Associations Between Musculoskeletal Pain Experience and Pressure and Cold Pain Sensitivity: A Community-based Cross-sectional Study of Young Adults in the Raine Study

Increased central sensitivity is associated with greater shoulder disability in people with musculoskeletal shoulder symptoms: a cross-sectional study

BACKGROUND

To fully comprehend shoulder pain and disability, a better understanding of the factors that may contribute to chronicity is required, i.e., increased central sensitivity.

OBJECTIVE

To determine the association between increased central sensitivity and shoulder disability whilst accounting for confounding factors. To determine the prevalence of increased central sensitivity in those with musculoskeletal shoulder symptoms.

DESIGN

Cross sectional design collecting data via an online survey. Participants with shoulder symptoms were recruited via social media and through flyer advertisement in Australia.

METHODS

The Central Sensitivity Inventory and Shoulder Pain and Disability Index were used. Confounding factors included sex, age, socioeconomic status, obesity, psychological distress, sleep quality, physical activity, smoking, ethnicity, and the symptoms of neuropathic pain. The association between increased central sensitivity and shoulder disability was assessed by linear regression whilst adjusting for confounding factors. The percentage of participants with increased central sensitivity was calculated.

RESULTS

In 249 participants with shoulder symptoms, increased central sensitivity was positively associated with greater shoulder disability, either as a categorical (coefficient 5.5, 95 % CI 0.1-11.0, p 0.046) or continuous variable (coefficient 0.2, 95 % CI 0.03-0.50, p 0.025) whilst adjusting for confounding factors. In the sample, 48.2 % of survey respondents met the threshold for having increased central sensitivity.

CONCLUSION

Increased central sensitivity was positively associated with greater disability even when accounting for multiple confounders in participants with musculoskeletal shoulder symptoms. These findings highlight the importance of considering increased central sensitivity in the clinical management of those with shoulder symptoms.

Pressure and cold pain threshold reference values in a pain-free older adult population

Background

More sex-specific pain sensitivity normative values from population-based cohorts in pain-free older adults are required. The aims of this study were (1) to provide sex- and age-specific normative values of pressure and cold pain thresholds in older pain-free adults and (2) to examine the association of potential correlates of pain sensitivity with pain threshold values.

Methods

This study investigated sex-specific pressure (lumbar spine, tibialis anterior, neck and dorsal wrist) and cold (dorsal wrist) pain threshold estimates for older pain-free adults aged 41-70 years. This cross-sectional study used participants (n = 212) from the Raine Study Gen1-26 year follow-up. The association of pain thresholds, with correlates including sex, test site, ethnicity, waist-hip ratio, smoking status, health-related quality of life, depression, anxiety and stress symptoms, sleep quality, socioeconomic status and physical activity levels, was examined.

Results

Values for pressure and cold pain thresholds for older pain-free adults are provided, grouped by vicennium, sex and test site (pressure). Statistically significant independent correlates of increased pressure pain sensitivity were test site, ethnicity and sex. Only lower waist/hip ratio was a statistically significant, independent correlate of increased cold pain sensitivity.

Conclusions

This study provides robust sex- and age-specific normative values for pressure pain threshold and cold pain threshold for an older adult pain-free population. Combined with existing values, these data provide an important resource in assisting interpretation of pain sensitivity in clinical pain disorders and provide insights into the complex association of pain sensitivity with correlates that can be used in research.

Relationship of Healthy Building Determinants With Musculoskeletal Disorders of the Extremities: A Systematic Review

Musculoskeletal disorders (MSDs) are a substantial societal burden and various factors affect their causation, recovery, and prognosis. Management of MSDs is complex and requires multifaceted interventions. Given the challenges of MSDs and their continued burden, it is possible that additional elements could impact these disorders that have not been fully researched, for example, indoor environmental quality. Our previous review provided preliminary evidence that healthy building determinants (HBDs) are associated with the risk of back and neck pain. However, the relationship of HBDs with extremity MSDs and general MSDs (i.e., MSDs involving multiple body regions or in which body regions were unspecified in the original reports) has not been formally studied. The purpose of this review was to conduct a systematic literature review to assess the relationship of HBDs with extremity and general MSDs (PROSPERO ID: CRD42022314832). PubMed, CINAHL, Embase, and PEDRo databases were searched through April 2022. Inclusion criteria for study eligibility were as follows: humans of ages ≥18 years, reported on one or more of eight HBDs (1. air quality and ventilation, 2. dust and pests, 3. lighting and views, 4. moisture, 5. noise, 6. safety and security, 7. thermal health, 8. water quality), and compared these HBDs with extremity MSDs or general MSDs, original research, English. Exclusion criteria were as follows: articles not published in peer-reviewed journals, full-text articles unavailable. Review procedures were conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Empirical evidence statements were developed for 33 pairwise comparisons of HBDs with MSDs. The search uncovered 53 eligible studies with 178,532 participants. A total of 74.6% (39/53) of the studies were cross-sectional and 81.1% (43/53) were fair quality. Overall, the majority of uncovered evidence indicates that HBDs are related to risk of extremity and general MSDs. Nineteen comparisons support that as HBDs worsen, the risk of MSDs increases. Six comparisons had conflicting evidence. Three comparisons support that poor HBDs are not related to increased risk of extremity and general MSDs. Five comparisons had no evidence. This systematic review builds upon previous work to provide useful starting points to enhance awareness about the HBD-MSD relationship. These findings can help inform research and public health efforts aimed at addressing suboptimal HBDs through appropriate interventions to improve the lives of those suffering from MSDs.

Association between long-term static postures exposure and musculoskeletal disorders among university employees: A viewpoint of inflammatory pathways

Background

Musculoskeletal disorders (MSDs) are critical occupational and social problems. With the improvement of production mechanization and automation, and the widespread application of computers, more occupations are exposed to static postures and load. This study explored the role of inflammation in the association between static postures exposure and MSDs.

Methods

This study adopted a prospective nested case-control design in which 66 lower back MSDs cases and 66 healthy controls were selected from a cohort study of university employees. The personal information, postural load, musculoskeletal symptoms, pressure pain thresholds (PPTs), and inflammatory cytokines were collected. Logistic and linear regressions were used to investigate the association among postural load, inflammatory cytokines, and lower back MSDs. Mediation analysis was used to calculate the mediation effect.

Results

The results of logistic and linear regressions showed that postural load and inflammatory cytokines were positively associated with lower back MSDs (P < 0.05), and postural load was positively associated with inflammatory cytokines (P < 0.05). Further, mediation analysis showed that the mediation effect of postural load on the lower back MSDs through TNF-α was 0.073 (95%CI: 0.025-0.128), and the mediation effect of posture load on the lower back MSDs through IL-6 was 0.098 (95%CI: 0.041-0.179), respectively.

Conclusion

Static postures were associated with the occurrence of MSDs through inflammatory cytokines, and low-level inflammation may be a critical early event in the generation of MSDs. This study may help bridge the gap of potential mechanisms linking static postures to increased risks of MSDs, and provide new evidence for targeted protection against the global increasing MSDs.

Association between pelvic pain bothersomeness and pain sensitivity: A community-based cross-sectional study of young adult females in the Raine Study

OBJECTIVE

Pelvic pain has been associated with augmented nociceptive processing, but large studies controlling for multiple potential confounding factors are lacking. This study investigated the association between pelvic pain bothersomeness and pain sensitivity in young adult women, accounting for potential confounding factors.

DESIGN

Cross-sectional study.

SETTING

Community-dwelling sample.

POPULATION

The Raine Study Gen2-22 year follow-up (n = 475).

MAIN OUTCOME MEASURES

The experience of bothersomeness related to pelvic pain was determined from a question in the Urogenital Distress Inventory short form. Pain sensitivity was measured using pressure pain and cold pain thresholds. Potential confounding factors included ethnicity, marital status, highest level of education, income, waist-hip ratio, level of activity, sleep quality, smoking, comorbidity history, C-reactive protein level, musculoskeletal pain experience and psychological distress.

RESULTS

Three hundred and sixty-two women (76.2%) reported no pelvic pain bothersomeness, 74 (15.6%) reported mild pelvic pain bothersomeness and 39 (8.2%) reported moderate-severe pelvic pain bothersomeness. After adjusting for marital status (and test site), moderate-severe pelvic pain bothersomeness was associated with a lower pressure pain threshold (i.e. greater pressure pain sensitivity) (coefficient -51.46, 95% CI -98.06 to -4.86, p = 0.030). After adjusting for smoking, moderate-severe pelvic pain bothersomeness was also associated with a higher cold pain threshold (i.e. greater cold pain sensitivity) (coefficient 4.35, 95% CI 0.90-7.79, p = 0.014).

CONCLUSIONS

This study suggests augmented nociceptive processing as a contributing factor in pelvic pain bothersomeness for some women. Thorough assessment of women who present clinically with pelvic pain should consider pain sensitivity as a potential contributing factor to their presentation.

Heritability of musculoskeletal pain and pain sensitivity phenotypes: two generations of the Raine Study

ABSTRACT

There is a need to better understand biological factors that increase the risk of persistent musculoskeletal pain and heightened pain sensitivity. Knowing the heritability (how genes account for differences in people's traits) can enhance the understanding of genetic versus environmental influences of pain and pain sensitivity. However, there are gaps in current knowledge, including the need for intergenerational studies to broaden our understanding of the genetic basis of pain. Data from Gen1 and Gen2 of the Raine Study were used to investigate the heritability of musculoskeletal pain, and pressure and cold pain sensitivity. Participants included parents (Gen 1, n=1092) and their offspring (Gen 2, n=688) who underwent a battery of testing and questionnaires including pressure and cold pain threshold testing and assessments of physical activity, sleep, musculoskeletal pain, mental health and adiposity. Heritability estimates were derived using the Sequential Oliogenic Linkage Analysis Routines (SOLAR) software. Heritability estimates for musculoskeletal pain and pressure pain sensitivity were significant, accounting for between 0.190 and 0.289 of the variation in the phenotype. In contrast, heritability of cold pain sensitivity was not significant. This is the largest intergenerational study to date to comprehensively investigate the heritability of both musculoskeletal pain and pain sensitivity, using robust statistical analysis. This study provides support for the heritability of musculoskeletal pain and pain sensitivity to pressure, suggesting the need for further convergence of genetic and environmental factors in models for the development and/or maintenance of these pain disorders.

Interaction between occupational physical burdens and low job control on musculoskeletal pain: Analysis of the 5th Korean Working Environment Survey

OBJECTIVE

This study aimed to investigate the interactive impacts between occupational physical burdens and psychological job demand or control on musculoskeletal pain (MSP) using nationally representative data for Korean workers.

METHODS

Using 5th Korean Working Conditions Survey (KWCS), we explored the interaction between occupational physical burdens and levels of psychological job demand or control on risk of MSP in 49 572 eligible participants. For quantitative evaluation of the interaction, relative excess risk due to interaction (RERI) was calculated.

RESULTS

In a group with low job control and at least one occupational physical burden, odds ratio (OR) for neck and upper extremity pain was 2.44 (95% CI, 2.24-2.66) compared with a group with high job control and no physical burden (a reference group: lowest risk), which was the highest value among the four groups, and the RERI was 0.35 (95% CI, 0.19-0.51). Similarly, OR for lower extremity pain was 2.15 (95% CI, 1.95-2.37) and RERI was 0.26 (95% CI, 0.07-0.45). However, the RERI was not significant in the case of psychological job demand.

CONCLUSION

This study revealed significant interactions between occupational physical burdens and low job control on MSP.