A Systematic Review with Meta-analysis of Studies Comparing Response to Experimentally-evoked Pain Between Obese and Non-Obese Individuals

Rehab Astita1, 3, Osama A. Tashani1, *, Carole A. Paley1, 2, Duncan Sharp1, Mark I. Johnson1
1 Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, City Campus, Leeds LS1 3HE, United Kingdom
2 Airedale NHS Foundation Trust, Keighley, West Yorkshire BD20 6TD, UK
3 Higher Institute of Medical Professions, Al-Bayda, Libya

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© 2018 Astita et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address for correspondence Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, City Campus, Leeds LS1 3HE, United Kingdom, E-mail:



The relationship between obesity and pain remains unclear. The aim of this systematic review was to determine whether response to experimentally-evoked pain differed between obese and non-obese individuals. Studies that compared responses to experimentally-evoked pain between obese and non-obese human participants post-puberty (i.e. >16 years) were sought. Eligible studies published between January 1950 and May 2017 were identified by searching OVID, MEDLINE, EMBASE and Science Direct.


Methodological quality of included studies was assessed using the ‘QualSyst’ questionnaire. Of 1106 references identified only nine studies (683 participants) were eligible for review. Pressure pain was assessed in five studies and electrical pain in three studies. Two studies investigated thermal pain. Obesity was categorized according to body mass index (BMI) or as weight as a percentage of ideal body weight. Six of the nine included studies were of low methodological quality. There was a lack of extractable data to pool for meta-analysis of studies using thermal or electrical pain. A forest plot of data extracted from four studies on pressure pain threshold found no differences between obese and non-obese groups (overall effect size was Z=0.57, p=0.57).


Small sample size was the main limitation in all studies. Participants with obesity were more sensitive to mechanical noxious stimuli than non-obese participants in three of five studies. However, overall, it was not possible to determine whether there are differences in pain sensitivity response to experimental stimuli between obese and non-obese individuals.

Keywords: Pain, Pain threshold, Pain sensitivity, Obesity, Body fat, BMI.