Musculoskeletal pain and loneliness, social support and social engagement among older adults: Analysis of the Oxford Pain, Activity and Lifestyle cohort

Understanding the biopsychosocial knee osteoarthritis pain experience: an ecological momentary assessment

Introduction

Psychological, social, and lifestyle factors contribute to the knee osteoarthritis (OA) pain experience. These factors could be measured more accurately using smartphone ecological momentary assessment (EMA).

Objectives

The objective of this study was to characterise the pain experiences of those with knee OA by a smartphone EMA survey and explain how momentary psychological and social states influence knee OA pain experiences.

Methods

A smartphone EMA survey was designed and piloted. Eligible participants completed smartphone EMA assessing the knee OA pain experience 3 times daily for 2 weeks. Descriptive statistics were used to characterise factors involved in knee OA pain followed by the development of mixed-effects location scale models to explore heterogeneity and relationships between symptoms involved in the knee OA pain experience.

Results

Eighty-six community-dwelling volunteers with knee OA were recruited. Pain, psychosocial, and lifestyle factors involved in knee OA pain experience were heterogeneous and variable. Those with greater variability in pain, fatigue, negative affect, and stress had worse levels of these symptoms overall. In addition, fatigue, negative affect, stress, anxiety, loneliness, and joint stiffness demonstrated within-person relationships with knee OA pain outcomes.

Conclusions

Knee OA pain is a heterogeneous biopsychosocial condition. Momentary experiences of psychological, social, fatigue, and joint stiffness explain individual and between-individual differences in momentary knee OA pain experiences. Addressing these momentary factors could improve pain and functional outcomes in those with knee OA. Validation studies, including individuals with more severe knee OA presentations, are required to support findings and guide clinical interventions to improve outcomes for those with knee OA.

Social participation classification and activities in association with health outcomes among older adults: Results from a scoping review

AIMS

The aim of this study is to summarize the characteristics of social participation classification and examine the association between activities and health outcomes among older adults.

DESIGN

Scoping review.

DATA SOURCES

Eight databases (Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Embase, ProQuest, Psychological Information Database, PubMed, Scopus and Web of Science) were searched. Reference lists of relevant social participation reviews were also considered.

METHODS

This study applied a five-stage methodological framework. A narrative synthesis summarized social participation classification and activities and their associations with health outcomes among older adults (≥65 years) living at home, in the community or in nursing residences.

RESULTS

Forty-two articles published between 1975 and 2022 were selected. Four classification criteria of social participation were extracted and summarized from these studies. Based on the depth and breadth of social interactions, this review proposed a four-level classification schema. A lower risk of mortality and less visual impairment were associated with participation in level-one, level-three or level-four activities, whereas less depression, less pain and better cognitive function were linked to participation in level-three or level-four activities.

CONCLUSION

Future studies should provide a clear definition, establish classification criteria for participation and properly select activity forms while considering both subjective and objective dimensions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The results could provide data for designing targeted social participation interventions to improve specific health outcomes among older adults.

IMPACT

This review could help researchers examine the role of social participation activities in specific health outcomes. Moreover, a proposed classification of social participation activities would benefit researchers and community nurses in discerning the similarities and differences among activities.

REPORTING METHOD

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews guideline.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The Effect of Everyday-Life Social Contact on Pain

Pain is a biopsychosocial phenomenon, resulting from the interplay between physiological and psychological processes and social factors. Given that humans constantly interact with others, the effect of social factors is particularly relevant. Documenting the significance of the social modulation of pain, an increasing number of studies have investigated the effect of social contact on subjective pain intensity and pain-related physiological changes. While evidence suggests that social contact can alleviate pain, contradictory findings indicate an increase in pain intensity and a deterioration of pain coping strategies. This evidence primarily stems from studies examining the effect of social contact on pain within highly controlled laboratory conditions. Moreover, pain assessments often rely on one-time subjective reports of average pain intensity across a predefined period. Ecological momentary assessments (EMAs) can circumvent these problems, as they can capture diverse aspects of behavior and experiences multiple times a day, in real time, with high resolution, and within naturalistic and ecologically valid settings. These multiple measures allow for the examination of fluctuations of pain symptoms throughout the day in relation to affective, cognitive, behavioral, and social factors. In this opinion paper, we review the current state and future relevance of EMA-based social pain research in daily life. Specifically, we examine whether everyday-life social support reduces or enhances pain. The first part of the paper provides a comprehensive overview of the use of EMA in pain research and summarizes the main findings. The review of the relatively limited number of existing EMA studies shows that the association between pain and social contact in everyday life depends on numerous factors, including pain syndromes, temporal dynamics, the nature of social interactions, and characteristics of the interaction partners. In line with laboratory research, there is evidence that everyday-life social contact can alleviate, but also intensify pain, depending on the type of social support. Everyday-life emotional support seems to reduce pain, while extensive solicitous support was found to have opposite effects. Moreover, positive short-term effects of social support can be overshadowed by other symptoms such as fatigue. Overall, gathering and integrating experiences from a patient's social environment can offer valuable insights. These insights can help interpret dynamics in pain intensity and accompanying symptoms such as depression or fatigue. We conclude that factors determining the reducing versus enhancing effects of social contact on pain need to be investigated more thoroughly. We advocate EMA as the assessment method of the future and highlight open questions that should be addressed in future EMA studies on pain and the potential of ecological momentary interventions for pain treatment.

Bidirectional Longitudinal Association between Back Pain and Loneliness in Later Life: Evidence from English Longitudinal Study of Ageing

BACKGROUND

This study examined the bidirectional and temporal-ordinal relationship between loneliness and back pain.

METHODS

Data from 7,730 participants in waves 6 (2012-2013), 7 (2014-2015), and 8 (2016-2017) of the national English Longitudinal Study of Ageing were analyzed. Back pain was graded on a scale of 0-10 (0, no discomfort; 10, unbearable pain). Loneliness was measured using the Revised University of California Los Angeles Loneliness Scale. A targeted minimum loss-based estimator was used to examine the bidirectional longitudinal associations between back pain and loneliness.

RESULTS

No loneliness in waves 6 and 7 (relative risk [RR]=0.76; 95% confidence interval [CI], 0.61-0.94), no loneliness in wave 6 but loneliness in wave 7 (RR=0.58; 95% CI, 0.50-0.68), and loneliness in wave 6 but not in wave 7 (RR=0.69; 95% CI, 0.57-0.86) were associated with significant risk reductions of back pain in wave 8 compared with the scenario of loneliness in waves 6 and 7. Mild back pain in wave 6 but moderate back pain (RR=0.55; 95% CI, 0.35-0.86) or severe back pain in wave 7 (RR=0.49; 95% CI, 0.34-0.72) showed a significant risk reduction of loneliness in wave 8 compared with severe back pain in waves 6 and 7.

CONCLUSION

Loneliness may be a risk factor for back pain, and back pain may be a risk factor for loneliness. The results of this study will inform the development of more effective interventions for loneliness and back pain.

Burden of Other Musculoskeletal Disorders in Latin America and the Caribbean: Findings of Global Burden of Disease Study 2019

OBJECTIVE

To describe the results from the Global Burden Disease (GBD) study 2019 on the burden of other musculoskeletal (MSK) disorders in Latin America and the Caribbean (LAC).

METHODS

In this cross-sectional study, we analyzed data from all LAC region in the GBD study from 1990 to 2019. Other MSK (other than rheumatoid arthritis, osteoarthritis, gout, low back pain, and neck pain) burden was measured as prevalence, mortality, years lived with disability (YLD), and disability-adjusted life (DALY), by year, sex, and country. We show the counts, rates, and 95% uncertainty intervals (95% UI). Joinpoint regression analysis was used to estimate the average annual percentage change (AAPC) from 1990 to 2019. A correlational analysis between the burden parameters and sociodemographic index (SDI) was performed.

RESULTS

In 2019, there were 52.0 million (95% UI, 44.8-60.1 million) individuals with other MSK disorders in LAC. The age-standardized mortality rate in 2019 was 1.2 (95% UI, 0.8-1.6) per 100,000 inhabitants. The AAPC was estimated as 0.1% (95% confidence interval [CI], 0.1-0.2) and 0.2% (95% CI, 0.1-0.3) for prevalence and mortality rates, respectively. The age-standardized DALY rate was 685.4 (95% UI, 483.6-483.6) per 100,000 inhabitants, representing an AAPC of 0.2% (95% CI, 0.1-0.3). The burden was larger in women and the elderly. The SDI was positively correlated with the prevalence of YLD in 2019.

CONCLUSIONS

LAC region has experienced a significant burden of other MSK disorders over the last three decades. To challenge this growing burden, population-based strategies designed to reduce the burden of other MSK and strengthen health systems to contribute effective and cost-efficient care are necessary.

Symptom burden, fatigue, sleep quality and perceived social support in hemodialysis patients with musculoskeletal discomfort: a single center experience from Egypt

BACKGROUND AND AIMS

Musculoskeletal disorders (MSDs) are commonly encountered in hemodialysis (HD) patients. However, the causes linked to these disorders are still partially defined. The aim of this study was to determine the frequency of MSDs and their relationship to a variety of clinico-social characteristics such as sleep quality, mood disorders, fatigue, and social support, in addition to the patients' clinical and therapeutic profile.

METHOD

The study included 94 patients on maintenance HD. Clinical and Sociodemographic data was gathered. To investigate the prevalence and trends of MSDs, the Nordic Musculoskeletal Questionnaire (NMQ-E) was employed. Patients completed the modified Edmonton Symptom Assessment System, Pittsburgh Sleep Quality Index (PSQI), multidimensional Fatigue Inventory (MFI-20), and Perceived Social Support from Family Scales. Univariate and multivariate regression analysis were used to assess the determinants of MSDs.

RESULTS

The patients' mean age was 49.73 and 59.6% were males. Seventy-two percent of patients were afflicted by MSDs. Knee pain (48.9%), low back pain (43.6%), shoulder pain (41.6%), hip/thigh pain (35.1%), and neck pains (35.1%) were the most reported MSD domains. Pain (p = 0.001), fatigue (p = 0.01), depression (p = 0.015), and anxiety (p = 0.003) scores were substantially higher in patients with MSDs. Furthermore, patients with MSDs engaged in less physical activity (p = 0.02) and perceived less social support (p = 0.029). Patients with MSDs had lower subjective sleep quality, daytime dysfunction domains, and global PSQI scores (p = 0.02, 0.031, 0.036, respectively). Female gender (p = 0.013), fatigue (p = 0.012), depression (p = 0.014), anxiety (p = 0.004), lower activity (p = 0.029), and PSQI score (0.027), use of erythropoiesis-stimulating agents (ESAs), antihypertensive drugs, calcium and Iron supplementation were all significantly associated with MSDs. At the multivariable regression model, administration of ESAs (p = 0.017) and pain score (p = 0.040) were the only independent variables associated with the outcome.

CONCLUSION

MSDs are quite common among HD patients. Female gender, pain, fatigue, depression, anxiety, reduced activity, poor sleep quality, and use of ESAs are all significantly associated with MSDs in HD patients. Patients with MSD perceived less social support compared to the other group. Patients treated with antihypertensive drugs, calcium and iron supplements were more likely to suffer MSDs.

Eveningness is associated with persistent multisite musculoskeletal pain: a 15-year follow-up study of Northern Finns

Chronotype, a phenotype representing a person's 24-hour circadian rhythm, has been increasingly acknowledged as playing a role in musculoskeletal (MSK) pain. Most prior research on chronotype and MSK pain have been based on cross-sectional data, and no study has explored multisite MSK pain (two or more pain locations) as the outcome. We drew the study sample from the 31- and 46-year data collections (baseline and follow-up, respectively) of the Northern Finland Birth Cohort 1966 and collected self-reported data on chronotype at follow-up (morning [M]-type, intermediate [I]-type, and evening [E]-type) and longitudinal multisite MSK pain trajectories (n=3,294). Multinomial logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) in multisite MSK pain trajectories between the chronotypes. We conducted additional sensitivity analyses that 1) accounted for several confounders, and 2) examined the potential moderating role of sex, mental distress, and sleep disturbance status in the chronotype-multisite MSK pain associations. The E-types had two-and-a-half-times higher odds of multisite MSK pain at baseline and follow-up (OR 2.47, 95% CI 1.84-3.32) than the M-types. Having severe mental distress or poor sleep at baseline and follow-up, or sex did not change the strength of this association. Our examination of this longitudinal birth cohort study suggested that evening types, in comparison to morning types, are more likely to experience multisite MSK pain between ages 31 and 46 years. Chronotype should be recognized as a predictor of multisite pain and thus taken into account in the evaluation of a patient's risk for multisite pain. Perspective: This longitudinal study shows that evening types, compared to morning types, have higher odds of experiencing multisite MSK pain between ages 31 and 46 years. Chronotype should be considered while evaluating MSK patient's risk for persistent multisite pain symptoms.

The association between pain and central nervous system depressing medication among hospitalised Norwegian older adults

OBJECTIVES

Central nervous system depressant medications (CNSD) including benzodiazepines, z-hypnotics and opioids are regularly prescribed for the older patient. These medications are linked to dependence and associated with severe side effects in some older patients. Consensus recommendations for this group suggest limiting their use. We have recently described a high proportion of long-term CNSD use and dependence among older in-hospital patients. In this study, we aim to investigate factors associated with pain intensity and presentation of pain among older adults with long-term use of CNSDs compared to non-users.

METHODS

Two hundred and forty six elderly hospitalised patients were recruited consecutively in a cross-sectional study. Data was collected from patients and electronic health records (EHR). Independent variables were sex, age, education, emotional symptoms (hospital anxiety and depression scale [HADS]), cognitive function (Mini-mental State Examination test [MMSE]), comorbidity (cumulative illness rating score - geriatrics [CIRS-G]), loneliness (the six-item De Jong Gierveld Loneliness Scale) and prolonged (≥4 weeks) use of any CNSDs or prolonged use of opioids (≥4 weeks). All variables, including pain intensity, were collected at one time point consistent with the cross-sectional study design. Statistical analyses included descriptive statistics and linear regression models using the above mentioned variables and pain intensity (visual analogue scale for pain intensity [VAS] pain 0-100) as outcome. Additional information regarding pain presentation was extracted from the patients' EHR.

RESULTS

Mean pain intensity VAS (SD) was 35.2 (30.4) and 18.1 (24.2) respectively, for patients with vs. without prolonged use of CNSDs. In the multivariable linear regression analysis, prolonged use of CNSDs and opioids were positively associated with pain intensity (VAS) (regression coefficient (95% CI) 20.7 (11.0; 30.3), p<0.001, and 19.8 (5.7; 33.8), p=0.006, respectively), while sex, age, education, MMSE, HADS, CIRS-G and loneliness scores were not. Pain related to back (23.2%) and lower extremities (23.2%) were most common pain sites, and those with one or more pain sites reported overall higher pain intensity compared to those with no reported pain sites (p<0.006).

CONCLUSIONS

Prolonged use of CNSD medications as well as prolonged use of opioids are both positively associated with pain intensity. The results may have implications for treatment and long-term pain management for older patients.

Pain Characteristics, Cardiovascular Risk Factors, and Cardiovascular Disease

BACKGROUND

There is unclear evidence that chronic pain may increase the risk of cardiovascular disease (CVD) incidence and mortality. This work evaluated the association between chronic pain, incidence of CVD and changes in CVD risk factors.

METHODS

Cohort of 1091 community-dwelling individuals ≥60years, free from CVD at baseline, followed up for 6 years. Data on psychosocial factors and CVD risk factors was obtained through validated questionnaires and laboratory measurements. A pain scale ranging from 0 (no pain) to 6 (worst pain) was created according to pain frequency, location and intensity.

RESULTS

The cumulative incidence of CVD was 4.2% at 3 years, and 7.7% at 5-years of follow-up. Compared to individuals without pain in the first 3 years (2012-2015), those with maintained scores ≥2 showed a mean reduction of 3.57 (-5.77,-1.37) METs-h/week in recreational physical activity; a 0.38-point (0.04,0.73) increase in psychological distress; and a 1.79 (1.03,3.11) higher odds of poor sleep. These associations held in the second follow-up period, when individuals with maintained pain also worsened their diet quality. A 1-point increase in the pain scale in 2012 was associated with a 1.21 (1.03,1.42) and 1.18 (0.97,1.44) increased CVD incidence in 2015 and 2017, respectively; none of the studied factors mediated this relationship.

CONCLUSIONS

Older adults with chronic pain show important reductions in recreational physical activity and deterioration in mental health, sleep and diet quality, which may well aggravate pain. Future studies should evaluate whether these factors mediate the increased risk of CVD observed in older adults with chronic pain.