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Horike K, Ukezono M. Efficacy of chronic neck pain self-treatment using press needles: a randomized controlled clinical trial. FRONTIERS IN PAIN RESEARCH 2024; 5:1301665. [PMID: 38586186 PMCID: PMC10995221 DOI: 10.3389/fpain.2024.1301665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/14/2024] [Indexed: 04/09/2024] Open
Abstract
Background Chronic neck pain is common among Japanese individuals, but few receive treatment. This randomized controlled trial aimed to evaluate the efficacy of acupuncture using press needles in the self-treatment of chronic neck pain and preliminarily identify the characteristics of patients likely to benefit from this treatment. Methods Fifty participants with chronic neck pain were allocated to receive either press needle or placebo treatment for 3 weeks. The visual analogue scale (VAS) and motion-related VAS (M-VAS) scores for neck pain, Neck Disability Index score, and pressure pain threshold were measured at baseline, after the first session, at the end of the last session, and 1 week after the last session. Changes in the outcomes were analyzed using analysis of variance, and the relationships between the variables were evaluated using structural equation modeling. Results Intervention results as assessed by VAS score revealed no significant differences in the ANOVA. A between-groups comparison of M-VAS scores at the end of the last session and baseline showed a significant difference (press needle: -21.64 ± 4.47, placebo: -8.09 ± 3.81, p = 0.025, d = -0.65). Structural equation modeling revealed a significant pain-reducing effect of press needle treatment (β = -0.228, p = 0.049). Severity directly affected efficacy (β = -0.881, p < 0.001). Pain duration, baseline VAS and Neck Disability Index scores were variables explaining severity, while age and occupational computer use were factors affecting severity. Conclusion Self-treatment with press needles for chronic neck pain did not significantly reduce the VAS score compared to placebo but reduced the motion-related pain as assessed by M-VAS score. A direct association was observed between pain severity and the effectiveness of press needles, and the impact of age and computer were indirectly linked by pain severity. Clinical Trial Registration Identifier UMIN-CTR, UMIN000044078.
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Affiliation(s)
- Kaori Horike
- Comprehensive Human Science, University of Tsukuba, Bunkyo, Japan
- Product Development Department, Sompo Care Inc., Shinagawa, Japan
| | - Masatoshi Ukezono
- Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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Hashem M, AlMohaini RA, Alharbi TM, Aljurfi MM, Alzmamy SA, Alhussainan FS. Impact of Musculoskeletal Pain on Health-Related Quality of Life Among Adults in Saudi Arabia. Cureus 2024; 16:e57053. [PMID: 38681335 PMCID: PMC11051673 DOI: 10.7759/cureus.57053] [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: 03/23/2024] [Indexed: 05/01/2024] Open
Abstract
Background Musculoskeletal pain (MSP) is widely recognized as a prevalent public health issue that affects individuals of various genders and age groups. The aim of this study is to assess the influence of musculoskeletal pain on the quality of life (QoL) of adult individuals living in Saudi Arabia. Method This is a cross-sectional study using an online-administered questionnaire that was distributed via online platforms in Saudi Arabia for the duration between January and August 2023. Three questionnaire instruments were used in this study. The 36-item Short Form Health Survey questionnaire (SF-36), The 5-level EQ-5D version (EQ-5D-5L), and Roland-Morris Disability Questionnaire. Binary logistic regression analysis was used to identify predictors of better QoL and having mild to moderate disability. Results A total of 8359 participants were involved in this study. The most commonly reported sites of musculoskeletal pain were the lower back, neck, and shoulder, accounting for 36.8% (n= 3072), 30.5% (n= 2549), and 30.1% (n= 2514), respectively. The mean pain score for the study participants was 4.3 (SD: 2.3), which indicates mild degree of pain. The median EQ-5D-5L index value for the study participants was 0.827 (0.756-1.00), which demonstrates a high quality of life. The mean SF-36 score for the study participants was 63.11 (17.4), which demonstrates moderate quality of life. The median Roland-Morris Disability score for the study participants was 1.00 (0.00-7.00), which demonstrates a low level of pain-related disability. Male gender, younger age (30-39 years), having higher education attainment, having higher monthly income (more than SAR 20000), and having lower BMI (less than 25.8 kg/cm2) were predictors of better QoL (p<0.05). Conclusion Musculoskeletal pain is a multifactorial condition influenced by structural, physical, psychological, social, lifestyle, and comorbid health elements. It ranges from acute to chronic pain and, despite rarely being fatal, has a significant impact on QoL. Musculoskeletal discomfort varies in terms of intensity, affected regions, and demographic and lifestyle factors. This study sheds light on the multifaceted nature of MSP, its impact on QoL, and the significance of early intervention and individualized management strategies to improve the QoL of those affected.
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Affiliation(s)
- Majdi Hashem
- Surgery, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | - Turki Melfi Alharbi
- Internal Medicine, College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, SAU
| | - Muhamad Muslim Aljurfi
- Orthopedics, College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, SAU
| | - Saad Abdullah Alzmamy
- Internal Medicine, College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, SAU
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Benebo FO, Lukic M, Jakobsen MD, Braaten TB. Lifestyle risk factors of self-reported fibromyalgia in the Norwegian Women and Cancer (NOWAC) study. BMC Public Health 2023; 23:1967. [PMID: 37821848 PMCID: PMC10566054 DOI: 10.1186/s12889-023-16773-7] [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: 03/15/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND While the aetiology of fibromyalgia syndrome (FM) remains unknown, lifestyle factors have been linked to the disorder. However, there are few studies on the association between lifestyle factors and FM, thus we examine the risk of self-reported fibromyalgia given selected lifestyle factors. METHODS We used data from 75,485 participants in the Norwegian Women and Cancer study. Information on FM and the lifestyle factors body mass index (BMI), physical activity level, smoking status/intensity, and alcohol consumption were obtained from baseline and follow-up questionnaires. We used Cox proportional hazards model to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS After a median follow-up time of 10 years, we observed 2,248 cases of self-reported fibromyalgia. Overweight (BMI 25-29.9 kg/m2) and obese (BMI ≥ 30 kg/m2) women had a relative risk of 1.34 (95% CI 1.21-1.47) and 1.62 (95% CI 1.41-1.87), respectively, compared to women with normal weight (BMI 18.5-24.9 kg/m2). Very low physical activity level (1-2) was associated with a 31% higher risk of self-reported fibromyalgia (HR 1.31, 95% CI 1.09-1.57) when compared to moderate physical activity level (5-6). There was a strong dose-response relationship between smoking status/intensity and self-reported fibromyalgia (p for trend < 0.001). Compared with moderate alcohol consumption (4.0-10 g/day), the risk of self-reported FM was 72% (HR 1.72; 95% CI 1.45-2.03) higher among teetotallers, and 38% (HR 1.38, 95% CI 1.23-1.54) higher among those with low consumption (0.1-3.9 g/day). CONCLUSIONS Overweight and obesity, very low physical activity level, smoking, and alcohol consumption were associated with an increased risk of self-reported FM.
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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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Areias AC, Molinos M, Moulder RG, Janela D, Scheer JK, Bento V, Yanamadala V, Cohen SP, Correia FD, Costa F. The potential of a multimodal digital care program in addressing healthcare inequities in musculoskeletal pain management. NPJ Digit Med 2023; 6:188. [PMID: 37816899 PMCID: PMC10564877 DOI: 10.1038/s41746-023-00936-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
Digital interventions have emerged as a solution for time and geographical barriers, however, their potential to target other social determinants of health is largely unexplored. In this post-hoc analysis, we report the impact of social deprivation on engagement and clinical outcomes after a completely remote multimodal musculoskeletal (MSK) digital care program managed by a culturally-sensitive clinical team. Patients were stratified in five categories according to their social deprivation index, and cross-referenced with their race/ethnicity, rurality and distance to healthcare facilities. From a total of 12,062 patients from all U.S. states, 8569 completed the program. Higher social deprivation was associated with greater baseline disease burden. We observed that all categories reported pain improvements (ranging from -2.0 95%CI -2.1, -1.9 to -2.1 95%CI -2.3, -1.9, p < 0.001) without intergroup differences in mean changes or responder rates (from 59.9% (420/701) to 66.6% (780/1172), p = 0.067), alongside reduction in analgesic consumption. We observed significant improvements in mental health and productivity across all categories, with productivity and non-work-related functional recovery being greater within the most deprived group. Engagement was high but varied slightly across categories. Together these findings highlight the importance of a patient-centered digital care program as a tool to address health inequities in musculoskeletal pain management. The idea of investigating social deprivation within a digital program provides a foundation for future work in this field to identify areas of improvement.
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Affiliation(s)
| | | | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | | | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
| | - Steven P Cohen
- Department of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Fraeyman N, De Bacquer D, Fiers T, Godderis L, Verhaeghe R, Eeckloo K, Gemmel P, Viaene L, Mortier E. Body mass index and occupational accidents among health care workers in a large university hospital. Acta Clin Belg 2023; 78:128-134. [PMID: 35703157 DOI: 10.1080/17843286.2022.2084936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Obesity is associated with a number of chronic diseases such as cardiovascular diseases and cancers. The association of obesity with occupational accidents has been suggested although the evidence is less convincing. The objective of the study is to analyse the relationship between BMI values and ergonomic accidents in a large University Hospital. METHODS The relationship between body mass index (BMI) and the incidence of ergonomic occupational accidents over a period of 8 years was investigated in a cohort of employees of a large University Hospital, covering almost 27,000 person-years of observation. This relationship was stratified according to the variables age, gender, functional status within the organization and work schedule (part-time or full time). Height and weight were objectively measured, demographic data were obtained from the human resource department and the registration of ergonomic accidents was carried out by the safety and prevention department of the hospital. RESULTS The number of ergonomic accidents, expressed as number/1000 person-years was higher for female employees compared to male employees, increased with age and markedly increased from functional class A (leading or expert function and higher educational level) to D (executive function in patient care and technical department). However, the incidence of ergonomic accidents accompanied by loss of working time was not significantly associated with BMI, independently of age and gender. In addition, the type of accident and the severity of the accidents expressed as the number of days absent from work were unrelated to BMI. CONCLUSION No independent relationship between BMI and the incidence of ergonomic accidents could be identified in our cohort. Tailoring working conditions to individual BMI levels is not recommended.
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Affiliation(s)
- N Fraeyman
- Environmental Department [Milieudienst], University Hospital, Gent University, Gent, Belgium.,Central Administration, Secretariat of the Board of Governors, Faculty of Medicine and Health Sciences, University Hospital, Gent University, Gent, Belgium
| | - D De Bacquer
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Gent University, Gent University Hospital, Gent, Belgium
| | - T Fiers
- Clinical Chemistry Laboratory, Gent University Hospital, Gent University, Gent, Belgium
| | - L Godderis
- Department of Public Health and Primary Care, Faculty of Medicine, Leuven University, University Hospital Leuven, Gasthuisberg Campus, Leuven, Belgium
| | - R Verhaeghe
- Central Administration, Secretariat of the Board of Governors, Faculty of Medicine and Health Sciences, University Hospital, Gent University, Gent, Belgium
| | - K Eeckloo
- Central Administration, Secretariat of the Board of Governors, Faculty of Medicine and Health Sciences, University Hospital, Gent University, Gent, Belgium
| | - P Gemmel
- University Ghent, Faculty of Economics and Business Administration, Gent, Belgium
| | - L Viaene
- Safety Department [Preventiedienst], University Hospital, Gent University, Gent, Belgium
| | - E Mortier
- Central Administration, Secretariat of the Board of Governors, Faculty of Medicine and Health Sciences, University Hospital, Gent University, Gent, Belgium
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Scheer J, Areias AC, Molinos M, Janela D, Moulder R, Lains J, Bento V, Yanamadala V, Dias Correia F, Costa F. Engagement and Utilization of a Complete Remote Digital Care Program for Musculoskeletal Pain Management in Urban and Rural Areas Across the United States: Longitudinal Cohort Study. JMIR Mhealth Uhealth 2023; 11:e44316. [PMID: 36735933 PMCID: PMC10132051 DOI: 10.2196/44316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/12/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Musculoskeletal (MSK) conditions are the number one cause of disability worldwide. Digital care programs (DCPs) for MSK pain management have arisen as alternative care delivery models to circumvent challenges in accessibility of conventional therapy. Despite the potential of DCPs to reduce inequities in accessing care, the outcomes of such interventions in rural and urban populations have yet to be studied. OBJECTIVE The aim of this study was to assess the impact of urban or rural residency on engagement and clinical outcomes after a multimodal DCP for MSK pain. METHODS This study consists of an ad hoc analysis of a decentralized single-arm investigation into engagement and clinical-related outcomes after a multimodal DCP in patients with MSK conditions. Patients were coded according to their zip codes to a specific rural-urban commuting area code and grouped into rural and urban cohorts. Changes in their engagement and clinical outcomes from baseline to program end were assessed. Latent growth curve analysis was performed to estimate change trajectories adjusting for the following covariates: age, gender, BMI, employment status, and pain acuity. Outcomes included engagement, self-reported pain, and the results of the Generalized Anxiety Disorder 7-item, Patient Health Questionnaire 9-item, and Work Productivity and Activity Impairment scales. A minimum clinically important difference (MCID) of 30% was considered for pain. RESULTS Patients with urban and rural residency across the United States participated in the program (n=9992). A 73.8% (7378/9992) completion rate was observed. Both groups reported high satisfaction scores and similar engagement with exercise sessions, with rural residents showing higher engagement with educational content (P<.001) and higher program completion rates (P=.02). All groups showed a significant improvement in all clinical outcomes, including pain, mental health, and work productivity, without statistically significant intergroup differences. The percentage of patients meeting the MCID was similar in both groups (urban: 67.1%, rural: 68.3%; P=.30). CONCLUSIONS This study advocates for the utility of a DCP in improving access to MSK care in urban and rural areas alike, showcasing its potential to promote health equity. High engagement, satisfaction, and completion rates were noted in both groups, as well as significant improvements in clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946.
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Affiliation(s)
- Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, United States
| | | | | | | | - Robert Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Coimbra, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Vijay Yanamadala
- Sword Health Inc, Draper, UT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
| | - Fernando Dias Correia
- Sword Health Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Zhu Y, Loggia ML, Edwards RR, Flowers KM, Muñoz-Vergara DW, Partridge AH, Schreiber KL. Increased Clinical Pain Locations and Pain Sensitivity in Women After Breast Cancer Surgery: Influence of Aromatase Inhibitor Therapy. Clin J Pain 2022; 38:721-729. [PMID: 36136765 PMCID: PMC9649865 DOI: 10.1097/ajp.0000000000001073] [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: 09/20/2021] [Accepted: 09/13/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Aromatase inhibitors (AIs), which potently inhibit estrogen biosynthesis, are a standard treatment for hormone sensitive early-stage breast cancer. AIs have been associated with substantial joint pain and muscle stiffness (aromatase inhibitor-associated musculoskeletal syndrome). However, the link between AIs and number of clinical pain locations and pain sensitivity are less well understood. The aim of this study was to compare longitudinal changes in clinical pain and quantitative pain sensitivity between women who did or did not receive AI therapy. METHODS Women with early-stage breast cancer were prospectively enrolled and assessed for clinical pain in surgical and nonsurgical body areas using the Brief Pain Inventory and Breast Cancer Pain Questionnaire, and for pain sensitivity using quantitative sensory testing preoperatively and at 1 year postoperatively. Pain outcomes between participants who did and did not begin adjuvant AI therapy were compared using Wilcoxon Signed-Ranks and generalized estimating equation linear regression analyses. RESULTS Clinical pain and pain sensitivity were comparable between AI (n=49) and no-AI (n=106) groups preoperatively. After adjusting for body mass index, AI therapy was associated with a greater increase in the number of painful nonsurgical body sites (significant time by treatment interaction, P =0.024). Pain location was most frequent in knees (28%), lower back (26%), and ankles/feet (17%). Quantitative sensory testing revealed a significant decrease in pain sensitivity (increased pressure pain threshold) in the no-AI group over time, but not in the AI group. CONCLUSIONS AI therapy was associated with increased diffuse joint-related pain and greater post-treatment pain sensitivity, potentially implicating central sensitization as a contributing pain mechanism of aromatase inhibitor-associated musculoskeletal syndrome worthy of future investigation.
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Affiliation(s)
- Yehui Zhu
- Department of Radiology, Massachusetts General Hospital, A. A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts, USA
| | - Marco L. Loggia
- Department of Radiology, Massachusetts General Hospital, A. A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelsey M. Flowers
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis W. Muñoz-Vergara
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Long-Term Clinical Outcomes of a Remote Digital Musculoskeletal Program: An Ad Hoc Analysis from a Longitudinal Study with a Non-Participant Comparison Group. Healthcare (Basel) 2022; 10:healthcare10122349. [PMID: 36553873 PMCID: PMC9778537 DOI: 10.3390/healthcare10122349] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
Digital solutions have emerged as an alternative to conventional physiotherapy, particularly for chronic musculoskeletal pain (CMP) management; however, its long-term effects remain largely unexplored. This study focuses on patients reporting CMP, assessing 1-year clinical outcomes after a multimodal digital care program (DCP) versus non-participants, who enrolled in the program but never engaged in a single exercise session or partook of the educational content made available to them. In this longitudinal study ad-hoc analysis, pain and functionality outcomes at 1-year reassessment were studied, focusing on the odds of reaching minimal clinically important difference (MCID) and, overall average reduction in both outcomes. Healthcare utilization was additionally studied within the same period. From 867 individuals allocated to the study, 460 completed the 1-year reassessment (intervention group: 310; comparison group: 150). The intervention group presented sustained and greater pain reduction until 1-year reassessment than the comparison group, reflecting greater odds ratio of achieving the MCID both in pain and functionality (1.90 95% CI: 1.27-2.86, p = 0.002 and 2.02 95% CI: 1.31-3.12, p = 0.001, respectively). A lower healthcare utilization during the 1-year follow-up was observed in the intervention group than in the comparison group. This study suggests that a digital CMP program may have a lasting impact on improved pain and functionality in patients with CMP.
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Association between Body Weight and Body Mass Index and Patellar Tendinopathy in Elite Basketball and Volleyball Players, a Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10101928. [PMID: 36292375 PMCID: PMC9601617 DOI: 10.3390/healthcare10101928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022] Open
Abstract
The features of Patellar-Tendinopathy are (1): pain localised to the inferior pole of the patellar; (2): the presence of load-related pain. Body-Weight and Body-Mass-Index, as two easily-measured variables, could potentially aid the prediction of PT. This review aims to establish relationships between Body-Weight and Body-Mass-Index and Patellar-Tendinopathy via synthesising the evidence from prospective-cohort and cross-sectional studies in elite basketball and volleyball players. Seven databases (PubMed, EMBASE, CINAHL, Google Scholar, Health-Management-Information-Consortium, National-Technical-Information-Service, ClinicalTrial.gov) and citation chasing were used to identify English peer-review articles from 2000 to 2022. An adapted version of the Newcastle-Ottawa scale was used for critical appraisal. Two reviewers were involved in literature searching, data extraction, and quality review. Two prospective cohort and five cross-sectional studies met the inclusion criteria, providing 849 subjects (male:female: 436:413). Five studies found BW is associated with PT. Three studies found a relationship between BMI and PT. Six out of seven studies were classified as very good studies. All studies were level IV evidence. The very low certainty evidence suggests an association between BW and PT. There is moderate certainty evidence that BMI is associated with PT. These preliminary findings should be treated cautiously due to the lack of strong evidence.
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10
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Norman KS, Goode AP, Alvarez C, Hu D, George SZ, Schwartz TA, Danyluk ST, Fillipo R, Kraus VB, Huebner JL, Cleveland RJ, Jordan JM, Nelson AE, Golightly YM. Association of Biomarkers with Individual and Multiple Body Sites of Pain: The Johnston County Osteoarthritis Project. J Pain Res 2022; 15:2393-2404. [PMID: 36000076 PMCID: PMC9393091 DOI: 10.2147/jpr.s365187] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Biochemical biomarkers may provide insight into musculoskeletal pain reported at individual or multiple body sites. The purpose of this study was to determine if biomarkers or pressure-pain threshold (PPT) were associated with individual or multiple sites of pain. Methods This cross-sectional analysis included 689 community-based participants. Self-reported symptoms (ie, pain, aching, or stiffness) were ascertained about the neck, upper back/thoracic, low back, shoulders, elbows, wrist, hands, hips, knees, ankles, and feet. Measured analytes included CXCL-6, RANTES, HA, IL-6, BDNF, OPG and NPY. A standard dolorimeter measured PPT. Logistic regression was used determine the association between biomarkers and PPT with individual and summed sites of pain. Results Increased IL-6 and HA were associated with knee pain (OR=1.30, 95% CI 1.03, 1.64) and (OR=1.32, 95% CI 1.01, 1.73) respectively; HA was also associated with elbow/wrist/hand pain (OR=1.60, 95% CI 1.22, 2.09). Those with increased NPY levels were less likely to have shoulder pain (OR=0.56, 95% CI 0.33, 0.93). Biomarkers HA (OR=1.50, 95% CI 1.07, 2.10), OPG (OR=1.74, 95% CI 1.00, 3.03), CXCL-6 (OR=1.75, 95% CI 1.02, 3.01) and decreased PPT (OR=3.97, 95% CI 2.22, 7.12) were associated with multiple compared to no sites of pain. Biomarker HA (OR=1.57, 95% CI 1.06, 2.32) and decreased PPT (OR=3.53, 95% CI 1.81, 6.88) were associated with multiple compared to a single site of pain. Conclusion Biomarkers of inflammation (HA, OPG, IL-6 and CXCL-6), pain (NPY) and PPT may help to understand the etiology of single and multiple pain sites.
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Affiliation(s)
- Katherine S Norman
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Adam P Goode
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - David Hu
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Steven Z George
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Stephanie T Danyluk
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca Fillipo
- Duke Department of Physical Therapy and Occupational Therapy, Duke University Health System, Durham, NC, USA
| | - Virginia B Kraus
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
- Duke Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
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An Exploratory Study on the Physical Activity Health Paradox-Musculoskeletal Pain and Cardiovascular Load during Work and Leisure in Construction and Healthcare Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052751. [PMID: 35270444 PMCID: PMC8910306 DOI: 10.3390/ijerph19052751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/04/2022]
Abstract
Using a novel approach, this exploratory study investigated whether the physical activity (PA) paradox extends to cardiovascular load and musculoskeletal pain. At baseline, 1–2 days of 24 h heart rate was assessed in 72 workers from construction and healthcare. Workers then reported pain intensity in 9 body regions (scale 0–3) every 6 months for two years. The 2 year average of musculoskeletal pain (sum of 9 pain scores; scale 0–27) was regressed on time spent during work and leisure above three thresholds of percentage heart rate reserve (%HRR), i.e., ≥20 %HRR, ≥30 %HRR, and ≥40 %HRR, using a novel ilr structure in compositional data analysis. Analyses were stratified for several important variables. Workers spending more time in physical activity at work had higher pain, while workers with more time in physical activity during leisure had less pain (i.e., the PA paradox), but none of the associations were statistically significant. Higher aerobic capacity and lower body mass index lowered the pain score among those with higher physical activity at work. This exploratory study suggests that the PA paradox may apply to musculoskeletal pain and future studies with larger sample sizes and additional exposure analyses are needed to explain why this occurs.
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Chin SH, Huang WL, Akter S, Binks M. Obesity and pain: a systematic review. Int J Obes (Lond) 2019; 44:969-979. [PMID: 31848456 DOI: 10.1038/s41366-019-0505-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/04/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES The current systematic review considered research published within the 10 years preceding June 2019, dealing with the topic of obesity and pain. Within the context of the complex biological and behavioral interrelationships among these phenomena, we sought to identify gaps in the literature and to highlight key targets for future transdisciplinary research. The overarching inclusion criteria were that the included studies could directly contribute to our understanding of these complex phenomena. METHODS We searched PubMed/Medline/Cochrane databases dating back 10 years, using the primary search terms "obesity" and "pain," and for a secondary search we used the search terms "pain" and "diet quality." RESULTS Included studies (n = 70) are primarily human; however, some animal studies were included to enhance understanding of related basic biological phenomena and/or where human data were absent or significantly limited. CONCLUSIONS Our overall conclusions highlight (1) the mechanisms of obesity-related pain (i.e., mechanical, behavioral, and physiological) and potential biological and behavioral contributors (e.g., gender, distribution of body fat, and dietary factors), (2) the requirement for accurate and reliable objective measurement, (3) the need to integrate biological and behavioral contributors into comprehensive, well-controlled prospective study designs.
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Affiliation(s)
- Shao-Hua Chin
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA
| | - Wei-Lin Huang
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA
| | - Sharmin Akter
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA
| | - Martin Binks
- Texas Tech University, 1301 Akron Street, Box 41270, Lubbock, TX, 79409-1270, USA.
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Shade MY, Herr K, Kupzyk K. Self-Reported Pain Interference and Analgesic Characteristics in Rural Older Adults. Pain Manag Nurs 2019; 20:232-238. [PMID: 31080145 DOI: 10.1016/j.pmn.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pain impacts the lives of millions of community-dwelling older adults. An important characteristic of pain is "pain interference" which describes the influence of pain on function. A description of pain interference is limited in rural settings where the number of older adults is expected to increase, and health disparities exist. AIMS The purpose of this study was to describe pain interference and analgesic medication use, highlighting those that may be potentially inappropriate in a sample of rural community-dwelling older adults. DESIGN This secondary analysis was from a cross sectional study. SAMPLE AND SETTINGS Data were analyzed from a sample of 138 rural community-dwelling older adults. METHODS Statistical analyses were performed on demographics, health characteristics, pain interference, and potentially inappropriate analgesic medication data. RESULTS Pain interference with work activity was reported by 76% of older adults overall, with 23% reporting moderate and 4% extreme interference, and 41% reported sleep difficulty due to pain. Higher pain interference was significantly associated with higher body mass index, more health providers, and the daily use of non-steroidal anti-inflammatory drugs (NSAIDs). Older women experienced more sleep difficulties due to pain. Over-the-counter analgesics were used most frequently by rural older adults to manage pain. Of most risk was the daily use of NSAIDs, in which only 30% used medications to protect the gastrointestinal system. CONCLUSIONS Older adults in rural settings experience pain interference and participate in independent-medicating behaviors that may impact safety.
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Affiliation(s)
- Marcia Y Shade
- University of Nebraska Medical Center College of Nursing, Omaha, Nebraska; University of Iowa College of Nursing, Iowa City, Iowa.
| | - Keela Herr
- University of Iowa College of Nursing, Iowa City, Iowa
| | - Kevin Kupzyk
- University of Nebraska Medical Center College of Nursing, Omaha, Nebraska
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14
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Impact of pain in overweight to morbidly obese women: preliminary findings of a cross-sectional study. Physiotherapy 2018; 104:417-423. [DOI: 10.1016/j.physio.2018.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 05/04/2018] [Indexed: 12/16/2022]
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15
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McDevitt AW, Mintken PE, Cleland JA, Bishop MD. Impact of expectations on functional recovery in individuals with chronic shoulder pain. J Man Manip Ther 2018; 26:136-146. [PMID: 30042628 DOI: 10.1080/10669817.2018.1432541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Study Design Retrospective cohort. Objectives To examine general expectations for treatment by physical therapists and specific expectations for common interventions in patients with shoulder pain. A secondary objective was to assess the extent to which patients' general and specific expectations for treatment affect clinical outcomes. Methods We performed a secondary analysis of data from a clinical trial of interventions for shoulder pain. Prior to beginning treatment for shoulder pain, 140 patients were asked their general expectations of benefit and their specific expectations for individual interventions. Next we examined how these expectations related to the patients' ratings of the success of treatment at one and six months after treatment. Results Patients had positive general expectations for treatment by a physical therapist. Specific manual therapy interventions of range of motion and strengthening had the highest proportion of patients who expected these interventions to significantly improve shoulder pain. Seventy-two patients (58%) reported themselves to be improved using the global rating of change (GROC) at one month and six months. In the full model predicting one-month GROC, only the expectation of moderate relief (p = 0.012) and body mass index (BMI) (p = 0.013) had significant effects. Overall, the Shoulder Pain and Disability Index (SPADI) significantly decreased over time (p = 0.004); however, a significant interaction did occur between time and BMI (p = 0.021). Discussion Patients expect common interventions used by physical therapists to be effective to manage shoulder pain. In conclusion, patients with shoulder pain had high general expectations for physical therapy. Level of Evidence Prognosis, level 2b.
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Affiliation(s)
- Amy W McDevitt
- Physical Therapy Program, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Paul E Mintken
- Physical Therapy Program, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA.,Rehabilitation Services, Concord Hospital, Concord, NH, USA
| | - Mark D Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA.,Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA
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Affiliation(s)
- Fernando Ide Yamauchi
- MD, Attending Radiologist at Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), Attending Radiologist in the Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. (E-mail: )
| | - Adham do Amaral E Castro
- PhD, MD, Attending Radiologist in the Department of Radiology, Hospital Israelita Albert Einstein, Attending Radiologist in the Department of Diagnostic Imaging , Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Heidari Z, Feizi A, Roohafza H, Keshteli AH, Shiravi FZ, Adibi P. Demographic and Life Styles Determinants of Somatic Complaints' Structures: A Cross-sectional Study on a Large Sample of Iranian Adults Using Factor Mixture Model. Int J Prev Med 2017; 8:8. [PMID: 28299032 PMCID: PMC5343604 DOI: 10.4103/2008-7802.200526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 12/24/2016] [Indexed: 11/06/2022] Open
Abstract
Background: To identify somatic complaints dimensions, classify studied population and study the association of demographic and lifestyle factors with somatic complaints dimensions. Methods: In a cross-sectional study conducted on 4763 Iranian adults, somatic complaints were assessed using a comprehensive 30-item questionnaire. Self-administered standard questionnaires were used to assess demographic and lifestyle factors. Factor mixture modeling (FMM) was used to identify somatic complaints dimensions and classify studied population. Results: The mean age of participants was 36.58 ± 0.13 years, 55.8% were females, 81.2% were married, and 57.2% had college education. About 9.4% of individuals were obese, and 34.8% of participants had regular physical activity. Four domains of somatic complaints were extracted, including “psychological,” “gastrointestinal,” “neuro-skeletal,” and “pharyngeal-respiratory.” Females, obese and inactive participants, and those in low educations had significantly greater scores in terms of four domains than the others (P < 0.05). A two-class, four-factor structure fitted to the somatic complaints based on FMM. Two classes were labeled “high psychological complaints” (519 individuals (11%) and “low psychological complaints” (4243 individuals (89%). There were no significant differences between two classes in terms of demographic and lifestyle factors, except in educational level. Conclusions: This study suggested that somatic complaints had a dimensional-categorical structure within studied population so that it could be useful for dealing with diagnostic and therapeutic approaches. The results did not show any association between somatic complaints dimensions and demographic, lifestyle factors, except in educational level.
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Affiliation(s)
- Zahra Heidari
- Department of Biostatistics and Epidemiology, Student Research Center, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ammar Hassanzadeh Keshteli
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Zahra Shiravi
- Department of Biostatistics and Epidemiology, Student Research Center, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Payman Adibi
- Department of Internal Medicine, Integrative Functional Gastroenterology Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Dario AB, Loureiro Ferreira M, Refshauge K, Luque-Suarez A, Ordoñana JR, Ferreira PH. Obesity does not increase the risk of chronic low back pain when genetics are considered. A prospective study of Spanish adult twins. Spine J 2017; 17:282-290. [PMID: 27751965 DOI: 10.1016/j.spinee.2016.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 10/06/2016] [Accepted: 10/12/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Obesity is commonly investigated as a potential risk factor for low back pain (LBP); however, current evidence remains unclear. Limitations in previous studies may explain the inconsistent results in the field, such as the use of a cross sectional design, limitations in the measures used to assess obesity (eg, body mass index-BMI), and poor adjustment for confounders (eg, genetics and physical activity). PURPOSE AND DESIGN To better understand the effects of obesity on LBP, our aim was to investigate in a prospective cohort whether obesity-related measures increase the risk of chronic LBP outcomes using a longitudinal design. We assessed obesity through measures that consider the magnitude as well as the distribution of body fat mass. A within-pair twin case-control analysis was used to control for the possible effects of genetic and early shared environmental factors on the obesity-LBP relationship. PATIENT SAMPLE AND OUTCOME MEASURES Data were obtained from the Murcia Twin Registry in Spain. Participants were 1,098 twins, aged 43 to 71 years, who did not report chronic LBP at baseline. Follow-up data on chronic LBP (>6 months), activity-limiting LBP, and care-seeking for LBP were collected after 2 to 4 years. RISK FACTORS The risk factors were BMI, percentage of fat mass, waist circumference, and waist-to-hip ratio. METHODS Sequential analyses were performed using logistic regression controlling for familial confounding: (1) total sample analysis (twins analyzed as independent individuals); (2) within-pair twin case-control analyses (all complete twin pairs discordant for LBP at follow-up); and within-pair twin case-control analyses separated for (3) dizygotic and (4) monozygotic twins. RESULTS No increase in the risk of chronic LBP was found for any of the obesity-related measures: BMI (men/women, odds ratio [OR]: 0.99; 95 % confidence interval [CI]: 0.86-1.14), % fat mass (women, OR: 0.87; 95% CI: 0.66-1.14), waist circumference (women, OR: 0.98; 95% CI: 0.74-1.30), and waist-to-hip ratio (women, OR: 1.05; 95% CI: 0.81-1.36). Similar results were found for activity-limiting LBP and care-seeking due to LBP. After the adjustment for genetics and early environmental factors shared by twins, the non-significant results remained unchanged. CONCLUSIONS After 2 to 4 years, obesity-related measures did not increase the risk of developing chronic LBP or care-seeking for LBP with or without adjustment for familial factors such as genetics in Spanish adults.
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Affiliation(s)
- Amabile Borges Dario
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, Sydney 1825, Australia.
| | - Manuela Loureiro Ferreira
- The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, Missenden Rd, NSW 2050, Australia; Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, University of Sydney, Reserve Road, St Leonards, NSW 2605, Australia
| | - Kathryn Refshauge
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, Sydney 1825, Australia
| | - Alejandro Luque-Suarez
- Discipline of Physiotherapy, University of Málaga, Avenida Cervantes, 2, 29071 Malaga, Spain
| | - Juan Ramon Ordoñana
- Murcia Twin Registry, Department of Human Anatomy and Psychobiology, University of Murcia, Campus de Espinardo, 30100 Murcia, Spain; IMIB-Arrixaca, HUVA Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Paulo Henrique Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, Sydney 1825, Australia
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Seaman DR. Toxins, Toxicity, and Endotoxemia: A Historical and Clinical Perspective for Chiropractors. JOURNAL OF CHIROPRACTIC HUMANITIES 2016; 23:68-76. [PMID: 27920621 PMCID: PMC5127911 DOI: 10.1016/j.echu.2016.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/29/2016] [Accepted: 07/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The purpose of this commentary is to review the notion of toxicity in the context of chiropractic practice. DISCUSSION The belief that body toxicity is the cause of disease has been promoted for thousands of years. Prior to the emergence of the chiropractic profession, the medical profession embraced the notion that the body becomes "toxic," requiring detoxification interventions or surgery. The legacy of body toxicity within the chiropractic approach to patient care began with Daniel David Palmer. Today, some sectors within the medical and chiropractic professions continue to embrace the concept of body toxicity and the related need to engage in detoxifying treatments. The most common areas of focus for detoxification are the intestines and liver; however, the nature of the toxicity in these organs has yet to be defined or measured. In contrast, diet-induced systemic bacterial endotoxemia is a measureable state that is known to be promoted by a diet rich in sugar, flour, and refined oil. This suggests that bacterial endotoxin may be a candidate toxin to consider in the clinical context, as many common conditions, such as obesity, metabolic syndrome, diabetes, interstitial cystitis, depression, and migraine headache, are known to be promoted by endotoxemia. CONCLUSION A diet rich in refined sugar, flour, and oils may induce proinflammatory changes within intestinal microbiota that lead to systemic, low-grade endotoxemia, which is a common variety of "toxicity" that is measurable and worthy of research consideration. Introducing a diet to reduce endotoxemia, rather than attempting to target a specific organ, appears to be a rational clinical approach for addressing the issue of toxicity.
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Affiliation(s)
- David R Seaman
- National University of Health Sciences, Pinellas Park, FL
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Shemory ST, Pfefferle KJ, Gradisar IM. Modifiable Risk Factors in Patients With Low Back Pain. Orthopedics 2016; 39:e413-6. [PMID: 27064774 DOI: 10.3928/01477447-20160404-02] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/09/2015] [Indexed: 02/03/2023]
Abstract
Low back pain is one of the most common reasons for physician visits in the United States and is a chief complaint frequently seen by orthopedic surgeons. Patients with chronic low back pain can experience recurring debilitating pain and disability, decreasing their quality of life. A commercially available software platform, Explorys (Explorys, Inc, Cleveland, Ohio), was used to mine a pooled electronic health care database consisting of the medical records of more than 26 million patients. According to the available medical history data, 1.2 million patients had a diagnosis of low back pain (4.54%). The information was used to determine the incidence of low back pain in patients with a history of nicotine dependence, obesity (body mass index, >30 kg/m(2)), depressive disorders, and alcohol abuse. Relative risk was then calculated for the defined modifiable risk factors. Patients with nicotine dependence, obesity, depressive disorders, and alcohol abuse had a relative risk of 4.489, 6.007, 5.511, and 3.326 for low back pain, respectively, compared with patients without the defined risk factor. A statistically significant difference was found in the incidence of low back pain between all 4 groups with the risk factors evaluated and the general population (P<.05). By determining treatable patient risk factors for low back pain, physicians can monitor at-risk patients and focus on prevention and control of debilitating disease. These approaches can decrease the number of patients with isolated low back pain who are seen by orthopedic surgeons. [Orthopedics. 2016; 39(3):e413-e416.].
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Castro ADAE, Skare TL, Nassif PAN, Sakuma AK, Barros WH. TENDINOPATHY AND OBESITY. ACTA ACUST UNITED AC 2016; 29Suppl 1:107-110. [PMID: 27683789 PMCID: PMC5064259 DOI: 10.1590/0102-6720201600s10026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/17/2016] [Indexed: 12/14/2022]
Abstract
Introduction Tendinopathies and tendon tears account for over 30% of all musculoskeletal consultations. Obesity, which is becoming one of the world´s most prevalent public health issues, may be associated with this condition. Objective To review the literature about tendinopathies and obesity association. Methods This is a descriptive exploratory study using the portal Medline. Literature in English language from 2006 to 2014 were reviewed. Results The pathogenesis of tendinopathies includes inflammatory, regenerative and degenerative processes that happen simultaneously from early to late phases of the disease. Mechanical stress upon tendons seems to be one of the most important factors to initiate the inflammatory response, but it´s not the only one that can deflagrate it: there are other extrinsic, genetic and metabolic factors that may be involved. Therefore, tendinopathies in obese patients can be due to tendon overload because of the excess of weight, but also because of increased production of pro-inflammatory mediators related to fat tissue such as adipokines. This pro-inflammatory state that obese people can suffer is known as adiposopathy, or sick fat syndrome. Weight loss is associated with decrease in adipokines and improvement of musculoskeletal symptoms. Conclusion The relation of obesity and tendinopathies is supported by evidences of recent studies, exemplified in this review of literature.
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Affiliation(s)
- Adham do Amaral E Castro
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Thelma Larocca Skare
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Paulo Afonso Nunes Nassif
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Alexandre Kaue Sakuma
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Wagner Haese Barros
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
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Gotfryd AO, Valesin Filho ES, Viola DCM, Lenza M, Silva JAD, Emi AS, Tomiosso R, Piccinato CDA, Antonioli E, Ferretti M. Analysis of epidemiology, lifestyle, and psychosocial factors in patients with back pain admitted to an orthopedic emergency unit. EINSTEIN-SAO PAULO 2015; 13:243-8. [PMID: 26154546 PMCID: PMC4943817 DOI: 10.1590/s1679-45082015ao3320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/27/2015] [Indexed: 01/07/2023] Open
Abstract
Objective: To correlate epidemiological data, lifestyle, and psychosocial factors as predictors for clinical manifestation of back pain in patients treated at the orthopedic emergency unit of a Brazilian tertiary care hospital, and to evaluate their interest in participating in a hypothetical program for physical rehabilitation. Methods: This is an observational cross-sectional study. We evaluated 210 patients from the emergency department of a tertiary hospital with a major complaint of back pain. We used: epidemiological multiple-choice questionnaires developed for this study; Oswestry questionnaire for physical disability; Hospital Anxiety and Depression Scale (HAD) scale. Data analyses were performed using SAS - Statistical Analysis System (SAS Institute, 2001). Measurements were performed with the SAS functions Proc MEANS and Proc Freq. Results: The mean age was 39.1 years and there was no predominance between genders. The usual work activity was administrative (65.2% of cases). The mean body mass index was 26.0, indicating overweight. The majority (83.3%) of patients had low physical disability (Oswestry 0 – 40%). The number of medical visits in the previous 6 months (p=0.04) and the scores of anxiety and depression (p=0.05), independently, were correlated with physical disability. Most patients (77%) would agree to participate in a hypothetical program of physical rehabilitation for prevention of back pain. Conclusion: Patients with back pain complaints were predominantly young adults, sedentary or hypoactive, overweight, and with recurrent complaints of symptoms. Most participants had low levels of physical disability and would accept participation in a hypothetical physical rehabilitation program for the prevention of back pain.
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Affiliation(s)
| | | | | | - Mario Lenza
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | | | | | - Mario Ferretti
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Noda M, Malhotra R, DeSilva V, Sapukotana P, DeSilva A, Kirkorowicz J, Allen J, Østbye T. Occupational risk factors for low back pain among drivers of three-wheelers in Sri Lanka. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2015; 21:216-24. [PMID: 25133353 PMCID: PMC4597010 DOI: 10.1179/2049396714y.0000000071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Approximately 5% of all households in Sri Lanka operate a three-wheeler as their primary source of income. However, very little is known about the occupational health risks associated with driving these vehicles. OBJECTIVES The aim of this study was to assess occupational risk factors, including the number of hours worked associated with the 4-week prevalence of low back pain (LBP) among drivers of three-wheelers. METHODS Questionnaires were administered to 200 full-time drivers of three-wheelers from the Galle District in Sri Lanka. Occupational, psychological, socio-demographic, lifestyle, and anthropometric variables were collected. Univariate and multivariate analysis were used to investigate the correlation between occupational risk factors of the prevalence of LBP. RESULTS 15·5% of respondents reported experiencing LBP in the previous 4 months. Univariate analysis revealed that the number of hours worked per week, feeling pressure to compete with other drivers, and perceived stress scale scores were significantly associated with the 4-week prevalence of LBP. Multivariate analysis found that the number of hours worked per week and engine type were significantly associated with LBP. CONCLUSIONS LBP is common among drivers of three-wheelers in Sri Lanka. Long work hours and two-stroke engines were significantly associated with LBP. Results from this study point towards a role for educational, behavioral health, and policy interventions to help prevent and reduce LBP among these drivers.
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Gupta A, Kulkarni A, Ramanujam V, Zheng L, Treacy E. Improvement in chronic low back pain in an obese patient with topiramate use. J Pain Palliat Care Pharmacother 2015; 29:140-3. [PMID: 26095484 DOI: 10.3109/15360288.2015.1035837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The objective of this study was to demonstrate efficacy, benefit, and potential use of topiramate in treating obese patients with chronic low back pain. This is a case report from an outpatient academic pain multidisciplinary clinical center. The patient was a 30-year-old morbidly obese (body mass index [BMI]: 61.4 kg/m(2)) female suffering from chronic low back pain. With a known association between obesity and chronic low back pain, and a possible role of topiramate in treating both simultaneously, the patient was started on a therapeutic trial of topiramate. Over a period of a 12-week topiramate therapy, the patient experienced clinically meaningful and significant weight loss as well as improvement in her chronic low back pain and functionality. With more substantial evidence, pain physicians may start considering using topiramate in the multimodal management of obesity-related chronic low back pain based on their thoughtful consideration of the drug's efficacy and side effects and the patient's comorbidities and preferences.
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Dean E, Söderlund A. What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain? BMC Musculoskelet Disord 2015; 16:87. [PMID: 25888381 PMCID: PMC4397667 DOI: 10.1186/s12891-015-0545-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/27/2015] [Indexed: 11/27/2022] Open
Abstract
Background Other than activity and exercise, lifestyle practices such as not smoking and healthy nutrition, well established for preventing and managing lifestyle-related non-communicable diseases (i.e., heart disease, cancer, hypertension, stroke, obstructive lung disease, diabetes, and obesity), are less emphasized in the physical therapy guidelines for addressing chronic pain, e.g., back pain. This state-of-the-art review examines the relationships between lifestyle behaviours and musculoskeletal health, with special reference to chronic pain, and their clinical and research implications. Discussion A state-of-the-art review was conducted to synthesize evidence related to lifestyle factors (not smoking, healthy diet, healthy weight, optimal sleep and manageable stress, as well as physical activity) and musculoskeletal health, with special reference to chronic pain. The findings support that health behaviour change competencies (examination/assessment and intervention/treatment) may warrant being included in first-line management of chronic pain, either independently or in conjunction with conventional physical therapy interventions. To address knowledge gaps in the literature however three lines of clinical trial research are indicated: 1) to establish the degree to which traditional physical therapy interventions prescribed for chronic pain augment the benefits of lifestyle behaviour change; 2) to establish the degree to which adopting healthier lifestyle practices, avoids or reduces the need for conventional physical therapy; and 3) to establish whether patients/clients with healthier lifestyles and who have chronic pain, respond more favourably to conventional physical therapy interventions than those who have less healthy lifestyles. Summary Lifestyle behaviour change is well accepted in addressing lifestyle-related non-communicable diseases. Compelling evidence exists however supporting the need for elucidation of the role of negative lifestyle behaviours on the incidence of chronic pain, and the role of positive lifestyle behaviours on its incidence and effective management. Addressing lifestyle behaviour change in patients/clients with chronic pain, e.g., back pain, as a first-line intervention might not only constitute a novel approach, but also reduce the socioeconomic burden related to chronic pain as well as non-communicable diseases.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, V6T 1Z3, Canada. .,School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, SE- 721 23, Sweden.
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, SE- 721 23, Sweden.
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Zdziarski LA, Wasser JG, Vincent HK. Chronic pain management in the obese patient: a focused review of key challenges and potential exercise solutions. J Pain Res 2015; 8:63-77. [PMID: 25709495 PMCID: PMC4332294 DOI: 10.2147/jpr.s55360] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In obese persons, general and specific musculoskeletal pain is common. Emerging evidence suggests that obesity modulates pain via several mechanisms such as mechanical loading, inflammation, and psychological status. Pain in obesity contributes to deterioration of physical ability, health-related quality of life, and functional dependence. We present the accumulating evidence showing the interrelationships of mechanical stress, inflammation, and psychological characteristics on pain. While acute exercise may transiently exacerbate pain symptoms, regular participation in exercise can lower pain severity or prevalence. Aerobic exercise, resistance exercise, or multimodal exercise programs (combination of the two types) can reduce joint pain in young and older obese adults in the range of 14%-71.4% depending on the study design and intervention used. While published attrition rates with regular exercise are high (∼50%), adherence to exercise may be enhanced with modification to exercise including the accumulation of several exercise bouts rather than one long session, reducing joint range of motion, and replacing impact with nonimpact activity. This field would benefit from rigorous comparative efficacy studies of exercise intensity, frequency, and mode on specific and general musculoskeletal pain in young and older obese persons.
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Affiliation(s)
- Laura Ann Zdziarski
- Department of Orthopaedics and Rehabilitation, Division of Research, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL, USA
| | - Joseph G Wasser
- Department of Orthopaedics and Rehabilitation, Division of Research, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL, USA
| | - Heather K Vincent
- Department of Orthopaedics and Rehabilitation, Division of Research, Interdisciplinary Center for Musculoskeletal Training and Research, University of Florida, Gainesville, FL, USA
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Vas J, Modesto M, Aguilar I, Gonçalo CDS, Rivas-Ruiz F. Efficacy and Safety of Auriculopressure for Primary Care Patients with Chronic Non-Specific Spinal Pain: A Multicentre Randomised Controlled Trial. Acupunct Med 2014; 32:227-35. [DOI: 10.1136/acupmed-2013-010507] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Chronic uncomplicated musculoskeletal pain in the spine (cervical, thoracic or lumbar) is highly prevalent and may severely limit the daily activities of those affected by it. Objective To evaluate the efficacy and safety of treatment with auriculopressure applied to patients with non-specific spinal pain. Methods A multicentre randomised controlled trial with two parallel arms (true auriculopressure (TAP) and placebo auriculopressure (PAP)) was performed. The intervention phase lasted 8 weeks and outcomes were measured 1 week after the last intervention (T1) and 6 months after baseline (T2). The primary outcome measure was change in pain intensity according to a 100 mm visual analogue scale (pain VAS) at T1. Secondary outcome measures were the Lattinen index, the McGill Pain Questionnaire and the SF-12 health-related quality of life scale (Spanish version in every case). Results There were 265 participants (TAP group, n=130; PAP group, n=135). Pain was most frequently located in the upper back (55.1%, n=146), followed by the lower back (25.3%, n=67) and the dorsal area (12.5%, n=33). Nineteen patients (7.2%) reported pain affecting the entire spine. There were statistically significant differences between TAP and PAP in the change in the pain VAS at T1 of 10 mm (95% CI 2.8 to 17.3, p=0.007) and in the change in the pain VAS at T2 of 7.2 mm (95% CI 0.02 to 14.3, p=0.049) in favour of TAP. We also observed a statistically significant difference of 3.4 points in the physical component of the SF-12 in favour of TAP at T2 (95% CI 0.45 to 6.3, p=0.024). No severe adverse effects were detected or reported during treatment. Conclusions The application of auriculopressure in patients with non-specific spinal pain in primary healthcare is effective and safe, and therefore should be considered for inclusion in the portfolio of primary healthcare services. Trial Registration Number ISRCTN01897462.
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Affiliation(s)
- Jorge Vas
- Pain Treatment Unit, Doña Mercedes Primary Health Care Centre, Dos Hermanas, Spain
- Carlos III Health Institute, Network of Research in Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | - Manuela Modesto
- Pain Treatment Unit, Doña Mercedes Primary Health Care Centre, Dos Hermanas, Spain
| | - Inmaculada Aguilar
- Pain Treatment Unit, Doña Mercedes Primary Health Care Centre, Dos Hermanas, Spain
| | | | - Francisco Rivas-Ruiz
- Carlos III Health Institute, Network of Research in Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
- Support Research Unit, Costa del Sol Hospital, Marbella, Spain
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Abstract
Among lean populations, cardiovascular disease (CVD) is rare. Among those with increased adiposity, CVD is the commonest cause of worldwide death. The "obesity paradox" describes seemingly contrary relationships between body fat and health/ill-health. Multiple obesity paradoxes exist, and include the anatomic obesity paradox, physiologic obesity paradox, demographic obesity paradox, therapeutic obesity paradox, cardiovascular event/procedure obesity paradox, and obesity treatment paradox. Adiposopathy ("sick fat") is defined as adipocyte/adipose tissue dysfunction caused by positive caloric balance and sedentary lifestyle in genetically and environmentally susceptible individuals. Adiposopathy contributes to the commonest metabolic disorders encountered in clinical practice (high glucose levels, high blood pressure, dyslipidemia, etc.), all major CVD risk factors. Ockham's razor is a principle of parsimony which postulates that among competing theories, the hypothesis with the fewest assumptions is the one best selected. Ockham's razor supports adiposopathy as the primary cause of most cases of adiposity-related metabolic diseases, which in turn helps resolve the obesity paradox.
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Affiliation(s)
- Harold Bays
- Louisville Metabolic and Atherosclerosis Research Center, 3288 Illinois Avenue, Louisville, KY, 40213, USA,
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Seaman DR. Weight gain as a consequence of living a modern lifestyle: a discussion of barriers to effective weight control and how to overcome them. JOURNAL OF CHIROPRACTIC HUMANITIES 2013; 20:27-35. [PMID: 25067929 PMCID: PMC4111078 DOI: 10.1016/j.echu.2013.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this commentary is to discuss modern lifestyle factors that promote weight gain and to suggest methods for clinicians to more effectively educate patients about weight management. DISCUSSION Most adults in the United States are overweight or obese. Multiple factors related to the modern lifestyle appear to play causal roles. In general, the population maintains sedentary lives and overconsumes calorie-dense foods. In particular, refined carbohydrates negatively impact metabolism and stimulate neural addiction mechanisms, which facilitate weight gain. As adipose tissue mass accumulates, satiation centers in the hypothalamus become resistant to insulin and leptin, which leads to increased caloric consumption. Several behavior issues further augment weight gain, such as eating too quickly, a lack of sleep, high stress levels, and a lack of exercise. Finally, adipose tissue accumulation alters the body weight set point, which leads to metabolic changes that function to resist weight loss efforts. Each of these factors may work together to augment weight gain and promote obesity. Health care providers, such as chiropractic physicians, who educate patients on wellness, prevention, and lifestyle changes are well positioned to address these issues. CONCLUSION People need to be educated about the modern lifestyle factors that prevent effective weight management. Without this knowledge and the associated practical application of lifestyle choices that prevent weight gain, becoming overweight or obese appears to be an unavoidable consequence of living a modern lifestyle.
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Affiliation(s)
- David R. Seaman
- Corresponding author. David R. Seaman, DC, MS, Professor, National University of Health Sciences, SPC-Health Education Center, 7200 66th St N, Pinellas Park, FL 33706. Tel.: + 1 727 803 6129; fax: + 1 727 329 8494.
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