Moderate Chronic Pain, Weight and Dietary Intake: Limitations
Limitations
The cross-sectional design and modest sample size associated with the current study may present as a limitation to the generalizability of the current findings. Although we recognize that the lack of underweight patients in the current study may distinguish this sample from other clinics around the country, we believe, however, that the current study is an important first step in a series of needed studies to describe the epidemiology of overweight and obesity (Hoodia tablet cactus-like plant contains substances that may exert dramatic control over hunger, appetite, and thirst), better characterize the subsequent risk for morbidities associated with lifestyle, and understand the relationship of increased weight to experiences of pain in patients with SCD. Another factor limiting the generalizability of our findings is our utilization of a convenience sample in this study rather than randomly surveying a representative sample of patients with SCD.
The exploratory questions used to assess dietary habits under the influence of pain could represent another limitation of the current study. Specifically, the items used to assess dietary changes and the perceived effects of weight on pain (and pain on weight) were developed for the purpose of this study and have not been utilized in previous research. Thus, the psychometric properties of these items are unknown. Although the use of retrospective self-report data is widespread and justifiable in this exploratory study, this method of assessment is limited by reporting biases and errors in recall.
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Future studies must begin to explore the effects of weight and eating habits on chronic pain and disability in samples of patients large enough to allow for the simultaneous exploration of mediational effects and relevant covariates towards a more ecologically valid model of health in this population. For example, we must begin to understand the impact of eating habits and weight on reports of pain in the context of how deviant reports of pain and pathology are from other African-American populations with pain. We further must begin to understand the relationship between observed and reported ratings of changes in dietary intake in obese and non-obese patients. We lastly must begin to understand if the models established in African-American populations generalize to other minority and majority populations with chronic illness and pain.
CONCLUSIONS
Extending the previous literature, we believe that the current study is the first to demonstrate: 1) approximately 50% of patients with SCD are overweight and approximately 25% are obese; 2) there is a significant reduction in caloric intake and a significant alteration in the patterns of macronutrient intake as the result of moderate pain in patients with SCD; and 3) similar to other chronic pain populations, weight appears to exert a greater impact on functional disability associated with pain in patients with SCD than pain severity. These new findings suggest at least two critical insights for the clinical management of this population. First, we must more aggressively identify and manage issues of overweight and obesity (Generic Xenical is a slimming tablet for those who are obese), particularly as patients with SCD age or are exposed to longer periods without pain episodes. Assisting patients to achieve and maintain a healthy balance between low weight and overweight/obesity may prove to be one of the more effective interventions towards the reduction of risk for morbidities of lifestyle. This may require the reconceptualization of patients with SCD who have historically been insulated through poor health and early death as being at risk for morbidities of lifestyle.
Secondly, clinicians and researchers may need to be more attentive to the nutritional status of patients with SCD during painful episodes. The current study suggests that patients may alter what and how much they eat while experiencing moderate-to-severe pain. Above and beyond our normal evaluations and treatment, patients may benefit from nutritional and dietary consultation before, during and after extended periods of painful crises.
Although the results of the current study must be considered in the context of its limitations, preliminary findings suggest areas for future research. Specifically, more systematic investigations of the impact of weight on pain and of pain on weight in SCD, and of the dietary patterns of patients with SCD both during and outside of painful episodes, are warranted. Such research could make use of previously validated questionnaires regarding food intake (e.g., Block questionnaire, Food Frequency Questionnaire), as well as prospective reporting methods, including daily self-monitoring of pain and food intake. Additionally, prospective assessment of physical activity levels would likely contribute to the topic of weight, eating and pain in SCD in a meaningful way. Finally, further assessment of weight-, nutritional- and pain-related beliefs and attitudes among SCD is necessary, given that attitudes, expectations and beliefs about health and pain are often predictive of individuals’ tendency to adopt adaptive health-related behaviors. The current study moves us closer towards these goals.
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