Synapsica Healthcare raises $ 4.2 million for global expansion

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Synapsica Healthcare creates India’s first integrated platform using AI to automate clinical and back office tasks in radiology

New Delhi-based startup Synapsica Healthcare recently announced $ 4.2 million in Series A funding backed by VC funds IvyCap Ventures and Endiya Partners. The Silicon Valley-based incubator Y Combinator and other angel investors also took part in the financing round.

Synapsica aims to improve the quality of radiology reports while making it easier for clinicians to create them. The new capital would be used to grow overseas and further expand the AI ​​capabilities that radiologists and spine specialists can use to generate patient reports quickly or even in real-time at the table.

Synapsica’s platform – Radiolens – enables radiologists and clinicians to compile reports with illustrations and objective evidence of disease, creating transparency and therefore better patient care for the community. Radiolens hosts several artificial intelligence-based algorithms that help radiologists describe the exact location and extent of spinal pathologies.

Given the increasing incidence of chronic back and neck pain among the elderly and working professionals, the reports generated on the Synapsica platform help both patients and clinicians understand the patient’s condition and create a tailored treatment plan.

“We are obsessed with the experience of the radiologists on our platform and we focus our research and technical development on creating the best possible environment for clinical diagnosis. This means that all day-to-day tasks – key clicks, measurements, repetitive diagnoses – are eliminated and time is given back to focus on the patient, ”says Meenakshi, CEO of Synapsica Healthcare.

Vikram Gupta, Founder and Managing Partner of IvyCap Ventures Advisors, said, “There is an ongoing need to make high quality diagnostic assessments available to everyone. Synapsica helps with its AI tools in the rapid creation of patient reports. Our investment in the company should support them in their expansion and growth. “

5 Myths and Truths About Minimally Invasive Spine Surgery | news

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WEST ORANGE, NJ, June 23, 2021 / PRNewswire-PRWeb / – If you have chronic back or neck pain that has not responded to conservative measures, you may be wondering whether surgery is an option. But there are many myths about minimally invasive spinal surgery (MISS) that might otherwise deter you from this popular and beneficial surgical option, so Kaixuan Liu, MD, PhD, Founder and President of the Atlantic Spine Center.

In minimally invasive surgery, small tools called retractors are used to access the spine with incisions of just an inch or less. These are placed in the tiny incisions to gently push away soft tissue and remove bone or disc material that encounters spinal nerves. In contrast to so-called open surgery, which requires large incisions, a minimally invasive approach does not move, remove, or change large muscles, normal bone structures, or nerve bundles.

“Even if medication, physical therapy, or other non-surgical treatments are not enough to relieve long-standing back or neck pain, it can still be intimidating to consider a surgical solution,” said Dr. Liu who specializes in minimally invasive spine surgery. “That’s why it’s especially important to break the myths and know the truths about minimally invasive options.”

Top misperceptions

What are the most common myths about MISS? Dr. Liu sets out the top 5 and also explains the realities:

Myth # 1: Minimally invasive spine surgery is still experimental.

Truth: Far from it. MISS has been in use successfully since the 1990s, with constant technological progress only increasing its range. Highly technical, minimally invasive surgery requires special training from surgeons and operating room staff. In addition, the equipment needed for MISS procedures can be expensive, which means that some smaller hospitals cannot provide it. Ask your doctor if MISS is an option in your location.

Myth # 2: Few spinal disorders can be treated with minimally invasive surgery.

Truth: Since it began three decades ago, the use of MISS has expanded enormously for those whose back or neck pain persists for 6 to 12 months or more despite conservative treatments. It can treat conditions ranging from spinal canal stenosis (a narrowing of the spinal canal) to sciatica, herniated discs, and spondylolisthesis when a bony vertebra slips onto the underlying bone. “All of these conditions can be pinpointed with various diagnostic and imaging tests that surgeons can tell exactly where to get the best results,” says Dr. Liu.

Myth # 3: Even with minimally invasive spine surgery, a long recovery is necessary.

The truth: you will recover faster than you imagine – starting with the procedure itself, as it is usually performed on an outpatient basis. “Many people can stand up and walk straight away with minimal pain after minimally invasive spinal surgery, and most go home within hours,” says Dr. Liu. “You can usually get back to work within a week or two, and some people do all of their previous activities within 6 weeks.”

Myth # 4: If I am undergoing minimally invasive spine surgery, I will not need physiotherapy.

Truth: While MISS can rid us of many of the potential pitfalls of traditional surgery, patients still need to be willing to strive for the fullest possible recovery. This may include physical therapy to strengthen the muscles around the spine and improve flexibility, a therapy that is often introduced 2 to 6 weeks after surgery. “Whether or not physiotherapy is necessary depends on the individual circumstances of each patient,” explains Dr. Liu. “Many find that physical therapy speeds their overall recovery and makes them feel better even faster.”

Myth # 5: MISS has no advantages compared to open surgery.

Truth: While any type of surgery carries risks, minimally invasive spine surgery offers many advantages over traditional surgeries. Because the incisions are small and trauma to the surrounding tissues is minimized, with MISS you can expect less pain and blood loss and a much faster recovery. “There is also a lower risk of needing a blood transfusion and a better cosmetic outcome with a minimally invasive approach,” says Dr. Liu. “You are less likely to get infected and should recover much faster in the days and weeks after surgery than if you had a long-incision procedure.”

Atlantic Spine Center is a nationally recognized leader in endoscopic spine surgery with multiple locations in New Jersey and NYC. http://www.atlanticspinecenter.com, http://www.atlanticspinecenter.nyc

Kaixuan Liu, MD, is a certified physician from the Atlantic Spine Center. He is trained in minimally invasive spinal surgery.

Media contact

Melissa chefec, MCPR, LLC, 2039686625, mchefec@gmail.com

SOURCE Atlantic Spine Center

Can dry eyes cause a headache? Causes and Treatment

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Although dry eyes and headaches are common triggers and can occur simultaneously, there is no research to establish a causal relationship between the two. However, if a trigger is causing both dry eyes and a headache, identifying and removing them can alleviate both.

Can dry eyes cause a headache? This is a common question people with headaches and dry eyes can ask.

Several studies have shown an association between dry eyes and headache, with an association that could run either way.

Dry eyes may be more common or a headache trigger in people with headaches. Headaches can also be a risk factor for dry eyes.

This article explores the symptoms, causes, treatments, and prevention of dry eyes and headaches, the relationship between dry eyes and headaches, and the research behind that relationship.

Some symptoms of dry eyes are:

  • Pain or burning sensation in the eye
  • Pressure in the eye
  • a feeling that something is stuck in the eye
  • frequent blinking
  • tear
  • Photosensitivity
  • blurred vision
  • Eye fatigue

People with a headache may find that the headache occurs before the eyes feel dry, around the same time the eyes feel dry, or after a period of dry eyes.

Headaches generally cause headaches, but can cause other symptoms, including eye and vision-related symptoms.

For example, migraine headaches can cause sensitivity to light or unusual visual sensations. Cluster headaches can also cause a stinging feeling behind one eye.

A number of studies have found a link between migraines and dry eyes.

For example, a 2017 study of 14,329 adults found that 14.4% of people who had migraines reported a diagnosis of dry eye, compared with 8.2% who had no migraines.

Additionally, 22% of participants in the study who had migraine headaches reported dry eye symptoms, compared with 15.1% who had no history of migraine headaches.

A 2019 population study of 72,969 participants found a similar association. In this study, people who had migraine headaches were 1.42 times more likely to be diagnosed with dry eye than those who didn’t.

However, researchers have not yet found a causal relationship between migraines and dry eyes. This means that it is unclear whether migraines cause dry eyes, whether dry eyes cause migraines, or whether some other factor explains the link.

People who experience migraine episodes can have a variety of triggers. For some, eye strain or dry eyes can be a trigger.

It is also possible that the two complaints have common triggers. Neck pain and exposure to light, for example, are common triggers for migraine headaches. Prolonged use of computers or other monitors can also cause dry eyes.

Some other possible links between dry eyes and headaches are:

  • Cluster headache: Cluster headaches are severe headaches that usually affect one side of the head. Some people feel pain or a stinging sensation in or just behind the eye. You may mistake this for dry eyes or think that dry eyes are causing the pain.
  • Sjörgen’s disease: Sjörgen is an autoimmune disease, which means that the immune system attacks healthy tissue. It can cause tear production problems that lead to dry eyes. It can also cause joint pain and tension, as well as headaches.
  • Eye strain: Eye strain can cause the eyes to feel dry or tired. Some people can attribute this to dry eyes. People with eye strain can also experience headaches and other types of muscle tension, such as neck pain, especially from sitting in one position and staring at a computer for long periods of time.

Dry eyes can occur for many reasons, including:

  • taking certain medications such as antihistamines and antidepressants
  • clogged meibomian glands, which are the sebum glands in the eyelids
  • the use of certain eye drops, such as B. Glaucoma drops
  • Irritation from the environment, e.g. For example, if a person lives in a very dry climate or if their eyes are strained by staring at a computer screen
  • recent eye surgery
  • Allergies
  • the use of contact lenses
  • Exposure to irritants such as perfume and smoke
  • Nutritional deficiencies, particularly vitamin A deficiencies

Certain factors can increase your risk of dry eyes, including:

  • to be older
  • if you have a condition that causes inflammation in or around the eyes, such as: B. Blepharitis
  • be female

Although some people experience dry eyes and headaches at the same time, there is no evidence that treating one cures or relieves the other.

If a single trigger is causing both, such as a person getting a headache after sitting at a desk all day staring at a screen, removing the trigger can help with both of these conditions.

Dry eyes

Some treatment options for dry eyes include:

  • Use of immunomodulators: Some people may find relief from over-the-counter (OTC) eye drops, but others may need prescription drops (immunomodulators) like Restasis or Cequa.
  • Dealing with triggers and environmental factors: Using a humidifier while sleeping, minimizing exposure to allergens, and taking frequent breaks from screen time can help.
  • Try therapy lenses: Certain types of contact lenses can help the eyes retain more moisture.
  • Use of tear duct (punctiform) plugs: Clogging the tear ducts can help keep tears in your eyes longer.
  • Is being operated: Various surgeries can help reduce dry eyes when other treatments don’t work. For example, a surgeon can permanently seal the lacrimal glands or place an amniotic fluid graft on the cornea to help with dryness.

Warm compresses and eyelid scrubs can relieve eye irritation from some eye conditions, such as blepharitis.

If home treatments don’t work, a doctor may recommend the following options:

  • Treating underlying eye or skin problems
  • prescription treatments for dry eyes
  • Steroid treatments
  • temporary stoppers in the tear ducts to lengthen the time the tears remain in the eyes
  • surgical treatments such as tearing the tear ducts occlusion
  • thermal pulsation
  • intense pulsed light

a headache

Headaches can have many causes. Although most are benign, severe or chronic headaches can warn of a serious condition such as high blood pressure, a stroke, or a neurological disorder.

A doctor can recommend treatments to manage headaches and make sure a person does not have serious underlying medical conditions.

For the occasional headache, a person may want to try:

It may be possible to prevent headaches and dry eyes by keeping a journal of the triggers and then removing or avoiding those triggers.

For example, a person might find that dehydration and eye strain trigger both headaches and dry eyes.

To prevent headaches, a person can also try:

  • Ask a doctor about headache prevention medication if you have chronic migraines or other severe headaches
  • Exercise regularly, which can improve general headache symptoms and relieve tension headache pain
  • Take frequent breaks from stretching when working in an awkward position or in front of the computer
  • Developing strategies for coping with stress

To prevent dry eyes, a person can also try:

  • Take frequent breaks from work and blink regularly when staring at a screen
  • Use a humidifier to make the air less dry
  • ask a doctor about a fatty acid supplement
  • Drink plenty of water
  • Minimizing the time in very dry environments
  • do not allow air to blow into your eyes, e.g. B. by not sitting in front of a fan or heater

Most headaches go away on their own with or without treatment.

Migraine headaches usually last 4–72 hours. Some headaches, including migraines, can become chronic. When this happens, a person can experience many episodes each month, especially if they are unable to control or identify their triggers.

Dry eyes can come and go too, although they are made worse when a person is near dry eye triggers such as dry air.

The outlook for any complaint is better when a person can identify the underlying cause and correct it.

Dry eyes and headaches sometimes go hand in hand, and people with certain types of headaches are more likely to have dry eyes.

Even so, the researchers did not find a clear causal link between the two.

People who experience both symptoms should inform a doctor and ask about treatment options for each problem.

Girl, 8, injured in an accident on Monday

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Tuesday, June 22, 2021 6:49 PM

Injuries were reported following the three-vehicle accident at the intersection of US 30 and CR 800W on Monday. Photo by Gary Nieter, Times-Union.

An 8-year-old girl from Goshen was rushed to hospital on Monday at the intersection of West US 30 and North CR 800W, Warsaw, after an accident involving three vehicles.

According to the accident report from the Kosciusko Sheriff’s Office, Dustin A. Sloan, 37, Goshen, was traveling north on the North CR 800W and reached the median. Sloan said he did not see a vehicle driven by Mark A. Ady, 45, of Smithville, Ohio, and was traveling west on US 30 lanes.

According to the report, Ady’s vehicle was traveling west on US 30 when Sloan’s vehicle drove in Ady’s path. Then Ady’s vehicle crashed into Sloan’s.

Sloan’s vehicle continued north and crashed into a vehicle belonging to Rachelle L. Norman, 33, East High Street, Etna Green, which was stopped on the North CR 800W heading south.

All three drivers complained of pain from seat belts and airbags, but refused to call emergency services.

A female passenger in Sloan’s vehicle, Olivia Sloan, 8, Goshen, was rushed to hospital with neck pain.

The estimated damage is $ 25,000 to $ 50,000.

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Zoom Almost broke my body. How to protect your

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If you stay Working from home or returning to the office, the pandemic has shown us the importance of a safe, comfortable workplace. For many of us who were forced to do our jobs where we lived, it meant moving the available space and supplies into a makeshift ward. Dining tables became desks, sofas became seats, and computers replaced personal interactions. Ergonomic errors resulted in discomfort and a variety of common injuries.

Last year I taught 133 eighth graders about Zoom science. I started with a healthy 29-year-old who ate well, exercised three times a week, meditated, and met friends on the weekends. Although I had a history of depression, I found ways to deal with it. After nine months of distance learning, I had back and neck pain, chronic abdominal pain, high levels of anxiety, and most importantly, pain in my shoulder that woke me up at night.

When he saw orthopedic surgeon Louis Peter Re, he noticed that my left shoulder was visibly sagging. He asked about my home desk setup. I told him my laptop was uploaded with books, so every time I typed, I reached for the keyboard with my elbows extended. He gave me a lecture on Ergonomics 101, diagnosed me with tendinitis, and offered me a cortisone injection at the same site where I had been vaccinated two months earlier. Before the school year, I had researched how to look good on Zoom to be a more engaging teacher. The articles I had read recommended stacking books under my laptop until the camera was at eye level to avoid the unattractive corner of my chin. Shaking his head, Re said he wished people cared more about staying healthy than looking good on camera.

Along with the physiotherapy exercises he recommended, I adjusted my work setup and interviewed experts. As businesses and individuals increasingly adopt the remote working model, there are important adjustments you can make to alleviate and prevent various injuries.

The laptop problem

Laptops are great for their portability, but not so good when used as a permanent solution. On small computers, the screen is well below eye level, which means you are more prone to leaning forward. The keyboard is not placed on the edge of the desk, where it should ideally be. According to Re, this leads to a “closed posture that can put strain on the neck, back and shoulders”.

In my case, the screen was at eye level after putting my laptop on top of books, but I was still hunched over to type. My exposed elbows put strain on the front of my shoulders, causing painful tendinitis.

One solution is an external keyboard. “To correct this,” says Re, “I usually recommend getting a separate full-size keyboard that is either wired or via bluetooth.” The external keyboard allows you to lift your laptop without reaching up to type . You can lift your laptop by stacking books or purchasing a laptop stand. The top of your laptop (or monitor) should be slightly above eye level. This setup will help you not to bend.

Find the right chair

After using a folding chair for too long, I pulled a muscle in my back. Physiotherapist Melanie Karol said her husband also injured himself using a folding chair, which caused a tingling sensation in his leg. In our interview, Karol made it clear that it is not just about choosing the right chair, but also about using it correctly.

An ergonomic desk chair is height adjustable. Both Karol and Dr. Re emphasize the importance of keeping your chair at the correct height, with your forearms, wrists, and hands level with your desk and keyboard. Otherwise, you will put strain on your shoulders, neck, and back. The ideal ergonomic chair has an adjustable lumbar support.

Track Chairs allow visitors with reduced mobility to hike in Staunton State Park – Boulder Daily Camera

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Next to the Mason Creek Trail in Staunton State Park, there is a spot that invites hikers to pause and linger. Tall pines rise above a small clearing next to the stream in a gorge and provide shade on hot days. Narrow rays of sunlight penetrate the branches above and cover the ground with shapes of light and shadow while the stream sparkles.

It’s the kind of place Mary Salisbury would have loved to hike before a stroke cost her legs four years ago. Before that happened, she was an avid runner and hiker.

“She had had unexplained neck and back pain for about a year,” said her mother, Ann. “One day she started to lose a feeling and from then on it got worse.”

But thanks to a program in the park for visitors with reduced mobility, Salisbury was able to take a 4.7-mile hike there last week that included solitude at the Mason Creek vent. Staunton State Park’s chair program features chairs with electric motors and caterpillars instead of wheels to help them navigate rocky areas that wheelchairs cannot. There are no costs for users, with the exception of entry to the park.

Mary, 26, her mother and two volunteer guides stayed at the Mason Creek Pull-Off for more than 30 minutes, enjoying the serenity it offered.

“I could stay here all day,” said Mary.

Mary and her mother, who live in Pennsylvania, went on an extensive road trip that took them to Santa Fe, Sedona, and the Grand Canyon. When they planned their trip and researched wheelchair accessible destinations, the Staunton State Park program was high on the search lists.

“It brings tears to my eyes,” Ann said along the way, “because that’s what I was hoping for, that she would be able to come out and do some of the things she loves. We did a lot before she was injured and that enabled her to do so. And the volunteers are so wonderful. “

At the end of her hike, Mary said that her favorite part of the day was “landing near the little waterfall and relaxing in nature.” She hopes to visit again someday.

“It was really nice to get back into nature, to go near the creek,” said Mary. “I can’t usually do this in my wheelchair, so it’s nice to get into a track chair and do it.”

Staunton’s Track Chair program began in 2001 when Mark Madsen dodged a deer and rolled over his car, leaving him with quadriplegics. He had loved hiking and biking in the area that later became Staunton State Park. After the park opened in 2013, he enjoyed his trails in a track chair borrowed from Craig Hospital.

Since his death in 2015, his family and nonprofit Friends of Staunton State Park have kept his memory through the Mark Madsen Accessibility Fund, which helped purchase track chairs that cost $ 14,000 or more each. The group still hosts annual fundraising barbecues to support the program.

“I was on the Friends board back then,” said Steve Sparer, one of Mary’s volunteer guides. “We collected the money to buy the first Track Chairs. I and the president at the time thought about which paths we could go, set up the program and then handed it over to the volunteers. “

Program participants consider it part of the healing heritage of the land the park is located in and dates from the turn of the 20th century when it was inhabited by doctors Rachel and Archibald Staunton. Rachel Staunton and her daughter Frances spent the summers there, according to the Track Chair program brochure. Rachel provided medical care to the people in the area, including local Ute tribes who taught her herbal medicines. Frances gave the 1,700-acre site to the state in 1986 to make a park.

The park, which has now grown to 3,800 acres, is 6 miles west of Conifer and features dramatic granite cliffs, historic cottages, lookout points and a large waterfall.

“We live in Colorado,” said Natalie Burnside-Bostow, a park employee who leads the Track Chair program. “Part of life in Colorado is being able to exercise outdoors. It’s always been a little passion project for me to get everyone outside, regardless of their skills, age or something. We have people who haven’t been outside in 15 years or more. Or parents who have never been able to hike with their child. To be able to bring this to people is absolutely amazing. One of the things I like most about my job is seeing the excitement on people’s faces when they finally go outside. “

The program takes place from June to October on Fridays, Saturdays and Sundays with reservation. All free places for June and July have been taken. and almost all of them for August are gone. There are still a few places left for September, and most of October is available. The hikes can take anywhere from two to five hours, and distances range from 2.5 to 5 miles. Most of the trails are wide and flat, but there are some rocky sections.

Terry Pascoe from Timnath, who lost his legs 34 years ago due to spinocerebellar degeneration, has done three track chair hikes in Staunton since moving from Montrose to the Front Range in 2018.

“I love going outside and going into the garden and all that,” says Pascoe, 65. “My normal electric chair gets stuck all the time. I just love walking through the forest without any problems. “

Pascoe and his wife Laurie spent much of their time in the mountains hiking, backpacking, and fishing along streams before showing symptoms at the age of 31.

“The challenge for us, especially back then, was finding things to do together as a family,” Laurie said. “We have done everything in recent years to go into nature and share it all with our children. But since Terry has aged and I have aged and as his disease progressed, it was impossible for me to push him anymore on trails, so these track chairs are great. I can go hiking with him, he’s comfortable, we’re outside, I can enjoy the hike and don’t get hurt. It’s great that we have the opportunity to enjoy nature as always. “

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Workers suffered more physical pain as a result of working remotely

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More than a quarter of people who recently responded to a TechRadar Pro and SmartBrief survey said they experienced physical pain such as neck or back pain from working from home during the pandemic.

In the survey of 1,200 US-based professionals, 90% of respondents said they had worked from home during lockdown, with 87% rated the convenience of remote working as either “important” or “very important”. Less than 3% said that comfort is “not important” when working remotely.

As many office workers know, back and neck pain are common symptoms when working at a desk and can be alleviated by properly positioning a monitor, sitting with your feet flat on the floor, and sitting in a good quality chair that supports the natural shape of your back.

Perhaps to make working from home more comfortable and productive, nearly two-thirds of respondents said they bought office equipment during the lockdown, with less than one-third of respondents (29%) saying they continue to plan to buy office equipment.

More than half of those surveyed probably also planned to buy a new home office chair with a new desk (35%), an external monitor (32%) and a headset with a microphone (25%).

Are you planning to purchase any of the following office supplies?

Results of the bar graph survey

(Photo credit: Future / SmartBrief)

Moving to a more flexible workplace then seems like a double-edged sword – beneficial for employers and employees, but also with new problems that need to be resolved. But with many companies now insisting that workers work from home at least a few days a week, the question arises: who is responsible for workers’ health – and even for equipment costs – when they are not on site? ?

According to Worksmart, the employer is responsible for “… protecting the health and safety at work of employees who work from home as well as employees in the office. This duty cannot be delegated to the employee even though your employer is not at your home and cannot control what is happening there. “

In addition, the employer must conduct a risk assessment and its duty extends to “… the mental health of its employees, including the risks of isolation, overload or not taking appropriate breaks,” concludes Worksmart.

In the United States, employers must comply with labor laws and take into account the state laws of the remote person’s location, as well as the broader Fair Labor Standards Act (FLSA).

However, employees are responsible for their own health and safety and are required to ensure a safe work environment.

It’s a complicated topic that we’ve explored further in this article: Remote Work and Health and Safety.

Read more about the results of this survey:

  • How has Covid changed work? Our survey shows how the world has changed forever
  • Over a quarter of people report physical pain as a result of working remotely
  • Covid has changed the way we work – but do employers listen to the wishes of employees?

A cohort study of patients with chronic pain and obesity

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1Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 2Department of Health Sciences, Research Group Rehabilitation Medicine, Lund University, Lund, Sweden; 3Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden

Correspondence: Huan-Ji Dong
Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE-581 85, Sweden
Tel +46 730488933
Email [email protected]

Background: It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥ 30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight.
Objective: This study investigated whether obese patients with chronic pain lost weight after completing IMMPR in specialist pain units. The association of pain relief and weight change over time was also examined.
Methods: Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used (N=224), including baseline and 12-month follow-up after IMMPR from 2016 to 2018. Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviours, psychological distress, and health-related quality of life (HRQoL). A reduction of at least 5% of initial weight indicates clinically significant weight loss. Patients were classified into three groups based on the pain relief levels after IMMPR: pain relief of clinical significance (30% or more reduction of pain intensity); pain relief without clinical significance (less than 30% reduction of pain intensity); and no pain relief. Linear mixed regression models were used to examine the weight changes among the groups with different pain relief levels.
Results: A significant reduction of pain intensity was found after IMMPR (p < 0.01, effect size Cohen’s d = 0.34). A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss (20.2%∼ 24.3%, p = 0.47). Significant improvements were reported regarding physical activity behaviour, psychological distress, and HRQoL, but weight change was not associated with changes of pain intensity.
Conclusion: About one-fifth of obese patients achieved significant weight reduction after IMMPR. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.

Keywords: obesity, weight loss, chronic pain, pain intensity, pain rehabilitation

Introduction

Pain and obesity are common comorbidities.1,2 Weight management programs have found that pain-related inhibition interferes with weight loss interventions.3–6 Obesity appears to be a potential marker of functional and psychological complications of chronic pain.7 The vicious cycle of pain-inactivity-weight gain-more pain related to obesity has also been identified as a difficult challenge in pain rehabilitation.8,9 Daily clinical practice, especially in specialist units of multidisciplinary pain rehabilitation, often focuses on interventions that address chronic pain and other common comorbidities such as anxiety, depression, and sleep deprivation. However, weight reduction for obese patients with chronic pain is not considered a primary goal. Typically, health professionals and patients expect that other comorbidities can be treated simultaneously after one major problem – eg, chronic pain – has improved.

Interdisciplinary multimodal pain rehabilitation (IMMPR) includes group activities (eg, chronic pain education, supervised physical activity, cognitive behavioural therapy, and work and activity training) led by health professionals over several weeks to a few months.10,11 As with interventions in weight management, IMMPRs are delivered by an interdisciplinary team working according to a biopsychosocial framework.12,13

Earlier studies report that pain rehabilitation increases weight loss and reduces pain in overweight/obese patients who have knee osteoarthritis.6,14 However, these studies were limited to specific pain conditions and pain reduction was not considered clinically important.15 As obesity is related to several pain conditions, it is worth studying the impact of IMMPR on obese patients with various pain conditions. Since 2016, the Swedish Quality Registry for Pain Rehabilitation (SQRP) has included self-reported body weight and height, data that reflect Sweden’s increased attention on obesity and pain. To understand how pain and weight control are related, it is also important to compare outcomes from patients with different pain conditions undergoing IMMPR to outcomes from weight management services. This study investigates whether obese patients presenting a variety of chronic pain conditions reduced their weight after completing an IMMPR in specialist pain units. As there are bilateral barriers between pain relief and weight reduction,4,5,16 this study also evaluates the influences of pain relief on weight change over time. Increased knowledge about whether obese patients can obtain weight loss benefits from IMMPR may help improve IMMPR interventions for this specific and growing patient group.

Materials and Methods

Study Sample and Procedure

This study used data from the Swedish Quality Registry for Pain Rehabilitation (SQRP). Most Swedish pain units (>90%) refer to data from this registry to assess patients and to develop interdisciplinary rehabilitation strategies. The SQRP and the instruments included have been described in detail elsewhere.10,11 Briefly, specialist pain units handle patients with complex chronic pain referred mainly by primary care physicians. Inclusion criteria were patients ≥18 years old with disabling chronic musculoskeletal pain (≥3 months), defined as non-malignant pain conditions such as back or neck pain and fibromyalgia or general widespread pain. For this study, we obtained SQRP data from two consecutive years, between 2016 and 2018, for subjects with additional comorbid obesity (Body Mass Index, BMI ≥30 kg/m2). The patients complete the SQRP questionnaires (see below) before their first visit (Pre-IMMPR), immediately after completing the IMMPR (between 4 and 18 weeks),17 and at a 12-month follow-up (FU-IMMPR). In this study, we used data from the Pre-IMMPR and FU-IMMPR to measure the maintained effect of weight changes. Exclusion criteria were ongoing major somatic or psychiatric disease, a history of significant substance abuse, or a state of acute crisis. Diseases that did not allow physical exercise and specific pain conditions with other treatment options available (red flags) were general exclusion criteria.

MMRP distinguishes itself as a well-coordinated intervention leading to a complex intervention instead of a single treatment. The MMRPs continue over a lengthy period with a common goal and generally include education, supervised physical activity, training in simulated environments, and cognitive behavioural therapy (CBT) coordinated by an interdisciplinary team (eg, physician, occupational therapist, physiotherapist, and psychologist) using a biopsychosocial view of chronic pain.17,18 IMMPR programs in specialist units are conducted in groups of six to eight patients. Each patient makes an individual plan and a schedule in collaboration with the IMMPR team. Systematic reviews have reported that IMMPRs are more effective than single treatment or treatment-as-usual programs.18–20

This study was conducted in accordance with the Helsinki Declaration and Good Clinical Practice and approved by the Ethical Review Board in Linköping (Dnr: 2015/108-31). Signed informed consent forms were collected from all participants.

Measurement

Background Variables

Self-administered SQRP questionnaires provided the socio-demographic information: age (years), gender (male/female), highest education level (college/university, secondary school, or primary school), country of birth (Nordic countries or Non-Nordic countries), and working or studying (yes/no).

Weight Status and Weight Changes

This study included all the participants classified as obese at the Pre-IMMPR according to the World Health Organization (WHO) criteria: obesity class I (BMI 30–34.9kg/m2); obesity class II (BMI ≥35–39.9kg/m2); and obesity class III (BMI ≥40kg/ m2).21 Body weight and height were self-reported or measured at the unit and registered during the clinical assessment. Weight change (Pre-IMMPR vs FU-IMMPR) is defined as weight loss of ≥5% of initial body weight (at Pre-IMMPR), weight stable with no more than 5% weight reduction or gain, and weight gain with an increase of >5% of body weight.5,22,23 A reduction of at least 5% of initial weight indicated clinically meaningful weight loss after one year of treatment.23,24

Previous studies have found high correlations between measured weight- and height-calculated BMI and self-reported values of BMI (Pearson’s r = 0.89–0.97 for different age groups and gender).25 Self-reported values (sensitivity of 88.1% and specificity of 97.4%) are used to identify overweight/obesity based on BMI measurements.26

Pain and Changes of Pain Intensity

A Numeric Rating Scale (NRS) was used to rate average pain intensity for the previous week, with a possible score from 0 to 10 where the highest number represents the worst possible pain. This variable is denoted as NRS-7d. Although no definitive meaningful pain relief exists, changes in pain intensity (pre-IMMPR vs FU-IMMPR) were grouped into three categories following the criteria that a 30% or more reduction in NRS is considered a clinically important difference.5,27 A minimal important reduction was considered as a one point NRS reduction or 10–20% NRS reduction, a limit found in the literature.28,29 This resulted in the following three categories: pain relief ≥30% NRS decrease, pain relief <30% NRS decrease, and no pain relief (no NRS change or increased NRS at FU-IMMPR).

Pain distribution (Pain Region Index, PRI) reflects the degree of anatomical spread of pain on the body. PRI was obtained using 36 predefined anatomical areas (18 on the front and 18 on the back of the body): (1) head/face, (2) neck, (3) shoulder, (4) upper arm, (5) elbow, (6) forearm, (7) hand, (8) anterior aspect of chest, (9) lateral aspect of chest, (10) belly, (11) sexual organs, (12) upper back, (13) low back, (14) hip/gluteal area, (15) thigh, (16) knee, (17) shank, and (18) foot. The number of areas with pain (range: 1–36) were summed. The PRI was measured at Pre-IMMPR. For descriptive purposes, self-reported pain duration (days) and persistent pain duration (days) are presented.

Physical Activity Variables

The SQRP includes two questions about physical activity (PA) based on the recommendation of the Swedish National Board of Health and Welfare.30 The questions are validated for use in Sweden: one about physical exercise every week (PE) and the one about everyday physical activity (EPA).31 The detailed calculation methods of PE time, EPA time, and total PA time have been described in a previous study.32 Briefly, during a regular week, self-perceived time spent on exercise that makes the person short winded (eg, running, fitness class, or ball games) was recognized as PE. The following answer alternatives were provided 0 minutes/none, less than 30 minutes, 30–60 minutes (0.5–1 hour), 60–90 minutes (1–1.5 hours), 90–120 minutes (1.5–2 hours), and more than 120 minutes (2 hours). Second, during a regular week, self-perceived time on non-exercise physical activity (eg, walks, bicycling, or gardening) lasting for at least ten minutes was recognized as EPA. The following answer alternatives were provided 0 minutes/none, less than 30 minutes, 30–60 minutes (0.5–1 hour), 60–90 minutes (1–1.5 hours), 90–150 minutes (1.5–2.5 hours), 150–300 minutes (2.5–5 hours), and more than 300 minutes (5 hours). Finally, the total PA time was calculated by multiplying PE by two and adding the product to EPA (PE minutes × 2 + EPA minutes). The midpoints of intervals for each answer option were used (ie, less than 30 minutes converted to 15 minutes, 30–60 minutes converted to 45 minutes, more than 120 minutes or 300 minutes converted to 120 and 300 minutes, respectively).

Psychological Variables

The Insomnia Severity Index (ISI) includes seven items that generate a score between 0 and 28 that quantifies perceived insomnia severity.33,34 The reliability, validity, and clinical utility of the Swedish version of ISI have been previously studied.35–37

The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression.38 HADS has two subscales – an anxiety subscale (HADS-A) and a depression subscale (HADS-D) – with a scoring range between 0 and 21. A higher score indicates a higher possibility of anxiety or depression. The Swedish translation of HADS has been validated.39

The Pain Catastrophizing Scale (PCS) measures catastrophic thinking related to pain.40 The PCS consists of 13 items in three domains: rumination, magnification, and helplessness. Each item has five answer alternatives on a five-point scale, ranging from 0 (not at all) to 4 (always). Patients assess the degree to which they experience certain thoughts or feelings during pain. Higher scores indicate a greater tendency for catastrophizing. The Swedish version of the PCS for patients with chronic pain has been validated.41 We use the total score (0–52) in this study.

HRQoL Variables

Health-related Quality of Life (HRQoL) was measured using the RAND-36 (RAND Corporation, www.rand.org), which assesses multi-dimensional health concepts.42,43 RAND-36 has eight dimensions, each ranging from 0 to 100. Two summary scores – physical and mental health composites (PCS and MCS) – are derived from these eight scales. We use both the PCS and MCS in this study.

Statistics

All statistics were performed using the statistical package IBM SPSS Statistics (version 26.0; IBM Corporation). Descriptive data include mean value with standard deviations (Mean ± SD) or median with interquartile range (IQR) for continuous variables and number with percentage (n, %) for categorical variables. SQRP uses predetermined rules to handle single missing items of a scale or a subscale. This procedure has been reported elsewhere.44 To investigate within group changes at FU-IMMPR, we used paired sample t-test and Wilcoxon Signed-rank test to quantify the differences between Pre-IMMPR and FU-IMMPR. Spearman correlations were calculated to test the linear relationship between weight changes, changes of pain intensity, and changes of other variables after IMMPR. A p value below 0.05 was considered significant. Effect sizes (ES) for within-group analysis were computed using a calculator when appropriate (Cohen’s d for t-test and r for Wilcoxon signed-rank test). A summary of the ES interpretation is listed in Table 1.45

Table 1 A Summary of Effect Size and Their Interpretations

To compare the impact of IMMPR to changes in the analysed variables between the three pain relief categories, we used linear mixed models to examine the influence of the main factors – ie, Group (groups with different levels of pain relief), Treatment (Pre-IMMPR and FU-IMMPR), and Group × Treatment interaction. Group x Treatment interaction indicated that group changes occurred as a consequence of IMMPR. Analysis of each variable of interest was adjusted for socio-demographic factors, change of pain intensity, and pain distribution.

Results

General Characteristics, Changes in Weight, and Changes in Pain

Of the 872 patients included in this study, 224 were classified as obese at Pre-IMMPR (224/872; 25.7%). A summary of general characteristics is shown in Table 2. Most of the chronic pain patients with obesity were middle-aged women born in a Nordic country who had completed secondary school education. A significant higher proportion were working or studying at FU-IMMPR but not at Pre-IMMPR (72.3% vs 51.3%, p < 0.01, small ES).

Table 2 General Characteristics of Obese Patients (N = 224)

Of the 224 patients classified as obese at admission, most were classified as class I (71.9%) or class II (20.5%). The absolute values of weight change and BMI change were non-significant from Pre-IMMPR to FU-IMMPR. At FU-IMMPR, over one-fifth (21.3%) of the patients had reached ≥5% weight loss.

In this study, most participants had a high pain intensity (ie, NRS = 7–10) at Pre-IMMPR (140/223; 62.5%). A significant reduction of pain intensity was found at FU-IMMPR (p < 0.01; ES = 0.34; small ES) (Table 2). One-fifth of the patients achieved pain relief of clinical importance (NRS decrease at least 30%) and one-fourth had pain relief but it did not reach clinical importance (Table 3). A widespread pain distribution (PRI, 17 ± 9) with long pain duration (median years: 7.9) and persistent pain (median years: 5) was found in the sample.

Table 3 Weight Changes Among the Groups with Different Pain Relief at FU-IMMPR

No statistically significant difference was noted for weight, BMI, and pain intensity at Pre-IMMPR between the patients with complete information on weight and pain status at FU-IMMPR and dropouts (n = 44, data not shown).

Relationship Between Weight Change and Pain Change

A similar proportion of patients reached at least 5% weight loss in the three categories of pain relief (Chi2 = 3.524, df = 4, p = 0.47, Table 3). No significant change was found in absolute weight values from Pre-IMMPR to FU-IMMPR between the three categories of pain relief nor in each category (Cohen’s d = 0.07–0.23) (Figure 1 and Table 4).

Table 4 Changes in Weight, Physical Activity, and Psychological Variables and HRQoL as an Effect of IMMPR

Figure 1 Body weight for the three categories of pain relief. The boundary of the box closest to zero indicates the 25 th percentile, a black line within the box marks the median, and the boundary of the box farthest from zero indicates the 75 th percentile. Whiskers above and below the box indicate the error bars (95% confidence intervals). Mild outliers are marked with a circle (O) and extreme outliers are marked with an asterisk (*).

Relationship Between the Improvements at IMMPR and Weight Changes

Change in body weight only positively correlated with change in PCS (Spearman’s rho = 0.173) (Table 5). Change of pain intensity had weak correlations (Spearman’s rho = 0.26–0.35) with improvements in some psychological profiles as well as HRQoL, but change of pain intensity did not correlate with weight change, other pain aspects, nor changes in the amount of physical activities (Table 5).

Table 5 Spearman Correlations of Changes in Body Weight, Pain Intensity, and Other Outcomes After IMMPR

Compared to the group with pain relief of clinical importance, the other two groups had significantly higher psychological distress (HADS-A, HADS-D, ISI, and PCS) and lower HRQoL (Rand 36) at FU-IMMPR (Table 4). The group differences at Pre-IMMPR were only noted in HADS-A, ISI, and the two summary scores of Rand 36. Within each group of different pain relief levels, significant differences (small to large ES) were noted after IMMPR in the improvement of physical activity, psychological distress, and HRQoL. The group with pain relief of clinical importance had greater improvements (larger ES) than the other two groups except the change of total PA time.

Linear mixed regression analysis showed significant effects of IMMPR (F = 6.13~77.75, p < 0.01) on improvements of physical activity, psychological distress, and HRQoL (Table 4). After adjustment for background variables, changes of pain intensity, and pain distribution, the significant changes among the groups due to IMMPR were shown in psychological distress as well as HRQoL (Group x IMMPR interactions, F =4.39~14.03, p < 0.05). However, there were no significant effects of group, IMMPR, or Group x IMMPR factor interaction on weight change or BMI change.

Discussion

To the best of our knowledge, this is the first study reporting body weight changes after IMMPR for chronic pain patients with comorbid obesity in pain rehabilitation clinics. The current IMMPR had improvements in many aspects (ie, pain intensity, physical exercises, psychosocial well-beings, and HRQoL) but was not always effective in weight reduction for patients with obesity. As with the previous studies,15,46,47 we are aware that it is difficult to target obesity and chronic pain simultaneously. Since emerging evidence suggests weight reduction can alleviate pain and pain-related functional impairment,48,49 a more integrated program with a goal of weight loss should be considered in pain rehabilitation for obese patients.

Did Obese Patients Lose Weight After IMMPR?

No statistically significant difference in weight change or BMI change was found at FU-IMMPR among the obese patients. However, about one-fifth of the obese patients had achieved weight reduction of clinical significance at FU-IMMPR despite the fact that weight reduction is not considered a main goal in IMMPR. Our study had fewer weight losers compared to studies assessing traditional weight management programs.4,5 In addition to a relative lower baseline BMI than the patients included in weight management programs, one pronounced difference in our study was that our patients had more severe pain aspects, such as high baseline pain intensity, widespread pain distribution, and long persistent pain duration.

Relationship Between Weight Change and Pain Change

Reduction of pain intensity was statistically significant at FU-IMMPR among the obese patients. However, there were no significant weight changes in obese patients who reported reduction of pain nor in obese patients who did not report reduction of pain, findings that suggest that pain reduction was unrelated to weight reduction. Within each pain relief level, no significant weight change was evident. Obesity modulates pain in several ways, such as through mechanical loading,50 proinflammatory cytokines,51,52 and psychological strain.53,54 Previous qualitative studies demonstrate that obese patients are aware of the relationship between chronic pain and their weight problem.16,47 Simultaneous improvement should be expected when either condition is treated. However, a recent systematic review demonstrated a trivial relationship of weight loss and pain relief after completing a weight management program.15 This study quantified the effects of weight reduction interventions on both weight loss and pain relief for patients with these two comorbidities. As with these previous studies, our findings showed no significant overall relationship between weight loss and pain relief after IMMPR in obese patients with chronic pain. Moreover, we were unable to correlate weight change with other measured improvements after IMMRP at follow-up (Table 5). Together with the previous studies’ results about weight management services, our findings suggest future pain rehabilitation programs should incorporate both weight reduction and pain interventions for patients with the two comorbidities.

Relationship Between Weight Change and Other Improvements After IMMPR

Other factors closely related to weight control – eg, physical activity behaviour, psychological distress, and HRQoL – were significantly improved in the obese patients at FU-IMMPR. Most notably, regardless of the level of pain relief, the obese patients had significant improvements in depression, pain catastrophizing, and physical health. These results suggest that IMMPR can help obese patients address their weight management challenges (inactive lifestyle, increased eating, etc.).2,6,16,55–57 Significant effects of interactions of Group x IMMPR reflected that IMMPR and pain relief levels affected improvements in psychological distress and HRQoL. However, the varied improvements of physical activity behaviour among the groups confirm the complexity of the impacts on this lifestyle behaviour.32 As adherence to exercise is difficult for obese people,9 perhaps healthcare providers need access to interventions other than those included in current IMMPR to improve physical activity and weight control for obese patients.

Clinical Implications and Future Research

Since obesity is a risk factor for developing chronic pain and vice versa,8,9 a routine screening of the weight status and obesity-related medical conditions is included in pain rehabilitation practices. The complex clinical presentation of disabling pain indicates that no one intervention, either pharmacological/surgical or non-pharmacological, can tackle the consequences of chronic pain, such as sick leave, experiencing major interference in daily life, and chronic disability.

The need for simultaneous treatment of obesity and pain has already been highlighted.46,48 Unlike weight management programs, an interdisciplinary rehabilitation team of IMMPRs typically do not include a dietitian, an essential resource for patients who need help with weight control. Dietary intervention is crucial for weight loss, weight maintenance, and pain relief.47,49,58 A future integrated pain rehabilitation program should consider this aspect for patients with comorbid obesity. Second, scheduled daily physical activities can be encouraged before making great efforts to increase physical exercises.59 Third, psychological intervention on eating behaviour should be considered as much evidence has shown significant influences of pain inducing greater energy intake.7 Interventions that target weight reduction in pain rehabilitation may increase the possibility of weight changes, and this can affect the association to pain relief. Well-designed and high-quality RCTs are needed to examine whether one or more interventions integrated with IMMPR can simultaneously reduce pain and weight. Moreover, future IMMPR research on specific patient categories based on pain conditions (eg, fibromyalgia and low back pain) is particularly valuable due to the large populations in primary care as well as in community dwellings.

This study has several limitations. Although we used a feasible dataset registered for pain rehabilitation clinics, we did not have information about whether the patients received other weight management interventions during the follow-up period (12 months after IMMPR completed). Second, we did not analyse pharmacological treatment on chronic pain since some medications could negatively affect weight reduction. Third, we used ISI to assess insomnia in IMMPR, but we neglected the possible influence of another pain and obesity-linked sleep disturbance – ie, obstructive sleep apnoea.60,61 It is unknown whether a lack of improvement among the patients without pain relief after IMMPR was mediated by the existing comorbidity. Fragmented sleep is common in both chronic pain and obstructive sleep apnoea.1,62 As adequate treatment of obstructive sleep apnoea may contribute to pain relief,62 obese patients should be screened for sleep apnoea and optimising interventions should be included before IMMPR.60,62 Finally, the generalisation of the study results is limited to the obese patients with complex chronic pain referred to specialist pain rehabilitation clinics. However, our findings provide a great potential to improve IMMPR in both daily clinical practice and future pain rehabilitation research.

Conclusion

About one-fifth of obese chronic patients achieved significant weight reduction after IMMPR. The current pain rehabilitation programs (IMMPRs) displayed significant improvement in many aspects (ie, pain intensity, physical activity behaviour, psychosocial distress, and HRQoL), but they were ineffective in weight reduction for the majority of patients with obesity. Especially for the patients with obesity, future IMMPRs should consider incorporating a target approach for weight management.

Data Sharing Statement

The datasets generated and analysed in this study are not publicly available as the Ethical Review Board has not approved the public availability of these data.

Acknowledgments

The authors thank all the participants. This study was supported by grants from the County Council of Östergötland (Research-ALF, LIO-608021 and SC-2017-00202-28). The funders had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit for publication. The authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest.

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52. Bas S, Finckh A, Puskas GJ, et al. Adipokines correlate with pain in lower limb osteoarthritis: different associations in hip and knee. Int Orthop. 2014;38(12):2577–2583. doi:10.1007/s00264-014-2416-9

53. Li JX. Pain and depression comorbidity: a preclinical perspective. Behav Brain Res. 2015;276:92–98. doi:10.1016/j.bbr.2014.04.042

54. Okifuji A, Turk DC. Chronic pain and depression: vulnerability and resilience. In: Flaten MA, al’Absi M, editor. Neuroscience of Pain, Stress, and Emotion. Elsevier; 2016:181–201.

55. Bond DS, Buse DC, Lipton RB, et al. Clinical pain catastrophizing in women with migraine and obesity. Headache. 2015;55(7):923–933. doi:10.1111/head.12597

56. Hauser W, Schmutzer G, Brahler E, Schiltenwolf M, Hilbert A. The impact of body weight and depression on low back pain in a representative population sample. Pain Med. 2014;15(8):1316–1327. doi:10.1111/pme.12458

57. Schwarze M, Hauser W, Schmutzer G, Brahler E, Beckmann NA, Schiltenwolf M. Obesity, depression and hip pain. Musculoskelet Care. 2019;17(1):126–132. doi:10.1002/msc.1380

58. Jennings A, Hughes CA, Kumaravel B, et al. Evaluation of a multidisciplinary tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care. Clin Obes. 2014;4(5):254–266. doi:10.1111/cob.12066

59. Fontaine KR, Conn L, Clauw DJ. Effects of lifestyle physical activity on perceived symptoms and physical function in adults with fibromyalgia: results of a randomized trial. Arthritis Res Ther. 2010;12(2):R55. doi:10.1186/ar2967

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Lotus pose! | Knox County Health Dept. hosts free yoga classes in North Knoxville

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KNOXVILLE, Tennessee – For many people, yoga isn’t just a way to incorporate some exercise into their everyday lives. It can help people’s mental health while connecting them with people in their community.

The Knox County Health Department hosted a free yoga event in North Knoxville on Saturday, with more events planned for the following weeks. The event was open to people of all skill levels and the first 20 participants also received a free yoga mat.

Anyone who wants to learn more about yoga and practice it with their community can stop by the park on Saturdays at 10 a.m. Classes are scheduled until July 10th.

The Knox County Health Department asked participants to bring a mat or towel and some water so they can stay hydrated while exercising.

Typically, yoga classes focus on postures, breathing techniques, and meditation to help participants relax and stretch, calm them down, and improve overall well-being through stress relief. Health officials also said it can also help people relieve lower back or neck pain.

Top 10 Best Pillow For Headaches 2021 – Bestgamingpro

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Top 10 Best Pillow For Headaches 2021

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beegod Pillows for Sleeping, Quality Bed Pillows Super Soft & Comfortable Relief Migraine & Neck Pain Pillow Good for Side and Back Sleeper (2 Pack-16 x 24 inch)

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Cervical Traction Wedge Pillow - Neck and Shoulder Relaxer - Gentle Spinal Correction - Head Posture, Migraine, Headache, Occipital Release

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Power Of Nature Memory Foam Contour Pillow, Neck Support Cervical Bed Pillow for Sleeping, Side Sleeper - Relieve Neck Pain with Washable Zippered Soft Cover

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Cervical Memory Foam Pillow for Neck and Shoulder Pain Relief – Ergonomic, Orthopedic Pillow for Side, Back, Stomach Sleepers - Contour Pillows for Sleeping Support - Free Sleeping Mask

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Cervical Spine Alignment Chiropractic Pillow,Neck and Head Pain Relief Back Massage Traction Device Support Relaxer, Tension Headache Relief, 6 Trigger Point Therapy, Improved Mobility

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Sagino Cervical Memory Foam Pillow Standrad Size, Orthopedic Support with Contouring Comfort, Cradles Neck & Shoulder for Multiple Sleeping Positions, 2 Zip-Off Covers Included, CertiPUR-US Certified

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ZAMAT Contour Memory Foam Pillow for Neck Pain Relief, Adjustable Ergonomic Cervical Pillow for Sleeping, Orthopedic Neck Pillow with Washable Cover, Bed Pillows for Side, Back, Stomach Sleepers

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ROYAL THERAPY Queen Memory Foam Pillow,Bamboo-Adjustable Shredded Odor-Free Pillow for Neck & Shoulder Pain Relief, Support for Back, Stomach, Side Sleepers, Orthopedic Contour Pillow, CertiPUR-US

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EPABO Contour Memory Foam Pillow Orthopedic Sleeping Pillows, Ergonomic Cervical Pillow for Neck Pain - for Side Sleepers, Back and Stomach Sleepers, Free Pillowcase Included ( Firm & Queen )

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Mkicesky Side Sleeper Contour Memory Foam Pillow, Orthopedic Sleeping Pillow, Ergonomic Cervical Pillow for Neck Pain with Washable Hypoallergenic Pillowcase for Back, Stomach Sleepers (Queen Size)

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10. Cervical Traction Chiropractic Wedge Pillow – Neck and Shoulder Pain Relief – Gentle Spinal Correction – Head Posture, Migraine, Headache, and TMJ

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