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Benebo FO, Lukic M, Jakobsen MD, Braaten TB. The role of lifestyle factors in the association between education and self-reported fibromyalgia: a mediation analysis. BMC Womens Health 2024; 24:244. [PMID: 38632566 PMCID: PMC11022321 DOI: 10.1186/s12905-024-03060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Socioeconomic status as measured by education, income, or occupation, has been associated with fibromyalgia but the underlying mechanism and the role of lifestyle factors are unclear. Thus, we examine the role of modifiable lifestyle factors (body mass index, physical activity, alcohol consumption and smoking) in the association between education and self-reported fibromyalgia. METHODS We used data from 74,157 participants in the population-based prospective Norwegian Women and Cancer (NOWAC) study. Socioeconomic position, operationalized as years of educational attainment, and lifestyle factors were assessed via self-reported questionnaires. Multiple mediation analysis was used to decompose total effects into direct and indirect effects. Estimates were reported as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS The cumulative incidence of fibromyalgia was 3.2% after a median follow up time of 13 years. Fibromyalgia was inversely associated with years of educational attainment for ≤ 9 years (HR = 2.56; 95% CI 2.32-2.91) and for 10-12 years (HR = 1.84; 95% CI 1.72-2.02), compared with ≥ 13 years of education. Overall, all lifestyle factors together jointly mediated 17.3% (95% CI 14.3-21.6) and 14.1% (95% CI 11.3-18.9) of the total effect for ≤ 9 years and 10-12 years of education, respectively. Smoking and alcohol consumption contributed the most to the proportion mediated, for ≤ 9 years (5.0% and 7.0%) and 10-12 years (5.6% and 4.5%) of education. CONCLUSION The association between education and self-reported fibromyalgia was partly explained through lifestyle factors, mainly smoking and alcohol consumption.
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Affiliation(s)
- Faith Owunari Benebo
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway.
| | - Marko Lukic
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway
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Endrighi R, Borrelli B. Pain-Related Smoking Expectancies and Smoking Behavior Among U.S. Adult Cigarette Smokers with Chronic Pain. Int J Behav Med 2023:10.1007/s12529-023-10239-1. [PMID: 37935908 DOI: 10.1007/s12529-023-10239-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND This study investigated the factor structure of a measure of pain-smoking interrelations and expectancies (pain and smoking inventory (PSI)) and examined associations with risk factors for smoking maintenance among smokers with chronic pain (CP). METHOD Participants (n = 504; M age = 46 ± 13 years; 58% female) completed an online survey about health-related factors and smoking characteristics. Data were analyzed using Horn's parallel analysis (PA) and multiple linear regression. RESULTS PA indicated that a single-dimension structure was the best fit for the PSI. Our regression model accounted for 34% of the variance in PSI score. The PSI was associated with younger age, higher education, poorer physical functioning, greater pain severity and pain intensity, higher psychological distress, greater nicotine dependence, lower self-efficacy and greater perceived difficulty quitting, and lifetime use of behavioral treatment for quitting smoking. CONCLUSION This research is the first step in identifying potential targets for smoking cessation approaches tailored to smokers with CP.
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Affiliation(s)
- Romano Endrighi
- Center for Behavioral Science Research, Department of Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, 560 Harrison Ave, Boston, MA, 02118, USA.
| | - Belinda Borrelli
- Center for Behavioral Science Research, Department of Health Policy and Health Services Research, Boston University, Henry M. Goldman School of Dental Medicine, 560 Harrison Ave, Boston, MA, 02118, USA
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Manderlier A, de Fooz M, Patris S, Berquin A. Modifiable lifestyle-related prognostic factors for the onset of chronic spinal pain: A systematic review of longitudinal studies. Ann Phys Rehabil Med 2022; 65:101660. [PMID: 35351652 DOI: 10.1016/j.rehab.2022.101660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stratified approaches to spinal pain that address psychosocial risk factors reduce long-term disability to a moderate extent. Identifying and managing other risk factors might help improve outcomes. OBJECTIVE This systematic review of longitudinal studies aimed to evaluate possible associations between the onset of chronic spinal pain (including low back, back and neck pain) and putative modifiable lifestyle-related risk or protective factors. METHODS This systematic review of longitudinal studies published during the last 2 decades followed PRISMA guidelines. Two reviewers screened Medline, Scopus, Pedro, Cochrane Library, Psycinfo, Science Direct, PTSDpubs and Google Scholar for relevant studies. The QUIPS tool was used to assess the risk of bias. A qualitative meta-synthesis of relevant factors was performed. RESULTS Of 3716 unique records, 14 studies met the inclusion criteria (10 with low risk of bias and 4 moderate risk of bias). The highest bias observed was attrition. For chronic low back pain, we found moderate evidence for the involvement of high body weight, waist circumference, and hip circumference and conflicting evidence for high body mass index (BMI), smoking, and physical activity. For chronic neck pain, we found strong evidence for high BMI in women, moderate evidence for sleep disorders in women and conflicting evidence for high BMI in men and physical activity. For chronic back pain, we found limited evidence for gardening/yard work in men and more than one adult at home. Effect sizes were small. CONCLUSIONS Several modifiable lifestyle-related factors were identified. Evidence is still sparse and there is a need for more studies. PROSPERO database registration: Ref 172,112 CRD42020172112.
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Affiliation(s)
- Adrien Manderlier
- Saint-Luc University Hospital, Av. Hippocrate 10/1650, 1200 Brussels, Belgium
| | - Maxime de Fooz
- Saint-Luc University Hospital, Av. Hippocrate 10/1650, 1200 Brussels, Belgium
| | - Sophie Patris
- Psychology, Education and Motor Sciences Library, Université catholique de Louvain, Brussels, Place Cardinal Mercier, 10/L3.05.01, 1348 Louvain-la-Neuve, Belgium
| | - Anne Berquin
- Saint-Luc University Hospital, Av. Hippocrate 10/1650, 1200 Brussels, Belgium; Institute of Neuroscience, Université catholique de Louvain, Avenue E. Mounier 53, 1200 Brussels, Belgium.
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Sato EM, Magalhães MO, Jenkins BC, da Silva Ferreira L, da Silva HAR, Farias Furtado PR, Soares Ferreira EG, dos Santos ECS, Callegari B, Pasqual Marques A. Low Back Pain in Elderly from Belém-Pa, Brazil: Prevalence and Association with Functional Disability. Healthcare (Basel) 2021; 9:1658. [PMID: 34946384 PMCID: PMC8702051 DOI: 10.3390/healthcare9121658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This cross-sectional study aimed to determine the prevalence of low back pain (LBP) in the elderly population living in Belém-Pará and to assess the spectrum of problems related to these diseases including the demographic, socioeconomic, occupational characteristics and disability in this population. METHODS Three structured questionnaires were applied in a randomly selected representative sample of 512 elderly people aged ≥60 years. RESULTS LBP prevalence in the elderly population was 55.7%. Among then, 56.1% had pain at the time of the interview (punctual prevalence), 91.7% had LBP in the last 365 days (prevalence in the last year), and 85.3% at some point in life (prevalence at some point in life). Overall, most studies are above average. LBP was positively associated with hypertension and the influence of the physical and mental health on their social activities ranged from slightly to extreme. LBP was negatively associated with characteristics, such as education (over 11 years), class A or B income, physical activity, high satisfaction with previous work, and excellent self-perceived health, corroborating to the literature. CONCLUSIONS Greater intensity of pain and functional disability were associated with the presence of comorbidities, smoking habits, and low physical activity. LBP prevalence was high, above the national average, mainly affecting the underprivileged classes related to several modifiable factors, highlighting the importance of preventive and interventionist actions for healthy aging.
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Affiliation(s)
- Elaine Miyuka Sato
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
- Laboratory of Human Motricity Sciences, Federal University of Pará, Belém-Pará 66050-160, Brazil;
| | - Mauricio Oliveira Magalhães
- Master’s Program in Human Movement Sciences, Federal University of Pará, Belém-Pará 66050-160, Brazil; (M.O.M.); (L.d.S.F.)
| | - Beatriz Coelho Jenkins
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
| | - Lays da Silva Ferreira
- Master’s Program in Human Movement Sciences, Federal University of Pará, Belém-Pará 66050-160, Brazil; (M.O.M.); (L.d.S.F.)
| | - Hallyson Andrey Raposo da Silva
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
| | - Paulo Renan Farias Furtado
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
| | - Eder Gabriel Soares Ferreira
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
| | - Emmanuele Celina Souza dos Santos
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
| | - Bianca Callegari
- Laboratory of Human Motricity Sciences, Federal University of Pará, Belém-Pará 66050-160, Brazil;
- Master’s Program in Human Movement Sciences, Federal University of Pará, Belém-Pará 66050-160, Brazil; (M.O.M.); (L.d.S.F.)
| | - Amélia Pasqual Marques
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo 05508-060, Brazil;
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Zhang Y, Sevilla A, Weller R, Wang S, Gitlin MC, Candiotti KA. The role of α7-nicotinic acetylcholine receptor in a rat model of chronic nicotine-induced mechanical hypersensitivity. Neurosci Lett 2020; 743:135566. [PMID: 33352289 DOI: 10.1016/j.neulet.2020.135566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/19/2022]
Abstract
Smokers have a higher incidence of chronic pain than non-smokers, but the neural mechanism is not yet fully understood. Nicotine is the main component of tobacco and acts as an agonist for nicotinic cholinergic receptors (nAChRs) in the nervous system. This study was approved by the IACUC of UM. The effects of chronic nicotine administration on mechanical sensitivity were studied using a rat model. The changes in the expression levels of the α7 isoform of nAChR (α7-nAChR), inflammatory cytokines TNFα and COX-2, as well as the density of neuro-immune cells (astrocytes and microglia) were measured concurrently. The results indicate that long-term nicotine administration induces hypersensitivity to mechanical stimuli, as demonstrated by a significant reduction in the pain perception threshold. In response to nicotine, the expression levels of α7-nAChR increased in the periaqueductal gray matter (PAG) and decreased in the spinal cord. Acute administration of the selective α7-nAChR agonist CDP-Choline reversed this hypersensitivity. Chronic nicotine administration led to an increase of microglial cells in the dorsal horn of the spinal cord and increased expression levels of the cytokines TNFα and COX-2. This study suggests that decreased α7-nAChR expression in the spinal cord, as a result of long-term exposure to nicotine, may be causatively linked to chronic pain. Simultaneously, the increase of neuro-immune factors in the spinal cord is also a potential factor leading to chronic pain.
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Affiliation(s)
- Yanping Zhang
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, USA.
| | - Alec Sevilla
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, USA
| | - Robert Weller
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, USA
| | - Shuju Wang
- Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Melvin C Gitlin
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, USA
| | - Keith A Candiotti
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, USA.
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Buch MH, Eyre S, McGonagle D. Persistent inflammatory and non-inflammatory mechanisms in refractory rheumatoid arthritis. Nat Rev Rheumatol 2020; 17:17-33. [PMID: 33293696 DOI: 10.1038/s41584-020-00541-7] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 12/13/2022]
Abstract
Despite nearly three decades of advances in the management of rheumatoid arthritis (RA), a substantial minority of patients are exposed to multiple DMARDs without necessarily benefitting from them; a group of patients variously designated as having 'difficult to treat', 'treatment-resistant' or 'refractory' RA. This Review of refractory RA focuses on two types of patients: those for whom multiple targeted therapies lack efficacy and who have persistent inflammatory pathology, which we designate as persistent inflammatory refractory RA (PIRRA); and those with supposed refractory RA who have continued disease activity that is predominantly independent of objective evidence of inflammation, which we designate as non-inflammatory refractory RA (NIRRA). These two types of disease are not mutually exclusive, but identifying those individuals with predominant PIRRA or NIRRA is important, as it informs distinct treatment and management approaches. This Review outlines the clinical differences between PIRRA and NIRRA, the genetic and epigenetic mechanisms and immune pathways that might contribute to the immunopathogenesis of recalcitrant synovitis in PIRRA, and a possible basis for non-inflammatory symptomatology in NIRRA. Future approaches towards the definition of refractory RA and the application of single-cell and integrated omics technologies to the identification of refractory RA endotypes are also discussed.
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Affiliation(s)
- Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK. .,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK. .,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
| | - Stephen Eyre
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Cheatle MD, Falcone M, Dhingra L, Lerman C. Independent association of tobacco use with opioid use disorder in patients of European ancestry with chronic non-cancer pain. Drug Alcohol Depend 2020; 209:107901. [PMID: 32126454 PMCID: PMC7219106 DOI: 10.1016/j.drugalcdep.2020.107901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The harms associated with prescription opioid abuse have become a public health crisis. There is a need for evidence-based objective markers of the risk of opioid use disorder (OUD) in patients with pain receiving opioid treatment. The objective of this study was to evaluate the independent association of tobacco use and OUD in patients with chronic non-cancer pain. METHODS This cross-sectional naturalistic study evaluated 798 adults ≥ 18 years with chronic non-cancer pain treated with long-term opioid therapy (≥ 6 months) who either developed an OUD (cases, n = 216) or displayed no evidence of an OUD (controls, n = 582). The primary outcome was presence of OUD. In addition to current self-reported tobacco use (primary predictor), covariates included demographics, pain severity, and psychiatric history. Data were collected between November 2012 and September 2018. RESULTS Current tobacco use independently was strongly associated with OUD [odds ratio (OR) 14.0, 95 % confidence interval (CI) 9.5-20.6, p < 0.001], and this association remained significant after adjusting for other risk factors [adjusted odds ratio (aOR) 7.6, 95 % CI 4.8-12.2, p < 0.001]. Other factors associated independently with development of OUD included age, marital status, financial status, education and pain severity. CONCLUSIONS AND RELEVANCE Current tobacco use is significantly associated with OUD in patients with chronic pain receiving long-term opioid therapy.
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Affiliation(s)
- Martin D Cheatle
- Department of Psychiatry, Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Mary Falcone
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 99003, USA
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Caryn Lerman
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 99003, USA
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Perski O, Garnett C, Shahab L, Brown J, West R. Associations between smoking status and bodily pain in a cross-sectional survey of UK respondents. Addict Behav 2020; 102:106229. [PMID: 31862683 PMCID: PMC6959457 DOI: 10.1016/j.addbeh.2019.106229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 11/01/2022]
Abstract
BACKGROUND Research indicates that ex- and current smokers report increased levels of bodily pain compared with never smokers. This could be secondary to smoking-related disease or psychological characteristics of smokers, or it could be a neurological or vascular effect of a period of regular smoking. AIMS We compared self-reported levels of bodily pain in daily, never daily and former daily smokers stratified by age group and adjusting for a wider range of covariates than has been undertaken to-date, including health status, neuroticism, anxiety and depression. METHOD 223,537 UK respondents aged 16+ years were surveyed between 2009 and 2013 in the British Broadcasting Corporation (BBC) Lab UK Study. Respondents provided information on bodily pain, smoking status and a range of sociodemographic, health, behavioural and psychological characteristics. RESULTS After adjusting for all covariates, in 16-34-year-olds, reported levels of bodily pain in former daily smokers (Badj = 0.72, 95% CI = 0.30, 1.15, p < .001) and daily smokers (Badj = 0.50, 95% CI = 0.18, 0.82, p < .01) were higher than in never daily smokers. Reported levels of bodily pain were also higher in former daily smokers than in never daily smokers in those aged 35-64 (Badj = 1.04, 95% CI = 0.69, 1.38, p < .001) and 65 + years (Badj = 1.65, 95% CI = 0.07, 3.24, p < .05). CONCLUSIONS After adjusting for key characteristics, former daily smokers reported higher levels of bodily pain compared with never daily smokers at all ages. This raises the possibility that a period of smoking may have lasting effects on pain experiences.
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Affiliation(s)
- Olga Perski
- Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
| | - Claire Garnett
- Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Lion Shahab
- Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Jamie Brown
- Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Robert West
- Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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