Visceral obesity and chronic pain: effect of a 4-week rehabilitation program on adipokines and insulin resistance

Obesity and chronic pain are two major diseases of the 21th century. Our principal objective was to investigate the effects of a 4-week rehabilitation program on adiponectin and leptin concentrations, and insulin resistance, in patients with abdominal obesity and chronic pain syndrome. Our secondary objectives were to investigate the effects of this program on pain, body mass index (BMI), waist circumference and maximal oxygen consumption (VO(2max)) and to compare changes in VO(2max) between patients with or without insulin resistance. Among a consecutive sample of 128 patients with abdominal obesity hospitalized for rehabilitation for a chronic pain syndrome, 111 completed the protocol, which was a 4-week rehabilitation program including 6 hr of rehabilitation per day, 5 days per week, in a referral center of rehabilitation. This prospective cohort study compared clinical (BMI, waist circumference, VO(2max), pain) and biological measures (concentrations of adiponectin, leptin and insulin, score of homeostasis model assessment of insulin resistance [HOMA]) before and after the program. Plasma leptin, adiponectin and insulin concentrations (P<0.0001) and score of HOMA (P=0.0002) had decreased significantly by the end of the 4 weeks. Pain, BMI and waist circumference decreased significantly, and VO(2max) improved significantly (P=0.0001). Patients with insulin resistance had less improvement of their aerobic condition at the end of the 4 weeks (P<0.002). The rehabilitation program decreases the concentration of leptin, and improves insulin sensitivity in patients with chronic pain and visceral obesity. Aerobic recovery was worse for patients with insulin resistance than other patients.