Pain associated with health and economic burden in France: results from recent National Health and Wellness Survey data

Prescription opioids and economic hardship in France

This paper studies how opioid analgesic sales are empirically related to socioeconomic disparities in France, with a focus on poverty. This analysis is made possible using the OpenHealth database, which provides retail sales data for opioid analgesics available on the French market. We exploit firm-level data for each of the 94 departments in Metropolitan France between 2008 and 2017. We show that increases in the poverty rate are associated with increases in sales: a one percentage point increase in poverty is associated with approximately a 5% increase in mild opioid sales. Our analysis further shows that opioid sales are positively related to the share of middle-aged people and individuals with basic education only, while they are negatively related to population density. The granularity and longitudinal nature of these data allow us to control for a large pool of potential confounding factors. Our results suggest that additional interventions should be more intensively addressed toward the most deprived areas. We conclude that a combination of policies aimed at improving economic prospects and strictly monitoring access to opioid medications would be beneficial for reducing opioid-related harm.

A Cross-Sectional and Longitudinal Study of Pain among Middle-Aged and Older Adults in Thailand

Objective

The present study aimed to assess the prevalence and risk factors of pain among ageing adults in Thailand.

Methods

Cross-sectional and longitudinal data were analysed from two consecutive national waves of the Health, Aging, and Retirement in Thailand (HART) study in 2015 and 2017. The dependent variable pain was defined as moderate or severe pain in any of the 13 areas of the body over the past month. Independent variables included sociodemographic factors, health risk behaviour, physical and mental health conditions, and healthcare utilization.

Results

The baseline or cross-sectional sample consisted of 5,616 participants (≥45 years), and the follow-up or incident sample consisted of 2,305 participants. The proportion of pain in the cross-sectional/baseline sample was 36.0%, and in the incident/follow-up sample 39.9%. In the cross-sectional/baseline multivariable model, poor self-reported mental health, sleep problem, arthritis or rheumatism, brain disease and/or psychiatric problems, lung disease, use of hospital in-patient, conventional out-patient, and traditional medicine practitioners were positively associated with pain. In the incident/follow-up multivariable model, older age, Buddhist religion, class I obesity, poor self-reported mental health, hospital in-patient, private clinic out-patient, and use of a practitioner of traditional medicine were positively associated with pain. Male sex and higher education were negatively associated with both cross-sectional and incident pain.

Conclusions

More than one-third of older adults in Thailand had past month moderate or severe pain. Risk factors of pain from cross-sectional and/or incident analysis included older age, female sex, lower education, obesity, poor self-reported mental health, sleep problem, arthritis or rheumatism, brain disease and/or psychiatric problems, lung disease, and conventional and traditional healthcare utilization.

Global Cluster Analysis and Network Visualization in Musculoskeletal Pain Management: A Scientometric Mapping

OBJECTIVE

Musculoskeletal pain is the most prominent clinical manifestation of more than 150 musculoskeletal disease conditions, and its effective long-term management poses a great challenge to healthcare systems globally. For this, it is important to understand current research progress on musculoskeletal pain management. The purpose of the present study is to provide a comprehensive insight into the current state of research and global trends in musculoskeletal pain management.

METHODS

Publications on musculoskeletal pain management from 1972 to 2021 were retrieved from the Science Citation Index-Expanded (SCIE) database. Included articles were any article type related to aspects of musculoskeletal pain management, including etiology, mechanisms, epidemiology, treatment, outcomes, side effects, and patient compliance. Publication data were analyzed using bibliometric methods. The software VOSviewer was employed to perform bibliographic coupling, co-authorship, co-citation, and co-occurrence analysis, and to visualize publication tendencies in musculoskeletal pain management.

RESULTS

A total of 5475 articles were included in this study. The number of global publications on musculoskeletal pain management has escalated annually. Based on the number of publications and citations from the published literature, as well as the H-index, the United States led global contributions in this area. The institutions making the highest contributions were the League of European Research Universities (LERU), the University of Sydney, and Harvard University. The journal BMC Musculoskeletal Disorders published the highest number of articles in this area. The published studies fall under six groups: "Prevention and rehabilitation," "Etiology and diagnosis," "Clinical study," "Epidemiology," "Mental health," and "Education." High-quality primary studies and epidemiology are predicted to be the next prevailing topics in this field of research.

CONCLUSIONS

Based on current global trends, the number of publications on musculoskeletal pain management will continue to increase. Future studies will likely place more emphasis on high-quality randomized controlled trials (RCTs) and epidemiological studies.

Impact of coronavirus disease 2019 on chronic pain structures: data from French national survey

Aims: The authors evaluated the impact of the first coronavirus disease 2019 pandemic wave on French chronic pain structures (CPSs). Methods: An online survey assessed CPS resource allocation, workflow and perceived impact on patient care. Results: All CPS workflow was severely impacted by the reallocation of 42% of specialists. In-person appointments were cancelled by 72% of participants. Follow-up was maintained in 91% of participants (telemedicine). Skills in end-of-life decision-making/counseling were rarely solicited. The perceived impact of the crisis on the experience of patients was high (eight out of ten), with a significant increase in access-to-care delay. Conclusion: CPSs maintained patient follow-up. Special features of CPS specialists were rarely solicited by coronavirus disease 2019 teams experiencing a high workload. Recommendations on optimal CPS resource reallocations have to be standardized in crisis conditions.

Prevalence and Factors Associated With Body Pain: Results of a Nationally Representative Survey of 9,586 Chinese Adults Aged 60 and Over

Background: Pain management has become a critical problem worldwide with the aging population. More than half of older people have experienced pain with different severity. The aim of this research is to identify the characteristics of older people with body pain and the associations between pain and characteristics of demographic, health status, and health services use amongst Chinese seniors. Methods: This cross-sectional study was based on the China Health and Retirement Longitudinal Study (CHARLS), using follow-up survey data in 2015. The national survey comprised 20,284 women and men aged 45 years or older who completed questionnaires. Data of older people who were asked whether they had troubles with body pain were extracted and analyzed. Multiple logistic regression modeling was used to determine the important indicators (demographic, health status, and health services use) amongst Chinese elderly with pain. Results: Analyses revealed that 32.5% (n = 9,586) of Chinese people aged over 60 reported having body pain. Pain is positively associated with female gender (OR = 2.08, 95% CI 1.80-2.39, p < 0.001), living in non-urban areas (OR = 1.49, 95% CI 1.25-1.77, p < 0.001), having physical disabilities (OR = 1.45, 95% CI 1.15-1.82, p = 0.002), diagnosed with stomach diseases (OR = 1.40, 95% CI 1.20-1.64, p < 0.001), diagnosed with arthritis (OR = 1.91, 95% CI 1.66-2.20, p < 0.001), self-rating with poor health status (OR = 7.03, 95% CI 5.63-8.78, p < 0.001), self-purchased over-the-counter western medications (OR = 1.50, 95% CI 1.30-1.73, p < 0.001) and self-purchased Chinese herbal medicine (OR = 1.52, 95% CI 1.24-1.85, p < 0.001). Conclusion: Body pain is common amongst the Chinese elderly. This research highlights the need for further nationwide studies exclusively focusing on people with pain including the elder population, and provides evidence-based insights for healthcare providers and policy-makers, to improve the quality of pain management. Future research should also pay attention to the importance of health literacy for health outcomes with regard to pain management.

Decoding the mystery of American pain reveals a warning for the future

There is an expectation that, on average, pain will increase with age, through accumulated injury, physical wear and tear, and an increasing burden of disease. Consistent with that expectation, pain rises with age into old age in other wealthy countries. However, in America today, the elderly report less pain than those in midlife. This is the mystery of American pain. Using multiple datasets and definitions of pain, we show today's midlife Americans have had more pain throughout adulthood than did today's elderly. Disaggregating the cross-section of ages by year of birth and completion of a bachelor's degree, we find, for those with less education, that each successive birth cohort has a higher prevalence of pain at each age-a result not found for those with a bachelor's degree. Thus, the gap in pain between the more and less educated has widened in each successive birth cohort. The increase seen across birth cohorts cannot be explained by changes in occupation or levels of obesity for the less educated, but fits a more general pattern seen in the ongoing erosion of working-class life for those born after 1950. If these patterns continue, pain prevalence will continue to increase for all adults; importantly, tomorrow's elderly will be sicker than today's elderly, with potentially serious implications for healthcare.

The prevalence and economic burden of pain on middle-aged and elderly Chinese people: results from the China health and retirement longitudinal study

Background

To estimate the prevalence of pain among people aged 45 years and older in China, to analyze the effect factors of pain and pain related economic burden.

Methods

Nationally representative sample was derived from China Health and Retirement Longitudinal Study (CHARLS). Pain data, medical cost data were obtained, as well as information of demographic characteristics, social structure, social-economic status, other health needs and health behaviors. The prevalence of pain in 2011, 2013, and 2015 was calculated. Univariate analysis and multivariate analysis were used to find the effect factors of pain. An optimization two-part model was used to calculate the range of the direct medical costs caused by pain.

Results

The prevalence of pain among people 45 years or older in China was 31.73% in 2011, 37.27% in 2013 and 28.62% in 2015. When evaluating factors lead a higher prevalence of pain, the results of the multi-variable after one-way analysis were older age, female, lower education, rural residents, without insurance status, abstained from alcohol and lower body mass index (BMI). Through the optimization of two-part model, the direct medical costs caused by pain was 898.9–1563.0 yuan in 2011, 2035.8–2568.7 yuan in 2013 and 2628.8–3945.7 yuan in 2015 (129.9US$ - 225.9US$ in 2011, 294.2 US$ - 371.2US$ in 2013 and 379.9US$ - 570.2US$ in 2015, converted to 2010 RMB).

Conclusion

The prevalence of pain among middle-aged and elderly Chinese is high. Residents with older age, female, lower education, rural residents, without insurance status, abstained from alcohol and lower BMI seem to have a higher pain prevalence. Pain can cause extra direct medical costs and will cause more economic loss with the progress of time. Future research should pay more attention to effective treatment, management and prevention of pain to decrease its burden.

Burden of relapsing-remitting multiple sclerosis on workers in the US: a cross-sectional analysis of survey data

Background

Multiple sclerosis (MS) is prevalent among working age individuals (20–60 years), leading to high burden on work productivity. Few data are available about the absenteeism and presenteeism in employed individuals with MS in comparison to non-MS personnel. This study aimed to quantify the burden of illness of employed US adults with relapsing-remitting multiple sclerosis (RRMS) and examine burden by levels of work impairment.

Methods

A retrospective cross-sectional analysis was conducted using patient-reported responses from the US National Health and Wellness Survey (NHWS). Data from NHWS 2015–2016 were analyzed from 196 employed RRMS respondents who were matched 1:4 to employed respondents without MS based on demographic and general health characteristics. Demographic and general health characteristics for employed RRMS individuals were analyzed by levels of work impairment (none, 1–30%; 31–68%; 69–100%). Work productivity (absenteeism, presenteeism, and work impairment), decrements in health-related quality of life (HRQoL) (short form-36, EQ-5D), and healthcare resource utilization (HCRU) were compared to determine the burden of RRMS.

Results

After propensity score matching, the levels of absenteeism and presenteeism were 2 and 1.8 times higher in the employed RRMS population than the employed non-MS population, respectively (P < 0.001 for both). HRQoL was significantly lower in employed respondents with RRMS than those without MS (P < 0.001 for all). Employed respondents with RRMS had significantly more HCRU over 6 months compared to those without MS (P < 0.001). Furthermore, among employed RRMS respondents, greater levels of impairment were associated with increasing disease severity, greater healthcare resource use, fatigue, and cognitive impairment and inversely associated with mental and physical HRQoL (P < 0.0001 for all).

Conclusions

Among employed individuals, respondents with RRMS had lower, work productivity, HRQoL, and higher HCRU as compared with those without MS. Given the large impact RRMS has on work impairment, a need exists to manage individuals on therapies that improve HRQoL, reduce symptoms, and improve their ability to perform in the workforce.

Comparison of Different Histone Deacetylase Inhibitors in Attenuating Inflammatory Pain in Rats

Histone deacetylase inhibitors (HDACIs), which interfere with the epigenetic process of histone acetylation, have shown analgesic effects in animal models of persistent pain. The HDAC family comprises 18 genes; however, the different effects of distinct classes of HDACIs on pain relief remain unclear. The aim of this study was to determine the efficacy of these HDACIs on attenuating thermal hyperalgesia in persistent inflammatory pain. Persistent inflammatory pain was induced by injecting Complete Freund's Adjuvant (CFA) into the left hind paw of rats. Then, HDACIs targeting class I (entinostat (MS-275)) and class IIa (sodium butyrate, valproic acid (VPA), and 4-phenylbutyric acid (4-PBA)), or class II (suberoylanilide hydoxamic acid (SAHA), trichostatin A (TSA), and dacinostat (LAQ824)) were administered intraperitoneally once daily for 3 or 4 days. We found that the injection of SAHA once a day for 3 days significantly attenuated CFA-induced thermal hyperalgesia from day 4 and lasted 7 days. In comparison with SAHA, suppression of hyperalgesia by 4-PBA peaked on day 2, whereas that by MS-275 occurred on days 5 and 6. Fatigue was a serious side effect seen with MS-275. These findings will be beneficial for optimizing the selection of specific HDACIs in medical fields such as pain medicine and neuropsychiatry.