Pain rates in general population for the period 1991-2015 and 10-years prediction: results from a multi-continent age-period-cohort analysis

The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and the headache revolution: from headache burden to a global action plan for headache disorders

The World Health Organization (WHO) Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders was developed by WHO to address the worldwide challenges and gaps in provision of care and services for people with epilepsy and other neurological disorders and to ensure a comprehensive, coordinated response across sectors to the burden of neurologic diseases and to promote brain health across life-course. Headache disorders constitute the second most burdensome of all neurological diseases after stroke, but the first if young and midlife adults are taken into account. Despite the availability of a range of treatments, disability associated with headache disorders, and with migraine, remains very high. In addition, there are inequalities between high-income and low and middle income countries in access to medical care. In line with several brain health initiatives following the WHOiGAP resolution, herein we tailor the main pillars of the action plan to headache disorders: (1) raising policy prioritization and strengthen governance; (2) providing effective, timely and responsive diagnosis, treatment and care; (3) implementing strategies for promotion and prevention; (4) fostering research and innovation and strengthen information systems. Specific targets for future policy actions are proposed. The Global Action Plan triggered a revolution in neurology, not only by increasing public awareness of brain disorders and brain health but also by boosting the number of neurologists in training, raising research funding and making neurology a public health priority for policy makers. Reducing the burden of headache disorders will not only improve the quality of life and wellbeing of people with headache but also reduce the burden of neurological disorders increasing global brain health and, thus, global population health.

The burden of neck pain in the Middle East and North Africa region, 1990-2019

Background

Neck pain is a common cause of disability across the world. The objective of the present study was to present a thorough investigation of the burden caused by neck pain in the Middle East and North Africa (MENA) region, by country, sex, age group and socio-demographic index (SDI).

Methods

The data on the burden of neck pain, encompassing its prevalence, incidence and years lived with disability (YLDs), were extracted from the Global Burden of Disease (GBD) 2019 study. These findings are reported as age-standardised numbers and rates (per 100,000), accompanied by 95 % uncertainty intervals (UIs).

Results

The age-standardised point prevalence of neck pain in 2019 was 3066.7 (95 % UI: 2407.8 to 3894.3) per 100,000, with an age-standardised incidence rate of 649.2 (509.2-829.2) in the MENA region, neither of which have changed since 1990. The age-standardised YLD rate of neck pain was 303.0 (201.5-438.8) per 100,000 population in 2019. The highest YLD rate of neck pain was found in Iran [423.5 (280.3-609.8)] and the lowest in Kuwait [215.0 (141.0-314.1)]. The highest number of prevalent cases were seen in the 45-49 age-group for both sexes in 2019, but overall females had a higher point prevalence than males. Furthermore, over the study period (1990-2019) there was no clear and consistent relationship between the SDI and the burden of neck pain.

Conclusion

Although the burden of neck pain has largely remained stable over the past three decades, the prevalence and morbidity in the MENA region remains high. Preventive and rehabilitative programs should be implemented that firstly target middle-aged females and males.

Increasing pain prevalence and intensity among middle-aged and older adults: Evidence from the German Ageing Survey

OBJECTIVE

Pain is a very common chronic condition in late life that is associated with poorer quality of life and greater functional restrictions. Little is known regarding temporal trends in pain prevalence and pain intensity. Therefore, we estimated trends in pain prevalence and intensity over time among German middle-aged and older adults.

METHODS

We used two independent samples drawn in different years from the German Ageing Survey, which is a nationwide population-representative study with a cohort-sequential design. Specifically, a sample of individuals aged 40-85 years who were assessed in 2008 (n = 5961) was compared with a sample of individuals with the same age range who were assessed in 2014 (n = 5809). Individuals were asked if and to what extent they had experienced constant or recurrent pain within the past four weeks. χ² tests and regression analyses were computed.

RESULTS

In 2008, about 44% of all individuals reported suffering from at least very mild pain. In 2014, this proportion was higher by about 7%. Controlling for chronological age, gender, education, region of residence (West vs. East Germany), depressive symptoms, chronic diseases, BMI, and physical activity, the difference in pain prevalence and pain intensity between the samples remained statistically significant.

CONCLUSION

Our data suggest an increase in the prevalence and intensity of pain among middle-aged and older German adults between 2008 and 2014, which remained statistically significant when controlling for socio-demographic and health-related indicators. Further research is needed to identify the factors underlying this increasing pain prevalence and pain intensity in order to counteract this negative temporal trend.

Biopsychosocial Approach in Identifying Risk Factors of Kinesiophobia in Persons with Subacromial Pain Syndrome and Developing a Clinical Prediction Tool

Introduction

Although the negative effects of kinesiophobia on functional status in subacromial pain syndrome (SAPS) patients are clearly demonstrated, no study examines the risk factors of kinesiophobia in individuals with SAPS from a biopsychosocial perspective. The present study aims to determine the risk factors of kinesiophobia in individuals with SAPS using a biopsychosocial approach. This study also aims to explore the compounding effects of multiple associative risk factors by developing a clinical prediction tool to identify SAPS patients at higher risk for kinesiophobia.

Materials and methods

This cross-sectional study included 549 patients who were diagnosed with SAPS. The Tampa-Scale of Kinesiophobia (TSK) was used to assess kinesiophobia. Visual analog scale (VAS), The Shoulder Pain and Disability Index (SPADI), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the presence of metabolic syndrome, using any non-steroidal anti-inflammatory drugs, Pain Catastrophizing Scale (PCS), Illness Perception Questionnaire-revised (IPQ-R), Hospital Anxiety and Depression Scale (HADS), behavioral pattern of the patient, sociodemographic characteristics, and treatment expectancy were outcome measures.

Results

Thirteen significant risk factors of having kinesiophobia were: VASat rest (≥ 5.2), VASduring activity (≥ 7.1), DASH (≥ 72.1), presence of metabolic syndrome, PCShelplessness (≥ 16.1), IPQ-Rpersonal control (≤ 17.1), IPQ-Rtreatment control (≤ 16.3), HADSdepression (≥ 7.9), avoidance behavior type, being female, educational level (≤ high school), average hours of sleep (≤ 6.8), and treatment expectancy (≤ 6.6). The presence of seven or more risk factors increased the probability of having high level of kinesiophobia from 34.3 to 51%.

Conclusions

It seems necessary to address these factors, increase awareness of health practitioners and individuals.

Level of evidence

Level IV.

Trends in Musculoskeletal Rehabilitation Needs in China From 1990 to 2030: A Bayesian Age-Period-Cohort Modeling Study

Background

Disability and medical expenses caused by musculoskeletal disorders in China had a great impact on the global health and economy. Rehabilitation is essential for dealing with musculoskeletal disorders. However, China's musculoskeletal rehabilitation needs remain unknown. This study aimed to examine the secular trends for musculoskeletal rehabilitation needs in China from 1990 to 2030.

Methods

Data on musculoskeletal rehabilitation needs were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) repository. Estimated annual percentage changes (EAPCs) were calculated to reflect fluctuations in the age-standardized rates. The Bayesian age-period-cohort models were used to project rehabilitation needs.

Results

The number of prevalent cases and years lived with disability (YLD) counts in need of musculoskeletal rehabilitation increased greatly in China from 1990 to 2019. There will be 465.9 million Chinese people in need of rehabilitation, with the age-standardized prevalence rate increasing to 21,151.0 [2.5-97.5% predictive interval (95% PI) 14,872.6-27,429.3] per 100,000 persons in 2030. Similarly, the YLD counts will increase to 40.1 million, with the age-standardized YLD rate increasing to 1,811.2 (95% PI 1,232.5-2,390.0) per 100,000 persons in 2030.

Conclusions

Increasing trends in musculoskeletal rehabilitation needs were found from 1990 to 2019, which will be anticipated through 2030. Rehabilitation is suggested to be integrated into primary care settings.

Pain Among Latvian Workers: General Prevalence vs. Registered Occupational Diseases

The problem of painful and disabling work-related musculoskeletal disorders (MSDs) is increasing in many employment sectors of Latvia. Official statistics may underestimate the proportion of affected employees, causing delays in preventive interventions, ineffective rehabilitation, and a reduction of the workforce. This study investigated the prevalence of painful health conditions among Latvian workers by analyzing survey data and comparing these to official statistics on registered occupational diseases (ODs). A total of 2,446 workers participated in the state-level “Work conditions and risks in Latvia, 2017–2018” survey that included questions about pain lasting longer than 3 days during the previous year. The frequency of subjective reports on the presence, severity, and location of pain and related behaviors was assessed in relation to sex, age, education, and job position. Descriptive statistics and cross tabulation with the chi-squared test as well as multinomial logistic regression were applied to the data. Overall, 27.7% of respondents (n = 678) reported experiencing pain, predominantly in the lower back (14.3%) and mostly moderate (47.1%) or severe (45.1%). Only one-fifth of respondents (20.5%) took sick leave from work and one-third (29.0%) did not take action to alleviate their pain. Participants aged 55–74 years had a significantly higher odds ratio (OR) for pain in at least one body region—including hands and legs—than those aged 18–24 years. Women had significantly higher odds of headache (OR = 2.55) and neck pain (OR = 1.85) than men. Respondents with a primary or elementary education level had higher odds of pain in at least one body region (OR = 1.60) and in the lower back (OR = 1.86), while those with secondary education had higher odds of pain in hands (OR = 1.51) than employees with higher education. Unskilled workers had significantly higher odds of pain in hands (OR = 2.42) and legs (OR = 2.12) than directors. Official data revealed a dramatic increase in the proportion of MSDs and related disabilities in the last decade, reaching 75.5% of all first registered ODs in 2019. These results demonstrate a high prevalence of painful conditions among Latvian employees; urgent attention to diagnostics, treatment, and prevention is needed to ensure the musculoskeletal health and productivity of this population.

Secular Trends in the Incidence of Migraine in China from 1990 to 2019: A Joinpoint and Age–Period–Cohort Analysis

Background

Migraine is a common disorder of the nervous system in China, imposing heavy burdens on individual and societies. Optimal healthcare planning requires understanding the magnitude and changing the trend of migraine incidence in China. However, the secular trend of migraine incidence in China remains unclear.

Methods

Data were collected from the Global Burden of Disease Study 2019 in China from 1990 to 2019 to investigate changes in the incidence rate of migraine. The average annual percent change and the relative risk were calculated using the joinpoint regression model and the age–period–cohort model, respectively.

Results

From 1990 to 2019, the age-standardized incidence rates of migraine in China increased by 0.26% (95% CI: 0.22 to 0.31) and 0.23% (95% CI: 0.19 to 0.28) per year in males and females, respectively. Age effects exerted the most significant impact on migraine incidence. Period effects showed a slightly decreasing trend in the incidence of migraine. In terms of cohort effects, people born after the 1960s presented a higher risk of migraine as compared with the total cohort, with the incidence risk of migraine increasing with birth cohorts.

Conclusion

Migraine incidence shows an overall increasing trend in China, with a significant gender difference. A comprehensive understanding of the risk characteristics and disease pattern of migraine could allow the early detection of persons with a high risk of developing migraine and promote the development of timely intervention measures to relieve this burden effectively.

Female Gender Is Associated with a Higher Prevalence of Chronic Neck Pain, Chronic Low Back Pain, and Migraine: Results of the Spanish National Health Survey, 2017

OBJECTIVES

To assess the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine headache (MH) in the Spanish population and to identify sociodemographic and health-related variables associated with CNP, CLBP, and MH.

DESIGN

Observational study.

SETTING

Spain.

SUBJECTS

A total of 22,511 persons 18 years of age or older (10,304 males and 12,207 females) who participated in the 2017 Spanish National Health Survey.

METHODS

Stratified three-stage sampling was applied. CNP, CLBP, and MH were the dependent variables. The analysis was conducted separately by gender. Sociodemographic features, self-perceived health status, lifestyle habits, comorbidities, and pain features were analyzed by using logistic regression models.

RESULTS

Females reported a higher prevalence of CNP, CLBP, and MH (P < 0.001) than males. For both sexes, anxiety and/or depression and poor self-rated health were associated with a significantly increased prevalence of CNP, CLBP, and MH. For CNP and CLBP, the identified associated factors were older age and limitations to usual activity. For CNP and MH, the most common associated factor was comorbid respiratory disease.

CONCLUSIONS

Our study identified several factors associated with CNP, CLBP, and MH in Spanish female and male adults, with potential implications for health care providers.

Spousal Care and Pain Among the Population Aged 65 Years and Older: A European Analysis

Background: Spousal care is the most important source of informal care in old age. Nevertheless, despite the growing importance of this issue, the association between providing spousal care inside the household and pain remains unexplored in Europe. Objective and Methods: This study aims to estimate the prevalence of pain reported by spouse caregivers aged 65 plus that provide care inside the household and to investigate the association between providing spousal care and pain. Data from 17 European countries that participated in wave 6 of the Survey of Health, Aging and Retirement in Europe (SHARE) is used. The analyses are based on 26,301 respondents aged 65 years and older who provide informal care inside the household to their spouse/partner exclusively (N = 1,895) or do not provide any informal care (inside or outside the household) (24,406). Descriptive statistics and multilevel logistic regressions (individual-level as level 1, and country as level 2) were performed. Results: Overall, spouse caregivers report pain more often (63.4%) than their non-caregiver's counterparts (50.3%). Important differences in the prevalence of pain among spouse caregivers were found between countries, with Portugal (80.3%), Spain (74.6%), France (73%), Italy (72.4%), and Slovenia (72.1) showing the highest prevalence of pain, and Denmark (36%), Switzerland (41.5) and Sweden (42.3%), the lowest. Results from multilevel logistic regressions show that European individuals aged 65+ who provide spousal care have an increased likelihood of reporting pain (OR 1.30; CI = 1.13-1.48). Conclusion: Our results suggest that in Europe, spouse caregivers aged 65+ are at greater risk of experiencing pain. Therefore, European policymakers should consider spouse caregivers as a health priority group, and take measures to ensure they receive comprehensive health and socio-economic support.

Mask-associated 'de novo' headache in healthcare workers during the COVID-19 pandemic

OBJECTIVES

The pandemic caused by the new coronavirus (COVID-19) has changed care activities of health professionals. We analysed the possible association between the appearance of 'de novo' headache according to the type of mask used, the related factors and the impact of the cephalalgia on health professionals.

METHODS

Cross-sectional study in a tertiary hospital in Extremadura, Spain. We provided an online questionnaire to healthcare workers during the period of maximum incidence of COVID-19 in our setting.

RESULTS

The subjects are n=306, 244 women (79.7%), with an average age of 43 years (range 23-65). Of the total, 129 (42.2%) were physicians, 112 (36.6%) nurses and 65 (21.2%) other health workers. 208 (79.7%) used surgical masks and 53 (20.3%) used filter masks. Of all those surveyed, 158 (51.6%) presented 'de novo' headache. The occurrence of a headache was independently associated with the use of a filter mask, OR 2.14 (95% CI 1.07 to 4.32); being a nurse, OR 2.09 (95% CI 1.18 to 3.72) or another health worker, OR 6.94 (95% CI 3.01 to 16.04); or having a history of asthma, OR 0.29 (95% CI 0.09 to 0.89). According to the type of mask used, there were differences in headache intensity, and the impact of a headache in the subjects who used a filter mask was worse in all the aspects evaluated.

CONCLUSION

The appearance of 'de novo' headache is associated with the use of filter masks and is more frequent in certain healthcare workers, causing a greater occupational, family, personal and social impact.

Predictors of pain in general ageing populations: results from a multi-country analysis based on ATHLOS harmonized database

BACKGROUND

Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents.

METHODS

We used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Socio-demographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors.

RESULTS

A total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years' follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80).

CONCLUSIONS

Our results showed that 39.5% of respondents developed pain over a five-year follow-up period, that there are proximal and distal risk factors for pain, and that part of them are directly modifiable. Actions aimed at improving sleep, reducing weight among obese people and treating fatigue would positively impact on pain onset, and avoiding vigorous exercise should be advised to people aged 60 or over, in particular if female or obese.