BMI, Opioid Use, and Pain Perception: Insights from the DIPA Scale in Orthopedic Patients

Introduction Body Mass Index (BMI) and Morphine Milligram Equivalents (MMEs) are critical factors in pain management, especially for patients undergoing orthopedic procedures such as joint replacement and spinal surgeries. The Detroit Interventional Pain Assessment (DIPA) scale is a novel tool for stratifying pain severity to optimize pain management strategies. This study evaluates the relationship between BMI, MME levels, and pain ratings using this scale, to inform tailored analgesic strategies for orthopedic patients. Methods 527 patients undergoing joint replacement or spinal procedures were included in this retrospective analysis. Patients were categorized by BMI (<30 or ≥30) and MME levels (0, 1–20, 21–49 MME). Pain ratings (no pain, tolerable, intolerable) were assessed using the DIPA scale. Chi-squared tests were used to evaluate associations between BMI and MME levels for each pain rating category. Sample sizes varied across groups, with higher MME categories limited by smaller sample sizes. Statistical significance was determined at p<0.05. Results For MME=0, a significant association was observed between BMI and pain ratings (p=0.022). For MME=1–20 and MME=20–49, no significant associations were noted (p=0.528 and p=0.313, respectively). These findings suggest that BMI may play a significant role in pain perception without opioid usage but becomes less predictive with increasing MME levels due to limited sample sizes. Conclusion This study highlights the interplay between BMI, MMEs, and pain ratings, demonstrating significant associations with no opioid usage. Future research should explore larger cohorts for higher MMEs to refine individualized pain management strategies using the DIPA scale.