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Rheel E, De Craemer M, Deliens T, Pleysier S, Ickmans K. Establishing Consensus on Biopsychosocial Factors Associated with Pediatric Chronic Pain: a Modified Delphi Study. THE JOURNAL OF PAIN 2024:104703. [PMID: 39395567 DOI: 10.1016/j.jpain.2024.104703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/28/2024] [Accepted: 10/07/2024] [Indexed: 10/14/2024]
Abstract
A variety of factors are associated with the development and maintenance of chronic pain in children. Identifying modifiable factors associated with pediatric chronic pain is important to use them as target outcomes in the development and evaluation of interventions for the prevention and management of chronic pain. This study aimed to reach expert consensus on factors associated with pediatric chronic pain and their modifiability and population-level effect. Pediatric pain experts were questioned using a web-based two-round modified Delphi method. Two rounds of questions with Likert scaling were used to identify influencing factors (Round 1) and to reach consensus on each factor (Round 2) in terms of: 1) strength of association with chronic pain in children; 2) modifiability; and 3) population-level effect. An inductive approach was used to derive categories (ranging from 'very low' to 'very high') and subcategories (ranging from 'low' to 'high'). In total, 48 experts from 14 different countries completed Round 1, and 31 completed Round 2. A list of 47 factors was considered to be associated with pediatric chronic pain. Four factors (physical activity (PA), sedentary behavior (SB), pain-related school absence, and pain concept/knowledge of the child) were considered highly modifiable and three factors having a high population-level effect (PA, SB, and the child's depressive or negative emotional feelings). Expert consensus was established about modifiable and population-level factors associated with pediatric chronic pain through this web-based modified Delphi study, guiding target outcomes for its prevention and management. PERSPECTIVE: This article presents the results of a modified Delphi study with pediatric pain experts to gain consensus on factors associated with pediatric chronic pain. Relationship strength, modifiability, and population-level effect of associated factors were rated to identify areas of research priority and interventions aiming to reduce the development and maintenance of chronic pain in children.
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Affiliation(s)
- Emma Rheel
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.
| | - Marieke De Craemer
- 24-hour Movement Behaviors in Clinical Populations (MOVEUP24), Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Tom Deliens
- Movement & Nutrition for Health & Performance research group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Sophie Pleysier
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Kelly Ickmans
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Movement & Nutrition for Health & Performance research group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium; Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels Brussels, Belgium
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Chen D, Zhang Y, Zhou Y, Liang Z. Association of Short-term Pain and Chronic Pain Intensity With Cardiometabolic Multimorbidity Progression: A Multistate Markov Model Analysis. Anesth Analg 2024:00000539-990000000-00973. [PMID: 39383101 DOI: 10.1213/ane.0000000000007228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2024]
Abstract
BACKGROUND The impact of pain intensity on the progression trajectories of cardiometabolic multimorbidity (CMM) is not well understood. We attempted to dissect the relationship of short-term pain (STP) and chronic pain intensity with the temporal progression of CMM. METHODS We conducted a prospective cohort study based on the UK Biobank participants. Incident cases of cardiometabolic diseases (CMDs) were identified based on self-reported information and multiple health-related records in the UK Biobank. CMM was defined as the occurrence of at least 2 CMDs, including heart failure (HF), ischemic heart disease (IHD), stroke, and type 2 diabetes (T2D). The pain intensity was categorized into 5 levels based on pain duration and the number of sites involved, including chronic widespread pain (CWSP), chronic multilocation pain (CMLP), chronic single-location pain (CSLP), STP, and free-of-pain (FOP). Multistate models were used to assess the impact of pain intensity on the CMM trajectories from enrollment to initial cardiometabolic disease (ICMD), subsequently to CMM, and ultimately to death. RESULTS A total of 429,145 participants were included. Over the course of a 12.8-year median follow-up, 13.1% (56,137/429,145) developed ICMD, 19.6% (10,979/56,137) further progressed to CMM, and a total of 5.3% (22,775/429,145) died. Compared with FOP, CMLP (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.06-1.17) and CWSP (HR, 1.26; 95% CI, 1.13-1.42) elevated the risk of transitioning from ICMD to CMM. STP (HR, 0.89; 95% CI, 0.82-0.96), CSLP (HR, 0.88; 95% CI, 0.82-0.95), and CMLP (HR, 0.87; 95% CI, 0.81-0.93) lowered the risk of transition from ICMD to mortality, and STP also reduced the risk of transition from enrollment to mortality (HR, 0.94; 95% CI, 0.89-0.98). The results of disease-specific transitions revealed that the influence of pain intensity varied across transitional stages. Specifically, CMLP and CWSP heightened the risk of conversion from T2D or IHD to CMM, whereas only CWSP substantially elevated the transition risk from HF to CMM. CONCLUSIONS Our results highlighted reductions in chronic pain may mitigate both the onset and progression of CMM, potentially having an important impact on future revisions of cardiometabolic and pain-related guidelines.
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Affiliation(s)
- Dongze Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yali Zhang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Yi Zhou
- Department of Third Research, Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Zhisheng Liang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
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Barrett JE, Kohut AR. A historical perspective and recent advances on the evolution of the relationship between acute and chronic pain and cardiovascular disease. Biochem Pharmacol 2024; 228:116357. [PMID: 38857831 DOI: 10.1016/j.bcp.2024.116357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
The relationship between acute pain and the cardiovascular system was recognized approximately 50 years ago following the initial observation, along with several subsequent experimental studies, that hypertension can result in decreases in the perception of pain. These studies provided a strong impetus to study potential mechanisms to clarify commonalities between the regulatory pathways associated with pain and the cardiovascular system. Attention subsequently shifted to an emphasis on the impact of chronic pain on cardiovascular diseases and mortality with several large meta-analyses of longitudinal studies providing clear evidence that chronic widespread pain increases the risk for developing cardiovascular disease and is associated with excess morbidity and mortality. Cardiovascular associated mortality from myocardial infarction and stroke appears to be directly related to the duration and severity of chronic pain, a result often characterized as a 'dose-response' relationship. The availability and reproducibility of extensive large-scale observational and retrospective studies have emphasized the critical need for more research, including prospective studies, along with the need for the development of preclinical animal models, to better understand the relationship(s) and underlying mechanisms between chronic pain, associated comorbidities, and cardiovascular disease. Elucidation and a deeper understanding of these relationships, including a focus on the link between chronic pain, cardiovascular disease, and depression, could provide valuable information to guide the development of potential treatment interventions to aid in attenuating pain while preventing pain-associated cardiovascular disease, comorbidities, and mortality.
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Affiliation(s)
- James E Barrett
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140; Penn Heart and Vascular Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19407.
| | - Andrew R Kohut
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140; Penn Heart and Vascular Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19407
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Pisaniello HL, Lester SE, Russell O, Black R, Tieu J, Richards B, Barrett C, Lassere M, March L, Buchbinder R, Hill C, Whittle SL. The associations between poorer pain-related health status and increased hospitalisations and excess mortality in patients with rheumatoid arthritis (RA): a prospective cohort analysis using the Australian Rheumatology Association Database (ARAD). Ann Rheum Dis 2024; 83:1400-1402. [PMID: 38811050 DOI: 10.1136/ard-2024-225696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Huai Leng Pisaniello
- Discipline of Medicine, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
| | - Susan Elizabeth Lester
- Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Oscar Russell
- Discipline of Medicine, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Rachel Black
- Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Joanna Tieu
- Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Bethan Richards
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Rheumatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Claire Barrett
- Department of Rheumatology, Redcliffe Hospital, Redcliffe, Queensland, Australia
- Department of Medicine, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Marissa Lassere
- Department of Rheumatology, St George Hospital, Sydney, New South Wales, Australia
- Department of Medicine, University of New South Wales School of Population Health, Sydney, New South Wales, Australia
| | - Lyn March
- Florence and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Institute of Bone and Joint Research at Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine Hill
- Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Samuel Lawrance Whittle
- Basil Hetzel Institute for Translational Health Research, Woodville South, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Årnes AP, Fjeld MK, Stigum H, Nielsen CS, Stubhaug A, Johansen A, Hopstock LA, Morseth B, Wilsgaard T, Steingrímsdóttir ÓA. Does pain tolerance mediate the effect of physical activity on chronic pain in the general population? The Tromsø Study. Pain 2024; 165:2011-2023. [PMID: 38442413 DOI: 10.1097/j.pain.0000000000003209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
ABSTRACT Knowledge is needed regarding mechanisms acting between physical activity (PA) and chronic pain. We investigated whether cold pain tolerance mediates an effect of leisure-time physical activity on the risk of chronic pain 7 to 8 years later using consecutive surveys of the population-based Tromsø Study. We included participants with information on baseline leisure-time PA (LTPA) and the level of cold pressor-assessed cold pain tolerance, who reported chronic pain status at follow-up as any of the following: chronic pain for ≥3 months, widespread chronic pain, moderate-to-severe chronic pain, or widespread moderate-to-severe chronic pain. We included 6834 participants (52% women; mean age, 55 years) in counterfactual mediation analyses. Prevalence decreased with severity, for example, 60% for chronic pain vs 5% for widespread moderate-to-severe chronic pain. People with one level higher LTPA rating (light to moderate or moderate to vigorous) at baseline had lower relative risk (RR) of 4 chronic pain states 7 to 8 years later. Total RR effect of a 1-level LTPA increase was 0.95 (0.91-1.00), that is, -5% decreased risk. Total effect RR for widespread chronic pain was 0.84 (0.73-0.97). Indirect effect for moderate-to-severe chronic pain was statistically significant at RR 0.993 (0.988-0.999); total effect RR was 0.91 (0.83-0.98). Statistically significantly mediated RR for widespread moderate-to-severe chronic pain was 0.988 (0.977-0.999); total effect RR was 0.77 (0.64-0.94). This shows small mediation of the effect of LTPA through pain tolerance on 2 moderate-to-severe chronic pain types. This suggests pain tolerance to be one possible mechanism through which PA modifies the risk of moderate-to-severe chronic pain types with and without widespread pain.
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Affiliation(s)
- Anders Pedersen Årnes
- Department of Pain, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mats Kirkeby Fjeld
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hein Stigum
- Institute of Health and Society, University of Oslo, Norway
| | - Christopher Sivert Nielsen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Audun Stubhaug
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Aslak Johansen
- Department of Pain, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Polli A, Nijs J. Exploring biological mechanisms of lifestyle and environmental factors in humans: Current challenges and future directions. Invited comment on: "Environmental factors and their impact on chronic pain development and maintenance", by Sant'Anna et al. Phys Life Rev 2024; 50:43-45. [PMID: 38905875 DOI: 10.1016/j.plrev.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/23/2024]
Affiliation(s)
- Andrea Polli
- Pain in Motion (PAIN) research group, Department of Physiotherapy, Human Physiology, and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium; Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Research Foundation, Flanders (FWO), Belgium.
| | - Jo Nijs
- Pain in Motion (PAIN) research group, Department of Physiotherapy, Human Physiology, and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium; Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
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Leroux A, Crainiceanu C, Zeger S, Taub M, Ansari B, Wager TD, Bayman E, Coffey C, Langefeld C, McCarthy R, Tsodikov A, Brummet C, Clauw DJ, Edwards RR, Lindquist MA. Statistical modeling of acute and chronic pain patient-reported outcomes obtained from ecological momentary assessment. Pain 2024; 165:1955-1965. [PMID: 38718196 DOI: 10.1097/j.pain.0000000000003214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/11/2024] [Indexed: 05/18/2024]
Abstract
ABSTRACT Ecological momentary assessment (EMA) allows for the collection of participant-reported outcomes (PROs), including pain, in the normal environment at high resolution and with reduced recall bias. Ecological momentary assessment is an important component in studies of pain, providing detailed information about the frequency, intensity, and degree of interference of individuals' pain. However, there is no universally agreed on standard for summarizing pain measures from repeated PRO assessment using EMA into a single, clinically meaningful measure of pain. Here, we quantify the accuracy of summaries (eg, mean and median) of pain outcomes obtained from EMA and the effect of thresholding these summaries to obtain binary clinical end points of chronic pain status (yes/no). Data applications and simulations indicate that binarizing empirical estimators (eg, sample mean, random intercept linear mixed model) can perform well. However, linear mixed-effect modeling estimators that account for the nonlinear relationship between average and variability of pain scores perform better for quantifying the true average pain and reduce estimation error by up to 50%, with larger improvements for individuals with more variable pain scores. We also show that binarizing pain scores (eg, <3 and ≥3) can lead to a substantial loss of statistical power (40%-50%). Thus, when examining pain outcomes using EMA, the use of linear mixed models using the entire scale (0-10) is superior to splitting the outcomes into 2 groups (<3 and ≥3) providing greater statistical power and sensitivity.
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Affiliation(s)
- Andrew Leroux
- Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Ciprian Crainiceanu
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Scott Zeger
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Margaret Taub
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Briha Ansari
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tor D Wager
- Department of Psychological and Brain Science, Dartmouth College, Hanover, NH, United States
| | - Emine Bayman
- Departments of Biostatistics and
- Anesthesia, University of Iowa, Iowa City, IA, United States
| | | | - Carl Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, United States
- The Comprehensive Cancer Center of Wake Forest University, Winston Salem, NC, United States
| | - Robert McCarthy
- Department of Anesthesiology, Rush University, Chicago, IL, United States
| | | | - Chad Brummet
- Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Daniel J Clauw
- Anesthesiology, University of Michigan, Ann Arbor, MI, United States
| | - Robert R Edwards
- Harvard Medical School, Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, MA, United States
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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Fu K, Cai Q, Jin X, Chen L, Oo WM, Duong V, Li G, Zhu Z, Ding C, Zhang C, Gao Y, Hunter DJ. Association of serum calcium, vitamin D, and C-reactive protein with all-cause and cause-specific mortality in an osteoarthritis population in the UK: a prospective cohort study. BMC Public Health 2024; 24:2286. [PMID: 39175018 PMCID: PMC11342510 DOI: 10.1186/s12889-024-19825-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/19/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Osteoarthritis is a prevalent musculoskeletal condition, but the role of specific serum biomarkers, such as calcium, vitamin D, and C-reactive protein (CRP), in predicting mortality among individuals with osteoarthritis remains unclear. METHODS This observational study analyzed longitudinal data from over 500,000 participants in the UK Biobank, identifying those with osteoarthritis using ICD-9/10 codes or self-reported history. We performed multivariable cox-regression and flexible parametric survival model (FPSM) for survival analysis, with adjustments made through the inverse probability of treatment weight (IPTW) for baseline covariates identified by directed acyclic graphs (DAGs). RESULTS Of the 49,082 osteoarthritis population, the average age was 60.69 years, with 58.7% being female. During the follow-up period exceeding 15 years, a total of 5,522 people with osteoarthritis died. High serum calcium levels, compared to normal serum calcium levels, were significantly associated with all-cause mortality (hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.11, 1.59), cardiovascular diseases (CVD)-related deaths (HR 1.55, 95% CI 1.05, 2.29), and other deaths (HR 1.59, 95% CI 1.20, 2.11). Low serum calcium levels, compared to normal serum calcium levels, was linked with CVD-related deaths (HR 2.06, 95% CI 1.02, 4.14). Vitamin D insufficiency, compared to sufficient vitamin D levels, was correlated with all-cause mortality (HR 1.22, 95% CI 1.13, 1.33), CVD-related deaths (HR 1.43, 95% CI 1.20, 1.72), and other deaths (HR 1.26, 95% CI 1.09, 1.45) but not with cancer-related deaths. High serum CRP levels, compared to normal CRP levels, were associated with all outcomes (all-cause mortality: HR 1.22, 95% CI 1.12, 1.33; CVD-related death: HR 1.24, 95%CI 1.03, 1.49; cancer-related death: HR 1.23, 95% CI 1.09, 1.40; other deaths: HR 1.19, 95%CI 1.03, 1.38). CONCLUSIONS Both high and low serum calcium levels, elevated CRP, and vitamin D insufficiency are potential predictors of increased mortality risk in the osteoarthritis population. These findings emphasize the importance of monitoring and possibly addressing these serum biomarkers in osteoarthritis populations to improve long-term outcomes. Further studies are needed to understand the underlying mechanisms and to propose therapeutic interventions.
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Affiliation(s)
- Kai Fu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Kolling Institute, Sydney Musculoskeletal Health, The University of Sydney, Sydney, Australia.
| | - Qianying Cai
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Microsurgery on Extremities, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinzhong Jin
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Lingxiao Chen
- Department of Orthopaedics, Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, Shandong University, Jinan, Shandong, China
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Win Min Oo
- Kolling Institute, Sydney Musculoskeletal Health, The University of Sydney, Sydney, Australia
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine Mandalay, Mandalay, Myanmar
| | - Vicky Duong
- Kolling Institute, Sydney Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | - Guangyi Li
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaohua Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Changqing Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Youshui Gao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - David J Hunter
- Kolling Institute, Sydney Musculoskeletal Health, The University of Sydney, Sydney, Australia
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Barrett JE, Terry AV. IUPHAR editorial: Emerging targets for the treatment of pain: Moving towards non-addicting therapeutics and new preclinical directions. Pharmacol Res 2024:107339. [PMID: 39106907 DOI: 10.1016/j.phrs.2024.107339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Affiliation(s)
- James E Barrett
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States.
| | - Alvin V Terry
- Regents Professor and Chair, Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, 1460 Laney Walker Blvd. CB-3542, Augusta, GA, 30912, United States.
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Tamargo JA, Strath LJ, Cruz-Almeida Y. High-Impact Pain Is Associated With Epigenetic Aging Among Middle-Aged and Older Adults: Findings From the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae149. [PMID: 38855906 PMCID: PMC11226994 DOI: 10.1093/gerona/glae149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Chronic pain has been associated with accelerated biological aging, which may be related to epigenetic alterations. We evaluated the association of high-impact pain (ie, pain that limits activities and function) with epigenetic aging, a measure of biological aging, in a nationally representative sample of middle-aged and older adults in the United States. METHODS Cross-sectional analysis of adults 50 years of age and older from the 2016 Health and Retirement Study. Epigenetic aging was derived from 13 epigenetic clocks based on DNA methylation patterns that predict aging correlates of morbidity and mortality. Ordinary least squares regressions were performed to test for differences in the epigenetic clocks, adjusting for the complex survey design, as well as biological, social, and behavioral factors. RESULTS The analysis consisted of 3 855 adults with mean age of 68.5 years, including 59.8% with no pain and 25.8% with high-impact pain. Consistent with its operational definition, high-impact pain was associated with greater functional and activity limitations. High-impact pain was associated with accelerated epigenetic aging compared to no pain, as measured via second (Zhang, PhenoAge, GrimAge) and third (DunedinPoAm) generation epigenetic clocks. Additionally, GrimAge was accelerated in high-impact pain as compared to low-impact pain. CONCLUSIONS High-impact pain is associated with accelerated epigenetic aging among middle-aged and older adults in the United States. These findings highlight aging-associated epigenetic alterations in high-impact chronic pain and suggest a potential for epigenetic therapeutic approaches for pain management and the preservation of physical function in older adults.
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Affiliation(s)
- Javier A Tamargo
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Institute on Aging, University of Florida, Gainesville, Florida, USA
| | - Larissa J Strath
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Institute on Aging, University of Florida, Gainesville, Florida, USA
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Zhang Z, Xue D, Bian Y. Association Between Socioeconomic Inequalities in Pain and All-Cause Mortality in the China Health and Retirement Longitudinal Study: Longitudinal Cohort Study. JMIR Public Health Surveill 2024; 10:e54309. [PMID: 38872381 PMCID: PMC11282390 DOI: 10.2196/54309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 05/04/2024] [Accepted: 06/13/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Few studies focus on the equality of pain, and the relationship between pain and death is inconclusive. Investigating the distribution of pain and potential mortality risks is crucial for ameliorating painful conditions and devising targeted intervention measures. OBJECTIVE Our study aimed to investigate the association between inequalities in pain and all-cause mortality in China. METHODS Longitudinal cohort data from waves 1 and 2 of the China Health and Retirement Longitudinal Study (2011-2013) were used in this study. Pain was self-reported at baseline, and death information was obtained from the 2013 follow-up survey. The concentration index and its decomposition were used to explain the inequality of pain, and the association between pain and death was analyzed with a Cox proportional risk model. RESULTS A total of 16,747 participants were included, with an average age of 59.57 (SD 9.82) years. The prevalence of pain was 32.54% (8196/16,747). Among participants with pain, the main pain type was moderate pain (1973/5426, 36.36%), and the common pain locations were the waist (3232/16,747, 19.3%), legs (2476/16,747, 14.78%) and head (2250/16,747, 13.44%). We found that the prevalence of pain was concentrated in participants with low economic status (concentration index -0.066, 95% CI -0.078 to -0.054). Educational level (36.49%), location (36.87%), and economic status (25.05%) contributed significantly to the inequality of pain. In addition, Cox regression showed that pain was associated with an increased risk of all-cause mortality (hazard ratio 1.30, 95% CI 1.06-1.61). CONCLUSIONS The prevalence of pain in Chinese adults is concentrated among participants with low economic status, and pain increases the risk of all-cause death. Our results highlight the importance of socioeconomic factors in reducing deaths due to pain inequalities by implementing targeted interventions.
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Affiliation(s)
- Zhuo Zhang
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Taipa, Macao
| | - Dongmei Xue
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Taipa, Macao
| | - Ying Bian
- Institute of Chinese Medical Sciences, State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Taipa, Macao
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12
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Yarns BC, Jackson NJ, Alas A, Melrose RJ, Lumley MA, Sultzer DL. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2415842. [PMID: 38869899 PMCID: PMC11177167 DOI: 10.1001/jamanetworkopen.2024.15842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
Importance Chronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy (CBT), produces only modest benefits, and more powerful options are needed. Objectives To evaluate whether emotional awareness and expression therapy (EAET) is superior to CBT for treatment of chronic pain among predominantly male older veterans and whether higher baseline depression, anxiety, or posttraumatic stress disorder (PTSD) symptoms-key targets of EAET-moderate treatment response. Design, Setting, and Participants This 2-arm randomized clinical trial was conducted from May 16, 2019, to September 14, 2023, in the US Department of Veterans Affairs Greater Los Angeles Healthcare System. The trial included a racially and ethnically diverse group of veterans aged 60 to 95 years with at least 3 months of musculoskeletal pain. Interventions Emotional awareness and expression therapy or CBT, conducted concurrently, each presented as one 90-minute individual session followed by eight 90-minute group sessions. Main Outcomes and Measures The primary outcome was Brief Pain Inventory pain severity (range, 0 to 10) from baseline to posttreatment (week 10, primary end point) and 6-month follow-up. Secondary outcomes included Patient Reported Outcomes Institute Measurement System Anxiety, Depression, Fatigue, General Life Satisfaction (NIH Toolbox), Pain Interference, and Sleep Disturbance Short Forms, Patient Global Impression of Change (PGIC), and Satisfaction with Therapy and Therapist Scale-Revised. A subset of participants completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). All analyses were for the intention-to-treat population and included all randomized participants. Results Among 126 randomized participants (66 in the EAET group and 60 in the CBT group; mean [SD] age, 71.9 [5.9] years; 116 [92%] male), 111 (88%) completed posttreatment, and 104 (82%) completed the 6-month follow-up. The EAET was superior to CBT for the primary outcome of reduction in pain severity at posttreatment (estimate, -1.59 [95% CI, -2.35 to -0.83]; P < .001) and follow-up (estimate, -1.01 [95% CI, -1.78 to -0.24]; P = .01). A greater percentage of participants in EAET vs CBT had clinically significant (at least 30%) pain reduction (63% vs 17%; odds ratio, 21.54 [95% CI, 4.66-99.56]; P < .001) at posttreatment. In addition, EAET was superior to CBT on 50% pain reduction (35% vs 7%; odds ratio, 11.77 [95% CI, 2.38-58.25]; P = .002), anxiety (estimate, -2.49 [95% CI, -4.30 to -0.68]; P = .006), depression (estimate, -3.06 [95% CI, -5.88 to -0.25]; P = .03), general life satisfaction (estimate, 1.23 [95% CI, 0.36-2.10]; P = .005), PTSD symptoms (estimate, -4.39 [95% CI, -8.44 to -0.34]; P = .03), PGIC score (estimate, 1.46 [95% CI, 0.77-2.15]; P < .001), and global treatment satisfaction (estimate, 0.28 [95% CI, 0.12-0.45]; P < .001) at posttreatment. Higher baseline depression (estimate, -1.55 [95% CI, -0.37 to 2.73]; P < .001), anxiety (estimate, -1.53 [95% CI, -2.19 to -0.88]; P < .001), and PTSD symptoms (estimate, -1.69 [95% CI, -2.96 to -0.42]; P = .009) moderated greater reduction in pain severity after EAET but not CBT. Conclusions and Relevance The results of this randomized clinical trial suggest that EAET may be a preferred intervention for medically and psychiatrically complex patients with pain. The societal burden of chronic pain could be improved by further incorporating the principles of EAET into mainstream clinical pain medicine. Trial Registration ClinicalTrials.gov Identifier: NCT03918642.
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Affiliation(s)
- Brandon C. Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Nicholas J. Jackson
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Alexander Alas
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
| | - Rebecca J. Melrose
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
| | - David L. Sultzer
- Department of Mental Health, VA Greater Los Angeles Healthcare System, California
- Department of Psychiatry and Human Behavior, University of California, Irvine School of Medicine, Irvine
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13
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Riffin C, Mei L, Brody L, Herr K, Pillemer KA, Reid MC. Program of All-Inclusive Care for the Elderly: an untapped setting for research to advance pain care in older persons. FRONTIERS IN PAIN RESEARCH 2024; 5:1347473. [PMID: 38712020 PMCID: PMC11070459 DOI: 10.3389/fpain.2024.1347473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/10/2024] [Indexed: 05/08/2024] Open
Abstract
The Program of All-Inclusive Care for the Elderly (PACE) is a community-based care model in the United States that provides comprehensive health and social services to frail, nursing home-eligible adults aged 55 years and older. PACE organizations aim to support adequate pain control in their participants, yet few evidence-based pain interventions have been adopted or integrated into this setting. This article provides a roadmap for researchers who are interested in collaborating with PACE organizations to embed and evaluate evidence-based pain tools and interventions. We situate our discussion within the Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework that considers multi-level influences to implementation and evaluation of evidence-based programs. Within each CFIR domain, we identify key factors informed by our own work that merit consideration by research teams and PACE collaborators. Inner setting components pertain to the organizational culture of each PACE organization, the type and quality of electronic health record data, and availability of staff to assist with data abstraction. Outer setting components include external policies and regulations by the National PACE Association and audits conducted by the Centers for Medicare and Medicaid Services, which have implications for research participant recruitment and enrollment. Individual-level characteristics of PACE organization leaders include their receptivity toward new innovations and perceived ability to implement them. Forming and sustaining research-PACE partnerships to deliver evidence-based pain interventions pain will require attention to multi-level factors that may influence future uptake and provides a way to improve the health and well-being of patients served by these programs.
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Affiliation(s)
- Catherine Riffin
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Lauren Mei
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Lilla Brody
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, IA, United States
| | - Karl A. Pillemer
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
- College of Human Ecology, Cornell University, Ithaca, NY, United States
| | - M. Carrington Reid
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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14
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Domenico LH, Tanner JJ, Mickle AM, Terry EL, Garvan C, Lai S, Deshpande H, Staud R, Redden D, Price CC, Goodin BR, Fillingim RB, Sibille KT. Environmental and sociocultural factors are associated with pain-related brain structure among diverse individuals with chronic musculoskeletal pain: intersectional considerations. Sci Rep 2024; 14:7796. [PMID: 38565879 PMCID: PMC10987661 DOI: 10.1038/s41598-024-58120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
Chronic musculoskeletal pain including knee osteoarthritis (OA) is a leading cause of disability worldwide. Previous research indicates ethnic-race groups differ in the pain and functional limitations experienced with knee OA. However, when socioenvironmental factors are included in analyses, group differences in pain and function wane. Pain-related brain structures are another area where ethnic-race group differences have been observed. Environmental and sociocultural factors e.g., income, education, experiences of discrimination, and social support influence brain structures. We investigate if environmental and sociocultural factors reduce previously observed ethnic-race group differences in pain-related brain structures. Data were analyzed from 147 self-identified non-Hispanic black (NHB) and non-Hispanic white (NHW), middle and older aged adults with knee pain in the past month. Information collected included health and pain history, environmental and sociocultural resources, and brain imaging. The NHB adults were younger and reported lower income and education compared to their NHW peers. In hierarchical multiple regression models, sociocultural and environmental factors explained 6-37% of the variance in pain-related brain regions. Self-identified ethnicity-race provided an additional 4-13% of explanatory value in the amygdala, hippocampus, insula, bilateral primary somatosensory cortex, and thalamus. In the rostral/caudal anterior cingulate and dorsolateral prefrontal cortex, self-identified ethnicity-race was not a predictor after accounting for environmental, sociocultural, and demographic factors. Findings help to disentangle and identify some of the factors contributing to ethnic-race group disparities in pain-related brain structures. Numerous arrays of environmental and sociocultural factors remain to be investigated. Further, the differing sociodemographic representation of our NHB and NHW participants highlights the role for intersectional considerations in future research.
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Affiliation(s)
- Lisa H Domenico
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA.
| | - Jared J Tanner
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32603, USA
| | - Angela M Mickle
- Pain Research and Intervention Center of Excellence, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
- Department of Physical Medicine and Rehabilitation, University of Florida, 3450 Hull Road, Gainesville, FL, 32607, USA
| | - Ellen L Terry
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA
- Pain Research and Intervention Center of Excellence, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Cynthia Garvan
- Department of Anesthesiology, Division of Pain Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Song Lai
- Department of Radiation Oncology, University of Florida, 2000 SW Archer Road, Gainesville, FL, 32610, USA
| | - Hrishikesh Deshpande
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL, 35294, USA
| | - Roland Staud
- Department of Rheumatology, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32610, USA
| | - David Redden
- Department of Biostatistics, University of Alabama at Birmingham, 1665 University Blvd #327, Birmingham, AL, 35294, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, Gainesville, FL, 32603, USA
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1300 University Blvd, Birmingham, AL, 35223, USA
- Department of Anesthesiology, Washington University, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA
- Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, 1329 SW 16th Street, Gainesville, FL, 32610-3628, USA
| | - Kimberly T Sibille
- Department of Physical Medicine and Rehabilitation, University of Florida, 3450 Hull Road, Gainesville, FL, 32607, USA
- Department of Anesthesiology, Division of Pain Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
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15
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Ryan CG, Karran EL, Wallwork SB, Pate JW, O'Keeffe M, Fullen BM, Livadas N, Jones N, Toumbourou JW, Gilchrist P, Cameron PA, Fatoye F, Ravindran D, Lorimer Moseley G. We Are All in This Together-Whole of Community Pain Science Education Campaigns to Promote Better Management of Persistent Pain. THE JOURNAL OF PAIN 2024; 25:902-917. [PMID: 37918470 DOI: 10.1016/j.jpain.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/02/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
Persistent pain is a major public health issue-estimated to affect a quarter of the world's population. Public understanding of persistent pain is based on outdated biomedical models, laden with misconceptions that are contrary to best evidence. This understanding is a barrier to effective pain management. Thus, there have been calls for public health-based interventions to address these misconceptions. Previous pain-focussed public education campaigns have targeted pain beliefs and behaviours that are thought to promote recovery, such as staying active. However, prevailing pain-related misconceptions render many of these approaches counter-intuitive, at best. Pain Science Education improves understanding of 'how pain works' and has been demonstrated to improve pain and disability outcomes. Extending Pain Science Education beyond the clinic to the wider community seems warranted. Learning from previous back pain-focussed and other public health educational campaigns could optimise the potential benefit of such a Pain Science Education campaign. Pain Science Education-grounded campaigns have been delivered in Australia and the UK and show promise, but robust evaluations are needed before any firm conclusions on their population impact can be made. Several challenges exist going forward. Not least is the need to ensure all stakeholders are involved in the development and implementation of Pain Science Education public messaging campaigns. Furthermore, it is crucial that campaigns are undertaken through a health equity lens, incorporating underrepresented communities to ensure that any intervention does not widen existing health inequalities associated with persistent pain. PERSPECTIVE: Public misconceptions about pain are a significant public health challenge and a viable intervention target to reduce the personal, social, and economic burden of persistent pain. Adaptation of Pain Science Education, which improves misconceptions in a clinical setting, into the public health setting seems a promising approach to explore.
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Affiliation(s)
- Cormac G Ryan
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK
| | - Emma L Karran
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Sarah B Wallwork
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Joshua W Pate
- Pain Education Team to Advance Learning (PETAL) Collaboration; Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mary O'Keeffe
- Pain Education Team to Advance Learning (PETAL) Collaboration; Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, University of Sydney, Australia
| | - Brona M Fullen
- Pain Education Team to Advance Learning (PETAL) Collaboration; UCD School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Nick Livadas
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK
| | - Niki Jones
- Pain Education Team to Advance Learning (PETAL) Collaboration
| | - John W Toumbourou
- Pain Education Team to Advance Learning (PETAL) Collaboration; Deakin University, School of Psychology and Centre for Social and Early Emotional Development, Geelong, Australia
| | - Peter Gilchrist
- Pain Education Team to Advance Learning (PETAL) Collaboration; The University of Adelaide Rural Clinical School, Rural Generalist Program, South Australia
| | - Paul A Cameron
- Pain Education Team to Advance Learning (PETAL) Collaboration; Fife Health & Social Care Partnership, Scotland, UK; School of Medicine, Cardiff University, UK
| | - Francis Fatoye
- Pain Education Team to Advance Learning (PETAL) Collaboration; Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, UK; Lifestyle Disease Entity, North-West University, South Africa
| | - Deepak Ravindran
- Pain Education Team to Advance Learning (PETAL) Collaboration; Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, UK; Department of Pain Medicine, Royal Berkshire NHS Foundation Trust, UK
| | - G Lorimer Moseley
- Pain Education Team to Advance Learning (PETAL) Collaboration; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
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16
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Keogh E, Boerner KE. Challenges with embedding an integrated sex and gender perspective into pain research: Recommendations and opportunities. Brain Behav Immun 2024; 117:112-121. [PMID: 38145854 DOI: 10.1016/j.bbi.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023] Open
Abstract
The focus of this article, within this BBI horizons special issue, is on sex, gender, and pain. We summarise what is currently known about sex- and gender-related variations in pain, exploring intersectional biological and psychosocial mechanisms, and highlight gaps in knowledge and understanding. Five key challenges with the exploration of sex and gender in pain research are presented, relating to: conceptual imprecision, research bias, limitations with binary descriptions, integrating sex and gender, and timely adoption/implementation of good research practice. Guidance on how to overcome such challenges is provided. Despite clear evidence for sex and gender differences in pain, there are conceptual and methodological barriers to overcome. Innovation in methods and approach can help develop more effective and tailored treatment approaches for men, women, boys, girls, and gender-diverse people.
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Affiliation(s)
- Edmund Keogh
- Bath Centre for Pain Research & Department of Psychology, University of Bath, UK.
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17
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Bjelkarøy MT, Simonsen TB, Siddiqui TG, Cheng S, Grambaite R, Benth JŠ, Lundqvist C. Mortality and health-related quality of life in older adults with long-term use of opioids, z-hypnotics or benzodiazepines: a prospective observational study at 5 years follow-up. BMJ Open 2024; 14:e079347. [PMID: 38387984 PMCID: PMC10882342 DOI: 10.1136/bmjopen-2023-079347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES Disease and medication use in older age is a consequence of age-related declining health. Multimorbidity followed by polypharmacy is common. Central nervous system depressing (CNSD) drugs such as opioids, benzodiazepines and z-hypnotics are not recommended for long-term use in older adults but are in use by many. We aimed to assess mortality and change in health-related quality of life (HRQoL) in older adults with long-term use of CNSDs. METHOD A prospective observational study was conducted at Akershus University Hospital, Norway, 2017-2019, with follow-up in 2021-2022, including 246 participants aged 65-90. At 5-year follow-up, 78 (32%) participants had passed away. Mortality data were collected from patient electronic health records. Of the surviving 168 (68%), we collected further follow-up data from 38 (16%) participants. Follow-up included demographic and clinical data. The EuroQuol Group EQ-5D-5L questionnaire was used to measure HRQoL. Analysis include Cox regression model for survival data and linear mixed model for change in HRQoL over time. RESULTS At follow-up, 78 (31.7%) were deceased. Mean survival time was 3.3 years. Total time for survival data was 4.7 years. Mortality was higher among participants with long-term use of CNSD (HR 1.9 95% CI (1.2 to 3.2), p=0.01). The multivariable analysis found being older (HR 1.1 95% CI (1.0 to 1.1), p=0.020) and male sex (HR 2.1 95% CI (1.2 to 3.5), p=0.008) to be associated with increased risk of mortality. According to the linear mixed model (n=38), there was no significant difference between surviving users and non-users in change in HRQoL EQ-5D-5L index from baseline to follow-up. CONCLUSION Mortality was higher for long-term users of CNSDs at 5-year follow-up. Being older and male sex were associated with mortality. Among survivors, there was no significant difference between the groups in change of HRQoL over time. TRIAL REGISTRATION NUMBER NCT03162081; 22 May 2017.
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Affiliation(s)
| | | | | | - Socheat Cheng
- Akershus University Hospital, Lorenskog, Norway
- University of Oslo, Oslo, Norway
| | - Ramune Grambaite
- Akershus University Hospital, Lorenskog, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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18
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Li L, Li CX, Zhang H, Zhang J. Nerve block reduces the incidence of 3-year postoperative mortality: a retrospective cohort study. Front Surg 2024; 11:1284892. [PMID: 38362458 PMCID: PMC10867203 DOI: 10.3389/fsurg.2024.1284892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Purpose A retrospective cohort study was performed to determine the effect of nerve block on the incidence of postoperative mortality in patients with hip replacement. Methods According to the inclusion and exclusion criteria, patients who were undergoing hip replacement for the first time under general or intraspinal anesthesia, classified as ASA class I-IV, and aged ≥65 years were selected. We collected the general data, past medical history, preoperative laboratory test results, perioperative fluid intake and outflow data, perioperative anesthesia and related drug data, postoperative laboratory results, and correlation time index. Patients with preoperative combined nerve block were included in the N group, and those without combined nerve block were included in the NN group. The patients were followed up via telephone call to assess survival outcomes at 3 years after surgery. Propensity score matching and uni- and multivariate analyses were performed to determine the influence of nerve block and other related factors on postoperative mortality. Results A total of 743 patients were included in this study, including 262 in the N group and 481 in the NN group. Two hundred five patients in both groups remained after propensity score matching. Main result: Preoperative nerve block was associated with reduced mortality three years after surgery. Conclusion Nerve block reduces the incidence of 3-year postoperative mortality, and composite nerve block with general anesthesia and neuraxial anesthesia is worthy of promotion.
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Affiliation(s)
| | | | | | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
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19
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Nijs J, Malfliet A, Roose E, Lahousse A, Van Bogaert W, Johansson E, Runge N, Goossens Z, Labie C, Bilterys T, Van Campenhout J, Polli A, Wyns A, Hendrix J, Xiong HY, Ahmed I, De Baets L, Huysmans E. Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective. J Clin Med 2024; 13:644. [PMID: 38337338 PMCID: PMC10855981 DOI: 10.3390/jcm13030644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic pain is the most prevalent disease worldwide, leading to substantial disability and socioeconomic burden. Therefore, it can be regarded as a public health disease and major challenge to scientists, clinicians and affected individuals. Behavioral lifestyle factors, such as, physical (in)activity, stress, poor sleep and an unhealthy diet are increasingly recognized as perpetuating factors for chronic pain. Yet, current management options for patients with chronic pain often do not address lifestyle factors in a personalized multimodal fashion. This state-of-the-art clinical perspective aims to address this gap by discussing how clinicians can simultaneously incorporate various lifestyle factors into a personalized multimodal lifestyle intervention for individuals with chronic pain. To do so the available evidence on (multimodal) lifestyle interventions targeting physical (in)activity, stress, sleep and nutritional factors, specifically, was reviewed and synthetized from a clinical point of view. First, advise is provided on how to design a personalized multimodal lifestyle approach for a specific patient. Subsequently, best-evidence recommendations on how to integrate physical (in)activity, stress, sleep and nutritional factors as treatment targets into a personalized multimodal lifestyle approach are outlined. Evidence supporting such a personalized multimodal lifestyle approach is growing, but further studies are needed.
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Affiliation(s)
- Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Goteborg, Sweden
| | - Anneleen Malfliet
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Eva Roose
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Rehabilitation Research Group, Department of Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- REVAL, Universiteit Hasselt, 3590 Diepenbeek, Belgium
| | - Astrid Lahousse
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Wouter Van Bogaert
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Elin Johansson
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research in Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Nils Runge
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Zosia Goossens
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Brain, Body and Cognition (BBCO), Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Céline Labie
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Division of Rheumatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Thomas Bilterys
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Institute of Advanced Study, University of Warwick, Coventry CV4 7AL, UK
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Jente Van Campenhout
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Andrea Polli
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Arne Wyns
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Jolien Hendrix
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
- Department of Public Health and Primary Care, Centre for Environment and Health, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Huan-Yu Xiong
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Ishtiaq Ahmed
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
| | - Eva Huysmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.M.); (E.R.); (A.L.); (W.V.B.); (E.J.); (N.R.); (Z.G.); (C.L.); (T.B.); (J.V.C.); (A.P.); (A.W.); (J.H.); (H.-Y.X.); (I.A.); (L.D.B.); (E.H.)
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
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20
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Glei DA, Weinstein M. Is the Pain killing you? Could Pain interference be a warning signal for midlife mortality? SSM Popul Health 2023; 24:101513. [PMID: 37771419 PMCID: PMC10523021 DOI: 10.1016/j.ssmph.2023.101513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023] Open
Abstract
Although prior studies have documented an association between various measures of pain and mortality, none of those studies has evaluated whether the association between pain and mortality varies significantly by age. We suspect that pain-particularly pain that interferes with the ability to lead a normal life-could be an early warning sign that may portend increased risk of physical impairment and mortality later in life. In this paper, we investigated whether pain was associated with increased mortality risk, particularly in midlife. Data came from the Midlife in the US study, which sampled non-institutionalized, English-speaking adults aged 25-74 in the contiguous United States in 1995-96. Our analysis included 4041 respondents who completed a follow-up self-administered questionnaire in 2004-05, 2703 of whom completed another self-administered questionnaire in 2013-14. We modeled mortality through December 31, 2021. In demographic-adjusted models, pain interference was more strongly associated with mortality than other pain measures, and the association was stronger at younger ages. The hazard ratio for pain interference declined from 1.39 per SD (95% CI 1.26-1.54) at age 60 to 1.14 (95% CI 1.04-1.24) at age 90. Although potential confounders accounted for more than 60% of the association with premature mortality, pain interference remained significantly associated with increased mortality rates (HR = 1.13 at age 60, 95% CI 1.02-1.26). We found no evidence that the association between pain and mortality was driven by cancer. If anything, pain interference was more strongly associated with cardiovascular than cancer mortality. At the oldest ages, physical function is likely to be a better predictor of mortality than pain. Yet, pain interference may be a useful warning sign at younger ages, when there are fewer physical limitations and mortality rates are low. It may be particularly helpful in identifying risk of premature mortality in midlife, before the emergence of severe physical limitations.
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Affiliation(s)
- Dana A. Glei
- Center for Population and Health, Georgetown University, Mailing address: 5985 San Aleso Ct., Santa Rosa, CA, 95409-3912, USA
| | - Maxine Weinstein
- Center for Population and Health, Georgetown University, 37th & O Streets, NW, 312 Healy Hall, Washington, DC, 20057-1197, USA
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21
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Liu YC, Ho CH, Chen YC, Hsu CC, Lin HJ, Wang CT, Huang CC. Association between chronic pain and acute coronary syndrome in the older population: a nationwide population-based cohort study. BMC Geriatr 2023; 23:708. [PMID: 37907842 PMCID: PMC10619318 DOI: 10.1186/s12877-023-04368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Chronic pain (CP) may increase the risk of acute coronary syndrome (ACS); however, this issue in the older population remains unclear. Therefore, this study was conducted to clarify it. METHODS We used the Taiwan National Health Insurance Research Database to identify older patients with CP between 2001 and 2005 as the study cohort. Comparison cohort was the older patients without CP by matching age, sex, and index date at 1:1 ratio with the study cohort in the same period. We also included common underlying comorbidities in the analyses. The risk of ACS was compared between the two cohorts by following up until 2015. RESULTS A total of 17241 older patients with CP and 17241 older patients without CP were included in this study. In both cohorts, the mean age (± standard deviation) and female percentage were 73.5 (± 5.7) years and 55.4%, respectively. Spinal disorders (31.9%) and osteoarthritis (27.0%) were the most common causes of CP. Older patients with CP had an increased risk for ACS compared to those without CP after adjusting for all underlying comorbidities (adjusted sub-distribution hazard ratio [sHR] 1.18; 95% confidence interval: 1.07-1.30). The increasement of risk of ACS was more when the follow-up period was longer (adjusted sHR of < 3 years: 1.8 vs. <2 years: 1.75 vs. <1 year: 1.55). CONCLUSIONS CP was associated with an increased risk of ACS in the older population, and the association was more prominent when the follow-up period was longer. Early detection and intervention for CP are suggested in this population.
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Affiliation(s)
- Yu-Chang Liu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Ti Wang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
- Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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22
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Wiitavaara B, Rissén D, Nilsson A. Demographic and clinical factors associated with psychological wellbeing in people with chronic, non-specific musculoskeletal pain engaged in multimodal rehabilitation: -a cross-sectional study with a correlational design. Scand J Pain 2023; 23:705-711. [PMID: 37440704 DOI: 10.1515/sjpain-2023-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To investigate which demographic and clinical factors were associated with psychological wellbeing in working-aged people in multimodal rehabilitation for musculoskeletal disorders. METHODS 116 participants met the criteria for inclusion: persistent or intermittent pain for at least three months; pain that adversely impacts daily life; potential for active change despite pain; no co-morbidity or condition that will hinder participation in the rehabilitation program. Primary outcome was psychological wellbeing and independent measures were general, physical and mental health, pain intensity, limitations in daily life, depression and sleep. RESULTS The results show decreased odds of psychological wellbeing for persons rating high on depression. The results remained significant after adjusting for sex and age. Being a woman increased the odds of high psychological wellbeing. Logistic regression showed that psychological wellbeing was not significantly associated with pain intensity; sleep; functional limitations; general, physical, or mental health. None of the other independent variables was significantly associated with high vs. low psychological wellbeing. CONCLUSIONS Depression turned out to be significantly related to psychological wellbeing, contrary to pain and limitations in daily life. If further studies with larger, random samples can confirm these results, this knowledge may be important both in clinical settings and in future research.
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Affiliation(s)
- Birgitta Wiitavaara
- Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Dag Rissén
- Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Annika Nilsson
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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23
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Domenico L, Tanner J, Mickle A, Terry E, Garvan C, Lai S, Deshpande H, Staud R, Redden D, Price C, Goodin B, Fillingim R, Sibille K. Environmental and sociocultural factors are associated with pain-related brain structure among diverse individuals with chronic musculoskeletal pain. RESEARCH SQUARE 2023:rs.3.rs-3425338. [PMID: 37886554 PMCID: PMC10602144 DOI: 10.21203/rs.3.rs-3425338/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Chronic musculoskeletal pain is a leading cause of disability worldwide. Previous research indicates ethnic/race groups are disproportionately affected by chronic pain conditions. However, when considering socioenvironmental factors these disparities are no longer observed. Ethnic/race group differences have also been reported in pain-related brain structure. Given that environmental and sociocultural factors influence biology and health outcomes, this study aimed to investigate possible environmental and sociocultural contributions to structural differences in pain-related brain regions. A total of 147 non-Hispanic black and non-Hispanic white, middle and older aged adults with knee pain in the past month and a brain MRI are included in the analyses. Individuals also provided information specific to health and pain history and environmental and sociocultural resources. In hierarchical multiple regression models, sociocultural and environmental factors explained 6%-37% of the variance in thickness of pain-related brain regions, with seven of the eight brain regions being statistically significant. In the amygdala, hippocampus, insula, bilateral primary somatosensory cortex, and thalamus, ethnicity/race provided an additional 4%-13% of explanatory value. In the rostral/caudal anterior cingulate and dorsolateral prefrontal cortex, ethnicity/race was not a predictor after accounting for environmental, sociocultural, and other demographic measures. Findings inform health disparities research by elucidating the complexity of factors contributing to previously reported ethnicity/race group differences.
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24
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Kobayashi N, Watanabe K, Murakami H, Yamauchi M. Continuous visualization and validation of pain in critically ill patients using artificial intelligence: a retrospective observational study. Sci Rep 2023; 13:17479. [PMID: 37838818 PMCID: PMC10576770 DOI: 10.1038/s41598-023-44970-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/13/2023] [Indexed: 10/16/2023] Open
Abstract
Machine learning tools have demonstrated viability in visualizing pain accurately using vital sign data; however, it remains uncertain whether incorporating individual patient baselines could enhance accuracy. This study aimed to investigate improving the accuracy by incorporating deviations from baseline patient vital signs and the concurrence of the predicted artificial intelligence values with the probability of critical care pain observation tool (CPOT) ≥ 3 after fentanyl administration. The study included adult patients in intensive care who underwent multiple pain-related assessments. We employed a random forest model, utilizing arterial pressure, heart rate, respiratory rate, gender, age, and Richmond Agitation-Sedation Scale score as explanatory variables. Pain was measured as the probability of CPOT scores of ≥ 3, and subsequently adjusted based on each patient's baseline. The study included 10,299 patients with 117,190 CPOT assessments. Of these, 3.3% had CPOT scores of ≥ 3. The random forest model demonstrated strong accuracy with an area under the receiver operating characteristic curve of 0.903. Patients treated with fentanyl were grouped based on CPOT score improvement. Those with ≥ 1-h of improvement after fentanyl administration had a significantly lower pain index (P = 0.020). Therefore, incorporating deviations from baseline patient vital signs improved the accuracy of pain visualization using machine learning techniques.
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Affiliation(s)
- Naoya Kobayashi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | | | | | - Masanori Yamauchi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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25
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Emerson AJ, Einhorn L, Groover M, Naze G, Baxter GD. Clinical conversations in the management of chronic musculoskeletal pain in vulnerable patient populations: a meta-ethnography. Disabil Rehabil 2023; 45:3409-3434. [PMID: 36205554 DOI: 10.1080/09638288.2022.2130447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this meta-ethnography was to synthesize the research exploring patient/provider perceptions of clinical conversations (CC) centered on chronic musculoskeletal pain (CMP) in vulnerable adult populations. MATERIALS AND METHODS A systematic search for qualitative/mixed method studies in CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used PRIMSA-P guidelines. Data synthesis used eMERGe guidelines; findings were presented in nested hierarchal theoretical frameworks. RESULTS The included studies explored patients' (n = 18), providers' (n = 2), or patients' and providers' perspectives (n = 5) with diversity in patient participants represented (n = 415): immigrants, indigenous people, women, and veterans. Themes for each level of the nested hierarchal models revealed greater complexity in patients' perceptions about the CC in CMP relative to clinicians' perceptions. A unique finding was sociopolitical/historical factors can influence CC for vulnerable populations. CONCLUSION The combined nested hierarchical models provided insight into the need for clinicians to be aware of the broader array of influences on the CC. Key themes indicated that improving continuity of care and cultural training are needed to improve the CC. Additionally, due to patients' perception of how healthcare systems' policies influence the CC, patients should be consulted to guide the change needed to improve inequitable outcomes.IMPLICATIONS FOR REHABILITATIONHealthcare providers wishing to improve the clinical conversation in chronic musculoskeletal pain can more broadly explore potential factors influencing patients' experiences and perceptions.Screening during the clinical conversation can include assessing for sociopolitical and historical influences on patients' experiences with chronic musculoskeletal pain.Healthcare providers can explore how to minimize disjointed care in an effort to improve the clinical conversation and outcomes in chronic musculoskeletal pain.Healthcare providers and patients can work together to improve inequitable outcomes for vulnerable adults with chronic musculoskeletal pain.This may include cultural training for healthcare providers that is informed by patients.
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Affiliation(s)
- Alicia J Emerson
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
- School of Physiotherapy, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | | | - Morgan Groover
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Garrett Naze
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - G David Baxter
- School of Physiotherapy, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
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26
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Hébert HL, Pascal MM, Smith BH, Wynick D, Bennett DL. Big data, big consortia, and pain: UK Biobank, PAINSTORM, and DOLORisk. Pain Rep 2023; 8:e1086. [PMID: 38225956 PMCID: PMC10789453 DOI: 10.1097/pr9.0000000000001086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 01/17/2024] Open
Abstract
Chronic pain (CP) is a common and often debilitating disorder that has major social and economic impacts. A subset of patients develop CP that significantly interferes with their activities of daily living and requires a high level of healthcare support. The challenge for treating physicians is in preventing the onset of refractory CP or effectively managing existing pain. To be able to do this, it is necessary to understand the risk factors, both genetic and environmental, for the onset of CP and response to treatment, as well as the pathogenesis of the disorder, which is highly heterogenous. However, studies of CP, particularly pain with neuropathic characteristics, have been hindered by a lack of consensus on phenotyping and data collection, making comparisons difficult. Furthermore, existing cohorts have suffered from small sample sizes meaning that analyses, especially genome-wide association studies, are insufficiently powered. The key to overcoming these issues is through the creation of large consortia such as DOLORisk and PAINSTORM and biorepositories, such as UK Biobank, where a common approach can be taken to CP phenotyping, which allows harmonisation across different cohorts and in turn increased study power. This review describes the approach that was used for studying neuropathic pain in DOLORisk and how this has informed current projects such as PAINSTORM, the rephenotyping of UK Biobank, and other endeavours. Moreover, an overview is provided of the outputs from these studies and the lessons learnt for future projects.
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Affiliation(s)
- Harry L. Hébert
- Chronic Pain Research Group, Division of Population Health and Genomics, Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - Mathilde M.V. Pascal
- Neural Injury Group, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Blair H. Smith
- Chronic Pain Research Group, Division of Population Health and Genomics, Ninewells Hospital & Medical School, University of Dundee, Dundee, United Kingdom
| | - David Wynick
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David L.H. Bennett
- Neural Injury Group, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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27
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Courel-Ibáñez J, Estévez-López F, Hughes C, Adams N, Fullen BM, Davison G, Montgomery A, Cramp F, Maestre C, Martin D, McVeigh JG. Proof of concept of prehabilitation: a combination of education and behavioural change, to promote physical activity in people with fibromyalgia. BMJ Open 2023; 13:e070609. [PMID: 37451740 PMCID: PMC10351288 DOI: 10.1136/bmjopen-2022-070609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES To establish proof of concept of a prehabilitation intervention, a combination of education and behavioural change, preceding a physical activity programme in people with fibromyalgia (FM). SETTINGS Open-label, feasibility clinical trial. PARTICIPANTS Eleven people with FM (10 women). INTERVENTIONS The prehabilitation intervention consisted of 4 weeks, 1 weekly session (~1 to 1.5 hours), aimed to increase self-efficacy and understand why and how to engage in a gentle and self-paced physical activity programme (6 weeks of walking with telephone support). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the acceptability and credibility of the intervention by means of the Credibility/Expectancy Questionnaire. Secondary outcomes comprised scales to measure FM severity, specific symptoms and sedentary behaviour. An exit interview was conducted to identify the strengths and weaknesses and barriers to the intervention. RESULTS One participant dropped out due to finding the walking programme excessively stressful. Participants expected the intervention would improve their symptoms by 22%-38% but resulted in 5%-26% improvements. Participants would be confident in recommending this intervention to a friend who experiences similar problems. The interviews suggested that the fluctuation of symptoms should be considered as an outcome and that the prehabilitation intervention should accomodate these fluctuation. Additional suggestions were to incorporate initial interviews (patient-centred approach), to tailor the programmes to individuals' priorities and to offer a variety of physical activity programmes to improve motivation. CONCLUSIONS This feasibility study demonstrated that our novel approach is acceptable to people with FM. Future interventions should pay attention to flexibility, symptoms fluctuation and patients support. TRIAL REGISTRATION NUMBER NCT03764397.
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Affiliation(s)
- Javier Courel-Ibáñez
- Department of Physical Education and Sports, Faculty of Education and Sport Sciences, University of Granada, Melilla, Spain
| | - Fernando Estévez-López
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Department of Education, Faculty of Education Sciences, SPORT Research Group (CTS-1024) and CERNEP Research Center, University of Almería, Almería, Spain
| | - Ciara Hughes
- School of Health Sciences, Ulster University, Belfast, UK
| | - Nicola Adams
- Department of Sport, Exercise & Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Brona M Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Gareth Davison
- Sport and Exercise Sciences Research Institute, Ulster University, Belfast, UK
| | | | - Fiona Cramp
- College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Cristina Maestre
- Department of Health and Human Performance, Universidad Politécnica de Madrid, Madrid, Spain
| | - Denis Martin
- School of Health and Life Sciences, Teesside University & NIHR Applied Research Collaboration for the North East and North Cumbria, Middlesbrough, UK
| | - Joseph G McVeigh
- Discipline of Physiotherapy, College of Medicine and Health, University College Cork, Cork, Ireland
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Ahmed W, Pai M, Muhammad T, Maurya C, Mohanty P, Javed NB. Early life factors associated with the experiences of pain in later life: evidence from a population based study in India. BMC Public Health 2023; 23:968. [PMID: 37237340 PMCID: PMC10214646 DOI: 10.1186/s12889-023-15805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The influence of early life factors is becoming increasingly apparent as studies investigate how experiences, resources, and constraints in childhood affect health and well-being later in life. The present study contributes to this literature by examining the association between several early life factors and self-reported pain among older adults in India. METHODS Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study of India (LASI). The sample size includes 28,050 older adults aged 60 and above (13,509 men and 14,541 women). Pain is a self-reported, dichotomous measure where participants responded to whether they were often troubled with pain and whether this experience interfered with their ability to carry out daily household chores. Early life factors, which are retrospective accounts of experiences, included the respondent's position in birth order, their health status, school absenteeism, being bedridden, family socioeconomic status (SES), and their parent's experience with chronic disease. Logistic regression analysis is employed to examine the unadjusted and adjusted average marginal effects (AME) of selected domains of early life factors associated with the probability of experiencing pain. RESULTS 22.8% of men and 32.3% of women reported pain that interfered with daily activities. Pain was higher among men (AME: 0.01, confidence interval (CI): 0.01-0.03) and women (AME: 0.02, CI: 0.01-0.04) with third or fourth birth order compared to counterparts with first birth order. Both men (AME: -0.02, CI: -0.04-0.01) and women (AME: -0.07, CI: -0.09 - -0.04) having a fair childhood health status reported a lower probability of pain. The probability of pain was higher among both men (AME: 0.03, CI: 0.01-0.07) and women (AME: 0.07, CI: 0.03-0.13) who were bedridden due to sickness in their childhood. Similarly, the pain likelihood was higher among men who missed school for more than a month due to health problems (AME: 0.04, CI: -0.01-0.09). Men and women with poor financial condition in their childhood reported (AME: 0.04, CI: 0.01-0.07) a higher probability of experiencing pain relative to their peers who reported a more financially advantaged early life. CONCLUSIONS Findings of the present study add to the empirical literature on the association between early life factors and later life health and well-being. They also are pertinent to health care providers and practitioners working in pain management, as this knowledge better positions them to identify older adults most susceptible to pain. Moreover, findings of our study underscore that the interventions to ensure health and well-being in later life must start far earlier in the life course.
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Affiliation(s)
- Waquar Ahmed
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH 44242 USA
| | - T. Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - Chanda Maurya
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - Parimala Mohanty
- Institute of Medical Sciences … Sum Hospital, Siksha “O” Anusandhan Deemed to be University, Bhubaneswar, Odisha India
| | - Nargis Begum Javed
- Department of Public health, College of Health sciences, Saudi Electronic University, Dammam, Saudi Arabia
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Tian J, Zhou Y, Lin X, Jones G, Pan F. Multisite Pain and Myocardial Infarction and Stroke: A Prospective Cohort and Mendelian Randomization Analysis. JACC. ADVANCES 2023; 2:100295. [PMID: 38939595 PMCID: PMC11198351 DOI: 10.1016/j.jacadv.2023.100295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/17/2023] [Accepted: 02/12/2023] [Indexed: 06/29/2024]
Abstract
Background Whether individuals with multisite pain had a higher risk of cardiovascular diseases is unclear. Objectives The purpose of this study was to investigate the longitudinal association of pain in multiple sites with incident myocardial infarction (MI) and stroke, and to disentangle the genetic causality of these associations. Methods A total of 281,760 participants (mean age: 56.3 years) who had no MI and stroke at baseline from UK Biobank study were included. Data on pain in the hip, knee, back and neck/shoulder, or 'all over the body' were collected. Chronic pain was defined if pain had lasted for ≥3 months. MI and stroke events were determined from hospital admission records and death registries. Cox regression and 2-sample Mendelian randomization were used for the analyses. Results During a median follow-up of 11.9 years, 4,854 had a first MI and 2,827 had a first stroke. In multivariable analyses, greater number of painful sites was dose-responsively associated with higher risks of incident MI and stroke, with a higher risk among participants with pain 'all over the body' (MI: HR: 1.65, 95% CI: 1.32-2.07; stroke: HR: 1.44, 95% CI: 1.13-1.85). Similar trends and associations were observed in those with chronic pain. Two-sample Mendelian randomization results supported a causal effect of multisite pain on MI risk, but not vice versa. No causal association was found between multisite pain and stroke risk. Conclusions Pain in multiple sites causally increases the risk of MI, highlighting that pain should be considered when assessing individuals' MI risk, and pain treatment and management may prevent MI risk.
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Affiliation(s)
- Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Xin Lin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Reynolds CA, Minic Z. Chronic Pain-Associated Cardiovascular Disease: The Role of Sympathetic Nerve Activity. Int J Mol Sci 2023; 24:5378. [PMID: 36982464 PMCID: PMC10049654 DOI: 10.3390/ijms24065378] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/26/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Chronic pain affects many people world-wide, and this number is continuously increasing. There is a clear link between chronic pain and the development of cardiovascular disease through activation of the sympathetic nervous system. The purpose of this review is to provide evidence from the literature that highlights the direct relationship between sympathetic nervous system dysfunction and chronic pain. We hypothesize that maladaptive changes within a common neural network regulating the sympathetic nervous system and pain perception contribute to sympathetic overactivation and cardiovascular disease in the setting of chronic pain. We review clinical evidence and highlight the basic neurocircuitry linking the sympathetic and nociceptive networks and the overlap between the neural networks controlling the two.
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Affiliation(s)
- Christian A. Reynolds
- Department of Emergency Medicine, Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI 48201, USA
- Department of Biotechnology, University of Rijeka, 51000 Rijeka, Croatia
| | - Zeljka Minic
- Department of Emergency Medicine, Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI 48201, USA
- Department of Biotechnology, University of Rijeka, 51000 Rijeka, Croatia
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Parisien M, Grant AV, Muralidharan A, Diatchenko L, Mogil JS. Chronic pain and premature mortality in men and women, using data from UK Biobank. Reply. J Clin Invest 2023; 133:e168070. [PMID: 36856114 PMCID: PMC9974091 DOI: 10.1172/jci168070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- Marc Parisien
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - Audrey V. Grant
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - Arjun Muralidharan
- Charles Perkin Centre, Faculty of Science, University of Sydney, New South Wales, Australia
| | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - Jeffrey S. Mogil
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
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Millecamps M, Sotocinal SG, Austin JS, Stone LS, Mogil JS. Sex-specific effects of neuropathic pain on long-term pain behavior and mortality in mice. Pain 2023; 164:577-586. [PMID: 35916733 DOI: 10.1097/j.pain.0000000000002742] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Human epidemiological studies suggest that chronic pain can increase mortality risk. We investigated whether this was true in mice so that underlying mechanisms might be identified. At 10 weeks of age, C57BL/6 mice of both sexes received sham or spared nerve injury (SNI) surgery producing neuropathic pain. Mice were weighed monthly, tested behaviorally for mechanical and cold sensitivity and guarding behavior every 3 months postsurgery, and otherwise left undisturbed in their cages until death by natural causes. Evidence of pain over the lifespan displayed a strikingly sex-specific pattern. Male mice displayed largely stable mechanical and cold hypersensitivity and guarding at 6 to 30 months post-SNI. By contrast, female mice displayed a biphasic temporal pattern of mechanical hypersensitivity and guarding behavior, with a complete resolution of SNI-induced pain behavior at 6 to 9 months post-SNI followed by the return of pain thereafter. Mouse lifespan was not significantly altered by SNI in either sex nor was frailty as assessed by cage inspection in the last 6 months of life. However, in male mice with SNI, we observe a significant correlation between average lifetime mechanical hypersensitivity and lifespan, such that death occurred sooner in male mice exhibiting more evidence of chronic pain. This relationship was not observed in female SNI mice nor in sham-operated mice of either sex. This experiment is the first to investigate pain behavior over an entire adult lifetime and suggests that biology of relevance to human chronic pain is being ignored by the very short timespans of most extant preclinical pain research.
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Affiliation(s)
- Magali Millecamps
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | - Susana G Sotocinal
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
| | | | - Laura S Stone
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, United States
| | - Jeffrey S Mogil
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
- Departments of Psychology and Anesthesia, McGill University, Montreal, QC, Canada
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Zhu J, Wang N, Liu H, Jiang H, Cai B, Chen D, Li Y. Multisite chronic pain as a causal risk factor for coronary artery disease: findings from Mendelian randomization. Pain 2023; 164:e135-e143. [PMID: 35916731 DOI: 10.1097/j.pain.0000000000002732] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT The potential consequences of the number of chronic pain sites (referred to multisite chronic pain) on the risk of cardiovascular diseases (CVDs) remain unclear. We attempted to investigate the causality of multisite chronic pain with CVDs and its possible causal mediators. Using summary genome-wide association statistics, two-sample Mendelian randomization (MR) analyses were performed to assess whether multisite chronic pain has a causal effect on the 3 CVDs including coronary artery disease, atrial fibrillation, and stroke. We then conducted MR mediation analyses to establish whether body mass index (BMI), smoking, and depression causally mediate any association. Genetic liability to multisite chronic pain was associated with increased risk of coronary artery disease (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.19-1.95 per one increase in the number of pain locations) but not with atrial fibrillation or stroke. We also found positive causal effects of multisite chronic pain on BMI, smoking, and depression and causal effects of BMI, smoking, and depression on coronary artery disease. In multivariable MR analyses, the excess risk of coronary artery disease was attenuated after adjusting for BMI (OR 1.43, 95% CI 1.05-1.93), smoking (OR 1.49, 95% CI 1.11-2.00), depression (OR 1.44, 95% CI 1.03-2.01), and 3 risk factors combined (OR 1.34, 95% CI 0.88-2.05). Our findings demonstrated that multisite chronic pain led to higher risk of coronary artery disease, which is partly mediated through BMI, smoking, and depression.
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Affiliation(s)
- Jiahao Zhu
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Nini Wang
- Puyan Community Healthcare Center of Binjiang District, Hangzhou, China
| | - Houpu Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Han Jiang
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Bingyue Cai
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Dingwan Chen
- Department of Prevention and Health Care, Puyan Community Healthcare Center of Binjiang District, Hangzhou, China
| | - Yingjun Li
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou, China
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Macfarlane GJ, Beasley M, Jones GT. Chronic pain and premature mortality in men and women, using data from UK Biobank. J Clin Invest 2023; 133:166949. [PMID: 36856113 PMCID: PMC9974089 DOI: 10.1172/jci166949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Affiliation(s)
- Gary J. Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | - Marcus Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | - Gareth T. Jones
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
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Mickle AM, Domenico LH, Tanner JJ, Terry EL, Cardoso J, Glover TL, Booker S, Addison A, Gonzalez CE, Garvan CS, Redden D, Staud R, Goodin BR, Fillingim RB, Sibille KT. Elucidating factors contributing to disparities in pain-related experiences among adults with or at risk for knee osteoarthritis. FRONTIERS IN PAIN RESEARCH 2023; 4:1058476. [PMID: 36910251 PMCID: PMC9992984 DOI: 10.3389/fpain.2023.1058476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023] Open
Abstract
Background and purpose We and others have reported ethnic/race group differences in clinical pain, physical function, and experimental pain sensitivity. However, recent research indicates that with consideration for socioenvironmental factors, ethnicity/race differences become less or non-significant. Understanding of factors contributing to pain inequities are needed. Guided by the NIA and NIMHD Health Disparities Research Frameworks, we evaluate the contributions of environmental and behavioral factors on previously reported ethnic/race group differences in: (1) clinical pain, (2) physical function, and (3) experimental pain in individuals with knee pain. Methods Baseline data from Understanding of Pain and Limitations in Osteoarthritis Disease (UPLOAD) and UPLOAD-2 studies were analyzed. Participants were adults 45 to 85 years old who self-reported as non-Hispanic white (NHW) or black (NHB) with knee pain. A health assessment and quantitative sensory testing were completed. Sociodemographics, environmental, health, clinical and experimental pain, and physical functioning measures were included in nested regressions. Results Pooled data from 468 individuals, 57 ± 8 years of age, 63% women, and 53% NHB adults. As NHB adults were younger and reported greater socioenvironmental risk than the NHW adults, the term sociodemographic groups is used. With inclusion of recognized environmental and behavioral variables, sociodemographic groups remained a significant predictor accounting for <5% of the variance in clinical pain and physical function and <10% of variance in experimental pain. Conclusion The incorporation of environmental and behavioral factors reduced relationships between sociodemographic groups and pain-related outcomes. Pain sites, BMI, and income were significant predictors across multiple models. The current study adds to a body of research on the complex array of factors contributing to disparities in pain-related outcomes.
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Affiliation(s)
- Angela M. Mickle
- College of Medicine, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Lisa H. Domenico
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Jared J. Tanner
- College of Public Health and Health Professionals, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Ellen L. Terry
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Josue Cardoso
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Toni L. Glover
- School of Nursing, Oakland University, Rochester, MI, United States
| | - Staja Booker
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | - Adriana Addison
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Cesar E. Gonzalez
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Cynthia S. Garvan
- College of Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - David Redden
- Department of Biostatistics, School of Public Health, University of Birmingham Alabama, Birmingham, AL, United States
| | - Roland Staud
- College of Medicine, Department of Rheumatology, University of Florida, Gainesville, FL, United States
| | - Burel R. Goodin
- Department of Psychology, College of Arts and Science, University of Birmingham Alabama, Birmingham, AL, United States
| | - Roger B. Fillingim
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Kimberly T. Sibille
- College of Medicine, Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
- College of Dentistry, Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
- College of Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL, United States
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Vági OE, Svébis MM, Domján BA, Körei AE, Tesfaye S, Horváth VJ, Kempler P, Tabák ÁG. The association between distal symmetric polyneuropathy in diabetes with all-cause mortality - a meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1079009. [PMID: 36875485 PMCID: PMC9978416 DOI: 10.3389/fendo.2023.1079009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Distal symmetric polyneuropathy (DSPN) is a common microvascular complication of both type 1 and 2 diabetes with substantial morbidity burden and reduced quality of life. Its association with mortality is equivocal. PURPOSE To describe the association between DSPN and all-cause mortality in people with diabetes and further stratify by the type of diabetes based on a meta-analysis of published observational studies. DATA SOURCES We searched Medline from inception to May 2021. STUDY SELECTION Original data were collected from case-control and cohort studies that reported on diabetes and DSPN status at baseline and all-cause mortality during follow-up. DATA EXTRACTION was completed by diabetes specialists with clinical experience in neuropathy assessment. DATA SYNTHESIS Data was synthesized using random-effects meta-analysis. The difference between type 1 and 2 diabetes was investigated using meta-regression. RESULTS A total of 31 cohorts (n=155,934 participants, median 27.4% with DSPN at baseline, all-cause mortality 12.3%) were included. Diabetes patients with DSPN had an almost twofold mortality (HR: 1.96, 95%CI: 1.68-2.27, I2 = 91.7%), I2 = 91.7%) compared to those without DSPN that was partly explained by baseline risk factors (adjusted HR: 1.60, 95%CI: 1.37-1.87, I2 = 78.86%). The association was stronger in type 1 compared to type 2 diabetes (HR: 2.22, 95%CI: 1.43-3.45). Findings were robust in sensitivity analyses without significant publication bias. LIMITATIONS Not all papers reported multiple adjusted estimates. The definition of DSPN was heterogeneous. CONCLUSIONS DSPN is associated with an almost twofold risk of death. If this association is causal, targeted therapy for DSPN could improve life expectancy of diabetic patients.
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Affiliation(s)
- Orsolya E. Vági
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- *Correspondence: Orsolya E. Vági, ; Ádám Gy. Tabák,
| | - Márk M. Svébis
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- School of PhD studies, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Beatrix A. Domján
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Anna E. Körei
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Viktor J. Horváth
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Péter Kempler
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Ádám Gy. Tabák
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- *Correspondence: Orsolya E. Vági, ; Ádám Gy. Tabák,
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MELCHIOR MDO, ANTUNES LG, BATAGLION C, MAGRI LV. Can high pain intensity and catastrophizing interfere with the cognitive performance of women with chronic pain related TMD? A cross-sectional study. J Appl Oral Sci 2023; 31:e20220384. [PMID: 36995880 PMCID: PMC10065759 DOI: 10.1590/1678-7757-2022-0384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/16/2022] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Interventions based on pain education and self-management are dependent on factors such as attention, memory, concentration, and executive function. To explore the relationship between cognitive performance and the variables pain intensity, central sensitization, catastrophizing, and hypervigilance in women diagnosed with chronic pain-related TMD. METHODOLOGY This is a cross-sectional study. A total of 33 women (mean age: 38±4.6 years; range: 18 to 66 years) with chronic pain-related TMD (myalgia and/or arthralgia) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Specific questionnaires were used to evaluate cognitive performance, overall pain intensity, central sensitization, hypervigilance, and pain catastrophizing. The data were analyzed using Pearson's correlation coefficient and backward stepwise multiple linear regression (statistical significance at 5% alpha). RESULTS Approximately 53% of the study sample showed decreased cognitive performance. High central sensitization, hypervigilance, and pain catastrophizing were observed. A significant negative correlation was observed between cognitive performance and hypervigilance (p=.003, r=-.49), cognitive performance and catastrophizing (p<.001, r=-.58), and cognitive performance and pain intensity (p<.001, r=-.58). Regarding the partial regression coefficients, only catastrophizing and pain intensity showed statistical significance (t=-2.12, p=.043; t=-2.64, p=.014, respectively), indicating a significant role in explaining cognitive performance at the sample. CONCLUSION High pain intensity and the presence of catastrophic thoughts regarding pain can predict impaired cognitive performance in women with chronic pain-related TMD. Management strategies addressing psychosocial dimensions such as reducing catastrophizing and ensuring complete understanding of the condition are important.
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Singh SP, Guindon J, Mody PH, Ashworth G, Kopel J, Chilakapati S, Adogwa O, Neugebauer V, Burton MD. Pain and aging: A unique challenge in neuroinflammation and behavior. Mol Pain 2023; 19:17448069231203090. [PMID: 37684099 PMCID: PMC10552461 DOI: 10.1177/17448069231203090] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Chronic pain is one of the most common, costly, and potentially debilitating health issues facing older adults, with attributable costs exceeding $600 billion annually. The prevalence of pain in humans increases with advancing age. Yet, the contributions of sex differences, age-related chronic inflammation, and changes in neuroplasticity to the overall experience of pain are less clear, given that opposing processes in aging interact. This review article examines and summarizes pre-clinical research and clinical data on chronic pain among older adults to identify knowledge gaps and provide the base for future research and clinical practice. We provide evidence to suggest that neurodegenerative conditions engender a loss of neural plasticity involved in pain response, whereas low-grade inflammation in aging increases CNS sensitization but decreases PNS sensitivity. Insights from preclinical studies are needed to answer mechanistic questions. However, the selection of appropriate aging models presents a challenge that has resulted in conflicting data regarding pain processing and behavioral outcomes that are difficult to translate to humans.
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Affiliation(s)
- Shishu Pal Singh
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Josee Guindon
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Prapti H Mody
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Gabriela Ashworth
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jonathan Kopel
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sai Chilakapati
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Volker Neugebauer
- Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Michael D Burton
- Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
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Sarvilina IV, Danilov AB, Tkacheva ON, Gromova OA, Solovieva EY, Dudinskaya EN, Rozanov AV, Kartashova EA. [Influence of chronic pain in osteoarthritis on the risk of cardiovascular diseases and modern methods of drug prevention]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:20-30. [PMID: 37315238 DOI: 10.17116/jnevro202312305120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The purpose of the review of scientific medical literature was to evaluate the data of the epidemiology of osteoarthritis (OA) and cardiovascular diseases (CVD) with the analysis of risk factors, pathophysiological and pathobiochemical mechanisms of the relationship between OA and the risk of developing CVD in the presence of chronic pain, modern strategies for screening and management of this cohort of patients, the mechanism of action and pharmacological effects of chondroitin sulfate (CS). Conclusions were drawn about the need for additional clinical and observational studies of the efficacy and safety of the parenteral form of CS (Chondroguard) in patients with chronic pain in OA and CVD, improvement of clinical recommendations for the treatment of chronic pain in patients with OA and cardiovascular risk, with special attention to interventions that eliminate mobility restrictions in patients and the inclusion of basic and adjuvant therapy with DMOADs to achieve the goals of multipurpose monotherapy in patients with contraindications to standard therapy drugs.
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Affiliation(s)
- I V Sarvilina
- Medical Center «Novomedicina» LLC, Rostov-on-Don, Russia
| | - Al B Danilov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O N Tkacheva
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
| | - O A Gromova
- Federal Research Center «Computer Science and Control», Moscow, Russia
| | - E Yu Solovieva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E N Dudinskaya
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Rozanov
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
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Ickmans K, Rheel E, Rezende J, Reis FJJ. Spreading the word: pediatric pain education from treatment to prevention. Arch Physiother 2022; 12:25. [PMID: 36376953 PMCID: PMC9663293 DOI: 10.1186/s40945-022-00151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022] Open
Abstract
Pain affects everyone hence one can argue that it is in each individual’s interest to understand pain in order to hold correct and adaptive beliefs and attitudes about pain. In addition, chronic pain is reaching pandemic proportions and it is now well known that people living with chronic pain have a reduced life expectancy. To address and to prevent the growth of this public health disaster, we must start looking beyond adulthood. How children view pain has an impact on their behavioral coping responses which in turn predict persistent pain early in the lifespan. In addition, children who suffer from chronic pain and who are not (properly) treated for it before adolescence have an increased risk of having chronic pain during their adult life. Explaining pain to children and youth may have a tremendous impact not only on the individual child suffering from chronic pain but also on society, since the key to stop the pain pandemic may well lie in the first two decades of life. In order to facilitate the acquisition of adaptive behavioral coping responses, pain education aims to shift people’s view on pain from being an apparent threat towards being a compelling perceptual experience generated by the brain that will only arise whenever the conceivable proof of danger to the body is greater than the conceivable proof of safety to the body. Nowadays a lot of pain education material is available for adults, but it is not adapted to children’s developmental stage and therefore little or not suitable for them. An overview of the state-of-the-art pain education material for children and youth is provided here, along with its current and future areas of application as well as challenges to its development and delivery. Research on pediatric pain education is still in its infancy and many questions remain to be answered within this emerging field of investigation.
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Rönnegård AS, Nowak C, Äng B, Ärnlöv J. The association between short-term, chronic localized and chronic widespread pain and risk for cardiovascular disease in the UK Biobank. Eur J Prev Cardiol 2022; 29:1994-2002. [PMID: 35727954 DOI: 10.1093/eurjpc/zwac127] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 12/30/2022]
Abstract
AIMS The interplay between pain of different chronicity and cardiovascular disease (CVD) is incompletely understood. We aimed to investigate the association between different levels of chronic or nonchronic pain and risk of CVD. METHODS AND RESULTS Participants in the UK Biobank who reported pain at baseline were divided into three groups according to pain duration and widespreadness. Participants reporting no pain were controls. Multivariable Cox regression was used to investigate the association between pain and incidence of myocardial infarction, heart failure, stroke, cardiovascular mortality, and composite CVD (defined as any of the before-mentioned cardiovascular events). Of 475 171 participants, 189 289 reported no pain, 87 830 reported short-term pain, 191 716 chronic localized pain, and 6336 chronic widespread pain (CWP). During a median of 7.0 years' follow-up, participants with chronic localized pain and CWP had, after adjustment for age, sex, established cardiovascular risk factors, physical activity, anxiety, depression, cancer, chronic inflammatory/painful disease, pain/anti-inflammatory medication, socioeconomic status, a significantly increased risk for composite CVD [hazard ratio (HR) 1.14, confidence interval (CI) 1.08-1.21, P < 0.001; and HR 1.48, CI 1.28-1.73, P < 0.001, respectively] compared with controls, with similar results when using the different specific CVDs as outcomes. Population attributable risk proportion for chronic pain as a risk factor for composite CVD was comparable with that of diabetes (8.6 vs. 7.3%, respectively). CONCLUSION Chronic pain is associated with an increased risk for myocardial infarction, stroke, heart failure, and cardiovascular death independent of established cardiovascular risk factors, socioeconomic factors, comorbidities and medication. Our study, the largest to date, confirms and extends our understanding of chronic pain as an underestimated cardiovascular risk factor with important public health implications.
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Affiliation(s)
- Ann-Sofie Rönnegård
- Department of Health and Social Studies, Dalarna University, Falun, Sweden.,Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden
| | - Christoph Nowak
- Department of Neurobiology, Care Sciences and Society (NVS), Family Medicine and Primary Care Unit, Karolinska Institutet, Huddinge, Sweden
| | - Björn Äng
- Department of Health and Social Studies, Dalarna University, Falun, Sweden.,Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society (NVS), Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Johan Ärnlöv
- Department of Health and Social Studies, Dalarna University, Falun, Sweden.,Center for Clinical Research Dalarna, Uppsala University, Region Dalarna, Falun, Sweden.,Department of Neurobiology, Care Sciences and Society (NVS), Family Medicine and Primary Care Unit, Karolinska Institutet, Huddinge, Sweden
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42
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Zhang C, Gao R, Zhou R, Chen H, Liu C, Zhu T, Chen C. The emerging power and promise of non-coding RNAs in chronic pain. Front Mol Neurosci 2022; 15:1037929. [PMID: 36407760 PMCID: PMC9668864 DOI: 10.3389/fnmol.2022.1037929] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/07/2022] [Indexed: 08/26/2023] Open
Abstract
Chronic pain (CP) is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage lasting longer than 3 months. CP is the main reason why people seek medical care and exerts an enormous economic burden. Genome-wide expression analysis has revealed that diverse essential genetic elements are altered in CP patients. Although many possible mechanisms of CP have been revealed, we are still unable to meet all the analgesic needs of patients. In recent years, non-coding RNAs (ncRNAs) have been shown to play essential roles in peripheral neuropathy and axon regeneration, which is associated with CP occurrence and development. Multiple key ncRNAs have been identified in animal models of CP, such as microRNA-30c-5p, ciRS-7, and lncRNA MRAK009713. This review highlights different kinds of ncRNAs in the regulation of CP, which provides a more comprehensive understanding of the pathogenesis of the disease. It mainly focuses on the contributions of miRNAs, circRNAs, and lncRNAs to CP, specifically peripheral neuropathic pain (NP), diabetic NP, central NP associated with spinal cord injury, complex regional pain syndrome, inflammatory pain, and cancer-induced pain. In addition, we summarize some potential ncRNAs as novel biomarkers for CP and its complications. With an in-depth understanding of the mechanism of CP, ncRNAs may provide novel insight into CP and could become new therapeutic targets in the future.
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Affiliation(s)
- Changteng Zhang
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Gao
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruihao Zhou
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Chen
- Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, China
- Department of Respiratory and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Changliang Liu
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Chan Chen
- Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
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43
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Nielsen CS. Assessing the societal cost of chronic pain. Scand J Pain 2022; 22:684-685. [PMID: 36138564 DOI: 10.1515/sjpain-2022-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Christopher Sivert Nielsen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
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44
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Jiang W, Yin Y, Gu X, Zhang Z, Ma H. Opportunities and challenges of pain-related myocardial ischemia-reperfusion injury. Front Physiol 2022; 13:900664. [PMID: 36117689 PMCID: PMC9481353 DOI: 10.3389/fphys.2022.900664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Pain is one of the most serious problems plaguing human health today. Pain is not an independent pathophysiological condition and is associated with a high impact on elevated disability and organ dysfunction. Several lines of evidence suggested the associations of pain with cardiovascular diseases, especially myocardial ischemia-reperfusion (I/R) injury, while the role of pain in I/R injury and related mechanisms are not yet comprehensively assessed. In this review, we attempted to explore the role of pain in myocardial I/R injury, and we concluded that acute pain protects myocardial ischemia-reperfusion injury and chronic pain aggravates cardiac ischemia-reperfusion injury. In addition, the construction of different pain models and animal models commonly used to study the role of pain in myocardial I/R injury were discussed in detail, and the potential mechanism of pain-related myocardial I/R injury was summarized. Finally, the future research direction was prospected. That is, the remote regulation of pain to cardiac function requires peripheral pain signals to be transmitted from the peripheral to the cardiac autonomic nervous system, which then affects autonomic innervation during cardiac ischemia-reperfusion injury and finally affects the cardiac function.
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Affiliation(s)
- Wenhua Jiang
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Yue Yin
- Department of Physiology and Pathophysiology, Fourth Military Medical University, Xi’an, China
| | - Xiaoming Gu
- Department of Physiology and Pathophysiology, Fourth Military Medical University, Xi’an, China
| | - Zihui Zhang
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- *Correspondence: Zihui Zhang, ; Heng Ma,
| | - Heng Ma
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- Department of Physiology and Pathophysiology, Fourth Military Medical University, Xi’an, China
- *Correspondence: Zihui Zhang, ; Heng Ma,
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45
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Enogela EM, Buchanan T, Carter CS, Elk R, Gazaway SB, Goodin BR, Jackson EA, Jones R, Kennedy RE, Perez-Costas E, Zubkoff L, Zumbro EL, Markland AD, Buford TW. Preserving independence among under-resourced older adults in the Southeastern United States: existing barriers and potential strategies for research. Int J Equity Health 2022; 21:119. [PMID: 36030252 PMCID: PMC9419141 DOI: 10.1186/s12939-022-01721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Disability prevention and preservation of independence is crucial for successful aging of older adults. To date, relatively little is known regarding disparities in independent aging in a disadvantaged older adult population despite widely recognized health disparities reported in other populations and disciplines. In the U.S., the Southeastern region also known as “the Deep South”, is an economically and culturally unique region ravaged by pervasive health disparities – thus it is critical to evaluate barriers to independent aging in this region along with strategies to overcome these barriers. The objective of this narrative review is to highlight unique barriers to independent aging in the Deep South and to acknowledge gaps and potential strategies and opportunities to fill these gaps. We have synthesized findings of literature retrieved from searches of computerized databases and authoritative texts. Ultimately, this review aims to facilitate discussion and future research that will help to address the unique challenges to the preservation of independence among older adults in the Deep South region.
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Affiliation(s)
- Ene M Enogela
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Taylor Buchanan
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Christy S Carter
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Ronit Elk
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Shena B Gazaway
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Jackson
- Department of Medicine - Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raymond Jones
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Richard E Kennedy
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Emma Perez-Costas
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Lisa Zubkoff
- Department of Medicine - Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
| | - Emily L Zumbro
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Alayne D Markland
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
| | - Thomas W Buford
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA. .,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA.
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Lövgren A, Visscher CM, Lobbezoo F, Yekkalam N, Vallin S, Wänman A, Häggman-Henrikson B. The association between myofascial orofacial pain with and without referral and widespread pain. Acta Odontol Scand 2022; 80:481-486. [PMID: 35776512 DOI: 10.1080/00016357.2022.2036363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Pain referral on palpation has been suggested to be a clinical sign of central sensitization potentially associated with widespread pain conditions. Our aim was to evaluate if myofascial pain with referral is a better predictor for widespread pain when compared to no pain or local myofascial pain. MATERIALS AND METHODS Individuals at the Public Dental services in Västerbotten, Sweden, were randomly invited based on their answers to three screening questions for temporomandibular disorders (TMD). In total, 300 individuals (202 women, 20-69 yrs) were recruited, and examined according to the Diagnostic Criteria for TMD (DC/TMD) after completion of a body pain drawing. Widespread pain was considered present when seven or more pain sites were reported on the widespread pain index. A binary logistic regression model, adjusted for the effect of age and gender were used to evaluate the association between myofascial orofacial pain and widespread pain. RESULTS Widespread pain was reported by 31.3% of the study sample. There was a 57.3% overlap with myofascial pain. Widespread pain was associated to myofascial orofacial pain with and myofascial orofacial pain (OR 4.83 95% CI 2.62-9.05 and OR 11.62 95% CI 5.18-27.88, respectively). CONCLUSION These findings reinforce the existing knowledge on the overlap between painful TMD and other chronic pain conditions.
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Affiliation(s)
- Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands
| | - Negin Yekkalam
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Simon Vallin
- Northern Register Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anders Wänman
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Birgitta Häggman-Henrikson
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, University of Umeå, Umeå, Sweden.,Department of Orofacial Pain and Jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden
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47
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Bai J, Cheng C. Anxiety, Depression, Chronic Pain, and Quality of Life Among Older Adults in Rural China: An Observational, Cross-Sectional, Multi-Center Study. J Community Health Nurs 2022; 39:202-212. [PMID: 35653791 DOI: 10.1080/07370016.2022.2077072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the incidence of anxiety and depression and examine their cross-sectional associations with chronic pain and quality of life among older adults in rural China. DESIGN Observational, multi-center, cross-sectional study. METHODS A structured, self-report questionnaire was administered. Descriptive statistics analysis and stepwise multiple linear regression analysis were performed. FINDINGS 244 participants (female: 47.1%) filled out the questionnaires. 87 (35.7%) had symptoms of anxiety and 123 (50.4%) had symptoms of depression. The sensory pain descriptor, affective pain descriptor, physical component summary, and mental component summary significantly influenced symptoms of anxiety while affective pain descriptor, physical component summary, and mental component summary significantly influenced symptoms of depression. CONCLUSION Subjective pain experiences and QoL, including physical and mental domains, are strongly related to symptoms of anxiety and depression among older adults in rural China. CLINICAL EVIDENCE Interventions that highlight subjective pain experiences and QoL may help to relieve symptoms of anxiety and depression in older adults.
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Affiliation(s)
- Jie Bai
- IVF Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, Xuhui, China
| | - Cheng Cheng
- School of Nursing, Shanghai Medical College, Fudan University, Shanghai, Xuhui, China
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48
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Zhao SS, Holmes MV, Alam U. Chronic pain is associated with higher risk of developing and being hospitalized for COVID-19: a Mendelian randomization study. Rheumatology (Oxford) 2022; 61:SI189-SI190. [PMID: 35253865 PMCID: PMC9383504 DOI: 10.1093/rheumatology/keac135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/26/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool
| | - Michael V Holmes
- MRC Population Health Research Unit, University of Oxford, Oxford
| | - Uazman Alam
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool
- Department of Diabetes and Endocrinology, Liverpool University Hospital NHS Foundation Trust, Liverpool
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester, UK
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49
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Muralidharan A, Sotocinal SG, Yousefpour N, Akkurt N, Lima LV, Tansley S, Parisien M, Wang C, Austin JS, Ham B, Dutra GM, Rousseau P, Maldonado-Bouchard S, Clark T, Rosen SF, Majeed MR, Silva O, Nejade R, Li X, Donayre Pimentel S, Nielsen CS, Neely GG, Autexier C, Diatchenko L, Ribeiro-da-Silva A, Mogil JS. Long-term male-specific chronic pain via telomere- and p53‑mediated spinal cord cellular senescence. J Clin Invest 2022; 132:e151817. [PMID: 35426375 PMCID: PMC9012275 DOI: 10.1172/jci151817] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 03/08/2022] [Indexed: 12/13/2022] Open
Abstract
Mice with experimental nerve damage can display long‑lasting neuropathic pain behavior. We show here that 4 months and later after nerve injury, male but not female mice displayed telomere length (TL) reduction and p53‑mediated cellular senescence in the spinal cord, resulting in maintenance of pain and associated with decreased lifespan. Nerve injury increased the number of p53‑positive spinal cord neurons, astrocytes, and microglia, but only in microglia was the increase male‑specific, matching a robust sex specificity of TL reduction in this cell type, which has been previously implicated in male‑specific pain processing. Pain hypersensitivity was reversed by repeated intrathecal administration of a p53‑specific senolytic peptide, only in male mice and only many months after injury. Analysis of UK Biobank data revealed sex-specific relevance of this pathway in humans, featuring male‑specific genetic association of the human p53 locus (TP53) with chronic pain and a male-specific effect of chronic pain on mortality. Our findings demonstrate the existence of a biological mechanism maintaining pain behavior, at least in males, occurring much later than the time span of virtually all extant preclinical studies.
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Affiliation(s)
- Arjun Muralidharan
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | | | - Nur Akkurt
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Lucas V. Lima
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Shannon Tansley
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | - Chengyang Wang
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | - Boram Ham
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | | | - Philippe Rousseau
- Bloomfield Centre for Research in Aging, McGill University, Montreal, Quebec, Canada
| | | | - Teleri Clark
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah F. Rosen
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Mariam R. Majeed
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Olivia Silva
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Rachel Nejade
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Xinyu Li
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Christopher S. Nielsen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - G. Gregory Neely
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Chantal Autexier
- Bloomfield Centre for Research in Aging, McGill University, Montreal, Quebec, Canada
| | | | | | - Jeffrey S. Mogil
- Department of Psychology, McGill University, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
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50
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You DS, Ziadni MS, Hettie G, Darnall BD, Cook KF, Von Korff MR, Mackey SC. Comparing Perceived Pain Impact Between Younger and Older Adults With High Impact Chronic Pain: A Cross-Sectional Qualitative and Quantitative Survey. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:850713. [PMID: 35465295 PMCID: PMC9030949 DOI: 10.3389/fpain.2022.850713] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/07/2022] [Indexed: 01/19/2023]
Abstract
High impact chronic pain (HICP) is a recently proposed concept for treatment stratifying patients with chronic pain and monitoring their progress. The goal is to reduce the impact of chronic pain on the individual, their family, and society. The US National Pain Strategy defined HICP as the chronic pain associated with substantial restrictions on participation in work, social, and self-care activities for at least 6 months. To understand the meaning and characteristics of HICP from the younger (<65 years old) and older adults (≥65 years old) with chronic pain, our study examined patients' perceived pain impact between the two age groups. We also characterize the degree of pain impact, assessed with the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI), between adults and older adults with HICP. We recruited patients at a tertiary pain clinic. The survey included open-ended questions about pain impact, the Graded Chronic Pain Scale-Revised to identify patients' meeting criteria for HICP, and the Patient-Reported Outcomes Measurement Information System (PROMIS®) 8-item PI short form (v.8a). A total of 55 younger adults (65.5% women, 72.7% HICP, mean age = 55.0 with SD of 16.2) and 28 older adults (53.6% women, 64.3% HICP, mean age = 72.6 with SD of 5.4) with chronic pain participated in this study. In response to an open-ended question in which participants were asked to list out the areas of major impact pain, those with HICP in the younger group most commonly listed work, social activity, and basic physical activity (e.g., walking and standing); for those in the older group, basic physical activity, instrumental activity of daily living (e.g., housework, grocery shopping), and participating in social or fun activity for older adults with HICP were the most common. A 2 × 2 ANOVA was conducted using age (younger adults vs. older adults) and HICP classification (HICP vs. No HICP). A statistically significant difference was found in the PROMIS-PI T-scores by HICP status (HICP: M = 58.4, SD = 6.3; No HICP: M = 67.8, SD = 6.3), but not by age groups with HICP. In conclusion, perceived pain impacts were qualitatively, but not quantitatively different between younger and older adults with HICP. We discuss limitations and offer recommendations for future research.
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Affiliation(s)
- Dokyoung S. You
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Maisa S. Ziadni
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Gabrielle Hettie
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Beth D. Darnall
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Michael R. Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sean C. Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States,*Correspondence: Sean C. Mackey
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