Obesity is a risk factor for musculoskeletal pain in adolescents: findings from a population-based cohort

Sleep, Nutrition, and Health Maintenance in Cardiothoracic Surgery

Cardiothoracic surgeons work in high-intensity environments starting in surgical training and throughout their careers. They deal with critical patients. Their routine procedures are delicate, require extensive attention to detail, and can have detrimental effects on patients' lives. Cardiothoracic surgeons are required to perform at their best capacity incessantly. To do this, they must safeguard their mental and physical well-being. Preserving health through sleep, nutrition, exercise, and routine medical checkups ensures a cardiothoracic surgeon's well-being. Great personal effort and discipline is required to maintain health in a busy schedule. We offer our best recommendations from expert peers in the field.

Feasibility of wearable activity tracking devices to measure physical activity and sleep change among adolescents with chronic pain-a pilot nonrandomized treatment study

Purpose

Personal informatics devices are being used to measure engagement in health behaviors in adults with chronic pain and may be appropriate for adolescent use. The aim of this study was to evaluate the utilization of a wearable activity tracking device to measure physical activity and sleep among adolescents attending a three-week, intensive interdisciplinary pain treatment (IIPT) program. We also assessed changes in physical activity and sleep from baseline to the treatment phase.

Methods

Participants (57.1% female, average age 15.88, SD = 1.27) wore an activity tracking device three weeks prior to starting and during the treatment program.

Results

Of 129 participants contacted, 47 (36.4%) agreed to participate. However, only 30 (64%) complied with the instructions for using the device prior to programming and during program participation. Preliminary analyses comparing averages from 3-weeks pre-treatment to 3-weeks during treatment indicated increases in daily overall activity minutes, daily step counts, and minutes of moderate to vigorous physical activity (by 353%), as well as a corresponding decrease in sedentary minutes. There was more missing data for sleep than anticipated.

Conclusions

Wearable activity tracking devices can be successfully used to measure adolescent physical activity in-person, with more difficulty obtaining this information remotely. Adolescents with chronic pain experience improvements in objective measurements of physical activity over the course of a 3-week IIPT program. Future studies may want to spend more time working with pediatric patients on their understanding of how to use trackers for sleep and physical activity.

Does spinal deformity affect adolescents' quality of life before we tell them it should?

PURPOSE

The Scoliosis Research Society 22r Questionnaire(SRS-22r) is the standard for assessing health-related quality of life(HRQoL) in patients with adolescent idiopathic scoliosis. Here we investigate whether patients' perceptions of their HRQoL are influenced by knowledge of scoliosis and counseling by an orthopedic surgeon.

METHODS

Patients ages 10-18 years referred for their first visit with an orthopaedic surgeon for scoliosis were enrolled from 9/30/19 to 10/22/20. Patients completed the SRS-22r pre- and post-visit. A Wilcoxon signed-rank test was used to analyze the SRS-22r scores.

RESULTS

52 patients participated in the study at a mean age of 14.3 years (95% CI 13.8-14.8 years) with an average major curve magnitude of 23.2 degrees (95% CI 19.4-27.0 degrees). SRS-22r scores were not correlated to curve magnitude pre- or post-visit. The SRS-22r Satisfaction with care domain exhibited a small increase from pre- to post-visit (pre: 3.3, post: 3.6). All other SRS-22r domains and total scores did not exhibit clinically significant differences.

CONCLUSION

Among new adolescent referrals for scoliosis, it is unlikely that counseling by a surgeon influences perceptions of HRQoL as measured by the SRS-22r.

LEVEL OF EVIDENCE

III.

Automated measurement of size of spinal curve in population-based cohorts: Validation of a method based on total body dual energy X-ray absorptiometry scans

BACKGROUND

Scoliosis is spinal curvature that may progress to require surgical stabilisation. Risk factors for progression are little understood due to lack of population-based research, since radiographs cannot be performed on entire populations due to high levels of radiation. To help address this, we have previously developed and validated a method for quantification of spinal curvature from total body dual energy X-ray absorptiometry (DXA) scans. The purpose of this study was to automate this quantification of spinal curve size from DXA scans using machine learning techniques.

METHODS

To develop the automation of curve size, we utilised manually annotated scans from 7298 participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 9 and 5122 at age 15. To validate the automation we assessed (1) agreement between manual vs automation using the Bland-Altman limits of agreement, (2) reliability by calculating the coefficient of variation, and (3) clinical validity by running the automation on 4969 non-annotated scans at age 18 to assess the associations with physical activity, body composition, adipocyte function and backpain compared to previous literature.

RESULTS

The mean difference between manual vs automated readings was less than one degree, and 90.4 % of manual vs automated readings fell within 10°. The coefficient of variation was 25.4 %. Clinical validation showed the expected relationships between curve size and physical activity, adipocyte function, height and weight.

CONCLUSION

We have developed a reasonably accurate and valid automated method for quantifying spinal curvature from DXA scans for research purposes.

Short-Term Changes in Posture and Pain of the Neck and Lower Back of Women Undergoing Lipoabdominoplasty: A Case Series Report

Objective

The purpose of this study was to analyze short-term variations in posture and intensity of neck and lower back pain in women undergoing lipoabdominoplasty.

Methods

This prospective case series study involved 17 women (age 43 ± 12 years, presurgical body mass index 27.0 ± 3.7 kg/m2). Participants were assessed preoperatively (T0) and at 15 (T15) and 30 days (T30) after surgery for clinical data (number of pregnancies, number of deliveries, presurgical body mass), neck and lower back angles calculated by photogrammetry, and pain intensity by numeric pain rating scale. Postoperative complications were assessed at T15 and T30.

Results

After adjusting for age and presurgical body mass index, there was an increase in forward head position in T15 and a return by T30 (marginal R2 = 0.411). The lower back showed an increase in flexion at T15 and return by T30 (marginal R2 = 0.266). No statistical evidence of significance was observed for changes in the intensity of neck (P > .355) or lower back (P > .293) pain. Complications were mild and common at T15; most of them resumed at T30.

Conclusion

A transient, nonlinear compensatory change in neck and lower back lordosis was observed 15 days after lipoabdominoplasty, with almost full recovery in the short term (30 days). No systematic change in pain intensity was observed within this period. Postsurgical complications were mild and common, and most of them resumed shortly after surgery.

Combined high-intensity interval training as an obesity-management strategy for adolescents

Effective and safe exercise protocols for obesity management in adolescents are imperative. This study aimed to analyse compliance, efficacy, and safety of combined high-intensity interval training circuit (HIIT) in the management of obesity (including overweight) in adolescents, compared to traditional training (TT). Data from 55 adolescents (47.3% girls) (TT n = 31; HIIT n = 24), aged 12-18 (mean age of 14.3 ± 1.7), with overweight and obesity (median BMI z-score of 2.95), were assessed at baseline and month 6 (Clinicaltrials.gov/NCT02941770). During the 6-month intervention, participants in both exercise groups attended two exercise sessions/week (60 min/session) along with a set of appointments with a paediatrician, nutritionist, and exercise physiologist. Forty-six participants completed the intervention (TT n = 23; HIIT n = 23). Exercise session attendance (≥80%) was significantly higher among HIIT participants (73.9 vs. 13.0%, p < .001). HIIT, but not TT, showed a significant decrease in BMI z-score (d = 0.40, p < .001), body fat mass (BFM, %) (d = 0.41, p = .001), and trunk fat mass (d = 0.56, p < .001), as well as a significant increase in muscle mass (MM, %) (d = 0.28, p = .001) between baseline and 6 months. According to generalized estimating equations, time-by-attendance interactions (instead of time-by group) were found in BMI z-score (β = 0.25, 95%CI: 0.17, 0.33), BFM (β = 2.29, 95%CI: 1.02, 3.56), trunk fat mass (β = 2.94, 95%CI: 1.70, 4.18), and MM (β = -1.16, 95%CI: -1.87, -0.45). No adverse events were reported during HIIT sessions. Although compliance may mediate the impact of an exercise protocol on health-related outcomes, HIIT showed to be safe, with higher compliance compared to TT, which may result in improved outcomes overtime.

Multidimensional pain profiling in people living with obesity and attending weight management services: a protocol for a longitudinal cohort study

INTRODUCTION

Pain is prevalent in people living with overweight and obesity. Obesity is associated with increased self-reported pain intensity and pain-related disability, reductions in physical functioning and poorer psychological well-being. People living with obesity tend to respond less well to pain treatments or management compared with people living without obesity. Mechanisms linking obesity and pain are complex and may include contributions from and interactions between physiological, behavioural, psychological, sociocultural, biomechanical and genetic factors. Our aim is to study the multidimensional pain profiles of people living with obesity, over time, in an attempt to better understand the relationship between obesity and pain.

METHODS AND ANALYSIS

This longitudinal observational cohort study will recruit (n=216) people living with obesity and who are newly attending three weight management services in Ireland. Participants will complete questionnaires that assess their multidimensional biopsychosocial pain experience at baseline and at 3, 6, 12 and 18 months post-recruitment. Quantitative analyses will characterise the multidimensional pain experiences and trajectories of the cohort as a whole and in defined subgroups.

ETHICS AND DISSEMINATION

The study protocol has been approved by the Ethics and Medical Research Committee of St Vincent's Healthcare Group, Dublin, Ireland (reference no: RS21-059) and the University College Dublin Human Research Ethics Committee (reference no: LS-E-22-41-Hinwood-Smart). Findings will be disseminated through peer-reviewed journals, conference presentations, public and patient advocacy groups, and social media.

STUDY REGISTRATION

Open Science Framework Registration DOI: https://doi.org/10.17605/OSF.IO/QCWUE.

Sedentary behavior and neck pain in children and adolescents; a systematic review and meta-analysis

Background: Sedentary behavior (SB) is considered a risk factor for musculoskeletal pain. We aimed to explore the association of sedentary behavior indicators with neck pain among children and adolescents. Methods: A comprehensive review was performed in different databases until the end of January 2022. Odds ratios (ORs) with 95% confidence intervals were used as desired effect sizes to evaluate the association between prolonged screen time or mobile phone (MP) usage and neck pain risk. Results: Among 1651 records, 15 cross-sectional studies were included in the systematic review, and 7 reports were included in the meta-analysis. Our results suggested a significant relationship between prolonged MP use and neck pain (OR=1.36, 95% CI=1.001-1.85, I²=40.8%, P value for heterogeneity test=0.119). Furthermore, a marginally insignificant association was found between prolonged screen time and neck pain (OR=1.13, 95% CI=0.98-1.30, I²=60.3%, P value=0.01); however, after sensitivity analysis and removing one study, this association became significant (OR=1.30, 95% CI=1.03-1.64). Moreover, a significant association between prolonged sitting time and neck pain was reported in two studies. Conclusion: Available good-quality evidence reveals a significant mild association between sedentary behavior and the risk of neck pain among children and adolescents. However, longitudinal studies with objective measurement tools are warranted. In particular, potential preventive educational programs are suggested for pediatrics to reduce sedentary behavior and neck pain.

Correlation of Percentage Body Fat, Waist Circumference and Waist-to-Hip Ratio with Abdominal Muscle Strength

Sedentary lifestyle and consumption of high-fat foods have become widespread, especially in the urban population. This leads to a reduction in lean body mass and increased body fat. The correlation between body fat indices and low back pain has been less explored and documented. The aim of this study was to identify the correlation between the percentage of body fat, waist circumference and waist-to-hip ratio and abdominal muscle strength. Percentage of body fat was estimated by using the body composition analyzer method using Tanita BC-545 Innerscan Segmental Body Composition. Waist-to-hip ratio was calculated by dividing the waist circumference by hip circumference. Abdominal muscle (rectus abdominis and external oblique) strength was measured by maximum voluntary isometric contraction as measured by surface electromyography. A positive correlation was observed between waist circumference and the percentage of body fat, while a negative correlation was observed between the average maximum voluntary isometric contraction of rectus abdominis and external oblique muscles and the percentage of body fat. Individuals with a high percentage of body fat tend to have higher fat distribution over the abdominal region and decreased abdominal muscle strength. Therapists should emphasize the use of abdominal muscles in individuals with high body fat in order to reduce the associated risk of the development of poor posture and low back pain.

Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case-control study

OBJECTIVE

To test whether variant connective tissue structure, as indicated by the presence of joint hypermobility, poses a developmental risk for mood disorders in adolescence.

DESIGN

Cohort-based case-control study.

SETTING

Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) were interrogated.

PARTICIPANTS

6105 children of the ALSPAC cohort at age 14 years old, of whom 3803 also were assessed when aged 18 years.

MAIN OUTCOME MEASURES

In a risk analysis, we examined the relationship between generalised joint hypermobility (GJH) at age 14 years with psychiatric symptoms at age 18 years. In an association analysis, we examined the relationship between presence of symptomatic joint hypermobility syndrome (JHS) and International Classification of Diseases-10 indication of depression and anxiety (Clinical Interview Schedule Revised (CIS-R), Anxiety Sensitivity Index) at age 18 years.

RESULTS

GJH was more common in females (n=856, 28%) compared with males (n=319, 11%; OR: 3.20 (95% CI: 2.78 to 3.68); p<0.001). In males, GJH at age 14 years was associated with depression at 18 years (OR: 2.10 (95% CI: 1.17 to 3.76); p=0.013). An index of basal physiological arousal, elevated resting heart rate, mediated this effect. Across genders, the diagnosis of JHS at age 18 years was associated with the presence of depressive disorder (adjusted OR: 3.53 (95% CI: 1.67 to 7.40); p=0.001), anxiety disorder (adjusted OR: 3.14 (95% CI: 1.52 to 6.46); p=0.002), level of anxiety (B=8.08, t(3278)=3.95; p<0.001) and degree of psychiatric symptomatology (B=5.89, t(3442)=5.50; p<0.001).

CONCLUSIONS

Variant collagen, indexed by joint hypermobility, is linked to the emergence of depression and anxiety in adolescence, an effect mediated by autonomic factors in males. Recognition of this association may motivate further evaluation, screening and interventions to mitigate development of psychiatric disorders and improve health outcomes.

Chronic widespread pain in children and adolescents presenting in primary care: prevalence and associated risk factors

ABSTRACT

A significant proportion of children/adolescents report chronic widespread pain (CWP), but little is known about clinically relevant CWP or what factors lead to onset in this population. Objectives were to report the primary care consultation prevalence of CWP and investigate risk factors associated with onset. A validated algorithm for identifying CWP status from primary care electronic healthcare records was applied to a child or adolescent population (aged 8-18 years). The algorithm records patients who have recurrent pain consultations (axial skeleton and upper or lower limbs) or those with a nonspecific generalised pain disorder (eg, fibromyalgia). Prevalence was described, and a nested case-control study was established to identify risk factors associated with CWP onset using logistic regression producing odds ratios (ORs) and 95% confidence intervals (95% CIs). Two hundred seventy-one children or adolescents were identified with CWP, resulting in a 5-year consultation prevalence of 3.19%. Risk factors significantly associated with CWP onset were as follows: mental health (eg, anxiety/neurosis consultations), neurological (eg, headaches), genitourinary (eg, cystitis), gastrointestinal (eg, abdominal pain), and throat problems (eg, sore throats). Children or adolescents with 1 or 2 risk factors (OR 2.15, 95% CI 1.6-2.9) or 3 or more risk factors (OR 9.17, 95% CI 5.9-14.3) were at significantly increased odds of CWP onset compared with those with none. Findings show a significant proportion of the child or adolescent primary care population has CWP. Most risk factors involved pain-related conditions, suggesting potential pathways of pain development. Further work is now needed to better understand the development of CWP in children and adolescents.

[Conservative treatment options for arthritis of the ankle : What is possible, what is effective?]

In this article the causes of arthritis in the region of the ankle are introduced and the conservative treatment options are described and discussed more extensively. The risks of treatment with nonopioid analgesics (NOPA) are presented in detail. The topical use of nonsteroidal anti-inflammatory drugs (NSAID) should always be considered in the clinical routine. If contraindications for oral NSAIDs are present, intra-articular treatment is a meaningful option. The best evidence is currently available for viscosupplementation but the study situation for the use of platelet-rich plasma (PRP) is still not sufficiently comprehensive and there are only a few case reports on the use of mesenchymal stem cells..

Anxiety and depressive symptoms among adults with obesity and chronic pain: the role of anxiety sensitivity

Obesity and chronic pain frequently co-occur, and this co-occurrence can have potential negative consequences, particularly as it relates to mental health. As such, there is a need to understand potential risk factors for poor mental health among this co-morbid population. Thus, the current study examined the predictive role of anxiety sensitivity (and its sub-facets) on anxiety and depressive symptoms among adults (82.5% female, M_age = 40.2 years, SD = 10.92) with obesity and chronic pain. Results revealed that greater levels of anxiety sensitivity were associated with greater levels of both anxiety and depressive symptoms, with medium to large effect sizes. Post hoc analyses also indicated that specific sub-facets of anxiety sensitivity (cognitive and social concerns) were significant predictors of the criterion variables. The current study highlights the potential clinical utility in targeting anxiety sensitivity among individuals with co-occurring obesity and chronic pain in the treatment of anxiety and depressive symptoms.

Incidence and factors associated with low back pain in adolescents: A prospective study

BACKGROUND

Low back pain (LBP) is a common complaint among children and adolescents and can negatively impact their physical and mental health. Although previous studies investigating the incidence of low back pain (LBP) in children and adolescents have been performed in high income countries, it is unclear whether countries such as Brazil would show similar incidence rates.

OBJECTIVE

To determine the incidence and to identify predictors of new episodes of LBP in high school students.

METHODS

This is a 1-year longitudinal study of high school students from public schools in the city of Bauru, Sao Paulo. Collected clinical data were: demographic and socioeconomic factors, information on the use of electronic devices, mental health status (the Strengths and Difficulties Questionnaires), level of habitual physical activity (Baecke Physical Activity Questionnaire), and incidence of LBP (measured with question about LBP in the past 12 months and the Nordic Musculoskeletal Questionnaire). Descriptive analysis and bivariate and multivariate logistic regressions were performed.

RESULTS

The cumulative incidence of new LBP episodes for the total cohort of 757 high school students was 18.9% (95% CI: 16.2, 21.8). The cumulative incidence was 14.8% (95% CI: 11.7, 18.5) for male students and 24.1% (95% CI: 19.8, 29.9) for female students. Being a female student (OR = 1.78; 95% CI: 1.23, 2.59), sitting posture while using tablet (OR = 4.34; 95% CI: 1.19, 16.60), daily time spent on tablet (OR = 3.21; 95% CI: 1.41, 7.30), daily time spent on mobile phone (OR =1.49; 95% CI: 1.11, 2.00), lying posture while using mobile phone (OR = 1.49; 95% CI: 1.05, 2.12), and mental health status (OR = 2.81; 95% CI: 1.76, 4.48) were identified as predictor variables.

CONCLUSION

Our findings showed that one in five high school students reported having a LBP episode over the last year. The predictors found to be associated with low back pain include those related to sex, time and posture while using electronic devices, and mental health status.

Is adiposity associated with back and lower limb pain? A systematic review

BACKGROUND

Back and lower limb pain have a major impact on physical function and quality of life. While obesity is a modifiable risk factor for musculoskeletal pain, the role of adiposity is less clear. This systematic review aimed to examine the relationship between both adiposity and its distribution and back and lower limb pain.

METHODS

A systematic search of electronic databases was conducted to identify studies that examined the association between anthropometric and/or direct measures of adiposity and site specific musculoskeletal pain. Risk of bias was assessed and a best evidence synthesis was performed.

RESULTS

A total of 56 studies were identified which examined 4 pain regions, including the lower back (36 studies), hip (two studies), knee (13 studies) and foot (eight studies). 31(55%) studies were assessed as having low to moderate risk of bias. 17(30%) studies were cohort in design. The best evidence synthesis provided evidence of a relationship between central adiposity and low back and knee pain, but not hip or foot pain. There was also evidence of a longitudinal relationship between adiposity and the presence of back, knee and foot pain, as well as incident and increasing foot pain.

CONCLUSIONS

This systematic review provides evidence of an association between both body fat and its central distribution and low back and knee pain, and a longitudinal relationship between adiposity and back, knee and foot pain. These results highlight the potential for targeting adiposity in the development of novel treatments at these sites.

An adolescent rat model of vincristine-induced peripheral neuropathy

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Vincristine treatment in adolescent rat induces significant mechanical and cold allodynia and muscle weakness.

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Voluntary exercise prevents vincristine-induced peripheral neuropathy.

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Vincristine treatment during early adolescence produces more severe peripheral neuropathy than treatment during late adolescence.

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Peripheral neuropathy induced by vincristine during adolescence persists into early adulthood.

Childhood acute lymphoblastic leukemia (ALL) is a significant clinical problem that can be effectively treated with vincristine, a vinca alkaloid-based chemotherapeutic agent. However, nearly all children receiving vincristine treatment develop vincristine-induced peripheral neuropathy (VIPN). The impact of adolescent vincristine treatment across the lifespan remains poorly understood. We, consequently, developed an adolescent rodent model of VIPN which can be utilized to study possible long term consequences of vincristine treatment in the developing rat. We also evaluated the therapeutic efficacy of voluntary exercise and potential impact of obesity as a genetic risk factor in this model on the development and maintenance of VIPN. Out of all the dosing regimens we evaluated, the most potent VIPN was produced by fifteen consecutive daily intraperitoneal (i.p.) vincristine injections at 100 µg/kg/day, throughout the critical period of adolescence from postnatal day 35 to 49. With this treatment, vincristine-treated animals developed hypersensitivity to mechanical and cold stimulation of the plantar hind paw surface, which outlasted the period of vincristine treatment and resolved within two weeks following the cessation of vincristine injection. By contrast, impairment in grip strength gain was delayed by vincristine treatment, emerging shortly following the termination of vincristine dosing, and persisted into early adulthood without diminishing. Interestingly, voluntary wheel running exercise prevented the development of vincristine-induced hypersensitivities to mechanical and cold stimulation. However, Zucker fa/fa obese animals did not exhibit higher risk of developing VIPN compared to lean rats. Our studies identify sensory and motor impairments produced by vincristine in adolescent animals and support the therapeutic efficacy of voluntary exercise for suppressing VIPN in developing rats.

Helping Children with Obesity "Move Well" To Move More: An Applied Clinical Review

ABSTRACT

Children with obesity experience musculoskeletal pain and reduced physical function and well-being, which collectively impact their fitness, strength, motor skills, and even their ability to undertake simple tasks, like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children's physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity.

Modulatory Effect of Probiotic Lactobacillus rhamnosus PB01 on Mechanical Sensitivity in a Female Diet-Induced Obesity Model

Obese animals and humans demonstrate higher sensitivity to pain stimuli. Among the endogenous factors prompting obesity, the intestinal microbiota has been proposed to influence responsiveness to pain. The beneficial effects of probiotics on obesity are well documented, whereas data on their analgesic efficacy is minimal. The protective effect of probiotics on nociception in diet-induced obese male mice has been previously demonstrated, but the sex differences in pain sensitivity and analgesic response do not allow for the generalization of these findings to the female gender. Hence, this study aimed at investigating the potential effects of oral probiotic supplementation on mechanical pain thresholds in female diet-induced obese mice compared with controls. Thirty-two adult female mice (N=32) were randomly divided into two groups receiving standard (normal-weight group; NW) or high-fat diet (diet-induced obesity; DIO). All rats received a single daily dose (1 × 109 CFU) of probiotics (Lactobacillus rhamnosus PB01, DSM14870) for four weeks by gavage. Mechanical pain thresholds were recorded by an electronic von Frey device at baseline, at the end of weeks 2, 4, 6, and 8 in both DIO and NW groups with and without consumption of probiotics. Blood samples were obtained for the measurement of lipid profile and reproductive hormone levels. Bodyweight was considerably lower (P < 0.001) in groups supplied with probiotics than groups without probiotics. Pressure pain threshold values showed a significant (P < 0.001) increase (reduced pain sensitivity) following probiotic supplementation, proposing a modulatory effect of probiotics on mechanical sensory circuits and mechanical sensitivity, which might be a direct consequence of weight loss or an indirect result of the probiotics' anti-inflammatory properties. Understanding the precise underlying mechanism for the effect of probiotics on weight loss and mechanical pain sensitivity seen in this study warrants further investigation.

The effect of obesity on pain severity and pain interference

Aim: Obesity is one of the most prevalent comorbidities associated with chronic pain, which can severely interfere with daily living and increase utilization of clinical resources. We hypothesized that a higher level of obesity, measured by BMI, would be associated with increased pain severity (intensity) and interference (pain related disability). Materials & methods: Participant data was pulled from a multisite chronic pain outpatient database and categorized based on BMI. Results: A total of 2509 patients were included in the study. We found significant differences between BMI groups for all pain severity scores (worst, least, average, current) and total pain interference score. Obese patients had significantly higher scores than normal weight patients. Conclusion: We found obesity to be associated with increased pain severity and pain interference.

Circulating inflammatory biomarkers in adolescents: evidence of interactions between chronic pain and obesity

Introduction

The negative effects of chronic pain and obesity are compounded in those with both conditions. Despite this, little research has focused on the pathophysiology in pediatric samples.

Objective

To examine the effects of comorbid chronic pain and obesity on the concentration of circulating inflammatory biomarkers.

Methods

We used a multiple-cohort observational design, with 4 groups defined by the presence or absence of obesity and chronic pain: healthy controls, chronic pain alone, obesity alone, as well as chronic pain and obesity. Biomarkers measured were leptin, adiponectin, leptin/adiponectin ratio (primary outcome), tumor necrosis factor-alpha, interleukin 6, and C-reactive protein (CRP).

Results

Data on 125 adolescents (13-17 years) were analyzed. In females, there was an interaction between chronic pain and obesity such that leptin and CRP were higher in the chronic pain and obesity group than in chronic pain or obesity alone. Within the chronic pain and obesity group, biomarkers were correlated with worsened pain attributes, and females reported worse pain than males. The highest levels of interleukin 6 and CRP were found in youth with elevated weight and functional disability. We conclude that in adolescents, chronic pain and obesity interact to cause dysregulation of the inflammatory system, and this effect is more pronounced in females.

Conclusion

The augmented levels of inflammatory biomarkers are associated with pain and functional disability, and may be an early marker of future pain and disability.

Investigating the Relationship between Body Mass Index and Pain in the Spine in Children or Adolescents: A Systematic Review

Background: Neck pain (NP), back pain (BP), and low back pain (LBP) are generally defined as "pain in the spine." With the increasing prevalence of childhood obesity, secondary problems such as pain in the spine have arisen. The purpose of this review was to investigate the relationship between body mass index (BMI) and pain in the spine in children or adolescents. Methods: Publications were searched in PubMed, Web of Science, Scopus, and Google Scholar databases up to December 12, 2020. The search strategy in the database consisted of free text words and MeSH terms. Results: Twelve studies were reviewed. It was determined that different methods were used in all 12 studies to evaluate pain. In the evaluation of overweight/obesity, these studies performed BMI assessment by dividing body weight in kilograms by height squared. Five studies showed a relationship between LBP and BMI, two studies showed a relationship between BP and BMI, and two studies showed a relationship between NP and BMI. Conclusions: The review shows that there is a relationship between BMI and pain in the spine, especially LBP. There may be factors affecting this condition such as mechanical loading and hormonal metabolic activity in childhood and adolescence. Different methods are used in the studies in literature for the assessment pain in the spine and BMI, overweight, and obesity.

The effect of obesity on pain and disability in chronic shoulder pain patients

OBJECTIVE

This study aimed to investigate the relationship between chronic shoulder pain and the increase in BMI.

METHODS

A prospective, cross-sectional study design was adopted for the study. Two hundred and eighty-five patients with chronic shoulder pain were evaluated for eligibility. A total of 94 patients were excluded from the study. The 191 remaining volunteers filled out a questionnaire (Pain (VAS), Shoulder Pain and Disability Index (SPADI)) and weight, height, C-reactive protein (CRP) results and 1-hour-rate of erythrocyte sedimentation rate (ESR) were measured. The participants were dived into the normal weight, overweight or obese group, considering the obesity classification defined by the World Health Organization (WHO).

RESULTS

A statistically significant correlation was found between the increase in BMI and pain (VAS), SPADI (pain, activity and total) and ESR. Although there was no statistically significant difference between the normal weight and overweight groups in all parameters, there was a statistically significant difference between the obese group and other groups.

CONCLUSIONS

Shoulder pain may associated with obesity and we recommend the addition of weight control to the treatment of patients with shoulder pain.

Back and neck pain and poor sleep quality in adolescents are associated even after controlling for confounding factors: An epidemiological study

Objective

Back pain and poor sleep quality are public health issues. Relating to adolescents particularly, the way in which this relationship can occur is still unclear. The aim of this study was to investigate whether low back and neck pain are associated with sleep quality among adolescents.

Material and Methods

In total, 1011 randomly selected adolescents participated in this study. Neck and back pain were assessed using the Nordic questionnaire, while sleep quality was assessed through the Mini-Sleep Questionnaire. The confounding variables used in the statistical analysis were age, socioeconomic status, physical activity, and body mass index. To analyze the associations between sleep quality and low back and neck pain, multivariate models and binary logistic regression were used.

Results

19.9% of the girls reported low back pain while 18.9% reported neck pain. 15.6% of the boys reported low back or neck pain. Regarding low sleep quality, the prevalence was 46.0% for girls and 49.6% for boys. An association was observed between low back pain and sleep quality among girls (OR=1.98 [1.25 - 3.12]) and boys (OR=2.58 [1.48 - 4.50]). An association between neck pain and sleep quality was also observed among girls (OR=2.27 [1.41 - 3.64]) and boys (OR=2.80 [1.59 - 4.91]).

Conclusion

Low back pain and neck pain were associated with poor sleep quality among adolescents even after the insertion of confounding variables.

Serum soluble urokinase plasminogen activator receptor in adolescents: interaction of chronic pain and obesity

Pediatric chronic pain is exacerbated by obesity. Serum soluble urokinase plasminogen activator receptor, a novel inflammation biomarker, was increased in obese adolescents with chronic pain indicating interactive inflammatory conditions.

Introduction:

Obesity in adolescents is increasing in frequency and is associated with short-term and long-term negative consequences that include the exacerbation of co-occurring chronic pain.

Objective:

To determine whether the interaction between chronic pain and obesity would be reflected in changes in serum soluble urokinase plasminogen activator receptor (suPAR) concentrations, a novel marker of systemic inflammation associated with obesity, insulin resistance, and cardiovascular disease.

Methods:

We measured serum suPAR levels in 146 adolescent males and females with no pain or obesity (healthy controls; n = 40), chronic pain with healthy weight (n = 37), obesity alone (n = 41), and the combination of chronic pain and obesity (n = 28).

Results:

Serum suPAR (median [interquartile range]) was not increased by chronic pain alone (2.2 [1.8–2.4] ng/mL) or obesity alone (2.2 [2.0–2.4] ng/mL) but was increased significantly with the combination of chronic pain and obesity (2.4 [2.1–2.7] ng/mL; P < 0.019). This finding confirms the proposition that pain and obesity are inflammatory states that display a classic augmenting interaction.

Conclusion:

We propose that measurement of serum suPAR can be added to the armamentarium of serum biomarkers useful in the evaluation of mechanisms of inflammation in adolescent obesity and chronic pain.

Association of Knee Pain and Crouch Gait in Individuals With Cerebral Palsy

BACKGROUND

Crouch gait (ie, excessive knee flexion) is commonly seen in patients with cerebral palsy (CP) and has been inconsistently linked with knee pain. The definitive cause of knee pain is unknown, but may result from increased joint forces due to crouch gait kinematics. Our purpose was to determine whether knee pain is positively associated with knee flexion in gait among a large sample of ambulatory individuals with CP. We hypothesized that knee pain prevalence would increase as knee flexion increased.

METHODS

In this retrospective study, pain questionnaire and 3-dimensional gait analysis data from 2015 to 2018 were extracted from the medical records of individuals with CP who had a clinical gait analysis. The pain questionnaire asked caregivers/patients to indicate the location of pain and when it occurs. A multivariate logistic regression was performed with minimum knee flexion in stance, patella alta, age, and sex as predictors of knee pain.

RESULTS

Among the 729 participants included in the analysis, 147 reported knee pain (20.1%). The odds of knee pain were not associated with minimum knee flexion in stance or sex. However, the odds of knee pain increased 73.2% when patella alta was present (P=0.008) and tended to increase 2.2% as age increased (P=0.059).

CONCLUSIONS

The data suggest that there is not a meaningful association between crouch gait and knee pain. Having patella alta was associated with pain. Further studies that use validated pain questionnaires are needed to understand the multifactorial etiology of knee pain within ambulatory individuals with CP.

LEVEL OF EVIDENCE

Level III-case-control study.

Prevalence of Hip or Groin Pain in Adolescents: A Systematic Review and Meta-Analysis

Musculoskeletal pain is a common cause of pain in adolescence and can be an important predictor of future pain. The prevalence of hip or groin pain that could potentially affect different adolescent populations has not yet been systematically reviewed. This systematic review aimed to determine the prevalence of hip or groin pain in this population. Five electronic databases were searched until January 2019 for eligible studies that included males and females 13 to 19 years of age. Study selection, data extraction, and risk of bias assessments were completed by 2 independent researchers. Based on inclusion criteria, 8 population-based, 8 clinical, and 4 sports populations were included. Studies were conducted in Europe, North America, and Australia. The prevalence was dichotomized into "0 to 3 months" and "3 months and above." Meta-analyses were performed to estimate the prevalence from 0 to 3 months, and individual estimates were reported for studies of 3 months and above. The overall prevalence of hip or groin pain in all adolescents from 0 to 3 months was 12% (95% confidence interval [CI] 6%, 23%) based on 10 studies, and was 7% (95% CI 6%, 10%) based on 7 population studies. Caution should be applied to these estimates due to substantial study heterogeneity. The pain prevalence in cerebral palsy from 0 to 3 months based on 4 studies was 13% (95% CI 10%, 15%). Individual prevalence estimates were 6% and 31% in obese and 4% in hypermobility populations, respectively, and ranged from 6% to 100% in 4 sports studies. The validity of these estimates is compromised by poor methodological quality.

Body mass in adolescents with chronic pain: observational study

OBJECTIVE

In a paediatric chronic pain population, to determine whether higher body mass was associated with poorer functioning, mood or treatment outcome.

DESIGN

Cross-sectional study with examination of treatment outcomes.

SETTING

Tertiary specialist adolescent pain rehabilitation unit.

PATIENTS

355 adolescents with relatively severe non-malignant chronic pain.

INTERVENTIONS

Intensive 3-week pain rehabilitation programme.

MAIN OUTCOME MEASURES

Objective physical measures (walk, sit-to-stand); self-reported functioning and mood RESULTS: Average body mass index (BMI) in the sample was relatively high (24.2 (SD 5.6)) with 20.5% being classified as obese. However, there were no relationships between body mass and objective physical measures, physical or social functioning, depression or anxiety (all p>0.05). There was a small relationship between higher body mass and greater pain-related fear (r=0.17, p<0.01). Treatment improved all variables (p<0.001) apart from pain intensity. There were no relationships between higher body mass and poorer treatment outcome; in fact, patients with higher BMI showed slightly greater decreases in depression (r=0.12, p<0.05) and pain-specific anxiety (r=0.18, p<0.01) during treatment.

CONCLUSIONS

Higher body mass does not worsen functioning, mood or treatment response in adolescents with disabling chronic pain. Childhood obesity and chronic pain are both stigmatised conditions; clinicians should avoid implying that high body mass alone is a causal factor in the struggles of a young person with chronic pain.

Weight Gain Trajectory and Pain Interference in Young Adulthood: Evidence from a Longitudinal Birth Cohort Study

OBJECTIVE

Obesity is associated with chronic pain, but the contribution of body mass index (BMI) trajectories over the life course to the onset of pain problems remains unclear. We retrospectively analyzed how BMI trajectories during the transition to adulthood were associated with a measure of pain interference obtained at age 29 in a longitudinal birth cohort study.

METHODS

Data from the National Longitudinal Survey of Youth, 1997 Cohort (follow-up from 1997 to 2015), were used to determine BMI trajectories from age 14 to 29 via group trajectory modeling. At age 29, respondents described whether pain interfered with their work inside and outside the home over the past four weeks (not at all, a little, or a lot). Multivariable ordinal logistic regression was used to evaluate pain interference according to BMI trajectory and study covariates.

RESULTS

Among 7,875 respondents, 11% reported "a little" and 4% reported "a lot" of pain interference at age 29. Four BMI trajectory groups were identified, varying in starting BMI and rate of weight gain. The "obese" group (8% of respondents) had a starting BMI of 30 kg/m2 and gained an average of 0.7 kg/m2/y. On multivariable analysis, this group was the most likely to have greater pain interference, compared with "high normal weight" (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.14-1.88), "low normal weight" (OR = 1.45, 95% CI = 1.13-1.87), and "overweight" trajectories (OR = 1.33, 95% CI = 1.02-1.73).

CONCLUSIONS

Obesity and rapid weight gain during the transition to adulthood were associated with higher risk of pain interference among young adults.

Practical Challenges-Use of Paracetamol in Children and Youth Who are Overweight or Obese: A Narrative Review

Worldwide, > 380 million children and adolescents are overweight or obese, including 41 million children aged < 5 years. Obesity can change the pharmacokinetic properties of drugs by altering their distribution, metabolism, and elimination. Thus, children who are overweight or obese are at increased risk for receiving inappropriate doses of commonly used drugs, which can result in treatment failure, adverse events, and/or drug toxicity. This review analyzes available data on paracetamol dosing for pain and fever in children and adolescents who are overweight or obese to identify gaps and challenges in optimal dosing strategies. Literature searches using Medline, Embase, and ClinicalTrials.gov were conducted to identify English-language articles reporting paracetamol pharmacokinetics, dosing practices, and guidelines in children and adolescents who are overweight or obese. Of 24 relevant studies identified, 20 were specific to overweight/obese individuals and 15 were specific to children and/or adolescents. Data on paracetamol pharmacokinetics in children and adolescents who are overweight or obese are lacking, and there is no high-quality evidence to guide paracetamol prescribing practices in these patients. Adult data have been extrapolated to pediatric populations; however, extrapolation does not address differences in paracetamol metabolism in adults versus children; the efficacy and safety effects of such differences are unknown. Given the growing worldwide prevalence of obesity in children and adolescents and the likelihood that paracetamol use in this population will increase accordingly, obesity-specific pediatric dosing guidelines for paracetamol are urgently needed. High-quality research is necessary to inform such guidelines.

Musculoskeletal Pain, Physical Function, and Quality of Life After Bariatric Surgery

OBJECTIVES

To evaluate the longitudinal effects of metabolic and bariatric surgery (MBS) on the prevalence of musculoskeletal and lower extremity (LE) pain, physical function, and health-related quality of life.

METHODS

The Teen Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected data on 242 adolescents undergoing MBS at 5 centers over a 3-year follow-up. Joint pain and physical function outcomes were assessed by using the Health Assessment Questionnaire Disability Index, Impact of Weight on Quality of Life - Kids, and the Short Form 36 Health Survey. Adolescents with Blount disease (n = 9) were excluded.

RESULTS

Prevalent musculoskeletal and LE pain were reduced by 40% within 12 months and persisted over 3 years. Adjusted models revealed a 6% lower odds of having musculoskeletal pain (odds ratio = 0.94, 95% confidence interval: 0.92-0.99) and a 10% lower odds of having LE pain (odds ratio = 0.90, 95% confidence interval: 0.86-0.95) per 10% reduction of BMI. The prevalence of poor physical function (Health Assessment Questionnaire Disability Index score >0) declined from 49% to <20% at 6 months (P < .05), Physical comfort and the physical component scores, measured by the Impact of Weight on Quality of Life - Kids and the Short Form 36 Health Survey, improved at 6 months postsurgery and beyond (P < .01). Poor physical function predicted persistent joint pain after MBS.

CONCLUSIONS

Joint pain, impaired physical function, and impaired health-related quality of life significantly improve after MBS. These benefits in patient-reported outcomes support the use of MBS in adolescents with severe obesity and musculoskeletal pain and suggest that MBS in adolescence may reverse and reduce multiple risk factors for future joint disease.

Potential risk factors and triggers for back pain in children and young adults. A scoping review, part II: unclear or mixed types of back pain

Background

Back pain is a global problem in terms of disability and financially, with a large burden both to the individual and to society. Back pain was previously believed to be uncommon in children. However, there is a growing body of evidence that this is not the case.

Objective

Part I of this scoping review studied risk factors of incident and episodic back pain. In this part II we aimed to identify all risk factors and triggers with unclear or mixed type back pain in young people and to identify any gaps in the literature.

Methods

A scoping review design was selected to summarise the evidence, as there are many studies on “risk factors” for back pain. The scoping review followed the PRISMSA-ScR guidelines. We considered all studies that tested potential risk factors and triggers for thoracic and/or lumbar spine pain, in children, adolescents, and young adults (≤ 24 years). PubMed and Cochrane databases were searched from inception to September 2018, to identify relevant English language articles. The results regarding potential risk factors were separated into temporal precursors and bidirectional risk factors and the studies were classified by study design.

Results

Our comprehensive search strategy identified 7356 articles, of which 83 articles were considered eligible for this review (part II). There were 53 cross-sectional studies and 30 cohort studies. Potential risk factors for back pain were: female sex, older age, later pubertal status, positive family history of back pain, increased growth, and a history of back pain, most of which are temporal precursor variables. There was limited research for the illness factors, spinal posture, and muscle endurance in the development of back pain.

Conclusion

Many of the included studies approached risk factors in similar ways and found factors that were associated with back pain but were not obvious risk factors as causality was uncertain. Future research should be more rigorous and innovative in the way that risk factors are considered. This could be through statistical approaches including cumulative exposures, or longitudinal approaches including multi-trajectory methods. Additionally, data on proposed risk factors should be collected before the onset of back pain.

Chronic Widespread Pain and Fibromyalgia Syndrome: Life-Course Risk Markers in Young People

Although the life-course concept of risk markers as potential etiological influences is well established in epidemiology, it has not featured in academic publications or clinical practice in the context of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). Studies of risk markers are required considerations for evaluation of patients and for research because there is no single cause, pathological feature, laboratory finding, or biomarker for CWP or FMS. The early-life risk markers identified by extensive literature review with best evidence for potential causal influence on the development and progression of CWP and FMS include genetic factors, premature birth, female sex, early childhood adversity, cognitive and psychosocial influences, impaired sleep, primary pain disorders, multiregional pain, physical trauma, infectious illness, obesity and inactivity, hypermobility of joints, iron deficiency, and small-fiber polyneuropathy. The case history illustrates the potential etiological influence of multiple risk markers offset by personal resilience.

Back pain and sagittal spine alignment in obese patients eligible for bariatric surgery

OBJECTIVE

The objective of this research was to evaluate the prevalence of cervical and lumbar pain in obese patients eligible for bariatric surgery and to investigate possible changes in sagittal spine alignment in these patients.

METHODS

The following parameters were compared in 30 obese patients and a control group of 25 non-obese volunteers: body mass index, prevalence of cervical and lumbar pain assessed by visual analog scale (VAS), Neck Disability Index [NDI] and Oswestry Disability Index [ODI], as well as radiographic parameters of the spine and pelvis measured with Surgimap software.

RESULTS

The cervical and lumbar VAS and the NDI and ODI were significantly worse in obese patients. Compared with the control group, the cervical sagittal vertical axis (cSVA) of the obese group had higher variance (p value = 0.0025) and the cervical lordosis was diminished (p value = 0.0023). Thoracic kyphosis, lumbar lordosis, and the pelvic parameters were not significantly different between the groups.

CONCLUSIONS

Obese patients demonstrated lower functional performance compared with their non-obese counterparts, while cervical lordosis was diminished and the cSVA was increased in obese patients. These slides can be retrieved under Electronic Supplementary Material.

Impact of Child and Maternal Weight on Healthcare Trainee Clinical Assessment Decision Making: A Virtual Human Study

BACKGROUND

Adult literature documents that healthcare providers rely on patient characteristics, such as age, race, and weight, when making clinical decisions. However, little research has examined these biases among pediatric populations. This study aimed to examine the impact of child and maternal weight and race on clinical decision-making of healthcare trainees in the context of a pediatric pain assessment using standardized virtual pediatric patients and mothers.

METHODS

Ninety-two healthcare trainees read a standardized clinical vignette describing a child with chronic pain, which was accompanied by eight virtual human (VH) scenes-each with a child and mother. Scenes varied by the dyad's race, child's weight status, and mother's weight status. For each scene, participants were asked to make six healthcare assessment ratings.

RESULTS

Participants rated children (M = 42.44 vs. 48.69; p < 0.001) and mothers (M = 51.06 vs. 65.31; p < 0.001) with obesity as being less likely to adhere to physician recommendations compared with healthy weight children and mothers. Child patients with obesity (M = 38.88 vs. 30.08; p < 0.001) and mothers with obesity (M = 49.71 vs. 43.71; p < 0.001) were also rated as bearing more responsibility for the child's health status compared with healthy weight peers.

CONCLUSIONS

This study provides evidence that child and mother weight can impact clinical decision-making, as well as for the utility of VH technology in studying decision-making among healthcare trainees and providers.

Characterizing chronic pain in late adolescence and early adulthood: prescription opioids, marijuana use, obesity, and predictors for greater pain interference

Introduction:

Chronic pain in late adolescence and young adults is understudied and poorly characterized.

Objectives:

We sought to characterize key variables that may impact pain interference in late adolescents and young adults with chronic pain, including prescription opioid use, marijuana use, psychological symptoms, and obesity.

Methods:

Retrospective, cross-sectional medical chart review for patients aged 17 to 23 years (N = 283; 61% Females) seeking care at a tertiary care pain clinic. Data on pain characteristics, health behaviors, and mental health distress were examined, in addition to self-reported pain intensity and interference.

Results:

Overlapping pain conditions were common in this young adult sample (mean ≥ 2 pain conditions). Back pain was the most commonly cited pain condition, and the majority of pain was of unknown etiology. Results revealed high rates for current opioid prescription, overweight or obese status, and mental health problems. Those using prescription opioids were more likely to endorse tobacco use and had greater pain interference. Importantly, the presence of mental health distress and opioid use were predictive of higher levels of pain-related interference.

Conclusion:

Treatment-seeking adolescents and young adults with chronic pain evidence complex care needs that include pain and mental comorbidities, as well as risky health behaviors. Pain and mental health distress were associated with poorer physical health, opioid prescription and marijuana use, and pain-related interference. Findings underscore the need for additional research on pain, treatment patterns, and health behaviors and their impact on developmental trajectories, as well as the need to develop and apply effective early interventions in this at-risk population.

Radiographic evaluation and pain symptomatology of the knee in severely obese individuals - controlled transversal study

Objective

To evaluate the prevalence of pain and radiographic degenerative arthritis in a group of severe obese patients (body mass index [BMI] > 35).

Methods

41 patients with an indication of bariatric surgery were studied. The group of severely obese patients was subdivided into two subgroups: those with BMI < 50 and those with BMI > 50 (n = 14). They were compared to control group (n = 39). The following parameters were analyzed and correlated: radiographic arthritis by Kellgren-Lawrence's classification, tibiofemoral axis, gender, age, and knee pain (visual analog scale [VAS]). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to evaluate in 21 severe obese patients and IN 19 controls.

Results

A higher incidence of knee pain was observed in the severely obese group when compared with the control group (p < 0.0001, odds ratio: 2.96). In the severely obese group, increasing levels of pain with aging were observed (p = 0.047). A positive correlation was observed between the incidence of radiographic arthritis and increasing age in the severely obese (p = 0.001) and control (p = 0.037) groups. The WOMAC index results were worse in the severely obese group when compared with the control group (p = 0.001, odds ratio: 18.2).

Conclusion

A higher incidence of knee pain was observed in the severely obese group when compared with the control group. In the severely obese group, there increasing levels of pain with aging. A positive relation between the incidence of arthritis and increasing age was observed in the severely obese and control groups. The WOMAC index results were worse in the severely obese group.

A Pilot Study of Iyengar Yoga for Pediatric Obesity: Effects on Gait and Emotional Functioning

Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary outcome) in youths with obesity. Secondary outcomes included health-related quality of life (HRQoL), physical activity, and pain. Feasibility and acceptability were also assessed. Nine youths (11⁻17 years) participated in an eight-week Iyengar yoga intervention (bi-weekly 1-h classes). Gait, HRQOL (self and parent-proxy reports), and physical activity were assessed at baseline and post-yoga. Pain was self-reported at the beginning of each class. Significant improvements were found in multiple gait parameters, including hip, knee, and ankle motion and moments. Self-reported and parent-proxy reports of emotional functioning significantly improved. Time spent in physical activity and weight did not change. This study demonstrates that a relatively brief, non-invasive Iyengar yoga intervention can result in improved malalignment of the lower extremities during ambulation, as well as in clinically meaningful improvements in emotional functioning. This study extends current evidence that supports a role for yoga in pediatric obesity.

Distinct pain profiles in patients with chronic obstructive pulmonary disease

Background

Few studies have examined changes in the pain experience of patients with COPD and predictors of pain in these patients.

Objectives

The objectives of the study were to examine whether distinct groups of COPD patients could be identified based on changes in the occurrence and severity of pain over 12 months and to evaluate whether these groups differed on demographic, clinical, and pain characteristics, and health-related quality of life (HRQoL).

Patients and methods

A longitudinal study of 267 COPD patients with very severe COPD was conducted. Their mean age was 63 years, and 53% were females. The patients completed questionnaires including demographic and clinical variables, the Brief Pain Inventory, and the St Georges Respiratory Questionnaire at enrollment, and 3, 6, 9, and 12 months follow-up. In addition, spirometry and the 6 Minute Walk Test were performed. Latent class analysis was used to identify subgroups of patients with distinct pain profiles based on pain occurrence and worst pain severity.

Results

Most of the patients (77%) reported pain occurrence over 12 months. Of these, 48% were in the "high probability of pain" group, while 29% were in the "moderate probability of pain" group. For the worst pain severity, 37% were in the "moderate pain" and 39% were in the "mild pain" groups. Females and those with higher body mass index, higher number of comorbidities, and less education were in the pain groups. Patients in the higher pain groups reported higher pain interference scores, higher number of pain locations, and more respiratory symptoms. Few differences in HRQoL were found between the groups except for the symptom subscale.

Conclusion

Patients with COPD warrant comprehensive pain management. Clinicians may use this information to identify those who are at higher risk for persistent pain.

Identification of pain categories associated with change in pain in patients receiving placebo: data from two phase 3 randomized clinical trials in symptomatic knee osteoarthritis

Background

Pain is the principal clinical symptom of osteoarthritis (OA), and development of safe and effective analgesics for OA pain is needed. Drug development of new analgesics for OA pain is impaired by substantial change in pain in patients receiving placebo, and more data describing clinical characteristics and pain categories particularly associated with this phenomenon is needed.

The purpose of this post-hoc analysis was to investigate clinical characteristics and pain categories and their association with radiographic progression and placebo pain reduction (PPR) in OA patients as measured the Western Ontario and McMasters Arthritis (WOMAC).

Methods

Pooled data from the placebo groups of two phase III randomized clinical trials in patients with knee OA followed for 2 years were analyzed. Differences between individual sub-scores and pain categories of weight-bearing and non-weight bearing pain over time were assessed. Selected patient baseline characteristics were assessed for association with PPR. Association between pain categories and radiographic progression was analyzed.

Results

The reduction of pain in placebo-treated patients was significantly higher in the composite of questions related to weight-bearing pain compared to non-weight-bearing pain of the target knee. Baseline BMI, age and JSW were not associated with pain change. Pain reduction was higher in the Target knee, compared to the Non-Target knee at all corresponding time-points. A very weak correlation was found between weight-bearing pain and progression in the non-target knee.

Conclusions

These results indicate that the reduction in pain in patients treated with placebo is significantly different between pain categories, as weight-bearing pain was significantly more reduced compared to non-weight-bearing pain. Further research in pain categories in OA is warranted.

Trial Registration

NCT00486434 (trial 1) and NCT00704847 (trial 2)

Transmission of risk from parents with chronic pain to offspring: an integrative conceptual model

Offspring of parents with chronic pain are at increased risk for pain and adverse mental and physical health outcomes (Higgins et al, 2015). Although the association between chronic pain in parents and offspring has been established, few studies have addressed why or how this relation occurs. Identifying mechanisms for the transmission of risk that leads to the development of chronic pain in offspring is important for developing preventive interventions targeted to decrease risk for chronic pain and related outcomes (eg, disability and internalizing symptoms). This review presents a conceptual model for the intergenerational transmission of chronic pain from parents to offspring with the goal of setting an agenda for future research and the development of preventive interventions. Our proposed model highlights 5 potential mechanisms for the relation between parental chronic pain and pediatric chronic pain and related adverse outcomes: (1) genetics, (2) alterations in early neurobiological development, (3) pain-specific social learning, (4), general parenting and family health, and (5) exposure to stressful environment. In addition, the model presents 3 potential moderators for the relation between parent and child chronic pain: (1) the presence of chronic pain in a second parent, (2) timing, course, and location of parental chronic pain, and (3) offspring's characteristics (ie, sex, developmental stage, race or ethnicity, and temperament). Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family centered and include at-risk children.

The Association Between Symptomatic and Diagnostic Depression and Pain Among the Elderly Population in South Korea

The exact nature of pain (amount or severity) associated with in depression in the elderly population has not been studied extensively yet. We investigated the association between the characteristics of pain and both symptomatic and diagnostic depression using data from the 2012 Korean Longitudinal Study of Aging (2164 men, 2066 women). Symptomatic depression was identified a score of 12 or higher on the 10-item Center for Epidemiologic Studies-Depression Scale. Odds ratios with a 95% confidence interval was calculated for depression using multiple logistic regression models after adjusting for age, sex, socioeconomic status, health behavioral factors, and chronic diseases. The fully adjusted odds ratio (95% confidence interval) for symptomatic/diagnostic depression were "1" = 2.09 (1.62-2.49)/1.71 (1.03-2.86), "2" = 1.88 (1.42-2.49)/1.82 (1.05-3.13), and ">3" = 2.27 (1.71-3.01)/3.21 (1.94-5.32), and 1.86 (1.48-2.33)/1.57 (1.00-2.49) for mild, 1.74 (1.22-2.48)/2.10 (1.11-3.98) for moderate, and 5.41 (3.77-7.77)/7.34 (4.15-12.99) for severe of pain. The results indicated a significant association between the number of sites and severity of pain and the prevalence of depression in the Korean elderly.

Incidence and risk factors of exercise-related knee disorders in young adult men

Background

Musculoskeletal disorders and injuries are common causes of morbidity and loss of active, physically demanding training days in military populations. We evaluated the incidence, diagnosis, and risk factors of knee disorders and injuries in male Finnish military conscripts.

Methods

The study population comprised 5 cohorts of 1000 men performing their military service, classified according to birth year (1969, 1974, 1979, 1984, and 1989). Follow-up time for each conscript was the individual conscript’s full, completed military service period. Data for each man were collected from a standard pre-information questionnaire used by defense force healthcare officials and from all original medical reports of the garrison healthcare centers. Background variables for risk factor analysis included the conscripts’ service data, i.e., service class (A, B), length of military service, age, height, weight, body mass index (BMI), underweight, overweight, obesity, smoking habit, education, diseases, injuries, and subjective symptoms.

Results

Of the 4029 conscripts, 853 visited healthcare professionals for knee symptoms during their military service, and 103 of these had suffered a knee injury. Independent risk factors for the incidence of knee symptoms were: older age; service class A; overweight (BMI 25.0–29.9 kg/m²); smoking habit; comprehensive school education only; and self-reported previous symptoms of the musculoskeletal, respiratory, and gastrointestinal system. The majority of visits to garrison healthcare services due to knee symptoms occurred during the first few months of military service. Knee symptoms were negatively correlated with self-reported mental and behavioral disorders.

Conclusions

The present study highlights the frequency of knee disorders and injuries in young men during physically demanding military training. One-fifth of the male conscripts visited defense force healthcare professionals due to knee symptoms during their service period. Independent risk factors for the incidence of knee symptoms during military service were age at military service; military service class A; overweight; smoking habit; comprehensive school education only; and self-reported previous symptoms of the musculoskeletal system, respiratory system, or gastrointestinal system. These risk factors should be considered when planning and implementing procedures to reduce knee disorders and injuries during compulsory military service.

Reference values and factors associated with musculoskeletal symptoms in healthy adolescents and adults

BACKGROUND

Insufficient attention has been given to individuals who report musculoskeletal symptoms yet experience minimal disability.

OBJECTIVES

To examine musculoskeletal symptoms among healthy individuals, and compare demographic, psychological and physical factors between individuals with and without symptoms.

DESIGN

Cross-sectional observational study.

METHOD

Data were from the 1000 Norms Project which recruited 1000 individuals aged 3-101 years. Participants were healthy by self-report and had no major physical disability. Musculoskeletal symptoms (ache/pain/discomfort, including single-site and multi-site symptoms) were assessed in adolescents (11-17y) and adults (18-101y) using the Extended Nordic Musculoskeletal Questionnaire (NMQ-E). To compare individuals with single-site, multi-site and no symptoms, body mass index, grip strength, 6-min walk, 30-s chair stand and timed up-and-down stairs (all participants), and mental health, sleep difficulties, self-efficacy and physical activity (adults), were collected.

RESULTS

/findings: Socio-demographic characteristics were similar to the Australian population. Twelve-month period prevalence of all symptoms was 69-82%; point prevalence was 23-39%. Adults with single-site symptoms were more likely to be overweight/obese and had lower sit-to-stand and stair-climbing performance (p < 0.05). Adults with multi-site symptoms were more likely to be female and overweight/obese, had lower mental health, greater sleep difficulties and lower grip strength, 6-min walk and sit-to-stand performance (p < 0.05). Differences were only observed among 50-59, 60-69, 70-79 and 80-101 year-olds.

CONCLUSIONS

Normative reference data for the NMQ-E have been generated. Musculoskeletal symptoms are common among healthy individuals. In older adults, musculoskeletal symptoms are linked with overweight/obesity, lower mental health, sleep difficulties and lower physical performance, emphasising the importance of multi-dimensional assessments in musculoskeletal disorders.

Mechanical factors and vitamin D deficiency in schoolchildren with low back pain: biochemical and cross-sectional survey analysis

OBJECTIVE

This study was designed to evaluate the role of vitamin D, muscle fatigue biomarkers, and mechanical factors in the progression of low back pain (LBP) in schoolchildren.

BACKGROUND

Children and adolescents frequently suffer from LBP with no clear clinical causes, and >71% of schoolchildren aged 12-17 years will show at least one episode of LBP.

MATERIALS AND METHODS

A total of 250 schoolchildren aged 12-16 years were randomly enrolled in this study. For all schoolchildren height, weight, percentage of daily sun exposure and and areas of skin exposed to sun, method of carrying the bag, and bag weight and type were recorded over a typical school week. Pain scores, physical activity (PA), LBP, serum vitamin 25(OH)D level, serum bone-specific alkaline phosphatase, creatine kinase (CK), and lactate dehydrogenase (LDH) activities and calcium (Ca) concentrations were estimated using prevalidated Pain Rating Scale, modified Oswestry Low Back Pain Disability Questionnaire, short-form PA questionnaire, and colorimetric and immunoassay techniques.

RESULTS

During the period of October 2013-May 2014, LBP was estimated in 52.2% of the schoolchildren. It was classified into moderate (34%) and severe (18%). Girls showed a higher LBP (36%) compared with boys (24%). In schoolchildren with moderate and severe LBP significantly higher (P=0.01) body mass index, waist, hip, and waist-to-hip ratio measurements were observed compared with normal schoolchildren. LBP significantly correlated with less sun exposure, lower PA, sedentary activity (TV/computer use), and overloaded school bags. In addition, schoolchildren with severe LBP showed lower levels of vitamin 25(OH)D and Ca and higher levels of CK, LDH, and serum bone-specific alkaline phosphatase compared with moderate and healthy schoolchildren. Stepwise regression analysis revealed that age, gender, demographic parameters, PA, vitamin D levels, Ca, CK, and LDH associated with ~56.8%-86.7% of the incidence of LBP among schoolchildren.

CONCLUSION

In children and adolescents, LBP was shown to be linked with limited sun exposure, inadequate vitamin D diets, adiposity, lower PA, sedentary lifestyles, vitamin 25 (OH) D deficiency, and lower levels of Ca, CK, and LDH.