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Roberts KE, Ho E, Gassen-Fritsch C, Halliday M, Mattinty MM, Ferreira P. Perceived social support impacts on exercise adherence in patients with chronic low back pain. J Back Musculoskelet Rehabil 2024:BMR230239. [PMID: 39240623 DOI: 10.3233/bmr-230239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
BACKGROUND Initiating and maintaining physical activity is particularly difficult for at-risk groups such as those with chronic low back pain (LBP). OBJECTIVE This study aimed to assess whether there is a relationship between perceived social support (e.g., emotional and physical support) in individuals recently discharged from treatment for chronic LBP and the number of exercise sessions and total amount of exercise they perform over a 6-month period. This study also aimed to investigate a possible mediation effect of exercise self-efficacy on the relationship between perceived social support and exercise adherence (number of exercise sessions and total amount of exercise). METHODS This prognostic study employed a secondary analysis of data collected for The Buddy Study; Data was collected through online weekly diaries over a 6-month period. Poisson regression analyses were used to quantify the relationship between social support at baseline and total number of exercise sessions, and total amount of exercise performed (frequency and duration) in the 6-month follow-up period. Where a relationship was observed, the Stata SEM command was used for the mediation analysis. RESULTS A positive relationship was found between participants' perceived levels of social support at baseline and the total number of exercise sessions they performed (IRR = 1.56, 95%CI: 1.18 to 2.06) and the total amount of exercise they performed (IRR = 1.57, 95%CI: 1.05 to 2.35) during the 6-month follow-up period. No mediating relationship was found between exercise self-efficacy at 3-months and the total number of exercise sessions performed (β 3.96, 95% CI: -4.91 to 12.84), or the total amount of exercise performed (β 243.96, 95% CI: -258.08 to 746.01). CONCLUSION Social support is potentially an important aspect of exercise adherence, following discharge from treatment, for those with chronic LBP. People's self-efficacy to exercise does not appear to mediate this relationship. Harnessing social support following physiotherapy treatment may increase exercise adherence and may therefore improve long term outcomes for those with chronic LBP.
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Affiliation(s)
- Katharine E Roberts
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Ho
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carolina Gassen-Fritsch
- Sydney Musculoskeletal Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark Halliday
- Concord Repatriation General Hospital, Sydney, Australia
| | | | - Paulo Ferreira
- Sydney Musculoskeletal Health, Charles Perkins Centre, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Shockey T, Alterman T, Yang H, Lu ML. Workplace Psychosocial Factors, Work Organization, and Physical Exertion as Risk Factors for Low Back Pain Among US Workers: Data From the 2015 National Health Interview Survey. J Occup Environ Med 2024; 66:467-474. [PMID: 38471812 DOI: 10.1097/jom.0000000000003087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To evaluate the association between workplace psychosocial, organization, and physical risk factors with low back pain (LBP) among US workers. METHODS 2015 National Health Interview Survey data were analyzed to calculate the prevalence rates and prevalence ratios for LBP across levels of workplace psychosocial and organizational risk factors among 17,464 US adult workers who worked ≥20 hours per week. Results were also stratified by workplace physical exertion. RESULTS The adjusted prevalence rates of LBP were significantly elevated for workers reporting high job demand, low job control, work-family imbalance, bullying, job insecurity, working alternate shifts, and physical exertion. Job control and nonstandard shifts were significantly associated with LBP only among those who reported low/no physical exertion. CONCLUSIONS LBP prevalence was associated with select workplace psychosocial and organization risk factors. Stratification by physical exertion modified multiple associations.
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Affiliation(s)
- Taylor Shockey
- From the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio (T.S., T.A., M.-L.L.); and University of California-Irvine, School of Medicine, Irvine, California (H.Y.)
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Melguizo-Ibáñez E, Ubago-Jiménez JL, Sanz-Martín D, Alonso-Vargas JM. Health-Related Quality of Life and Injuries in Physical Education Students: A Multi-Group Model According to the Degree of Adherence to the Mediterranean Diet. Eur J Investig Health Psychol Educ 2024; 14:1140-1152. [PMID: 38785573 PMCID: PMC11120319 DOI: 10.3390/ejihpe14050075] [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: 03/20/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
The Mediterranean diet is considered a healthy eating pattern. It has been shown to improve people's quality of life. When a person suffers injuries, their quality of life suffers. This research aims to accomplish the following: (a) to study the differences in the effect of the health-related quality of life on injuries according to the degree of adherence to the Mediterranean diet, (b) to analyse the existing differences in the variables that make up the health-related quality of life according to the degree of adherence to the Mediterranean diet, and (c) to analyse the degree of adherence to the Mediterranean diet according to whether the participants have suffered any injury. The study was descriptive, cross-sectional, and exploratory in a sample of 556 physical education students. The PREDIMED questionnaire, the SF-36 questionnaire, and a self-administered questionnaire were used. The results showed that high adherence to the Mediterranean diet was associated with higher quality of life and lower injury rates. It was also observed that high adherence to the Mediterranean diet improved the effect of the quality of life on injuries. In conclusion, the Mediterranean diet is beneficial for the quality of life of young university students.
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Affiliation(s)
- Eduardo Melguizo-Ibáñez
- Department of Didactics Musical, Plastic and Corporal Expression, Faculty of Education Science, University of Granada, 18071 Granada, Spain; (E.M.-I.); (J.L.U.-J.); (J.M.A.-V.)
| | - José Luis Ubago-Jiménez
- Department of Didactics Musical, Plastic and Corporal Expression, Faculty of Education Science, University of Granada, 18071 Granada, Spain; (E.M.-I.); (J.L.U.-J.); (J.M.A.-V.)
| | - Daniel Sanz-Martín
- Faculty of Humanities and Social Sciences, Universidad Isabel I, 09003 Burgos, Spain
| | - José Manuel Alonso-Vargas
- Department of Didactics Musical, Plastic and Corporal Expression, Faculty of Education Science, University of Granada, 18071 Granada, Spain; (E.M.-I.); (J.L.U.-J.); (J.M.A.-V.)
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Nava-Bringas TI, Manrique CMJ, González-Huerta NC, Morales-Hernández E, Miranda-Duarte A. COMT and SCN9A gene variants do not contribute to chronic low back pain in Mexican-Mestizo patients. Acta Neurochir (Wien) 2024; 166:73. [PMID: 38329587 DOI: 10.1007/s00701-024-05937-y] [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: 07/13/2023] [Accepted: 11/26/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Chronic low back pain (CLBP) is a complex condition in which genetic factors play a role in its susceptibility. Catechol-O-methyltransferase (COMT) and sodium channel NaV1.7 (SCN9A) genes are implicated in pain perception. The aim is to analyze the association of COMT and SCN9A with CLBP and their interaction, in a Mexican-Mestizo population. METHODS A case-control study was conducted. Cases corresponded to adults of both sexes with CLBP. Controls were adults with no CLBP. Variants of SCN9A and COMT were genotyped. Allelic and genotypic frequencies and Hardy-Weinberg equilibrium (HWE) were calculated. Association was tested under codominant, dominant, and recessive models. Multifactor dimensionality reduction was developed to detect epistasis. RESULTS Gene variants were in HWE, and there was no association under different inheritance models in the whole sample. In women, in codominant and dominant models, a trend to a high risk was observed for AA of rs4680 of COMT (OR = 1.7 [0.5-5.3] and 1.6 [0.7-3.4]) and for TT of rs4633 (OR = 1.6 [0.7-3.7] and 1.6 [0.7-3.4]). In men, a trend to low risk was observed for AG genotype of rs4680 in the same models (OR = 0.6 [0.2-1.7] and 0.7 [0.3-1.7]), and for TC genotype of rs4633 in the codominant model (OR = 0.6 [0.2-1.7]). In the interaction analysis, a model of the SCN9A and COMT variants showed a CVC of 10/10; however, the TA was 0.4141. CONCLUSION COMT and SCN9A variants are not associated with CLBP in the analyzed Mexican-Mestizo population.
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Affiliation(s)
- Tania Inés Nava-Bringas
- Department of Orthopedic Rehabilitation, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Av. México-Xochimilco 289, Colonia Arenal de Guadalupe, Tlalpan, 14389, Mexico City, Mexico
| | - Carlos Manuel Juaristi Manrique
- Department of Genomic Medicine, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Av. México-Xochimilco 289, Colonia Arenal de Guadalupe, Tlalpan, 14389, Mexico City, Mexico
| | - Norma Celia González-Huerta
- Department of Genomic Medicine, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Av. México-Xochimilco 289, Colonia Arenal de Guadalupe, Tlalpan, 14389, Mexico City, Mexico
| | - Eugenio Morales-Hernández
- Radiology Service, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Av. México-Xochimilco 289, Colonia Arenal de Guadalupe, Tlalpan, 14389, Mexico City, Mexico
| | - Antonio Miranda-Duarte
- Department of Genomic Medicine, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Av. México-Xochimilco 289, Colonia Arenal de Guadalupe, Tlalpan, 14389, Mexico City, Mexico.
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Stoecklein VM, Grosu S, Nikolova T, Tonn JC, Zausinger S, Ricke J, Schlett CL, Maurer E, Walter SS, Peters A, Bamberg F, Rospleszcz S, Stoecklein S. Strong Association of Depression and Anxiety With the Presence of Back Pain While Impact of Spinal Imaging Findings is Limited: Analysis of an MRI Cohort Study. THE JOURNAL OF PAIN 2024; 25:497-507. [PMID: 37742905 DOI: 10.1016/j.jpain.2023.09.009] [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: 03/19/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
Development of back pain is multifactorial, and it is not well understood which factors are the main drivers of the disease. We therefore applied a machine-learning approach to an existing large cohort study data set and sought to identify and rank the most important contributors to the presence of back pain amongst the documented parameters of the cohort. Data from 399 participants in the KORA-MRI (Cooperative health research in the region Augsburg-magnetic resonance imaging) (Cooperative Health Research in the Region Augsburg) study was analyzed. The data set included MRI images of the whole body, including the spine, metabolic, sociodemographic, anthropometric, and cardiovascular data. The presence of back pain was one of the documented items in this data set. Applying a machine-learning approach to this preexisting data set, we sought to identify the variables that were most strongly associated with back pain. Mediation analysis was performed to evaluate the underlying mechanisms of the identified associations. We found that depression and anxiety were the 2 most selected predictors for back pain in our model. Additionally, body mass index, spinal canal width and disc generation, medium and heavy physical work as well as cardiovascular factors were among the top 10 most selected predictors. Using mediation analysis, we found that the effects of anxiety and depression on the presence of back pain were mainly direct effects that were not mediated by spinal imaging. In summary, we found that psychological factors were the most important predictors of back pain in our cohort. This supports the notion that back pain should be treated in a personalized multidimensional framework. PERSPECTIVE: This article presents a wholistic approach to the problem of back pain. We found that depression and anxiety were the top predictors of back pain in our cohort. This strengthens the case for a multidimensional treatment approach to back pain, possibly with a special emphasis on psychological factors.
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Affiliation(s)
- Veit M Stoecklein
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Sergio Grosu
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Trayana Nikolova
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Stefan Zausinger
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elke Maurer
- Department of Trauma and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Sven S Walter
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, LMU Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany; German Center for Diabetes Research (DZD), Partner Site Neuherberg, Neuherberg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, LMU Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sophia Stoecklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Magnusson K, Turkiewicz A, Rydén M, Englund M. Genetic Influence on Osteoarthritis Versus Other Rheumatic Diseases. Arthritis Rheumatol 2024; 76:206-215. [PMID: 37691153 DOI: 10.1002/art.42696] [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: 04/25/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE We aimed to compare the genetic contribution to osteoarthritis (OA) versus other rheumatic/musculoskeletal diseases (RMDs) in the same population and to explore the role for any shared genetics between OA and other RMDs. METHODS In 59,970 Swedish twins aged 35 years or older, we estimated the heritability (the variance explained by genetic factors) of OA in peripheral joints, back and neck pain, shoulder pain (adhesive capsulitis, impingement syndrome, etc), rheumatoid arthritis, spondyloarthritis (SpA) and psoriatic arthritis, myalgia, and osteoporosis diagnosed in specialist and inpatient care. We also studied how much covariance between OA and each of the RMDs could be explained by genetics by studying phenotypic correlations in bivariate classical twin models. RESULTS Any-site OA and hip OA (50% and 64%) were among the most heritable RMDs (as compared with 23% for fibromyalgia [lowest] and 63% for SpA [highest]). The highest phenotypic correlations were between OA (any joint site) and shoulder pain in the same individual (r = 0.33, 95% confidence interval 0.31-0.35), of which 70% (95% confidence interval 52-88) could be explained by shared genetics. The phenotypic correlation between OA and back/neck pain was r = 0.25, with 25% to 75% explained by genetics. Phenotypic correlations between OA and each of the other RMDs were lower (r ~ 0.1 to r ~ 0.2), with inconclusive sources of variation. CONCLUSION OA has relatively large heritability as compared with other RMDs. The coexistence of OA and shoulder pain, as well as back pain, was common and could often be explained by genetic factors. Findings imply similar etiologies of OA and several pain conditions.
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Affiliation(s)
- Karin Magnusson
- Lund University, Lund, Sweden and Norwegian Institute of Public Health, Oslo, Norway
| | - Aleksandra Turkiewicz
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Martin Rydén
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
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Wirth B, Schweinhardt P. Personalized assessment and management of non-specific low back pain. Eur J Pain 2024; 28:181-198. [PMID: 37874300 DOI: 10.1002/ejp.2190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/22/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Low back pain (LBP), and in particular non-specific low back pain (NSLBP), which accounts for approximately 90% of LBP, is the leading cause of years lived with disability worldwide. In clinical trials, LBP is often poorly categorized into 'specific' versus 'non-specific' and 'acute' versus 'chronic' pain. However, a better understanding of the underlying pain mechanisms might improve study results and reduce the number of NSLBP patients. DATABASES AND DATA TREATMENT Narrative review. RESULTS NSLBP is a multi-dimensional, biopsychosocial condition that requires all contributing dimensions to be assessed and prioritized. Thereby, the assessment of the contribution of nociceptive, neuropathic and nociplastic pain mechanisms forms the basis for personalized management. In addition, psychosocial (e.g. anxiety, catastrophizing) and contextual factors (e.g. work situation) as well as comorbidities need to be assessed and individually weighted. Personalized treatment of NSLBP further requires individually choosing treatment modalities, for example, exercising, patient education, cognitive-behavioural advice, pharmacotherapy, as well as tailoring treatment within these modalities, for example, the delivery of tailored psychological interventions or exercise programs. As the main pain mechanism and psychosocial factors may vary over time, re-assessment is necessary and treatment success should ideally be assessed quantitatively and qualitatively. CONCLUSIONS The identification of the main contributing pain mechanism and the integration of the patients' view on their condition, including beliefs, preferences, concerns and expectations, are key in the personalized clinical management of NSLBP. In research, particular importance should be placed on accurate characterization of patients and on including outcomes relevant to the individual patient. SIGNIFICANCE STATEMENT Here, a comprehensive review of the challenges associated with the diagnostic label 'non-specific low back pain' is given. It outlines what is lacking in current treatment guidelines and it is summarized what is currently known with respect to individual phenotyping. It becomes clear that more research on clinically meaningful subgroups is needed to best tailor treatment approaches.
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Affiliation(s)
- Brigitte Wirth
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Petra Schweinhardt
- Department of Chiropractic Medicine, Integrative Spinal Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Kang X, Qian M, Liu M, Xu H, Xu B. Predictive Factors Associated with Chronic Neck Pain in Patients with Cervical Degenerative Disease: A Retrospective Cohort Study. J Pain Res 2023; 16:4229-4239. [PMID: 38107369 PMCID: PMC10723189 DOI: 10.2147/jpr.s423144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To explore the predictive factors of neck pain (NP) in patients with cervical degenerative disease by retrospectively analyzing their occupational and demographic characteristics and to provide a valuable reference for preventing and treating chronic NP. Patients and Methods We retrospectively reviewed the occupational and demographic data of patients with cervical degenerative disease who had undergone anterior cervical surgery between June 2021 and December 2022 at our center. The patients were divided into NP and no-NP groups based on whether they had chronic NP before surgery. Relevant occupational and demographic data from all patients were statistically analyzed, and all variables were made categorical. Forward stepwise logistic regression models were constructed for preoperative chronic neck pain to explore the possible risk factors associated with chronic neck pain. Results The differences in smoking, being an office worker, BMI, and disease types between NP and no-NP groups were statistically significant. In contrast, there were no statistically significant in age, sex, academic level, duration, and degeneration grade between the two groups. Moreover, further logistic regression analysis indicated that smoking, being an office worker, having an abnormal BMI, and cervical spondylotic radiculopathy (CSR) were related to chronic neck pain. Conclusion The present study indicated that smoking, being an office worker, having an abnormal BMI, and CSR were predisposing risk factors for NP associated with cervical degenerative disease. Although intervertebral disc degeneration is the pathology basis of NP, the degeneration grade was not related to the occurrence of NP in our current study. Therefore, quitting smoking, avoiding sedentariness, and maintaining a normal BMI may prevent NP to some extent.
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Affiliation(s)
- Xinjian Kang
- Department of Orthopedics, Traditional Chinese Medicine Hospital of Qinhuangdao, Qinhuangdao, Hebei, People’s Republic of China
- Tianjin Medical University, Graduate School, Tianjin, People’s Republic of China
| | - Man Qian
- Department of Refractive Surgery, Qinhuangdao Aier Ophthalmic Hospital, Qinhuangdao, Hebei, People’s Republic of China
| | - Mingli Liu
- Tianjin Medical University, Graduate School, Tianjin, People’s Republic of China
| | - Haiwei Xu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, People’s Republic of China
| | - Baoshan Xu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, People’s Republic of China
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Calais-Ferreira L, Pozzobon D, Pinheiro MB, Blyth FM, Ordoñana JR, Duncan GE, Hopper JL, Ferreira PH, Ferreira ML. Sex differences in lifetime prevalence of low back pain: A multinational study of opposite-sex twin pairs. Eur J Pain 2023; 27:1150-1160. [PMID: 37357463 DOI: 10.1002/ejp.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/09/2023] [Accepted: 06/03/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Low back pain (LBP) is more likely to occur in people with a family history of this condition, highlighting the importance of accounting for familial factors when studying the individual risk of LBP. We conducted a study of opposite-sex twin pairs investigating sex differences in LBP while accounting for (genetic and shared environmental) familial factors. METHODS We applied a matched co-twin control design to study 795 adult opposite-sex pairs from Australia, Spain, and the United States (US). We used mixed-effects logistic regression to assess the within-pair association between female sex and lifetime prevalence of LBP in unadjusted and adjusted models for body-mass-index, and depression, as well as interactions between female sex and age ( RESULTS The mean age of the sample was 47.4 years (Standard Deviation = 16.5). The adjusted odds ratio (aOR) of the association between sex and LBP in the merged sample was 1.11 (95% Confidence Interval = 0.88-1.40), with 87.4% of the variance in the studied association explained by between-site heterogeneity (Q test; p = 0.001). Females had 2.37 (95% CI: 1.48-3.78) higher odds of LBP compared to their male co-twins in the Spanish sample (adjusted), but a sex association was not found in the Australian nor US samples. CONCLUSIONS We found no evidence of the association between sex and LBP in our merged sample. Between-population differences (i.e. cultural background or health system characteristics) are likely to be major factors leading to variation in the sex association with LBP when familial factors are accounted for. SIGNIFICANCE Our study of adult opposite-sex twin pairs found no evidence of an association between female sex and lifetime prevalence of low back pain after controlling for familial factors in the merged sample from Australia, Spain and USA, contrary to findings from previous studies of unrelated individuals. Our findings indicate potentially relevant between-country genetic, cultural and environmental differences which may need to be considered for optimal and individualized strategies for the prevention and management of low back pain across the lifespan.
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Affiliation(s)
- Lucas Calais-Ferreira
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Daniel Pozzobon
- Biomechanics Laboratory, Sports and Physical Education Center, Federal University of Santa Maria, Santa Maria, Brazil
| | - Marina B Pinheiro
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Juan R Ordoñana
- Department of Human Anatomy and Psychobiology, University of Murcia, Murcia, Spain
- Murcia Institute of Biomedical Research, IMIB-Arrixaca, Murcia, Spain
| | - Glen E Duncan
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University Health Sciences Spokane, Washington, USA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paulo H Ferreira
- Musculoskeletal Research Hub, Charles Perkins Centre, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Manuela L Ferreira
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney Musculoskeletal Health, The Kolling Institute, Sydney, New South Wales, Australia
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Green BN, Johnson CD, Crawford C, Tavares PA, Murnaghan K, Haldeman S, Hurwitz EL, Yang H, de Luca K. Association between spinal and non-spinal health conditions reported in epidemiological studies: a scoping review protocol. BMJ Open 2023; 13:e075382. [PMID: 37788930 PMCID: PMC11148655 DOI: 10.1136/bmjopen-2023-075382] [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: 05/05/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION The increasing prevalence of coexisting health conditions poses a challenge to healthcare providers and healthcare systems. Spinal pain (eg, neck and back pain) and spinal pathologies (eg, osteoporotic fractures and degenerative spinal disease) exist concurrently with other non-spinal health conditions (NSHC). However, the scope of what associations may exist among these co-occurring conditions is unclear. Therefore, this scoping review aims to map the epidemiological literature that reports associations between spine-related pain and pathologies (SPPs) and NSHCs. METHODS AND ANALYSIS This scoping review will follow the JBI protocol and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We will systematically search the literature using key words and MeSH terms for SPPs and NSHCs. Terminology/vocabulary for NSHCs will include those for communicable and non-communicable diseases as reported by WHO Global Burden of Disease reports. Five databases will be searched from inception: MEDLINE, EMBASE, APA PsycInfo, Scopus and Web of Science Core Collection. Papers published in English, in peer-reviewed journals, including measures of association between SPPs and NSHCs and using observational epidemiologic study designs will be included. Excluded will be studies of cadaveric, animal or health behaviours; studies with no measures of association and non-observational epidemiologic studies. Results will include the number of studies, the studies that have evaluated the measures of association and the frequency of the studied associations between SPPs and NSHCs. Results will be reported in tables and diagrams. Themes of comorbidities will be synthesised into a descriptive report. ETHICS AND DISSEMINATION This scoping review was deemed exempt from ethics review. This review will provide a comprehensive overview of the literature that reports associations between SPPs and NSHCs to inform future research initiatives and practices. Results will be disseminated through publication in peer-reviewed journals and research conferences. REGISTRATION DETAILS https://osf.io/w49u3.
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Affiliation(s)
- Bart N Green
- Employer Based Integrated Primary Care Health Centers, Qualcomm Health Center, Stanford Health Care, San Diego, California, USA
- National University of Health Sciences, Lombard, Illinois, USA
| | | | | | | | - Kent Murnaghan
- Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Scott Haldeman
- Department of Neurology, University of California Irvine, Orange, California, USA
- World Spine Care, Tustin, California, USA
| | - Eric L Hurwitz
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Honolulu, Hawaii, USA
| | - Haiou Yang
- University of California, Irvine, California, USA
| | - Katie de Luca
- CQUniversity Brisbane, Brisbane, Queensland, Australia
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11
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Knapik JJ, Farina EK, Steelman RA, Trone DW, Lieberman HR. The Medical Burden of Obesity and Overweight in the US Military: Association of BMI with Clinically Diagnosed Medical Conditions in United States Military Service Members. J Nutr 2023; 153:2951-2967. [PMID: 37619919 DOI: 10.1016/j.tjnut.2023.08.023] [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: 04/18/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND A high BMI is associated with various medical conditions, notably type 2 diabetes, cardiovascular disease, and mental health disorders. In the US military, BMI increased linearly between 1975 and 2015. OBJECTIVE This cross-sectional study investigated the associations between BMI and a comprehensive range of clinically diagnosed medical conditions (CDMCs) in US military service members (SMs). METHODS A stratified random sample of SMs (n=26,177) completed an online questionnaire reporting their height, weight, and demographic/lifestyle characteristics. Medical conditions for 6 mo before questionnaire completion were obtained from a comprehensive military electronic medical surveillance system and grouped into 39 CDMCs covering both broad (largely systemic) and specific medical conditions. BMI was calculated as weight/height2 (kg/m2). The prevalence of CDMCs was compared among normal weight (<25.0 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2) SMs. RESULTS After multivariable adjustment for demographic/lifestyle characteristics, higher BMI was associated with higher odds of a diagnosed medical condition in 30 of 39 CDMCs, with all 30 displaying dose-response relationships. The 5 major CDMCs with the largest odds ratios comparing obese to normal weight were endocrine/nutritional/metabolic diseases (OR=2.67, 95%CI=2.24-3.15), nervous system diseases (odds ratio [OR]=2.59, 95%CI=2.32-2.90), circulatory system diseases (OR=2.56, 95%CI=2.15-3.06), musculoskeletal system diseases (OR=1.92, 95%CI=1.76-2.09), and mental/behavioral disorders (OR=1.69, 95%CI=1.51-1.90). Compared with normal weight SMs, overweight or obese SMs had a higher number of CDMCs (1.8±1.9 vs. 2.0±2.0 and 2.5±2.3, mean ± standard deviation, respectively, P<0.01). CONCLUSIONS In a young, physically active population, higher BMI was associated with a host of medical conditions, even after adjustment for demographic/lifestyle characteristics. The US Department of Defense should improve nutrition education and modify other factors that contribute to overweight and obesity. This study demonstrates that the medical burden of obesity is substantial in overweight and obese SMs.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, MA, United States.
| | - Emily K Farina
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, MA, United States
| | - Ryan A Steelman
- Clinical Public Health and Epidemiology, Defense Centers for Public Health-Aberdeen, MD, United States
| | - Daniel W Trone
- Deployment Health, Naval Health Research Center, CA, United States
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, MA, United States
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12
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Tu J, Li W, Hansbro PM, Yan Q, Bai X, Donovan C, Kim RY, Galvao I, Das A, Yang C, Zou J, Diwan A. Smoking and tetramer tryptase accelerate intervertebral disc degeneration by inducing METTL14-mediated DIXDC1 m 6 modification. Mol Ther 2023; 31:2524-2542. [PMID: 37340635 PMCID: PMC10422004 DOI: 10.1016/j.ymthe.2023.06.010] [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: 11/29/2022] [Revised: 04/24/2023] [Accepted: 06/14/2023] [Indexed: 06/22/2023] Open
Abstract
Although cigarette smoking (CS) and low back pain (LBP) are common worldwide, their correlations and the mechanisms of action remain unclear. We have shown that excessive activation of mast cells (MCs) and their proteases play key roles in CS-associated diseases, like asthma, chronic obstructive pulmonary disease (COPD), blood coagulation, and lung cancer. Previous studies have also shown that MCs and their proteases induce degenerative musculoskeletal disease. By using a custom-designed smoke-exposure mouse system, we demonstrated that CS results in intervertebral disc (IVD) degeneration and release of MC-restricted tetramer tryptases (TTs) in the IVDs. TTs were found to regulate the expression of methyltransferase 14 (METTL14) at the epigenetic level by inducing N6-methyladenosine (m6A) deposition in the 3' untranslated region (UTR) of the transcript that encodes dishevelled-axin (DIX) domain-containing 1 (DIXDC1). That reaction increases the mRNA stability and expression of Dixdc1. DIXDC1 functionally interacts with disrupted in schizophrenia 1 (DISC1) to accelerate the degeneration and senescence of nucleus pulposus (NP) cells by activating a canonical Wnt pathway. Our study demonstrates the association between CS, MC-derived TTs, and LBP. These findings raise the possibility that METTL14-medicated DIXDC1 m6A modification could serve as a potential therapeutic target to block the development of degeneration of the NP in LBP patients.
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Affiliation(s)
- Ji Tu
- Spine Labs, St. George & Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Wentian Li
- Spine Labs, St. George & Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Philip M Hansbro
- Faculty of Science, School of Life Sciences, Centre for Inflammation, Centenary Institute, University of Technology Sydney, Sydney, NSW, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Qi Yan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xupeng Bai
- Center for Innovation and Translational Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory of Pancreatic Disease, First Affiliated Hospital, and Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Chantal Donovan
- Faculty of Science, School of Life Sciences, Centre for Inflammation, Centenary Institute, University of Technology Sydney, Sydney, NSW, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Richard Y Kim
- Faculty of Science, School of Life Sciences, Centre for Inflammation, Centenary Institute, University of Technology Sydney, Sydney, NSW, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Izabela Galvao
- Faculty of Science, School of Life Sciences, Centre for Inflammation, Centenary Institute, University of Technology Sydney, Sydney, NSW, Australia; Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Abhirup Das
- Spine Labs, St. George & Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cao Yang
- Department of Orthopedic Surgery, Wuhan Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China.
| | - Jun Zou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Ashish Diwan
- Spine Labs, St. George & Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Spine Service, Department of Orthopedic Surgery, St. George Hospital, Kogarah, NSW, Australia.
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13
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Suri P, Elgaeva EE, Williams FMK, Freidin MB, Zaytseva OO, Aulchenko YS, Tsepilov YA. Evidence of causal effects of blood pressure on back pain and back pain on type II diabetes provided by a bidirectional Mendelian randomization study. Spine J 2023; 23:1161-1171. [PMID: 37061135 DOI: 10.1016/j.spinee.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/01/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND CONTEXT Cardiovascular risk factors (hypertension, dyslipidemia, and type II diabetes) have been proposed as risk factors for back pain. However, few longitudinal studies have found significant associations between cardiovascular risk factors and back pain, and these may be explained by confounding or reverse causation. PURPOSE To examine potential causal effects of cardiovascular risk factors on back pain, and vice versa. STUDY DESIGN Bidirectional Mendelian randomization (MR) study. PATIENT SAMPLES Genome-wide association studies (GWAS) with sample sizes between 173,082 and 1,028,947 participants. OUTCOME MEASURES Outcomes included (1) back pain associated with health care use (BP-HC) in the forward MR; and (2) seven cardiovascular phenotypes in the reverse MR, including 2 measurements used for the evaluation of hypertension (diastolic blood pressure and systolic blood pressure), 4 phenotypes related to dyslipidemia (LDL cholesterol, HDL cholesterol, total cholesterol, and triglycerides), and type II diabetes. METHODS We used summary statistics from large, publicly available GWAS for BP-HC and the 7 cardiovascular phenotypes to obtain genetic instrumental variables. We examined MR evidence for causal associations using inverse-variance weighted (IVW) analysis, Causal Analysis Using Summary Effect (CAUSE), and sensitivity analyses. RESULTS In forward MR analyses of seven cardiovascular phenotypes, diastolic blood pressure was associated with BP-HC across all analyses (IVW estimate: OR = 1.10 per 10.5 mm Hg increase [1.04-1.17], p-value = .001), and significant associations of systolic blood pressure with BP-HC were also found (IVW estimate: OR = 1.09 per 19.3 mm Hg increase [1.04-1.15], p-value = .0006). In reverse MR analyses, only type II diabetes was associated with BP-HC across all analyses (IVW estimate: OR = 1.40 [1.13-1.73], p-value = .002). CONCLUSIONS These findings from analyses of large, population-based samples indicate that higher blood pressure increases the risk of BP-HC, and BP-HC itself increases the risk of type II diabetes.
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Affiliation(s)
- Pradeep Suri
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, 1660 S. Columbian Way, 98108, Seattle, USA; Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, 1660 S. Columbian Way, 98108, Seattle, USA; Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, 98104, Seattle, USA; Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, 325 Ninth Avenue, 98104, Seattle, USA.
| | - Elizaveta E Elgaeva
- Department of Natural Sciences, Novosibirsk State University, Pirogova Street 2, 630090,Novosibirsk, Russia; Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, 630090, Novosibirsk, Russia
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, Westminster Bridge Road, London, UK
| | - Maxim B Freidin
- Department of Biology, School of Biological and Behavioural Sciences, Queen Mary University of London, Fogg Buliding, Mile End Road, London, UK
| | - Olga O Zaytseva
- Genos Glycoscience Research Laboratory, Borongajska cesta 83H, 10000, Zagreb, Croatia
| | - Yurii S Aulchenko
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, 630090, Novosibirsk, Russia; PolyOmica, Het Vlaggeschip 61, 5237 PA, 's-Hertogenbosch, the Netherlands
| | - Yakov A Tsepilov
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, 630090, Novosibirsk, Russia; Kurchatov Genomics Center, Institute of Cytology & Genetics, 630090, Novosibirsk, Russia
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14
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Kärkkäinen S, Bergström J, Ropponen A, Wang M, Narusyte J, Svedberg P. Sickness absence transitions among Swedish twins with back, neck or shoulder pain and common mental disorders applying a multi-state approach. Sci Rep 2023; 13:10520. [PMID: 37386053 PMCID: PMC10310811 DOI: 10.1038/s41598-023-37572-5] [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: 03/30/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023] Open
Abstract
We aimed to investigate transitions to and from sickness absence, or disability pension among individuals with back, neck, or shoulder pain and/or with common mental disorders (CMDs), and the role of familial (genetics and shared environment) influences on the transitions. Swedish twins born 1935-1985 who responded to pain and CMDs survey items (N = 41,516) were followed on average 8.7 years for sickness absence states in national registers. Multi-state Cox regression models were applied for three exposure groups: pain, CMDs, and presence of both, compared to unexposed. Exposure discordant twin pairs, stratified by zygosity, were analysed to assess the role of familial factors. Hazard Ratios (HR) with 95% confidence intervals and transition intensities were calculated. HRs were similar for transitions between states among those with pain or CMDs. The highest HRs were for transitions from entry to sickness absence and sickness absence to disability pension among those with both pain and CMDs (HRs: 1.61 and 1.43, respectively). Higher HRs for dizygotic compared to monozygotic twins for the first transition to sickness absence and for altering back to not being sickness absent indicate familial confounding. Back, neck, or shoulder pain and/or CMDs indicate a higher risk to become sickness absent and for repeated sickness absence episodes over time compared to unaffected.
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Affiliation(s)
- Sanna Kärkkäinen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jakob Bergström
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Annina Ropponen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jurgita Narusyte
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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15
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Rohaj A, Bulaj G. Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health. Healthcare (Basel) 2023; 11:healthcare11101469. [PMID: 37239755 DOI: 10.3390/healthcare11101469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Digital therapeutics (DTx, software as a medical device) provide personalized treatments for chronic diseases and expand precision medicine beyond pharmacogenomics-based pharmacotherapies. In this perspective article, we describe how DTx for chronic low back pain (CLBP) can be integrated with pharmaceutical drugs (e.g., NSAIDs, opioids), physical therapy (PT), cognitive behavioral therapy (CBT), and patient empowerment. An example of an FDA-authorized DTx for CLBP is RelieVRx, a prescription virtual reality (VR) app that reduces pain severity as an adjunct treatment for moderate to severe low back pain. RelieVRx is an immersive VR system that delivers at-home pain management modalities, including relaxation, self-awareness, pain distraction, guided breathing, and patient education. The mechanism of action of DTx is aligned with recommendations from the American College of Physicians to use non-pharmacological modalities as the first-line therapy for CLBP. Herein, we discuss how DTx can provide multimodal therapy options integrating conventional treatments with exposome-responsive, just-in-time adaptive interventions (JITAI). Given the flexibility of software-based therapies to accommodate diverse digital content, we also suggest that music-induced analgesia can increase the clinical effectiveness of digital interventions for chronic pain. DTx offers opportunities to simultaneously address the chronic pain crisis and opioid epidemic while supporting patients and healthcare providers to improve therapy outcomes.
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Affiliation(s)
- Aarushi Rohaj
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
- Department of Medicinal Chemistry, L.S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, L.S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
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16
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Back Pain without Disease or Substantial Injury in Children and Adolescents: A Twin Family Study Investigating Genetic Influence and Associations. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020375. [PMID: 36832504 PMCID: PMC9955700 DOI: 10.3390/children10020375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/22/2022] [Accepted: 01/06/2023] [Indexed: 02/17/2023]
Abstract
This twin family study first aimed to investigate the evidence for genetic factors predicting the risk of lifetime prevalence of non-specific low back pain of at least three months duration (LBP (life)) and one-month current prevalence of thoracolumbar back pain (TLBP (current)) using a study of children, adolescents, and their first-degree relatives. Secondly, the study aimed to identify associations between pain in the back with pain in other regions and also with other conditions of interest. Randomly selected families (n = 2479) with child or adolescent twin pairs and their biological parents and first siblings were approached by Twins Research Australia. There were 651 complete twin pairs aged 6-20 years (response 26%). Casewise concordance, correlation, and odds ratios were compared for monozygous (MZ) and dizygous (DZ) pairs to enable inference about the potential existence of genetic vulnerability. Multivariable random effects logistic regression was used to estimate associations between LBP (life) or TLBP (current) as an outcome with the potentially relevant condition as predictors. The MZ pairs were more similar than the DZ pairs for each of the back pain conditions (all p values < 0.02). Both back pain conditions were associated with pain in multiple sites and with primary pain and other conditions using the combined twin and sibling sample (n = 1382). Data were consistent with the existence of genetic influences on the pain measures under the equal environments assumption of the classic twin model and associations with both categories of back pain were consistent with primary pain conditions and syndromes of childhood and adolescence which has research and clinical implications.
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17
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Roberts KE, Beckenkamp PR, Ferreira ML, Duncan GE, Calais-Ferreira L, Gatt JM, Ferreira P. Positive lifestyle behaviours and emotional health factors are associated with low back pain resilience. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3616-3626. [PMID: 36208321 DOI: 10.1007/s00586-022-07404-7] [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: 06/04/2022] [Revised: 08/18/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To evaluate the relationship between lifestyle behaviours, emotional health factors, and low back pain (LBP) resilience. METHODS This retrospective longitudinal study utilised 1,065 twins with a recent history of LBP from the Washington State Twin Registry. A lifestyle behaviour score was built using variables of body mass index, physical activity engagement, sleep quality, smoking status, and alcohol consumption. An emotional health score was built using variables of the absence of depressed mood, perceived stress, and active coping. The main outcome was LBP resilience, assessed as recovery ("bouncing back"), and sustainability (maintaining high levels of function despite LBP). RESULTS After adjusting for covariates, there was no relationship between the lifestyle behaviour score (OR 1.05, 95% CI 0.97-1.15, p = 0.218) and the emotional health score (OR 1.08, 95% CI 0.98-1.19, p = 0.142) with the likelihood of recovering from LBP. There was however, evidence of a positive association between the lifestyle behaviour score (β 0.20, 95% CI 0.04-0.36, p = 0.013), the emotional health score (β 0.22, 95% CI 0.00-0.43, p = 0.049), and greater levels of sustainability. These results were confirmed by a within-pair analysis (lifestyle behaviour score: β 1.79, 95% CI 0.05-3.53, p = 0.043) and (emotional health score: β 0.52, 95% CI 0.09-0.96, p = 0.021) adjusting for genetic and early shared environmental confounding. CONCLUSION Findings from this study suggest that people who adopt optimal lifestyle behaviours and positive emotional factors are more likely to be resilient and maintain high levels of function despite suffering from LBP.
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Affiliation(s)
- K E Roberts
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - P R Beckenkamp
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - M L Ferreira
- Sydney Musculoskeletal Health, Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - G E Duncan
- Washington State Twin Registry, Elson S Floyd College of Medicine, Washington State University Health Sciences Spokane, Spokane, USA
| | - L Calais-Ferreira
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - J M Gatt
- Neuroscience Research Australia and the School of Psychology, The University of New South Wales, Sydney, NSW, Australia
| | - P Ferreira
- School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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18
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Vraa M, Pascoe S, Maddox D, Rhon DI, Cleland JA, Young JL. Prevalence and extent of low back pain and low back-related disability in non-care-seeking working-age adults. Musculoskelet Sci Pract 2022; 60:102572. [PMID: 35512483 DOI: 10.1016/j.msksp.2022.102572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To explore the prevalence and extent of low back pain (LBP) and low back-related disability in working-age adults not seeking care. METHODS A convenience sample of 101 working-age adults not seeking care for LBP completed the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ) as measures of disability and completed questionnaires that collected information on various demographic and health-related variables. Those reporting current LBP also completed a Numeric Pain Rating Scale (NPRS). Prevalence was assessed based on a dichotomization of whether any disability or pain was reported and also as a continuous variable to assess the extent of pain and disability present for each participant. RESULTS Of the 101 participants, 72.3% reported some level of disability (ODI mean = 7.91%, RMDQ mean = 2.63) and 46.5% reported some level of pain (NRPS mean = 3.68). Previous care-seeking for LBP was associated with increased odds of reporting disability (ODI odds ratio [OR] 7.91, 95% confidence interval [CI], 2.43 to 31.18; RMDQ OR 2.69, 95% CI, 1.05 to 7.24), as was reporting any current LBP (ODI OR 9.45, 95% CI, 3.15 to 33.21; RMDQ OR 7.03, 95% CI, 2.82 to 18.89). No other demographic or health-related variables were associated with the presence or extent of pain or disability. CONCLUSION Many non-care-seeking individuals reported some level of LBP and/or disability, suggesting that some level of pain and disability may be considered normal, acceptable, or manageable. One-third of individuals with no pain reported some disability.
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Affiliation(s)
- Matthew Vraa
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Doctor of Physical Therapy Program, Northwest University, Kirkland, WA, USA; Residency in Orthopaedic Physical Therapy, Evidence in Motion, San Antonio, TX, USA.
| | - Stephanie Pascoe
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Residency in Orthopaedic Physical Therapy, Evidence in Motion, San Antonio, TX, USA; Department of Physical Therapy and Integrative Care, Wardenburg Student Health Center, Boulder, CO, USA
| | - Daniel Maddox
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Department of Physical Therapy, Ivester College of Health Sciences, Brenau University, Gainesville, GA, USA; Fellowship in Orthopaedic Manual Physical Therapy, Upstream Rehab Institute, Smyrna, GA, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA; Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Joshua A Cleland
- Doctor of Physical Therapy Program, School of Medicine, Tufts University, Boston, MA, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
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Steinmetz A. Back pain treatment: a new perspective. Ther Adv Musculoskelet Dis 2022; 14:1759720X221100293. [PMID: 35814351 PMCID: PMC9260567 DOI: 10.1177/1759720x221100293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
This article aims to provide new perspectives for the treatment of low back pain
(LBP). A narrative literature review highlights the treatment strategies
currently anchored in the guidelines as well as the extensive attempts to
identify subgroups within the non-specific low back pain (NSLBP) classification.
A variety of multimodal approaches exist for both diagnostic assessments and
therapy approaches. Nonetheless, there are often gaps in the classification
systems as well as in published treatment concepts with regard to the
implementation of musculoskeletal functional disorders. Indeed, a growing body
of evidence shows that more holistic and flexible approaches are needed to
individually diagnose and target the complexity of LBP. As an example, both a
diagnostic and a (independently developed) therapeutic LBP concept will be
presented and discussed. Ultimately, guidelines and subgroup classification
systems can only reflect the complexity of LBP, if they capture its entire
multidimensional and biopsychosocial character in both the diagnostic and
therapeutic processes. Furthermore, the expansion of the pain definition to
include the nociplastic pain mechanism, as an important driver of LBP, has the
potential to provide important impulses for further necessary research. In
conclusion, the implementation of a functional musculoskeletal approach along
with the emerging nociceptive pain concept in individually targeted holistic
approaches seems to be the successful way to deal with the complexity of
LBP.
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Affiliation(s)
- Anke Steinmetz
- University Medicine Greifswald, Physical and Rehabilitation Medicine, Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, 17475 Greifswald, Germany
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20
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Causal effects of psychosocial factors on chronic back pain: a bidirectional Mendelian randomisation study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1906-1915. [PMID: 35662366 PMCID: PMC9273132 DOI: 10.1007/s00586-022-07263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/16/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Risk factors for chronic back pain (CBP) may share underlying genetic factors, making them difficult to study using conventional methods. We conducted a bi-directional Mendelian randomisation (MR) study to examine the causal effects of risk factors (education, smoking, alcohol consumption, physical activity, sleep and depression) on CBP and the causal effect of CBP on the same risk factors. METHODS Genetic instruments for risk factors and CBP were obtained from the largest published genome-wide association studies (GWAS) of risk factor traits conducted in individuals of European ancestry. We used inverse weighted variance meta-analysis (IVW), Causal Analysis Using Summary Effect (CAUSE) and sensitivity analyses to examine evidence for causal associations. We interpreted exposure-outcome associations as being consistent with a causal relationship if results with IVW or CAUSE were statistically significant after accounting for multiple statistical testing (p < 0.003), and the direction and magnitude of effect estimates were concordant between IVW, CAUSE, and sensitivity analyses. RESULTS We found evidence for statistically significant causal associations between greater education (OR per 4.2 years of schooling = 0.54), ever smoking (OR = 1.27), greater alcohol consumption (OR = 1.29 per consumption category increase) and major depressive disorder (OR = 1.41) and risk of CBP. Conversely, we found evidence for significant causal associations between CBP and greater alcohol consumption (OR = 1.19) and between CBP and smoking (OR = 1.21). Other relationships did not meet our pre-defined criteria for causal association. CONCLUSION Fewer years of schooling, smoking, greater alcohol consumption, and major depressive disorder increase the risk of CBP. CBP increases the risk of greater alcohol consumption and smoking.
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Ho KKN, Simic M, Pinheiro MB, Miller CB, Ferreira ML, Grunstein RR, Hopper JL, Ordoñana JR, Ferreira PH. Efficacy of a digital cognitive behavioral therapy for insomnia in people with low back pain: a feasibility randomized co-twin and singleton-controlled trial. Pilot Feasibility Stud 2022; 8:125. [PMID: 35701842 PMCID: PMC9195289 DOI: 10.1186/s40814-022-01087-z] [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: 12/07/2020] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Digital cognitive behavioral therapy for insomnia (CBT-i) in people with low back pain (LBP) may be efficacious in improving both sleep and pain; and twin trial designs provide greater precision of treatment effects by accounting for genetic and early environmental factors. We aimed to determine the feasibility of a trial investigating the efficacy of a digital CBT-i program in people with comorbid symptoms of insomnia and LBP, in twins and people from the general community (singletons). Methods Thirty-two twins (16 pairs) and 66 singletons with comorbid symptoms of insomnia and LBP (> 6 weeks duration) were randomized to digital CBT-i (intervention) or educational program (control) for 6 weeks. The digital CBT-I, Sleepio (developed by Big Health Inc.), was an online interactive, automated, personalized course comprising of six sessions, once a week. The education program was six emails with general sleep information, once a week. Participants were blinded to their group allocation and offered the alternative intervention at the completion of the study. Feasibility outcomes included recruitment and follow-up rates, data collection and outcome measure completion, contamination (communication about trial interventions), acceptability (adherence), credibility, and participants’ experience of the intervention. Results Sixteen out of 722 contacted twin pairs were recruited (recruitment rate = 2.2%). Twins were recruited between September 2015 and August 2018 (35 months) and singletons between October 2017 and Aug 2018 (10 months). Follow-up rates for post-intervention and 3-month follow-up were 81% and 72% for twins and 82% and 78% for singletons respectively. Adherence rates (percentage of sessions completed out of six) for the digital CBT-i were 63% for twins and 55% for singletons. Contamination (speaking about the study to each other) was present in two twin pairs (13%). Written or verbal feedback (n = 21) regarding the digital CBT-i intervention from participants were positive (n = 11), neutral (n = 5), or negative (n = 6). Conclusions Online CBT-i was received favorably with people with comorbid symptoms of insomnia and LBP. While the online data collection was successful, strategies need to be implemented to improve adherence, follow-up, control group credibility (for digital CBT-i), and twin recruitment rates (for twin trials). Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12615000672550). Registered 29 June 2015 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01087-z.
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Affiliation(s)
- Kevin K N Ho
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Sydney, NSW, 2050, Australia.
| | - Milena Simic
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Sydney, NSW, 2050, Australia
| | - Marina B Pinheiro
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Sydney, NSW, 2050, Australia.,Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Christopher B Miller
- Big Health Inc., San Francisco, USA.,Big Health Inc., London, UK.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Juan R Ordoñana
- Murcia Twin Registry, Department of Human Anatomy and Psychobiology, University of Murcia, and IMIB-Arrixaca, Murcia, Spain
| | - Paulo H Ferreira
- Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Sydney, NSW, 2050, Australia
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22
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Ziegler DS, Westermann CE, Aalling AF, O'Neill SFD, Andersen MO. The association between sociodemographic characteristics and the event of undergoing first-time, simple lumbar discectomy: A case-control study. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 9:100106. [PMID: 35281995 PMCID: PMC8907305 DOI: 10.1016/j.xnsj.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
Educational level and pre-OP sick leave affect the probability of lumbar discectomy. Discectomy is more common with low socioeconomic status compared to high status. Sociodemographic factors should be noted for their importance in choice of treatment.
Background In disc herniation, nonsurgical treatments are recommended prior to elective discectomy but are often associated with consultation fees, whereas the discectomy itself may be without user payment. This may affect individual preferences in the choice of treatment. This retrospective case-control study examined the association between socioeconomic characteristics and the event of undergoing a first-time, single-level, simple lumbar discectomy. Methods The consecutively formed study population comprised patients undergoing elective lumbar discectomy at a Danish public hospital between 2010 and 2013. A national authority identified three gender- and age-matched controls per case for comparison. Measures investigated in this study were marital status, ethnicity, socioeconomic classification, educational level, the extent of sick leave 52 weeks prior to surgery, personal income, and equivalized disposable household income. All measures were provided by national registries. The associations were examined using uni- and multivariate logistic regression analysis. Results In a study population of 888 operated patients (age (SD) 46 (14); ODI (SD) 47 (18); leg pain intensity (VAS) (iqr) 74 (33), EQ-5D (iqr) 0.26 (0.62)) compared to 2664 controls, the probability of undergoing lumbar discectomy was significantly associated with lower vs. higher educational levels ((OR 1.98-2.53), and with periods of sick leave exceeding two weeks within one year prior to surgery (OR 9.47 (95% CI 7.68-11.68)). In the multivariate analysis, the event of undergoing discectomy was insignificantly associated with any other socioeconomic characteristics, whereas the personal income was of significant importance in the univariate analysis. Conclusion The event of undergoing free-of-fee elective first-time, single-level, simple lumbar discectomy is more common among individuals with low educational levels and unstable labor market attachment when examined in a case-control study. Being a multifactorial challenge, this calls upon the active engagement of several policy sectors.
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Affiliation(s)
- Dorthe Schoeler Ziegler
- Medical Spinal Research Unit, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Oestre Hougvej 55, 5500 Middelfart, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
- Corresponding author.
| | - Clara Emilie Westermann
- Faculty of Health Sciences, University of Southern, J.B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Ann Fredsted Aalling
- Faculty of Health Sciences, University of Southern, J.B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Soeren Francis Dyhrberg O'Neill
- Medical Spinal Research Unit, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Oestre Hougvej 55, 5500 Middelfart, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
| | - Mikkel Oesterheden Andersen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
- Spine Surgery and Research, Spine Center of Southern Denmark – part of Lillebaelt Hospital, Oestre Hougvej 55, 5500 Middelfart, Denmark
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Øverås CK, Nilsen TIL, Nicholl BI, Rughani G, Wood K, Søgaard K, Mair FS, Hartvigsen J. Multimorbidity and co-occurring musculoskeletal pain do not modify the effect of the SELFBACK app on low back pain-related disability. BMC Med 2022; 20:53. [PMID: 35130898 PMCID: PMC8822859 DOI: 10.1186/s12916-022-02237-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/04/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND SELFBACK, an artificial intelligence (AI)-based app delivering evidence-based tailored self-management support to people with low back pain (LBP), has been shown to reduce LBP-related disability when added to usual care. LBP commonly co-occurs with multimorbidity (≥ 2 long-term conditions) or pain at other musculoskeletal sites, so this study explores if these factors modify the effect of the SELFBACK app or influence outcome trajectories over time. METHODS Secondary analysis of a randomized controlled trial with 9-month follow-up. Primary outcome is as follows: LBP-related disability (Roland Morris Disability Questionnaire, RMDQ). Secondary outcomes are as follows: stress/depression/illness perception/self-efficacy/general health/quality of life/physical activity/global perceived effect. We used linear mixed models for continuous outcomes and logistic generalized estimating equation for binary outcomes. Analyses were stratified to assess effect modification, whereas control (n = 229) and intervention (n = 232) groups were pooled in analyses of outcome trajectories. RESULTS Baseline multimorbidity and co-occurring musculoskeletal pain sites did not modify the effect of the SELFBACK app. The effect was somewhat stronger in people with multimorbidity than among those with LBP only (difference in RMDQ due to interaction, - 0.9[95 % CI - 2.5 to 0.6]). Participants with a greater number of long-term conditions and more co-occurring musculoskeletal pain had higher levels of baseline disability (RMDQ 11.3 for ≥ 2 long-term conditions vs 9.5 for LBP only; 11.3 for ≥ 4 musculoskeletal pain sites vs 10.2 for ≤ 1 additional musculoskeletal pain site); along with higher baseline scores for stress/depression/illness perception and poorer pain self-efficacy/general health ratings. In the pooled sample, LBP-related disability improved slightly less over time for people with ≥ 2 long-term conditions additional to LBP compared to no multimorbidity and for those with ≥4 co-occurring musculoskeletal pain sites compared to ≤ 1 additional musculoskeletal pain site (difference in mean change at 9 months = 1.5 and 2.2, respectively). All groups reported little improvement in secondary outcomes over time. CONCLUSIONS Multimorbidity or co-occurring musculoskeletal pain does not modify the effect of the selfBACK app on LBP-related disability or other secondary outcomes. Although people with these health problems have worse scores both at baseline and 9 months, the AI-based selfBACK app appears to be helpful for those with multimorbidity or co-occurring musculoskeletal pain. TRIAL REGISTRATION NCT03798288 . Date of registration: 9 January 2019.
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Affiliation(s)
- Cecilie K Øverås
- Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Tom I L Nilsen
- Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Barbara I Nicholl
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Guy Rughani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Karen Wood
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark
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Zhang Z, Gewandter JS, Geha P. Brain Imaging Biomarkers for Chronic Pain. Front Neurol 2022; 12:734821. [PMID: 35046881 PMCID: PMC8763372 DOI: 10.3389/fneur.2021.734821] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022] Open
Abstract
The prevalence of chronic pain has reached epidemic levels. In addition to personal suffering chronic pain is associated with psychiatric and medical co-morbidities, notably substance misuse, and a huge a societal cost amounting to hundreds of billions of dollars annually in medical cost, lost wages, and productivity. Chronic pain does not have a cure or quantitative diagnostic or prognostic tools. In this manuscript we provide evidence that this situation is about to change. We first start by summarizing our current understanding of the role of the brain in the pathogenesis of chronic pain. We particularly focus on the concept of learning in the emergence of chronic pain, and the implication of the limbic brain circuitry and dopaminergic signaling, which underly emotional learning and decision making, in this process. Next, we summarize data from our labs and from other groups on the latest brain imaging findings in different chronic pain conditions focusing on results with significant potential for translation into clinical applications. The gaps in the study of chronic pain and brain imaging are highlighted in throughout the overview. Finally, we conclude by discussing the costs and benefits of using brain biomarkers of chronic pain and compare to other potential markers.
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Affiliation(s)
- Zhengwu Zhang
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jennifer S Gewandter
- Anesthesiology and Perioperative Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States
| | - Paul Geha
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.,Del Monte Neuroscience Institute, University of Rochester, Rochester, NY, United States
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25
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Shirado O, Arai Y, Iguchi T, Imagama S, Kawakami M, Nikaido T, Ogata T, Orita S, Sakai D, Sato K, Takahata M, Takeshita K, Tsuji T. Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition. J Orthop Sci 2022; 27:3-30. [PMID: 34836746 DOI: 10.1016/j.jos.2021.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine. METHODS The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, "body of evidence" and "benefit and harm balance" were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members. RESULTS Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature. CONCLUSIONS The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.
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Affiliation(s)
- Osamu Shirado
- Department of Orthopaedic and Spinal Surgery, Aizu Medical Center (AMEC) at Fukushima Medical University, Japan.
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Japan
| | - Tetsuhiro Iguchi
- Department of Orthopaedic Surgery, Saiseikai Hyogo Prefectural Hospital, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | | | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Japan
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
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Gao S, Zhou H, Luo S, Cai X, Ye F, He Q, Huang C, Zheng X, Li Y, Du Z, Wang Y, Qi Z, Wang Z. Investigating the Causal Relationship Between Physical Activity and Chronic Back Pain: A Bidirectional Two-Sample Mendelian Randomization Study. Front Genet 2021; 12:758639. [PMID: 34987546 PMCID: PMC8721110 DOI: 10.3389/fgene.2021.758639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/25/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Recent observational studies have reported a negative association between physical activity and chronic back pain (CBP), but the causality of the association remains unknown. We introduce bidirectional Mendelian randomization (MR) to assess potential causal inference between physical activity and CBP. Materials and Methods: This two-sample MR used independent genetic variants associated with physical activity and CBP as genetic instruments from large genome-wide association studies (GWASs). The effects of both directions (physical activity to CBP and CBP to physical activity) were examined. Inverse variance-weighted meta-analysis and alternate methods (weighted median and MR-Egger) were used to combine the MR estimates of the genetic instruments. Multiple sensitivity analyses were conducted to examine the robustness of the results. Results: The MR set parallel GWAS cohorts, among which, those involved in the primary analysis were comprised of 337,234 participants for physical activity and 158,025 participants (29,531 cases) for CBP. No evidence of a causal relationship was found in the direction of physical activity to CBP [odds ratio (OR), 0.98; 95% CI, 0.85-1.13; p = 0.81]. In contrast, a negative causal relationship in the direction of CBP to physical activity was detected (β = -0.07; 95% CI, -0.12 to -0.01; p = 0.02), implying a reduction in moderate-vigorous physical activity (approximately 146 MET-minutes/week) for participants with CBP relative to controls. Conclusion: The negative relationship between physical activity and CBP is probably derived from the reduced physical activity of patients experiencing CBP rather than the protective effect of physical activity on CBP.
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Affiliation(s)
- Shaowei Gao
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Huaqiang Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Siyu Luo
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Xiaoying Cai
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Fang Ye
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Qiulan He
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Chanyan Huang
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Xiaoyang Zheng
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Ying Li
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Zhanxin Du
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Yaqing Wang
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Zhihui Qi
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
| | - Zhongxing Wang
- Department of Anesthesia, Sun Yat-sen University First Affiliated Hospital, Guangzhou, China
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Epigenetic signature of chronic low back pain in human T cells. Pain Rep 2021; 6:e960. [PMID: 34746619 PMCID: PMC8568391 DOI: 10.1097/pr9.0000000000000960] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 12/19/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. This study reveals sex-specific DNA methylation signatures in human T cells that discriminate chronic low back pain participants from healthy controls. Objective: Determine if chronic low back pain (LBP) is associated with DNA methylation signatures in human T cells that will reveal novel mechanisms and potential therapeutic targets and explore the feasibility of epigenetic diagnostic markers for pain-related pathophysiology. Methods: Genome-wide DNA methylation analysis of 850,000 CpG sites in women and men with chronic LBP and pain-free controls was performed. T cells were isolated (discovery cohort, n = 32) and used to identify differentially methylated CpG sites, and gene ontologies and molecular pathways were identified. A polygenic DNA methylation score for LBP was generated in both women and men. Validation was performed in an independent cohort (validation cohort, n = 63) of chronic LBP and healthy controls. Results: Analysis with the discovery cohort revealed a total of 2,496 and 419 differentially methylated CpGs in women and men, respectively. In women, most of these sites were hypomethylated and enriched in genes with functions in the extracellular matrix, in the immune system (ie, cytokines), or in epigenetic processes. In men, a unique chronic LBP DNA methylation signature was identified characterized by significant enrichment for genes from the major histocompatibility complex. Sex-specific polygenic DNA methylation scores were generated to estimate the pain status of each individual and confirmed in the validation cohort using pyrosequencing. Conclusion: This study reveals sex-specific DNA methylation signatures in human T cells that discriminates chronic LBP participants from healthy controls.
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28
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Heritability of musculoskeletal pain and pain sensitivity phenotypes: two generations of the Raine Study. Pain 2021; 163:e580-e587. [PMID: 34686644 DOI: 10.1097/j.pain.0000000000002411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 07/12/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT There is a need to better understand biological factors that increase the risk of persistent musculoskeletal pain and heightened pain sensitivity. Knowing the heritability (how genes account for differences in people's traits) can enhance the understanding of genetic versus environmental influences of pain and pain sensitivity. However, there are gaps in current knowledge, including the need for intergenerational studies to broaden our understanding of the genetic basis of pain. Data from Gen1 and Gen2 of the Raine Study were used to investigate the heritability of musculoskeletal pain, and pressure and cold pain sensitivity. Participants included parents (Gen 1, n=1092) and their offspring (Gen 2, n=688) who underwent a battery of testing and questionnaires including pressure and cold pain threshold testing and assessments of physical activity, sleep, musculoskeletal pain, mental health and adiposity. Heritability estimates were derived using the Sequential Oliogenic Linkage Analysis Routines (SOLAR) software. Heritability estimates for musculoskeletal pain and pressure pain sensitivity were significant, accounting for between 0.190 and 0.289 of the variation in the phenotype. In contrast, heritability of cold pain sensitivity was not significant. This is the largest intergenerational study to date to comprehensively investigate the heritability of both musculoskeletal pain and pain sensitivity, using robust statistical analysis. This study provides support for the heritability of musculoskeletal pain and pain sensitivity to pressure, suggesting the need for further convergence of genetic and environmental factors in models for the development and/or maintenance of these pain disorders.
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Basiński K, Zdun-Ryżewska A, Majkowicz M. Psychosocial predictors of persistent low back pain in patients presenting to the emergency department. Am J Emerg Med 2021; 51:85-91. [PMID: 34695641 DOI: 10.1016/j.ajem.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Chronic low back pain is an important public health problem, generating high financial and social costs. While most clinical guidelines stress the importance of managing low back pain in primary care, in practice a disproportionate amount of patients with low back pain present to emergency departments. Patients presenting to emergency departments may form a specific group with different factors leading to chronicity. This prospective cohort study aimed to determine the sociodemographic and psychological predictors of persistent low back pain and the length of sick leave due to pain in patients with acute symptoms visiting an emergency department. METHODS Patients with a first episode of non-specific acute low back pain in at least three months were qualified for this study. The participants filled a battery of questionnaires, including measures of pain, pain-related disability, depression, anxiety and pain coping strategies. A structured telephone interview was performed after three months with questions regarding pain and the length of sick leave. RESULTS 110 patients participated in the study. 97 patients completed the follow-up, with 70.1% suffering from pain after three months. Lower self-rated health predicted pain after three months. Longer length of sick leave was predicted by lower self-rated health, distraction as a coping strategy and decreased behavioral activity. CONCLUSION Because of its simplicity, a measurement of self-rated health may be included in future clinical practice for assessing the risk of persistent pain.
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Affiliation(s)
- Krzysztof Basiński
- Department of Quality of Life Research, Faculty of Health Sciences, Medical University of Gdańsk, Poland.
| | - Agata Zdun-Ryżewska
- Department of Quality of Life Research, Faculty of Health Sciences, Medical University of Gdańsk, Poland
| | - Mikołaj Majkowicz
- Department of Health Science, Pomeranian University in Slupsk, Poland
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Cho G, Chang VW. Obesity and the Receipt of Prescription Pain Medications in the US. J Gen Intern Med 2021; 36:2631-2638. [PMID: 33555551 PMCID: PMC8390709 DOI: 10.1007/s11606-020-06581-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about disparities in pain treatment associated with weight status despite prior research on weight-based discrepancies in other realms of healthcare and stigma among clinicians. OBJECTIVE To investigate the association between weight status and the receipt of prescription analgesics in a nationally representative sample of adults with back pain, adjusting for the burden of pain. DESIGN Cross-sectional analyses using the Medical Expenditure Panel Survey (2010-2017). PARTICIPANTS Five thousand seven hundred ninety-one civilian adults age ≥ 18 with back pain. MAIN MEASURES We examine the odds of receiving prescription analgesics for back pain by weight status using logistic regression. We study the odds of receiving (1) any pain prescription, (2) three pain prescription categories (opioid only, non-opioid only, the combination of both), and (3) opioids conditional on having a pain prescription. KEY RESULTS The odds of receiving pain prescriptions increase monotonically across weight categories, when going from normal weight to obesity II/III, despite adjustments for the burden of pain. Relative to normal weight, higher odds of receiving any pain prescription is associated with obesity I (OR = 1.30 [95% CI = 1.04-1.63]) and obesity II/III (OR = 1.72 [95% CI = 1.36-2.18]). Obesity II/III is also associated with higher odds of receiving opioids only (OR = 1.53 [95% CI = 1.16-2.02]), non-opioids only (OR = 1.77 [95% CI = 1.21-2.60]), and a combination of both (OR = 2.48 [95% CI = 1.44-4.29]). Obesity I is associated with increased receipt of non-opioids only (OR = 1.55 [95% CI = 1.07-2.23]). Conditional on having a pain prescription, the odds of receiving opioids are comparable across weight categories. CONCLUSIONS This study suggests that, relative to those with normal weight, adults with obesity are more likely to receive prescription analgesics for back pain, despite adjustments of the burden of pain. Hence, the possibility of weight-based undertreatment is not supported. These findings are reassuring because individuals with obesity generally experience a higher prevalence of back pain. The possibility of over-treatment associated with obesity, however, may warrant further investigation.
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Affiliation(s)
- Gawon Cho
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Virginia W Chang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA. .,Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA.
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Abstract
Pain is an immense clinical and societal challenge, and the key to understanding and treating it is variability. Robust interindividual differences are consistently observed in pain sensitivity, susceptibility to developing painful disorders, and response to analgesic manipulations. This review examines the causes of this variability, including both organismic and environmental sources. Chronic pain development is a textbook example of a gene-environment interaction, requiring both chance initiating events (e.g., trauma, infection) and more immutable risk factors. The focus is on genetic factors, since twin studies have determined that a plurality of the variance likely derives from inherited genetic variants, but sex, age, ethnicity, personality variables, and environmental factors are also considered.
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Affiliation(s)
- Jeffrey S Mogil
- Departments of Psychology and Anesthesia, Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec H3A 1B1, Canada;
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Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet 2021; 398:78-92. [PMID: 34115979 DOI: 10.1016/s0140-6736(21)00733-9] [Citation(s) in RCA: 440] [Impact Index Per Article: 146.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 12/23/2020] [Accepted: 02/16/2021] [Indexed: 12/31/2022]
Abstract
Low back pain covers a spectrum of different types of pain (eg, nociceptive, neuropathic and nociplastic, or non-specific) that frequently overlap. The elements comprising the lumbar spine (eg, soft tissue, vertebrae, zygapophyseal and sacroiliac joints, intervertebral discs, and neurovascular structures) are prone to different stressors, and each of these, alone or in combination, can contribute to low back pain. Due to numerous factors related to low back pain, and the low specificity of imaging and diagnostic injections, diagnostic methods for this condition continue to be a subject of controversy. The biopsychosocial model posits low back pain to be a dynamic interaction between social, psychological, and biological factors that can both predispose to and result from injury, and should be considered when devising interdisciplinary treatment plans. Prevention of low back pain is recognised as a pivotal challenge in high-risk populations to help tackle high health-care costs related to therapy and rehabilitation. To a large extent, therapy depends on pain classification, and usually starts with self-care and pharmacotherapy in combination with non-pharmacological methods, such as physical therapies and psychological treatments in appropriate patients. For refractory low back pain, a wide range of non-surgical (eg, epidural steroid injections and spinal cord stimulation for neuropathic pain, and radiofrequency ablation and intra-articular steroid injections for mechanical pain) and surgical (eg, decompression for neuropathic pain, disc replacement, and fusion for mechanical causes) treatment options are available in carefully selected patients. Most treatment options address only single, solitary causes and given the complex nature of low back pain, a multimodal interdisciplinary approach is necessary. Although globally recognised as an important health and socioeconomic challenge with an expected increase in prevalence, low back pain continues to have tremendous potential for improvement in both diagnostic and therapeutic aspects. Future research on low back pain should focus on improving the accuracy and objectivity of diagnostic assessments, and devising treatment algorithms that consider unique biological, psychological, and social factors. High-quality comparative-effectiveness and randomised controlled trials with longer follow-up periods that aim to establish the efficacy and cost-effectiveness of low back pain management are warranted.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA.
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, USA; Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Johan W S Vlaeyen
- Research Group Health Psychology, University of Leuven, Leuven, Belgium; Research Group Experimental Health Psychology, Maastricht University, Maastricht, Netherlands; TRACE Center for Translational Health Research, KU, Leuven-Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Neurology, Physical Medicine and Rehabilitation, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Factors associated with care-seeking for low back pain when genetics and the familial environment are considered. Musculoskelet Sci Pract 2021; 53:102365. [PMID: 33765632 DOI: 10.1016/j.msksp.2021.102365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/12/2021] [Accepted: 03/05/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of disability worldwide. Care-seekers for LBP cause substantial economic burden to governments and the healthcare system. OBJECTIVE To investigate lifestyle and health-related factors associated with care-seeking (including pain medication use) in individuals experiencing LBP, after controlling for important genetic and early environmental confounders through the use of a within-twin pair case-control design. DESIGN A secondary analysis of observational longitudinal data, derived from the Australian Twin low BACK pain (AUTBACK) study, was performed on 66 twin pairs that presented with similar symptoms of LBP at baseline but became discordant for care-seeking behaviour over one month. METHODS Subjective and objective assessment of pain intensity, disability, depression, sleep quality, physical activity and body mass index were performed. Data was analysed using stepwise conditional logistic regression in two stages: within-pair case-control for monozygotic and dizygotic twins together; and within-pair case-control analysis of monozygotic twins only. Results were expressed as odds ratios (OR) and 95% confidence intervals (CI). RESULTS Higher LBP intensity (OR 2.9; 95% CI 1.3-6.8) and poorer sleep quality (OR 10.9; 95% CI 1.5-77.7) were the main factors that increased the likelihood of care-seeking for LBP. These associations remained significant and increased in magnitude after adjusting for genetic confounding. CONCLUSIONS Individuals with higher LBP intensity and worse sleep quality are more likely to seek care for LBP, and this relationship is likely to be causal after adjustment of familial and genetic confounding.
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Ortolá R, García-Esquinas E, Sotos-Prieto M, Struijk EA, Caballero FF, Lopez-Garcia E, Rodríguez-Artalejo F. Mediterranean diet and changes in frequency, severity and localization of pain in older adults: The Seniors-ENRICA cohorts. J Gerontol A Biol Sci Med Sci 2021; 77:122-130. [PMID: 33839765 DOI: 10.1093/gerona/glab109] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although some components of the Mediterranean diet have shown benefits in pain risk through its anti-inflammatory/antioxidant properties, no population-based studies have investigated the effect of adherence to this diet on changes in pain over time. METHODS We used data from 864 and 862 older adults recruited in the Seniors-ENRICA-1 and Seniors-ENRICA-2 cohorts and followed-up for 2.8 and 2.4 years, respectively. Adherence to the Mediterranean diet was assessed with the MEDAS score at baseline. Frequency, severity and locations of pain obtained at baseline and follow-up were used to compute a pain scale. Analyses were performed using multinomial logistic regression models, and adjusted for the main confounders. RESULTS Participants had a mean (SD) age of 71.5 (5.1) years, 36.8% were men and 78.3% had chronic conditions. In the pooled cohorts, compared with participants in the lowest quartile of the MEDAS score (lowest adherence to the Mediterranean diet), those in the highest quartile showed a higher frequency of pain improvement versus worsening (relative risk ratio [95% confidence interval]: 1.43 [1.03,1.99]). This association was also evidenced in two components of the pain scale: improvement in pain severity (1.43 [1.01,2.04]) and reduction in pain locations (1.54 [1.08,2.20]), but a tendency to pain frequency improvement (1.34 [0.92,1.93]) was also observed. The main contributors to these associations were high consumption of fruit and vegetables, and low consumption of sugar-sweetened beverages. CONCLUSIONS A higher adherence to the Mediterranean diet was related to a subsequent improvement in pain characteristics in older adults, suggesting that improving diet quality may help reduce the high health impact of pain.
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Affiliation(s)
- Rosario Ortolá
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Environmental Health and Nutrition, Harvard T.H. Chan School of Public Health. Boston, MA, USA
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Francisco Félix Caballero
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid and Idipaz, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,IMDEA Food Institute. CEI UAM+CSIC, Madrid, Spain
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Rossi MK, Pasanen K, Heinonen A, Äyrämö S, Leppänen M, Myklebust G, Vasankari T, Kannus P, Parkkari J. The standing knee lift test is not a useful screening tool for time loss from low back pain in youth basketball and floorball players. Phys Ther Sport 2021; 49:141-148. [PMID: 33689988 DOI: 10.1016/j.ptsp.2021.01.017] [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: 12/30/2019] [Revised: 10/22/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between pelvic kinematics during the standing knee lift (SKL) test and low back pain (LBP) in youth floorball and basketball players. DESIGN A prospective cohort study. SETTING Finnish elite youth floorball and basketball players. PARTICIPANTS Finnish elite youth female and male floorball and basketball players (n = 258, mean age 15.7 ± 1.8). MAIN OUTCOME MEASURES LBP resulting in time loss from practice and games was recorded over a 12-month period and verified by a study physician. Associations between LBP and sagittal plane pelvic tilt and frontal plane pelvic obliquity during the SKL test as measured at baseline were investigated. Individual training and game hours were recorded, and Cox's proportional hazard models with mixed effects were used for the analysis. RESULTS Cox analyses revealed that sagittal plane pelvic tilt and frontal plane pelvic obliquity were not associated with LBP in floorball and basketball players during the follow-up. The hazard ratios for pelvic tilt and pelvic obliquity ranged between 0.93 and 1.08 (95% CIs between 0.91 and 1.07 and 0.83 and 1.29), respectively. CONCLUSIONS Pelvic movement during the SKL test is not associated with future LBP in youth floorball and basketball players.
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Affiliation(s)
- Marleena Katariina Rossi
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Faculty of Sport and Health Sciences, P.O. Box 35 40014, University of Jyväskylä, Jyväskylä, Finland.
| | - Kati Pasanen
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada; Alberta Children's Hospital Research Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2n 4N1, Canada; McCaig Institute for Bone and Joint Health, 3280 Hospital Drvie NW, Calgary, AB, T2N 4Z6, Canada
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, P.O. Box 35 40014, University of Jyväskylä, Jyväskylä, Finland
| | - Sami Äyrämö
- Faculty of Information Technology, P.O. Box 35 40014, University of Jyväskylä, Jyväskylä, Finland
| | - Mari Leppänen
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Grethe Myklebust
- Oslo Sports Trauma Research Center, Department of Sports Sciences, Norwegian School of Sport Sciences, Sognsveien 220, 0806, Oslo, Norway
| | - Tommi Vasankari
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland
| | - Pekka Kannus
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Department of Orthopedics & Traumatology, Central Hospital, PO BOX 2000, FI-33521, Tampere, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, The UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500, Tampere, Finland; Tampere University Hospital, Central Hospital, PO BOX 2000, FI-33521, Tampere, Finland
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36
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Ho EKY, Ferreira M, Pinheiro M, Carvalho-E-Silva AP, Madrid-Valero JJ, Zadro J, Ordoñana J, Ferreira P. Factors associated with seeking medical care for low back pain in a twin adult sample. Eur J Pain 2021; 25:1091-1106. [PMID: 33469982 DOI: 10.1002/ejp.1731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/10/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Previous studies have only investigated how symptom presentation and socio-demographic factors influence care-seeking for low back pain (LBP). However, the influence of health and lifestyle factors remains unclear, and the potential confounding effects of aggregated familial factors (including genetics and the early shared environment) has not been considered extensively. METHODS A cross-sectional analysis was performed on 1605 twins enrolled in the Murcia Twin Registry (Spain). The outcome was seeking medical care for LBP and various self-reported demographic, health and lifestyle factors were considered predictors. All variables except sleep quality and diabetes were collected in 2013, which were cross-referenced from 2009 to 2010. A multivariate logistic regression model was performed on the total sample, followed by a co-twin case-control analysis. RESULTS The only significant factor found to increase the odds of seeking medical care for LBP without being affected by familial factors was poor sleep quality (total sample OR = 1.58, 95%CI 1.24-2.01; case-control OR = 1.75, 95%CI 1.14-2.69). The factors that were associated with reduced odds of seeking medical care for LBP and not confounded by familial factors were male sex (case-control OR = 0.55, 95%CI 0.33-0.93), alcohol intake (case-control OR = 0.90, 95%CI 0.82-0.99) and a history of diabetes (case-control OR = 0.50, 95%CI 0.25-0.97). No other factors significantly influenced medical care-seeking for LBP. CONCLUSIONS People reporting poor sleep quality are more likely to seek medical care for LBP in the long term, with this relationship being independent from aggregated familial factors. Conversely, males, people reporting higher alcohol intake, and people with a history of diabetes are less likely to seek medical care for LBP. SIGNIFICANCE This is the first study investigating the factors that influence seeking medical care for LBP, while adjusting for the influence of familial factors using a co-twin control design. Poor sleep quality is associated with seeking medical care for LBP in the long term and does not appear to be confounded by familial factors. Early screening for indicators of poor sleep quality and appropriate referral to interventions for improving sleep quality or reducing pain in sleep may improve LBP management.
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Affiliation(s)
- Emma Kwan-Yee Ho
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Manuela Ferreira
- Institute of Bone and Joint Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Marina Pinheiro
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ana Paula Carvalho-E-Silva
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Juan Jose Madrid-Valero
- Department of Human Anatomy and Psychobiology and Murcia Institute for Biomedical Research, (IMIB-Arrixaca-UMU), University of Murcia, Murica, Spain
| | - Joshua Zadro
- The University of Sydney, Institute for Musculoskeletal Health, Sydney School of Public Health, Sydney, NSW, Australia
| | - Juan Ordoñana
- Department of Human Anatomy and Psychobiology and Murcia Institute for Biomedical Research, (IMIB-Arrixaca-UMU), University of Murcia, Murica, Spain
| | - Paulo Ferreira
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Familial and Genetic Influences on the Common Pediatric Primary Pain Disorders: A Twin Family Study. CHILDREN-BASEL 2021; 8:children8020089. [PMID: 33525537 PMCID: PMC7911833 DOI: 10.3390/children8020089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
The primary pain disorders of childhood are highly prevalent but have infrequently been studied collectively. Genetic influences have been suggested to be causally implicated. Surveys were sent to 3909 Australian twin families, assessing the lifetime prevalence of growing pains, migraine, headache, recurrent abdominal pain, low back pain, and persistent pain (not otherwise specified) in pediatric twins and their immediate family members. Comparisons between monozygous (MZ) and dizygous (DZ) twin pair correlations, concordances and odds ratios were performed to assess the contribution of additive genetic influences. Random-effects logistic regression modelling was used to evaluate relationships between twin individuals and their co-twins, mothers, fathers and oldest siblings with the subject conditions. Twin analyses of responses from 1016 families revealed significant influence of additive genetic effects on the presence of growing pains, migraine, and recurrent abdominal pain. The analyses for headache, low back pain, and persistent pain overall did not conclusively demonstrate that genetic influences were implicated more than shared environmental factors. Regression analyses demonstrated varying levels of significance in relationships between family members and twin individuals for the tested conditions, with strongest support for genetic influences in growing pains and migraine. These data, together with previously published association analyses, suggest common causal influences including genes.
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38
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Xu YZ, Wang YT, Fan P, Yin XJ, Liu H, Jiang F. Complications and outcomes of open posterior lumbar spinal fusion surgery in obese patients: a meta-analysis. Br J Neurosurg 2020; 36:427-435. [PMID: 33377806 DOI: 10.1080/02688697.2020.1867059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether obesity affects the operation, complications and outcomes after open posterior lumbar spinal fusion surgery for the treatment of low back pain and leg pain. METHODS A meta-analysis of studies that compared the outcome of posterior lumbar spinal fusion in obese and non-obese patients. A total of 16 studies were included. RESULTS There was no difference in pain and functional outcomes. Posterior lumbar spinal fusion in obese patients resulted in a statistically significant increase in intra-operative blood loss (weighted mean difference 40.93, 95% confidence interval (CI) 15.97-65.90, n = 243, and p=.001), longer duration of surgery (weighted mean difference -1.64, 95% CI -4.12 to 0.84, n = 1460, and p=.19), more complications (odds ratio: 1.59, 95% CI 1.24-2.05, n = 339, and p<.001) and extend length of stay (weighted mean difference 0.31, 95% CI 0.07-0.55, n = 1408, and p=.01). CONCLUSIONS Obese patients experience more blood loss, longer duration of surgery, more complications and extended length of stay, but their back and leg pain and functional outcomes are similar to non-obese patients. Based on these results, obesity is not a contraindication to open posterior lumbar spinal fusion surgery.
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Affiliation(s)
- Yu-Zhu Xu
- Department of Orthopaedics, The Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Yun-Tao Wang
- Department of Orthopaedics, The Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Pan Fan
- Department of Orthopaedics, The Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Xiang-Jie Yin
- Department of Orthopaedics, The Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Hang Liu
- Department of Orthopaedics, The Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Feng Jiang
- Department of Orthopaedics, The Zhongda Hospital Affiliated to Southeast University, Nanjing, China
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Bayartai ME, Ferreira PH, Pappas E, Pinheiro MB, Dambadarjaa B, Khuyagbaatar E, Sullivan J. Genetic and environmental effects on lumbar posture, flexibility and motion control in healthy adults. Musculoskelet Sci Pract 2020; 50:102253. [PMID: 32920227 DOI: 10.1016/j.msksp.2020.102253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although alterations in posture, flexibility, and motion control of the lumbar spine are associated with low back pain, the underlying interplay between genetic and environmental influences on these traits remains unclear. The aim of this study is to investigate the extent to which genetics and the environment influence lumbar lordosis, flexibility, and motion control. DESIGN The present cross-sectional and observational study employed the classic twin design with structural equation models. METHODS An inertial measurement unit with a wireless movement analysis system, the ViMove (DorsaVi, Melbourne, Australia) was used to measure lumbar lordosis, flexibility, and motion control during range of motion and functional tests. Intraclass correlation was used to determine twin resemblance for the traits. Heritability (genetic influence on trait variation) of lumbar lordosis, flexibility and motion control was estimated from 52 healthy twins, 34 monozygotic and 18 dizygotic using age and sex adjusted univariate genetic models. RESULTS A strong heritability estimate was found in lumbar lordosis (77%, 95% confidence interval [CI]: 38%-91%) in standing, followed by lumbar flexibility (67%, 95% CI: 32%-85%) in the sagittal plane. No significant intraclass correlations were found in monozygotic twin pairs for lumbar motion control or in dizygotic twin pairs during the hurdle step and in-line lunge test. CONCLUSION Genetic factors appear to have a substantial influence on lumbar lordosis and lumbar sagittal flexibility. Lumbar motion control may be more influenced by environmental factors.
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Affiliation(s)
- Munkh-Erdene Bayartai
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Physical Therapy, School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
| | - Paulo H Ferreira
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Evangelos Pappas
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Marina B Pinheiro
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Batlkham Dambadarjaa
- Department of Physical Therapy, School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Enkhchimeg Khuyagbaatar
- Department of Physical Therapy, School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Circulating Levels of Visceral Adipose Tissue-Derived Serine Protease Inhibitor (Vaspin) Appear as a Marker of Musculoskeletal Pain Disability. Diagnostics (Basel) 2020; 10:diagnostics10100797. [PMID: 33049941 PMCID: PMC7599595 DOI: 10.3390/diagnostics10100797] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022] Open
Abstract
Musculoskeletal pain (MSP), specifically low back pain (LBP), is often associated with several adipose tissue-derived cytokines (adipokines) and body composition, but their correlations with the LBP-related disability/severity phenotypes remain poorly understood. In this cross-sectional study, two self-reported validated questionnaires were used to collect back pain and disability data in an ethnically homogeneous family-based population sample (N = 1078). Plasma levels of relatively new adipokines, vaspin and adipsin, were detected by ELISA. Body composition parameters, including fat, skeletal muscle mass, extracellular water (ECW), and others were assessed through bioelectrical impedance analysis (BIA) technology. Statistical analysis was conducted, accounting for the familial composition of the sample. The multiple regression analyses with four LBP-related phenotypes as dependent variables consistently showed, for the first time, the significant associations with vaspin levels, regardless of other covariates. The odds ratios (OR)/SD ranged between 1.24 (95%CI = 1.03-1.50) and 1.33 (95%CI = 1.07-1.64), depending on the LBP phenotype. Among the tested body composition covariates, only ECW levels displayed consistent and highly significant associations with all tested LBP phenotypes (OR from 1.43, 95%CI = 1.14-1.79 to 1.68, 95%CI = 1.26-2.24). The results clearly suggest that circulating concentrations of vaspin and ECW levels could serve as biomarkers of MSP/LBP severity and complications.
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Schembri E, Massalha V, Spiteri K, Camilleri L, Lungaro-Mifsud S. Nicotine dependence and the International Association for the Study of Pain neuropathic pain grade in patients with chronic low back pain and radicular pain: is there an association? Korean J Pain 2020; 33:359-377. [PMID: 32989201 PMCID: PMC7532299 DOI: 10.3344/kjp.2020.33.4.359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background This study investigated whether current smoking and a higher nicotine dependency were associated with chronic low back pain (LBP), lumbar related leg pain (sciatica) and/or radicular neuropathic pain. Methods A cross-sectional study was conducted on 150 patients (mean age, 60.1 ± 13.1 yr). Demographic data, the International Association for the Study of Pain (IASP) neuropathic pain grade, STarT Back tool, and the Fagerström test were completed. A control group (n = 50) was recruited. Results There was a significant difference between current smokers and non-smokers in the chronic LBP group in the mean pain score (P = 0.025), total STarT Back score (P = 0.015), worst pain location (P = 0.020), most distal pain radiation (P = 0.042), and in the IASP neuropathic pain grade (P = 0.026). There was a significant difference in the mean Fagerström score between the four IASP neuropathic pain grades (P = 0.005). Current smoking yielded an odds ratio (OR) of 3.071 (P = 0.011) for developing chronic LBP and sciatica, and an OR of 4.028 (P = 0.002) for obtaining an IASP “definite/probable” neuropathic pain grade, for both cohorts. The likelihood for chronic LBP and sciatica increased by 40.9% (P = 0.007), while the likelihood for an IASP neuropathic grade of “definite/probable” increased by 50.8% (P = 0.002), for both cohorts, for every one unit increase in the Fagerström score. Conclusions A current smoking status and higher nicotine dependence increase the odds for chronic LBP, sciatica and radicular neuropathic pain.
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Affiliation(s)
- Emanuel Schembri
- Physiotherapy Outpatients, Karin Grech Hospital, Pieta, Malta.,Master of Science (MSc) Candidate, MSc Clinical Management of Pain (Headache), University of Edinburgh, Edinburgh, UK
| | - Victoria Massalha
- Physiotherapy Services, Ministry for Health, Valletta, Malta.,Department of Physiotherapy, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Karl Spiteri
- Department of Physiotherapy, St Vincent de Paul Long Term Care Facility, Luqa, Malta
| | - Liberato Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - Stephen Lungaro-Mifsud
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, Msida, Malta
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Schwertner DS, Oliveira RANS, Koerich MHAL, Motta AF, Pimenta AL, Gioda FR. Prevalence of low back pain in young Brazilians and associated factors: Sex, physical activity, sedentary behavior, sleep and body mass index. J Back Musculoskelet Rehabil 2020; 33:233-244. [PMID: 31356188 DOI: 10.3233/bmr-170821] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Low back pain (LBP) has become increasingly common, but the prevalence of this complaint and associated factors in young people remains controversial. OBJECTIVE This study aimed to identify the prevalence of LBP and to explore the existence of associated factors (sex, physical activity, sedentary lifestyle, sleep, body mass index and waist circumference). METHODS This study considered all complaints of the lumbar region (acute or chronic) as LBP, which can irradiate to the backside and legs, lasting a minimum of 24 hours. Youngsters aged 15 to 18 years from a school in the south of Brazil were evaluated. Descriptive statistics was used, in particular Chi-square, Mann-Whitney U tests and binary logistic regression. A significance level of p< 0.05 was adopted. RESULTS A total of 330 youngsters answered a questionnaire and had their anthropometric measurements measured (response rate 84%). The prevalence of LBP in the present was 30%, quarterly 63% and throughout life 77%. There was a significant association between LBP and sex: girls have an increased risk of LBP in the last three-month period (PR = 1.3, 95% CI 1.06-1.56) and throughout life (PR = 1.2, 95% CI 1.04-1.43). The practice of physical activities was also associated with LBP, but as a protection factor in the present and in the last three-month period (PR = 0.7, 95% CI 0.47-0.90). Physical education at school has demonstrated a protective factor regarding LBP throughout life (PR = 0.9, 95% CI 0.77-0.97). Most of the students did not comply with recommendations related to sleep and time spent doing activities in front of a screen, and no association of these factors with LBP was detected. This exposure (physical activity, sleep time, sedentarism) did not present significant association with LBP when adjusted by the confusion factors (sex, age, BMI). CONCLUSIONS Youngsters reported a high prevalence of LBP. Girls were at greater risk of LBP than boys. It is recommended that prevention strategies focus on the practices of physical activities and scholar physical education. No association of LBP with sedentary lifestyle (TV and computer use time, sleep time), anthropometric measures and sleeping duration was observed.
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Affiliation(s)
- Debora Soccal Schwertner
- Universidade do Estado de Santa Catarina - UDESC, Santa Catarina State University, Florianópolis, Brazil.,Laboratory of Motor Behaviour, Postgraduate Program of Human Kinetics Faculty, University of Lisbon, UL, Lisbon, Portugal
| | - Raul A N S Oliveira
- Laboratory of Motor Behaviour, Postgraduate Program of Human Kinetics Faculty, University of Lisbon, UL, Lisbon, Portugal
| | - Micheline H A L Koerich
- Universidade do Estado de Santa Catarina - UDESC, Santa Catarina State University, Florianópolis, Brazil
| | - Andréa Fontoura Motta
- Universidade do Estado de Santa Catarina - UDESC, Santa Catarina State University, Florianópolis, Brazil
| | | | - Fabiane Rosa Gioda
- Universidade Regional de Blumenau - FURB, Regional University of Blumenau, Blumenau, Brazil
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Suntsov V, Jovanovic F, Knezevic E, Candido KD, Knezevic NN. Can Implementation of Genetics and Pharmacogenomics Improve Treatment of Chronic Low Back Pain? Pharmaceutics 2020; 12:pharmaceutics12090894. [PMID: 32967120 PMCID: PMC7558486 DOI: 10.3390/pharmaceutics12090894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/17/2022] Open
Abstract
Etiology of back pain is multifactorial and not completely understood, and for the majority of people who suffer from chronic low back pain (cLBP), the precise cause cannot be determined. We know that back pain is somewhat heritable, chronic pain more so than acute. The aim of this review is to compile the genes identified by numerous genetic association studies of chronic pain conditions, focusing on cLBP specifically. Higher-order neurologic processes involved in pain maintenance and generation may explain genetic contributions and functional predisposition to formation of cLBP that does not involve spine pathology. Several genes have been identified in genetic association studies of cLBP and roughly, these genes could be grouped into several categories, coding for: receptors, enzymes, cytokines and related molecules, and transcription factors. Treatment of cLBP should be multimodal. In this review, we discuss how an individual's genotype could affect their response to therapy, as well as how genetic polymorphisms in CYP450 and other enzymes are crucial for affecting the metabolic profile of drugs used for the treatment of cLBP. Implementation of gene-focused pharmacotherapy has the potential to deliver select, more efficacious drugs and avoid unnecessary, polypharmacy-related adverse events in many painful conditions, including cLBP.
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Affiliation(s)
- Vladislav Suntsov
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (V.S.); (F.J.); (E.K.); (K.D.C.)
| | - Filip Jovanovic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (V.S.); (F.J.); (E.K.); (K.D.C.)
| | - Emilija Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (V.S.); (F.J.); (E.K.); (K.D.C.)
| | - Kenneth D. Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (V.S.); (F.J.); (E.K.); (K.D.C.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (V.S.); (F.J.); (E.K.); (K.D.C.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
- Correspondence: ; Tel.: +1-773-296-5619; Fax: +1-773-296-5362
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Tani N, Ohta M, Higuchi Y, Akatsu J, Kumashiro M. Lifestyle and subjective musculoskeletal symptoms in young male Japanese workers: A 16-year retrospective cohort study. Prev Med Rep 2020; 20:101171. [PMID: 32904206 PMCID: PMC7452148 DOI: 10.1016/j.pmedr.2020.101171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/14/2020] [Accepted: 07/30/2020] [Indexed: 12/02/2022] Open
Abstract
The SN/S and LBP risk was higher in the PL than in the GL group. Four positive predictors (life satisfaction, hours of sleep, exercise habits, physical fitness) are important factors. Health staff should advise on workers’ individual lifestyle.
This longitudinal study was conducted from 2002 to 2018 and aimed to investigate predictive lifestyle factors for the occurrence of subjective musculoskeletal symptoms. The participants came from several employers in Japan. Setting 2002 as the baseline, we performed logistic regression analyses using lifestyle questionnaire items as explanatory variables and Stiff neck/shoulders (SN/S) and Lower back pain (LBP) as objective variables (n = 16,748). Workers who responded positively to good lifestyle items with an odds ratio < 1.0 and those who did not were classified in the Good (GL) and Poor lifestyle groups (PL), respectively. The survival period between the groups was compared using the log-rank test and Cox hazard regression analysis with propensity score matching (n = 3,593). Based on the Cox hazard regression analysis results, the risk of SN/S was about 2.54 (95% confidence interval [CI]: 1.80–3.59) times higher for PL than for GL (p < 0.001). Similarly, after propensity score matching, the risk was about 2.33 (95% CI: 1.07–5.10) times higher for PL than for GL (p < 0.05). Further, LBP risk was about 2.45 (95% CI: 1.67–3.58) times higher for PL than for GL (p < 0.001). Similarly, after propensity score matching, the risk was about 3.50 (95% CI: 1.60–7.68) times higher for PL than for GL (p < 0.01). This study highlighted that workers with four good lifestyle factors (life satisfaction, hours of sleep, exercise habits, and physical fitness) presented reduced risk of subjective musculoskeletal symptom occurrence. To prevent musculoskeletal symptoms, physicians and occupational health staff should advise on workers’ individual lifestyle.
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Affiliation(s)
- Naomichi Tani
- OH Solution Group, The Association for Preventive Medicine of Japan, Fukuoka, Japan
| | | | | | - Junichi Akatsu
- Wellbeing Mori Clinic, The Association for Preventive Medicine of Japan, Tokyo, Japan.,University of Occupational and Environmental Health, Japan
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Gedin F, Alexanderson K, Zethraeus N, Karampampa K. Productivity losses among people with back pain and among population-based references: a register-based study in Sweden. BMJ Open 2020; 10:e036638. [PMID: 32792439 PMCID: PMC7430424 DOI: 10.1136/bmjopen-2019-036638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Back pain is the leading cause for years lived with disability globally and among the main reasons for sickness absence (SA) and disability pension (DP). The objective of this study was to explore the occurrence of SA and DP and to estimate productivity losses among individuals with back pain compared with among matched population-based references. DESIGN Explorative prospective cohort study using register microdata. PARTICIPANTS AND SETTING A total of 23 176 people, aged 19-60 years, with a first visit to inpatient or specialised outpatient healthcare for back pain (International Statistical Classification of Diseases and Related Health Problems code M54) in 2010 in Sweden and a matched population-based reference group (n=115 880). OUTCOMES Long-term SA (in SA spells >14 days) and DP and productivity losses, measured in € (2018 prices) by multiplying the SA and DP net days by the societal cost of each such day. RESULTS In the back-pain group, 42% had SA or DP days; in the reference group, the corresponding proportion was 15%. Productivity loss per patient with back pain was €8928 during the 12-month follow-up period; in the reference group, it was €3499 (p<0.0001). CONCLUSIONS SA and DP, leading to excess productivity losses among people with back pain, reflect the challenges these patients are facing to maintain their work capacity. Interventions to promote that individuals with back pain remain in paid work should be a priority in order to address the high costs.
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Affiliation(s)
- Filip Gedin
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Korinna Karampampa
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Carvalho-E-Silva AP, Pinheiro MB, Ferreira ML, Hübscher M, Calais-Ferreira L, Ferreira PH. Cohort profile: the AUstralian Twin BACK pain and physical activity study (AUTBACK study). BMJ Open 2020; 10:e036301. [PMID: 32723740 PMCID: PMC7389487 DOI: 10.1136/bmjopen-2019-036301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/17/2020] [Accepted: 05/28/2020] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Despite the growing evidence that physical activity and familial factors play a role in low back pain (LBP), there is a lack of robust longitudinal studies that (1) investigate the types and dosages of physical activity that are protective or harmful for LBP, (2) employ objective measures of physical activity and (3) conduct appropriate adjustment for confounders. The AUstralian Twin BACK (AUTBACK) study was established to elucidate the longitudinal LBP-physical activity relationship with the benefits of controlling for familial (both genetic/nongenetic) factors that may influence physical activity engagement and LBP. PARTICIPANTS Participants are twins registered at Twins Research Australia (TRA), older than 18 years, with access to internet. We collected data on LBP status (weekly) and physical activity levels (monthly) for 12 months as well as a wide range of health, lifestyle and physical activity (objective, self-reported, including different types and dosages) data. FINDINGS TO DATE We included 401 twins, 157 being complete twin pairs (n=314). Lifetime prevalence of LBP was 85%. Participants spent 61% of their week in sedentary time and only 4% in moderate/vigorous intensity physical activity (accelerometer). So far, 168 participants (40% of the sample) have completed the 12-month follow-up. A total of 7150 weekly (LBP status) and 1763 monthly questionnaires (physical activity status) have been answered (92% response rate). FUTURE PLANS The 12-month follow-up will be completed by June 2020. This cohort represents a novel and comprehensive resource for researchers in the field, and includes high-quality, and frequent data on LBP and physical activity. It allows the investigation of genetic and shared environmental factors on the LBP-physical activity relationship. The AUTBACK group has planned a number of projects, with the main one being the investigation of the influence of physical activity on recurrence of LBP. Data linkage opportunities are available, including with other studies conducted by TRA.
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Affiliation(s)
- Ana Paula Carvalho-E-Silva
- Musculoskeletal Health Research Group, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Marina B Pinheiro
- Musculoskeletal Health Research Group, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Markus Hübscher
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Lucas Calais-Ferreira
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paulo H Ferreira
- Musculoskeletal Health Research Group, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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Insight into the genetic architecture of back pain and its risk factors from a study of 509,000 individuals. Pain 2020; 160:1361-1373. [PMID: 30747904 DOI: 10.1097/j.pain.0000000000001514] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Back pain (BP) is a common condition of major social importance and poorly understood pathogenesis. Combining data from the UK Biobank and CHARGE consortium cohorts allowed us to perform a very large genome-wide association study (total N = 509,070) and examine the genetic correlation and pleiotropy between BP and its clinical and psychosocial risk factors. We identified and replicated 3 BP-associated loci, including one novel region implicating SPOCK2/CHST3 genes. We provide evidence for pleiotropic effects of genetic factors underlying BP, height, and intervertebral disk problems. We also identified independent genetic correlations between BP and depression symptoms, neuroticism, sleep disturbance, overweight, and smoking. A significant enrichment for genes involved in the central nervous system and skeletal tissue development was observed. The study of pleiotropy and genetic correlations, supported by the pathway analysis, suggests at least 2 strong molecular axes of BP genesis, one related to structural/anatomical factors such as intervertebral disk problems and anthropometrics, and another related to the psychological component of pain perception and pain processing. These findings corroborate with the current biopsychosocial model as a paradigm for BP. Overall, the results demonstrate BP to have an extremely complex genetic architecture that overlaps with the genetic predisposition to its biopsychosocial risk factors. The work sheds light on pathways of relevance in the prevention and management of low BP.
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Zadro JR, Shirley D, Nilsen TIL, Mork PJ, Ferreira PH. Family History Influences the Effectiveness of Home Exercise in Older People With Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 101:1322-1331. [PMID: 32376326 DOI: 10.1016/j.apmr.2020.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/24/2019] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate whether a family history of low back pain (LBP) influences patient outcomes and treatment effects following home exercises in older people with chronic LBP. DESIGN Secondary analysis of a randomized controlled trial. SETTING Local community. PARTICIPANTS People older than 55 years with chronic LBP (N=60). INTERVENTIONS Participants in the intervention group completed video game exercises for 60 minutes 3 times per week for 8 weeks. Participants in the control group were instructed to maintain their usual levels of activity and care seeking behaviors. MAIN OUTCOMES MEASURES Participants indicated whether any of their immediate family members had a history of "any" LBP or "activity-limiting" LBP at baseline. We collected self-reported measures of pain, function, pain self-efficacy, care seeking, physical activity, disability, fear of movement and/or reinjury, and falls efficacy at baseline, 8 weeks, 3 months, and 6 months. We performed regression analyses to determine whether a family history of LBP predicted patient outcomes and moderated the effects of home exercise. RESULTS Participants with a family history of any LBP were less likely to be highly active than those without a family history (odds ratio, 0.08; 95% CI, 0.01-0.42; P=.003). Home-based video game exercises led to improvements in function in those without a family history of activity-limiting LBP (β=1.78; 95% CI, 0.56-3.00; P=.006) but not in those with a family history (β=-0.17; 95% CI, -2.56 to 2.21; P=.880) (interaction P=.049). A family history of LBP did not influence the remaining patient outcomes or treatment effects. CONCLUSIONS A family history of LBP appears to negatively influence physical activity levels in older people with chronic LBP. Further, home-based video game exercises appear to be beneficial for older people with chronic LBP that do not have a family history of LBP.
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Affiliation(s)
- Joshua R Zadro
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
| | - Debra Shirley
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, NSW, Australia
| | - Tom I L Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Paul J Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Paulo H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, NSW, Australia
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No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. J Biomech 2020; 102:109312. [DOI: 10.1016/j.jbiomech.2019.08.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/10/2019] [Accepted: 08/09/2019] [Indexed: 12/26/2022]
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Lunde LK, Koch M, Merkus SL, Knardahl S, Wærsted M, Veiersted KB. Associations of objectively measured forward bending at work with low-back pain intensity: a 2-year follow-up of construction and healthcare workers. Occup Environ Med 2020; 76:660-667. [PMID: 31413188 PMCID: PMC6824615 DOI: 10.1136/oemed-2019-105861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/26/2019] [Accepted: 07/06/2019] [Indexed: 12/05/2022]
Abstract
Objectives This study aimed to determine possible associations between objectively measured forward bending at work (FBW) and low-back pain intensity (LBPi) among Norwegian construction and healthcare workers. Methods One-hundred and twenty-five workers wore two accelerometers for 3–4 consecutive days, during work and leisure to establish duration of ≥30° and ≥60° forward bending. The participating workers reported LBPi (0–3) at the time of objective measurements and after 6, 12, 18 and 24 months. We investigated associations using linear mixed models with significance level p≤0.05 and presented results per 100 min. Results The duration of ≥30° and ≥60° FBW was not associated with average LBPi during follow-up, neither for the total sample nor stratified on work sector. Furthermore, analyses on all workers and on construction workers only found no significant association between ≥30° or ≥60° FBW and change in LBPi over the 2-year follow-up. For healthcare workers we found a consistent significant association between the duration of ≥30° FBW at baseline and the change in LBPi during follow-up, but this was not found for ≥60° FBW. Conclusions This study suggests that objectively measured duration of FBW in minutes is not associated with average levels of, or change in LBPi in construction workers over a 2-year period. In healthcare workers, exposure to ≥30° FBW was associated with change in LBPi, while we did not find this for ≥60° FBW. Results may indicate that the associations between FWB and LBP vary depending on type of work tasks, gender or sector-specific factors.
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Affiliation(s)
- Lars-Kristian Lunde
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Markus Koch
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Suzanne Lerato Merkus
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Stein Knardahl
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Morten Wærsted
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Kaj Bo Veiersted
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
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