Prevalence and characteristics of chronic Pain in the Chinese community-dwelling elderly: a cross-sectional study

Depression and its influencing factors among older adults with chronic pain in China: an empirical analysis based on CHARLS data

Background

China's aging problem is intensifying, the older adult not only face a variety of chronic physical diseases and pain, but also have higher levels of depression than other age groups. This study explores the related factors of depression in older adults with chronic pain in China and provide evidence and reference for the formulation of intervention policies and measures.

Methods

Using the data of the fifth wave of national survey conducted by the China Health and Retirement Longitudinal Study (CHARLS) in 2020, a total of 10,581 older adults with chronic pain were selected as research objects, and their depression status was measured by the Depression Scale (CES-D). Chi-square test and multiple logistic regression were used to analyze the main factors affecting depression in older adults with chronic pain.

Results

The results of multivariate logistic regression analysis showed: gender (female: OR = 1.28, 95%CI = 1.16-1.41), age (≥75 years old: OR = 0.49, 95%CI = 0.42-0.56), spouse/partner living together (no: OR = 1.19, 95%CI = 1.06-1.32), place of residence (rural: OR = 1.19, 95%CI = 1.06-1.32), education level (High school and above: OR = 1.19, 95%CI = 1.06-1.32); satisfaction with child relationship (satisfaction: OR = 0.22, 95%CI = 0.18-0.28), smoking (no: OR = 0.60, 95%CI = 0.41-0.86), Internet use in the past month (Yes: OR = 0.77, 95%CI = 0.68-0.86), nap duration (1 ~ <2 h: OR = 0.75, 95%CI = 0.66-0.85; ≥2 h: OR = 0.75, 95%CI = 0.66-0.85), night sleep duration (6 ~ <8 h: OR = 0.75, 95%CI = 0.66-0.85; ≥8 h: OR = 0.56, 95%CI = 0.49-0.63), BADL damaged (Yes: OR = 1.45, 95%CI = 1.31-1.62), IADL damaged (Yes: OR = 1.31, 95%CI = 1.17-1.45), received outpatient services in the past month (Yes: OR = 1.18, 95%CI = 1.06-1.31), pain (Quite a Bit/Very: OR = 1.41, 95%CI = 1.26-1.58), number of body parts that feeling pain (1 ~ 3: OR = 1.42, 95%CI = 1.27-1.60; 4-6: OR = 1.76, 95%CI = 1.51-2.04; 7 ~ 9: OR = 2.21, 95%CI = 1.82-2.67; ≥10: OR = 2.63, 95%CI = 2.15-3.22) are the influencing factors of depressive symptoms in older adults with chronic pain (p < 0.05).

Conclusion

The incidence of depressive symptoms in older adults with chronic pain is 31.7%, and their depression status is affected by various factors. Medical and health institutions and policy makers should pay attention to the mental health of these older adults, and take targeted measures to improve health education, disease treatment, pain management, sleep improvement, family support, and other aspects according to their characteristics.

Impact of BMI and Work Environment Circumstances on Prevalence and Severity of Chronic Pain among Nurses

PURPOSE

The objective of this study was to explore the relationship between workplace conditions, demographic characteristics, and physical attributes with the prevalence and severity of chronic pain among nurses. The goal was to gain insights into the factors contributing to chronic pain within the nursing profession.

METHODS

A cross-sectional descriptive-analytic study was conducted among 415 nurses in Turkey using purposive convenience sampling. Data collection instruments included the Graded Chronic Pain Scale, a body diagram, a pain exacerbator/alleviator inquiry, and a socio-demographic form. Data were analyzed using SPSS 25.

RESULTS

The majority of participants were female nurses (87.7%) with a mean age of 34.62 ± 9.32 and a body mass index (BMI) of 24.51 ± 4.32. Nearly half reported irregular exercise habits (49.9%), and 36.1% indicated high levels of work-related stress. A significant proportion exhibited moderate levels of work-related anxiety (39%), smoked (40%), and consumed alcohol (37.1%). Chronic pain was experienced by 40.9% on most days, with the head and lumbar regions being the most affected (45.5% and 44.1%, respectively). The study identified a significant association between BMI and pain frequency (p = .043) and severity (p < .014). Furthermore, pain localization and management strategies varied between male and female nurses.

DISCUSSION

The study's results underscore the substantial impact of chronic pain on nurses' quality of life, activity levels, and work attendance. Notably, the study provides results that support the relationship between BMI and chronic pain. The study revealed gender-specific differences in pain localization and management strategies among nurses, highlighting the importance of gender-tailored interventions in chronic pain management among nurses.

CONCLUSION

Addressing the interplay between BMI, work-related factors, and chronic pain is vital for nurses' well-being and a conducive work environment, potentially reducing financial costs associated with medical leave and absenteeism.

Association of loneliness with the risk of pain in older Chinese adults

This study investigates the long-term effects of loneliness on pain experiences in older Chinese adults, focusing on the mediating role of depression. Data from the China Health and Retirement Longitudinal Study (2013-2020) included 1,592 participants aged 60 and above. Using robust mixed-effects logistic regression models, the study found that lonely participants were more likely to experience 12 site pain: headache (OR 1.23; 95% CI 1.09-1.39), shoulder (OR 1.16; 95% CI 1.04-1.30), wrist (OR 1.14; 95%CI 1.01-1.28), finger (OR 1.14, 95% CI 1.02-1.28), chest (OR 1.26; 95% CI 1.10-1.44), stomach (OR 1.28, 95% CI 1.12-1.46), back (OR 1.23; 95% CI 1.00-1.51), waist (OR 1.46; 95% CI 1.17-1.83), buttock (OR 1.15, 95% CI 1.02-1.30), leg (OR 1.20, 95% CI 1.08-1.33), knee (OR 1.16; 95% CI 1.04-1.30), and toe (OR 1.18; 95% CI 1.04-1.34) than participants who were not lonely. No such finding was found for neck, arm, or ankle pain. The risk of pain due to loneliness did not decrease with an increase in the frequency of social activities. These findings emphasize the need to address mental health as a crucial factor in pain prevention and management.

Effectiveness of Outpatient Chronic Pain Management for Middle-Aged Patients by Internet Hospitals: Retrospective Cohort Study

Background

Chronic pain is widespread and carries a heavy disease burden, and there is a lack of effective outpatient pain management. As an emerging internet medical platform in China, internet hospitals have been successfully applied for the management of chronic diseases. There are also a certain number of patients with chronic pain that use internet hospitals for pain management. However, no studies have investigated the effectiveness of pain management via internet hospitals.

Objective

The aim of this retrospective cohort study was to explore the effectiveness of chronic pain management by internet hospitals and their advantages and disadvantages compared to traditional physical hospital visits.

Methods

This was a retrospective cohort study. Demographic information such as the patient's sex, age, and number of visits was obtained from the IT center. During the first and last patient visits, information on outcome variables such as the Brief Pain Inventory (BPI), medical satisfaction, medical costs, and adverse drug events was obtained through a telephone follow-up. All patients with chronic pain who had 3 or more visits (internet or offline) between September 2021, and February 2023, were included. The patients were divided into an internet hospital group and a physical hospital group, according to whether they had web-based or in-person consultations, respectively. To control for confounding variables, propensity score matching was used to match the two groups. Matching variables included age, sex, diagnosis, and number of clinic visits.

Results

A total of 122 people in the internet hospital group and 739 people in the physical hospital group met the inclusion criteria. After propensity score matching, 77 patients in each of the two groups were included in the analysis. There was not a significant difference in the quality of life (QOL; QOL assessment was part of the BPI scale) between the internet hospital group and the physical hospital group (P=.80), but the QOL of both groups of patients improved after pain management (internet hospital group: P<.001; physical hospital group: P=.001). There were no significant differences in the pain relief rate (P=.25) or the incidence of adverse events (P=.60) between the two groups. The total cost (P<.001) and treatment-related cost (P<.001) of the physical hospital group were higher than those of the internet hospital group. In addition, the degree of satisfaction in the internet hospital group was greater than that in the physical hospital group (P=.01).

Conclusions

Internet hospitals are an effective way of managing chronic pain. They can improve patients' QOL and satisfaction, reduce treatment costs, and can be used as part of a multimodal strategy for chronic pain self-management.

Development of a set of indicators for the quality of chronic pain management in Chinese community-dwelling older adults: a Delphi study

BACKGROUND

Standardized and systematic quality assessments of chronic pain management, particularly among older adult populations, are lacking in resource-limited community settings. A specific set of indicators to evaluate the quality of chronic pain management in this population has yet to be developed. Therefore, the present study constructed a set of indicators to assess the quality of chronic pain management in Chinese community-dwelling older adults, providing a standardized reference and guidance for community health centers to manage chronic pain in this population.

METHODS

The indicator set was developed in three steps. Step 1 involved preparation by forming a research team and establishing the guiding theory. Step 2 included developing an expert inquiry questionnaire based on a literature review and semi-structured interviews. Step 3 completed the construction of the indicator set through the Delphi method and hierarchical analysis to quantify the relative importance of each indicator and ensure the development of a scientifically validated and practically applicable evaluation model.

RESULTS

The final set of indicators for evaluating the quality of chronic pain management among community-dwelling older adults in China comprised three primary indicators: structural quality indicator, process quality indicator, and outcome quality indicator. Structural quality indicators included 3 secondary and 11 tertiary indicators; process quality indicators included 4 secondary and 21 tertiary indicators; and outcome quality indicators included 2 secondary and 4 tertiary indicators. Across two rounds of questionnaires, the response rate was 100%, with expert authority coefficients of 0.924 and 0.938, coefficients of variation ranging from 0 to 0.32 and 0 to 0.20, and Kendall's concordance coefficients of 0.302 and 0.220, respectively. Hierarchical analysis showed that the consistency ratios of all indicators were < 0.1000, indicating a balanced distribution of indicator weights.

CONCLUSIONS

This study introduces a preliminary framework, based on the "Structure-Process-Outcome" theory, to evaluate chronic pain management in Chinese community-dwelling older adults. Its reliance on expert opinions without empirical validation, exclusion of patient perspectives, and focus on Chinese communities limit its applicability and generalizability. Future research should address these limitations by incorporating patient feedback, empirically validating indicators, and evaluating their applicability across diverse populations.

Impact of Pain on Activities of Daily Living in Older Adults: A Cross-Sectional Analysis of Korean Longitudinal Study of Aging (KLoSA)

Pain, particularly musculoskeletal (MSK) and multi-site pain, significantly impacts activities of daily living (ADL) in the elderly, leading to a decline in overall quality of life (QoL). This study, comprising 7490 participants, (mean age: 69 ± 10; females: 57%) from the sixth wave of the Korean Longitudinal Study of Aging (KLoSA), aimed to assess the association between self-reported pain and ADL impairment among the elderly population. Notably, 62% of participants reported experiencing pain, with back pain being the most prevalent (36%) and stomachache the least (0.39%). A majority (61%) of individuals reported MSK-related pain. Additionally, 20% reported pain at one site and 0.03% experienced pain at 12 sites. ADL impairment was observed in 376 (5.0%) participants. Compared to those without pain, participants reporting moderate and severe pain had higher odds of ADL impairment [2.31 (95% CI, 1.66-3.21) and 2.98 (95% CI, 1.95-4.53), respectively]. Pain experienced in the shoulder, arm, wrist, back, hip, leg, and ankle had a significant association with ADL impairment, with ORs ranging from 2.66 (95% CI, 1.80-3.93; hip pain) to 1.36 (95% CI 1.07-1.72; back pain). Furthermore, multi-site pain was associated with higher ADL impairment [1-6 sites: OR: 1.49 (95% CI, 1.11-2.01); 7-12 sites: OR: 7.16 (95% CI, 3.60-14.26)]. These findings underscore the importance of addressing MSK and multi-site pain through targeted interventions, potentially enhancing ADL and contributing to an improved QoL among the elderly population.

The effectiveness, acceptability, and sustainability of non-pharmacological interventions for chronic pain management in older adults in mainland China: A systematic review

OBJECTIVES

This systematic review aims to assess the effectiveness, acceptability, and sustainability of non-pharmacological pain management interventions for older adults in mainland China.

MATERIALS AND METHODS

Articles searching was conducted across six databases, including MEDLINE, PubMed, PsycINFO, Web of Science, China National Knowledge Infrastructure (CNKI), and WanFangdata. Quality appraisal was performed using the revised Cochrane risk of bias tool.

RESULTS

A total of 26 articles met the inclusion criteria, involving 2,197 participants with a mean age of 69.19 years. The participants' ages ranged from 63.85 to 81.75 years. The evaluated non-pharmacological interventions included psychotherapy, acupuncture, exercise, massage, neurotherapy, and multidisciplinary interventions. The overall changes in pain intensity varied from -5.19 to -0.65 on a numeric rating scale ranging from zero to ten.

CONCLUSIONS

Non-pharmacological interventions proved effective in alleviating pain intensity among older adults in mainland China. The findings suggest that mindfulness, exercise and pain education can be promoted as viable strategies for enhancing the well-being of the elderly population.

Mediating effect of depressive symptoms on the relationship of chronic pain and cardiovascular diseases among Chinese population: Evidence from the CHARLS

OBJECTIVE

Few studies have examined the direct or indirect effect of chronic pain on cardiovascular diseases (CVD) within Chinese population. The objective aimed to investigate the mediating role of depressive symptoms between chronic pain and CVD.

METHODS

6522 participants from China Health and Retirement Longitudinal Study were included in this retrospective cohort study. The main endpoint was the occurrence of CVD. Weighted multivariate logistic regression was used to assess the association between chronic pain and depressive symptoms. Distribution-of-product method was employed to examine the mediation effect of depressive symptoms. Subgroup analyses were performed.

RESULTS

219 developed CVD at the end of follow-up period. After adjusting all confounding variables, chronic pain was associated with increased risk of depressive symptoms in total population [odds ratio (OR) = 3.85, 95%confidence interval (CI): 3.35-4.42]. Among total population, there was a positive association of chronic pain and CVD [risk ratio (RR)a = 2.00, 95% CI: 1.33-3.00] (total effect). After further adjusting depressive symptoms, the association between chronic pain and CVD was significant (RRb = 1.67, 95% CI: 1.16-2.41) (direct effect). According to the distribution-of-product test, we observed a mediating effect of depressive symptoms on the relationship between chronic pain and CVD with the percentage of mediation of 32.8%. The mediating effect of depression was observed in individuals of aged45-65 years old, female participants, participants who never drinking and not have hypertension.

CONCLUSION

Chronic pain was positively associated with CVD for Chinese population, and depressive symptoms was considered to mediate the association between chronic pain and CVD.

Association between chronic pain classes and cognitive function in older adults: A cross-sectional study based on latent class analysis

The purpose of this study was to identify latent classes of chronic pain in older adults based on perceptual, cognitive, behavioral, emotional and social factors, and to explore the associations between each class of chronic pain and different cognitive domains. A total of 629 participants were included. Three classes of chronic pain were identified: "episodic recurrent mild pain with good psychosocial state" (class 1), "episodic recurrent moderate pain with general psychosocial state" (class 2) and "continuous multilocational severe pain with attacks accompanied by poor psychosocial state and avoidance of activity" (class 3). After adjusting for relevant confounders, chronic pain presenting as class 1 was associated with worse memory; class 2 was associated with worse global cognitive function, memory, information processing speed, and executive function; and class 3 was additionally associated with worse attention compared to class 2. The findings contribute to the development of targeted programs for treating pain and improving cognitive functioning.

Pain: its prevalence and correlates among the oldest old

BACKGROUND

There is very limited knowledge regarding pain among the oldest old.

AIMS

To investigate the prevalence and correlates of pain among the oldest old.

METHODS

Data were taken from the "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)", including individuals living in North Rhine-Westphalia aged 80 years and over. Pain was categorized as no pain, moderate pain and severe pain. Its prevalence was stratified by sex, age groups, marital status, place of residence and education. A multinomial logistic regression analysis was conducted.

RESULTS

28.50% of the participants reported no pain, 45.06% moderate pain and 26.44% severe pain. Regressions showed that being 85 years or older and a better self-rated health status decreased the likelihood of moderate pain. Being 85-89 years old, being male, highly educated and a better self-rated health status decreased the likelihood of severe pain. The likelihood of moderate and severe pain increased with a higher number of chronic diseases.

DISCUSSION

Study findings showed a high prevalence of pain in the oldest old living in North Rhine-Westphalia, Germany. The likelihood of having moderate or severe pain was reduced among those who were older and presented with a better self-rated health but increased with a growing number of comorbidities. Severe pain was less likely among men and those with a higher education.

CONCLUSION

This cross-sectional representative study adds first evidence of prevalence and correlations of pain among the oldest old. Longitudinal studies are required to further explore the determinants of pain in this age group.

Brain-derived neurotrophic factor (BDNF) in chronic pain research: A decade of bibliometric analysis and network visualization

Chronic pain research, with a specific focus on the brain-derived neurotrophic factor (BDNF), has made impressive progress in the past decade, as evident in the improved research quality and increased publications. To better understand this evolving landscape, a quantitative approach is needed. The main aim of this study is to identify the hotspots and trends of BDNF in chronic pain research. We screened relevant publications from 2013 to 2022 in the Scopus database using specific search subject terms. A total of 401 documents were selected for further analysis. We utilized several tools, including Microsoft Excel, Harzing's Publish or Perish, and VOSViewer, to perform a frequency analysis, citation metrics, and visualization, respectively. Key indicators that were examined included publication growth, keyword analyses, topmost influential articles and journals, networking by countries and co-citation of cited references. Notably, there was a persistent publication growth between 2015 and 2021. "Neuropathic pain" emerged as a prominent keyword in 2018, alongside "microglia" and "depression". The journal Pain® was the most impactful journal that published BDNF and chronic pain research, while the most influential publications came from open-access reviews and original articles. China was the leading contributor, followed by the United States (US), and maintained a leadership position in the total number of publications and collaborations. In conclusion, this study provides a comprehensive list of the most influential publications on BDNF in chronic pain research, thereby aiding in the understanding of academic concerns, research hotspots, and global trends in this specialized field.

Contribution of pain to subsequent cognitive decline or dementia: A systematic review and meta-analysis of cohort studies

BACKGROUND

Dementia is an urgent public health problem worldwide, and the determination of the contribution of pain to cognitive decline or dementia is significant for the prevention of dementia.

OBJECTIVE

To comprehensively explore the contribution of pain to subsequent cognitive decline or dementia and analyze possible influencing factors.

DESIGN

Systematic review and meta-analysis of cohort studies.

METHODS

We systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, China National Knowledge Internet, WANFANG DATA and VIP for cohort studies from database inception to January 21, 2022. Random-effects meta-analysis was used to pool odds ratios (ORs) and 95% confidence intervals (CIs) of incident cognitive decline or dementia among patients with pain. Subgroup analyses and meta-regression were used to explore the sources of heterogeneity.

RESULTS

A total of 35 cohort studies containing 1,122,503 participants were included. As a whole, pain (OR = 1.24; 95% CI = 1.17-1.31) was a risk factor for subsequent cognitive decline or dementia; headache, migraine, tension-type headache, widespread pain, and irritable bowel syndrome, but not burning mouth syndrome, were also risk factors. Pain increased the risk of all-cause dementia (OR = 1.26; 95% CI = 1.18-1.35), Alzheimer's disease (OR = 1.28; 95% CI = 1.12-1.47), and vascular dementia (OR = 1.31; 95% CI = 1.06-1.62). Pain interference (OR = 1.42; 95% CI = 1.16-1.74) was associated with an increased risk of cognitive decline or dementia, while pain intensity was not. Pooled results from studies with sample sizes less than 2000 or with relatively low quality showed that pain did not increase the risk of cognitive decline or dementia. There was no statistically significant increase in the risk of cognitive decline or dementia in people with pain aged ≥75 years.

CONCLUSIONS

Our results demonstrated that pain increased the risk of subsequent cognitive decline or dementia. Sample size, study methodological quality, types of pain, pain severity (pain interference), and age composition of the study population may affect the relationship between pain and cognitive decline or dementia.

REGISTRATION

PROSPERO (CRD42022316406).

Prevalence and influencing factors of chronic pain in middle-aged and older adults in China: results of a nationally representative survey

Background

With China's rapidly aging population, chronic pain has become a major public health issue. This article aims at determining associations between chronic pain and multiple factors, including demographic characteristics, health status, and health service utilization of middle-aged and older adults in China.

Methods

We selected all the 19,829 respondents who were over 45 years old from the China Health and Aging Tracking Survey 2018 (CHARLS) as our study population. The key information in terms of the body pain, demographic characteristics, health status, behaviors and health services use was extracted and analyzed. Logistic regression model was used to determine the influencing factors of chronic pain.

Results

Analysis revealed that 60.02% (9,257) of the data from this survey reported physical pain, with pain sites concentrated at the head (40.9%), lower back (62.2%) and knees (47.2%). Pain was positively associated with influencing factors for pain: being a female (OR = 2.10, 95% CI 1.90-2.33, p < 0.001), living in a western region (OR = 1.28, 95% CI 1.16-1.41, p < 0.001), living in a rural area (OR = 1.14, 95% CI 1.06-1.23, p < 0.001), smoked (OR = 1.26, 95% CI 1.14-1.38, p < 0.001), drank alcohol (OR = 1.16, 95% CI 1.06-1.26, p = 0.001), and had poor self-rated health (OR = 6.84, 95% CI 5.41-8.65, p < 0.001), had hearing problems (OR = 1.23, 95% CI 1.11-3.37, p < 0.001), were depressed (OR = 1.56, 95% CI 1.03-1.29, p < 0.001), had arthritis (OR = 2.21, 95% CI 2.02-2.41, p < 0.001), stomach disorders (OR = 1.69, 95% CI 1.55-1.85, p < 0.001), visited a Western medicine hospital (OR = 1.28, 95% CI 1.10-1.50, p = 0.002), and visits to other medical institutions (OR = 1.42, 95%CI 1.22-1.64, p < 0.001). On the other side, as a protective factor for pain, having nighttime sleep ≥7 h (OR = 0.74, 95%CI 0.68-0.80, p < 0.001) was negatively associated with pain.

Conclusion

Physical pain affects many older adults. Women, regional, rural residents, smokers, alcohol drinkers, people with poor self-rated health, those having <7 h of sleep at night, those with hearing problems, depression, arthritis, stomach disorders, and people who visits Western hospitals or other medical institutions are at greater risk for pain and deserve the attention of health care providers and policy makers to focus on pain prevention and management in middle-aged and older adults. Future research studies should also focus on the impact of health literacy on pain prevention and management outcomes.

Cross-cultural adaptation and validation of the Chinese version of the short-form of the Central Sensitization Inventory (CSI-9) in patients with chronic pain: A single-center study

Chronic pain affects more than 30% of the general population. The 9-item Central Sensitization Inventory (CSI-9) is a shortened version of the CSI-25, which is a patient-reported instrument used to screen people at risk of central sensitization (CS). The aim of this study was to cross-culturally adapt and validate a Chinese version of the CSI-9. The Chinese CSI-9 was generated by translation of the original English version, back-translation, cultural adaptation, and revision using the Delphi method. The Chinese CSI-9 was administered to 235 patients with chronic pain and 55 healthy controls. Structural validity (confirmatory factor analysis), construct validity (correlations with other scales), test-retest reliability (intraclass correlation coefficient, ICC), and internal consistency (Cronbach's α) were evaluated. Confirmatory factor analysis was performed using one factor. The Chinese CSI-9 score was positively correlated with the Pain Catastrophic Scale (PCS) total score (r = 0.463), PCS subscale scores (r = 0.347-0.463), Brief Pain Inventory (BPI) mean item score (r = 0.524), BPI total score (r = 0.773), and the number of painful sites (r = 0.451). The Chinese CSI-9 had excellent test-retest reliability (ICC = 0.958) and excellent internal consistency (Cronbach's α = 0.902 in the overall sample and 0.828 in the chronic pain population). The optimal cut-off value for the Chinese CSI-9 was 18 points. The Chinese CSI-9 had excellent test-retest reliability and satisfactory structural validity and construct validity. The CSI-9 could potentially be utilized in China as a self-report questionnaire in both clinical practice and research settings.

Glutamatergic systems in neuropathic pain and emerging non-opioid therapies

Neuropathic pain, a disease of the somatosensory nervous system, afflicts many individuals and adequate management with current pharmacotherapies remains elusive. The glutamatergic system of neurons, receptors and transporters are intimately involved in pain but, to date, there have been few drugs developed that therapeutically modulate this system. Glutamate transporters, or excitatory amino acid transporters (EAATs), remove excess glutamate around pain transmitting neurons to decrease nociception suggesting that the modulation of glutamate transporters may represent a novel approach to the treatment of pain. This review highlights and summarizes (1) the physiology of the glutamatergic system in neuropathic pain, (2) the preclinical evidence for dysregulation of glutamate transport in animal pain models, and (3) emerging novel therapies that modulate glutamate transporters. Successful drug discovery requires continuous focus on basic and translational methods to fully elucidate the etiologies of this disease to enable the development of targeted therapies. Increasing the efficacy of astrocytic EAATs may serve as a new way to successfully treat those suffering from this devastating disease.

A simple method for clinical implications of pain; comprehensive geriatric assessment

OBJECTIVE:

The effect of chronic pain on the elderly population is enormous in terms of both human suffering and cost. This study aimed to investigate the factors associated with chronic low back pain in older adults by performing a comprehensive geriatric assessment.

METHODS:

This cross-sectional study included 225 elderly patients admitted to a geriatric outpatient clinic. All participants underwent a comprehensive geriatric assessment, and factors related to chronic low back pain were assessed. Participants were grouped as those with and without chronic pain.

RESULTS:

The mean age of the participants was 72.9±6.9 years, and 149 (66.2%) of them had chronic pain complaints. The number of chronic diseases and medications, depressive symptom scores, and sleep quality scores were higher, and quality of life (European Quality of Life-5 Dimensions index and European Quality of Life-5 Dimensions visual analog scale) and nutritional status scores were lower in the chronic pain group. The pain visual analog scale score had a statistically significant moderate negative correlation with the European Quality of Life-5 Dimensions index (r=-0.440, p=0.000) and European Quality of Life-5 Dimensions visual analog scale (r=-0.398, p=0.000) scores. The male gender was associated with a reduced risk of chronic pain, while poor sleep quality and number of comorbidities were associated with an increased risk of chronic pain (p=0.000, OR 0.20, p=0.021, OR 2.54, and p=0.010, OR 1.40, respectively).

CONCLUSION:

Chronic pain is common and independently associated with poor sleep quality, an increased number of diseases, and female gender. The results of our study may guide pain management in older individuals.

Development and Validation of a Prediction Model for Chronic Post-Surgical Pain After Thoracic Surgery in Elderly Patients: A Retrospective Cohort Study

Purpose

Chronic post-surgical pain (CPSP) is one of the adverse outcomes after surgery, especially in thoracotomy. However, the prevalence of CPSP in elderly adults (≥65 years), is still limited. Therefore, the present study was undertaken to establish and validate the prediction model of CPSP in those patients after thoracic surgery, including thoracotomy and video-assisted thoracoscopic surgery.

Patients and Methods

This retrospective, observational single-center cohort study was conducted in Nanfang Hospital, Southern Medical University, which randomly and consecutively collected 577 elderly patients who underwent thoracic surgery between January 1, 2017, and December 31, 2020. According to the Akaike information criterion, the prediction model was built based on all the data and was validated by calibration with 500 bootstrap samples.

Results

The mean age of participants was 69.09±3.80 years old, and 63.1% were male. The prevalence of CPSP was 26.9%. Age more than 75 years, BMI, blood loss, longer length of hospital stays, and higher pre-operative neutrophil count were associated with CPSP. Except for these factors, we incorporated history of drinking to build up the prediction model. The areas under the curve (AUCs) of the prediction models were 0.66 (95% CI, 0.61–0.71) and 0.64 (95% CI, 0.59–0.69) in the observational and validation cohorts, respectively. And the calibration curve of the predictive model showed a good fit between the predicted risk of CPSP and observed outcomes in elderly patients.

Conclusion

The present developed model may help clinicians to find high-risk elderly patients with CPSP after thoracic surgery and take corresponding measures in advance to reduce the incidence of CPSP and improve their life quality.

Gender Differences in Pain Subtypes among Patients with Parkinson's Disease

BACKGROUND

To determine the influence of gender on the different pain subtypes experienced by patients with Parkinson's disease (PD).

METHODS

Two hundred patients with PD were recruited for this research. Demographic features for all patients were recorded, as well as clinical data on age, disease duration, levodopa equivalent daily dose (LEDD), and scores for Unified Parkinson's Disease Rating Scale-III (UPDRS III), Hoehn-Yahr Scale (H&Y), King's Parkinson's disease Pain Scale (KPPS), Pittsburgh Sleep Quality Index (PSQI), Mini-mental State Examination (MMSE), activities of daily living scale (ADL), Hamilton Depression Rating Scale (HAMD), and Hamilton Anxiety Rating Scale (HAMA) scales.

RESULTS

Male and female patients showed no significant differences in terms of age, disease duration, LEDD, H&Y stage, and UPDRS III, HAMD, HAMA, PSQI and ADL scores. Women showed significantly lower MMSE than men, but their KPPS scores were higher (both p < 0.05). Female also showed significantly higher scores for chronic, fluctuation-related pain and oro-facial pain and more discoloration;edema/swelling than males (p < 0.05).

CONCLUSIONS

Female gender was associated with pain in PD patients, with stronger associations for certain subtypes of PD-related pain.

Are Mind-Body Exercise Beneficial for Treating Pain, Function, and Quality of Life in Middle-Aged and Old People With Chronic Pain? A Systematic Review and Meta-Analysis

Background

Aging is a significant risk factor in chronic pain development with extensive disability and greater health care costs. Mind-body exercise (MBE) has been scientifically proven to affect the pain intensity and physical health.

Objectives

To assess the effects of MBE modes (Tai Chi, yoga, and qigong) for treating chronic pain among middle-aged and old people, compared with nonactive and active treatment, as well as function, quality of life, and adverse events.

Methods

We searched PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Scientific Journals Full-Text Database (VIP) till March 2022. No restrictions were chartered within the year and language of publication. We included randomized controlled trials of MBE treatment in middle-aged and elderly people with chronic pain. The overall certainty of evidence was evaluated by using the GRADE approach.

Results

A total of 17 studies (n = 1,332) were included in this review. There was low-certainty evidence indicating that MBE had a moderate effect on reducing pain compared with the nonactive and active control group (standard mean difference (SMD): -0.64, 95% confidence interval (CI): -0.86 to -0.42, P < 0.001). Very-low-certainty evidence showed that the pooled SMD for the functional improvement was -0.75 (95% CI: -1.13 to -0.37, P < 0.001). Low-certainty evidence presented that no influence was observed in physical component summary (SMD: 0.23, 95% CI: -0.16 to 0.62, P = 0.24) and mental component summary (SMD: -0.01, 95% CI -0.39 to 0.36, P = 0.95).

Conclusion

Our results indicated that MBE was an effective treatment for reducing symptoms of middle-aged and elderly people with chronic pain compared with nonactive and active control groups. TC and qigong had obvious benefits for knee osteoarthritis in self-reported function, but the efficacy of chronic low back pain was uncertain. No significant benefit of MBE on quality of life in older adults with chronic pain was found. More high-quality RCTs should be conducted to explore the efficacy and mechanism of MBE on chronic pain in middle-aged and elderly people from various dimensions, such as affective and cognitive dimensions.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=316591, identifier CRD42022316591.

Chronic Lumbar Pain and Insomnia in College-Aged Students

Insomnia in college students has a significant impact on academic performance and mental health (e.g., depression). Although the mechanisms underlying insomnia and chronic pain are becoming clearer, only a few studies on college students have examined these factors by their location in the body. The purpose of the present study was to identify the location of chronic pain in the body most associated with insomnia in college students. A web-based survey was used to collect information pertaining to nine questions from 494 university students: sex, age, presence of chronic pain, intensity of chronic pain, location of chronic pain, and duration of chronic pain, as well as scores from the Athens Insomnia Scale (AIS), Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. To examine the association between insomnia and the site of chronic pain, stepwise logistic regression analysis was conducted with AIS as the target variable. The results showed a significant positive correlation between chronic pain in the lumbar region and AIS scores. Future longitudinal studies including multiple factors are necessary to clarify the causal relationship between insomnia and chronic lower back pain.