Addressing co-occurring chronic pain and obesity simultaneously in a behavioral intervention: a pilot trial

Chronic musculoskeletal pain and overweight/obesity are comorbid conditions that negatively impact each other, yet interventions targeting this comorbidity are limited. This study evaluated the feasibility and acceptability of an integrated weight and pain management intervention that uniquely targets environmental reward processes and positive affect.

Participants (45-80 years) with comorbid overweight/obesity (BMI ≥ 25 kg/m²) and moderate-to-high impact musculoskeletal pain participated in a single-arm trial of a remotely delivered intervention integrating behavioral weight loss treatment and cognitive-behavioral pain coping therapy addressing mechanisms of environmental reward and positive affect. Assessments of weight, pain (via PROMIS pain intensity, interference, and physical function scales; Short Physical Performance Battery), and process variables were completed at baseline, 4 months (end of core intervention phase), and 8 months (end of elective intervention phase). Recruitment and retention metrics and patient satisfaction ratings were measured.

Thirty-three patients enrolled in the trial. Of these, 76% (n = 25) completed the core intervention and 79% (n = 26) completed the 4-month assessment. Results indicated high credibility (7.8/10) and session engagement (6.7/8), and global treatment satisfaction (3.6/4) was high. At 4 months, pain impact decreased by 4.0 points from pre- to post-intervention and mean weight loss was 2.4% of baseline body weight, with n = 4 participants (15.4%) achieving ≥ 5% weight loss. Of the 19 participants who completed the elective phase, pain impact decreased from baseline by 6.6 points and mean weight loss percent from baseline was 3.0%.

Overall, this pilot study demonstrated that a remotely delivered weight loss plus pain reduction intervention is feasible and was well accepted by participants with overweight/obesity and comorbid pain. The intervention produced reductions in pain and weight, supporting further testing in a fully powered clinical trial.

This trial is registered in ClinicalTrials.gov (NCT04851587).