Has the prevalence of invalidating musculoskeletal pain changed over the last 15 years (1993-2006)? A Spanish population-based survey

Reliability of a self-administrated musculoskeletal questionnaire: The fourth Trøndelag health study

BACKGROUND

The reliability of the Nordic Musculoskeletal Questionnaire (NMQ) has not been evaluated in an unselected general population. The aim of this population-based follow-up study was to estimate the reliability between a self-administered NMQ-based questionnaire and a face-to-face interview performed approximately two months later. To interpret the results, we assessed the 1-year prevalence of various pain musculoskeletal pain locations.

METHODS

A random sample of 1201 participants in the fourth wave of the Trøndelag Health Survey were invited to a follow-up interview focusing on sleep and pain. A total of 232 (19%) participated a semi-structured interview, and the agreement with the corresponding answers in the musculoskeletal questionnaire in HUNT4 were evaluated by Cohen's kappa statistics with 95% confidence interval (CI). The 1-year prevalence of the various pain sites was stratified by age and gender.

RESULTS

The reliability was good for chronic musculoskeletal pain (CMSP), chronic widespread musculoskeletal pain (CWMSP) and pain in hip and knee (kappa values between 0.63 and 0.68). Moderate kappa values between 0.51 and 0.60 were found for pain in the neck, shoulder, elbow, wrist/hand, upper back, lower back, calf, ankle/feet, and ≥7 pain sites. The 1-year prevalence was 54.3% for CMSP and 17.2 for CWMSP, substantially higher for women and among those aged 50 years or more.

CONCLUSION

In this population-based study the reliability between interview and questionnaire was good to moderate for most pain locations. In particular, the self-administered musculoskeletal questionnaire seems to be a useful tool in identifying individuals with CMSP, CWMSP, and pain in hip and knee.

Analysis of ergonomic occupational accidents and near misses in a large Belgian university hospital

INTRODUCTION

Health-care organizations are facing a high burden of ergonomic occupational accidents, and prevention is a continuous point of interest. In this manuscript, we describe the characteristics of ergonomic accidents in a large Belgian university hospital and discuss the value of near misses.

METHODS

Combining databases, we identified the frequency [number of accidents × 10⁶ hours worked per year], severity (number of days off work × 10³ hours worked per year), and profile of the victims of occupational ergonomic accidents (with absence from work) or incidents or near-misses (without absence from work). Ergonomic accidents and incidents include slips, trips, falls, injurious body movements, overexertion, and handling heavy weights.

RESULTS

In a period of 23 years, we noticed a significant decrease in the frequency of ergonomic accidents (from about 7 to about 4 standard units), without changes in the severity. The decrease in the frequency of accidents is mirrored by an increase in the frequency of incidents (from about 4 to about 6 standard units). Female and older employees are more vulnerable to accidents, and the frequency was between two and four times higher for employees mostly involved in manual tasks compared to employees mostly involved in managerial tasks. The profile of the victims and the causes of accidents and incidents were identical.

CONCLUSION

Although it is premature to assume a cause-consequence relationship between incidents and accidents, it is tempting to speculate that the increased ratio of the frequencies of incidents over accidents might be one of the variables reflecting the adequacy of preventive measures and the growth of safety behavior.

Pain rates in general population for the period 1991-2015 and 10-years prediction: results from a multi-continent age-period-cohort analysis

Background

Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people. The aims of this study are to evaluate the temporal variations of pain rates among general populations for the period 1991–2015 and to project 10-year pain rates.

Methods

We used the harmonized dataset of ATHLOS project, which included 660,028 valid observations in the period 1990–2015 and we applied Bayesian age–period–cohort modeling to perform projections up to 2025. The harmonized Pain variable covers the content “self-reported pain experienced at the time of the interview”, with a dichotomous (yes or no) modality.

Results

Pain rates were higher among females, older subjects, in recent periods, and among observations referred to cohorts of subjects born between the 20s and the 60s. The 10-year projections indicate a noteworthy increase in pain rates in both genders and particularly among subjects aged 66 or over, for whom a 10–20% increase in pain rate is foreseen; among females only, a 10–15% increase in pain rates is foreseen for those aged 36–50.

Conclusions

Projected increase in pain rates will require specific interventions by health and welfare systems, as pain is responsible for limited quality of subjective well-being, reduced employment rates and hampered work performance. Worksite and lifestyle interventions will therefore be needed to limit the impact of projected higher pain rates.

Immediate effects of variable durations of pressure release technique on latent myofascial trigger points of the levator scapulae: a double-blinded randomised clinical trial

OBJECTIVE

Latent myofascial trigger points (MTrPs) of the levator scapulae have a high prevalence and may influenceconditions of the neck and shoulder. The pressure release technique is one of the most recommended manual therapy techniques. The aim of this study was to determine the effect of varying durations of the pressure release technique application on latent MTrPs of the levator scapulae.

METHODS

In a three-arm (1:1:1 ratio), double-blinded, parallel, randomised clinical trial, 60 healthy university students (23 men, 37 women) with a mean±SD age of 20.0±2.67 years were recruited. Subjects were assigned to receive pressure release in one latent MTrP of the levator scapulae lasting 30s (T_30s; n=17), 60s (T_60s; n=22) or 90s (T_90s; n=21). Active cervical range of movement (CROM), strength, pressure pain threshold (PPT) and neck pain intensity at full stretch were measured immediately before and after treatment.

RESULTS

Mixed-model analyses of variance showed statistically significant differences for PPT (P=0.045; partial Eta²=0.103), comparing T_60s versus T_30s (P=0.009; Cohen's d=1.044) and T_90s versus T_30s groups (P=0.001; Cohen's d=1.253), and for left side bending strength (P=0.043; partial Eta²=0.105), comparing T_90s versus T_30s (P=0.023; Cohen's d=0.907). The rest of the comparisons did not present any significant differences (P⩾0.05).

CONCLUSIONS

The 60 s and 90 s applications of the pressure release technique may be recommended to increase PPT and strength, respectively, in latent MTrPs of the levator scapulae in the short term.

TRIAL REGISTRATION NUMBER

NCT03006822.

Do incident musculoskeletal complaints influence mortality? The Nord-Trøndelag Health study

Background

Musculoskeletal complaints (MSC) are common in the general population, causing a major disease burden to the individual and society. The association between MSC and mortality is still unclear. To our knowledge, no study has hitherto evaluated the association between MSC onset within the last month (incident MSC) on the one hand, and all-cause and cause-specific mortality on the other.

Methods

This prospective population-based cohort study was done using data from the second Nord-Trøndelag Health Study (HUNT2) linked with data from a comprehensive national registry of cause of death. A total of 25,931 participants at risk for incident MSC were included. Hazard ratios (HR) of mortality were estimated for participants with incident MSC using Cox regression based on a mean of 14.1 years of follow-up.

Results

Participants who reported incident MSC did not have an excess mortality compared to those with no MSC in the analyses of all-cause mortality (HR 0.99, 95% CI 0.89–1.10) and cause specific mortality. This was true also after adjustment for several potential confounding factors. No clear association between the number of MSC body sites and mortality was found.

Conclusion

Incident MSC were not associated with an increased mortality, neither for all-cause mortality, nor cause-specific mortality.

Dry Needling on the Infraspinatus Latent and Active Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized Clinical Trial

BACKGROUND AND PURPOSE

Shoulder pain is a prevalent condition in older adults. Some authors associate nonspecific shoulder pain with myofascial trigger points (MTrPs) in the infraspinatus muscle. Dry needling is recommended to relieve the MTrP pain of shoulders in the short term (<9 days). Active MTrPs dry needling improves shoulder pain and the irritability of the satellite MTrPs in the referred pain area. Nociceptive activity at a latent MTrP may influence motor activity and the sensitivity of MTrPs in distant muscles at a similar segmental level. Therefore, this study aimed to evaluate dry needling on 1 latent MTrP, in conjunction with 1 active MTrP, in the infraspinatus muscle of older adults with nonspecific shoulder pain.

METHODS

A single-center, randomized, single-blinded, controlled study (NCT02032602) was carried out. Sixty-six patients aged 65 years and older with trigger points in the ipsilateral infraspinatus of the painful shoulder were randomly assigned to (1) of (2) treatment groups. A session of dry needling on the infraspinatus was performed in (1) the most hyperalgesic active and latent MTrP or (2) only the most hyperalgesic active MTrP. The Numeric Rating Scale, the pressure pain threshold (primary outcome) on the anterior deltoid and extensor carpi radialis brevis latent MTrPs, and grip strength were assessed before, after, and 1 week after the intervention.

RESULTS

Statistically significant differences in the reduction of pain intensity (P ≤ .001; η = 0.159-0.269; d = 1.017-1.219) and the increase of pressure pain threshold (P < .001; η = 0.206-0.481; d = 0.870-1.924) were found for the (1) treatment group immediately and 1 week postintervention. Nevertheless, no statistical significant differences were found in grip strength (P >. 05; η = 0.006-0.033; d = 0.158-0.368).

CONCLUSIONS

One dry needling intervention of the latent MTrP associated with the key active MTrP of the infraspinatus reduces pain intensity and the irritability of the satellite MTrPs located in the referred pain area in the short term in older adults with nonspecific shoulder pain.

A prospective cohort study on risk factors of musculoskeletal complaints (pain and/or stiffness) in a general population. The Tromsø study

Background

Female gender has been associated with musculoskeletal complaints (MSCs), but there are limited studies on how other factors may influence women and men differently. The aim of this prospective cohort study was to explore possible predictors of MSCs in women and men free of MSCs at baseline.

Methods

The present study included participants from the population-based Tromsø study, with baseline data from 1994–1995 and follow-up data from 2007–2008. MSCs were defined as having pain and/or stiffness in muscles and joints for 3 consecutive months during the past year. Predictors of MSCs were examined through binary logistic regression analyses and presented as odds ratios with 95% confidence intervals.

Results

At baseline 4,496 participants reported no MSCs and among these 2,015 (44.8%) and 441 (9.8%) participants reported mild or severe MSCs, respectively, at follow-up. Female gender predicted MSCs in multivariable logistic regression analyses (odds ratio [OR] 1.46, 95% confidence interval [CI]: 1.29–1.66). Educational level of primary/secondary school (OR 1.73, 95% CI: 1.46–2.05) was the strongest predictor of MSCs, followed by poor self-perceived health (OR 1.62, 95% CI: 1.30–2.02). Other predictors were BMI ≥30 kg/m² (OR 1.39, 95% CI: 1.10–1.77) and smoking (OR 1.33, 95% CI: 1.16–1.52). Age and physical activity level were not significantly associated with MSCs. Gender-stratified analyses revealed that mental health complaints (i.e., depression and/or anxiety) predicted MSCs in men (OR 2.03, 95% CI: 1.18–3.50), but not in women. Current smoking (OR 1.43, 95% CI: 1.16–1.76) and poor self-perceived health (OR 1.90, 95% CI: 1.34–2.71) showed slightly higher odds ratios among women than men, but the gender differences were not significant.

Conclusion

The present study demonstrates that several negative health determinants are predicting subsequent MSCs. However, the examined risk factors could not explain the higher prevalence of MSCs in women.

The Mortality Associated With Chronic Widespread Musculoskeletal Complaints: A Systematic Review of the Literature

BACKGROUND

Chronic widespread musculoskeletal complaints (CWMSC) are a prevalent condition with a large impact on quality of life and with a large burden on society. Studies investigating the relationship between CWMSC and mortality have yielded inconsistent results. The present study aimed to clarify this relationship through a systematic review of the existing literature, including meta-analyses, to estimate pooled results and heterogeneity.

METHODS

The MEDLINE, EMBASE and Science Citation Index Expanded databases were searched in February 2016. Broad search terms were used to identify as many observational studies as possible that investigated the association between CWMSC and mortality. The identified studies were evaluated according to predetermined inclusion criteria.

RESULTS

Six studies fulfilled the inclusion criteria. In pooled unadjusted analyses of three studies evaluating CWMSC, a non-significant tendency of increased overall mortality was found [mortality risk ratio (MRR) 1.69, 95% confidence interval (CI) 0.91-3.14]. However, in pooled analyses of all six studies reporting adjusted results, the non-significant tendency for higher mortality rates in those with CWMSC was nearly eliminated (MRR 1.13, 95% CI 0.95-1.34). Heterogeneity between studies was moderate to high, particularly regarding the use of confounding factors.

CONCLUSIONS

In this systematic review, based on a limited number of studies, pooled data gave no evidence of a higher mortality rate among individuals with CWMSC. The non-significant tendency for a higher mortality rate in unadjusted pooled analyses was nearly eliminated in the adjusted pooled analyses, considering lifestyle factors such as physical activity smoking. In population-based studies evaluating the relationship between CWMSC and mortality rates, we recommend that both unadjusted and adjusted analyses should be presented. Copyright © 2016 John Wiley & Sons, Ltd.

Mechanisms of chronic pain - key considerations for appropriate physical therapy management

In last decades, knowledge of nociceptive pain mechanisms has expanded rapidly. The use of quantitative sensory testing has provided evidence that peripheral and central sensitization mechanisms play a relevant role in localized and widespread chronic pain syndromes. In fact, almost any patient suffering with a chronic pain condition will demonstrate impairments in the central nervous system. In addition, it is accepted that pain is associated with different types of trigger factors including social, physiological, and psychological. This rational has provoked a change in the understanding of potential mechanisms of manual therapies, changing from a biomechanical/medical viewpoint, to a neurophysiological/nociceptive viewpoint. Therefore, interventions for patients with chronic pain should be applied based on current knowledge of nociceptive mechanisms since determining potential drivers of the sensitization process is critical for effective management. The current paper reviews mechanisms of chronic pain from a clinical and neurophysiological point of view and summarizes key messages for clinicians for proper management of individuals with chronic pain.

Identification and description of controlled clinical trials published in Physiotherapy journals in Spain

RATIONALE AND OBJECTIVES

The quantity and quality of research in physiotherapy has increased exponentially during the past decades. However, retrieving publications associated with this field of research is difficult. The aim of this study is to identify and describe controlled clinical trials (CCT) published in Spanish physiotherapy journals using electronic and handsearching strategies.

METHOD

Observational study through which we identified eligible journals in order to retrieve CCTs using electronic and handsearching strategies, as proposed by the Cochrane Collaboration. A descriptive analysis of the main characteristics of these CCTs was completed.

RESULTS

Seventy-eight CCTs were identified in 10 eligible journals, none of which were indexed in the major databases. 16.7% of the identified studies were multicentric. Traumatology and orthopaedics was the most studied field (33.3%) followed by neurology (15.4%). The most researched health problems were back pain (17.24%) fibromyalgia, arthrosis and stroke (6.8% each). Measured outcomes varied greatly, including pain control, functional mobility and quality of life. Most CCTs (64.1%) had a high risk of bias.

CONCLUSIONS

The number of CCTs published in Spanish physiotherapy journals is limited. Handsearching these journals is essential, since none is indexed in major databases. In general, the identified CCTs carry a high risk of bias.

Musculoskeletal Complaints (Pain and/or Stiffness) and Their Impact on Mortality in the General Population. The Tromsø Study

Background

The long-term consequences of chronic pain and/or stiffness from the musculoskeletal system (musculoskeletal complaints: MSCs) have not been well explored. The aims of this study were to investigate whether MSCs reported at baseline influence all-cause and cause-specific mortality during 21 years follow-up of a general Northern Norwegian adult population.

Methods

A total of 26,977 men and women aged 25–97 years who participated in the 1994–1995 survey of the Tromsø study (response rate 77%) were included in the present prospective cohort study. Baseline data were collected from the 1994–1995 survey and information on death and emigration was taken from the National Register of Norway. Cox regression analyses were performed to examine if MSCs predicted risk of mortality.

Results

5693 (21.1%) participants died during follow-up. Mean time between entry into the survey and death or emigration was 18.6 years (standard deviation 4.87) for all-cause mortality. There was an increased risk of death among those with MSCs at baseline in the crude Cox regression model. However, the multivariable model revealed no significant association between MSCs at baseline and all-cause mortality by sex (women: hazard ratio [HR] = 0.93, 95% confidence interval [CI]: 0.85–1.01; men: HR = 0.93, 95%CI: 0.85–1.01). Furthermore, no significant associations were found between widespread MSCs at baseline and all-cause mortality in multivariable models (women: HR = 0.90, 95%CI: 0.80–1.01; men HR = 0.87, 95%CI: 0.76–1.00). Analyses on cause-specific mortality did not reveal any significant results.

Conclusion

MSCs are not independently associated with increased risk of death from cardiovascular disease, cancer, or death from all causes.

Patient Satisfaction with Spanish Pain Centers: Observational Study with More than 3,000 Patients

Chronic pain is a serious problem in Spain. This multicenter, epidemiological 3-month follow-up study investigates pain management efficacy in Spanish centers using patient satisfaction criteria. 3,414 eligible adult patients (65,6% female) with moderate to severe chronic pain from 146 pain centers were included. Patient satisfaction was assessed based onto question 18 of Spanish healthcare barometer-CSI. Pain evolution (Brief Pain Inventory-Short Form (BPI-SF) and visual analog scale (VAS)), quality of life/EuroQol-5, and pain control expectations fulfillment were also assessed. Mean age was 61.3 years. 64.4% of participating centers employed multidisciplinary pain management approach. After 3 months, mean patient satisfaction was 7.8 (1-10) on the CIS barometer. Medical staff received the highest scores, whereas waiting for tests, appointment request to appointment date time, and waiting times at the center the lowest. Mean pain decreased from 7.4 to 4.0; BPI-SF intensity decreased from 6.5 to 3.8; pain control expectations were met in 78.7% of patients; EuroQoL-5D utility index increased from 0.37 to 0.62, p < 0.001, and health status (VAS) from 40.6 to 61.9, p < 0.001. Chronic pain patients (90%) are satisfied with Spanish centers care; 80% had their pain control expectations met. Quality of life improved remarkably: 71% felt moderately to significantly better. However, waiting times need improvement.

Has the prevalence of migraine changed over the last decade (2003-2012)? A Spanish population-based survey

INTRODUCTION

Information on temporal trends can identify groups of people at risk for any particular condition; however information on temporal trends on migraine headache at population levels is scarce. Our aim was to estimate the time trends in the prevalence of migraine from 2003 to 2012 in Spain.

METHODS

A population-based national study was conducted. We analyzed data using individualized information taken from national surveys conducted in 2003/4, 2006/7, 2009/10 and 2011/12. A total of 94,158 Spanish adults participated. We considered the presence of self-rated and diagnosed migraine, and we analyzed socio-demographic features, lifestyle habits, self-rated health status, and comorbid diseases using logistic regressions.

RESULTS

The prevalence of migraine increased from 6.54% in 2003 to 9.69% in 2012 with significant time trends (adj. OR 1.65; 95%CI 1.50-1.81). The probability of women of suffering migraine was 3 times higher than for men (adj.OR 3.08; 2.82-3.37). There was a declining trend in migraine prevalence as age increased (adj.OR 0.42; 0.35-0.51). Demographic variables associated with migraine were lower educational level (adj.OR 1.32; 1.13-1.54) and not being an immigrant (adj.OR 1.37; 1.15-1.64). A worse self-reported health status was related to higher prevalence of migraine (adj.OR 2.83; 2.59-3.09). The prevalence of migraine also increased as the number of comorbid conditions increased (adj.OR 2.42; 2.05-2.86).

CONCLUSION

The prevalence of migraine has increased in the first decade of the 21st century in Spain. Migraine was associated with being female, mid-age, low educational level, not being an immigrant, worse self-rated health status and presence of comorbid conditions.

Physician practicing preferences for conventional or homeopathic medicines in elderly subjects with musculoskeletal disorders in the EPI3-MSD cohort

Background

Musculoskeletal pain is common in elderly persons. Analgesic use is high in the elderly and may involve unacceptable risk in individuals with chronic pain. Our aim was to compare the socio-demographic characteristics of elderly subjects with musculoskeletal disorders (MSD) and to assess medication use and clinical evolution of musculoskeletal pain according to physician prescribing preference: homeopathy (Ho) group, conventional medicine (CM) group, or mixed prescription (MX) group.

Methods

The EPI3 study was a 1 year observational survey carried out among general practitioners in France between March 2007 and July 2008. This sub-analysis was carried out on elderly subjects aged ≥70 years from the original EPI3 cohort. Socio-demographic data were collected at inclusion using a self-administered patient questionnaire and medical data were recorded for each patient. Quality of life was measured using the Short Form-12 questionnaire. Patients completed a structured telephone interview on their functional status (evaluated with the QuickDash questionnaire, EIFEL scale or Lequesne index) within 72 hours of inclusion. This telephone interview was repeated at 1, 3, and 12 months. Drug exposure was also assessed during these interviews.

Results

146 patients (mean age ± standard deviation: 75.8±4.8 years) were analyzed (80.1% female, 74.7% MSD of the spine or lower limbs, 64.4% chronic MSD). Patients in the CM and MX groups were 3.7 times or 2.5 times more likely (odds ratio [OR] =3.71, 95% confidence interval [CI]: 1.12–12.30; OR =2.52, 95% CI: 1.05–6.05; respectively) to have used non-steroidal anti-inflammatory drugs (NSAIDs) than those in the Ho group. In contrast, analgesic use was comparable in the three groups (OR =1.06 [CM versus Ho], 95% CI: 0.09–12.11; OR =0.34 [MX versus Ho], 95% CI: 0.07–1.57). Overall functional score evolution was similar in the three groups over time (P=0.16).

Conclusion

NSAID use was significantly higher in elderly MSD patients consulting a conventional practice general practitioner. In contrast, analgesic use and MSD evolution were similar in the three groups. Consulting a homeopathic physician for MSD management does not appear to represent a loss of therapeutic opportunity, and decreases the use of NSAIDs.

Prevalence of neck and low back pain in community-dwelling adults in Spain: an updated population-based national study (2009/10-2011/12)

PURPOSE

To estimate time trends in the prevalence of neck (NP) and low back pain (LBP) from 2009 to 2012; and to determine the socio-demographic features, self-rated health status, co-morbidity, lifestyle-related habits, and health care service associated with NP and LBP in Spanish adults.

OUTCOME MEASURES

The European Health Interview Survey for Spain (2009) and the Spanish National Health Survey (2011).

METHODS

A total of 43,072 subjects were included. We analyzed data collected from the European Health Interview Survey for Spain conducted in 2009 (n = 22,188), and the Spanish National Health Survey in 2011 (n = 20,884). We considered the presence of isolated NP, LBP and both (NP&LBP). We analyzed socio-demographic features; self-perceived health status; lifestyle habits; comorbid diseases, and professional treatment using logistic regression models.

RESULTS

The prevalence of isolated NP, LBP and NP&LBP increased from 2008/9 to 2011/12 (7.86 vs. 8.56 %; 5.18 vs.5.44 %; 10.61 vs.11.12 %, respectively). Being female, increased the probability of isolated NP and NP&LBP, but decreased the probability of LBP. The prevalence of all pain localizations increased with older age, lower education level, poor self-rated health, smoker, comorbidities, psychological distress (anxiety or depression), hospital and physiotherapist visits and consumed drugs for pain, in 2008/9 as compared to 2011/12. Moreover, LBP, and NP&LBP were associated with obesity, whereas NP&LBP was associated with being married.

CONCLUSIONS

The prevalence of LBP, NP and NP&LBP had increased in the last 3 years in Spain.

Has the prevalence of neck pain and low back pain changed over the last 5 years? A population-based national study in Spain

BACKGROUND CONTEXT

No study has determined time trends of neck pain and low back pain (NP&LBP) in the 20th century in Spain.

PURPOSE

To estimate current 1-year prevalence of NP&LBP using data from the 2009 European Health Survey and to analyze the time trends in the prevalence of NP&LBP from 2005 to 2010.

STUDY DESIGN

Population-based national study.

PATIENT SAMPLE

A total of 51,666 subjects were finally included.

OUTCOME MEASURES

The 2006 Spanish National Health Survey (SNHS) and the 2009 European Health Interview Survey for Spain (EHISS).

METHODS

We analyzed data from the 2006 SNHS (n=29,478) and the 2009 EHISS (n=22,188). We considered the presence of NP, LBP, and both NP&LBP. We analyzed sociodemographic features, self-perceived health status, lifestyle habits, and comorbid diseases using logistic regression models.

RESULTS

In 2009, the 1-year prevalence was 5.2% (95% confidence interval 4.8-5.5) for NP, 7.9% (7.4-8.3) for LBP, and 10.6% (10.2-11.1) for NP&LBP. Women increased the probability of NP and NP&LBP but decreased the probability of LBP. The prevalence of all pain localizations increased with age. Not practicing exercise or being obese was associated with lower NP and higher NP&LBP. One-year prevalence of NP decreased from 2006 (7.57%) to 2009 (5.18%) (prevalence ratio [PR] 0.66, 0.60-0.72; men: 0.68, 0.61-0.75; women: 0.66, 0.60-0.72). The prevalence of LBP did not change (PR 0.93, 0.86-101) from 2006 (8.34%) to 2009 (7.86%). The prevalence of NP&LBP decreased from 12.53% in 2006 to 10.61% in 2009 (PR 0.81, 0.75-0.86; men: 7.73% to 6.36%, PR 0.80, 0.70-0.90; women: 17.15% to 14.69%, PR 0.81, 0.74-0.87).

CONCLUSIONS

The prevalence of NP and NP&LBP, but not LBP, has decreased in the last years in Spain. NP&LBP were associated with similar sociodemographic and lifestyle habits in 2009 compared with 2006.

Musculoskeletal Pain Disorders among Secondary School Saudi Female Teachers

Objective. This study was conducted to estimate prevalence and pattern of musculoskeletal pain disorders among secondary school Saudi female teachers in Al-Khobar area and the psychodemographic and psychosocial factors that may affect them. Material and Method. A cross-sectional study was conducted using sample of secondary schools teachers (governmental and private school) in Al-Khobar area, Saudi Arabia (KSA). Data were collected using a structured self-administered questionnaire. Result. Prevalence of musculoskeletal pain disorders was 79.17%. Main sites of pain were lower back (63.8%) followed by shoulder (45.4%), neck (42.1%), leg (40.0%), wrist (16.2%), and elbow joint (10.0%). Factors that showed significant relationship were type of school (p value 0.038), age (p value 0.002), weight (p value 0.007), number of children (p value 0.006), shoe type (p value 0.000), teaching years (p value 0.003), and working daily hours (p value 0.027). Conclusion. Secondary school female teachers showed high prevalence of musculoskeletal pain disorders in most anatomic sites, namely, the back, shoulder, neck, legs, wrist, and elbow joint. Risk factors associated with significant pain were type of school, age, weight, number of children, and number of teaching years.

Prevalence of migraine headaches in the Romany population in Spain: sociodemographic factors, lifestyle and co-morbidity

PURPOSE

To compare the prevalence of migraine headaches in the Romany population with the prevalence in the general Spanish population and to describe its association with demographic and clinical risk factors.

METHOD

A cross-sectional study using data from the 2006 Spanish National Health Survey (n = 16,079) and the National Health Survey in the Romany Population (n = 993). Inclusion criteria were migraine headache diagnosed by a neurologist, suffered over the preceding 2 weeks that reduced work or leisure activity by half a day or more.

RESULTS

The prevalence of migraine in the Romany population (29.4%, 95% confidence interval [CI] = 26.48-32.53) was significantly higher than in the general Spanish population (12.52%, 95% CI = 11.85-13.22). Females (odds ratio [OR] = 1.56, 95% CI = 1.10-2.21), those ≤40 years old (OR = 4.17, 95% CI = 1.78-9.62), those sleeping ≤8 hours/day or less (OR = 1.85, 95% CI = 1.32-2.59), those with body mass index >30 kg/m(2) (OR = 1.75, 95% CI = 1.15-2.65), those suffering from osteoarthritis (OR = 2.59, 95% CI = 1.54-4.36), and those suffering from allergy (OR = 1.69, CI = 1.05-2.71) were associated with higher incidence of migraines. Romanies with migraines reported worse self-perceived health status (OR = 2.11, 95% CI = 1.41-3.15) and higher incidence of depression (OR = 2.09 95% CI = 1.32-3.30) than those without.

DISCUSSION

Prevalence of migraines is greater in the Romany living in Spain than in the general Spanish population.

IMPLICATION

Public health systems should focus prevention campaigns specifically on this population and concentrate on those factors that are potentially modifiable.

Prevalence of chronic head, neck and low back pain and associated factors in women residing in the Autonomous Region of Madrid (Spain)

OBJECTIVE

To compare the prevalence of chronic headache (CH), chronic neck pain (CNP) and chronic low back pain (CLBP) in the autonomous region of Madrid by analyzing gender differences and to determine the factors associated with each pain location in women in 2007.

METHODS

We analyzed data obtained from adults aged 16 years or older (n = 12,190) who participated in the 2007 Madrid Regional Health Survey. This survey includes data from personal interviews conducted in a representative population residing in family dwellings in Madrid. The presence CH, CNP, and CLBP was analyzed. Sociodemographic features, self-perceived health status, lifestyle habits, psychological distress, drug consumption, use of healthcare services, the search for alternative solutions, and comorbid diseases were analyzed by using logistic regression models.

RESULTS

The prevalence of CH, CNP and CLBP was significantly higher (P<0.001) in women (7.3%, 8.4%, 14.1%, respectively) than in men (2.2%, 3.2%, 7.8%, respectively). In women, CH, CNP and CBLP were significantly associated with having ≥3 chronic diseases (OR 7.1, 8.5, 5.8, respectively), and with the use of analgesics and drugs for inflammation (OR: 3.5, 1.95, 2.5, respectively). In the bivariate analysis, the factors associated with pain in distinct body locations differed between men and women.

CONCLUSIONS

This study found that CH, CNP and CLBP are a major public health problem in women in central Spain. Women have a higher overall prevalence of chronic pain than men. Chronic pain was associated with a higher use of analgesics and healthcare services.

Increasing prevalence of chronic musculoskeletal complaints. A large 11-year follow-up in the general population (HUNT 2 and 3)

OBJECTIVES

To assess the prevalence of chronic musculoskeletal complaints (MSCs) in a large adult population, and to determine any changes in prevalence during an 11-year period.

METHODS

This study involved two large cross-sectional surveys (Helseundersøkelsen i Nord-Trøndelag [HUNT] 2 and 3) of inhabitants in Nord-Trøndelag county aged ≥20 years performed in 1995-97 (N = 92,936) and 2006-08 (N = 94,194). Attendance rates were 70 and 42%, respectively. Respondents with chronic MSCs were identified through the screening question "Have you during the last year continuously for at least 3 months had pain and/or stiffness in muscles and joints?" The reliability of the screening question was evaluated in a random sample of participants (N = 563).

RESULTS

The reliability of the screening question was good (kappa value 0.63, 95% confidence interval [CI] 0.53-0.73). In HUNT 3, 48% had chronic MSCs and 20% had chronic widespread MSCs. The age-adjusted prevalence of chronic MSCs was higher (P < 0.001) in HUNT 3 (47.9%, 95% CI 47.6-48.2) compared with HUNT 2 (44.8%, 95% CI 44.5-45.2), evident for both genders, and most prominent in the age group 20-29 years. Chronic widespread MSCs were more common in HUNT 3 than in HUNT 2 among women (28.2 vs 26.0%, P < 0.001). Increased prevalence during the 11-year period was also found in supplementary analyses evaluating the influence of differences in participation rate.

CONCLUSIONS

The prevalence of chronic MSCs and chronic widespread MSCs is high. The prevalence of chronic MSCs increased during the 11-year period. A nonresponse bias interfering with the comparisons over time could not completely be ruled out.