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Costa D, Cruz EB, Lopes DG, da Silva CN, Henriques AR, Luis D, Branco J, Canhão H, Rodrigues AM. Prevalence of and factors associated with unmanageable pain levels in people with knee or hip osteoarthritis: a cross-sectional population-based study. BMC Musculoskelet Disord 2023; 24:60. [PMID: 36683031 PMCID: PMC9869512 DOI: 10.1186/s12891-022-06110-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/21/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pain due to knee and / or hip osteoarthritis (HKOA) is the most common symptom for seeking healthcare. Pain interferes on daily activities, social and occupational participation in people with HKOA. The goal of this study is to estimate the prevalence of unmanageable pain levels (UPL) among people with HKOA), characterize this population and identify factors associated with UPL, and compare therapeutic strategies used by people with UPL versus manageable pain levels (MPL). METHODS We analysed data from the EpiReumaPt study (n = 10,661), that included a representative sample of the Portuguese population. Among these, 1081 participants had a validated diagnosis of HKOA by a rheumatologist.. Sociodemographic, lifestyle and health-related data were collected in a structured interview. Pain intensity (NPRS) data were collected in a medical appointment. Painmedication (last month), physiotherapy and surgery were considered as therapies for pain management. UPL was defined as a mean pain intensity in the previous week of ≥5 points on 11-point numeric pain rating scale. The factors associated with UPL were analyzed with logistic regression (p < 0.05, 95%CI). The effect of unmanageable pain levels was assessed by the HOOS/KOOS activities of daily living and quality of life subscales. Symptoms of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Analysis was completed with linear and logistic regression. All analysis were weighted. RESULTS The estimated prevalence of UPL among people with HKOA was 68.8%. UPL was associated with being female (odds ratio (OR) = 2.36, p < 0.001), being overweight (OR = 1.84, p = 0.035) or obese (OR = 2.26, p = 0.006), and having multimorbidity (OR = 2.08, p = 0.002). People with UPL reported worse performance in activities of daily living and lower quality of life (β = - 21.28, p < 0.001 and β = - 21.19, p < 0.001, respectively) than people with MPL. People with UPL consumed more NSAIDs (22.0%, p = 0.003), opioids (4.8%, p = 0.008), paracetamol (2.7%, p = 0.033), and overall analgesics (7.3%, p = 0.013) than people with MPL. A higher proportion of people with UPL underwent physiotherapy (17.5%, p = 0.002) than people with MPL. CONCLUSION Two-thirds of people with HKOA in Portugal have poor management of their pain levels. Clinical and lifestyle factors, that are highly presented in individuals with HKOA, are associated with unmanageable pain. Our results highlighting the need for further research and implementation of effective interventions to improve pain, function and quality of life in people with HKOA.
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Affiliation(s)
- Daniela Costa
- grid.10772.330000000121511713NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal ,grid.10772.330000000121511713Comprehensive Health Research Centre (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal ,grid.10772.330000000121511713EpiDoC Unit, NOVA Medical School (NMS), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Eduardo B. Cruz
- grid.10772.330000000121511713Comprehensive Health Research Centre (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal ,grid.421114.30000 0001 2230 1638Physiotherapy Department, School of Health, Polytechnic Institute of Setúbal, Setúbal, Portugal
| | - David G. Lopes
- grid.10772.330000000121511713Comprehensive Health Research Centre (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal ,grid.10772.330000000121511713EpiDoC Unit, NOVA Medical School (NMS), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Catarina Nunes da Silva
- grid.10772.330000000121511713Comprehensive Health Research Centre (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal ,grid.10772.330000000121511713EpiDoC Unit, NOVA Medical School (NMS), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana Rita Henriques
- grid.10772.330000000121511713Comprehensive Health Research Centre (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal ,grid.10772.330000000121511713EpiDoC Unit, NOVA Medical School (NMS), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Luis
- grid.421114.30000 0001 2230 1638Physiotherapy Department, School of Health, Polytechnic Institute of Setúbal, Setúbal, Portugal
| | - Jaime Branco
- grid.10772.330000000121511713Comprehensive Health Research Centre (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal ,grid.10772.330000000121511713EpiDoC Unit, NOVA Medical School (NMS), Universidade NOVA de Lisboa, Lisbon, Portugal ,grid.414462.10000 0001 1009 677XServiço de Reumatologia do Hospital Egas Moniz, Centro Hospital Lisboa Ocidental (CHLO), Lisbon, Portugal
| | - Helena Canhão
- grid.10772.330000000121511713Comprehensive Health Research Centre (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal ,grid.10772.330000000121511713EpiDoC Unit, NOVA Medical School (NMS), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana M. Rodrigues
- grid.10772.330000000121511713Comprehensive Health Research Centre (CHRC), Universidade Nova de Lisboa, Lisbon, Portugal ,grid.10772.330000000121511713EpiDoC Unit, NOVA Medical School (NMS), Universidade NOVA de Lisboa, Lisbon, Portugal ,Rheumatology Unit, Hospital dos Lusíadas, Lisbon, Portugal
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Duarte IA, Reis-Santos P, Fick J, Cabral HN, Duarte B, Fonseca VF. Neuroactive pharmaceuticals in estuaries: Occurrence and tissue-specific bioaccumulation in multiple fish species. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 316:120531. [PMID: 36397612 DOI: 10.1016/j.envpol.2022.120531] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/06/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Contamination of surface waters by pharmaceuticals is an emerging problem globally. This is because the increased access and use of pharmaceuticals by a growing world population lead to environmental contamination, threatening non-target species in their natural environment. Of particular concern are neuroactive pharmaceuticals, which are known to bioaccumulate in fish and impact a variety of individual processes such as fish reproduction or behaviour, which can have ecological impacts and compromise fish populations. In this work, we investigate the occurrence and bioaccumulation of 33 neuroactive pharmaceuticals in brain, muscle and liver tissues of multiple fish species collected in four different estuaries (Douro, Tejo, Sado and Mira). In total, 28 neuroactive pharmaceuticals were detected in water and 13 in fish tissues, with individual pharmaceuticals reaching maximum concentrations of 1590 ng/L and 207 ng/g ww, respectively. The neuroactive pharmaceuticals with the highest levels and highest frequency of detection in the water samples were psychostimulants, antidepressants, opioids and anxiolytics, whereas in fish tissues, antiepileptics, psychostimulants, anxiolytics and antidepressants showed highest concentrations. Bioaccumulation was ubiquitous, occurring in all seven estuarine and marine fish species. Notably, neuroactive compounds were detected in every water and fish brain samples, and in 95% of fish liver and muscle tissues. Despite variations in pharmaceutical occurrence among estuaries, bioaccumulation patterns were consistent among estuarine systems, with generally higher bioaccumulation in fish brain followed by liver and muscle. Moreover, no link between bioaccumulation and compounds' lipophilicity, species habitat use patterns or trophic levels was observed. Overall, this work highlights the occurrence of a highly diverse suite of neuroactive pharmaceuticals and their pervasiveness in waters and fish from estuarine systems with contrasting hydromorphology and urban development and emphasizes the urgent need for toxicity assessment of these compounds in natural ecosystems, linked to internalized body concentration in non-target species.
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Affiliation(s)
- Irina A Duarte
- MARE - Marine and Environmental Sciences Centre / ARNET - Aquatic Research Network, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016, Lisboa, Portugal.
| | - Patrick Reis-Santos
- Southern Seas Ecology Laboratories, School of Biological Sciences, The University of Adelaide, South Australia, 5005, Australia
| | - Jerker Fick
- Department of Chemistry, Umeå University, Umeå, Sweden
| | | | - Bernardo Duarte
- MARE - Marine and Environmental Sciences Centre / ARNET - Aquatic Research Network, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016, Lisboa, Portugal; Departamento de Biologia Vegetal, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016, Lisboa, Portugal
| | - Vanessa F Fonseca
- MARE - Marine and Environmental Sciences Centre / ARNET - Aquatic Research Network, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016, Lisboa, Portugal; Departamento de Biologia Animal, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016, Lisboa, Portugal
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