Comorbidity of pain problems and depressive symptoms in young women: results from a cross-sectional survey among women aged 15-24 in Hungary

Can breast characteristics predict upper torso musculoskeletal pain?

BACKGROUND

Several studies have associated a large breast size with an increased prevalence and severity of musculoskeletal pain, particularly pain in the upper torso. Despite this evidence, no research has explored whether breast size or related characteristics are risk factors for upper torso musculoskeletal pain.

METHODS

A backward multiple regression analysis was performed to identify whether characteristics of the breasts and upper torso, as well as physical factors known to be associated with musculoskeletal pain, could predict musculoskeletal pain among a cohort of 378 Australian women aged 18 years and over who had a wide range of breast sizes.

FINDINGS

The model identified that breast volume, age and nipple-to-nipple distance predicted 23% of the variance in upper torso musculoskeletal pain reported by the participants.

INTERPRETATION

Women with a larger breast volume, lower age and a greater nipple-to-nipple distance were predicted to report a higher upper torso musculoskeletal pain score.

The Longitudinal Impact of Parent Distress and Behavior on Functional Outcomes Among Youth With Chronic Pain

Accumulating evidence supports the concurrent association between parent distress and behavior and child functioning in the context of chronic pain, with existing longitudinal studies limited to a pediatric surgical context that identify parent catastrophizing as influential. In this study, we examined how parent factors assessed at a multidisciplinary pediatric pain clinic evaluation affect child psychological and functional outcomes over time. A cohort of 195 patients with chronic pain (ages 8-17 years) and their parents who presented for a multidisciplinary evaluation completed measures at baseline and at 4-month follow-up. Patients completed measures of pain catastrophizing, pain-related fear and avoidance, generalized anxiety, depressive symptoms, and functional disability. Parents completed measures of pain catastrophizing, pain-related fear and avoidance, and protective responses to child pain. Parent-reported child school functioning was also collected. Parent distress and behavior was concurrently associated with child distress and functioning at evaluation. After controlling for baseline child functioning, baseline parent avoidance and protective behavior emerged as significant predictors of child functioning at 4-month follow-up. Parent distress and behavior influence child distress and functioning over time and these findings identify key parent domains to target in the context of a child's pain treatment.

PERSPECTIVE

Parent behavior, specifically avoidance and protective responses, influence child distress and functioning over time. Child pain treatment interventions should include influential parent factors to ensure successful outcomes.

Different patterns of morphological changes in the hippocampus and dentate gyrus accompany the differential expression of disability following nerve injury

Physical and psychological trauma which results in mood disorders and the disruption of complex behaviours is associated with reductions in hippocampal volume. Clinical evaluation of neuropathic pain reveals mood and behavioural change in a significant number of patients. A rat model of neuropathic injury results in complex behavioural changes in a subpopulation (~30%) of injured rats; these changes are co-morbid with a range of other 'disabilities'. The specific objective of this study was to determine in rats the morphology of the hippocampus and dentate gyrus in individuals with and without complex behavioural disruptions following a constriction injury of the sciatic nerve, and to determine whether rats that develop disabilities following nerve injury have a reduced hippocampal volume compared with injured rats with no disabilities. The social behaviours of nerve-injured rats were evaluated before and after nerve injury. The morphology of the hippocampus of rats with and without behavioural disruptions was compared in serial histological sections. Single-housing and repeated social-interaction testing had no effect on the morphology of either the hippocampus or the dentate gyrus. Rats with transient or ongoing disability identified by behavioural disruption following sciatic nerve injury, show bilateral reductions in hippocampal volume, and lateralised reduction in the dentate gyrus (left side). Disabled rats display a combination of behavioural and physiological changes, which resemble many of the criteria used clinically to diagnose mood disorders. They also show reductions in the volume of the hippocampus similar to people with clinically diagnosed mood disorders. The sciatic nerve injury model reveals a similarity to the human neuropathic pain presentation presenting an anatomically specific focus for the investigation of the neural mechanisms underpinning the co-morbidity of chronic pain and mood disorder.

The missing 'P' in pain management: how the current opioid epidemic highlights the need for psychiatric services in chronic pain care

OBJECTIVE

The prevalence of opioid therapy for chronic noncancer pain has increased dramatically in recent years, with a parallel increase in opioid abuse, misuse and deaths from accidental overdose. We review epidemiological and clinical data that point to the important roles psychiatric disorders have in the use and abuse of opioids in patients with chronic pain.

METHOD

We conducted literature searches on the PubMed with the key phrases "chronic pain" and "opioid therapy" and selected those articles on the epidemiology of comorbidity between chronic pain and psychiatric disorders, the trends in long-term opioid therapy and the clinical trials that involved using opioid therapy for chronic pain or for mental health disorders. We then thoroughly reviewed the bibliography of all relevant articles to identify additional papers to be included in the present review.

RESULTS

Chronic pain is highly comorbid with common psychiatric disorders. Patients with mental health and substance abuse disorders are more likely to receive long-term opioid therapy for chronic pain and more likely to have adverse outcomes from this therapy. Although opioids may exert brief antidepressant and anxiolytic effects in some patients with depression or anxiety, there is scant evidence for long-term benefit from opioid treatment of psychiatric disorders.

CONCLUSIONS

Opioids may be used in current clinical practice as the de facto and only psychiatric treatment for patients with chronic pain, despite little evidence for sustained benefit. The opioid epidemic thus reflects a serious unmet need for better recognition and treatment of common mental health problems in patients with chronic pain. Psychiatry is the missing P in chronic pain care.

Depressive symptoms and its associated factors in 13-year-old urban adolescents

The available estimates reveal that 20-50% of adolescents report depressive symptoms, being one of the most prevalent health problems in adolescence. The aim of this study was to assess the prevalence of depressive symptoms in a community sample of 13-year-old adolescents and identify associated features. Thirteen year-old adolescents attending private and public schools in Porto (n = 1,988, 52.2% females) were evaluated from October 2003 to June 2004 and completed a questionnaire including health behaviors and the Beck Depression Inventory II. A questionnaire on parents' socio-demographics and clinical characteristics was sent home. Data were analyzed separately by sex. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression. The prevalence of depressive symptoms was 18.8% in girls and 7.6% in boys (p < 0.001). Boys with a family history of depression and girls with smoking habits had a significantly increased risk of depressive symptoms (OR = 2.18, 95%CI 1.00-4.71; OR = 2.34, 95%CI 1.46-3.76). Menarche at an early age significantly increased the risk of depressive symptoms. The characteristics most strongly associated with depressive symptoms were family history of depression among boys, tobacco consumption and an early age at menarche among girls. The high prevalence of depressive symptoms early in adolescence calls for the awareness of public health professionals.

Current smoking as a predictor of chronic musculoskeletal pain in young adult twins

Chronic pain is common during adolescence and young adulthood and is associated with poor quality of life, depression, and functional disability. Recognizing that chronic pain has significant consequences, it is important to identify modifiable health behaviors that may place young adults at risk for chronic pain. This study examines associations between chronic musculoskeletal pain and smoking in young adult twins (n = 1,588, ages 18-30) participating in a statewide twin registry. Twins completed questionnaires assessing smoking, mood (anxiety, depressive symptoms, and stress), and chronic musculoskeletal pain. Analyses examined associations between chronic pain and smoking, particularly the role of genetics/shared familial factors and psychological symptoms. As predicted, results revealed a near-2-fold increased risk for chronic musculoskeletal pain in twins who currently smoked compared to nonsmokers, even when accounting for psychological factors. Results of within-pair analyses were only minimally attenuated, suggesting that associations between smoking and chronic musculoskeletal pain are better accounted for by nonshared factors than by shared familial factors/genetic effects. Future twin research is needed to identify what nonshared factors (eg, attitudes, direct effects of smoking on pain) contribute to these associations to further understand comorbidity. Longitudinal studies and recruitment of participants prior to smoking initiation and chronic pain onset will better identify causal associations.

PERSPECTIVE

This article describes associations between musculoskeletal pain and smoking in young adult twins, taking into account psychological symptoms. Findings highlight the importance of nonshared factors in associations between pain and smoking and the need to explore the roles of lifestyle, individual attitudes, and direct effects of smoking on pain.

Work or Place? Assessing the Concurrent Effects of Workplace Exploitation and Area-of-Residence Economic Inequality on Individual Health

Building on previous multilevel studies in social epidemiology, this cross-sectional study examines, simultaneously, the contextual effects of workplace exploitation and area-of-residence economic inequality on social inequalities in health among low-income nursing assistants. A total of 868 nursing assistants recruited from 55 nursing homes in Kentucky, Ohio, and West Virginia were surveyed between 1999 and 2001. Using a cross-classified multilevel design, the authors tested the effects of area-of-residence (income inequality and racial segregation), workplace (type of nursing home ownership and managerial pressure), and individual-level (age, gender, race/ethnicity, health insurance, length of employment, social support, type of nursing unit, preexisting psychopathology, physical health, education, and income) variables on health (self-reported health and activity limitations) and behavioral outcomes (alcohol use and caffeine consumption). Findings reveal that overall health was associated with both workplace exploitation and area-of-residence income inequality; area of residence was associated with activity limitations and binge drinking; and workplace exploitation was associated with caffeine consumption. This study explicitly accounts for the multiple contextual structure and effects of economic inequality on health. More work is necessary to replicate the current findings and establish robust conclusions on workplace and area of residence that might help inform interventions.

Pain and self-reported health in Canadian children

BACKGROUND

Despite increasing attention to the epidemiology of pain, relatively little is known about the association between pain and health in children. In particular, no studies have examined this relationship in the general population of children in Canada.

OBJECTIVES

To assess the association between self-reported pain experiences and health in school children in southeastern Ontario. Health measures included perceived health status, psychological complaints and satisfaction with school.

METHODS

A total of 495 nine- to 13-year-old school children completed the Pain Experience Interview -- Short Form and health-related questions from the Health Behaviour in School-aged Children questionnaire.

RESULTS

Of the 495 children in the present study, 8% rated their health as 'fair' to 'poor', 56% reported experiencing at least one of four psychological symptoms more than once a week and 24% said they disliked school. The strongest associations existed between headaches and poor self-rated health (OR=10.1; 95% CI 1.3 to 78.3), recurrent pain and psychological outcomes (OR=3.6; 95% CI 2.0 to 6.3), and recurrent pain and disliking school (OR=3.6; 95% CI 1.9 to 6.7).

DISCUSSION

These findings indicate that common childhood pains are associated with childhood health. Further studies are needed to assess the causal relationship between pain and health in children, to obtain a more comprehensive understanding of the personal and economic impact of childhood pain, and to monitor changes in the lives of children living with chronic pain.

Factors influencing health behaviors in the National Health and Nutritional Examination Survey, III (NHANES III)

This study investigated the influence of age, gender, race, place of residence, social networks, and socioeconomic status (SES) on health behaviors in the NHANES III, a large public domain database of approximately 16,000 subjects. Multiple regression analysis indicated that age, gender, social networks, and SES were statistically significant predictors of both positive and negative health behaviors, while race and place of residence were not. These results suggest an influence of age, gender, SES, and social support factors on health behaviors and reinforce the need for social work to take into account these factors at both the individual and public policy levels.

Epidemiology of chronic musculoskeletal pain

The rate of musculoskeletal pain in adolescent and adult populations is examined, with a focus on three commonly reported pain disorders: shoulder pain, low back pain and fibromyalgia/chronic widespread pain. There is a paucity of data on musculoskeletal pain in adolescent populations. Those studies available suggest that pain is common, although the actual rates are unclear. This is probably due to differences in study methodologies and populations. Pain is commonly reported among adult populations, with almost one fifth reporting widespread pain, one third shoulder pain, and up to one half reporting low back pain in a 1-month period. The prevalence of pain varies within specific population subgroups; group factors (including socioeconomic status, ethnicity and race) and individual factors (smoking, diet, and psychological status) are all associated with the reporting of musculoskeletal pain. However, the precise nature of these relationships, and particularly the mechanisms of association, are unclear and require further investigation.

Management of musculoskeletal pain

Chronic musculoskeletal pain is a major public health problem affecting about one third of the adult population. Pain is often present without any specific findings in the musculoskeletal system and a strictly biomedical approach could be inadequate. A biopsychosocial model could give a better understanding of symptoms and new targets for management. Identification of risk factors for chronicity is important for prevention and early intervention. The cornerstones in management of chronic non-specific, and often widespread, musculoskeletal pain are non-pharmacological. Physical exercise and cognitive behavioral therapy, ideally in combination, are first line treatments in e.g. chronic low back pain and fibromyalgia. Analgesics are useful when there is a specific nociceptive component, but are often of limited usefulness in non-specific or chronic widespread pain (including fibromyalgia). Antidepressants and anticonvulsants could be of value in some patients but there is a need for more knowledge in order to give general recommendations.

Musculoskeletal disorders among full-time homemakers in poor communities

OBJECTIVE

To examine factors associated with self-reported musculoskeletal disorders (MSD) among full-time female homemakers.

METHODS

Data on socio-demographic characteristics, lifestyle and health were collected on 1266 married women aged 15-59 years living in poor suburbs in the outskirts of Beirut, Lebanon. Independent associations with MSD of factors and characteristics were examined using odds ratios (ORs) derived from multiple logistic regression.

RESULTS

Women's age, weight, and number of children were significantly, positively, independently associated with self-reported MSD, while women's conduct of specific household tasks were not. Women with MSD were more likely to be stressed than women without MSD (OR = 1.5).

CONCLUSION

A major finding of this study was the positive association between distress and musculoskeletal disorders. The measures used to assess women's involvement in housework did not account for the duration of time spent performing each household task. Better measures of domestic labor, including housework and childcare, are required to understand better their impact on the health of full-time homemakers and on MSD in particular. Intervention programs to alleviate MSD in full-time homemakers should address psychosocial factors.

Living in Fear of Experiencing Physical and Sexual Abuse Is Associated with Severe Depressive Symptomatology among Young Women

PURPOSE

To analyze the relationship among fear of being abused, direct experience of physical and sexual abuse, and severe depressive symptoms among young women.

METHODS

A cross-sectional survey was conducted in schools and households among 3615 young Hungarian women, ages 15-24 years, of whom 2016 were students. A multistage stratified sampling method was applied. The shortened Beck Depression Inventory (BDI) and the modified Abuse Assessment Screen were used. Odds ratios (ORs) were calculated, and a general linear model was used to test effects of variables on the BDI score.

RESULTS

Severe depressive symptoms were significantly more common among women who were abused physically (OR=3.474, 95% CI 2.170-5.562) or sexually (OR=6.436, 95% CI 3.085-13.429) in the past year or abused by a partner (OR=3.167, 95% CI 1.806-5.554) or important person (OR=2.989, 95% CI 1.922-4.648) during their lifetime. Severe depressive symptoms were also found among those young women who reported feeling fearful of someone in the family (OR=5.027, 95% CI 2.805-9.012) or in their environment (OR=3.779, 95% CI 2.120-6.738). In a linear regression analysis, fear of someone in the environment or family had the strongest effect on BDI scores after controlling for frequent anxiety.

CONCLUSIONS

Not only the direct lifetime experience of abuse but also the presence of fear of abuse is associated with severe depressive symptomatology among young women. Fear of abuse is also an important factor to take into consideration in assessing young women with depressive symptoms.

The epidemiology of pain in depression

Over 75% of depressed patients in primary care complain of painful physical symptoms such as headache, stomach pain, neck and back pain as well as non-specific generalized pain. The presence of such symptoms predicts a greater severity and a less favourable outcome of depression with a poorer health-related quality of life. World Health Organization data obtained in primary care centres worldwide show that 22% of all primary care patients suffer from persistent debilitating pain and that these patients are four times more likely to have co-morbid anxiety or depressive disorder than pain-free primary care patients. Not unexpectedly, the risk of depression is greater when the pain is more diffuse, as indicated by the number of painful sites, and has a greater effect on the quality of life. Certain depressive symptoms, such as low energy and sleep disturbances, are commonly found in patients with co-morbid pain, whereas the opposite is true for symptoms such as guilt and loneliness. Increasingly, major depression is seen as being composed of psychological, somatic and painful physical symptoms. In order to achieve full sustained remission it is necessary to treat symptoms in all three of these areas. The area of painful physical symptoms is unfortunately still poorly understood and clearly merits greater attention.