Reduction in Pain and Pain Intensity with Nonpharmacological Treatment in Severely Obese Patients: A Randomized Clinical Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Ethical Aspects
2.2. Participants and Inclusion and Exclusion Criteria
2.3. Randomization
2.4. Interventions and Follow-Up
2.5. Blinding
2.6. Research Team and Quality Control
2.7. Demographic and Lifestyle Variables
2.8. Anthropometric Variables
2.9. Clinical Variables
2.10. Musculoskeletal Pain
2.11. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Afshin, A.; Forouzanfar, M.H.; Reitsma, M.B.; Sur, P.; Estep, K.; Lee, A.; Marczak, L.; Mokdad, A.H.; Moradi-Lakeh, M.; Naghavi, M.; et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N. Engl. J. Med. 2017, 377, 13–27. [Google Scholar]
- Vincent, H.K.; Adams, M.C.; Vincent, K.R.; Hurley, R.W. Musculoskeletal pain, fear avoidance behaviors, and functional decline in obesity: Potential interventions to manage pain and maintain function. Reg. Anesth. Pain Med. 2013, 38, 481–491. [Google Scholar] [CrossRef]
- Calenzani, G.; Santos, F.F.D.; Wittmer, V.L.; Freitas, G.K.F.; Paro, F.M. Prevalence of musculoskeletal symptoms in obese patients candidates for bariatric surgery and its impact on health related quality of life. Arch. Endocrinol. Metab. 2017, 61, 319–325. [Google Scholar] [CrossRef] [Green Version]
- MacLellan, G.A.; Dunlevy, C.; O’Malley, E.; Blake, C.; Breen, C.; Gaynor, K.; Wallace, N.; Yoder, R.; Casey, D.; Mehegan, J. Musculoskeletal pain profile of obese individuals attending a multidisciplinary weight management service. Pain 2017, 158, 1342–1353. [Google Scholar] [CrossRef]
- Magnusson, K.; Østerås, N.; Mowinckel, P.; Natvig, B.; Hagen, K. No strong temporal relationship between obesity and multisite pain–results from a population-based 20-year follow-up study. Eur. J. Pain 2014, 18, 120–127. [Google Scholar] [CrossRef]
- Mundal, I.; Bjørngaard, J.H.; Nilsen, T.I.; Nicholl, B.I.; Gråwe, R.W.; Fors, E.A. Long-term changes in musculoskeletal pain sites in the general population: The HUNT study. J. Pain 2016, 17, 1246–1256. [Google Scholar] [CrossRef] [Green Version]
- Perrot, S.; Cohen, M.; Barke, A.; Korwisi, B.; Rief, W.; Treede, R.-D. The ITftCoCP: The IASP classification of chronic pain for ICD-11: Chronic secondary musculoskeletal pain. Pain 2019, 160, 77–82. [Google Scholar] [CrossRef]
- Coggon, D.; Ntani, G.; Palmer, K.T.; Felli, V.E.; Harari, R.; Barrero, L.H.; Felknor, S.A.; Gimeno, D.; Cattrell, A.; Vargas-Prada, S.; et al. Patterns of multisite pain and associations with risk factors. Pain 2013, 154, 1769–1777. [Google Scholar] [CrossRef] [Green Version]
- Rondanelli, M.; Faliva, M.A.; Miccono, A.; Naso, M.; Nichetti, M.; Riva, A.; Guerriero, F.; De Gregori, M.; Peroni, G.; Perna, S. Food pyramid for subjects with chronic pain: Foods and dietary constituents as anti-inflammatory and antioxidant agents. Nutr. Res. Rev. 2018, 31, 131–151. [Google Scholar] [CrossRef]
- Mendonça, C.R.; Noll, M.; Castro, M.C.R.; Silveira, E.A. Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review. Nutrients 2020, 12, 3075. [Google Scholar] [CrossRef]
- Elma, Ö.; Yilmaz, S.T.; Deliens, T.; Coppieters, I.; Clarys, P.; Nijs, J.; Malfliet, A. Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review. J. Clin. Med. 2020, 5, 702. [Google Scholar] [CrossRef] [Green Version]
- Carrijo, A.P.; Botelho, R.B.A.; Akutsu, R.; Zandonadi, R.P. Is What Low-Income Brazilians Are Eating in Popular Restaurants Contributing to Promote Their Health? Nutrients 2018, 27, 414. [Google Scholar] [CrossRef] [Green Version]
- Tedeschi, S.K.; Frits, M.; Cui, J.; Zhang, Z.Z.; Mahmoud, T.; Iannaccone, C.; Lin, T.C.; Yoshida, K.; Weinblatt, M.E.; Shadick, N.A.; et al. Diet and Rheumatoid Arthritis Symptoms: Survey Results From a Rheumatoid Arthritis Registry. Arthritis Care Res. 2017, 69, 1920–1925. [Google Scholar] [CrossRef] [Green Version]
- Dyer, J.; Davison, G.; Marcora, S.M.; Mauger, A.R. Effect of a Mediterranean Type Diet on Inflammatory and Cartilage Degradation Biomarkers in Patients with Osteoarthritis. J. Nutr. Health Aging 2017, 21, 562–566. [Google Scholar] [CrossRef] [Green Version]
- Kaartinen, K.; Lammi, K.; Hypen, M.; Nenonen, M.; Hänninen, O.; Rauma, A.-L. Vegan diet alleviates fibromyalgia symptoms. Scand. J. Rheumatol. 2000, 29, 308–313. [Google Scholar] [CrossRef]
- Slim, M.; Calandre, E.P.; Garcia-Leiva, J.M.; Rico-Villademoros, F.; Molina-Barea, R.; Rodriguez-Lopez, C.M.; Morillas-Arques, P. The Effects of a gluten-free diet versus a hypocaloric diet among patients with fibromyalgia experiencing gluten sensitivity–like symptoms. J. Clin. Gastroenterol. 2017, 51, 500–507. [Google Scholar] [CrossRef]
- Cardeno, A.; Sanchez-Hidalgo, M.; Alarcon-de-la-Lastra, C. An up-date of olive oil phenols in inflammation and cancer: Molecular mechanisms and clinical implications. Curr. Med. Chem. 2013, 20, 4758–4776. [Google Scholar] [CrossRef]
- Bitler, C.M.; Matt, K.; Irving, M.; Hook, G.; Yusen, J.; Eagar, F.; Kirschner, K.; Walker, B.; Crea, R. Olive extract supplement decreases pain and improves daily activities in adults with osteoarthritis and decreases plasma homocysteine in those with rheumatoid arthritis. Nutr. Res. 2007, 27, 470–477. [Google Scholar] [CrossRef]
- Gelmini, F.; Ruscica, M.; Macchi, C.; Bianchi, V.; Maffei Facino, R.; Beretta, G.; Magni, P. Unsaponifiable Fraction of Unripe Fruits of Olea europaea: An Interesting Source of Anti-inflammatory Constituents. Planta Med. 2016, 82, 273–278. [Google Scholar] [CrossRef] [Green Version]
- Nakhostin-Roohi, B.; Khoshkhahesh, F.; Bohlooli, S. Effect of virgin olive oil versus piroxicam phonophoresis on exercise-induced anterior knee pain. Avicenna J. Phytomed. 2016, 6, 535. [Google Scholar]
- Veronese, N.; Koyanagi, A.; Stubbs, B.; Cooper, C.; Guglielmi, G.; Rizzoli, R.; Punzi, L.; Rogoli, D.; Caruso, M.G.; Rotolo, O. Mediterranean diet and knee osteoarthritis outcomes: A longitudinal cohort study. Clin. Nutr. 2019, 38, 2735–2739. [Google Scholar] [CrossRef]
- Cardoso, C.K.S.; Santos, A.; Rosa, L.P.S.; Mendonça, C.R.; Vitorino, P.V.O.; Peixoto, M.; Silveira, E.A. Effect of Extra Virgin Olive Oil and Traditional Brazilian Diet on the Bone Health Parameters of Severely Obese Adults: A Randomized Controlled Trial. Nutrients 2020, 12, 403. [Google Scholar] [CrossRef] [Green Version]
- Rodrigues, A.; Rosa, L.P.S.; da Silva, H.D.; Silveira-Lacerda, E.P.; Silveira, E.A. The Single Nucleotide Polymorphism PPARG2 Pro12Ala Affects Body Mass Index, Fat Mass, and Blood Pressure in Severely Obese Patients. J. Obes. 2018, 2018, 2743081. [Google Scholar] [CrossRef]
- Rodrigues, A.P.S.; Rosa, L.P.S.; Silveira, E.A. PPARG2 Pro12Ala polymorphism influences body composition changes in severely obese patients consuming extra virgin olive oil: A randomized clinical trial. Nutr. Metab. 2018, 15, 52. [Google Scholar] [CrossRef]
- Santos, A.; Rodrigues, A.; Rosa, L.P.S.; Noll, M.; Silveira, E.A. Traditional Brazilian Diet and Olive Oil Reduce Cardiometabolic Risk Factors in Severely Obese Individuals: A Randomized Trial. Nutrients 2020, 14, 1413. [Google Scholar] [CrossRef] [PubMed]
- Santos, A.S.; Rodrigues, A.P.S.; Rosa, L.P.; Sarrafzadegan, N.; Silveira, E.A. Cardiometabolic risk factors and Framingham Risk Score in severely obese patients: Baseline data from DieTBra trial. Nutr. Metab. Cardiovasc. Dis. 2020, 30, 474–482. [Google Scholar] [CrossRef]
- Wadden, T.A.; Webb, V.L.; Moran, C.H.; Bailer, B.A. Lifestyle modification for obesity: New developments in diet, physical activity, and behavior therapy. Circulation 2012, 125, 1157–1170. [Google Scholar] [CrossRef] [Green Version]
- Monteiro, C.A.; Cannon, G. The impact of transnational “big food” companies on the South: A view from Brazil. PLoS Med. 2012, 9, e1001252. [Google Scholar] [CrossRef] [Green Version]
- De Atenção Básica, D.; de Atenção à Saúde, S.; da Saúde, B.M. Guia Alimentar para a População Brasileira/Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica, 2nd ed.; Ministério da Saúde: Brasília, Brazil, 2014. [Google Scholar]
- Hall, K.D. What is the required energy deficit per unit weight loss? Int. J. Obes. 2008, 32, 573–576. [Google Scholar] [CrossRef] [Green Version]
- Horie, L.M.; Gonzalez, M.C.; Torrinhas, R.S.; Cecconello, I.; Waitzberg, D.L. New specific equation to estimate resting energy expenditure in severely obese patients. Obesity 2011, 19, 1090–1094. [Google Scholar] [CrossRef]
- Hill, J.O.; Wyatt, H.R.; Peters, J.C. Energy balance and obesity. Circulation 2012, 126, 126–132. [Google Scholar] [CrossRef] [PubMed]
- Trumbo, P.; Schlicker, S.; Yates, A.A.; Poos, M. Dietary reference intakes for energy, carbohdrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J. Acad. Nutr. Diet. 2002, 102, 1621. [Google Scholar]
- Satija, A.; Yu, E.; Willett, W.C.; Hu, F.B. Understanding nutritional epidemiology and its role in policy. Adv. Nutr. 2015, 6, 5–18. [Google Scholar] [CrossRef] [Green Version]
- Schulze, M.B.; Martínez-González, M.A.; Fung, T.T.; Lichtenstein, A.H.; Forouhi, N.G. Food based dietary patterns and chronic disease prevention. BMJ 2018, 361, k2396. [Google Scholar] [CrossRef] [Green Version]
- McCormack, V.A.; Agudo, A.; Dahm, C.C.; Overvad, K.; Olsen, A.; Tjonnelan, A.; Kaaks, R.; Boeing, H.; Manjer, J.; Almquist, M.; et al. Cigar and pipe smoking and cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Int. J. Cancer 2010, 127, 2402–2411. [Google Scholar] [CrossRef]
- Bloomfield, K.; Gmel, G.; Wilsnack, S. Introduction to special issue ‘Gender, Culture and Alcohol Problems: A Multi-national Study’. Alcohol. Suppl. 2006, 41, i3–i7. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kanny, D.; Naimi, T.S.; Liu, Y.; Lu, H.; Brewer, R.D. Annual total binge drinks consumed by US adults, 2015. Am. J. Prev. Med. 2018, 54, 486–496. [Google Scholar] [CrossRef] [PubMed]
- Lohman, T.G.; Roche, A.F.; Martorell, R. Anthropometric Standardization Reference Manual; Human Kinetics Books: Champaign, IL, USA, 1988; Volume 177. [Google Scholar]
- World Health Organization. Obesity: Preventing and Managing the Global Epidemic; World Health Organization: Geneva, Switzerland, 2000. [Google Scholar]
- Zigmond, A.; Snaith, R. The hospital anxiety and depression scale Acta Psychiatr. Scand. 1983, 67, 361–370. [Google Scholar]
- World Health Organization. WHO Collaborating Centre for Drug Statistics Methodology; ATC/DDD Index; WHO: Geneva, Switzerland, 2018. [Google Scholar]
- Holick, M.F.; Binkley, N.C.; Bischoff-Ferrari, H.A.; Gordon, C.M.; Hanley, D.A.; Heaney, R.P.; Murad, M.H.; Weaver, C.M. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 2011, 96, 1911–1930. [Google Scholar] [CrossRef] [Green Version]
- Thompson, F.; Subar, A. Dietary Assessment Methodology. In Nutrition in the Prevention and Treatment of Disease; National Cancer Institute: Bethesda, MD, USA, 2008. [Google Scholar]
- De Barros, E.N.; Alexandre, N.M. Cross-cultural adaptation of the Nordic musculoskeletal questionnaire. Int. Nurs. Rev. 2003, 50, 101–108. [Google Scholar] [CrossRef]
- Mendonça, C.R.; Noll, M.; Silveira, E.A. Adaptation and validation of body maps for musculoskeletal pain location in patients with severe obesity. Korean J. Pain 2018, 31, 268. [Google Scholar] [CrossRef] [PubMed]
- Kuorinka, I.; Jonsson, B.; Kilbom, A.; Vinterberg, H.; Biering-Sørensen, F.; Andersson, G.; Jørgensen, K. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl. Ergon. 1987, 18, 233–237. [Google Scholar] [CrossRef]
- Boonstra, A.M.; Stewart, R.E.; Koke, A.J.; Oosterwijk, R.F.; Swaan, J.L.; Schreurs, K.M.; Schiphorst Preuper, H.R. Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing. Front. Psychol. 2016, 7, 1466. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- McKellar, G.; Morrison, E.; McEntegart, A.; Hampson, R.; Tierney, A.; Mackle, G.; Scoular, J.; Scott, J.A.; Capell, H.A. A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow. Ann. Rheum. Dis. 2007, 66, 1239–1243. [Google Scholar] [CrossRef] [Green Version]
- Takeda, R.; Koike, T.; Taniguchi, I.; Tanaka, K. Double-blind placebo-controlled trial of hydroxytyrosol of Olea europaea on pain in gonarthrosis. Phytomedicine 2013, 20, 861–864. [Google Scholar] [CrossRef]
- Schell, J.; Scofield, R.H.; Barrett, J.R.; Kurien, B.T.; Betts, N.; Lyons, T.J.; Zhao, Y.D.; Basu, A. Strawberries improve pain and inflammation in obese adults with radiographic evidence of knee osteoarthritis. Nutrients 2017, 9, 949. [Google Scholar] [CrossRef] [PubMed]
- Nascimento, S.; Barbosa, F.S.; Sichieri, R.; Pereira, R.A. Dietary availability patterns of the brazilian macro-regions. Nutr. J. 2011, 28, 79. [Google Scholar] [CrossRef] [Green Version]
Total n = 149 n (%) | EVOO n = 50 n (%) | DieTBra n = 49 n (%) | EVOO + DieTBra n = 50 n (%) | p * | |
---|---|---|---|---|---|
Sex | |||||
Female | 127(85.2) | 45(35.4) | 40(31.5) | 42(33.1) | 0.480 |
Male | 22(14.8) | 5(22.7) | 9(40.9) | 8(36.4) | |
Age | |||||
<40 | 83(55.7) | 32(38.6) | 26(31.3) | 25(30.1) | 0.334 |
≥40 | 66(44.3) | 18(27.3) | 23(34.9) | 25(37.9) | |
Smoking | |||||
No | 100(67.1) | 32(32.0) | 36(36.0) | 32(32.0) | 0.513 |
Former smoker and smoker | 49(32.9) | 18(36.7) | 13(26.5) | 18(36.7) | |
Binge drinking | |||||
No | 106(71.1) | 35(33.0) | 36(34.0) | 35(33.0) | 0.908 |
Yes | 43(28.9) | 15(34.9) | 13(30.2) | 15(34.9) | |
MVPA (min/day) | |||||
<Median (8.39) | 71(50.7) | 21(29.6) | 21(29.6) | 29(40.9) | 0.180 |
≥Median (8.39) | 69(49.3) | 26(37.7) | 25(36.2) | 18(26.1) | |
Degree of obesity (kg/m2) | |||||
35–39.9 | 25(16.8) | 9(36.0) | 8(32.0) | 8(32.0) | 0.666 |
40–49.9 | 84(56.4) | 25(29.8) | 27(32.1) | 32(38.1) | |
≥50 | 40(26.9) | 16(40.0) | 14(35.0) | 10(25.0) | |
Use of analgesics | |||||
No | 84(56.4) | 24(28.6) | 30(35.7) | 30(35.7) | 0.339 |
Yes | 65(43.6) | 26(40.0) | 19(29.2) | 20(30.8) | |
Use of anti-inflammatories | |||||
No | 115(77.2) | 38(33.0) | 39(33.9) | 38(33.0) | 0.887 |
Yes | 34(22.8) | 12(35.3) | 10(29.4) | 12(35.3) | |
Use of muscle relaxant | |||||
No | 67(45.0) | 18(26.9) | 26(38.8) | 23(34.3) | 0.230 |
Yes | 82(55.0) | 32(39.0) | 23(28.0) | 27(32.9) | |
Arthritis/arthrosis | |||||
No | 118(79.2) | 36(30.5) | 40(33.9) | 42(35.6) | 0.294 |
Yes | 31(20.8) | 14(45.2) | 9(29.0) | 8(25.8) | |
Depression | |||||
No | 54(36.2) | 15(27.8) | 19(35.2) | 20(37.0) | 0.526 |
Yes | 95(63.8) | 35(36.8) | 30(31.6) | 30(31.6) | |
Anxiety | |||||
No | 41(27.5) | 12(29.3) | 19(46.3) | 10(24.4) | 0.089 |
Yes | 108(72.5) | 38(35.2) | 30(27.8) | 40(37.0) | |
C-reactive protein (mg/dL) | |||||
Nonreactive | 108(72.5) | 34(31.5) | 37(34.3) | 37(34.3) | 0.675 |
Reagent | 41(27.5) | 16(39.0) | 12(29.3) | 13(31.7) | |
Vitamin D (ng/mL) | |||||
Deficiency | 29(19.5) | 12(41.4) | 16(31.4) | 22(31.9) | 0.206 |
Insufficiency | 51(34.2) | 12(41.4) | 13(25.5) | 24(34.8) | |
Sufficiency | 69(46.3) | 5(17.2) | 22(43.1) | 23(33.3) | |
Consumption of fruit (daily) | |||||
No | 109(73.1) | 38(34.9) | 37(33.9) | 34(31.2) | 0.600 |
Yes | 40(26.9) | 12(30.0) | 12(30.0) | 16(40.0) | |
Vegetable consumption (daily) | |||||
No | 108(72.5) | 38(35.2) | 34(31.5) | 36(33.3) | 0.759 |
Yes | 41(27.5) | 12(29.3) | 15(36.6) | 14(34.1) | |
Pain | |||||
No | 16(10.7) | 5(31.3) | 5(31.3) | 6(37.50) | 0.939 |
Yes | 133(89.3) | 45(33.8) | 44(33.1) | 44(33.1) | |
Severe pain | |||||
No | 46(30.9) | 17(37.0) | 18(39.1) | 11(23.9) | 0.239 |
Yes | 103(69.1) | 33(32.0) | 31(30.1) | 39(37.9) | |
Multisite pain | |||||
0 | 16(10.7) | 5(31.3) | 5(31.3) | 6(37.5) | 0.946 |
1–3 | 53(35.6) | 20(37.7) | 15(28.3) | 18(34.0) | |
4–5 | 40(26.9) | 13(32.5) | 13(32.5) | 14(35.0) | |
6–9 | 40(26.9) | 12(30.0) | 16(40.0) | 12(30.0) | |
Pain by body regions | |||||
Wrists and hands | |||||
No | 83(55.7) | 28(33.7) | 25(30.1) | 30(36.1) | 0.667 |
Yes | 66(44.3) | 22(33.3) | 24(36.4) | 20(30.3) | |
Upper back | |||||
No | 71(47.7) | 28(39.4) | 21(29.6) | 22(31.0) | 0.347 |
Yes | 78(52.4) | 22(28.2) | 28(35.9) | 28(35.9) | |
Lower back | |||||
No | 56(37.6) | 22(39.3) | 14(25.0) | 20(35.7) | 0.259 |
Yes | 93(62.4) | 28(30.1) | 35(37.6) | 30(32.3) | |
Hip | |||||
No | 97(65.1) | 34(35.1) | 33(34.0) | 30(30.9) | 0.648 |
Yes | 52(34.9) | 16(30.8) | 16(30.8) | 20(38.5) | |
Knees | |||||
No | 70(47.0) | 25(35.7) | 24(34.3) | 21(30.0) | 0.684 |
Yes | 79(53.0) | 25(31.7) | 25(31.7) | 29(36.7) | |
Ankles and feet | |||||
No | 46(30.87) | 15(32.6) | 16(34.8) | 15(32.6) | 0.947 |
Yes | 103(69.1) | 35(34.0) | 33(32.0) | 35(34.0) |
EVOO | DieTBra | EVOO + DieTBra | |||||||
---|---|---|---|---|---|---|---|---|---|
Baseline (n = 50) n (%) | Final Follow-Up (n = 43) n (%) | p * | Baseline (n = 49) n (%) | Final Follow-Up (n = 43) n (%) | p * | Baseline (n = 50) n (%) | Final Follow-Up (n = 47) n (%) | p * | |
Pain (yes%) | 45 (90.0) | 37 (86.0) | 0.480 | 44 (89.8) | 40 (93.0) | 0.157 | 44 (88.0) | 40 (85.1) | 0.655 |
Pain intensity—Severe pain (yes%) | 33 (66.0) | 25 (58.1) | 0.405 | 31 (63.3) | 23 (53.5) | 0.197 | 39 (78.0) | 26 (55.3) | 0.002 |
Pain by body site (%) | |||||||||
Wrists and hands | 22 (44.0) | 19 (44.2) | 0.527 | 24 (49.0) | 15 (34.9) | 0.058 | 20 (40.0) | 13 (27.7) | 0.109 |
Upper back | 22 (44.0) | 15 (34.9) | 0.134 | 28 (57.1) | 13 (30.2) | 0.001 | 28 (56.0) | 19 (40.4) | 0.180 |
Lower back | 28 (56.0) | 23 (53.5) | 0.564 | 35 (71.4) | 29 (67.4) | 0.527 | 30 (60.0) | 24 (51.1) | 0.366 |
Hip | 16 (32.0) | 9 (20.9) | 0.132 | 16 (32.5) | 11 (25.6) | 0.317 | 20 (40.0) | 15 (31.9) | 0.368 |
Knees | 25 (50.0) | 19 (44.2) | 0.285 | 25 (51.0) | 14 (32.6) | 0.046 | 29 (58.0) | 22 (46.8) | 0.166 |
Ankles and feet | 35 (70.0) | 28 (65.1) | 0.564 | 33 (37.3) | 58 (65.1) | 0.317 | 35 (70.0) | 29 (61.7) | 0.248 |
Difference | EVOO | DieTBra | EVOO + DieTBra | EVOO × DieTBra * | EVOO × EVOO + DieTBra * | DieTBra × EVOO + DieTBra * |
---|---|---|---|---|---|---|
p | p | p | ||||
Δ Pain (yes%) | −4 | +3.2 | −2.9 | 1.000 | 0.405 | 0.705 |
Δ Pain intensity—Severe pain (yes%) | −7.9 | −9.8 | −22.7 | 0.131 | 0.007 | 0.003 |
Δ Pain by body site (yes%) | ||||||
Wrists and hands | +0.2 | −14.1 | −12.3 | 0.074 | 0.102 | 0.014 |
Upper back | −9.1 | −26.9 | −15.6 | 0.001 | 0.045 | 0.002 |
Lower back | −2.5 | −4 | −8.9 | 0.394 | 0.297 | 0.275 |
Hip | −11.1 | −6.9 | −8.1 | 0.074 | 0.088 | 0.179 |
Knees | −5.8 | −18.4 | −11.2 | 0.028 | 0.083 | 0.016 |
Ankles and feet | −4.9 | +27.8 | −8.3 | 0.275 | 0.221 | 0.126 |
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Mendonça, C.R.; Noll, M.; Cardoso, C.K.d.S.; Santos, A.S.A.d.C.; Rodrigues, A.P.d.S.; Silveira, E.A. Reduction in Pain and Pain Intensity with Nonpharmacological Treatment in Severely Obese Patients: A Randomized Clinical Trial. Int. J. Environ. Res. Public Health 2021, 18, 11112. https://doi.org/10.3390/ijerph182111112
Mendonça CR, Noll M, Cardoso CKdS, Santos ASAdC, Rodrigues APdS, Silveira EA. Reduction in Pain and Pain Intensity with Nonpharmacological Treatment in Severely Obese Patients: A Randomized Clinical Trial. International Journal of Environmental Research and Public Health. 2021; 18(21):11112. https://doi.org/10.3390/ijerph182111112
Chicago/Turabian StyleMendonça, Carolina Rodrigues, Matias Noll, Camila Kellen de Souza Cardoso, Annelisa Silva Alves de Carvalho Santos, Ana Paula dos Santos Rodrigues, and Erika Aparecida Silveira. 2021. "Reduction in Pain and Pain Intensity with Nonpharmacological Treatment in Severely Obese Patients: A Randomized Clinical Trial" International Journal of Environmental Research and Public Health 18, no. 21: 11112. https://doi.org/10.3390/ijerph182111112
APA StyleMendonça, C. R., Noll, M., Cardoso, C. K. d. S., Santos, A. S. A. d. C., Rodrigues, A. P. d. S., & Silveira, E. A. (2021). Reduction in Pain and Pain Intensity with Nonpharmacological Treatment in Severely Obese Patients: A Randomized Clinical Trial. International Journal of Environmental Research and Public Health, 18(21), 11112. https://doi.org/10.3390/ijerph182111112