-pain cycle and how patients can seek relief from long-standing or recent pain

There is a close relationship between obesity and pain. A study of over 1 million people in the US found that overweight individuals (BMI of 25-29.9 kg/m2) had 20% higher rates of recurring pain while those suffering from obesity (BMI above 30kg/m2) can have up to a whopping 254% increase in pain!

Obesity is on the rise in Singapore, with one in 10 adults aged 18 to 74 years old considered obese in 2020, compared with only 8.6% in 2017. Many elderly Singaporeans suffer from osteoarthritis in the knee due to excess body weight and have a 27% increased risk of requiring total knee replacement due to severe osteoarthritis.

We speak to general physician (GP), Dr James Lee from  DR+ Medical Paincare Clinic (Kovan), to find out more about the obesity-pain cycle.

Dr James Lee from  DR+ Medical Paincare Clinic (Kovan)

Dr James Lee from  DR+ Medical Paincare Clinic (Kovan)

For Life (FL): : What is the obesity-pain cycle and how is this vicious cycle perpetuated?

Dr James (Dr J): Studies have revealed a link between excessive body weight and heightened musculoskeletal pain, especially in the lower back and limbs. Excess weight puts added mechanical stress on muscles and joints, increasing the likelihood of musculoskeletal pain, injury, and structural degradation.

A lack of exercise is also a significant factor in the onset and persistence of obesity. Despite the proven benefits of exercise in relieving chronic pain, individuals dealing with chronic pain often refrain from physical activity, which not only exacerbates their obesity but also intensifies their pain.

FL: Do you see a lot of patients with chronic pain who are also obese or overweight?

Dr J: We’re witnessing a rise in patients, some as young as their 40s, experiencing pain linked to their weight. Over 50% of my chronic pain patients fall into the overweight or obese category, often reporting joint and muscle pain. Among those aged 60 and above, excess weight commonly contributes to knee osteoarthritis.

As the number of overweight and obese individuals grows, the prevalence of chronic pain in Singapore will surge if the excess weight is not managed across all age groups.

FL: How can pain management help to break the vicious obesity-pain cycle?

Dr J: More than 80% of patient visits to GP is due to pain. GPs trained in pain management have many ways of resolving pain other than prescribing painkillers, including minimally invasive approaches such as Platelet Rich Plasma (PRP) therapy, intra-articular injections, peripheral nerve blocks, and muscle relaxants. Surgery is usually considered a last resort for patients for whom the other methods are not viable or have not been successful to manage pain.

By addressing the root cause of pain, patients are able to experience improvements in mobility and reduced pain levels. This allows them to engage in more physical activities and exercise, leading to further reduction of inflammation, weight loss, and decreased mechanical stress on the joints. When mobility increases and pain diminishes, patients can break the cycle of obesity-related pain.

FL: Exercising may seem counterintuitive for those suffering from chronic pain. Why is exercise important and how does it help to alleviate or manage chronic pain? 

Dr J: Regular exercise is key for treating chronic pain across various conditions, and is an integral part of patient rehabilitation. Exercise not only diminishes pain perception but also improves mood and alleviates stress and depression commonly linked with chronic pain conditions. Additionally, it prompts the body to generate its own pain relief, beneficial for various conditions such as low back pain, osteoarthritis, myofascial pain, chronic fatigue syndrome, and fibromyalgia.

Physical activity decreases chronic pain by enhancing muscle strength and flexibility, thus preventing muscular atrophy. Moreover, exercise contributes to reducing inflammation, a factor in chronic pain, by activating the muscles to release chemicals that block pain signals and stimulating the immune system to aid in tissue healing.

FL: What sorts of exercises would you recommend for people suffering from chronic pain?

Dr J: The Singapore Physical Activity Guidelines (SPAG) advises adults to aim for 150 to 300 minutes of moderate-intensity aerobic physical activity each week. This can be spread out over the week in any duration to reap significant health benefits. It also recommends that adults incorporate exercises for building muscle strength and light-intensity activities to break up long periods of sitting.

Studies indicate that aerobic, resistance, or combined exercise programs can reduce joint pain in both young and older obese adults by 14% to 71.4%. For those who feel limited by chronic pain, consider adding daily walks to your routine with friends and family. Swimming and water aerobics offer low-impact options to strengthen joints and muscles. Additionally, stretching exercises such as yoga, Pilates, or using resistance bands can help build muscle strength.

FL: What are some common myths of pain management?

Dr J: Many patients mistakenly believe that their pain is incurable and that they are doomed to live with it forever. This misconception may arise from seeking help from multiple healthcare professionals, trying various treatments they have prescribed but seeing no improvement over time.

Some patients also think surgery is their only option for pain relief. However, surgery should be offered only as a last resort, especially for older patients with comorbidities such as diabetes, which can complicate recovery. Many are unaware that GPs trained in pain management can offer minimally invasive treatments as effective alternatives to surgery.

Additionally, patients mistakenly assume that exercise will worsen their pain. In reality, exercise can actually help alleviate pain and is often a crucial part of treating chronic pain and preventing chronic pain from recurring.

FL: How effective are pain management treatments and how soon can patients see results?

Dr J: Not all pain is the same. Each patient and type of pain is unique and must be treated accordingly. GPs specialising in pain management may employ several minimally invasive methods to treat pain, such as Platelet Rich Plasma (PRP) therapy, intra-articular injections, peripheral nerve blocks and muscle relaxants as well as medication such as anticonvulsants, antidepressants, and non-steroidal anti-inflammatory drugs (NSAIDS) when required.

When patients complete their treatment procedures, we usually schedule a follow-up visit to monitor their progress. To date, I am happy to share many of my patients have experienced 60% to 70% reduction in their pain levels following our recommended treatments. This is a great improvement considering that most of them experience chronic pain that affects their day-to-day activities.

Featured photo by Dreamstime.
Dr James Lee photo courtesy of Dr James lee.