Psychological, social and academic functioning in university students with chronic pain: A systematic review

First-year, first-generation to college undergraduates with chronic pain: A psychosociocultural exploration of wellness

Undergraduates' health and wellness is a critical focus in higher education, yet there remains a paucity of research exploring first-generation to college (FGC) undergraduates with chronic pain (CP). Examining 116 first-year, FGC undergraduates, this quantitative study sought to understand the impact of CP on pain acceptance for FGC undergraduates at a midwestern Predominately White Institution (PWI). Students were primarily White, self-identified female, domestic, and traditional first-year students, most of whom reported experiencing pain some to most days over the last 3 months. Using the Psychosociocultural Model, results revealed group differences by CP identity and onset. Regression analysis indicated adjustment and identity positively predicted wellness. Further, pain/pain impact partially mediated the relationship between identity and wellness. An ongoing, multidimensional examination in addressing pain acceptance for first-year, FGC undergraduates with CP is suggested, as it is not enough to just explore pain in and of itself.

US and UK college students' experiences of living with chronic pain: A qualitative analysis

Objective: To understand the lived experiences and needs of college students with chronic pain living in the US and the UK. Participants: College students (n = 115), mean age 21.4 years (SD = 1.73). Methods: As part of a larger survey, students were asked: (1) How, if at all, living with pain impacted their college experience; (2) Support they did/did not receive from students, faculty, staff, and college services; (3) What support would be most helpful to them as a college student living with pain. Qualitative data were analyzed using an immersion/crystallization approach. Results: Four main themes were identified: (1) Stress resulting from the rigid demands of academic life can exacerbate pain; (2) Lack of communication leaves many students feeling isolated; (3) Frustration at lack of faculty support; and (4) Need for chronic pain to be recognized. Conclusions: The findings suggest areas for intervention to support college students living with pain during this defining period.

Correlates Between Temporomandibular Disorder Symptom Severity, Psychological Distress, Well-Being, and Oral Health-Related Quality of Life: Insights From Chinese Young Adults

BACKGROUND

There is limited understanding of how temporomandibular disorder (TMD) symptoms, psychological distress, and well-being are related to each other and to OHRQoL in Chinese young adults.

OBJECTIVES

This study aimed to identify correlations between TMD symptom severity, psychological status, and OHRQoL while also examining factors associated with low OHRQoL.

METHODS

Participants, recruited from a major university in the capital city, completed a survey that included demographics, the Chinese versions of the expanded five TMD symptoms (5Ts) screener, Depression, Anxiety, Stress Scales-21 (DASS-21), Ryff's Scales of Psychological Well-being-18 (SPWB-18), and Oral Health Impact Profile for TMDs (OHIP-TMD). Data were analysed using Chi-square and Kruskal-Wallis/Mann-Whitney U tests, Spearman's correlation, and logistic regression (α = 0.05).

RESULTS

The study sample consisted of 414 individuals (mean age 22.0 years [SD 2.1], 77.8% female). Among them, 23.4%, 22.2%, 15.7%, and 38.6% had no (NT), intra-articular (IT), pain-related (PT), and combined (CT) TMD symptoms, respectively. Significant differences were observed in global TMD severity (CT>IT, PT>NT), global distress (CT>IT, NT), and OHRQoL (CT>IT, PT, NT), but not global well-being. Global TMD severity was significantly, albeit weakly, correlated with global distress (rs  = 0.32) and global well-being (rs  = -0.12). Global distress, in turn, showed a significant but weak negative association with global well-being (rs  = -0.34). Both global TMD severity and global distress exhibited moderate correlations with global OHIP (rs  = 0.63/0.42).

CONCLUSIONS

Global TMD severity, incorporating symptom duration, frequency, intensity, and interference, was the main determinant of low OHRQoL in Chinese young adults.

The Prevalence of Musculoskeletal Pain and Assessment of Potential Risk Factors Among a Sample of Medical Students in Giza, Egypt

INTRODUCTION

Musculoskeletal pain (MSP) is one of the most prevalent conditions among global medical students, affecting their daily lifestyle. In this study, we seek to determine the prevalence of MSP and its associated risk factors in a sample of medical students at Misr University for Science and Technology, Egypt.

METHODS

A cross-sectional study was conducted between December 2023 and February 2024, with a sample size of 1472 students who filled out a modified version of the Standardized Nordic Questionnaire. Demographic variables, study hours, and special habits were collected and analyzed. The prevalence of MSP in the past week and year was documented and analyzed using common risk factors.

RESULTS

A total of 971 responses were considered for analysis (66% of the total sample size and 27.7% of the total medical students). The majority were between 18 and 25 years old, with 50.7% males and 49.3% females. The median age was 21 (20-23) years. Most of the students were in their fifth year (23.8%). The prevalence of at least one MSP site was 459 (47.2%) in the past week and 702 (72.2%) in the past year. MSP in the past year was significantly associated with females (OR = 2.45, 95% CI = 1.82-3.3, p = 0.001) and those with a family history of autoimmune disease (OR = 2.19, 95% CI = 1.3-3.5, p = 0.001), while it was significantly associated in the past week with females (OR = 1.72, 95% CI = 1.3-2.2, p = 0.001) and those with a personal history of autoimmune disease (OR = 2.26, 95% CI = 1.09-4.7, p = 0.025). In the past year, neck pain was significantly associated with females (OR = 1.83, 95% CI = 1.42-3.27, p = 0.001) and those with a family history of autoimmune disease (OR = 1.4, 95% CI = 1.01-2.08, p = 0.047). Students living inside October city were less likely to have neck pain in the past year than those who lived outside October city (OR = 0.73, 95% CI = 0.56-0.94, p = 0.017). Shoulder pain in the past year was significantly associated with females (OR = 2.9, 95% CI = 2.1-3.98, p = 0.001) and those with a family history of autoimmune disease (OR = 1.9, 95% CI = 1.28-2.81, p = 0.001) while back pain in the past year was significantly associated with females (OR = 2.1, 95% CI = 1.6-2.7, p = 0.001). Gender was the only factor that was associated with MSP on multivariate regression analysis for the past week (p = 0.001) and past year (p = 0.001).

CONCLUSION

MSP is highly prevalent among medical students in Egypt, especially females, those with a personal history of autoimmune disease, and those with a family history of autoimmune disease. Despite the high prevalence and the effect on daily lifestyle, very few medical students sought help. More studies are needed to evaluate other risk factors and effective approaches to alleviate MSP among medical students in Egypt.

Conceptualising TMD symptom burden in youths: Symptom duration, frequency, intensity and interference

OBJECTIVE

This study aimed to conceptualise Temporomandibular disorder (TMD) symptom burden and severity and explored their interrelationships with somatic symptoms and psychological distress.

METHODS

Participants were recruited from a local polytechnic. The quintessential five TMD symptoms (5Ts) of the Diagnostic Criteria for TMDs (DC/TMD) were appraised and extended to evaluate the duration, frequency, intensity and interference of discrete TMD symptoms. Global TMD severity (GS) was computed by totaling the points for all TMD symptoms and dimensions. TMD (TS) and somatic symptom (SS) burden were assessed based on the Somatic Symptoms Scale-8, while psychological distress was measured with the Depression, Anxiety and Stress Scales-21. Statistical analyses were performed using Kruskal-Wallis/Dunn tests and Spearman's correlation (α = .05).

RESULT

Of the 366 eligible participants (mean age 19.1 ± 2.3 years), 51.4% were 5Ts-negative and 48.6% were 5Ts-positive. Among the 5Ts-positive individuals, 25.3%/64.0% were 'bothered a little' whereas 4.5%/10.7% were 'bothered a lot' by TMD pain/headache. Correspondingly, 32.6%/12.4%/5.1% were 'bothered a little' while 2.8%/2.8%/1.1% were 'bothered a lot' by TMJ sounds/closed/open locking. TS burden was moderate-to-strongly correlated to aggregate symptom duration, frequency, intensity, interference, GS and SS burden (rs = .50-.88). While TS burden and GS were weakly associated with psychological distress (rs = .18-.36), SS burden was moderately related to depression, anxiety and stress (rs = .47-.53).

CONCLUSIONS

TS burden can serve as a proxy for global TMD severity and may be more meaningful than the mere presence of TMD symptoms in clinical and research settings.

Social health in young women with chronic pain

Introduction

Chronic pain may negatively affect social functioning, but no study to date has examined the specific social impact of different chronic pain conditions in young women, and whether living with multiple chronic overlapping pain conditions (COPCs) differently influences social domains.

Objectives

This study aimed to assess social functioning (social isolation, hostility, informational support satisfaction, social roles, emotional support, friendships, and family relationships) among young women with chronic pain compared with pain-free controls and to test whether the number of COPCs influenced the extent of social burden.

Methods

Participants aged 18 to 30 years with a physician-confirmed diagnoses of migraine, fibromyalgia, or temporomandibular disorder (TMD) and pain-free controls were invited to participate from across the United States. After confirming eligibility, participants completed a 1-hour REDCap online questionnaire assessing social functioning.

Results

One hundred four participants (mean age 24.54 ± 3.35 years) were included (n = 26 with TMD, n = 25 with fibromyalgia, n = 25 with migraine, and n = 28 controls). All 3 chronic pain groups combined reported worse functioning than controls on friendship (P = 0.038), social isolation (P = 0.002), and social roles (P < 0.001). There were no differences on social variables between the 3 chronic pain groups (all P's > 0.05). Compared with those with 3 COPCs, participants with 1 condition reported better family relationships (P = 0.024).

Conclusions

Experience of chronic pain-regardless of the specific pain condition-may negatively affect some areas of social functioning in young women.

Psychological/behavioral interventions for emerging adults with chronic pain

Background

Emerging adults, of whom significant numbers report chronic pain, are characterized as having unique needs and challenges. Psychological/behavioral treatments found to be beneficial for reducing pain outcomes in children and adults are understudied in emerging adults. Following a systematic review of the literature, our objective is to report on quantitative studies of psychological/behavioral interventions for chronic pain in emerging adults.

Method

We conducted a search of six databases (Cochrane Central Register of Controlled Trials, Google Scholar, ProQuest, PsycINFO, PubMed, and Web of Science) and reference sections in dissertations and systematic reviews to 4/29/2023. Keywords and phrases were search term combinations of "chronic/persistent pain", "emerging/young adults," and "intervention/treatment" using Boolean logic.

Results

Our review resulted in identifying 37 articles, of which 2 duplicates were removed, and 31 were further excluded by a screening process based on various inclusionary and exclusionary criteria. The search yielded four studies on psychological/behavioral interventions (yoga, acceptance and commitment therapy and relaxation), all of which positively affected the pain experience and/or pain-related outcomes. These studies presented issues in design such as not being blinded or randomized, having a small sample size, and potential confounds that were not reported or examined.

Discussion

The low number of studies reveals a large gap in the literature and is a call-to-action to further expand our understanding of effective and safer psychological/behavioral therapies for chronic pain in emerging adults. Successful pain management during this developmental phase may help young adults achieve positive trajectories for personal, occupational, relational, and health aspects of their lives.

Psychological characteristics of young adults with temporomandibular disorders, somatization and combined conditions: A multidimensional evaluation

BACKGROUND

Temporomandibular disorders and somatization have shown interrelation in many studies. The physical and psychological factors which contributed to the occurrence and relation of both conditions are yet to be determined.

OBJECTIVES

The personality traits, coping styles and psychological distress of young adults with temporomandibular disorder (TMD) and somatic symptoms were characterized together with the determination of psychological risk factors for TMDs, somatization and combined conditions.

METHODS

Participants were recruited from university-attending young adults. TMD and somatic symptoms were appraised with the short-form Fonseca Anamnestic Index and Patient Health Questionnaire-15. Psychological variables were assessed with the Big Five Personality Inventory-10, Brief-COPE Inventory and Depression, Anxiety, and Stress Scales-21. Data were evaluated using chi-squared/non-parametric tests and logistic regression analyses (α = .05).

RESULTS

Among the 507 participants (mean age 22.2 ± 1.5 years), 46.4% reported no TMD/somatic symptoms (NS) while 7.5%, 34.5% and 11.6% had TMDs only (TS), somatization only (SS) and combined TMDs-somatization (CS), respectively. Significant differences in conscientiousness (NS > SS), agreeableness (NS, TS > CS; NS > SS), dysfunctional coping, general distress, depression, anxiety and stress (CS ≥ SS > NS) were discerned. Multivariate analyses indicated that the odds of TS were increased by anxiety (OR = 1.10; 95% CI = 1.01-1.21), while the odds of SS/CS were affected by anxiety (OR = 1.15; 95% CI = 1.06-1.25/OR = 1.34; 95% CI = 0.19-1.52) and problem-focused coping (OR = 0.71; 95% CI = 0.56-0.89/OR = 0.55; 95% CI = 0.39-0.78).

CONCLUSION

Though individuals with TMDs and somatization have dissimilar psychological profiles, anxiety constantly increased their likelihood. Problem-focused coping strategies may help alleviate psychosocial and physical stressors associated with TMDs and somatization.

Study environment and the incidence of mental health problems and activity-limiting musculoskeletal problems among university students: the SUN cohort study

OBJECTIVE

To determine the association between different aspects of study environment and the incidence of mental health problems and activity-limiting musculoskeletal problems.

DESIGN, SETTING AND PARTICIPANTS

We recruited a cohort of 4262 Swedish university students of whom 2503 (59%) were without moderate or worse mental health problems and 2871 (67%) without activity-limiting musculoskeletal problems at baseline. The participants were followed at five time points over 1 year using web surveys.

EXPOSURES

Self-rated discrimination, high study pace, low social cohesion and poor physical environment measured at baseline.

OUTCOMES

Self-rated mental health problems defined as scoring above cut-off on any of the subscales of the Depression, Anxiety and Stress Scale. Self-rated activity-limiting musculoskeletal problems in any body location assessed by the Nordic Musculoskeletal Questionnaire.

STATISTICAL ANALYSIS

Discrete survival-time analysis was used to estimate the hazard rate ratio (HR) of each exposure-outcome combination while adjusting for gender, age, living situation, education type, year of studies, place of birth and parental education as potential confounders.

RESULTS

For discrimination, adjusted HRs were 1.75 (95% CI 1.40 to 2.19) for mental health problems and 1.39 (95% CI 1.12 to 1.72) for activity-limiting musculoskeletal problems. For high study pace, adjusted HRs were 1.70 (95% CI 1.48 to 1.94) for mental health problems and 1.25 (95% CI 1.09 to 1.43) for activity-limiting musculoskeletal problems. For low social cohesion, adjusted HRs were 1.51 (95% CI 1.29 to 1.77) for mental health problems and 1.08 (95% CI 0.93 to 1.25) for activity-limiting musculoskeletal problems. For perceived poor physical study environment, adjusted HRs were 1.20 (95% CI 0.99 to 1.45) for mental health problems and 1.20 (95% CI 1.01 to 1.43) for activity-limiting musculoskeletal problems.

CONCLUSIONS

Several aspects of the study environment were associated with the incidence of mental health problems and activity-limiting musculoskeletal problems in this sample of Swedish university students.

The one-week prevalence of neck pain and low back pain in post-secondary students at two Canadian institutions

BACKGROUND

Low back and neck pain are common in the general population, but the prevalence among Canadian post-secondary students is not well known. We aimed to determine the one-week prevalence of neck pain (NP) and low back pain (LBP) among postsecondary students in Canada.

METHODS

We conducted a cross-sectional study of students enrolled in the Faculty of Health Sciences and Faculty of Education at Ontario Tech University, and the Canadian Memorial Chiropractic College (CMCC) in the Fall of 2017. Neck and low back pain intensity in the past week were measured with the 11-point numerical rating scale. We report the cumulative, gender- and institution-specific one-week prevalence (95% CI) of any pain (1-10/10) and moderate to severe pain (≥ 3/10).

RESULTS

The one-week prevalence of any neck pain ranged from 45.4% (95% CI: 38.4, 52.4) in the Faculty of Education to 76.9% (95% CI: 72.9, 80.4) at CMCC. The one-week prevalence of neck pain ≥3/10 ranged from 44.4% (95% CI: 37.5, 51.4) in the Faculty of Education to 58.4% (95% CI: 54.0, 62.7) at CMCC. The one-week prevalence of any low back pain ranged from 60.9% (95% CI: 53.8, 67.5) in the Faculty of Education to 69.0% (95% CI: 64.8, 73.0) at CMCC, and the one-week prevalence of low back pain ≥ 3/10 ranged from 47.8% (95% CI: 43.4, 52.2) at CMCC to 55.1% (95% CI: 51.2, 58.9) in the Faculty of Health Sciences. The prevalence of any back or neck pain and pain ≥ 3/10 was consistently higher in females than males, with the largest difference seen for neck pain at CMCC.

CONCLUSION

Most post-secondary students in our samples experienced LBP and NP in the past week. Overall, the one-week prevalence of NP and LBP was higher among chiropractic students and among females. This study should draw attention to school administrators about the burden of NP and LBP in post-secondary students.

Musculoskeletal Pain in Undergraduate Students Is Significantly Associated with Psychological Distress and Poor Sleep Quality

Musculoskeletal pain (MSKP), psychological distress, and poor sleep quality are common among undergraduate university students. Yet, few studies have assessed the association between MSKP and psychological distress and poor sleep quality. This cross-sectional study was conducted to determine this association among undergraduate students at a major public university in Saudi Arabia. MSKP was assessed using the Nordic Musculoskeletal Questionnaire, psychological distress using the Depression, Anxiety and Stress (DASS-21) questionnaire, and sleep quality using the Pittsburgh Sleep Quality Index. A total of 339 undergraduate students from various specialties provided complete responses and were included. The most common site of MSKP in the past 12 months and the past 7 days were neck pain (54.6% and 41.9%, respectively) and low back pain (49.4% and 48.2%, respectively). There was no difference in the prevalence of MSKP across colleges. The reported MSKP in the past 12 months and 7 days were significantly associated with the students' level of anxiety and stress as well as sleep quality (p < 0.05 for all), while depression was only significantly associated with MSKP in the past 7 days.