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Healey EL, Jinks C, Foster NE, Chew-Graham CA, Pincus T, Hartshorne L, Cooke K, Nicholls E, Proctor J, Lewis M, Dent S, Wathall S, Hay EM, McBeth J. The feasibility and acceptability of a physical activity intervention for older people with chronic musculoskeletal pain: The iPOPP pilot trial protocol. Musculoskeletal Care 2017; 16:118-132. [PMID: 29218808 DOI: 10.1002/msc.1222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION This pilot trial will inform the design and methods of a future full-scale randomized controlled trial (RCT) and examine the feasibility, acceptability and fidelity of the Increasing Physical activity in Older People with chronic Pain (iPOPP) intervention, a healthcare assistant (HCA)-supported intervention to promote walking in older adults with chronic musculoskeletal pain in a primary care setting. METHODS AND ANALYSIS The iPOPP study is an individually randomized, multicentre, three-parallel-arm pilot RCT. A total of 150 participants aged ≥65 years with chronic pain in one or more index sites will be recruited and randomized using random permuted blocks, stratified by general practice, to: (i) usual care plus written information; (ii) pedometer plus usual care and written information; or (iii) the iPOPP intervention. A theoretically informed mixed-methods approach will be employed using semi-structured interviews, audio recordings of the HCA consultations, self-reported questionnaires, case report forms and objective physical activity data collection (accelerometry). Follow-up will be conducted 12 weeks post-randomization. Collection of the quantitative data and statistical analysis will be performed blinded to treatment allocation, and analysis will be exploratory to inform the design and methods of a future RCT. Analysis of the HCA consultation recordings will focus on the use of a checklist to determine the fidelity of the iPOPP intervention delivery, and the interview data will be analysed using a constant comparison approach in order to generate conceptual themes focused around the acceptability and feasibility of the trial, and then mapped to the Theoretical Domains Framework to understand barriers and facilitators to behaviour change. A triangulation protocol will be used to integrate quantitative and qualitative data and findings.
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Affiliation(s)
- E L Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - N E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - T Pincus
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - L Hartshorne
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - K Cooke
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - E Nicholls
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J Proctor
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - M Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - S Dent
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - S Wathall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - E M Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J McBeth
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
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Beukenhorst AL, Schultz DM, McBeth J, Lakshminarayana R, Sergeant JC, Dixon WG. Using Smartphones for Research Outside Clinical Settings: How Operating Systems, App Developers, and Users Determine Geolocation Data Quality in mHealth Studies. Stud Health Technol Inform 2017; 245:10-14. [PMID: 29295042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Smartphones that collect user geolocation provid opportunities for mobile Health (mHealth). Although granularity of geolocation data may be high, data completeness depends on the device's operating system, application developer decisions, and user actions. We investigate completeness of geolocation data collected via smartphones of 5601 people that self-reported daily chronic pain symptoms on 349,293 days. On 17% of these days, hourly geolocation data is reported, but days with 0 (16%), 1 (14%) and 2 (13%) geolocations are common. Android phones collect geolocation more often than iPhones (median 17 versus 2 times a day). Factors on operating system level and individual user level influence completeness of geolocation data collected with smartphones. mHealth researchers should be aware of these factors when designing their studies. The mHealth research community should devise standards for reporting geolocation data quality, analysing systematic differences in data quality between participant groups, and methods for data imputation.
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Affiliation(s)
- A L Beukenhorst
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - D M Schultz
- Centre for Atmospheric Science, School of Earth and Environmental Sciences, University of Manchester, Manchester, UK
| | - J McBeth
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - J C Sergeant
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - W G Dixon
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Baker S, Chew-Graham C, Wilkie R, McBeth J. FRI0592 Maintaining Mental Health in Older People with Musculoskeletal Pain: A Longitudinal Cohort Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Patel R, Sergeant J, McBeth J, Schultz D, Sanders C, Cook L, Ainsworth J, Dixon W. AB1042 Patient Beliefs Regarding Associations between Weather and Pain; An Analysis of Enrolment Questionnaires within “Cloudy with A Chance of Pain”:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Patel R, Sergeant J, McBeth J, Schultz D, Sanders C, Cook L, Ainsworth J, Dixon W. FRI0590 Early Recruitment To “Cloudy with A Chance of Pain”; from Website Hits To Smartphone App Downloads. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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McBeth J, Tomenson B, Chew-Graham C, Macfarlane G, Jackson J, Littlewood A, Creed F. Common and unique associated factors for medically unexplained chronic widespread pain and chronic fatigue. J Psychosom Res 2015; 79:484-91. [PMID: 26652592 PMCID: PMC4678257 DOI: 10.1016/j.jpsychores.2015.10.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Chronic widespread pain and chronic fatigue share common associated factors but these associations may be explained by the presence of concurrent depression and anxiety. METHODS We mailed questionnaires to a randomly selected sample of people in the UK to identify participants with chronic widespread pain (ACR 1990 definition) and those with chronic fatigue. The questionnaire assessed sociodemographic factors, health status, healthcare use, childhood factors, adult attachment, and psychological stress including anxiety and depression. To identify persons with unexplained chronic widespread pain or unexplained chronic fatigue; we examined participant's medical records to exclude medical illness that might cause these symptoms. RESULTS Of 1443 participants (58.0% response rate) medical records of 990 were examined. 9.4% (N=93) had unexplained chronic widespread pain and 12.6% (N=125) had unexplained chronic fatigue. Marital status, childhood psychological abuse, recent threatening experiences and other somatic symptoms were commonly associated with both widespread pain and fatigue. No common effect was found for few years of education and current medical illnesses (more strongly associated with chronic widespread pain) or recent illness in a close relative, neuroticism, depression and anxiety scores (more strongly associated with chronic fatigue). Putative associated factors with a common effect were associated with unexplained chronic widespread pain or unexplained chronic fatigue only when there was concurrent anxiety and/or depression. DISCUSSION This study suggests that the associated factors for chronic widespread pain and chronic fatigue need to be studied in conjunction with concurrent depression/anxiety. Clinicians should be aware of the importance of concurrent anxiety or depression.
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Affiliation(s)
- J. McBeth
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK,Corresponding author.
| | - B. Tomenson
- Biostatistics Unit, Institute of Population Health, The University of Manchester, Manchester, UK
| | - C.A. Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Newcastle, Staffs, ST5 5BG, UK
| | - G.J. Macfarlane
- Musculoskeletal Research Collaboration (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK
| | - J. Jackson
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
| | - A. Littlewood
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, UK
| | - F.H. Creed
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK
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Lacey RJ, Strauss VY, Rathod T, Belcher J, Croft PR, Natvig B, Wilkie R, McBeth J. Clustering of pain and its associations with health in people aged 50 years and older: cross-sectional results from the North Staffordshire Osteoarthritis Project. BMJ Open 2015; 5:e008389. [PMID: 26553828 PMCID: PMC4654278 DOI: 10.1136/bmjopen-2015-008389] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Most pain in patients aged ≥50 years affects multiple sites and yet the predominant mode of presentation is single-site syndromes. The aim of this study was to investigate if pain sites form clusters in this population and if any such clusters are associated with health factors other than pain. SETTING Six general practices in North Staffordshire, UK. DESIGN Cross-sectional, postal questionnaire, study. PARTICIPANTS Community-dwelling adults aged ≥50 years registered at the general practices. MAIN OUTCOMES MEASURES Number of pain sites was measured by asking participants to shade sites of pain lasting ≥1 day in the past 4 weeks on a blank body manikin. Health factors measured included anxiety and depression (Hospital and Anxiety Depression Scale), cognitive complaint (Sickness Impact Profile) and sleep. Pain site clustering was investigated using latent class analysis. Association of clusters with health factors, adjusted for age, sex, body mass index and morbidities, was analysed using multinomial regression models. RESULTS 13 986 participants (adjusted response 70.6%) completed a questionnaire, of whom 12 408 provided complete pain data. Four clusters of participants were identified: (1) low number of pain sites (36.6%), (2) medium number of sites with no back pain (31.5%), (3) medium number of sites with back pain (17.9%) and (4) high number of sites (14.1%). Compared to Cluster 1, other clusters were associated with poor health. The strongest associations (relative risk ratios, 95% CI) were with Cluster 4: depression (per unit change in score) 1.11 (1.08 to 1.14); cognitive complaint 2.60 (2.09 to 3.24); non-restorative sleep 4.60 (3.50 to 6.05). CONCLUSIONS These results indicate that in a general population aged ≥50 years, pain forms four clusters shaped by two dimensions-number of pain sites (low, medium, high) and, within the medium cluster, the absence or presence of back pain. The usefulness of primary care treatment approaches based on this simple classification should be investigated.
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Affiliation(s)
- R J Lacey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - V Y Strauss
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK Centre for Statistics in Medicine, University of Oxford, Botnar Research Centre, Oxford, UK
| | - T Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - J Belcher
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK School of Computing and Mathematics, Keele University, Keele, Staffordshire, UK
| | - P R Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - B Natvig
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - R Wilkie
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
| | - J McBeth
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
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Parsons S, McBeth J, Macfarlane GJ, Hannaford PC, Symmons DPM. Self-reported pain severity is associated with a history of coronary heart disease. Eur J Pain 2014; 19:167-75. [PMID: 24890750 PMCID: PMC4322478 DOI: 10.1002/ejp.533] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have found an association between chronic pain and cardiovascular (CV) mortality. OBJECTIVE To explore the relationship between the severity of pain and non-fatal CV disease. METHODS A total of 45,994 adults randomly selected from general practice registers in Manchester and Aberdeen were posted a survey, which included a Chronic Pain Grade questionnaire, pain manikin and questions about lifestyle and medical history. A single component measuring pain severity was extracted using factor analysis. Logistic regression was used to test for an association between quintiles of pain severity and a history of CV disease, adjusting for confounders. RESULTS Of the 15,288 responders, 61% (n = 9357) reported pain for ≥ 1 day in the past month. Compared with the first (lowest) pain severity quintile, the fully adjusted odds ratio for heart attack in the second severity quintile was 1.25 (95% confidence interval 0.68, 2.30); third quintile: 1.65 (0.93, 2.94); fourth quintile: 1.76 (1.00, 3.11) and fifth (highest) quintile 2.47 (1.43, 4.28). Corresponding figures for angina (excluding heart attack) were: 1.79 (0.93, 3.45), 1.91 (1.00, 3.62), 1.03 (0.50, 2.11) and 3.17 (1.71, 5.85). CONCLUSION A history of CV disease is reported more often in those with severe pain than would be expected by chance, even when adjusting for shared risk factors.
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Affiliation(s)
- S Parsons
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, University of Manchester, UK
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Creed FH, Tomenson B, Chew-Graham C, Macfarlane GJ, Davies I, Jackson J, Littlewood A, McBeth J. Multiple somatic symptoms predict impaired health status in functional somatic syndromes. Int J Behav Med 2014; 20:194-205. [PMID: 22932928 DOI: 10.1007/s12529-012-9257-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The relationship between functional somatic syndromes and multiple somatic symptoms is unclear. PURPOSE We assessed whether the number of somatic symptoms is a predictor of health status in three functional somatic syndromes (FSS). METHODS In a population-based study of 990 UK adults we assessed chronic widespread pain (CWP), chronic fatigue (CF) and irritable bowel syndrome (IBS) by questionnaire and medical record data. We assessed health status (Short Form 12 and EQ-5D), number of somatic symptoms (Somatic Symptom Inventory) and anxiety/depression (Hospital Anxiety and Depression Scale) both at baseline and at follow-up 1 year later. RESULTS The proportion of people with an FSS who also have multiple somatic symptoms (52-55 %) was similar in the three functional syndromes. The presence of multiple somatic symptoms was associated with more impaired health status both at baseline and at follow-up. This finding was not explained by severity of FSS. In the absence of multiple somatic symptoms, the health status of the FSS was fair or good. In multiple regression analysis, the number of somatic symptoms, the presence of a functional syndrome (CWP or CF) and anxiety/depression were predictors of EQ-5D thermometer at follow-up after adjustment for confounders. CONCLUSIONS Multiple somatic symptoms in people with an FSS are associated with impaired health status and this cannot be explained by more severe functional syndrome or the presence of anxiety and depression.
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Affiliation(s)
- F H Creed
- School of Community Based Medicine, University of Manchester, Oxford Road, Manchester, UK.
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Aggarwal V, Macfarlane G, Tajar A, Mulvey M, Power A, Ray D, McBeth J. Functioning of the hypothalamic-pituitary-adrenal and growth hormone axes in frequently unexplained disorders: Results of a population study. Eur J Pain 2013; 18:447-54. [DOI: 10.1002/j.1532-2149.2013.00413.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
- V.R. Aggarwal
- School of Dentistry; Manchester Biomedical Research Centre; University of Manchester; UK
| | - G.J. Macfarlane
- Aberdeen Pain Research Collaboration (Epidemiology Group); Institute of Applied Health Sciences; University of Aberdeen, School of Medicine and Dentistry; Foresterhill UK
| | - A. Tajar
- Centre for Statistics in Medicine; University of Oxford; UK
| | - M.R. Mulvey
- Academic Unit of Palliative Care; Leeds Institute of Health Sciences; University of Leeds; UK
| | - A. Power
- School of Translational Medicine; University of Manchester; UK
- Human Pain Research Group; Salford Royal NHS Foundation Trust; UK
| | - D. Ray
- Centre for Endocrinology and Diabetes; Institute of Human Development; University of Manchester, and Manchester Academic Health Sciences Centre; UK
| | - J. McBeth
- Arthritis Research UK Primary Care Centre; Primary Care Sciences; Keele University; UK
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Beasley M, Prescott G, McBeth J, Scotland G, Lovell K, Keeley P, Hannaford P, McNamee P, Symmons DPM, Woby S, Gkazinou C, Macfarlane GJ. OP0232 Long-Term Effects of Cognitive Behaviour Therapy and Exercise for Chronic Widespread Pain. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tobias J, Deere K, Palmer S, Clark E, Clinch J, Fikree A, Aktar R, Wellstead G, Knowles C, Grahame R, Aziz Q, Amaral B, Murphy G, Ioannou Y, Isenberg DA, Tansley SL, Betteridge ZE, Gunawardena H, Shaddick G, Varsani H, Wedderburn L, McHugh N, De Benedetti F, Ruperto N, Espada G, Gerloni V, Flato B, Horneff G, Myones BL, Onel K, Frane J, Kenwright A, Lipman TH, Bharucha KN, Martini A, Lovell DJ, Baildam E, Ruperto N, Brunner H, Zuber Z, Keane C, Harari O, Kenwright A, Cuttica RJ, Keltsev V, Xavier R, Penades IC, Nikishina I, Rubio-Perez N, Alekseeva E, Chasnyk V, Chavez J, Horneff G, Opoka-Winiarska V, Quartier P, Silva CA, Silverman ED, Spindler A, Lovell DJ, Martini A, De Benedetti F, Hendry GJ, Watt GF, Brandon M, Friel L, Turner D, Lorgelly PK, Gardner-Medwin J, Sturrock RD, Woodburn J, Firth J, Waxman R, Law G, Siddle H, Nelson AE, Helliwell P, Otter S, Butters V, Loughrey L, Alcacer-Pitarch B, Tranter J, Davies S, Hryniw R, Lewis S, Baker L, Dures E, Hewlett S, Ambler N, Clarke J, Gooberman-Hill R, Jenkins R, Wilkie R, Bucknall M, Jordan K, McBeth J, Norton S, Walsh D, Kiely P, Williams R, Young A, Harkess JE, McAlarey K, Chesterton L, van der Windt DA, Sim J, Lewis M, Mallen CD, Mason E, Hay E, Clarson LE, Hider SL, Belcher J, Heneghan C, Roddy E, Mallen CD, Gibson J, Whiteford S, Williamson E, Beatty S, Hamilton-Dyer N, Healey EL, Ryan S, McHugh GA, Main CJ, Porcheret M, Nio Ong B, Pushpa-Rajah A, Dziedzic KS, MacRae CS, Shortland A, Lewis J, Morrissey M, Critchley D, Muller S, Mallen CD, Belcher J, Helliwell T, Hider SL, Cole Z, Parsons C, Crozier S, Robinson S, Taylor P, Inskip H, Godfrey K, Dennison E, Harvey NC, Cooper C, Prieto Alhambra D, Lalmohamed A, Abrahamsen B, Arden N, de Boer A, Vestergaard P, de Vries F, Kendal A, Carr A, Prieto-Alhambra D, Judge A, Cooper C, Chapurlat R, Bellamy N, Czerwinski E, Pierre Devogelaer J, March L, Pavelka K, Reginster JY, Kiran A, Judge A, Javaid MK, Arden N, Cooper C, Sundy JS, Baraf HS, Becker M, Treadwell EL, Yood R, Ottery FD. Oral Abstracts 3: Adolescent and Young Adult * O13. Hypermobility is a Risk Factor for Musculoskeletal Pain in Adolescence: Findings From a Prospective Cohort Study. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Holliday KL, McBeth J, Macfarlane G, Huhtaniemi IT, Bartfai G, Casanueva FF, Forti G, Kula K, Punab M, Vanderschueren D, Wu FC, Thomson W. Investigating the role of pain-modulating pathway genes in musculoskeletal pain. Eur J Pain 2012; 17:28-34. [PMID: 22730276 DOI: 10.1002/j.1532-2149.2012.00163.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2012] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to determine if genetic variation in the pain-modulating gene DREAM and its pathway genes influence susceptibility to reporting musculoskeletal pain in the population. METHODS Pairwise tag single nucleotide polymorphisms (SNPs) in DREAM, PDYN and OPRK1 were genotyped in a UK population-based discovery cohort in whom pain was assessed using blank body manikins at three time points. Depression and anxiety symptoms were assessed at the first time point. Zero-inflated negative binomial regression was used to test for association between SNPs and the maximum number of pain sites reported (0-29) across the three time points. Significantly associated SNPs (p < 0.05) were subsequently genotyped for validation in a cohort of European men with pain assessed at two time points. RESULTS Thirty-five SNPs were genotyped in 1055 subjects, of whom 83% reported pain, in the discovery cohort. SNPs in each gene were associated with the maximum number of pain sites reported, were independent of symptoms of anxiety and depression and had a significant cumulative effect (p = 7.0 × 10(-5) ). Significantly associated SNPs were successfully genotyped in 1733 men, 76% of whom reported pain, in the validation cohort, but did not show significant association with the number of pain sites. CONCLUSIONS Genetic variation in the DREAM pathway genes was associated with the extent of pain reporting in a population-based cohort. These findings were not replicated in a single independent cohort; however, given the potential of this pathway as a therapeutic target, further investigation in additional cohorts is warranted.
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Affiliation(s)
- K L Holliday
- Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Heathfield S, Parker B, Zeef L, Bruce I, Alexander Y, Collins F, Stone M, Wang E, Williams AS, Wright HL, Thomas HB, Moots RJ, Edwards SW, Bullock C, Chapman V, Walsh DA, Mobasheri A, Kendall D, Kelly S, Bayley R, Buckley CD, Young SP, Rump-Goodrich L, Middleton J, Chen L, Fisher R, Kollnberger S, Shastri N, Kessler BM, Bowness P, Nazeer Moideen A, Evans L, Osgood L, Williams AS, Jones SA, Nowell MA, Mahadik Y, Young S, Morgan M, Gordon C, Harper L, Giles JL, Paul Morgan B, Harris CL, Rysnik OJ, McHugh K, Kollnberger S, Payeli S, Marroquin O, Shaw J, Renner C, Bowness P, Nayar S, Cloake T, Bombardieri M, Pitzalis C, Buckley C, Barone F, Barone F, Nayar S, Cloake T, Lane P, Coles M, Buckley C, Williams EL, Edwards CJ, Cooper C, Oreffo RO, Dunn S, Crawford A, Wilkinson M, Le Maitre C, Bunning R, Daniels J, Phillips KLE, Chiverton N, Le Maitre CL, Kollnberger S, Shaw J, Ridley A, Wong-Baeza I, McHugh K, Keidel S, Chan A, Bowness P, Gullick NJ, Abozaid HS, Jayaraj DM, Evans HG, Scott DL, Choy EH, Taams LS, Hickling M, Golor G, Jullion A, Shaw S, Kretsos K, Bari SF, Rhys-Dillon B, Amos N, Siebert S, Phillips KLE, Chiverton N, Bunning RD, Haddock G, Cross AK, Le Maitre CL, Kate I, Phillips E, Cross A, Chiverton N, Haddock G, Bunning RAD, Le Maitre CL, Ceeraz S, Spencer J, Choy E, Corrigall V, Crilly A, Palmer H, Lockhart J, Plevin R, Ferrell WR, McInnes I, Hutchinson D, Perry L, DiCicco M, Humby F, Kelly S, Hands R, Buckley C, McInnes I, Taylor P, Bombardieri M, Pitzalis C, Mehta P, Mitchell A, Tysoe C, Caswell R, Owens M, Vincent T, Hashmi TM, Price-Forbes A, Sharp CA, Murphy H, Wood EF, Doherty T, Sheldon J, Sofat N, Goff I, Platt PN, Abdulkader R, Clunie G, Ismajli M, Nikiphorou E, Young A, Tugnet N, Dixey J, Banik S, Alcorn D, Hunter J, Win Maw W, Patil P, Hayes F, Main Wong W, Borg FA, Dasgupta B, Malaviya AP, Ostor AJ, Chana JK, Ahmed AA, Edmonds S, Hayes F, Coward L, Borg F, Heaney J, Amft N, Simpson J, Dhillon V, Ayalew Y, Khattak F, Gayed M, Amarasena RI, McKenna F, Amarasena RI, McKenna F, Mc Laughlin M, Baburaj K, Fattah Z, Ng N, Wilson J, Colaco B, Williams MR, Adizie T, Dasgupta B, Casey M, Lip S, Tan S, Anderson D, Robertson C, Devanny I, Field M, Walker D, Robinson S, Ryan S, Hassell A, Bateman J, Allen M, Davies D, Crouch C, Walker-Bone K, Gainsborough N, Gullick NJ, Lutalo PM, Davies UM, Walker-Bone K, Mckew JR, Millar AM, Wright SA, Bell AL, Thapper M, Roussou T, Cumming J, Hull RG, Thapper M, Roussou T, McKeogh J, O'Connor MB, Hassan AI, Bond U, Swan J, Phelan MJ, Coady D, Kumar N, Farrow L, Bukhari M, Oldroyd AG, Greenbank C, McBeth J, Duncan R, Brown D, Horan M, Pendleton N, Littlewood A, Cordingley L, Mulvey M, Curtis EM, Cole ZA, Crozier SR, Georgia N, Robinson SM, Godfrey KM, Sayer AA, Inskip HM, Cooper C, Harvey NC, Davies R, Mercer L, Galloway J, Low A, Watson K, Lunt M, Symmons D, Hyrich K, Chitale S, Estrach C, Moots RJ, Goodson NJ, Rankin E, Jiang CQ, Cheng KK, Lam TH, Adab P, Ling S, Chitale S, Moots RJ, Estrach C, Goodson NJ, Humphreys J, Ellis C, Bunn D, Verstappen SM, Symmons D, Fluess E, Macfarlane GJ, Bond C, Jones GT, Scott IC, Steer S, Lewis CM, Cope A, Mulvey MR, Macfarlane GJ, Symmons D, Lovell K, Keeley P, Woby S, Beasley M, McBeth J, Viatte S, Plant D, Lunt M, Fu B, Parker B, Galloway J, Solymossy C, Worthington J, Symmons D, Dixey J, Young A, Barton A, Williams FM, Osei-Bordom DC, Popham M, MacGregor A, Spector T, Little J, Herrick A, Pushpakom S, Ennis H, McBurney H, Worthington J, Newman W, Ibrahim I, Plant D, Hyrich K, Morgan A, Wilson A, Isaacs J, Barton A, Sanderson T, Hewlett S, Calnan M, Morris M, Raza K, Kumar K, Cardy CM, Pauling JD, Jenkins J, Brown SJ, McHugh N, Nikiphorou E, Mugford M, Davies C, Cooper N, Brooksby A, Bunn D, Symmons D, MacGregor A, Dures E, Ambler N, Fletcher D, Pope D, Robinson F, Rooke R, Hewlett S, Gorman CL, Reynolds P, Hakim AJ, Bosworth A, Weaver D, Kiely PD, Skeoch S, Jani M, Amarasena R, Rao C, Macphie E, McLoughlin Y, Shah P, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Patel Y, Baguley E, Jani M, Halsey J, Severn A, Bukhari M, Selvan S, Price E, Husain MJ, Brophy S, Phillips CJ, Cooksey R, Irvine E, Siebert S, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Griffiths B, Foggo H, Edgar S, Vadivelu S, Coady D, McHugh N, Ng WF, Dasgupta B, Taylor P, Iqbal I, Heron L, Pilling C, Marks J, Hull R, Ledingham J, Han C, Gathany T, Tandon N, Hsia E, Taylor P, Strand V, Sensky T, Harta N, Fleming S, Kay L, Rutherford M, Nicholl K, Kay L, Rutherford M, Nicholl K, Eyre T, Wilson G, Johnson P, Russell M, Timoshanko J, Duncan G, Spandley A, Roskell S, Coady D, West L, Adshead R, Donnelly SP, Ashton S, Tahir H, Patel D, Darroch J, Goodson NJ, Boulton J, Ellis B, Finlay R, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Vadivelu S, Coady D, McHugh N, Griffiths B, Foggo H, Edgar S, Ng WF, Murray-Brown W, Priori R, Tappuni T, Vartoukian S, Seoudi N, Picarelli G, Fortune F, Valesini G, Pitzalis C, Bombardieri M, Ball E, Rooney M, Bell A, Merida AA, Isenberg D, Tarelli E, Axford J, Giles I, Pericleous C, Pierangeli SS, Ioannou J, Rahman A, Alavi A, Hughes M, Evans B, Bukhari M, Parker B, Zaki A, Alexander Y, Bruce I, Hui M, Garner R, Rees F, Bavakunji R, Daniel P, Varughese S, Srikanth A, Andres M, Pearce F, Leung J, Lim K, Regan M, Lanyon P, Oomatia A, Petri M, Fang H, Birnbaum J, Amissah-Arthur M, Gayed M, Stewart K, Jennens H, Braude S, Gordon C, Sutton EJ, Watson KD, Gordon C, Yee CS, Lanyon P, Jayne D, Isenberg D, Rahman A, Akil M, McHugh N, Ahmad Y, Amft N, D'Cruz D, Edwards CJ, Griffiths B, Khamashta M, Teh LS, Zoma A, Bruce I, Dey ID, Kenu E, Isenberg D, Pericleous C, Garza-Garcia A, Murfitt L, Driscoll PC, Isenberg D, Pierangeli S, Giles I, Ioannou Y, Rahman A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Segeda I, Shevchuk S, Kuvikova I, Brown N, Bruce I, Venning M, Mehta P, Dhanjal M, Mason J, Nelson-Piercy C, Basu N, Paudyal P, Stockton M, Lawton S, Dent C, Kindness K, Meldrum G, John E, Arthur C, West L, Macfarlane MV, Reid DM, Jones GT, Macfarlane GJ, Yates M, Loke Y, Watts R, MacGregor A, Adizie T, Christidis D, Dasgupta B, Williams M, Sivakumar R, Misra R, Danda D, Mahendranath KM, Bacon PA, Mackie SL, Pease CT. Basic science * 232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McErlane F, Beresford MW, Baildam EM, Thomson W, Hyrich K, Chieng A, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Nikiphorou E, Carpenter L, Kiely P, Walsh D, Dixey J, Young A, Kapoor SR, Filer A, Fitzpatrick M, Fisher BA, Taylor PC, Buckley C, McInnes I, Raza K, Young SP, Dougados M, Kissel K, Amital H, Conaghan P, Martin-Mola E, Nasonov E, Schett G, Troum O, Veldi T, Bernasconi C, Huizinga T, Durez P, Genovese MC, Richards HB, Supronik J, Dokoupilova E, Aelion JA, Lee SH, Codding CE, Kellner H, Ikawa T, Hugot S, Ligozio G, Mpofu S, Kavanaugh A, Emery P, Fleischmann R, Van Vollenhoven R, Pavelka K, Durez P, Guerette B, Santra S, Redden L, Kupper H, Smolen JS, Wilkie R, Tajar A, McBeth J, Hooper LS, Bowen CJ, Gates L, Culliford D, Edwards CJ, Arden NK, Adams J, Ryan S, Haywood H, Pain H, Siddle HJ, Redmond AC, Waxman R, Dagg AR, Alcacer-Pitarch B, Wilkins RA, Helliwell PS, Norton S, Kiely P, Walsh D, Williams R, Young A, Halls S, Law RJ, Jones J, Markland D, Maddison P, Thom J, Parker B, Urowitz MB, Gladman DD, Bruce I, Croca SC, Pericleous C, Yong H, Isenberg D, Giles I, Rahman A, Ioannou Y, Warrell CE, Dobarro D, Handler C, Denton CP, Schreiber BE, Coghlan JG, Betteridge ZE, Woodhead F, Bunn C, Denton CP, Abraham D, Desai S, du Bois R, Wells A, McHugh N, Abignano G, Aydin S, Castillo-Gallego C, Woods D, Meekings A, McGonagle D, Emery P, Del Galdo F, Vila J, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Vadivelu S, Coady D, Griffiths B, Lendrem D, Foggo H, Tarn J, Ng WF, Goodhead C, Shekar P, Kelly C, Francis G, Bailey AM, Thompson L, Hamilton J, Salisbury C, Foster NE, Bishop A, Coast J, Franchini A, Hall J, Hollinghurst S, Hopper C, Grove S, Kaur S, Montgomery A, Paskins Z, Sanders T, Croft PR, Hassell AB, Coxon DE, Frisher M, Jordan KP, Jinks C, Peat G, Monk HL, Muller S, Mallen C, Hider SL, Roddy E, Muller S, Hayward R, Mallen C. Oral abstracts 3: RA Treatment and outcomes * O13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Aggarwal V, Macfarlane G, McBeth J. A high tender point count is associated with the presence of multiple idiopathic pain disorders: Results from a population study. Eur J Pain 2012; 16:1195-203. [DOI: 10.1002/j.1532-2149.2012.00127.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- V.R. Aggarwal
- Oral Health Unit; School of Dentistry; Manchester Biomedical Research Centre; University of Manchester; UK
| | - G.J. Macfarlane
- Aberdeen Pain Research Collaboration; Institute of Applied Health Sciences; University of Aberdeen; UK
| | - J. McBeth
- Arthritis Research Campaign Epidemiology Unit; Division of Epidemiology and Health Sciences; School of Medicine; University of Manchester; UK
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McBeth J, Pye SR, O'Neill TW, Macfarlane GJ, Tajar A, Bartfai G, Boonen S, Bouillon R, Casanueva F, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean MEJ, Pendleton N, Punab M, Silman AJ, Vanderschueren D, Wu FCW. Musculoskeletal pain is associated with very low levels of vitamin D in men: results from the European Male Ageing Study. Ann Rheum Dis 2010; 69:1448-52. [DOI: 10.1136/ard.2009.116053] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Macfarlane TV, McBeth J, Jones GT, Nicholl B, Macfarlane GJ. Whether the weather influences pain? Results from the EpiFunD study in North West England. Rheumatology (Oxford) 2010; 49:1513-20. [DOI: 10.1093/rheumatology/keq099] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shaikh MF, Shenker NG, Dale J, Else S, Stirling A, France J, Gordon MM, Hunter J, Porter D, Smith R, Khan J, Chan A, Paskins Z, John H, Hassell A, Rowe IF, Al-Mossawi MH, Chambers T, Greenbank C, Bronwen E, Halsey J, Bukhari M, Pearce FA, Lanyon P, Zakout S, Clarke L, Kirwan J, Marie Smith A, Lingard L, Heslop P, Walker DJ, Miller A, Johnston M, Timms A, Misbah S, Luqmani R, Bamji A, Lane J, Donnelly AA, Halsey JP, Bukhari MA, van Vollenhoven R, Cifaldi M, Roy S, Chen N, Gotlieb L, Malaise M, Ara R, Rafia R, Packham J, Haywood K, Healey E, Jones EA, Jones GT, Hannaford PC, Keeley P, Lovell K, McBeth J, McNamee P, Prescott GJ, Woby S, Macfarlane GJ, Munir M, Joshi AR, Johnson H, Smith EC, Poole CD, Lebmeier M, Currie CJ, Clark H, Rome K, Atkinson I, Plant M, Dixon J, Baskar S, Erb N, Whallett AJ, Arhinful-Adjapong A, Hawksley J, Tillett W, Green S, Tan WS, Pauling J, Michell L, Russell J, Derham S, Korendowych E, Bojke C, Cifaldi M, Ray S, Van Hout B, Grigor C, Porter D, Toner V, Stirling A, McEntegart A, Seng Edwin Lim C, Low ST, Joshi N, Walton T, Sanderson T, Morris M, Calnan M, Richards P, Hewlett S, Waller RD, Collins DA, Williamson LJ, Price EJ, Judge A, Dieppe PA, Arden NK, Cooper C, Carr A, Javaid K, Field R, Rafia R, Ara R, Lebmeier M. Health Services Research, Economics and Outcomes Research [86-113]: 86. What Happens to Patients with Complex Regional Pain Syndrome of Greater than 12 Months' Duration? Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Holliday KL, McBeth J, Thomson W, Goodson NJ, Smith BH, Goebel A, Goulston LM, Soni A, White KM, Kiran A, Javaid MK, Hart DJ, Spector TD, Arden NK, Stahl E, Eyre S, Hinks A, Barton A, Flynn E, Lee A, Coblyn J, Xie G, Padyukov L, Chen R, Siminovitch K, Klareskog L, Raychaudhuri S, Gregersen P, Plenge R, Worthington J, Chen Y, Dawes PT, Mattey DL, Camacho E, Farragher T, Lunt M, Verstappen S, Bunn D, Symmons D, Mirjafari H, Farragher T, Verstappen SM, Charlton-Menys V, Bunn D, Marshall T, Edlin H, Wilson P, Symmons DP, Bruce IN, Hinks A, Moncrieffe H, Martin P, Lal SD, Ursu S, Kassoumeri L, Wedderburn LR, Thomson W. Concurrent Oral 3 - Genetics and Epidemiology [OP16-OP23]: OP16. Genetic Variation in the Dream Pain Modulation Pathway is Associated with the Extent of Musculoskeletal Pain. Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Limer K, Nicholl B, Macfarlane G, Thomson W, Davies K, McBeth J. 67 GENETIC VARIATION IN THE HYPOTHALAMIC—PITUITARY—ADRENAL AXIS GENES MAY INFLUENCE SUSCEPTIBILTY TO MUSCULOSKELETAL PAIN: RESULTS FROM THE EPIFUND STUDY. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K. Limer
- University of Manchester, Manchester, United Kingdom
| | - B. Nicholl
- University of Manchester, Manchester, United Kingdom
| | | | - W. Thomson
- University of Manchester, Manchester, United Kingdom
| | - K. Davies
- University of Manchester, Manchester, United Kingdom
| | - J. McBeth
- University of Manchester, Manchester, United Kingdom
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Davies KA, Macfarlane GJ, McBeth J, Morriss R, Dickens C. Insecure attachment style is associated with chronic widespread pain. Pain 2009; 143:200-205. [PMID: 19345016 PMCID: PMC2806947 DOI: 10.1016/j.pain.2009.02.013] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 01/29/2009] [Accepted: 02/17/2009] [Indexed: 11/13/2022]
Abstract
Individuals with “insecure” adult attachment styles have been shown to experience more pain than people with secure attachment, though results of previous studies have been inconsistent. We performed a cross-sectional study on a large population-based sample to investigate whether, compared to pain free individuals, subjects with chronic widespread pain were more likely to report insecure adult attachment style. Subjects in a population-based cross-sectional study completed a self-rated assessment of adult attachment style. Attachment style was categorised as secure (i.e., normal attachment style); or preoccupied, dismissing or fearful (insecure attachment styles). Subjects completed a pain questionnaire from which three groups were identified: pain free; chronic widespread pain; and other pain. Subjects rated their pain intensity and pain-related disability on an 11 point Likert scale. Subjects (2509) returned a completed questionnaire (median age 49.9 years (IQR 41.2–50.0); 59.2% female). Subjects with CWP were more likely to report a preoccupied (RRR 2.6; 95%CI 1.8–3.7), dismissing (RRR 1.9; 95%CI 1.2–3.1) or fearful attachment style (RRR 1.4; 95%CI 1.1–1.8) than those free of pain. Among CWP subjects, insecure attachment style was associated with number of pain sites (Dismissing: RRR 2.8; 95%CI 1.2–2.3, Preoccupied: RRR = 1.8, 95%CI 0.98–3.5) and degree of pain-related disability (Preoccupied: RRR = 2.1, 95%CI 1.0–4.1), but not pain intensity. These findings suggest that treatment strategies based on knowledge of attachment style, possibly using support and education, may alleviate distress and disability in people at risk of, or affected by, chronic widespread pain.
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Affiliation(s)
- K A Davies
- Arthritis Research Campaign (ARC) Epidemiology Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK Aberdeen Pain Research Collaboration (Epidemiology Group), Department of Public Health, University of Aberdeen, School of Medicine, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK Division of Psychiatry, University of Nottingham, Nottingham, UK Department of Psychiatry, Rawnsley Building, The University of Manchester M13 9WL, UK
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McBeth J, Symmons DP, Silman AJ, Allison T, Webb R, Brammah T, Macfarlane GJ. Musculoskeletal pain is associated with a long-term increased risk of cancer and cardiovascular-related mortality. Rheumatology (Oxford) 2009; 48:74-7. [PMID: 19056799 PMCID: PMC2639482 DOI: 10.1093/rheumatology/ken424] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To test the hypothesis that individuals with regional and widespread pain disorders have an increased risk of mortality. METHODS We conducted a prospective cohort study of 4515 adults. Subjects were an age- and sex-stratified sample who had participated in a population study of pain occurrence during 1996. Based on those reports subjects were classified as having no pain, regional pain or widespread pain. All subjects were identified on the National Health Service Central Register and followed up until April 2005, a total of 8.2 yrs, at which time information was obtained on vital status, and if applicable, date and cause of death. The relationship between pain status and subsequent death is expressed as mortality rate ratios with 95% CIs, adjusted for age, gender, ethnicity and practice. RESULTS A total of 35.2% reported regional pain and 16.9% satisfied criteria for widespread pain. In comparison with those without pain, there was a 20% and 30% increased risk of dying over the follow-up period among subjects with regional and widespread pain, respectively. The specific causes of death in excess were cancer and cardiovascular disease. In addition, the mortality risk from both cancer and cardiovascular deaths was found to increase as the number of pain sites that subjects reported increased. CONCLUSIONS This study supports a previous observation that persons with regional and widespread pain are at an increased risk of cancer death. Possible mechanisms should be explored.
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Affiliation(s)
- J McBeth
- Arthritis Research Campaign Epidemiology Unit, Epidemiology Research Group, Research School of Translational Medicine, University of Manchester, Manchester, UK.
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McBeth J, Symmons DP, Silman AJ, Webb R, Macfarlane GJ. Comment on: Musculoskeletal pain is associated with a long-term increased risk of cancer and cardiovascular-related mortality: reply. Rheumatology (Oxford) 2008. [DOI: 10.1093/rheumatology/kep041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Davies KA, Macfarlane GJ, Nicholl BI, Dickens C, Morriss R, Ray D, McBeth J. Restorative sleep predicts the resolution of chronic widespread pain: results from the EPIFUND study. Rheumatology (Oxford) 2008; 47:1809-13. [PMID: 18842606 PMCID: PMC2582170 DOI: 10.1093/rheumatology/ken389] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives. Poor sleep is associated with chronic widespread pain (CWP). Conversely, good-quality sleep may play a role in the resolution of pain symptoms. Sleep is a multidimensional construct, comprising a number of diverse components. The aims of the current study were to examine the hypotheses that: (i) good sleep quality would predict the resolution of CWP, (ii) restorative sleep would predict the resolution of CWP and (iii) that these relationships would be independent of confounding psychological factors. Methods. Subjects in a population-based prospective study completed a pain questionnaire at baseline from which subjects with CWP were identified. Baseline sleep was measured using the Estimation of Sleep Problems Scale which measures sleep onset, maintenance, early wakening and restorative sleep. The questionnaire also contained scales examining psychosocial status. Subjects were followed up 15 months later and pain status was assessed. Results. A total of 1061 subjects reported CWP at baseline of whom 679 (75% of eligible subjects) responded at follow-up. Of those, a total of 300 (44%) no longer satisfied criteria for CWP. Univariate analysis revealed that three of the four sleep components were associated with the resolution of CWP: rapid sleep onset, odds ratio (OR) = 1.7, 95% CI 1.2, 2.5; absence of early wakening, OR = 1.6, 95% CI 1.1, 2.4; and restorative sleep, OR = 2.7, 95% CI 1.5, 4.8. After adjusting for the effect of psychosocial factors, which may have confounded the relationship, only restorative sleep (OR = 2.0, 95% CI 1.02, 3.8) was associated. Conclusions. Self-reported restorative sleep was independently associated with the resolution of CWP and return to musculoskeletal health.
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Affiliation(s)
- K A Davies
- Arthritis Research Campaign Epidemiology Unit, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
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Nicholl B, Halder S, Macfarlane G, Thompson D, O’Brien S, Musleh M, McBeth J. Psychosocial risk markers for new onset irritable bowel syndrome--results of a large prospective population-based study. Pain 2008; 137:147-155. [PMID: 17928145 PMCID: PMC2441776 DOI: 10.1016/j.pain.2007.08.029] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 08/14/2007] [Accepted: 08/21/2007] [Indexed: 12/13/2022]
Abstract
Irritable bowel syndrome (IBS) affects up to 22% of the general population. Its aetiology remains unclear. Previously reported cross-sectional associations with psychological distress and depression are not fully understood. We hypothesised that psychosocial factors, particularly those associated with somatisation, would act as risk markers for the onset of IBS. We conducted a community-based prospective study of subjects, aged 25-65 years, randomly selected from the registers of three primary care practices. Responses to a detailed questionnaire allowed subjects' IBS status to be classified using a modified version of the Rome II criteria. The questionnaire also included validated psychosocial instruments. Subjects free of IBS at baseline and eligible for follow-up 15 months later formed the cohort for this analysis (n=3732). An adjusted participation rate of 71% (n=2456) was achieved at follow-up. 3.5% (n=86) of subjects developed IBS. After adjustment for age, gender and baseline abdominal pain status, high levels of illness behaviour (odds ratio (OR)=5.2; 95% confidence interval (95% CI) 2.5-11.0), anxiety (OR=2.0; 95% CI 0.98-4.1), sleep problems (OR=1.6; 95% CI 0.8-3.2), and somatic symptoms (OR=1.6; 95% CI 0.8-2.9) were found to be independent predictors of IBS onset. This study has demonstrated that psychosocial factors indicative of the process of somatisation are independent risk markers for the development of IBS in a group of subjects previously free of IBS. Similar relationships are observed in other "functional" disorders, further supporting the hypothesis that they have similar aetiologies.
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Affiliation(s)
- B.I. Nicholl
- Arthritis Research Campaign (ARC) Epidemiology Unit, School of Translational Medicine, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, United Kingdom
| | - S.L. Halder
- Arthritis Research Campaign (ARC) Epidemiology Unit, School of Translational Medicine, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, United Kingdom
- Department of GI Sciences, Clinical Sciences Building, Hope Hospital, Salford M6 8HD, United Kingdom
| | - G.J. Macfarlane
- Epidemiology Group, Department of Public Health, School of Medicine, Polwarth Building, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| | - D.G. Thompson
- Department of GI Sciences, Clinical Sciences Building, Hope Hospital, Salford M6 8HD, United Kingdom
| | - S. O’Brien
- Division of Medicine and Neurosciences, Clinical Sciences Building, Hope Hospital, Salford M6 8HD, United Kingdom
| | - M. Musleh
- Arthritis Research Campaign (ARC) Epidemiology Unit, School of Translational Medicine, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, United Kingdom
| | - J. McBeth
- Arthritis Research Campaign (ARC) Epidemiology Unit, School of Translational Medicine, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, United Kingdom
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Limer KL, Nicholl BI, Thomson W, McBeth J. Exploring the genetic susceptibility of chronic widespread pain: the tender points in genetic association studies. Rheumatology (Oxford) 2008; 47:572-7. [DOI: 10.1093/rheumatology/ken027] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Macfarlane GJ, Jones GT, Knekt P, Aromaa A, McBeth J, Mikkelsson M, Heliovaara M. Is the report of widespread body pain associated with long-term increased mortality? Data from the Mini-Finland Health Survey. Rheumatology (Oxford) 2007; 46:805-7. [PMID: 17189245 DOI: 10.1093/rheumatology/kel403] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether an observation in a UK study, that persons with chronic widespread pain are at long-term increased risk of cancer mortality, can be replicated in a different setting. METHODS Subjects were participants aged >or=30 yrs in the Mini-Finland Health Survey conducted between 1979 and 1980. Information collected included prevalent pains at different joints throughout the body, demographic, anthropometric, lifestyle and occupational factors. During follow-up, until 1994, information on vital status and cause of death was obtained. RESULTS 7182 persons participated (89.8%). The prevalence of widespread body pain (pain at four or more sites) was 20% in females and 12% in males, and during follow-up there were a total of 1647 deaths. The risk of death was not elevated amongst those with widespread pain [relative risk (RR): 0.86; 95% confidence interval (CI): 0.74-1.00], and in particular, those with widespread pain were at a slightly lower risk of several disease-specific causes of death and cancer death (RR: 0.64; 95% CI: 0.46-0.91). CONCLUSIONS This study of multiple pains has not confirmed a previous observation of an association between the reporting of widespread pain and subsequent increased risk of cancer death. Differences in the definitions used or, more probably, the population studied, in particular, a larger rural population with more multiple pains related to physical activity may account for the differences.
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Affiliation(s)
- G J Macfarlane
- Aberdeen Pain Research Collaboration, Epidemiology Group, University of Aberdeen, Scotland, UK.
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Gupta A, Silman AJ, Ray D, Morriss R, Dickens C, MacFarlane GJ, Chiu YH, Nicholl B, McBeth J. The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study. Rheumatology (Oxford) 2006; 46:666-71. [PMID: 17085772 DOI: 10.1093/rheumatology/kel363] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Chronic widespread pain (CWP) is strongly associated with psychosocial distress both in a clinical setting and in the community. The aim of this study was to determine the contribution of measures of psychosocial distress, health-seeking behaviour, sleep problems and traumatic life events to the development of new cases of CWP in the community. METHODS In a population-based prospective study, 3171 adults aged 25-65 yrs free of CWP were followed-up 15 months later to identify those with new CWP. Baseline data were available on their scores from a number of psychological scales including Illness Attitude Scales (IAS), Somatic Symptom Checklist (SSC), Hospital Anxiety & Depression Scale, Sleep Problems Scale, and Life Events Inventory. RESULTS 324 subjects [10%, 95% confidence interval (CI) 9.2, 11.3] developed new CWP at follow-up. After adjustment for age and sex, three factors independently predicted the development of CWP: scoring three or more on the SSC [odds ratio (OR) 1.8, 95% CI 1.1, 3.1], scoring eight or more on the Illness Behaviour subscale of the IAS (OR 3.3, 95% CI 2.3, 4.8), and nine or more on the Sleep Problem Scale (OR 2.7, 95% CI 1.6, 3.2). Subjects exposed to all three factors were at 12 times the odds of new CWP than those with low scores on all scales. CONCLUSION Subjects are at substantial increased odds of developing CWP if they display features of somatization, health-seeking behaviour and poor sleep. Psychosocial distress has a strong aetiological influence on CWP.
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Affiliation(s)
- A Gupta
- Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
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Gupta A, McBeth J, Macfarlane GJ, Morriss R, Dickens C, Ray D, Chiu YH, Silman AJ. Pressure pain thresholds and tender point counts as predictors of new chronic widespread pain in somatising subjects. Ann Rheum Dis 2006; 66:517-21. [PMID: 17012291 PMCID: PMC1856033 DOI: 10.1136/ard.2006.054650] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tender points are a general measure of distress both in the community and in clinic subjects. It has been suggested that multiple tender points should be regarded as the early stages of somatisation of distress. Similarly, recent evidence suggests that chronic widespread pain (CWP) is one manifestation of the somatisation of distress. OBJECTIVE Given that a high tender point count and CWP are clinical hallmarks of the fibromyalgia syndrome, it was hypothesised that in somatising subjects, a high tender point count or a low pain threshold would predict the development of CWP in the future. METHODS In this population-based prospective study, 245 adults aged 25-65 years, free of CWP, were identified on the basis of a detailed questionnaire on pain and a psychosocial questionnaire comprising the Somatic Symptom Checklist and the Illness Behaviour subscale of the Illness Attitude Scales. These subjects took part in a pain threshold examination with a Fischer pressure algometer. Tender point counts were computed by including all areas with a pain threshold<4 kg/cm2. Individuals were followed up at 15 months, at which time 231 (93% of subjects still living at their baseline address) provided data on pain status, using the same instruments. RESULTS At follow-up, 26 (11%) subjects developed new CWP. Although subjects with a low baseline pain threshold were not at increased risk of developing symptoms, a high tender point count, adjusted for age, sex, baseline pain status and other confounding factors, predicted the development of new CWP. CONCLUSION Subjects free of CWP are at an increased risk of its development if they have a high tender point count. However, a low-pressure pain threshold does not predict the onset of symptoms. Data from this population-based prospective study suggest that a low pain threshold in subjects with CWP is likely to be a secondary phenomenon as a result of pain or associated distress rather than the antecedent of symptoms.
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Affiliation(s)
- A Gupta
- Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, and University Department of Psychiatry, Royal Liverpool University Hospital, UK
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McBeth J, Silman AJ, Gupta A, Chiu YH, Ray D, Morriss R, Dickens C, King Y, Macfarlane GJ. Moderation of psychosocial risk factors through dysfunction of the hypothalamic–pituitary–adrenal stress axis in the onset of chronic widespread musculoskeletal pain : Findings of a population-based prospective cohort study. ACTA ACUST UNITED AC 2006; 56:360-71. [PMID: 17195240 DOI: 10.1002/art.22336] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To test the hypothesis that abnormalities in the hypothalamic-pituitary-adrenal (HPA) stress-response system would act as an effect moderator between HPA function and the onset of chronic widespread pain (CWP). METHODS We conducted a population-based prospective cohort study. Current pain and psychosocial status were ascertained in 11,000 subjects. Of the 768 eligible subjects free of CWP but at future risk based on their psychosocial profile, 463 were randomly selected, and 267 (57.7%) consented to assessment of their HPA axis function. Diurnal function was measured by assessing levels of salivary cortisol in the morning (9:00 AM) and evening (10:00 PM). Serum cortisol levels were measured after an overnight low-dose (0.25 mg) dexamethasone suppression test and a potentially stressful clinical examination. All subjects were followed up 15 months later to identify cases of new-onset CWP. RESULTS A total of 241 subjects (94.9%) completed the followup study, and 28 (11.6%) reported the new onset of CWP. High levels of cortisol post-dexamethasone (odds ratio [OR] 3.53, 95% confidence interval [95% CI] 1.17-10.65), low levels in morning saliva (OR 1.43, 95% CI 0.52-3.94), and high levels in evening saliva (OR 2.32, 95% CI 0.64-8.42) were all associated with CWP. These 3 factors were found to be independent and additive predictors of CWP (OR for all 3 factors 8.5, 95% CI 1.5-47.9) in analyses controlling for age, sex, depression, sleep disturbance, recent traumatic life events, and pain status. One or more of these 3 HPA factors identified 26 (92.9%) cases of new-onset CWP. CONCLUSION Among a group of psychologically at-risk subjects, dysfunction of the HPA axis helps to distinguish those who will and will not develop new-onset CWP.
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Affiliation(s)
- J McBeth
- University of Manchester, Manchester, UK.
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Chiu YH, Silman AJ, Macfarlane GJ, Ray D, Gupta A, Dickens C, Morriss R, McBeth J. Poor sleep and depression are independently associated with a reduced pain threshold. Results of a population based study. Pain 2005; 115:316-321. [PMID: 15911158 DOI: 10.1016/j.pain.2005.03.009] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 01/07/2005] [Accepted: 03/03/2005] [Indexed: 11/29/2022]
Abstract
To determine the relative contributions of psychological factors and sleep disturbance to reduced pain threshold we conducted a cross-sectional two-phase population-based study. A total of 424 subjects were recruited, stratified by pain and distress status. Subjects completed a postal questionnaire that asked about current pain and covered aspects of psychological status and sleep disturbance. Samples of subjects stratified by the extent of bodily pain they reported and psychological status were invited to participate in an examination of pain threshold. The association between psychological status, sleep disturbance and a low pain threshold was examined using ordinal regression. High levels of psychological distress (OR=1.6, 95% CI (1.02, 2.5)), disturbed sleep (OR=2.2, 95% CI (1.4, 3.5)) and high scores on the HAD depression scale (OR=2.1, 95% CI (1.3, 3.2)) were all associated with having a low pain threshold. In multivariate analysis disturbed sleep and depression remained independently associated with a low pain threshold. These relationships persisted after adjustment for pain status. This study had demonstrated that depression and poor sleep are associated with a reduced pain threshold.
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Affiliation(s)
- Y H Chiu
- Arthritis Research Campaign (ARC) Epidemiology Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK Unit of Chronic Disease Epidemiology, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK Endocrine Sciences Research Group, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK Department of Psychiatry, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK University Department of Psychiatry, Royal Liverpool University Hospital, Liverpool L69 3GA, UK
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Harkness EF, Macfarlane GJ, Silman AJ, McBeth J. Is musculoskeletal pain more common now than 40 years ago?: two population-based cross-sectional studies. Rheumatology (Oxford) 2005; 44:890-5. [PMID: 15784630 DOI: 10.1093/rheumatology/keh599] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To test the hypothesis that the prevalence of specific musculoskeletal pain symptoms has increased over time in the northwest region of England. To meet this objective we have examined the difference in the prevalence of low back, shoulder and widespread pain between the 1950s and today using historical data collected by the Arthritis Research Campaign (arc). METHODS Two cross-sectional surveys conducted over 40 yr apart in the northwest region of England. The status of two regional pain sites and widespread pain was determined using interview and questionnaire responses, for the earlier and later studies respectively. Subjects were classified positively if they reported low back pain, shoulder pain or widespread pain on the day of the survey. Rates were standardized to the Greater Manchester population. RESULTS There were large differences in the prevalence of musculoskeletal pain between the two surveys. For all three symptoms examined prevalence increased from 2- to 4-fold between the two surveys. In both surveys low back pain was more common in women. Shoulder and widespread pain was less prevalent in women than in men in the earlier survey but by the time of the later survey women reported more pain at these sites. CONCLUSIONS The prevalence of musculoskeletal pain is much higher than that reported over 40 yr ago. The change in prevalence is unlikely to be entirely due to the study design; other possible explanations such as the increased reporting or awareness of these symptoms is discussed.
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Affiliation(s)
- E F Harkness
- ARC Epidemiology Unit, Medical School, University of Manchester, Oxford Road, Manchester M13 9PT, UK
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Abstract
BACKGROUND Despite extensive research, the reasons why patients consult their doctors are unclear. The aim of the current study was to identify the psychosocial and illness related factors that independently predicted primary care consultation over a 5-year period. METHOD We carried out a prospective, population-based cohort study with three waves of data collection by postal questionnaire in one general practice in Greater Manchester (UK). Consultation data were sought from primary care records on a random subsample of 800 adult patients. The main outcome measure was the number of consultations (including surgery and home visits) over the 5 years of the study as determined by raters blind to questionnaire responses. Questionnaire measures included the 12-item version of the General Health Questionnaire, the Illness Attitude Scales, a somatic symptom scale, a fatigue scale, a functional assessment of disability. RESULTS Consultation data were obtained on 738 patients (92% of selected subjects), who accounted for 12182 consultations. Negative illness attitudes, the presence of physical and psychiatric disorder, health anxiety, changes in psychological distress, reported physical symptoms and demographic factors such as age and sex were independently associated with consultation over a 5-year period. These variables together accounted for a difference of ten consultations per year between groups. CONCLUSION Consultation in primary care is a complex behaviour with a complex aetiology. Terms such as 'frequent attenders' may be less helpful than recognizing a number of dimensions that operate across the whole spectrum of consultation frequency. Future research should consider the wider context of consultation.
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Affiliation(s)
- N Kapur
- Department of Psychiatry and Behavioural Sciences, ARC Epidemiology Unit and Unit for Chronic Disease Epidemiology, University of Manchester.
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Storozhenko ON, Lesniak OM, Macfarlane GJ, McBeth J. [The prevalence of chronic generalized pain and its relationship to demographic characteristics and mental status]. Klin Med (Mosk) 2004; 82:48-52. [PMID: 15540424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Chronic generalized pain (CGP) as one of the diagnostic criteria of fibromyalgia is a common condition amongst the populations of Western Europe and the USA. The prevalence of CGP in these countries is 10.7-13.2%. The etiology of CGP is unclear; however, several findings suggest that this is a process of somatization that masks affective disorders. There have been no studies of the epidemiology of CGP in Russia. The study was undertaken to determine the prevalence of CGP in the Yekaterinburg adult population and to examine the relationship of CGP to its demographic characteristics and affective disorders. A ostal cross-sectional population survey was conducted. This covered 159 persons (54 males and 105 females) aged 27 to 75 years who had been randomly selected from the election lists of Yekaterinburg residents. A questionnaire was posted to each participant in order to reveal whether a respondent had experienced pain a month before, to define its location, duration, severity, and to evaluate psychoemotional disorders. The response rate was 75.5% (120 replies). The prevalence of CGP was 13.3%. There was no relationship of the sex of a respondent to CGP. The latter was shown to be associated with age. There was also its significant association with psychoemotional disorders. CGP is a common condition in the Yekateringburg population, which occurs in every 8 adult residents, more frequently in those aged above 43 years. The individuals who suffer from CGP exhibit a high level of psychological distress.
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McBeth J, Harkness EF, Silman AJ, Macfarlane GJ. The role of workplace low-level mechanical trauma, posture and environment in the onset of chronic widespread pain. Rheumatology (Oxford) 2003; 42:1486-94. [PMID: 12867586 DOI: 10.1093/rheumatology/keg399] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We have recently demonstrated that individual psychosocial factors are important predictors of the onset of chronic widespread pain. It has been hypothesized that excessive mechanical exposure may also be associated with symptom onset, although this has not been formally examined. We therefore determined the relative contributions of individual psychosocial and work-related mechanical, posture and environment factors in symptom onset. METHODS We conducted a population-based prospective survey and identified 1658 adults aged 18-65 yr who were symptom-free. At baseline, detailed information was obtained on work-related mechanical and environment factors using validated instruments. Individual psychosocial features were also measured. Subjects free of chronic widespread pain at baseline were followed up at 12 and 36 months to identify those reporting the onset of new symptoms. RESULTS In all, 1445 (91%) returned the questionnaire at 12 months and 978 (89%) at 36 months. Of these, 81 and 92 respectively reported new chronic widespread pain. Symptom onset was predicted by workplace factors [pushing/pulling heavy weights [relative risk (RR) = 1.8, 95% confidence interval (CI) 1.1, 3.0]; repetitive movements of the wrists (RR = 1.8, 95% CI 1.2, 2.7); kneeling (RR = 2.2, 95% CI 1.2, 4.1)] and individual factors [aspects of illness behaviour (RR = 2.9, 95% CI 1.6, 5.3); somatic symptoms (RR = 1.9 95% CI 1.1, 3.3); fatigue (RR = 1.9, 95% CI 1.2, 3.1); baseline pain symptoms (RR = 2.5, 95% CI 1.6, 3.9)]. In multivariate analysis, pushing/pulling heavy weights, repetitive wrist movements, kneeling and other pain at baseline were associated with new-onset chronic widespread pain. However, the strongest predictor was a high score on the illness behaviour scale. CONCLUSION This study provides only limited support for the hypothesis that low-level mechanical injury may be a risk factor for developing chronic widespread pain. The onset of chronic widespread pain appears to be multifactorial and is strongly predicted by individual psychosocial factors.
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Affiliation(s)
- J McBeth
- Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester, UK.
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Harkness EF, Macfarlane GJ, Nahit ES, Silman AJ, McBeth J. Mechanical and psychosocial factors predict new onset shoulder pain: a prospective cohort study of newly employed workers. Occup Environ Med 2003; 60:850-7. [PMID: 14573715 PMCID: PMC1740415 DOI: 10.1136/oem.60.11.850] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To test the hypothesis that work related mechanical and psychosocial factors predict new onset shoulder pain in newly employed workers. METHODS Two year prospective study of newly employed workers from 12 diverse occupational settings. At baseline, 1081 subjects provided information on work related mechanical and psychosocial risk factors, and current pain status. RESULTS In all, 803 (74%) subjects were free from shoulder pain at baseline. Of those, 638 (79%) responded at 12 months and 476 (88%) at 24 months. New onset shoulder pain was reported by 93 (15%) and 73 (15%) subjects respectively. An increased risk of symptom onset was found in subjects reporting mechanical exposures involving heavy weights including lifting with one or two hands, carrying on one shoulder, lifting at or above shoulder level, and pushing or pulling. Working with hands above shoulder level was also predictive of new onset shoulder pain. Of the psychosocial factors examined, the strongest predictor was monotonous work. Those individuals with any other previous pain also had an increased risk of new onset shoulder pain at follow up. In multivariate analysis, lifting heavy weights with one or two hands, pushing or pulling heavy weights, working with hands above shoulder level, and monotonous work were independently associated with new onset shoulder pain. CONCLUSIONS This study supports the hypothesised relation between mechanical risk factors and shoulder pain. In general, work related psychosocial factors were modestly associated with new onset shoulder pain. However, monotonous work was a strong risk factor for new onset shoulder pain.
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Affiliation(s)
- E F Harkness
- Arthritis Research Campaign Epidemiology Unit, Medical School, University of Manchester, Oxford Road, Manchester M13 9PT, UK.
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Harkness EF, Macfarlane GJ, Nahit ES, Silman AJ, McBeth J. Risk factors for new-onset low back pain amongst cohorts of newly employed workers. Rheumatology (Oxford) 2003; 42:959-68. [PMID: 12730508 DOI: 10.1093/rheumatology/keg265] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To test the hypothesis that work-related mechanical, psychosocial and physical environment factors would predict new-onset low back pain (LBP) in newly employed workers. METHODS A total of 1186 newly employed workers were recruited from a variety of occupational settings. Those who were free from LBP at baseline were identified. Subjects were followed up at 12 and 24 months. Work-related mechanical, psychosocial and physical environment exposures were measured. Generalized estimating equations were used to assess predictors of new-onset LBP. RESULTS New-onset LBP was reported by 119 (19%) and 81 (19%) subjects at 12 and 24 months, respectively. Several work-related mechanical exposures predicted new-onset LBP including lifting heavy weights with one or two hands, lifting heavy weights at or above shoulder level, pulling heavy weights, kneeling or squatting for 15 min or longer. Of the psychosocial factors examined, stressful and monotonous work significantly predicted symptom onset. In addition, hot working conditions and pain at other sites also predicted new-onset LBP. On multivariate analysis these risks were only moderately attenuated but the 95% confidence intervals excluded unity only for the latter, non-mechanical, exposures. CONCLUSION In this cohort of newly employed workers, from a range of occupations, several aspects of the work-place environment, other than mechanical factors, were important in predicting new-onset LBP. These results emphasize that interventions aimed at reducing the occurrence of LBP are likely to be most successful if they intervene across these domains.
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Affiliation(s)
- E F Harkness
- ARC Epidemiology Unit, The Medical School, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
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Harkness EF, Nahit ES, Macfarlane GJ, Silman AJ, McBeth J, Dunn G. Generalised estimating equations and low back pain. Occup Environ Med 2003; 60:378-80; author reply 380-1. [PMID: 12709527 PMCID: PMC1740537 DOI: 10.1136/oem.60.5.378-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
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McBeth J, Morris S, Benjamin S, Silman AJ, Macfarlane GJ. Associations between adverse events in childhood and chronic widespread pain in adulthood: are they explained by differential recall? J Rheumatol 2001; 28:2305-9. [PMID: 11669174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE Clinic based studies suggest that adverse events in childhood may predispose to chronic pain in adult life. These have been conducted on highly selected groups, and it is unknown whether these relationships hold in the general population and to what extent the increased rate of adverse childhood events in persons with pain is an artefact of differential reporting. We examined the hypothesis that chronic widespread pain was associated with reports of adverse experiences in childhood and whether any observed relationships could be explained by differential recall. METHODS A cross sectional population based screening survey was conducted. Subjects completed a questionnaire that included assessments of pain and psychological state. In total, 296 subjects who had demonstrated psychological distress were randomly selected and had a detailed interview, which included an assessment of 14 adverse childhood experiences. Medical records relating to childhood were also examined for those subjects. RESULTS The prevalence of self-reported adverse childhood experiences was greatest in adult subjects with current chronic widespread pain. Exposure to illness in family members, parental loss, operations, and abuse were all associated with increased, but nonsignificant, odds of having chronic widespread pain versus those without such exposures. However the only statistically significant association was with childhood hospitalizations. From medical record information the associations of hospitalizations (OR 5.1, 95% CI 2.0-13.0) and operations (OR 3.0, 95% CI 1.2-7.2) with pain previously noted were partly explained by differential recall between subjects with and without pain: hospitalizations, OR 2.2, 95% CI 0.9-5.5; operations, OR 1.2, 95% CI 0.5-3.4. CONCLUSION Although several reported adverse events in childhood were observed to be associated with chronic widespread pain in adulthood, only reports of hospitalizations were significantly associated. Validation of self-reported exposures suggests that there was differential recall of past events among those with and without pain, and this differential recall explained the association between hospitalizations and current chronic pain. Such differential recall may explain other observations of an association between reports of adverse childhood events and chronic pain in adulthood.
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Affiliation(s)
- J McBeth
- Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester, United Kingdom
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Abstract
OBJECTIVE To determine whether there is excess mortality in groups of people who report widespread body pain, and if so to establish the nature and extent of any excess. DESIGN Prospective follow up study over eight years. Mortality rate ratios were adjusted for age group, sex, and study location. SETTING North west England. PARTICIPANTS 6569 people who took part in two pain surveys during 1991-2. MAIN OUTCOME MEASURES Pain status at baseline and subsequent mortality. RESULTS 1005 (15%) participants had widespread pain, 3176 (48%) had regional pain, and 2388 (36%) had no pain. During follow up mortality was higher in people with regional pain (mortality rate ratio 1.21, 95% confidence interval 1.01 to 1.44) and widespread pain (1.31, 1.05 to 1.65) than in those who reported no pain. The excess mortality among people with regional and widespread pain was almost entirely related to deaths from cancer (1.55 (1.09 to 2.19) for regional pain and 2.07 (1.37 to 3.13) for widespread pain). The excess cancer mortality remained after exclusion of people in whom cancer had been diagnosed before the original survey and after adjustment for potential confounding factors. There were also more deaths from causes other than disease (for example, accidents, suicide, violence) among people with widespread pain (5.21, 0.94 to 28.78). CONCLUSION There is an intriguing association between the report of widespread pain and subsequent death from cancer in the medium and long term. This may have implications for the long term follow up of patients with "unexplained" widespread pain symptoms, such as those with fibromyalgia.
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Affiliation(s)
- G J Macfarlane
- Unit of Chronic Disease Epidemiology, Medical School, University of Manchester, Manchester M13 9PT.
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Abstract
The cardinal features of fibromyalgia are chronic widespread pain in the presence of widespread tenderness as measured by multiple tender points. Despite extensive investigations, the etiology of this syndrome remains unclear. Increased rates of psychiatric disorders, particularly depressive, anxiety, and somatoform disorders, are apparent in clinic populations. Epidemiologic evidence suggests that this is also true for community subjects. Depression, generalized psychological distress, and other psychological factors have been shown to be associated with the onset and persistence of fibromyalgia symptoms. However, the bodily processes through which such factors may lead to the onset of fibromyalgia are unclear. Recent investigations have demonstrated altered stress system responsiveness, most notably the hypothalamic-pituitary-adrenal stress axis, in patients with fibromyalgia. These findings, and one promising avenue for investigating the interaction between psychological and biological factors in the onset of chronic pain syndromes including fibromyalgia, are discussed.
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Affiliation(s)
- J McBeth
- Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK.
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Abstract
OBJECTIVE Chronic widespread pain, the clinical hallmark of the fibromyalgia syndrome, is associated with other physical and psychological symptoms both in patients studied in a clinical setting and in those identified in the community. The present study was undertaken to examine the hypothesis that psychological and physical indicators of the process of somatization predict the development of new chronic widespread pain. METHODS In this population-based prospective study, 1,658 adults ages 18-65 years completed a detailed pain questionnaire, which included a pain drawing. They also completed the following psychosocial instruments: General Health Questionnaire, Somatic Symptom Checklist, Fatigue Questionnaire, and Illness Attitude Scales. Individuals were followed up at 12 months, at which time 1,480 (93% of subjects still living at their baseline address) provided data on pain status, using the same instruments. RESULTS At baseline, 825 subjects were classified as pain free and 833 as having pain not satisfying criteria for chronic widespread pain. Of those, 18 (2%) and 63 (8%), respectively, were classified as having chronic widespread pain at followup. After adjustment for age and sex, there were strong relationships between baseline test scores and subsequent risk of chronic widespread pain (odds ratio for the Somatic Symptom Checklist 3.3; odds ratio for the Illness Behavior subscale of the Illness Attitude Scales 9.0). All 95% confidence intervals excluded unity. These associations were independent of baseline pain status. CONCLUSION Subjects who are free of chronic widespread pain are at increased future risk of its development if they display other aspects of the process of somatization. Data from this population-based prospective study lend powerful support to the hypothesis that chronic widespread pain can be one manifestation of the somatization of distress.
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Affiliation(s)
- J McBeth
- Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester, UK
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Abstract
BACKGROUND Chronic widespread pain is the cardinal clinical feature of the fibromyalgia syndrome, which, in the majority of clinic patients, is persistent. By contrast, in community-derived patients, pain is persistent in only half of the affected individuals, particularly those with psychological distress. Whether such distress is a consequence of the pain or a manifestation of a wider process of somatization which is associated with the persistence of pain is unclear. OBJECTIVES We tested in a large, prospective, population-based study the hypothesis that features of somatization predict the persistence of chronic widespread pain. METHODS In all, 252 (13%) of 1953 adult subjects selected from a population register were classified as having chronic widespread pain based on a detailed questionnaire which included a pain drawing. The patients also completed a number of psychosocial instruments which measure features known to be associated with somatization. Two hundred and twenty-five (91%) of the patients were successfully followed up after 12 months and provided data on pain status using the same instruments. RESULTS In all, 126 (56%) patients reported chronic widespread pain at follow-up, 74 (33%) reported other pain and 25 (11%) reported no pain. Persistent chronic widespread pain was strongly associated with baseline test scores for high psychological distress and fatigue. In addition, these subjects were more likely to display a pattern of illness behaviour characterized by frequent visits to medical practitioners for symptoms which disrupt daily activities. The prevalence of persistent pain increased with the number of risk factors the subjects were exposed to. CONCLUSIONS Although almost half of the cases of chronic widespread pain resolved within 1 yr, this study has demonstrated for the first time that those subjects who display features of somatization are more likely to have widespread pain which persists. These findings have implications for the identification and treatment of persons with persistent chronic widespread pain.
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Affiliation(s)
- J McBeth
- Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester M13 9PT, UK
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Macfarlane GJ, McBeth J, Garrow A, Silman AJ. Life is as much a pain as it ever was. BMJ 2000; 321:897. [PMID: 11021885 PMCID: PMC1118693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Abstract
OBJECTIVE Patients with chronic widespread pain (CWP) have been reported to have a greater prevalence of mental disorders and somatization than that found in the general population, but the true association between CWP and mental disorders is unknown. In this study, we investigated whether there is an increased prevalence of mental disorder in people with CWP from the general population. We also describe the psychiatric diagnoses associated with CWP. METHODS In a population-based case-control study, 1,953 subjects (75% of a random sample of individuals age 18-65 years) completed a questionnaire that included a pain assessment and the 12-item General Health Questionnaire (GHQ-12). Of 710 subjects scoring >1 on the GHQ-12, 301 were assessed further using a structured psychiatric interview and detailed assessment of medical records to identify cases of mental disorder, in accordance with criteria of the 10th edition of the International Classification of Diseases. The association between CWP and mental disorder was modeled using logistic regression, adjusting for possible confounders including age, sex, and nonresponders. RESULTS We estimated the overall population prevalence of mental illness to be 11.9%. The odds of having a mental disorder for subjects with versus those without CWP were 3.18 (95% confidence interval 1.97-5.11). Most subjects with mental disorders were diagnosed as having mood and anxiety disorders. Only 3 cases of somatoform disorders were identified, and all were associated with pain. CONCLUSION This study, although unable to demonstrate a cause-and-effect relationship, showed that 16.9% of those with CWP were estimated to have a psychiatric diagnosis, suggesting that these disorders should be identified and treated.
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McBeth J, Macfarlane GJ, Benjamin S, Morris S, Silman AJ. The association between tender points, psychological distress, and adverse childhood experiences: a community-based study. Arthritis Rheum 1999; 42:1397-404. [PMID: 10403267 DOI: 10.1002/1529-0131(199907)42:7<1397::aid-anr13>3.0.co;2-7] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the hypothesis that characteristics of somatization and illness behavior, and their childhood antecedents, are associated with the presence of multiple tender points. METHODS Two hundred eighty-nine subjects who had demonstrated psychological distress (General Health Questionnaire score > or =2) had a tender point examination and in-depth psychological evaluation. In addition, subjects were interviewed about a number of adverse childhood experiences. The 99 subjects with 5 or more tender points were compared with the remaining 190 subjects. RESULTS A high tender point count (> or =5) was associated with low levels of self-care (odds ratio [OR] 2.4, 95% confidence interval [95% CI] 1.1-5.0), reports of a greater number of somatic symptoms (OR 2.2, 95% CI 1.0-4.9), high levels of fatigue (OR 3.3, 95% CI 1.7-6.3), and a pattern of illness behavior characterized by increased medical care usage (OR 4.2, 95% CI 2.1-8.4). Those with high tender point counts were substantially more likely to report adverse childhood experiences, including loss of parents (OR 2.1, 95% CI 1.1-3.9) and abuse (OR 6.9, 95% CI 2.0-24.6). These results were not explained by the presence of chronic pain. CONCLUSION These data add further weight to the hypothesis that tender points, as part of the fibromyalgia syndrome, are strongly associated with specific components of psychological distress as well as characteristics of somatization and its antecedents. It is possible that these features contribute to the development of the syndrome of fibromyalgia.
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Affiliation(s)
- J McBeth
- Arthritis Research Campaign Epidemiology Unit, University of Manchester, UK
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McBeth J, Macfarlane GJ, Benjamin S, Morris S, Silman AJ. The association between tender points, psychological distress, and adverse childhood experiences: a community-based study. Arthritis Rheum 1999. [PMID: 10403267 DOI: 10.1002/1529-0131(199907)42:73.0.co;2-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To examine the hypothesis that characteristics of somatization and illness behavior, and their childhood antecedents, are associated with the presence of multiple tender points. METHODS Two hundred eighty-nine subjects who had demonstrated psychological distress (General Health Questionnaire score > or =2) had a tender point examination and in-depth psychological evaluation. In addition, subjects were interviewed about a number of adverse childhood experiences. The 99 subjects with 5 or more tender points were compared with the remaining 190 subjects. RESULTS A high tender point count (> or =5) was associated with low levels of self-care (odds ratio [OR] 2.4, 95% confidence interval [95% CI] 1.1-5.0), reports of a greater number of somatic symptoms (OR 2.2, 95% CI 1.0-4.9), high levels of fatigue (OR 3.3, 95% CI 1.7-6.3), and a pattern of illness behavior characterized by increased medical care usage (OR 4.2, 95% CI 2.1-8.4). Those with high tender point counts were substantially more likely to report adverse childhood experiences, including loss of parents (OR 2.1, 95% CI 1.1-3.9) and abuse (OR 6.9, 95% CI 2.0-24.6). These results were not explained by the presence of chronic pain. CONCLUSION These data add further weight to the hypothesis that tender points, as part of the fibromyalgia syndrome, are strongly associated with specific components of psychological distress as well as characteristics of somatization and its antecedents. It is possible that these features contribute to the development of the syndrome of fibromyalgia.
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Affiliation(s)
- J McBeth
- Arthritis Research Campaign Epidemiology Unit, University of Manchester, UK
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Hunt IM, Silman AJ, Benjamin S, McBeth J, Macfarlane GJ. The prevalence and associated features of chronic widespread pain in the community using the 'Manchester' definition of chronic widespread pain. Rheumatology (Oxford) 1999; 38:275-9. [PMID: 10325667 DOI: 10.1093/rheumatology/38.3.275] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We examine the descriptive epidemiology of chronic widespread pain using the 'Manchester' definition [CWP(M)] and assess psychosocial and other features which characterize subjects with such pain according to these more stringent criteria. METHODS A population postal survey of 3004 subjects was conducted in the Greater Manchester area of the UK. RESULTS The point prevalence of Manchester-defined chronic widespread pain was 4.7%. CWP(M) was associated with psychological disturbance [risk ratio (RR) = 2.2, 95% confidence interval (CI) (1.4-3.5)], fatigue [RR = 3.8, 95% CI (2.3-6.1)], low levels of self-care [RR = 2.2, 95% CI (1.4-3.6)] and with the reporting of other somatic symptoms [RR = 2.0, 95% CI (1.3-3.1)]. Hypochondriacal beliefs and a preoccupation with bodily symptoms were also associated with the presence of CWP(M). CONCLUSION This definition of chronic widespread pain is more precise in identifying subjects with truly widespread pain and its associated adverse psychosocial factors. Clear associations with other 'non-pain' somatic symptoms were identified, which further supports the hypothesis that chronic widespread pain is one feature of somatization.
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Affiliation(s)
- I M Hunt
- Arthritis Research Campaign, Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester, UK
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