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Valdes-Hernandez PA, Johnson AJ, Montesino-Goicolea S, Nodarse CL, Bashyam V, Davatzikos C, Fillingim RB, Cruz-Almeida Y. Accelerated Brain Aging Mediates the Association Between Psychological Profiles and Clinical Pain in Knee Osteoarthritis. THE JOURNAL OF PAIN 2024; 25:104423. [PMID: 37952863 PMCID: PMC11144298 DOI: 10.1016/j.jpain.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/12/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
Chronic pain is driven by factors across the biopsychosocial spectrum. Previously, we demonstrated that magnetic resonance images (MRI)-based brain-predicted age differences (brain-PAD: brain-predicted age minus chronological age) were significantly associated with pain severity in individuals with chronic knee pain. We also previously identified four distinct, replicable, multidimensional psychological profiles significantly associated with clinical pain. The brain aging-psychological characteristics interface in persons with chronic pain promises elucidating factors contributing to their poor health outcomes, yet this relationship is barely understood. That is why we examined the interplay between the psychological profiles in participants having chronic knee pain impacting function, brain-PAD, and clinical pain severity. Controlling for demographics and MRI scanner, we compared the brain-PAD among psychological profiles at baseline (n = 164) and over two years (n = 90). We also explored whether profile-related differences in pain severity were mediated by brain-PAD. Brain-PAD differed significantly between profiles (ANOVA's omnibus test, P = .039). Specifically, participants in the profile 3 group (high negative/low positive emotions) had an average brain-PAD ∼4 years higher than those in profile- (low somatic reactivity), with P = .047, Bonferroni-corrected, and than those in profile 2 (high coping), with P = .027, uncorrected. Repeated measures ANOVA revealed no significant change in profile-related brain-PAD differences over time, but there was a significant decrease in brain-PAD for profile 4 (high optimism/high positive affect), with P = .045. Moreover, profile-related differences in pain severity at baseline were partly explained by brain-PAD differences between profile 3 and 1, or 2; but brain-PAD did not significantly mediate the influence of variations in profiles on changes in pain severity over time. PERSPECTIVE: Accelerated brain aging could underlie the psychological-pain relationship, and psychological characteristics may predispose individuals with chronic knee pain to worse health outcomes via neuropsychological processes.
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Affiliation(s)
- Pedro A. Valdes-Hernandez
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, University of Florida, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, USA
| | - Alisa J. Johnson
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, University of Florida, USA
| | - Soamy Montesino-Goicolea
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, University of Florida, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, USA
| | - Chavier Laffitte Nodarse
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, University of Florida, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, USA
| | - Vishnu Bashyam
- Center for Biomedical Image Computing & Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA
- Artificial Intelligence in Biomedical Imaging Lab (AIBIL), Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA
| | - Christos Davatzikos
- Center for Biomedical Image Computing & Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, University of Florida, USA
| | - Yenisel Cruz-Almeida
- Department of Community Dentistry and Behavioral Science, University of Florida, USA
- Pain Research and Intervention Center of Excellence, University of Florida, USA
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, USA
- Department of Neuroscience, College of Medicine, University of Florida, USA
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Morris MC, Bruehl S, Rao U, Goodin BR, Karlson C, Carter C, Nag S, Huber FA, Bendinskas KG, Hidoyatov M, Kinney K, Rochelle A, Funches G. Biobehavioral Predictors of Pain Intensity, Pain Interference, and Chronic Pain Episodes: A Prospective Cohort Study of African-American Adults. THE JOURNAL OF PAIN 2024:104501. [PMID: 38369220 DOI: 10.1016/j.jpain.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/19/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
Racial disparities in pain experiences are well-established, with African-American (AA) adults reporting higher rates of daily pain, increased pain severity, and greater pain-related interference compared to non-Hispanic Whites. However, the biobehavioral factors that predict the transition to chronic pain among AA adults are not well understood. This prospective cohort study provided a unique opportunity to evaluate predictors of chronic pain onset among 130 AA adults (81 women), ages 18 to 44, who did not report chronic pain at their baseline assessment and subsequently completed follow-up assessments at 6- and 12-months. Outcome measures included pain intensity, pain-related interference, and chronic pain status. Comprehensive assessments of sociodemographic and biobehavioral factors were used to evaluate demographics, socioeconomic status, stress exposure, psychosocial factors, prolonged hypothalamic-pituitary-adrenal secretion, and quantitative sensory testing responses. At baseline, 30 adults (23.1%) reported a history of prior chronic pain. Over the 12-month follow-up period, 13 adults (10.0%) developed a new chronic pain episode, and 18 adults (13.8%) developed a recurrent chronic pain episode. Whereas socioeconomic status measures (ie, annual income, education) predicted changes in pain intensity over the follow-up period, quantitative sensory testing measures (ie, pain threshold, temporal summation of pain) predicted changes in pain interference. A history of chronic pain and higher depressive symptoms at baseline independently predicted the onset of a new chronic pain episode. The present findings highlight distinct subsets of biobehavioral factors that are differentially associated with trajectories of pain intensity, pain-related interference, and onset of chronic pain episodes in AA adults. PERSPECTIVE: This prospective study sought to advance understanding of biobehavioral factors that predicted pain outcomes over a 12-month follow-up period among AA adults without chronic pain at their initial assessment. Findings revealed distinct subsets of factors that were differentially associated with pain intensity, pain-related interference, and onset of chronic pain episodes.
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Affiliation(s)
- Matthew C Morris
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Uma Rao
- Department of Psychiatry & Human Behavior and Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, California; Psychiatry Division, Children's Hospital of Orange County, Orange, California
| | - Burel R Goodin
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri
| | - Cynthia Karlson
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi; Department of Hematology and Oncology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Chelsea Carter
- School of Medicine, Meharry Medical College, Nashville, Tennessee
| | - Subodh Nag
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Felicitas A Huber
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Muhammad Hidoyatov
- Chemistry Department, State University of New York at Oswego, Oswego, New York
| | - Kerry Kinney
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - Aubrey Rochelle
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
| | - Gaarmel Funches
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi
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Kaplan CM, Schrepf A, Boehnke KF, He Y, Smith T, Williams DA, Bergmans R, Voepel-Lewis T, Hassett AL, Harris RE, Clauw DJ, Beltz AM, Harte SE. Risk Factors for the Development of Multisite Pain in Children. Clin J Pain 2023; 39:588-594. [PMID: 37440345 PMCID: PMC10592500 DOI: 10.1097/ajp.0000000000001148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Chronic pain has economic costs on par with cardiovascular disease, diabetes, and cancer. Despite this impact on the health care system and increasing awareness of the relationship between pain and mortality, efforts to identify simple symptom-based risk factors for the development of pain, particularly in children, have fallen short. This is critically important as pain that manifests during childhood often persists into adulthood. To date, no longitudinal studies have examined symptoms in pain-free children that presage a new, multisite manifestation of pain in the future. We hypothesized that female sex, sleep problems, and heightened somatic symptoms complaints at baseline would be associated with the risk of developing new multisite pain 1 year later. METHODS Symptom assessments were completed by parents of youth (ages 9 to 10) enrolled in the Adolescent Brain Cognitive Development study. Multivariate logistic regression models focused on children who developed multisite pain 1 year later (n=331) and children who remained pain free (n=3335). RESULTS Female sex (odds ratio [OR]=1.35; 95% CI, 1.07, 1.71; P =0.01), elevated nonpainful somatic symptoms (OR=1.17; 95% CI, 1.06, 1.29; P <0.01), total sleep problems (OR=1.20; 95% CI, 1.07, 1.34; P <0.01), and attentional issues (OR=1.22; 95% CI, 1.10, 1.35; P <0.001) at baseline were associated with new multisite pain 1 year later. Baseline negative affect was not associated with new multisite pain. DISCUSSION Identifying symptom-based risk factors for multisite pain in children is critical for early prevention. Somatic awareness, sleep and attention problems represent actionable targets for early detection, treatment, and possible prevention of multisite pain in youth.
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Affiliation(s)
| | - Andrew Schrepf
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Kevin F Boehnke
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Ying He
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Tristin Smith
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | | | - Rachel Bergmans
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | | | - Afton L Hassett
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Richard E Harris
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
- Susan Samueli Integrative Health Institute, School of Medicine
- Department of Anesthesiology and Perioperative Care, School of Medicine, University of California at Irvine, Irvine, CA
| | - Daniel J Clauw
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Adriene M Beltz
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Steven E Harte
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
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Willeke K, Janson P, Zink K, Tischer C, Heuschmann PU, Zapf A, Wildner M, Stupp C, Keil T. Comparing the occurrence of chronic physical disorders in self-employed individuals with that of employees: A systematic review. Work 2023; 75:1179-1198. [PMID: 36710710 PMCID: PMC10473076 DOI: 10.3233/wor-220145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/14/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND A stringent systematic review of population-based observational studies focusing on the physical health of self-employed individuals as a basis for the development of targeted prevention strategies is lacking. OBJECTIVE We aimed to systematically evaluate all the studies of good quality that compared the occurrence of chronic physical disorders in self-employed individuals with that of employees. METHODS We searched three major medical databases (MEDLINE, Web of Science, Embase) following the Cochrane guidelines. The quality of the studies was rated based on the slightly modified validated assessment tool that was developed by Hoy et al.RESULTS:We included 16 population-based studies of good quality, with data from 15,369,964 participants in total. The two longitudinal evaluations of Swedish national registers with the longest follow-up periods showed increased cardiovascular mortality and incidence estimates of cardiovascular disease in self-employed individuals compared with those of white-collar (i.e., nonmanual) employees but decreased risk estimates compared with those of blue-collar (i.e., manual) workers. The results of the shorter cohort studies were heterogeneous. In cross-sectional studies, prevalence estimates for musculoskeletal, respiratory and malignant diseases were higher among self-employed individuals than among employees. CONCLUSION The long-term cardiovascular disease risk and mortality of self-employed individuals seemed to be higher than those of white-collar employees but lower than those of blue-collar employees. As a basis for targeted prevention strategies, further longitudinal studies in different settings are required to better understand the development of physical health disorders for specific self-employment categories such as sole proprietors, small entrepreneurs, family businesses and others.
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Affiliation(s)
- Kristina Willeke
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Patrick Janson
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Katharina Zink
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Christina Tischer
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- Department of Health Security, Finnish Institute of Health and Welfare, Kuopio, Finland
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- Clinical Trial Center Wuerzburg, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Andreas Zapf
- Bavarian State Ministry of the Environment and Consumer Protection, Munich, Germany
- Pettenkofer School of Public Health, University of Munich, Munich, Germany
| | - Manfred Wildner
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Pettenkofer School of Public Health, University of Munich, Munich, Germany
| | - Carolin Stupp
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Thomas Keil
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Abstract
OBJECTIVE Up to 10% of the general population experiences persistent somatic symptoms (PSS). Numerous studies in a variety of health domains are dedicated to identifying factors that are associated with PSS onset. The present study aimed to provide an overview of predictors for PSS onset in the general population and the related health domains. METHODS A systematic search was performed identifying longitudinal cohort studies that examined factors associated with PSS onset in the general population. Included studies measured potential predictors before PSS onset and were categorized according to the dynamic biopsychosocial model. Four levels of evidence were discerned for predictors, based on the number of studies and percentage of consistent findings. RESULTS In the 154 articles eligible for analysis, 27 PSS subtypes were studied, with primary focus on fibromyalgia (25.0%) and irritable bowel syndrome (23.3%). Of the >250 predictors of PSS onset, 46 were investigated more than once and showed consistent results. Strong evidence identifies biological (e.g., infections, body weight-related metrics), psychological (e.g., sleep problems, psychopathology), interpersonal (life events, childhood/interpersonal stress), contextual (employment), and health behavioral (health care utilization) predictors. CONCLUSIONS The results provide strong evidence for factors from all dynamic biopsychosocial domains, although interpersonal and health behavioral factors are relatively under investigated. Thus, evidence suggests that reduction of predictors of PSS onset to a specific factor/domain may be too restrictive. There is no evidence that this differs per PSS subtype. Exploring all domains and measuring common factors across subtypes are essential to improve the clinical course of PSS.
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Schrepf A, Hellman KM, Bohnert AM, Williams DA, Tu FF. Generalized sensory sensitivity is associated with comorbid pain symptoms: a replication study in women with dysmenorrhea. Pain 2023; 164:142-148. [PMID: 35543649 PMCID: PMC9704354 DOI: 10.1097/j.pain.0000000000002676] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/04/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Dysmenorrhea is characterized by high rates of transition to chronic pain. In a previous study using structural equation modeling, we demonstrated that several symptom domains associated with the emerging concept of nociplastic pain can be described using 2 symptom groups: generalized sensory sensitivity (GSS; composed of widespread pain, interceptive sensitivity, and environmental sensitivity) and SPACE (composed of unrefreshing sleep, pain, affective disturbances, cognitive issues, and reduced energy). Here, we perform a secondary cross-sectional analysis examining the same symptoms groups in a cohort of patients with dysmenorrhea without a diagnosis of chronic pain. Our purpose is to determine if the same symptom patterns are apparent and if they are associated with the presence and severity of comorbid pain. Participants were 201 women with dysmenorrhea. We replicated the hypothesized 2-factor structure in this cohort (comparative fit index = 0.971 and root mean square error of approximation =0.055; 90% CI: 0.000-0.097). Generalized sensory sensitivity was associated with the severity of bladder, bowel, and overall pain in multivariable models including SPACE, patient age, and BMI (all β > 0.32, all P < 0.05). Sleep, pain, affective disturbances, cognitive issues, and reduced energy were associated with menstrual pain during nonsteroidal anti-inflammatory drug use, whereas GSS was associated with the same in the absence of nonsteroidal anti-inflammatory drug use (both P < 0.05). This 2-factor model of symptoms seems to be replicable and valid in a cohort of women at risk for developing chronic pain conditions. These symptom groups are promising potential markers of future pain chronification and may point to patients in need of earlier or more aggressive intervention.
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Affiliation(s)
- Andrew Schrepf
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Kevin M Hellman
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Obstetrics and Gynecology, Prizker School of Medicine, University Of Chicago, Chicago, IL, United States
| | - Amy M Bohnert
- Department of Psychology, Loyola University, Chicago, IL, United States
| | - David A Williams
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Frank F Tu
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, United States
- Department of Obstetrics and Gynecology, Prizker School of Medicine, University Of Chicago, Chicago, IL, United States
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Kolaitis G, van der Ende J, Zaravinos-Tsakos F, White T, Derks I, Verhulst F, Tiemeier H. The occurrence of internalizing problems and chronic pain symptoms in early childhood: what comes first? Eur Child Adolesc Psychiatry 2022; 31:1933-1941. [PMID: 34137940 DOI: 10.1007/s00787-021-01821-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 06/03/2021] [Indexed: 01/26/2023]
Abstract
Chronic pain and internalizing problems are characterized by concurrent associations but the directionality of this relationship in early childhood remains unclear. This prospective study aimed to investigate the bidirectional effect of chronic pain and internalizing problems and test the persistence of pain over time in a population-based sample of preschoolers. The study was embedded in Generation R, a large population-based cohort. Mothers of 3,996 children assessed their child's experienced pain and internalizing problems at 3 and 6 years. At 3 years, paternal reports were available too. Reports of family functioning, discipline practices and parental psychopathology were also collected. The prevalence of chronic pain was 2.7% (106) and 8.0% (294) at baseline and follow-up, respectively. The presence of internalizing problems at child age 3 years predicted chronic pain at 6 years, for both maternal (OR 1.05, 95% CI 1.02,1.07, p < 0.001) and paternal (OR 1.03, 95%CI 1.00, 1.06, p < 0.05) internalizing problem reports, when adjusted for potential confounding factors. In contrast, chronic pain did not increase the likelihood of internalizing problems. The temporal relationship between chronic pain and internalizing problems appears to follow a largely unidirectional trend in early childhood, with internalizing problems increasing the likelihood of concurrent physical symptoms. Current understanding of the directionality of this relationship, highlights the importance for comprehensive assessment of psychiatric problems contributing to the manifestation of chronic pain.
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Affiliation(s)
- Gerasimos Kolaitis
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece.
| | - Jan van der Ende
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Foivos Zaravinos-Tsakos
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Thivon and Papadiamantopoulou, 11527, Athens, Greece
| | - Tonya White
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ivonne Derks
- The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University, Rotterdam, The Netherlands
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, USA
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Creed F. The risk factors for self-reported fibromyalgia with and without multiple somatic symptoms: The Lifelines cohort study. J Psychosom Res 2022; 155:110745. [PMID: 35123251 DOI: 10.1016/j.jpsychores.2022.110745] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The numerous risk factors for fibromyalgia reflect its heterogeneous nature. This study assessed whether the predictors of fibromyalgia onset vary according to number of prior somatic symptoms. METHODS The prospective, population-based Lifelines cohort study included 138,617 adults without fibromyalgia or marked muscle pain. At baseline socio-demographic status, physical and psychiatric disorders, psycho-social and behavioural variables were assessed as potential predictors. At follow-up (mean 2.4 years later) new onsets of fibromyalgia were recorded by self-report. The predictors of new onsets of self-reported fibromyalgia were assessed using logistic regression with interaction terms between key variables and number of somatic symptoms. RESULTS At follow-up 679 (0.5%) participants reported new onset fibromyalgia. The strongest predictors were: female sex, rheumatoid and osteo-arthritis, IBS, impaired sleep, migraine, few years of education and impairment by bodily pain. Interaction terms with somatic symptoms were significant for years of education, low income, rheumatoid arthritis and no. of analgesics; these were predictors only for fibromyalgia with few somatic symptoms. Participants with multiple somatic symptoms had a higher number of predictors than those with few somatic symptoms. CONCLUSION This study suggests that people developing self-reported fibromyalgia with multiple pre-existing somatic symptoms have a high risk factor load reflecting risk factors for both fibromyalgia and multiple somatic symptoms. Self-reported fibromyalgia with few somatic symptoms has fewer predictors which may be specific to fibromyalgia. Future research could usefully study whether different pathophysiological mechanisms occur when fibromyalgia is preceded by high or low number of somatic symptoms.
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Affiliation(s)
- Francis Creed
- Emeritus Professor of Psychological Medicine, Psychology and Mental Health, University of Manchester, UK.
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Alalawi A, Evans DW, Liew B, Peolsson A, Heneghan N, Rushton A, Peterson G, Barbero M, Falla D. Does Pain Extent Predict Ongoing Pain and Disability in Patients with Chronic Whiplash-Associated Disorders? J Clin Med 2022; 11:jcm11030555. [PMID: 35160006 PMCID: PMC8837121 DOI: 10.3390/jcm11030555] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/13/2022] Open
Abstract
This study investigates whether baseline pain extent, extracted from an electronic pain drawing, is an independent predictive factor of pain and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Neck Disability Index (NDI), psychological features, and work ability. Participants also completed electronic pain drawings from which their pain extent was extracted. A two-step modelling approach was undertaken to identify the crude and adjusted association between pain extent and NDI measured at 1-year and 2-year follow-ups. A total of 205 participants were included in the analysis. The univariate analysis showed that pain extent was significantly associated with the NDI score at the 1-year (p = 0.006, 95% CI: 0.159-0.909) and 2-year (p = 0.029, 0.057-0.914) follow-ups. These associations were not maintained when we introduced perceived disability, psychological health, and work ability into the model after 1 year (p = 0.56, 95%CI: -0.28-0.499) and 2 years (p = 0.401, -0.226-0.544). Pain extent, as an independent factor, was significantly associated with perceived pain and disability in patients with chronic WAD for up to 2 years. This association was masked by neck disability, psychological health, and work ability.
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Affiliation(s)
- Ahmed Alalawi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 1JN, UK; (A.A.); (D.W.E.); (N.H.); (A.R.)
- Physical Therapy Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - David W. Evans
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 1JN, UK; (A.A.); (D.W.E.); (N.H.); (A.R.)
| | - Bernard Liew
- School of Sport, Rehabilitation and Exercise Sciences, Faculty of Physiotherapy, University of Essex, Colchester CO4 3WA, UK;
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden; (A.P.); (G.P.)
- Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, SE-581 83 Linköping, Sweden
| | - Nicola Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 1JN, UK; (A.A.); (D.W.E.); (N.H.); (A.R.)
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 1JN, UK; (A.A.); (D.W.E.); (N.H.); (A.R.)
| | - Gunnel Peterson
- Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden; (A.P.); (G.P.)
- Centre for Clinical Research Sörmland, Uppsala University, SE-751 05 Uppsala, Sweden
| | - Marco Barbero
- Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland;
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 1JN, UK; (A.A.); (D.W.E.); (N.H.); (A.R.)
- Correspondence: ; Tel.: +44-(0)121-415-4220
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10
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Miseré RML, van der Hulst RRWJ. Self-Reported Health Complaints in Women Undergoing Explantation of Breast Implants. Aesthet Surg J 2022; 42:171-180. [PMID: 33252630 PMCID: PMC8756082 DOI: 10.1093/asj/sjaa337] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Concerns about the safety of silicone breast implants (SBIs) have existed for years, but a causal relation between systemic complaints and SBIs has not been proven. Nevertheless, some women are worried and even request explantation. Objectives This study aimed to review the explantation procedures performed, focusing on patient-reported symptoms preoperatively, the effect of explantation, and the effect of breast reconstruction on these symptoms. Methods A retrospective chart review was performed for patients who had undergone explantation between 2010 and 2020 at Maastricht University Medical Center. Patients who had undergone tissue expander removal, tissue expander–implant exchange, or direct implant exchange were excluded. Results More than half of the patients undergoing explantation reported complaints, mostly pain. Some 15% reported systemic complaints they believed were implant related. Breast implant illness (BII) was found to be the fifth most common indication for explantation (11.2%). A history of either allergies or implant rupture resulted in higher odds ratios of having BII (odd ratios, 2.1 and 2.1, respectively). Subjective improvement of BII after explantation was reported by about 60% of patients. Conclusions A relatively low prevalence of suggested BII exists among women undergoing explantation; 1 in 9 procedures were performed for this reason. Allergy and implant rupture may increase the likelihood of having BII. About 60% of BII patients experienced an improvement in their complaints after implant removal. Autologous breast reconstruction appears a good alternative. Prospective studies into health complaints and quality of life should be performed to confirm the effectiveness of explantation as a therapy for BII. Level of Evidence: 4
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Affiliation(s)
- Renée M L Miseré
- From the Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - René R W J van der Hulst
- From the Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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11
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Abstract
Fibromyalgia developed in the 1950s from a substrate of difficult to explain regional and widespread pain mixed with symptoms of psychosocial distress. Controversies regarding psychological issues were common. Multiple criteria arose to define the disorder, but each identified a different set of patients. The identification of widespread pain as a criterion changed the nature of the disorder by effectively eliminating regional pain as a component condition. The easy-to-measure and relatively reliable widespread pain criterion then came to define the disorder. In the primary care community, diagnostic criteria were largely ignored, and a substantial fraction of diagnosed patients with lower pain scores, particularly women and those with high non-pain symptom scores, were diagnosed. Non-pain symptoms were added back to the fibromyalgia definition and criteria in 2010. Recognition grew that fibromyalgia fit the description of a functional somatic disorder. The idea of fibromyalgia as a primary pain disorder with a neurobiological basis contended with fibromyalgia as a broader biopsychosocial disorder. It is increasingly recognized that fibromyalgia represents a dimensional, non-binary condition and that features of fibromyalgia extend to persons who do not satisfy the criteria. Severity assessments are now available but rarely used. The course of fibromyalgia is not well studied, and improvement and remission criteria have not been successfully defined. The future of fibromyalgia as a discrete disorder remains uncertain as features of fibromyalgia are increasingly observed in patients with multiple different medical conditions.
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Affiliation(s)
- Frederick Wolfe
- Research, National Data Bank for Rheumatic Diseases, Wichita, USA.,Internal Medicine, University of Kansas School of Medicine Wichita, Wichita, USA
| | - Johannes J Rasker
- Faculty of Behavioural Management and Social Sciences, Department of Psychology Health and Technology, University of Twente, Enchede, NLD
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12
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Ahlholm VH, Rönkkö V, Ala-Mursula L, Karppinen J, Oura P. Modeling the Multidimensional Predictors of Multisite Musculoskeletal Pain Across Adulthood-A Generalized Estimating Equations Approach. Front Public Health 2021; 9:709778. [PMID: 34458229 PMCID: PMC8385412 DOI: 10.3389/fpubh.2021.709778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/13/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Multisite pain is commonly chronic and often lacks its initial role as a potential tissue damage signal. Chronic pain among working-age individuals is a risk for disability and imposes a major burden on health care systems and society. As effective treatments for chronic pain are largely lacking, better identification of the factors associated with pain over working years is needed. Methods: Members of the Northern Finland Birth Cohort 1966 participated in data collection at the ages of 31 (n = 4,028) and 46 (n = 3,429). Using these two time points, we performed a multivariable analysis of the association of socioeconomic, occupational, psychological and lifestyle factors (i.e., low education, living alone, low household income, unemployment, occupational physical exposures [hard physical labor, leaning forward, back twisting, constant moving, lifting loads of ≥ 1 kg], physical inactivity, regular smoking, regular drinking, overweight, and psychiatric symptoms) with the number of musculoskeletal pain sites (i.e., upper extremity, lower extremity, lower back, and the neck-shoulder region; totalling 0-4 pain sites). The data were analyzed using generalized estimating equations. Results: At the age of 31, multisite pain was reported by 72.5% of men and 78.6% of women. At the age of 46, the prevalence of multisite pain was 75.7% among men and 82.7% among women. Among men, the number of pain sites was positively associated with age (rate ratio 1.05, 95% confidence interval 1.01-1.08), low household income (1.05, 1.01-1.08), unemployment (1.13, 1.06-1.19), any occupational exposure (1.17, 1.12-1.22), regular smoking (1.06, 1.02-1.11), and psychiatric symptoms (1.21, 1.17-1.26). Among women, the number of pain sites was positively associated with age (1.06, 1.04-1.10), unemployment (1.10, 1.05-1.15), any occupational exposure (1.10, 1.06-1.13), regular smoking (1.06, 1.02-1.10), overweight (1.08, 1.05-1.11), and psychiatric symptoms (1.19, 1.15-1.22); living alone was negatively associated with the number of pain sites (0.95, 0.91-0.99). Conclusion: Of the studied predictors, psychiatric symptoms, occupational physical exposures and unemployment were most strongly associated with multisite pain among both sexes. The results of this study deepen the understanding of the underlying factors of and comorbidities behind multisite pain, and help develop pain relief and rehabilitation strategies for working-age individuals with multisite pain.
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Affiliation(s)
- Ville-Heikki Ahlholm
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Viljami Rönkkö
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Leena Ala-Mursula
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | - Petteri Oura
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.,Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
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13
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Begum N, Taylor JR, Brown C, Rajan J, Keevil B, Pye E, Rainey T, Jones A. Morning and evening salivary cortisol levels in patients with chronic widespread pain and those at high risk. Eur J Pain 2021; 26:197-206. [PMID: 34437747 DOI: 10.1002/ejp.1854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation has been implicated in chronic widespread pain (CWP); the hallmark of fibromyalgia (FM). This is the first study to compare HPA axis changes in individuals with CWP and those at high risk of symptom development. METHODS We sought to determine differences in morning and evening salivary cortisol levels in FM (n = 19), those at-risk (n = 20) and pain-free controls (n = 17). Risk factors included non-CWP pain, somatic symptoms, illness behaviour and sleep disturbance. We conducted the study in the absence of centrally acting medication, to address limitations of previous research. RESULTS Repeated measures ANOVA revealed significant main effects of group (p = 0.003), and time of day (p = 0.002), with no significant interaction. Cortisol levels were higher in FM (p = 0.027) and at-risk (p = 0.003) groups, compared to controls, but there was no significant difference between FM and at-risk groups. The main effect of group remained significant with sleep problems (p = 0.021) and life events (p = 0.007), but was not significant with anxiety (p = 0.076) or depression (p = 0.098) scores as covariates. With sleep problems as a covariate, cortisol levels remained significantly higher only in the at-risk group (p = 0.017). CONCLUSIONS This study indicates elevated salivary cortisol in FM and those at high risk, and identifies anxiety, depression and sleep problems as potential contributing factors. The results shed light on the dynamic relationship between stress, mood and sleep disorders and the brain's resilience to pain. SIGNIFICANCE This study examines neurobiological changes in chronic widespread pain and high risk individuals. One strength of the study is the absence of centrally acting medication. We found high salivary cortisol common to Fibromyalgia and those at risk and identified contributing factors. Our results offer insight into the early mechanistic changes underlying Fibromyalgia development and open up possibilities for early diagnosis and prevention.
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Affiliation(s)
- Nayab Begum
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Jason R Taylor
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Christopher Brown
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK.,Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Jonathan Rajan
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Brian Keevil
- Department of Clinical Biochemistry, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Emily Pye
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Timothy Rainey
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Anthony Jones
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
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14
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Hu WS, Lin CL, Chen TS. Association between fibromyalgia and cataract: A database retrospective cohort study. Medicine (Baltimore) 2021; 100:e26447. [PMID: 34398002 PMCID: PMC8294873 DOI: 10.1097/md.0000000000026447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
This study was set to investigate whether fibromyalgia increased cataract risk.Fibromyalgia patients were the case group and controls were people who never had a history of fibromyalgia. We estimated the hazard ratio of cataract by Cox proportional-hazards model. The adjusted hazard ratios were obtained by controlling variables of age, sex, and comorbidities. Stratification analysis was also performed to ensure the association of fibromyalgia and cataract.We included 6949 participants in each groups. The incidence rate of cataract in patients with fibromyalgia (108.9 per 1000 person-years) was higher than that of control group (58.9 per 1000 person-years). The risk of cataract in fibromyalgia patients was 2.48 (95% confidence interval = 2.34-2.63) times higher than subjects without fibromyalgia.Fibromyalgia is associated with higher risk of cataract.
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Affiliation(s)
- Wei-Syun Hu
- School of Medicine, College of Medicine, China Medical University
- Division of Cardiovascular Medicine, Department of Medicine
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung
| | - Tung-Sheng Chen
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan
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15
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Wilderman I, Pugacheva O, Perelman VS, Wansbrough MCT, Voznyak Y, Zolnierczyk L. Repeated Intravenous Lidocaine Infusions for Patients with Fibromyalgia: Higher Doses of Lidocaine Have a Stronger and Longer-Lasting Effect on Pain Reduction. PAIN MEDICINE 2021; 21:1230-1239. [PMID: 31621870 DOI: 10.1093/pm/pnz251] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine the effect of escalating doses of lidocaine infusion with or without added magnesium on pain levels and the duration of pain relief in patients with fibromyalgia (FM). METHODS A retrospective chart review of 74 patients diagnosed with FM who underwent at least three escalating doses of intravenous (IV) lidocaine infusions (5 mg/kg of body weight, 7.5 mg/kg, and 7.5 mg/kg of lidocaine + 2.5 g of magnesium sulfate) was conducted. Each patient's subjective impression of change in pain intensity and duration of pain relief after each treatment was recorded, along with an 11-point numeric rating scale (NRS) for pain intensity, immediately before and after each infusion. RESULTS Short-term lidocaine analgesia was evaluated by the reduction in NRS pain score according to the patients reported pre- (immediately before treatment) and post-treatment (immediately after treatment) values. There was a statistical difference in the NRS score reduction between doses 5 mg/kg and 7.5 mg/kg of lidocaine (P = 0.009). Long-term analgesia was evaluated at follow-up visits by the patient's subjective impression of change in pain intensity and duration of pain relief. There was a statistical difference in the percentage of pain relief and the mean duration of pain relief between the treatments with 5 mg/kg and 7.5 mg/kg of lidocaine (P = 0.007 and P = 0.003). Although there was a trend of greater response to magnesium sulfate as a beneficial adjunct to the lidocaine infusion, we were unable to find a statistically significant difference for any of the variables studied. CONCLUSIONS This study demonstrated that escalating doses of IV lidocaine to 7.5 mg/kg safely and effectively reduced the pain with prolonged effect in a significant number of patients diagnosed with fibromyalgia. Larger, prospective clinical studies are required to confirm this finding.
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Affiliation(s)
| | | | | | | | - Yuri Voznyak
- Wilderman Medical Clinic, Thornhill, Ontario, Canada
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16
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Rahman A. Why Do Patients With Systemic Lupus Erythematosus Suffer Pain? J Rheumatol 2021; 48:1195-1197. [PMID: 33934072 DOI: 10.3899/jrheum.210057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Anisur Rahman
- A. Rahman, PhD, FRCP, Professor of Rheumatology, Centre for Rheumatology Research, Division of Medicine, University College London, London, UK. The author declares no conflicts of interest.
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17
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Macfarlane GJ, Beasley M, Scott N, Chong H, McNamee P, McBeth J, Basu N, Hannaford PC, Jones GT, Keeley P, Prescott GJ, Lovell K. Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study). Ann Rheum Dis 2021; 80:903-911. [PMID: 33526434 PMCID: PMC8237175 DOI: 10.1136/annrheumdis-2020-219091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/22/2020] [Accepted: 11/30/2020] [Indexed: 01/01/2023]
Abstract
Objective Cognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk. Methods A population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment. Results 996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR 1.05; 95% CI 0.75 to 1.48). Participants who received tCBT were more likely to report better quality of life (EQ-5D-5L utility score mean difference 0.024 (95% CI 0.009 to 0.040)); and had 0.023 (95% CI 0.007 to 0.039) more quality-adjusted life-years at an additional cost of £42.30 (95% CI −£451.19 to £597.90), yielding an incremental cost-effectiveness ratio of £1828. Most secondary outcomes showed significant benefit for the intervention. Conclusions A short course of tCBT did not prevent onset of CWP in adults at high risk, but improved quality of life and was cost-effective. A low-cost, short-duration intervention benefits persons at risk of CWP. Trial registration number ClinicalTrials.gov Registry (NCT02668003).
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Affiliation(s)
- Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Marcus Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Neil Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - Huey Chong
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul McNamee
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - John McBeth
- Versus Arthritis Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Gareth T Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Phil Keeley
- School of Nursing and Midwifery, University of Keele, Stoke-on-Trent, Staffordshire, UK
| | - Gordon J Prescott
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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18
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33501463 PMCID: PMC7836135 DOI: 10.1101/2020.12.03.20242032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Multisensory hypersensitivity (MSH), which refers to persistent discomfort across sensory modalities, is a risk factor for chronic pain. Developing a better understanding of the neural contributions of disparate sensory systems to MSH may clarify its role in the development of chronic pain. We recruited a cohort of women (n=147) enriched with participants with menstrual pain at risk for developing chronic pain. Visual sensitivity was measured using a periodic pattern-reversal stimulus during EEG. Self-reported visual unpleasantness ratings were also recorded. Bladder pain sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visual stimulation induced unpleasantness was associated with bladder pain and evoked primary visual cortex excitation; however, the relationship between unpleasantness and cortical excitation was moderated by bladder pain. Thus, future studies aimed at reversing the progression of MSH into chronic pain should prioritize targeting of cortical mechanisms responsible for maladaptive sensory input integration.
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Affiliation(s)
- Matthew J Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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19
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Lanzara R, Conti C, Camelio M, Cannizzaro P, Lalli V, Bellomo RG, Saggini R, Porcelli P. Alexithymia and Somatization in Chronic Pain Patients: A Sequential Mediation Model. Front Psychol 2020; 11:545881. [PMID: 33192791 PMCID: PMC7655126 DOI: 10.3389/fpsyg.2020.545881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To investigate whether chronic pain (CP) patients with somatization reported higher alexithymic traits than those without somatization and to study the different relationships between psychological characteristics, pain, health-related quality of life (HRQL), and somatization. Method A consecutive sample of 134 CP treatment-seeking outpatients were evaluated for alexithymia (TAS-20), somatization (PHQ-15), distress (HADS), HRQL (SF-12), and pain (BPI). Results Patients with somatization (37.04%) reported significantly higher TAS-20 total scores (p < 0.001) and difficulty in identifying feelings (DIF) (p < 0.001) than those without somatization. The somatizer group had also a significantly higher disease duration, severity and interference of pain, distress, and lower HRQL than the non-somatizer group. Hierarchical regression analysis showed that although distress, pain interference and the mental HRQL component are closely related to somatization (R2 = 0.55), DIF was the strongest predictor of severity of somatization (β = 0.31). A sequential indirect effect from DIF to somatization via distress symptoms and pain interference turned out to be significant [95% CI (0.01, 0.09)]. Support was also found for sequential mediation paths from DIF to somatization via distress and mental HRQL [95% CI (0.01, 0.11)]. Conclusions Our results pointed-out that alexithymia, particularly DIF, may be major factor for somatization risk in CP patients. Longitudinal observations are needed for evaluating the role of alexithymia in clinical outcomes.
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Affiliation(s)
- Roberta Lanzara
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy.,Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Chiara Conti
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Martina Camelio
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Paolo Cannizzaro
- Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy
| | - Vittorio Lalli
- Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy
| | - Rosa Grazia Bellomo
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Raoul Saggini
- Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
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20
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Axelsson E, Hedman-Lagerlöf M, Hedman-Lagerlöf E, Ljótsson B, Andersson E. Symptom Preoccupation in Fibromyalgia: Prevalence and Correlates of Somatic Symptom Disorder in a Self-Recruited Sample. PSYCHOSOMATICS 2020; 61:268-276. [PMID: 32169307 DOI: 10.1016/j.psym.2020.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Somatic symptom disorder (SSD) is characterized by a persistent and distressing psychological reaction to somatic symptoms. In pain disorders, the preoccupation with physical symptoms is associated with poor long-term outcomes. SSD may therefore be of use to identify and help chronic pain patients with particular needs. OBJECTIVE To test the hypothesis that in fibromyalgia, SSD is associated with higher anxiety sensitivity, health anxiety, and reactivity to pain, in addition to lower nonreactivity to inner experiences. In addition, to investigate if individuals with SSD report a larger impact of fibromyalgia core symptoms, more somatic symptoms, and higher psychiatric comorbidity. METHODS Using data from a clinical trial involving self-referred individuals with fibromyalgia, we compared participants with SSD to participants without SSD using t-tests and logistic regression. RESULTS Forty-nine out of 140 participants (35%) had SSD. Most findings corroborate that individuals with fibromyalgia who also meet criteria for SSD are worse off in terms of traits previously found to be predictive of a poor course in pain disorders. Post hoc analyses indicated that this could not be explained merely by a higher level of fibromyalgia core symptoms. CONCLUSION SSD appears to be associated with a higher symptom burden in fibromyalgia, but further research is needed to draw firm conclusions regarding the reliability, acceptability, and utility of the SSD diagnosis in the clinic.
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Affiliation(s)
- Erland Axelsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Maria Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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21
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Boerner KE, Green K, Chapman A, Stanford E, Newlove T, Edwards K, Dhariwal A. Making Sense of "Somatization": A Systematic Review of its Relationship to Pediatric Pain. J Pediatr Psychol 2020; 45:156-169. [PMID: 32053181 DOI: 10.1093/jpepsy/jsz102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 12/04/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Pain and other physical symptoms commonly co-occur in childhood. There is debate about the relevance of somatization in understanding pain. The present review critically appraised and synthesized the extant literature on the relationship between pediatric pain and somatization. METHODS A systematic review (PROSPERO registration #95956) was conducted in Medline, PsycINFO, EMBASE, and CINAHL using search terms related to pain and somatization in children and adolescents. A total of 156 articles were eligible for inclusion in the review. For studies that measured somatization using a symptom questionnaire, descriptions of "somatization" were extracted. Data regarding the relationship between pain and somatization were extracted for studies measuring somatization using a diagnostic category (e.g., Somatic Symptom and Related Disorders [SSRDs]). RESULTS While many studies using somatic symptom questionnaires described somatization as having a psychological component, this was not always captured in measurement tools. Pain was reported as a common symptom in patients with an SSRD diagnosis, though rates varied depending on the specific diagnosis and pain location. Rates of SSRD diagnoses among pain patients were less frequent than rates of pain amongst SSRD patients. CONCLUSIONS SSRDs and pain commonly co-occur, though rates differ depending on diagnosis and pain location. Understanding the relationship between pain and somatization is complicated by the discrepancy between how somatization is defined and measured in questionnaire studies. A comprehensive and measurable definition of somatization is needed so researchers can better identify the shared and unique contributions of pain and somatization in pediatric populations.
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Affiliation(s)
- Katelynn E Boerner
- Department of Psychiatry, University of British Columbia.,Department of Psychiatry, BC Children's Hospital
| | - Katherine Green
- Department of Psychiatry, BC Children's Hospital.,Department of Medicine, University of British Columbia
| | - Andrea Chapman
- Department of Psychiatry, University of British Columbia.,Department of Psychiatry, BC Children's Hospital
| | | | | | | | - Amrit Dhariwal
- Department of Psychiatry, University of British Columbia.,Department of Psychiatry, BC Children's Hospital
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A review of the incidence and risk factors for fibromyalgia and chronic widespread pain in population-based studies. Pain 2020; 161:1169-1176. [DOI: 10.1097/j.pain.0000000000001819] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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23
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Fernandes GS, Parekh SM, Moses J, Fuller CW, Scammell B, Batt ME, Zhang W, Doherty M. Depressive symptoms and the general health of retired professional footballers compared with the general population in the UK: a case-control study. BMJ Open 2019; 9:e030056. [PMID: 31501119 PMCID: PMC6738669 DOI: 10.1136/bmjopen-2019-030056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine the prevalence of depressive symptoms and general health of male ex-professional footballers compared with general population controls. METHODS 572 retired professional footballers and 500 general population controls in the UK were assessed by postal questionnaire. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale and a threshold score of ≥11 was used to indicate probable caseness. General health was ascertained using the Short Form-12 Health Survey Questionnaire quality of life (QoL) tool; self-reported comorbidities, analgesic usage and body pain; and Index of Multiple Deprivation based on postcode data. Mood was assessed using the Positive and Negative Affect Scale and sleep using the Medical Outcome Survey. Linear regression analysis was used to determine adjusted relative risk with 95% CI and adjusted for age, body mass index, comorbidities, body pain and medication usage. RESULTS The prevalence of depressive symptoms in retired professional footballers was 5.66% compared with 5.76% in the general population and anxiety prevalence was also comparable (12.01% vs 10.29%; all p>0.05). However, footballers had lower physical and mental component scores compared with controls (p<0.01). They also reported significantly more sleep problems, more negative mood profiles and more widespread body pain (adjusted relative risk (aRR) 1.88, 95% CI 1.15 to 3.09). They also reported greater pain medication usage compared with controls (aRR 1.54, 95% CI 1.26 to 1.89). However, compared with controls, they were 26% (95% CI 15% to 37%) less likely to report comorbidities, especially heart attacks (aRR 57%, 95% CI 27% to 74%) and diabetes (aRR 61%, 95% CI 37% to 76%). CONCLUSIONS The prevalence of depressive symptoms and anxiety symptoms and probable caseness in ex-professional footballers is comparable with general population controls. However, ex-footballers reported lower health-related QoL, more widespread body pain and higher analgesic usage. Conversely, lower reporting of diabetes and heart attacks indicates potential long-term physical health benefits of professional football.
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Affiliation(s)
- Gwen S Fernandes
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sanjay M Parekh
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jonathan Moses
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Brigitte Scammell
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mark Edward Batt
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
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Abstract
Neuropathic pain was relatively rare and predicted a small number of chronic widespread pain cases. Using these estimates, treatments targeting neuropathic pain would at best prevent 6% of chronic widespread pain cases. This study was performed to test whether the risk of developing chronic widespread pain (CWP) in those with regional pain was augmented in those with symptoms of neuropathic pain (NP). Persons free of CWP completed the Douleur Neuropathique 4 (scores ≥3 indicating NP); demographics; Hospital Anxiety and Depression scale; Pittsburgh Sleep Quality Index; and pain medications. Participants were classified as having no pain, regional pain with no symptoms of NP (), or regional pain with symptoms of NP (NP). At the 12-month follow-up, participants with CWP were identified. Logistic regression estimated the odds ratio, with 95% confidence intervals, of CWP in the and NP groups compared with no pain, and NP compared with . Partial population attributable risks estimated the proportion of CWP attributable to baseline or NP exposure. One thousand one hundred sixty-two participants completed the baseline DN4 and provided pain data at follow-up: 523 (45.0%) had no baseline pain, 562 (48.4%) , and 77 (6.6%) NP. One hundred fifty-three (13.2%) had CWP at 12 months: 19 (3.6%) no pain, 108 (19.2%) , and 26 (33.8%) NP. (2.9 [1.9-4.3]) and NP (2.1 [1.1-4.0]) predicted CWP after adjusting for demographics, Hospital Anxiety and Depression scale, Pittsburgh Sleep Quality Index, and medications. The partial population attributable risk was 41.3% (25.2-54.0) for and 6.0% (0.1-11.6) for NP. The NP group were not more likely to develop CWP when compared directly with (1.5 [0.8-2.8]). Neuropathic pain was relatively rare and predicted a small number of new-onset CWP cases. Using these estimates, treatments targeting NP would at best prevent 6% of CWP cases.
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25
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Fibromyalgia and rheumatoid arthritis: Personality and psychopathology differences from the Minnesota Multiphasic Personality Inventory-2. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2018.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Development and course of chronic widespread pain: the role of time and pain characteristics (the HUNT pain study). Pain 2019; 160:1976-1981. [DOI: 10.1097/j.pain.0000000000001585] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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27
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You DS, Albu S, Lisenbardt H, Meagher MW. Cumulative Childhood Adversity as a Risk Factor for Common Chronic Pain Conditions in Young Adults. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:486-494. [PMID: 30011037 PMCID: PMC6387984 DOI: 10.1093/pm/pny106] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Multiple and specific types of childhood adverse events are risk factors for chronic pain conditions. Although both can covary, no study has evaluated one aspect while controlling for the other. Therefore, the current study examined whether more adverse events would be a risk factor for common chronic pain conditions and pain medication use in young adults after controlling for different adversity types such as physical, emotional, and sexual traumatic events or vice versa. METHODS This cross-sectional study recruited 3,073 undergraduates (72% female, mean age = 18.8 years, SD = 1.4 years) who completed the survey for current health status and early life traumatic events. RESULTS More adverse events were associated with a 1.2-1.3-fold increase in the odds of any chronic pain, chronic back pain, headache, and dysmenorrhea with adjusting for adversity types, but they were not associated with the risk of comorbid pain conditions and use of pain medications. In contrast, specific adversity types were unrelated to chronic pain conditions when controlling for the number of adverse events. CONCLUSIONS Cumulative childhood adverse events may be a more relevant risk factor for chronic pain conditions than the experience of a specific type of adverse event. Clinicians and researchers need to evaluate cumulative childhood adversity when assessing its link to chronic pain.
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Affiliation(s)
- Dokyoung S You
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station TX 77843, USA
| | - Sergiu Albu
- Institute Guttmann, Neurorehabilitation Hospital, Badalona, Barcelona, Spain
| | - Hans Lisenbardt
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station TX 77843, USA
| | - Mary W Meagher
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station TX 77843, USA
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Clauw DJ, Essex MN, Pitman V, Jones KD. Reframing chronic pain as a disease, not a symptom: rationale and implications for pain management. Postgrad Med 2019; 131:185-198. [DOI: 10.1080/00325481.2019.1574403] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Daniel J. Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Verne Pitman
- Global Medical Affairs, US Medical Affairs, Pfizer Inc, New York, NY, USA
| | - Kim D. Jones
- School of Nursing, Linfield College, Portland, OR, USA
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29
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Aili K, Andersson M, Bremander A, Haglund E, Larsson I, Bergman S. Sleep problems and fatigue as predictors for the onset of chronic widespread pain over a 5- and 18-year perspective. BMC Musculoskelet Disord 2018; 19:390. [PMID: 30390670 PMCID: PMC6215341 DOI: 10.1186/s12891-018-2310-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 10/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Previous research suggests that sleep problems may be an important predictor for chronic widespread pain (CWP). With this study we investigated both sleep problems and fatigue as predictors for the onset of CWP over a 5-year and an 18-year perspective in a population free from CWP at baseline. METHODS To get a more stable classification of CWP, we used a wash-out period, including only individuals who had not reported CWP at baseline (1998) and three years prior baseline (1995). In all, data from 1249 individuals entered the analyses for the 5-year follow-up and 791 entered for the 18-year follow-up. Difficulties initiating sleep, maintaining sleep, early morning awakening, non-restorative sleep and fatigue were investigated as predictors separately and simultaneously in binary logistic regression analyses. RESULTS The results showed that problems with initiating sleep, maintaining sleep, early awakening and non-restorative sleep predicted the onset of CWP over a 5-year (OR 1.85 to OR 2.27) and 18-year (OR 1.54 to OR 2.25) perspective irrespective of mental health (assessed by SF-36) at baseline. Also fatigue predicted the onset of CWP over the two-time perspectives (OR 3.70 and OR 2.36 respectively) when adjusting for mental health. Overall the effect of the sleep problems and fatigue on new onset CWP (over a 5-year perspective) was somewhat attenuated when adjusting for pain at baseline but remained significant for problems with early awakening, non-restorative sleep and fatigue. Problems with maintaining sleep predicted CWP 18 years later irrespective of mental health and number of pain regions (OR 1.72). Reporting simultaneous problems with all four aspects of sleep was associated with the onset of CWP over a five-year and 18-yearperspective, irrespective of age, gender, socio economy, mental health and pain at baseline. Sleep problems and fatigue predicted the onset of CWP five years later irrespective of each other. CONCLUSION Sleep problems and fatigue were both important predictors for the onset of CWP over a five-year perspective. Sleep problems was a stronger predictor in a longer time-perspective. The results highlight the importance of the assessment of sleep quality and fatigue in the clinic.
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Affiliation(s)
- Katarina Aili
- Spenshult Research and Development Center, FoU Spenshult, Bäckagårdsvägen 47, SE-302 74, Halmstad, Sweden. .,Unit of occupational medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. .,School of Health and Welfare, Halmstad University, Halmstad, Sweden.
| | - Maria Andersson
- Spenshult Research and Development Center, FoU Spenshult, Bäckagårdsvägen 47, SE-302 74, Halmstad, Sweden.,Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Ann Bremander
- Spenshult Research and Development Center, FoU Spenshult, Bäckagårdsvägen 47, SE-302 74, Halmstad, Sweden.,Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.,School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Syddansk Universitet Research Unit, King Christian X Hospital for Rheumatic Diseases, Hospital of Southern Jutland, Copenhagen, Graasten, Denmark
| | - Emma Haglund
- Spenshult Research and Development Center, FoU Spenshult, Bäckagårdsvägen 47, SE-302 74, Halmstad, Sweden.,School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
| | - Ingrid Larsson
- Spenshult Research and Development Center, FoU Spenshult, Bäckagårdsvägen 47, SE-302 74, Halmstad, Sweden.,School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Stefan Bergman
- Spenshult Research and Development Center, FoU Spenshult, Bäckagårdsvägen 47, SE-302 74, Halmstad, Sweden.,School of Health and Welfare, Halmstad University, Halmstad, Sweden.,Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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30
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Zuckerman RM, Silton RL, Tu FF, Eng JS, Hellman KM. Somatic symptoms in women with dysmenorrhea and noncyclic pelvic pain. Arch Womens Ment Health 2018; 21:533-541. [PMID: 29525829 PMCID: PMC6126970 DOI: 10.1007/s00737-018-0823-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 02/27/2018] [Indexed: 12/30/2022]
Abstract
Somatic symptoms are a robust, transdiagnostic risk factor for pain conditions. However, the extent to which somatic symptoms contribute to the manifestation of the women's pain syndromes, such as dysmenorrhea and noncyclic pelvic pain (NCPP), is unclear due to high rates of co-occurrence. Therefore, the present study investigated the primary hypothesis that somatic symptoms would be elevated in NCPP and distinctly influence the relationship between dysmenorrhea and co-occurring NCPP. A secondary analysis was performed on cross-sectional questionnaire data from 1012 nonpregnant reproductive-aged women. Eligible analyzed participants (n = 834) were categorized into four groups: healthy, dysmenorrhea, NCPP, and NCPP with co-occurring dysmenorrhea (NCPP+dysmenorrhea). A parallel mediation analysis was run to evaluate the primary hypothesis that somatic symptoms are the primary factor associated with increased NCPP accounting for dysmenorrhea. The NCPP+dysmenorrhea group had higher somatic, anxiety, and depression symptom T-scores (respectively 61, 61, 60) compared to the healthy controls (46, 51, 51; p's < .001) and the dysmenorrhea group (50, 53, 54; p's < .001). The pain and psychological symptoms were significantly correlated across the entire sample (r's = .29, - .64, p's < .01). Results from parallel mediation analysis showed that somatic symptoms were distinctly associated with NCPP+dysmenorrhea. Women with NCPP+dysmenorrhea have increased psychological and somatic symptoms compared to women with dysmenorrhea alone. Given that NCPP often co-occurs with dysmenorrhea, failure to account for comorbidity in previous studies has likely led to an overestimation of psychological symptoms in dysmenorrhea. Future studies should evaluate whether somatic sensitivity is a modifiable risk factor for NCPP.
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Affiliation(s)
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, 1032 W. Sheridan Road, Chicago, IL, 60660, USA.
| | - Frank F Tu
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, USA
| | - Joshua S Eng
- Department of Child and Family Health Studies, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kevin M Hellman
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, USA
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Schrepf A, Williams DA, Gallop R, Naliboff B, Basu N, Kaplan C, Harper DE, Landis R, Clemens JQ, Strachan E, Griffith JW, Afari N, Hassett A, Pontari MA, Clauw DJ, Harte SE. Sensory sensitivity and symptom severity represent unique dimensions of chronic pain: a MAPP Research Network study. Pain 2018; 159:2002-2011. [PMID: 29863527 PMCID: PMC6705610 DOI: 10.1097/j.pain.0000000000001299] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic overlapping pain conditions (COPCs) are characterized by aberrant central nervous system processing of pain. This "centralized pain" phenotype has been described using a large and diverse set of symptom domains, including the spatial distribution of pain, pain intensity, fatigue, mood imbalances, cognitive dysfunction, altered somatic sensations, and hypersensitivity to external stimuli. Here, we used 3 cohorts, including patients with urologic chronic pelvic pain syndrome, a mixed pain cohort with other COPCs, and healthy individuals (total n = 1039) from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network to explore the factor structure of symptoms of centralized pain. Using exploratory and confirmatory factor analysis, we identified 2 general factors in all 3 cohorts, one characterized by a broad increased sensitivity to internal somatic sensations,environmental stimuli, and diffuse pain, termed Generalized Sensory Sensitivity, and one characterized by constitutional symptoms-Sleep, Pain, Affect, Cognition, Energy (SPACE). Longitudinal analyses in the urologic chronic pelvic pain syndrome cohort found the same 2-factor structure at month 6 and 1 year, suggesting that the 2-factor structure is reproducible over time. In secondary analyses, we found that Generalized Sensory Sensitivity particularly is associated with the presence of comorbid COPCs, whereas SPACE shows modest associations with measures of disability and urinary symptoms. These factors may represent an important and distinct continuum of symptoms that are indicative of the centralized pain phenotype at high levels. Future research of COPCs should accommodate the measurement of each factor.
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Affiliation(s)
- Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - David A. Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Robert Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bruce Naliboff
- Departments of Medicine and Psychiatry and Biobehavioral Sciences, University of California, Los Angeles CA, USA
| | - Neil Basu
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Chelsea Kaplan
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel E. Harper
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Richard Landis
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Niloofar Afari
- VA San Diego Healthcare System and Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Afton Hassett
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Daniel J. Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Steven E. Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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Kapos FP, Look JO, Zhang L, Hodges JS, Schiffman EL. Predictors of Long-Term Temporomandibular Disorder Pain Intensity: An 8-Year Cohort Study. J Oral Facial Pain Headache 2018; 32:113-122. [PMID: 29694463 DOI: 10.11607/ofph.1819] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To investigate, in individuals with pain-related temporomandibular disorder (TMD), the association of long-term pain intensity with baseline health-related quality of life (HRQoL) and jaw functional limitation. METHODS Of 513 cases with baseline pain-related TMD (masticatory muscle and/or temporomandibular joint [TMJ] pain), 273 were reevaluated after 8 years, and 258 of them had complete baseline data for Jaw Functional Limitation Scale (JFLS) scores and HRQoL measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-item Short Form Health Survey and follow-up data for Characteristic Pain Intensity (CPI) from the Graded Chronic Pain Scale. Secondary analyses of existing data quantified the effects of primary (PCS, MCS) and secondary (JFLS) predictors on follow-up CPI by using multivariable linear regression. Sensitivity analyses considered differences between the included participants (n = 258) and those who were not included (n = 255) by using inverse probability weighting. Interactions of baseline predictors with age, sex, and baseline CPI were evaluated using multivariable linear regression. RESULTS The score for baseline PCS, but not MCS or JFLS, was associated with follow-up CPI (P = .012). One standard deviation (SD = 9.0)-higher baseline PCS score predicted an overall 3.2-point-lower follow-up CPI (95% confidence interval -5.8 to -0.7) after adjusting for age, sex, MCS, JFLS, and baseline CPI scores. However, the effect of PCS score was not uniform: the association between PCS and follow-up CPI scores was statistically significant for participants with baseline CPI ≥ 51.3/100 and clinically significant for participants with baseline CPI ≥ 68.7/100. Adjustment for TMD treatments and sensitivity analyses had negligible effect. CONCLUSION In participants with moderate to severe baseline TMD pain intensity, higher baseline physical HRQoL predicted lower TMD pain intensity at 8 years follow-up. PCS score could contribute to a multifactorial long-term TMD pain prediction model.
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Gellatly J, Pelikan G, Wilson P, Woodward-Nutt K, Spence M, Jones A, Lovell K. A qualitative study of professional stakeholders' perceptions about the implementation of a stepped care pain platform for people experiencing chronic widespread pain. BMC FAMILY PRACTICE 2018; 19:151. [PMID: 30172253 PMCID: PMC6119589 DOI: 10.1186/s12875-018-0838-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 08/20/2018] [Indexed: 12/02/2022]
Abstract
Background Chronic widespread pain (CWP) is a major public health problem. Many people experiencing CWP experience mental health problems such as anxiety or depression. Complete relief of skeletal and body pain symptoms is unlikely but with appropriate treatment the impact upon quality of life, functioning and mental health symptoms can be reduced. Cognitive behavioural therapy (CBT) is widely used for a range of health conditions and can have short and long-term improvements in patients with CWP. This research aimed to explore, from a professional stakeholder perspective, the implementation of a local Pain Platform offering a stepped care approach for interventions including telephone delivered CBT (T-CBT). Methods Fourteen professional stakeholders holding various roles across primary and secondary care services within the Pain Platform took part in semi-structured interviews. Their views and experiences of the implementation of the Pain Platform were explored. Interviews were recorded, transcribed verbatim and analysed according to Normalisation Process Theory (NPT). Results Professional stakeholders were positive about the Pain Platform and its potential to overcome previously identified existing access issues to psychological interventions for CWP patients. It was considered a valuable part of ensuring that patients’ preferences and needs are more readily addressed. In some circumstances, however, introducing psychological interventions to patients was considered challenging and the introduction of new referral processes was raised concerns. To ensure sustainability more work is required to reduce professional isolation and ensure efficient referral procedures between primary and secondary care services are established to reduce concerns over issues related to clinical governance and potential risk to patient. Conclusions The findings provide professional insight into the key challenges of introducing a Pain Platform incorporating psychological support across primary and secondary care services within a local service. These included development of sustainable procedures and closer working relationships. Areas requiring future development are identified.
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Affiliation(s)
- Judith Gellatly
- NIHR CLAHRC Greater Manchester, Division of Nursing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | | | - Paul Wilson
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Kate Woodward-Nutt
- NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Michael Spence
- NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Anthony Jones
- Human Pain Research Group, Division of Neuroscience and Cognitive Psychology, University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Karina Lovell
- NIHR CLAHRC Greater Manchester, Division of Nursing, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Abstract
Supplemental Digital Content is Available in the Text. Patients with chronic widespread pain may regularly consult in primary care for regional pain without being recognized as having a generalized condition. Chronic widespread pain (CWP) is common in the general population. It is unclear how people reporting this problem present in primary care; they may regularly consult for regional pains without being recognized as having a generalized condition. Our objectives were to determine the prevalence of people consulting in primary care for musculoskeletal conditions in different body regions on different occasions (recurrent regional pain consultation), the proportion with diagnosed generalized pain and survey-reported widespread pain, and if they have features characteristic of CWP. Phase 1 used electronic records from 12 general practices in North Staffordshire (Consultations in Primary Care Archive) from 2005 to 2009. Phase 2 used linked self-reported health and primary health care data from 8286 people aged >50 years in 8 general practices (North Staffordshire Osteoarthritis Project) between 2002 and 2005. In Phase 1, 11% of registered patients fulfilled criteria for recurrent regional pain consultation. Three-quarters had no recorded CWP-related generalized pain condition (eg, fibromyalgia). In Phase 2, 53% of recurrent regional pain consulters had survey-reported widespread pain and 88% had consulted for somatic symptoms. Self-reported general health was worse in recurrent regional pain consulters than in single-region consulters and poorest in those who also reported persistent widespread pain. Recurrent regional pain consulters are a heterogeneous group of frequent consulters sharing features with CWP (eg, somatic symptoms) but including those less severely affected. They lie on the spectrum of polysymptomatic distress characteristic of CWP and represent a group whose needs may be better met by earlier diagnosis of multisite pain.
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Clinical, psychological features and quality of life of fibromyalgia patients: a cross-sectional study of Chinese sample. Clin Rheumatol 2017; 37:527-537. [PMID: 29027043 DOI: 10.1007/s10067-017-3872-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 01/09/2023]
Abstract
This study aimed to determine the clinical, psychological features, and quality of life in Chinese fibromyalgia (FM) patients who fulfilled the American College of Rheumatology (ACR) 2010 FM classification criteria at initial diagnosis. A cross-sectional study was carried out in the Chinese People's Liberation Army (PLA) General Hospital. A hundred and seven Chinese FM patients (86 females, 21 males) were included. Eighty-six patients completed the questionnaires. Descriptive, differences, and correlation analyses were performed. The results showed that Chinese FM patients started their diseases at a median age of 37 years, with a male-to-female ratio of 1:4.1. Most patients were diagnosed about 2 years after symptoms onset. Nearly 60 % (59.81%) patients had less than college education, 58.88% did not have a full-time job, and 41.12% had low-back pain. Out of 86 patients, 58 (67.4%) had anxiety and 75 (87.2%) had depression. FM patients had poor quality of life in each aspect and deficient social support. The level of pain for the past 7 days was strongly correlated with patient global impression of severity (PGI-S; r = 0.651, p < 0.001) and patient global impression of bother (PGI-B; r = 0.628, p < 0.001). PGI-B was correlated with seven subscales of short-form health survey (SF-36). The study demonstrated the clinical, psychological features of Chinese patients. The diagnosis was delayed for about 2 years. Most of the patients had anxiety and depression, had poor quality of life, and lacked proper social support. PGI-B might be a simple measurement to evaluate patients' quality of life.
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Maixner W, Fillingim RB, Williams DA, Smith SB, Slade GD. Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification. THE JOURNAL OF PAIN 2017; 17:T93-T107. [PMID: 27586833 DOI: 10.1016/j.jpain.2016.06.002] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 12/26/2022]
Abstract
UNLABELLED There is increasing recognition that many if not most common chronic pain conditions are heterogeneous with a high degree of overlap or coprevalence of other common pain conditions along with influences from biopsychosocial factors. At present, very little attention is given to the high degree of overlap of many common pain conditions when recruiting for clinical trials. As such, many if not most patients enrolled into clinical studies are not representative of most chronic pain patients. The failure to account for the heterogeneous and overlapping nature of most common pain conditions may result in treatment responses of small effect size when these treatments are administered to patients with chronic overlapping pain conditions (COPCs) represented in the general population. In this brief review we describe the concept of COPCs and the putative mechanisms underlying COPCs. Finally, we present a series of recommendations that will advance our understanding of COPCs. PERSPECTIVE This brief review describes the concept of COPCs. A mechanism-based heuristic model is presented and current knowledge and evidence for COPCs are presented. Finally, a set of recommendations is provided to advance our understanding of COPCs.
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Affiliation(s)
- William Maixner
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina.
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - David A Williams
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Shad B Smith
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Gary D Slade
- Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Johnsen TL, Indahl A, Eriksen HR, Ihlebæk C, Tveito TH. Work and Mental Complaints: Are Response Outcome Expectancies More Important Than Work Conditions and Number of Subjective Health Complaints? JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:218-227. [PMID: 27342242 PMCID: PMC5405098 DOI: 10.1007/s10926-016-9648-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose Investigate the relative effect of response outcome expectancies, work conditions, and number of subjective health complaints (SHC) on anxiety and depression in Norwegian employees. Learned response outcome expectancies are important contributors to health. Individual differences in the expectancy to cope with workplace and general life demands may be important for how work conditions influence health. Method A survey was conducted among 1746 municipal employees (mean age 44.1, SD = 11.5, 81.5 % female), as part of a randomized controlled trial. This cross-sectional study used baseline data. Multiple logistic regression analysis was performed. Outcome variables were anxiety and depression; response outcome expectancies, work conditions, and number of SHC were independent variables. Results A high number of SHC was a significant factor in explaining anxiety (OR 1.26), depression (OR 1.22) and comorbid anxiety and depression (OR 1.31). A high degree of no and/or negative response outcome expectancies was a significant factor in explaining depression (OR 1.19) and comorbid anxiety and depression (OR 1.28). The variance accounted for in the full models was 14 % for anxiety, 23 % for depression, and 41 % for comorbid anxiety and depression. Conclusion A high number of SHC, and a high degree of no and/or negative response outcome expectancies were associated with anxiety and depression. The strongest association was found for number of SHC. However, previous studies indicate that it may not be possible to prevent the occurrence of SHC. We suggest that workplace interventions targeting anxiety and depression could focus on influencing and altering employees' response outcome expectancies.
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Affiliation(s)
- Tone Langjordet Johnsen
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, POB 2168, 3103 Tønsberg, Norway
- Department of Health Promotion, University College of Southeast Norway, Horten, Norway
| | - Aage Indahl
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, POB 2168, 3103 Tønsberg, Norway
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Hege Randi Eriksen
- Uni Research Health, POB 7810, 5020 Bergen, Norway
- Department of Sport and Physical Activity, Bergen University College, Bergen, Norway
| | - Camilla Ihlebæk
- Section of Public Health, ILP, Norwegian University of Life Sciences, Ås, Norway
| | - Torill Helene Tveito
- Uni Research Health, POB 7810, 5020 Bergen, Norway
- Department of Health Promotion, University College of Southeast Norway, Horten, Norway
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The placebo effect and its determinants in fibromyalgia: meta-analysis of randomised controlled trials. Clin Rheumatol 2017; 36:1623-1630. [PMID: 28299460 PMCID: PMC5486479 DOI: 10.1007/s10067-017-3595-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/14/2017] [Accepted: 02/07/2017] [Indexed: 12/31/2022]
Abstract
The aims of this study were to determine whether placebo treatment in randomised controlled trials (RCTs) is effective for fibromyalgia and to identify possible determinants of the magnitude of any such placebo effect. A systematic literature search was undertaken for RCTs in people with fibromyalgia that included a placebo and/or a no-treatment (observation only or waiting list) control group. Placebo effect size (ES) for pain and other outcomes was measured as the improvement of each outcome from baseline divided by the standard deviation of the change from baseline. This effect was compared with changes in the no-treatment control groups. Meta-analysis was undertaken to combine data from different studies. Subgroup analysis was conducted to identify possible determinants of the placebo ES. A total of 3912 studies were identified from the literature search. After scrutiny, 229 trials met the inclusion criteria. Participants who received placebo in the RCTs experienced significantly better improvements in pain, fatigue, sleep quality, physical function, and other main outcomes than those receiving no treatment. The ES of placebo for pain relief was clinically moderate (0.53, 95%CI 0.48 to 0.57). The ES increased with increasing strength of the active treatment, increasing participant age and higher baseline pain severity, but decreased in RCTS with more women and with longer duration of fibromyalgia. In addition, placebo treatment in RCTs is effective in fibromyalgia. A number of factors (expected strength of treatment, age, gender, disease duration) appear to influence the magnitude of the placebo effect in this condition.
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Barbero M, Fernández-de-Las-Peñas C, Palacios-Ceña M, Cescon C, Falla D. Pain extent is associated with pain intensity but not with widespread pressure or thermal pain sensitivity in women with fibromyalgia syndrome. Clin Rheumatol 2017; 36:1427-1432. [PMID: 28161767 DOI: 10.1007/s10067-017-3557-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
Abstract
Widespread pain is considered a sign of central sensitization in people with chronic pain. Our aim was to examine whether pain extent, assessed from the pain drawing, relates to measures from quantitative sensory testing in fibromyalgia syndrome (FMS). Thirty women with FMS and no other co-morbid conditions completed pain drawings (dorsal and ventral views) and clinical and related disability questionnaires. Pain extent and pain frequency maps were obtained from the pain drawings using a novel customized software. Pressure pain thresholds were assessed over the 18 tender points considered by the 1990 American College of Rheumatology criteria for FMS diagnosis and over two additional standardized points. Heat and cold pain thresholds were also assessed on the dorsal aspect of the neck, the dorsal aspect of the wrist, and the tibialis anterior. Spearman's correlation coefficients were used to assess the relationship between pain extent and quantitative sensory testing outcomes as well as clinical symptoms. Larger extent of pain was associated with a higher pain intensity (dorsal area: r s = 0.461, P = 0.010; total area: r s = 0.593, P = 0.001), younger age (ventral area: r s = -0.544, P = 0.002; total area: r s = -0.409, P = 0.025), shorter history of pain (ventral area: r s = -0.367, P = 0.046), and higher cold pain thresholds over the tibialis anterior muscle (r s = -0.406, P = 0.001). No significant association was observed between pain extent and the remaining outcomes. Pain drawings constitute an easy and accurate approach to quantify widespread pain. Larger pain extent is associated with pain intensity but not with signs of central sensitization in women with FMS.
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Affiliation(s)
- Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain. .,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain. .,Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
| | - María Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Corrado Cescon
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain 2016; 157:55-64. [PMID: 26270591 PMCID: PMC4711387 DOI: 10.1097/j.pain.0000000000000314] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
One in 10 adults report chronic widespread pain with potential sociocultural variation. Cultural differences in pain reporting should be considered in future research. Supplemental Digital Content is Available in the Text. Chronic widespread pain (CWP) is common and associated with poor general health. There has been no attempt to derive a robust prevalence estimate of CWP or assess how this is influenced by sociodemographic factors. This study therefore aimed to determine, through a systematic review and meta-analysis, the prevalence of CWP in the adult general population and explore variation in prevalence by age, sex, geographical location, and criteria used to define CWP. MEDLINE, Embase, CINAHL, and AMED were searched using a search strategy combining key words and related database-specific subject terms to identify relevant cohort or cross-sectional studies published since 1990. Included articles were assessed for risk of bias. Prevalence figures for CWP (American College of Rheumatology criteria) were stratified according to geographical location, age, and sex. Potential sources of variation were investigated using subgroup analyses and meta-regression. Twenty-five articles met the eligibility criteria. Estimates for CWP prevalence ranged from 0% to 24%, with most estimates between 10% and 15%. The random-effects pooled prevalence was 10.6% (95% confidence intervals: 8.6-12.9). When only studies at low risk of bias were considered pooled, prevalence increased to 11.8% (95% confidence intervals: 10.3-13.3), with reduced but still high heterogeneity. Prevalence was higher in women and in those aged more than 40 years. There was some limited evidence of geographic variation and cultural differences. One in 10 adults in the general population report chronic widespread pain with possible sociocultural variation. The possibility of cultural differences in pain reporting should be considered in future research and the clinical assessment of painful conditions.
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Ayorinde A, Bhattacharya S, Druce K, Jones G, Macfarlane G. Chronic pelvic pain in women of reproductive and post-reproductive age: a population-based study. Eur J Pain 2016; 21:445-455. [DOI: 10.1002/ejp.938] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- A.A. Ayorinde
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - S. Bhattacharya
- Institute of Applied Health Sciences; School of Medicine and Dentistry; University of Aberdeen; Aberdeen UK
| | - K.L. Druce
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - G.T. Jones
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
| | - G.J. Macfarlane
- Epidemiology Group; Institute of Applied Health Sciences; University of Aberdeen; Aberdeen UK
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Somatic Awareness and Tender Points in a Community Sample. THE JOURNAL OF PAIN 2016; 17:1281-1290. [PMID: 27589911 DOI: 10.1016/j.jpain.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 02/05/2023]
Abstract
Somatic awareness (SA) refers to heightened sensitivity to a variety of physical sensations and symptoms. Few attempts have been made to dissociate the relationship of SA and affective symptoms with pain outcomes. We used a validated measure of mood and anxiety symptoms that includes questions related to SA to predict the number of tender points found on physical examination in a large cross-sectional community sample (the Midlife in the United States [MIDUS] Biomarker study). General distress, positive affect, and SA, which were all significantly associated with tender point number in bivariate analyses, were used as predictors of the number of tender points in a multivariate negative binomial regression model. In this model a greater number of tender points was associated with higher levels of SA (P = .02) but not general distress (P = .13) or positive affect (P = .50). Follow-up mediation analyses indicated that the relationship between general distress and tender points was partially mediated by levels of SA. Our primary finding was that SA is strongly related to the number of tender points in a community sample. Mechanisms linking SA to the spatial distribution of pain sensitivity should be investigated further. PERSPECTIVE This article presents an analysis of 3 overlapping psychological constructs and their relationship to widespread pain sensitivity on palpation. The findings suggest that SA is most strongly related to the spatial distribution of pain sensitivity and that further assessing it may improve our understanding of the relationship between psychological factors and pain.
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Abstract
Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.
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Affiliation(s)
- Andrea T Borchers
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA.
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Macfarlane GJ, Beasley M, Prescott G, McNamee P, Keeley P, Artus M, McBeth J, Hannaford P, Jones GT, Basu N, Norrie J, Lovell K. The Maintaining Musculoskeletal Health (MAmMOTH) Study: Protocol for a randomised trial of cognitive behavioural therapy versus usual care for the prevention of chronic widespread pain. BMC Musculoskelet Disord 2016; 17:179. [PMID: 27113442 PMCID: PMC4845348 DOI: 10.1186/s12891-016-1037-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) has been shown to improve outcomes for patients with fibromyalgia, and its cardinal feature chronic widespread pain (CWP). Prediction models have now been developed which identify groups who are at high-risk of developing CWP. It would be beneficial to be able to prevent the development of CWP in these people because of the high cost of symptoms and because once established they are difficult to manage. We will test the hypothesis that among patients who are identified as at high-risk, a short course of telephone-delivered CBT (tCBT) reduces the onset of CWP. We will further determine the cost-effectiveness of such a preventative intervention. METHODS The study will be a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. Eligible participants will be identified from a screening questionnaire sent to patients registered at general practices within three Scottish health boards. Those returning questionnaires indicating they have visited their doctor for regional pain in the last 6 months, and who have two of, sleep problems, maladaptive behaviour response to illness, or high number of somatic symptoms, will be invited to participate. After giving consent, participants will be randomly allocated to either tCBT or usual care. We aim to recruit 473 participants to each treatment arm. Participants in the tCBT group will have an initial assessment with a CBT therapist by telephone, then 6 weekly sessions, and booster sessions 3 and 6 months after treatment start. Those in the usual care group will receive no additional intervention. Follow-up questionnaires measuring the same items as the screening survey questionnaire will be sent 3, 12 and 24 months after start of treatment. The main outcome will be CWP at the 12 month questionnaire. DISCUSSION This will be the first trial of an intervention aimed at preventing fibromyalgia or CWP. The results of the study will help to inform future treatments for the prevention of chronic pain, and aetiological models of its development. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02668003URL: Please check that the following URLs are working. If not, please provide alternatives: NCT02668003Alternative is: https://www.clinicaltrials.gov/ct2/show/NCT02668003> . Date registered: 28-Jan-2016.
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Affiliation(s)
- Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Marcus Beasley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. .,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK.
| | - Gordon Prescott
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Philip Keeley
- Department of Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Majid Artus
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
| | - John McBeth
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
| | - Philip Hannaford
- Centre of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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46
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Zeng F, Sun X, Yang B, Fu X. Life events, anxiety, social support, personality, and alexithymia in female patients with chronic pain: A path analysis. Asia Pac Psychiatry 2016; 8:44-50. [PMID: 26568558 PMCID: PMC5063115 DOI: 10.1111/appy.12222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 10/06/2015] [Indexed: 02/05/2023]
Abstract
INTRODUCTION This study sought to identify a model that explains the relationship between psychosocial factors and chronic pain in female patients, and to explore all of these constructs in a single study and provide a more holistic examination of the overall psychosocial factors that female patients with chronic pain encounter. METHODS Female patients with chronic pain (n = 147), aged 20-65 (M = 34.9 years, SD = 11.25), from an outpatient pain clinic completed a cross-sectional self-report questionnaire on anxiety, life events, personality, social support, and alexithymia. Data were analyzed by means of path analysis. RESULTS The direct effect of anxiety on female patients with chronic pain was greatest among all the paths. Personality and alexithymia led to chronic pain in female patients only indirectly, mediated by life events. The personality factors of neuroticism and extraversion were associated positively with social support, which had an indirect effect on the influence of life events on chronic pain. However, alexithymia was associated negatively with social support, which had an indirect effect on the influence of life events on chronic pain. DISCUSSION Our findings provide evidence that life events are a mediator in the relationship between personality, social support, alexithymia, and chronic pain in female patients.
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Affiliation(s)
- Fanmin Zeng
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xueli Sun
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bangxiang Yang
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqian Fu
- Department of Psychiatry, Suzhou Psychiatry Hospital, Suzhou, China
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47
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Abstract
This review discusses the basic pathophysiological mechanisms that are necessary to understand the principles of diagnosis and management of fibromyalgia, and outlines a practical diagnostic approach to patients presenting with chronic widespread pain.
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Affiliation(s)
- Ernest Suresh
- Senior Consultant Rheumatologist in the Department of Medicine, Ng Teng Fong General Hospital, Singapore 609606
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48
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McCabe PS, Pye SR, Beth JM, Lee DM, Tajar A, Bartfai G, Boonen S, Bouillon R, Casanueva F, Finn JD, Forti G, Giwercman A, Huhtaniemi IT, Kula K, Pendleton N, Punab M, Vanderschueren D, Wu FC, O'Neill TW. Low vitamin D and the risk of developing chronic widespread pain: results from the European male ageing study. BMC Musculoskelet Disord 2016; 17:32. [PMID: 26774507 PMCID: PMC4715359 DOI: 10.1186/s12891-016-0881-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 01/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background The association between low levels of vitamin D and the occurrence of chronic widespread pain (CWP) remains unclear. The aim of our analysis was to determine the relationship between low vitamin D levels and the risk of developing CWP in a population sample of middle age and elderly men. Methods Three thousand three hundred sixty nine men aged 40–79 were recruited from 8 European centres for a longitudinal study of male ageing, the European Male Ageing Study. At baseline participants underwent assessment of lifestyle, health factors, physical characteristics and gave a fasting blood sample. The occurrence of pain was assessed at baseline and follow up (a mean of 4.3 years later) by shading painful sites on a body manikin. The presence of CWP was determined using the ACR criteria for fibromyalgia. Serum 25-hydroxyvitamin D (25-(OH) D) was assessed by radioimmunoassay. Logistic regression was used to determine the relationship between baseline vitamin D levels and the new occurrence of CWP. Results Two thousand three hundred thirteen men, mean age 58.8 years (SD = 10.6), had complete pain and vitamin data available and contributed to this analysis. 151 (6.5 %) developed new CWP at follow up and 577 (24.9 %) were pain free at both time points, the comparator group. After adjustment for age and centre, physical performance and number of comorbidities, compared to those in upper quintile of 25-(OH) D ( ≥36.3 ng/mL), those in the lowest quintile (<15.6 ng/mL) were more likely to develop CWP (Odds Ratio [OR] = 1.93; 95 % CI = 1.0-3.6). Further adjustment for BMI (OR = 1.67; 95 % CI = 0.93-3.02) or depression (OR = 1.77; 95 % CI = 0.98-3.21), however rendered the association non-significant. Conclusions Low vitamin D is linked with the new occurrence of CWP, although this may be explained by underlying adverse health factors, particularly obesity and depression.
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Affiliation(s)
- Paul S McCabe
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK.
| | - Stephen R Pye
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK
| | - John Mc Beth
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK.,Arthritis Research Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
| | - David M Lee
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK
| | - Abdelouahid Tajar
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK
| | - Gyorgy Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-Gyorgy Medical University, Szeged, Hungary
| | - Steven Boonen
- University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Roger Bouillon
- Department of Experimental Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Felipe Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, CIBER de Fisiopatología Obesidad y Nutricion, Instituto Salud Carlos III, ; Santiago de Compostela, Spain
| | - Joseph D Finn
- Andrology Research Unit, Centre for Endocrinology and Diabetes, University of Manchester, Manchester, UK
| | - Gianni Forti
- Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Aleksander Giwercman
- Scanian Andrology Centre, Department of Urology, Malmö University Hospital, University of Lund, Lund, Sweden
| | - Ilpo T Huhtaniemi
- Department of Reproductive Biology, Imperial College London, London, UK
| | - Krzysztof Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Lodz, Poland
| | - Neil Pendleton
- Clinical Gerontology, University of Manchester, Salford Royal Hospital, Salford, UK
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Frederick C Wu
- Andrology Research Unit, Centre for Endocrinology and Diabetes, University of Manchester, Manchester, UK
| | - Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Stopford Building, Oxford Road, M13 9PT, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Walitt B, Nahin RL, Katz RS, Bergman MJ, Wolfe F. The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey. PLoS One 2015; 10:e0138024. [PMID: 26379048 PMCID: PMC4575027 DOI: 10.1371/journal.pone.0138024] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/24/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most knowledge of fibromyalgia comes from the clinical setting, where healthcare-seeking behavior and selection issues influence study results. The characteristics of fibromyalgia in the general population have not been studied in detail. METHODS We developed and tested surrogate study specific criteria for fibromyalgia in rheumatology practices using variables from the US National Health Interview Survey (NHIS) and the modification (for surveys) of the 2010 American College of Rheumatology (ACR) preliminary fibromyalgia criteria. The surrogate criteria were applied to the 2012 NHIS and identified persons who satisfied criteria from symptom data. The NHIS weighted sample of 8446 persons represents 225.7 million US adults. RESULTS Fibromyalgia was identified in 1.75% (95% CI 1.42, 2.07), or 3.94 million persons. However, 73% of identified cases self-reported a physician's diagnosis other than fibromyalgia. Identified cases had high levels of self-reported pain, non-pain symptoms, comorbidity, psychological distress, medical costs, Social Security and work disability. Caseness was associated with gender, education, ethnicity, citizenship and unhealthy behaviors. Demographics, behaviors, and comorbidity were predictive of case status. Examination of the surrogate polysymptomatic distress scale (PSD) of the 2010 ACR criteria found fibromyalgia symptoms extending through the full length of the scale. CONCLUSIONS Persons identified with criteria-based fibromyalgia have severe symptoms, but most (73%) have not received a clinical diagnosis of fibromyalgia. The association of fibromyalgia-like symptoms over the full length of the PSD scale with physiological as well as mental stressors suggests PSD may be a universal response variable rather than one restricted to fibromyalgia.
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Affiliation(s)
- Brian Walitt
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Richard L. Nahin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Robert S. Katz
- Rush University Medical Center, Chicago, IL, United States of America
| | - Martin J. Bergman
- Drexel University College of Medicine, Philadelphia, PA, United States of America
| | - Frederick Wolfe
- National Data Bank for Rheumatic Diseases, Wichita, KS, United States of America
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Macfarlane GJ, Beasley M. Alcohol Consumption in Relation to Risk and Severity of Chronic Widespread Pain: Results From a UK Population-Based Study. Arthritis Care Res (Hoboken) 2015; 67:1297-1303. [PMID: 26212017 PMCID: PMC4855637 DOI: 10.1002/acr.22604] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/12/2015] [Accepted: 04/21/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine whether the reported level of alcohol consumption is associated with the likelihood of reporting chronic widespread pain (CWP) and, among persons with CWP, the associated disability. METHODS In a population-based study in 2 areas of the UK, participants self-completed a postal questionnaire. They were classified according to whether they met the American College of Rheumatology definition of CWP and whether the pain was disabling (Chronic Pain Grade III or IV). They reported their usual level of alcohol consumption. Potential confounding factors on which information was available included age, sex, cigarette smoking, employment status, self-reported weight and height, and level of deprivation. RESULTS A total of 13,574 persons participated (mean age 55 years, 57% women) of whom 2,239 (16.5%) had CWP; 28% reported never regularly consuming alcohol, 28% reported consuming up to 5 units/week, 20% reported 6-10 units/week, and 24% reported >10 units/week. Among persons with CWP, disability was strongly linked to level of alcohol consumption. Prevalence of disability decreased with increasing alcohol consumption up to 35 units/week (odds ratio [OR]21-35 units alcohol/week versus never drinkers 0.33 [95% confidence interval (95% CI) 0.19-0.58]) adjusted for confounders. A similar relationship was found between reporting CWP and level of alcohol consumption (adjusted OR21-35 units alcohol/week versus never drinkers 0.76 [95% CI 0.61-0.94]). CONCLUSION This study has demonstrated strong associations between level of alcohol consumption and both CWP and related disabilities. However, the available evidence does not allow us to conclude that the association is causal. The strength of the associations means that specific studies to examine this potential relationship are warranted.
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Affiliation(s)
- Gary J. Macfarlane
- Gary J. Macfarlane, PhD, MD(Hons), Marcus Beasley, BSc, MSc: School of Medicine and DentistryUniversity of AberdeenAberdeenUK
| | - Marcus Beasley
- Gary J. Macfarlane, PhD, MD(Hons), Marcus Beasley, BSc, MSc: School of Medicine and DentistryUniversity of AberdeenAberdeenUK
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