1
|
Gorito V, Brandão M, Azevedo I, Moreira A, Lucas R. Atopic dermatitis in early life and pain at 10 years of age: An exploratory study. Eur J Pediatr 2024; 183:2239-2249. [PMID: 38400917 PMCID: PMC11035428 DOI: 10.1007/s00431-024-05439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/11/2024] [Accepted: 01/14/2024] [Indexed: 02/26/2024]
Abstract
Pain is a distinctive burden in atopic dermatitis and recognized as an important and highly prevalent symptom. It is unknown if the presence of atopic disease may sensitize children to adverse pain profiles in the long term. We aimed to assess the impact of early-life atopic dermatitis-like symptoms on pain at 10 years of age. We used data from 1302 and 874 participants of the Generation XXI birth cohort evaluated at 6 and 15 months, respectively, and 10 years. Atopy-like symptoms since birth, including atopic dermatitis, were collected at ages 6 and 15 months by interviewing parents. Pain history in the last 3 months at age 10 was collected from parents and children using structured questionnaires. We computed relative risks (RR) and respective 95% confidence intervals of pain features at age 10 according to each atopic-like symptom at 6 and 15 months. Children whose parents reported atopic dermatitis-like symptoms at 6 months and at 15 months had higher risk of reporting any pain (RR 1.75 [1.15-2.66]) and multisite pain, respectively (RR 1.67 [1.18-2.37]) at 10 years of age. Conclusion: Atopic dermatitis symptoms in early life were associated with a higher risk of pain at age 10, suggesting that potential for sensitization during the first decade of life and highlighting the importance of improving the health care of children with atopic dermatitis is worth investigating. What is Known: • Atopic disorders have been associated with many non-atopic comorbidities, including chronic pain. • Pain and atopic dermatitis share common inflammatory pathways. Inflammation, injury to the skin from scratching, fissures, and intolerance to irritants related to atopic dermatitis can cause pain. What is New: • Atopic dermatitis in early life is linked to an increased likelihood of experiencing pain at the age of 10, which suggests that exploring the potential for sensitization is a worthwhile area of investigation. • Our proof-of-concept study highlights the potential benefit of studying management targets and improving itching and relieving skin pain as quickly as possible, avoiding potential long-term consequences of the sensitization process.
Collapse
Affiliation(s)
- Vanessa Gorito
- EPIUnit - Instituto de Saúde Pública e Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas 135, 050-600, Porto, Portugal
- Serviço de Pediatria e Neonatologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria Brandão
- EPIUnit - Instituto de Saúde Pública e Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas 135, 050-600, Porto, Portugal
| | - Inês Azevedo
- EPIUnit - Instituto de Saúde Pública e Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas 135, 050-600, Porto, Portugal
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Serviço de Pediatria Médica, UAG da Mulher e Criança, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - André Moreira
- EPIUnit - Instituto de Saúde Pública e Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas 135, 050-600, Porto, Portugal
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
- Unidade de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Raquel Lucas
- EPIUnit - Instituto de Saúde Pública e Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas 135, 050-600, Porto, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
| |
Collapse
|
2
|
Fernandes F, Talih M, Pires C, Navasardyan N, Santos MJ, Lucas R. Pain site persistence and changes from childhood to adolescence: a prospective cohort study. Pediatr Res 2024; 95:1625-1633. [PMID: 38225449 DOI: 10.1038/s41390-024-03021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/22/2023] [Accepted: 12/29/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Pain is a complex experience that interferes with the well-being of youth who experience it. We aimed to assess whether recurrent pain sites in childhood can predict later recurrent pain sites prospectively. METHODS Pain was assessed using the Luebeck Pain Screening Questionnaire at ages 7, 10, and 13 from the Generation XXI cohort. We used multinomial regression to assess the association of recurrent pain sites at ages 7 and 10 with those at age 13. RESULTS We included 3833 participants. Boys with recurrent abdominal/pelvic pain at age 7 were more likely to report headaches (OR 2.81; 95%CI 1.48-5.34), abdominal/pelvic (OR 2.92; 95%CI 1.46-5.84), and musculoskeletal pain (OR 1.55; 95%CI 1.02-2.34) at age 13. Girls with recurrent abdominal/pelvic pain at age 7 were more likely to report both musculoskeletal (OR 1.62; 95%CI 1.10-2.40) and abdominal/pelvic pain (OR 1.74; 95%CI 1.15-2.65). At age 10, all pain sites were associated with pain in the same site at age 13. CONCLUSION Recurrent abdominal/pelvic pain at age 7 may be related to the development of various pains in adolescence. Pain at a given site at age 10 can be associated with pain at that same site at age 13. IMPACT Recurrent abdominal or pelvic pain during childhood was distinctively associated with an increased risk of recurrent pain in other sites during adolescence. Recurrent pain during childhood was associated with pain in the same sites at age 13, and this persistence seemed to emerge between the ages of 7 and 10 for both boys and girls. Studying early pain sites may add to the understanding of the etiology of chronic pain.
Collapse
Affiliation(s)
- Francisco Fernandes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal.
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal.
- Unidade de Saúde Pública - Agrupamento de Centros de Saúde Baixo Mondego, Coimbra, Portugal.
| | - Makram Talih
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Catarina Pires
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
| | - Naré Navasardyan
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
| | - Maria José Santos
- Rheumatology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Raquel Lucas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
| |
Collapse
|
3
|
Lucas R, Talih M, Soares S, Fraga S. Bullying Involvement and Physical Pain Between Ages 10 and 13 Years: Reported History and Quantitative Sensory Testing in a Population-Based Cohort. THE JOURNAL OF PAIN 2024; 25:1012-1023. [PMID: 37914095 DOI: 10.1016/j.jpain.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/06/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023]
Abstract
We aimed to quantify the prospective association between bullying and physical pain in a population-based cohort of adolescents. We assessed 4,049 participants of the 10 and 13 years waves of the Generation XXI birth cohort study in Portugal. Pain history was collected using the Luebeck pain screening questionnaire. A subsample of 1,727 adolescents underwent computerized cuff pressure algometry to estimate pain detection/tolerance thresholds, temporal pain summation and conditioned pain modulation. Participants completed the Bully Scale Survey and were classified as "victim only", "both victim and aggressor", "aggressor only", or "not involved". Associations were quantified using Poisson or linear regression, adjusted for sex and adverse childhood experiences. When compared to adolescents "not involved", participants classified as "victim only" or "both victim and aggressor" at age 10 had higher risk of pain with psychosocial triggers, pain that led to skipping leisure activities, multisite pain, pain of higher intensity, and pain of longer duration, with relative risks between 1.21 (95% confidence interval: .99, 1.49) and 2.17 (1.57, 3.01). "Victims only" at age 10 had lower average pain detection and tolerance thresholds at 13 years (linear regression coefficients: -1.81 [-3.29, -.33] and -2.73 [-5.17, -.29] kPa, respectively), as well as higher pain intensity ratings (.37 [.07, .68] and .39 [.06, .72] mm), when compared with adolescents not involved. No differences were seen for the remaining bullying profiles or sensory measures. Our findings suggest that bullying may have long-term influence on the risk of chronic musculoskeletal pain and may interfere with responses to painful stimuli. PERSPECTIVE: We found prospective evidence that bullying victimization in youth: 1) is more likely to lead to negative reported pain experiences than the reverse, 2) may have long-term influence on adverse pain experiences, and 3) may contribute to pain phenotypes partly by interfering with somatosensory responses to painful stimuli.
Collapse
Affiliation(s)
- Raquel Lucas
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal; Department of Population Studies, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Makram Talih
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Sara Soares
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Sílvia Fraga
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| |
Collapse
|
4
|
Brandão M, Talih M, Holden S, Fernandes F, Graven-Nielsen T, Lucas R. Pain history and experimental pressure pain responses in adolescents: Results from a population-based birth cohort. Eur J Pain 2024; 28:70-82. [PMID: 37485565 DOI: 10.1002/ejp.2159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Sensitized pain mechanisms are often reported in musculoskeletal pain conditions, but population-based paediatric studies are lacking. We assessed whether adolescents with musculoskeletal pain history had evidence of increased responsiveness to experimental pressure stimuli. METHODS Data were from 1496 adolescents of the Generation XXI birth cohort. Pain history was collected using the Luebeck Pain Questionnaire (self-reported at 13, parent-reported at 7 and 10 years). Two case definitions for musculoskeletal pain were considered: (1) cross-sectional-musculoskeletal pain lasting more than 3 months at age 13 and (2) longitudinal-musculoskeletal pain at age 13 with musculoskeletal pain reports at ages 7 and/or 10. Lower limb cuff pressure algometry was used to assess pain detection and tolerance thresholds, conditioned pain modulation effects (CPM, changes in thresholds in the presence on painful conditioning) and temporal summation of pain effects (TSP, changes in pain intensity to 10 phasic painful cuff stimulations). RESULTS Adolescents with musculoskeletal pain at age 13 plus a history of pain in previous evaluations (longitudinal definition) had lower pain tolerance thresholds compared to the remaining sample (40.2 v. 49.0 kPa, p = 0.02), but showed no differences in pain detection threshold, CPM effect and TSP effect. Pain sensitivity, CPM effects and TSP effects were not significantly different when the current pain only case definition (cross-sectional) was used. CONCLUSIONS Adolescents with current musculoskeletal pain who had a history of pain since childhood had lower tolerance to cuff stimulation. This may suggest long-standing musculoskeletal pain since childhood may contribute to sensitisation, rather than the presence of current pain only. SIGNIFICANCE Repeated musculoskeletal pain up to age 13 years may contribute to higher pain sensitivity (particularly lowered pressure pain tolerance) in the general adolescent population. This does not seem to be the case when reported pain experiences are recent or when the outcomes are temporal pain summation or CPM. In this community-based paediatric sample, the vast majority showed no sign of altered pain processing, but a small fraction may reveal some pain sensitization at 13 years of age.
Collapse
Affiliation(s)
- Maria Brandão
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Makram Talih
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Sinead Holden
- Center for Neuroplasticity and Pain (CNAP), Aalborg University, Copenhagen, Denmark
| | - Francisco Fernandes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Raquel Lucas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| |
Collapse
|
5
|
Lucas R, Brandão M, Gorito V, Talih M. Refining the prediction of multisite pain in 13-year-old boys and girls by using parent-reported pain experiences in the first decade of life. Eur J Pain 2021; 26:695-708. [PMID: 34904323 PMCID: PMC9305734 DOI: 10.1002/ejp.1898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/10/2021] [Indexed: 11/11/2022]
Abstract
Background We evaluated different pain profiles as prospective predictors of multisite pain in 13‐year‐old adolescents (1300 girls and 1457 boys) enrolled in Generation XXI, a birth cohort study in Portugal. Methods Pain history was queried using the Luebeck Pain Questionnaire through parent proxy‐ (ages 7 and 10) and adolescent (age 13) self‐reports. We estimated the risk of multisite pain (2 or more pain sites) at age 13, according to previous pain experiences, including accumulation and timing. We defined five profiles that combined adverse features at ages 7 and 10 (recurrence, multisite, frequency, duration, intensity, triggers, activity restrictions, passive coping, and family history) and estimated their relative risks (RR) and likelihood ratios (LR) for adolescent multisite pain. Results At age 13, 39.2% of girls and 27.2% of boys reported multisite pain in the previous three months. The risk was higher among girls with multisite and recurrent pain at ages 7 and 10 than in girls without those adverse features, especially if psychosocial triggers were also present (RR 1.87; 95% confidence interval 1.36, 2.36 and LR 3.49; 1.53, 7.96). Boys with recurrent pain of higher frequency and causing activity restrictions at ages 7 and 10 had a higher risk of multisite pain at 13 (RR 2.05; 1.03, 3.05 and LR 3.06; 1.12, 8.39). Earlier adverse experiences were more predictive of future pain in girls than in boys. Conclusions Different profiles were useful to rule in future multisite pain in boys and girls. This provides clues for early stratification of chronic pain risk. Significance We identified sex‐specific pain features that can be collected by practitioners in the first decade of life to improve the stratification of children in terms of their future risk of a maladaptive pain experience in adolescence. Using a prospective population‐based cohort design, we show that early multisite pain and psychosocial triggers are relevant predictors of future multisite pain in girls, whereas repeated reports of high‐frequency pain leading to activity restrictions are predictive of adolescent multisite pain in boys.
Collapse
Affiliation(s)
- Raquel Lucas
- EPIUnit (Epidemiology Research Unit), ITR (Laboratory for Integrative and Translational Research in Population Health), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria Brandão
- EPIUnit (Epidemiology Research Unit), ITR (Laboratory for Integrative and Translational Research in Population Health), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Vanessa Gorito
- EPIUnit (Epidemiology Research Unit), ITR (Laboratory for Integrative and Translational Research in Population Health), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Makram Talih
- EPIUnit (Epidemiology Research Unit), ITR (Laboratory for Integrative and Translational Research in Population Health), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| |
Collapse
|