Prevalence and associated factors of disability in patients with chronic pain: An observational study

Pain symptoms and physical performance in older adults: cross-sectional findings from the International Mobility in Aging Study (IMIAS)

PURPOSE

To analyze the associations between pain and physical performance in different aging contexts.

METHODS

Data from 1725 older adults from Canada, Brazil, Colombia, and Albania from the 2014 wave of the IMIAS were used to assess the associations between Back Pain (BP) or Lower Limb Pain (LLP) and physical performance by the Short Physical Performance Battery (SPPB). Three binary logistic regression models adjusted for sex, age, study site, education, income sufficiency, BMI, depressive symptoms, and chronic conditions were used to estimate the associations between LLP or BP and SPPB. The SPPB was classified into good performance (8 points or more) and poor physical performance (< 8 points).

RESULTS

The mean age of the older men was 71.2 (± 3.0) and the mean age of the women was 71.2 (± 2.8) years. Older men (72.8%, p < 0.05) and women (86.1%, p-value < 0.05) from Albania had the highest frequencies of self-reported general pain. Older women in Colombia had the highest frequencies of LLP or BP (33.5%, p-value < 0.05). In the fully adjusted logistic regression model, LLP or BP was significantly associated with poor SPPB (OR = 0.48, 0.35 to 0.66 95% CI, p < 0.01).

CONCLUSIONS

Pain symptoms are associated with reduced physical performance in older people, even when adjusted for other clinical and sociodemographic factors. Protocols for aiming to increase the level of physical activity to manage pain should be incorporated into health care strategies.

The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review

The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.

Designing a minimum data set for the information management system (registry) of spinal canal stenosis: An applied-descriptive study

Background and Aims

Spinal canal stenosis is one of the most common vertebral column diseases, which can lead to disability. Developing a registry system can help in research on the prevention and effective treatment of it. This study designs a minimum data set (MDS) as the first step in creating a registry system for spinal canal stenosis.

Method

The present research is of applied-descriptive type, performed in 2022. First, the applicable data elements about the disease were selected from a vast range of English and Farsi references, including peer reviewed articles, academic books, credible websites, and medical records of hospitalized patients. Through the extracted data, the primary MDS plan was designed as a questionnaire. The validity of the questionnaire was conducted via asking the opinion of experts (neurosurgeons, physiotherapists, epidemiologists, and health information management specialists). Also, its reliability was calculated via Cronbach ⍺ coefficient, which was 86%. Finally, the MDS of the spinal canal stenosis national registry system (for Iran) was confirmed through a two stage Delphi technique. Data analysis was applied through descriptive statistics via SPSS21 software.

Results

The proposed MDS is offered in two general sets of data: administrative and clinical. For the administrative data set, 40 data elements had been proposed, as five classes. Twenty-six of them were confirmed. In the clinical section, 95 data elements had been proposed in 14 classes; 94 of which were finally confirmed.

Conclusion

Since there is no spinal canal stenosis MDS available, this study can be a turning point in the standardization of the data on this disease. Moreover, these precise, coherent, and standard data elements can be contributed to improving disease management and enhancing the public healthcare quality. Also, the MDS proposed in this study can help researchers and experts, design a spinal canal stenosis registry system in other countries.

Persistent postoperative pain at 1 year after orthopedic surgery and its association with functional disability

PURPOSE

Orthopedic hip, knee, and spinal surgeries have a relatively high incidence of persistent postoperative pain, with the highest risk observed in Asian ethnicity. This study aimed to investigate the distribution of persistent pain at 1 year after surgery and its associated factors and effects on functional disability.

METHODS

This secondary analysis of a prospective observational study included 297 patients aged ≥ 55 years who underwent elective total hip arthroplasty, total knee arthroplasty, and spine and spinal cord surgeries under general anesthesia. Data were collected perioperatively and at 3 months and 1 year postoperatively to assess persistent postoperative pain on a numerical rating scale.

RESULTS

At 1 year postoperatively, 34.6% (103/297) of patients reported pain, with a score of ≥ 1 and a mean score of 1.2. Multivariable negative binomial regression analysis revealed that less preoperative bodily pain (risk ratio [RR], 0.97; 95% confidence interval [CI] 0.94-0.99), preoperative C-reactive protein (CRP) level (RR, 1.19; 95% CI 1.01-1.39), and spine and spinal cord surgeries (RR, 2.48; 95% CI 1.30-4.75) increased the risk of persistent pain at 1 year after surgery, which was a significant factor for predicting the 12-item World Health Organization Disability Assessment Schedule 2.0 score (p < 0.001).

CONCLUSION

The mean score for persistent pain at 1 year after surgery on the numerical rating scale was 1.2. Worse preoperative bodily pain, higher preoperative serum CRP level, and spine and spinal cord surgeries increased the persistent pain score at 1 year after surgery, which was associated with functional disability CLINICAL TRIAL REGISTRATION: This prospective observational study was registered on the University Hospital Medical Information Network (31 December 2015; UMIN000021671).

Association of Pre-operative Functional Disability with Chronic Postsurgical Pain: A Prospective Observational Study

BACKGROUND

Chronic postsurgical pain negatively affects postoperative recovery. We aimed to assess the association between pre-operative functional disability and chronic postsurgical pain.

METHODS

This secondary analysis of a prospective observational study included 920 inpatients aged≥55 years undergoing elective abdominal surgery. We assessed functional disability using the 12-item World Health Organization Disability Assessment Schedule 2.0 before surgery and measured postoperative pain using a numerical rating scale at a postanaesthetic clinic 3 months and 1 year after surgery. We performed multiple logistic regression analysis to determine associations with chronic postsurgical pain 1 year after surgery. We analysed the sequential pain score using a mixed-effects model in patients with and without pre-operative functional disability. The primary outcome in this study was chronic postsurgical pain and its associated factors with a focus on preoperative functional disability. The secondary outcome was pain trajectories in patients with and without preoperative functional disability.

RESULTS

Of the 899 patients included in the analysis, 11.9% had chronic postsurgical pain 1 year later. The multiple logistic regression analysis revealed that pre-operative functional disability was associated with this outcome (OR 2.80, 95% CI, 1.70 to 4.59) as well as use of pre-operative pain medication (OR 2.74, 95% CI, 1.24 to 6.03) and pain numerical rating scale at the postanaesthetic clinic (OR 1.19, 95% CI 1.10 to 1.29). The pain trajectories were different in the presence or absence of functional disability (P<0.001) and the time of measurement (P<0.001).

CONCLUSIONS

Pre-operative functional disability was associated with chronic postsurgical pain and pain trajectories.