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Ryan E, Grol-Prokopczyk H, Dennison CR, Zajacova A, Zimmer Z. Is the relationship between chronic pain and mortality causal? A propensity score analysis. Pain 2024:00006396-990000000-00649. [PMID: 38981067 DOI: 10.1097/j.pain.0000000000003336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Indexed: 07/11/2024]
Abstract
ABSTRACT Chronic pain is a serious and prevalent condition that can affect many facets of life. However, uncertainty remains regarding the strength of the association between chronic pain and death and whether the association is causal. We investigate the pain-mortality relationship using data from 19,971 participants aged 51+ years in the 1998 wave of the U.S. Health and Retirement Study. Propensity score matching and inverse probability weighting are combined with Cox proportional hazards models to investigate whether exposure to chronic pain (moderate or severe) has a causal effect on mortality over a 20-year follow-up period. Hazard ratios (HRs) with 95% confidence intervals (CIs) are reported. Before adjusting for confounding, we find a strong association between chronic pain and mortality (HR: 1.32, 95% CI: 1.26-1.38). After adjusting for confounding by sociodemographic and health variables using a range of propensity score methods, the estimated increase in mortality hazard caused by pain is more modest (5%-9%) and the results are often also compatible with no causal effect (95% CIs for HRs narrowly contain 1.0). This attenuation highlights the role of confounders of the pain-mortality relationship as potentially modifiable upstream risk factors for mortality. Posing the depressive symptoms variable as a mediator rather than a confounder of the pain-mortality relationship resulted in stronger evidence of a modest causal effect of pain on mortality (eg, HR: 1.08, 95% CI: 1.01-1.15). Future work is required to model exposure-confounder feedback loops and investigate the potentially cumulative causal effect of chronic pain at multiple time points on mortality.
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Affiliation(s)
- Eva Ryan
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, New York, NY, United States
| | - Christopher R Dennison
- Department of Sociology, University at Buffalo, State University of New York, New York, NY, United States
| | - Anna Zajacova
- Department of Sociology, University of Western Ontario, London, ON, Canada
| | - Zachary Zimmer
- Department of Family Studies and Gerontology and Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, NS, Canada
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2
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Lin L, Lin J, Qiu J, Liufu N, Lin S, Wei F, Liu Q, Zeng J, Zhang M, Cao M. Genetic liability to multi-site chronic pain increases the risk of cardiovascular disease. Br J Anaesth 2023:S0007-0912(23)00195-2. [PMID: 37225534 DOI: 10.1016/j.bja.2023.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Observational studies have shown associations between multi-site chronic pain (MCP) and cardiovascular disease. However, it remains unclear whether these associations are causal. Therefore, this study aimed to assess the causal associations between MCP and cardiovascular disease and identify possible mediators between them. METHODS A two-sample Mendelian randomisation analysis was applied in this study. The summary data for MCP were obtained from a genome-wide association study that included 387 649 individuals from the UK Biobank, whereas summary-level data for cardiovascular disease and its subtypes were obtained from relevant genome-wide association studies. Finally, summary-level data for common cardiovascular risk factors and inflammatory biomarkers were leveraged to identify possible mediators. RESULTS Genetic liability to multi-site chronic pain is associated with higher risks for coronary artery disease (CAD), myocardial infarction (MI), heart failure (HF), and stroke, with a combined odds ratio (OR) of 1.537 (per site increment in MCP; 95% confidence interval [CI]: 1.271-1.858; P=0.0001) for CAD, 1.604 (95% CI: 1.277-2.014; P=0.0005) for MI, 1.722 (95% CI: 1.423-2.083; P<0.00001) for HF, and 1.332 (95% CI: 1.093-1.623; P=0.00001) for stroke. Genetic liability to MCP was found to be associated with mental disorders, smoking initiation, physical activity, BMI, and lipid metabolites. Multivariable Mendelian randomisation suggested a mediating role for mental disorders, smoking initiation, physical activity, and BMI in the relationship between multi-site chronic pain and cardiovascular disease. CONCLUSIONS Our findings provide new insights into the role of multi-site chronic pain in cardiovascular disease. Additionally, we identified several modifiable risk factors for reducing cardiovascular disease.
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Affiliation(s)
- Liling Lin
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianwei Lin
- Big Data Laboratory, Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Junxiong Qiu
- Department of Cardiovascular Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ning Liufu
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shishi Lin
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Feng Wei
- Department of Cardiovascular Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qingping Liu
- Joint Shantou International Eye Centre of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jingxian Zeng
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Mingzhi Zhang
- Joint Shantou International Eye Centre of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China.
| | - Minghui Cao
- Department of Anesthesiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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3
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Yin M, Wang C, Gu K, Bao P, Shu XO. Chronic pain and its correlates among long-term breast cancer survivors. J Cancer Surviv 2023; 17:460-467. [PMID: 35963975 DOI: 10.1007/s11764-022-01241-9] [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: 04/05/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Chronic pain is a common symptom affecting quality of life for breast cancer survivors. However, its prevalence and correlate factors in long-term breast cancer survivors, particularly Asian women, are understudied. The reported study is to address these knowledge gaps. METHODS We evaluated pain severity and frequency, and their associations with clinical features and lifestyle factors among 3640 5-year breast cancer survivors who participated in the Shanghai Breast Cancer Survival Study. Demographic, clinical, and lifestyle information was collected at study enrollment, which occurred 6 months post-diagnosis, and pain was assessed at the 5-year post-diagnosis follow-up survey. RESULTS In total, 42% of participants reported experiencing pain. Pain is more prevalent among survivors with low educational attainment or low income. Multivariable polytomous regression analyses showed that pain was positively associated with metastasis or recurrence (moderate pain OR: 2.17, 95% CI: 1.45, 3.26, frequent pain OR: 1.92, 95% CI: 1.37, 2.70), triple negative status (infrequent pain OR: 1.36, 95% CI: 1.04, 1.78), obesity (frequent pain OR: 1.80, 95% CI: 1.41, 2.31), and multiple comorbidities. Exercise (OR: 0.65, 95%: 0.49, 0.88), chemotherapy (OR: 0.59, 95% CI: 0.41, 0.849), and HER2-positive and ER/PR-negative status (OR: 0.64, 95% CI: 0.43, 0.97) were inversely associated with moderate pain. CONCLUSIONS Chronic pain is highly prevalent among long-term breast cancer survivors in China and was associated with obesity, physical inactivity, and several clinical factors. IMPLICATIONS FOR CANCER SURVIVORS This study highlights the importance of promoting weight control and exercise to alleviate chronic pain.
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Affiliation(s)
- Michelle Yin
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cong Wang
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kai Gu
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Pingping Bao
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Epidemiology Center, Vanderbilt University Institute of Medicine and Public Health, 2525 West End Avenue, Suite 600, Nashville, TN, 37203-1738, USA.
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4
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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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5
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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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6
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Occupational Physical Activity Was Associated With Disability Levels at 6-Month Follow-Up of Patients With Chronic Nonspecific Low Back Pain: A Prospective Cohort Study. J Phys Act Health 2022; 19:409-416. [PMID: 35551113 DOI: 10.1123/jpah.2021-0798] [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: 12/14/2021] [Revised: 04/05/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Physical activity plays an important role in the prognosis of chronic low back pain (LBP); however, whether physical activity predicts pain intensity and disability remains unknown. This study investigated whether objective and subjective physical activity measures predict pain intensity and disability levels 6 months later in patients with chronic LBP. METHODS Patients with chronic LBP seeking care at 2 outpatient physiotherapy clinics were recruited. At baseline assessment, we collected anthropometric/sociodemographic data, duration of symptoms, pain intensity, disability, and physical activity (accelerometer and questionnaire). After 6 months, we reassessed pain and disability. Multivariable regression analyses were performed to investigate the association of physical activity measures with pain and disability at follow-up. RESULTS A total of 179 patients with chronic LBP were included. High occupational physical activity at baseline predicted disability at 6-month follow-up (B = 1.22; 95% confidence interval, 0.21 to 2.21) after controlling for age and baseline disability, meaning that for every 1-point increase in occupational physical activity, disability increased on average by 1.22 point. The remaining physical activity measures showed no association with pain intensity or disability at follow-up. CONCLUSION Higher perceived levels of occupational physical activity predicted higher disability levels at 6-month follow-up in patients with chronic LBP.
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7
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Patel A. Health disparities in chronic back pain and associated mortality seen in ischemic cardiac disease: a commentary. Arch Public Health 2021; 79:191. [PMID: 34749798 PMCID: PMC8576877 DOI: 10.1186/s13690-021-00710-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022] Open
Abstract
Prescription opioid use for nonmalignant chronic pain has grown in the US over the last decade. Those with chronic back pain have a higher risk of mortality from ischemic heart disease than those without. Studies have demonstrated a higher prevalence of cardiac disease in adults who report chronic pain. In addition, there is research that supports some association with pain sites and cardiovascular morbidity. Studies have also shown a high-grade chronic neck pain to be more associated with cardiovascular conditions when compared to moderate or low-grade chronic pain. Given this information, it is important to assess pain medication burden present in those who have a diagnosis of coronary artery disease and chronic lower back pain.
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Affiliation(s)
- Ashruta Patel
- Philadelphia College of Osteopathic Medicine, Georgia Campus, 625 Old Peachtree Road NW, GA, 30024, Suwanee, USA.
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8
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Wickrama KAS, O'Neal CW. Midlife Marital and Financial Stress and the Progression of Later-Life Health Problems for Husbands and Wives. J Aging Health 2021; 33:685-697. [PMID: 33787388 PMCID: PMC8416932 DOI: 10.1177/08982643211004364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Locating the family systems theory within the life course stress process perspective, this study investigates how husbands' and wives' marital and financial stress were implicated in their subsequent physical health, psychological distress, and loneliness. Methods: Using prospective data from 254 husbands and wives over 27 years, a path model examined the influence of marital stress and family financial stress during midlife (40-50 years) on later-life (65+ years) physical health, psychological distress, and loneliness. Results: For wives, loneliness was a mechanism linking marital stress to their health outcomes and their husbands' physical health. For husbands, physical health was a mechanism linking financial strain to husbands' health outcomes and wives' physical health. Discussion: The findings emphasize the consideration of midlife financial and marital stress for policies and programs for older adults, particularly the prevention of loneliness and improving interpersonal processes, as ways to protect from earlier stressful experiences.
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Affiliation(s)
- Kandauda A S Wickrama
- Department of Human Development and Family Science, The University of Georgia, Athens, GA, USA
| | - Catherine W O'Neal
- Department of Human Development and Family Science, The University of Georgia, Athens, GA, USA
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9
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Hypertension prevalence in patients attending tertiary pain management services, a registry-based Australian cohort study. PLoS One 2020; 15:e0228173. [PMID: 31978196 PMCID: PMC6980551 DOI: 10.1371/journal.pone.0228173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/08/2020] [Indexed: 12/20/2022] Open
Abstract
Persistent pain and hypertension often co-occur, and share several biological and lifestyle risk factors. The present study aimed to provide insight into the prevalence of, and factors associated with, hypertension in the largest cohort of patients seeking treatment in 43 tertiary pain clinics in Australia. Adults aged > = 18 years registered to the electronic Persistent Pain Outcomes Collaboration registry between 2013 and 2018 were included if they had persistent non-cancer pain (N = 43,789). Risk Ratios (RRs) compared prevalence of self-reported hypertension with the general and primary care Australian populations, and logistic regression examined factors associated with hypertension. One in four (23.9%) patients had hypertension, which was higher than the Australian adult population (2014–15: RR = 5.86, 95%CI: 5.66, 6.06; 2017–18: RR = 9.40, 95%CI: 9.01, 9.80), and in primary care patients (2011–13: RR = 1.17, 95%CI: 1.15, 1.20). Adjusting for covariates, patients with higher odds of hypertension were older, lived in regions with higher socioeconomic disadvantage, had higher levels of BMI, were born outside the Oceania/Australasia region, and had comorbid arthritis, diabetes, or severe-extremely severe anxiety symptoms. Female patients and those with depression symptoms had lower adjusted odds. Unadjusted analyses showed an association between widespread pain, pain duration, pain severity and interference, and lower pain self-efficacy with hypertension; however, only pain severity remained significant in adjusted analyses. Hypertension was more prevalent in people with persistent pain than in the general community, was associated with more severe pain, and commonly co-occurred with pain-related impairments. Routine hypertension screening and treatment targeting shared mechanisms of hypertension and pain may improve treatment outcomes in the pain clinic setting.
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10
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Oliveira CB, Maher CG, Franco MR, Kamper SJ, Williams CM, Silva FG, Pinto RZ. Co-occurrence of Chronic Musculoskeletal Pain and Cardiovascular Diseases: A Systematic Review with Meta-analysis. PAIN MEDICINE 2019; 21:1106-1121. [DOI: 10.1093/pm/pnz217] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
Objective
To determine the magnitude of the association between cardiovascular disease and chronic musculoskeletal pain.
Design
Systematic review with meta-analysis.
Methods
A comprehensive search was performed in five electronic databases. Population-based studies reporting the prevalence of cardiovascular diseases in adults stratified by chronic musculoskeletal pain status were considered eligible. Two independent reviewers performed the screening of the records following the inclusion criteria, extracted data, and evaluated the risk of bias of the included studies using an assessment tool of risk of bias for observational studies. In addition, we assessed the overall quality of evidence using an adaptation of the GRADE approach for prognosis.
Results
Twenty studies were included in this review. There was high-quality evidence that people with chronic musculoskeletal pain are 1.91 times more likely to report having a cardiovascular disease compared with those without chronic musculoskeletal pain (risk ratio = 1.91, 95% confidence interval = 1.64–2.21).
Conclusions
Our findings demonstrated associations between chronic musculoskeletal pain and any cardiovascular diseases. Future studies are still warranted to better understand the association between chronic musculoskeletal pain and the specific types of cardiovascular diseases.
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Affiliation(s)
- Crystian B Oliveira
- Department of Physical Therapy, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, Brazil
| | - Chris G Maher
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, Sydney, Australia
| | - Marcia R Franco
- Department of Physical Therapy, Centro Universitário UNA, Contagem, Brazil
| | - Steven J Kamper
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, Sydney, Australia
- Centre for Pain, Health and Lifestyle, New Lambton Heights, Australia
| | - Christopher M Williams
- Centre for Pain, Health and Lifestyle, New Lambton Heights, Australia
- Hunter New England Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Fernanda G Silva
- Department of Physical Therapy, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista (UNESP), Presidente Prudente, Brazil
| | - Rafael Z Pinto
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Oliveira CB, Franco MR, Maher CG, Ferreira PH, Morelhão PK, Damato TM, Gobbi C, Pinto RZ. Physical Activity–Based Interventions Using Electronic Feedback May Be Ineffective in Reducing Pain and Disability in Patients With Chronic Musculoskeletal Pain: A Systematic Review With Meta-Analysis. Arch Phys Med Rehabil 2018; 99:1900-1912. [DOI: 10.1016/j.apmr.2017.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 11/25/2022]
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12
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Dwyer CP, MacNeela P, Durand H, Gibbons A, Reynolds B, Doherty E, Conneely S, Slattery BW, Murphy AW, McGuire BE. Judgement analysis of case severity and future risk of disability regarding chronic low back pain by general practitioners in Ireland. PLoS One 2018; 13:e0194387. [PMID: 29579072 PMCID: PMC5868792 DOI: 10.1371/journal.pone.0194387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 03/02/2018] [Indexed: 11/18/2022] Open
Abstract
Chronic low back pain is a major healthcare burden that has wide ranging effects on the individual, their family, society and the workplace. However, appropriate management and treatment is often difficult, as a majority of cases are non-specific in terms of underlying pathology. As a result, there are extensive differences in both individual patient preferences for treatment and treatment decisions amongst general practitioners. The current study examined the clinical judgements of GPs in Ireland, regarding fictional patients’ case severity and future risk of disability, through judgement analysis. Judgement analysis (JA) is an idiographic regression modelling technique that has been utilised in extant healthcare research for the purpose of allocating weighting to judgement criteria, or cues, observed by professionals in their clinical decision-making. The primary aim of the study was to model two critical information utilisation tasks performed by GPs with regard to CLBP–in combining information cues to form a judgement about current case severity and a judgement about the same patient’s risk of future disability. It was hypothesised that the judgement weighting would differ across the two judgements and that judgements regarding future risk of disability would be less consistent among GPs than judgements about case severity. Results from the regression-based judgement analysis and subsequent follow-up statistical analysis provided support for both study hypotheses. Study findings are discussed in light of theory and research on judgement, clinical decision-making and chronic low back pain.
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Affiliation(s)
- Christopher P. Dwyer
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
- * E-mail:
| | - Pádraig MacNeela
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Hannah Durand
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Andrea Gibbons
- Health Psychology Research Unit, Royal Holloway, University of London, London, United Kingdom
| | - Bronagh Reynolds
- Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Edel Doherty
- Discipline of Economics, J E Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Sinéad Conneely
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Brian W. Slattery
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Andrew W. Murphy
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Brian E. McGuire
- Centre for Pain Research, National University of Ireland, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Ireland
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13
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Assessing the relationship between chronic pain and cardiovascular
disease: A systematic review and meta-analysis. Scand J Pain 2016; 13:76-90. [DOI: 10.1016/j.sjpain.2016.06.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/06/2016] [Accepted: 06/10/2016] [Indexed: 11/18/2022]
Abstract
Abstract
Background and Aims
Chronic pain is a potentially disabling condition affecting one in three people through impaired physical function and quality of life. While the psychosocial impact of chronic pain is already well established, little is known about the potential biological consequences. Chronic pain may be associated with an increased prevalence of cardiovascular disease, an effect that has been demonstrated across a spectrum of chronic pain conditions including low back pain, pelvic pain, neuropathic pain and fibromyalgia. The aim of this study was to review and summarize the evidence for a link between chronic pain and cardiovascular disease. We sought to clarify the nature of the relationship by examining the basis for a dose-response gradient (whereby increasing pain severity would result in greater cardiovascular disease), and by evaluating the extent to which potentially confounding variables may contribute to this association.
Methods
Major electronic databases MEDLINE, EMBASE, Psychinfo, Cochrane, ProQuest and Web of Science were searched for articles reporting strengths of association between chronic pain (pain in one or more body regions, present for three months or longer) and cardiovascular outcomes (cardiovascular mortality, cardiac disease, and cerebrovascular disease). Meta-analysis was used to pool data analysing the association between chronic pain and the three principal cardiovascular outcomes. The impact of pain severity, and the role of potentially confounding variables were explored narratively.
Results
The searches generated 11,141 studies, of which 25 matched our inclusion criteria and were included in the review. Meta-analysis (of unadjusted study outcomes) demonstrated statistically significant associations between chronic pain and mortality from cardiovascular diseases: pooled odds ratio 1.20, (95% confidence intervals 1.05–1.36); chronic pain and cardiac disease: pooled odds ratio 1.73 (95% confidence intervals 1.42–2.04); and chronic pain and cerebrovascular disease: pooled odds ratio 1.81 (95% confidence intervals 1.51–2.10). The systematic review also found evidence supporting a dose-response relationship, with greater pain intensity and distribution producing a stronger association with cardiovascular outcomes.
All of the included studies were based on observational data with considerable variation in chronic pain taxonomy, methodology and study populations. The studies took an inconsistent and incomplete approach in their adjustment for potentially confounding variables, making it impossible to pool data after adjustments for confounding variables, so it cannot be concluded that these associations are causal.
Conclusions
Our review supports a possible dose-response type of association between chronic pain and cardiovascular disease, supported by a range of observational studies originating from different countries. Such research has so far failed to satisfactorily rule out that the association is due to confounding variables. What is now needed are further population based longitudinal studies that are designed to allow more robust exploration of a cause and effect relationship.
Implications
Given the high prevalence of chronic pain in developed and developing countries our results highlight a significant, but underpublicized, public health concern. Greater acknowledgement of the potentially harmful biological consequences of chronic pain may help to support regional, national and global initiatives aimed at reducing the burden of chronic pain.
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Fernandez M, Ordoñana JR, Hartvigsen J, Ferreira ML, Refshauge KM, Sánchez-Romera JF, Pinheiro MB, Simpson SJ, Hopper JL, Ferreira PH. Is Chronic Low Back Pain Associated with the Prevalence of Coronary Heart Disease when Genetic Susceptibility Is Considered? A Co-Twin Control Study of Spanish Twins. PLoS One 2016; 11:e0155194. [PMID: 27171210 PMCID: PMC4865187 DOI: 10.1371/journal.pone.0155194] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/25/2016] [Indexed: 01/23/2023] Open
Abstract
Objective To investigate the chronic low back pain and coronary heart disease relationship, after adjusting for relevant confounders, including genetics. Methods In a cross-sectional design, 2148 twins were recruited from the Murcia Twin Registry, Spain. The exposure was chronic LBP and the outcomes were myocardial infarction and other coronary heart diseases—lifetime and in the last 2 years–based on standardized health-related questionnaires. First, logistic regression analysis investigated associations of the total sample followed by a matched co-twin control analyses, with all complete twin pairs discordant for chronic LBP utilised, separated for zygosity—dizygotic (DZ) and monozygotic (MZ) pairs, which adjusted for shared familial factors, including genetics. Results Chronic LBP pain is associated with lifetime myocardial infarction [odds ratio (OR) = 2.69, 95% confidence interval (CI) = 1.35–5.36], other coronary heart diseases over a lifetime (OR = 2.58, 95% CI: 1.69–3.93) and in the last two years (OR = 2.19, 95% CI: 1.33–3.60), while there was a borderline association with myocardial infarction in the last 2 years (OR = 2.64, 95% CI: 0.98–7.12). Although the magnitude of the association remained or increased in the co-twin control analyses, none reached statistical significance. Conclusion Chronic LBP is associated with a higher prevalence of myocardial infarction and coronary heart disease. It is possible that this association remains even when controlling for genetics and early shared environment, although this should be investigated with larger samples of twins discordant for LBP.
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Affiliation(s)
- Matt Fernandez
- Arthritis & Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
- * E-mail:
| | - Juan R. Ordoñana
- Murcia Twin Registry, Department of Human Anatomy and Psychobiology, University of Murcia and IMIB-Arrixaca, Murcia, Spain
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Manuela L. Ferreira
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Kathryn M. Refshauge
- Arthritis & Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Juan F. Sánchez-Romera
- Murcia Twin Registry, Department of Human Anatomy and Psychobiology, University of Murcia and IMIB-Arrixaca, Murcia, Spain
| | - Marina B. Pinheiro
- Arthritis & Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Stephen J. Simpson
- Charles Perkins Centre, School of Biological Sciences, The University of Sydney, Sydney, Australia
| | - John L. Hopper
- Australian Twin Registry, Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Victoria, Australia
| | - Paulo H. Ferreira
- Arthritis & Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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