• Diana M Higgins, Eugenia Buta, Alicia A Heapy, Mary A Driscoll, Robert D Kerns, Robin Masheb, William C Becker, HausmannLeslie R MLRMCenter for Health Equity Research and Promotion (CHERP), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.University of Pittsburgh, Pittsburgh, Pennsylvania., Matthew J Bair, Laura Wandner, E Amy Janke, Cynthia A Brandt, and Joseph L Goulet.
• Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts.
• Pain Med. 2020 Oct 1; 21 (10): 2563-2572.

ObjectiveTo examine the relationship between body mass index (BMI) and pain intensity among veterans with musculoskeletal disorder diagnoses (MSDs; nontraumatic joint disorder; osteoarthritis; low back, back, and neck pain).SettingAdministrative and electronic health record data from the Veterans Health Administration (VHA).SubjectsA national cohort of US military veterans with MSDs in VHA care during 2001-2012 (N = 1,759,338).MethodsThese cross-sectional data were analyzed using hurdle negative binomial models of pain intensity as a function of BMI, adjusted for comorbidities and demographics.ResultsThe sample had a mean age of 59.4, 95% were male, 77% were white/Non-Hispanic, 79% were overweight or obese, and 42% reported no pain at index MSD diagnosis. Overall, there was a J-shaped relationship between BMI and pain (nadir = 27 kg/m2), with the severely obese (BMI ≥ 40 kg/m2) being most likely to report any pain (OR vs normal weight = 1.23, 95% confidence interval = 1.21-1.26). The association between BMI and pain varied by MSD, with a stronger relationship in the osteoarthritis group and a less pronounced relationship in the back and low back pain groups.ConclusionsThere was a high prevalence of overweight/obesity among veterans with MSD. High levels of BMI (>27 kg/m2) were associated with increased odds of pain, most markedly among veterans with osteoarthritis.© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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