Greater Number Of Painful Sites Research Articles

Factors Associated With Interest in Engaging in Psychological Interventions for Pain Management.

Engagement in evidence-based psychological interventions for pain management is low. Identifying characteristics associated with interest in interventions can inform approaches to increase uptake and engagement. The purpose of this study was to examine factors associated with interest in psychological interventions among persons with chronic noncancer pain receiving prescription opioids. Participants with chronic noncancer pain and a new 30 to 90 day opioid prescription were recruited from 2 health systems. Participants (N=845) completed measures regarding pain, opioid use, psychiatric symptoms, emotional support, and interest in psychological interventions for pain management. There were 245 (29.0%) participants who reported a high interest in psychological interventions for pain management. In bivariate analyses, variables associated with interest included younger age, female sex, greater pain severity, greater pain interference, greater number of pain sites, lower emotional support, depression, anxiety, and post-traumatic stress disorder ( P <0.05). In a multivariate model, greater pain severity (odds ratio [OR]=1.17; CI: 1.04-1.32), depression (OR=2.10; CI: 1.39-3.16), post-traumatic stress disorder (OR=1.85; CI: 1.19-2.95), and lower emotional support (OR=0.69; CI: 0.5-0.97) remained statistically significant. The rate of interest in psychological interventions for pain management was low, which may indicate that patients initiating opioid treatment of chronic noncancer pain have low interest in psychological interventions. Greater pain severity and psychiatric distress were related to interest, and patients with these characteristics may especially benefit from psychological interventions. Providers may want to refer to psychological interventions before or when opioids are initiated. Additional work is needed to determine whether this would reduce long-term opioid use.

Association Between Pain and Fall Worry Among Community-Dwelling Older People With Cognitive Impairment in the United States.

Previous studies have found that pain is associated with fall worry among community-dwelling older people. However, both pain and fall worry are poorly understood and underaddressed among community-dwelling older people with cognitive impairment (CI). It is essential to examine the association between pain and fall worry, and how sociodemographic and health characteristics may shape fall worry among this subgroup. We used data from the 2015 National Health and Aging Trends Study (analytic sample: n = 1150 community-dwelling older people with CI; were self-interviewed; mean age: 81; age range: 65-107). The number of pain sites in the prior month was assessed by presenting a card listing common pain sites (eg, back, knees). Two questions assessed past-month fall worry, "did you worry about falling down" and "did this worry ever limit your activities." Following descriptive statistics, we fit multinomial logistic regression models to examine the associations between different pain characteristics (number of sites, severity, location) and non-activity-limiting and activity-limiting fall worry. Non-activity-limiting fall worry was endorsed by 21.1% and activity-limiting fall worry by 13.6% of community-dwelling older people with CI. After adjusting for sociodemographic characteristics and fall-worry-related covariates, multinomial logistic regression analysis found that a greater number of pain sites (relative risk ratio [RRR] = 1.22, 95% Confidence Interval [95% CI] = 1.12-1.33, p <.001) and severe pain (RRR = 2.05, 95% CI = 1.12-3.75, p = .020) was associated with activity-limiting fall worry. Both lower body (knee, foot, and leg) and upper body (hand, wrist, shoulder, neck, and stomach) pain were found to be associated with a high risk of activity-limiting fall worry. These findings suggest pain and fall worry are common among community-dwelling older people with CI and can be elicited directly from those who are communicative. Fall prevention for this population should prioritize pain management to mitigate activity-limiting fall worry because activity limitation increases the risk of falls.

Preference of musculoskeletal pain treatment in middle-aged and elderly chinese people: a machine learning analysis of the China health and retirement longitudinal study

BackgroundMusculoskeletal pain is a major cause of physical disability, associated with huge socioeconomic burden. Patient preference for treatment is an important factor contributing to the choice of treatment strategies. However, effective measurements for evaluating the ongoing management of musculoskeletal pain are lacking. To help improve clinical decision making, it’s important to estimate the current state of musculoskeletal pain management and analyze the contribution of patient treatment preference.MethodsA nationally representative sample for the Chinese population was derived from the China Health and Retirement Longitudinal Study (CHARLS). Information on the patients’ demographic characteristics, socioeconomic status, other health-related behavior, as well as history on musculoskeletal pain and treatment data were obtained. The data was used to estimate the status of musculoskeletal pain treatment in China in the year 2018. Univariate analysis and multivariate analysis were used to find the effect factors of treatment preference. XGBoost model and Shapley Additive exPlanations (SHAP) method were performed to analyze the contribution of each variable to different treatment preferences.ResultsAmong 18,814 respondents, 10,346 respondents suffered from musculoskeletal pain. Approximately 50% of musculoskeletal pain patients preferred modern medicine, while about 20% chose traditional Chinese medicine and another 15% chose acupuncture or massage therapy. Differing preferences for musculoskeletal pain treatment was related to the respondents’ gender, age, place of residence, education level, insurance status, and health-related behavior such as smoking and drinking. Compared with upper or lower limb pain, neck pain and lower back pain were more likely to make respondents choose massage therapy (P < 0.05). A greater number of pain sites was associated with an increasing preference for respondents to seek medical care for musculoskeletal pain (P < 0.05), while different pain sites did not affect treatment preference.ConclusionFactors including gender, age, socioeconomic status, and health-related behavior may have potential effects on people’ s choice of treatment for musculoskeletal pain. The information derived from this study may be useful for helping to inform clinical decisions for orthopedic surgeons when devising treatment strategies for musculoskeletal pain.

Pain severity, distribution, and duration are associated with spatiotemporal gait performance in community-dwelling older adults with chronic musculoskeletal pain

BackgroundOur current understanding of the impact of chronic pain on spatiotemporal gait performance has mainly been achieved through comparison studies between individuals with and without chronic pain. Further investigation into the relationship between specific outcome measures of chronic pain and gait may improve our understanding of the impact of pain on gait and may benefit future interventions that aim to improve mobility in this population. Research questionWhich pain outcome measures are associated with spatiotemporal gait performance in older adults with chronic musculoskeletal pain? MethodsThis study was secondary analysis of older adult participants enrolled in the Neuromodulatory Examination of Pain and Mobility Across the Lifespan (NEPAL) study (n = 43). Pain outcome measures were obtained using self-reported questionnaires, and spatiotemporal gait analysis was conducted using an instrumented gait mat. Separate multiple linear regressions were run to determine which pain outcome measurements were associated with gait performance. ResultsHigher pain severities were associated with shorter stride lengths (β = −0.336, p = 0.041), shorter swing times (β = −0.345, p = 0.037), and longer double support times (β = 0.342, p = 0.034). A greater number of pain sites was associated with a wider step width (β = 0.391, p = 0.024). Longer pain durations were associated with shorter double support times (β = −0.373, p = 0.022). SignificanceThe results of our study illustrate that specific pain outcomes measures are associated with specific gait impairments in community-dwelling older adults with chronic musculoskeletal pain. As such, pain severity, number of pain sites, and pain duration should be considered when developing mobility interventions in this population to reduce disability.

Multisite Pain and Myocardial Infarction and Stroke: A Prospective Cohort and Mendelian Randomization Analysis

BackgroundWhether individuals with multisite pain had a higher risk of cardiovascular diseases is unclear. ObjectivesThe purpose of this study was to investigate the longitudinal association of pain in multiple sites with incident myocardial infarction (MI) and stroke, and to disentangle the genetic causality of these associations. MethodsA total of 281,760 participants (mean age: 56.3 years) who had no MI and stroke at baseline from UK Biobank study were included. Data on pain in the hip, knee, back and neck/shoulder, or ‘all over the body’ were collected. Chronic pain was defined if pain had lasted for ≥3 months. MI and stroke events were determined from hospital admission records and death registries. Cox regression and 2-sample Mendelian randomization were used for the analyses. ResultsDuring a median follow-up of 11.9 years, 4,854 had a first MI and 2,827 had a first stroke. In multivariable analyses, greater number of painful sites was dose-responsively associated with higher risks of incident MI and stroke, with a higher risk among participants with pain ‘all over the body’ (MI: HR: 1.65, 95% CI: 1.32-2.07; stroke: HR: 1.44, 95% CI: 1.13-1.85). Similar trends and associations were observed in those with chronic pain. Two-sample Mendelian randomization results supported a causal effect of multisite pain on MI risk, but not vice versa. No causal association was found between multisite pain and stroke risk. ConclusionsPain in multiple sites causally increases the risk of MI, highlighting that pain should be considered when assessing individuals’ MI risk, and pain treatment and management may prevent MI risk.

The Impact of Rapid Weight Loss on Pain in Non-Hispanic Black and Hispanic/Latino/a/x Adults with Obesity

Significant weight loss with bariatric surgery improves self-reported pain, but the impact of weight loss on pain severity, interference, and number of painful sites after bariatric surgery, specifically in ethnically diverse adults, is unclear. The purpose of this study was to examine longitudinal changes and racial differences in pain intensity, interference, and number of sites 12 months after bariatric surgery. This is a secondary analysis from a study of patients undergoing a sleeve gastrectomy. Participants completed the Brief Pain Inventory (BPI) before surgery (BL), 3 months post-surgery (3M) and 12 months post-surgery (12M). Weight loss was calculated as a percentage of weight lost minus baseline weight (%TWL). Racial group differences were analyzed using t-test or Wilcoxon rank-sum test. A linear regression model was fitted to test which factors were associated with pain change (p <0.05). Data from 213 adults were analyzed (Mean(SD)) Age: 39.7(12.0); BMI: 43.3(6.4); Peak %TWL: 28.4(7.6); BPI Severity: 4.2(2.8); BPI Interference: 3.7(3.0); pain sites: 6.3(6.3). There were significant reductions in pain intensity, pain interference, and in the number of painful sites that plateaued between 3M and 12M. Hispanic/Latino/a/x and NH Black patients have greater pain severity at BL, but not at 3M and 12M compared with NH White patients. Hispanic/Latino/a/x participants have a significantly greater number of painful sites compared with other racial groups at BL but not at 3M and 12M. There was a trend toward higher %TWL being associated with a greater reduction in pain interference between BL and 3M. Findings from this study suggest that pain reduction after weight loss is influenced by time and race. Pain assessment during the early and late stages of weight loss could help clinicians use culturally informed strategies to address pain after rapid weight loss in ethnically diverse adults. Grant support from NYU Grossman School of Medicine Office of Research (internally funded, no grant number).

Differences in Pain Characteristics and Functional Associations between Nursing Home Residents and Community-Dwelling Older Adults: A Cross-Sectional Study.

BackgroundPain is one of the most critical issues in older adults, and the place of residence may play an important role in pain characteristics and related factors. However, it is an understudied subject. This study investigated differences in pain characteristics and functional associations between nursing home residents and community-dwelling older adults.MethodsOlder adult participants were recruited from nursing homes (n=73) and the community (n=73). Pain characteristics, including type, intensity, and number of pain sites, were evaluated. Other outcome measures were functional mobility, walking speed, functional independence, physical activity, anxiety, depression, and health-related quality of life.ResultsNursing home residents experienced musculoskeletal pain more frequently and had a greater number of pain sites than community-dwelling older adults (p<0.05). Walking speed and mobility were significantly lower and anxiety and depression were significantly higher in nursing home residents (p<0.05). While higher pain intensity was significantly correlated with low scores on physical measures, low health-related quality of life, and higher depression and anxiety symptoms in both groups (p<0.05), the magnitudes of the correlations were much higher in nursing home residents. The number of pain sites was significantly correlated with low scores on physical measures, low health-related quality of life, and higher depression and anxiety symptoms mainly in nursing home residents (p<0.05).ConclusionCompared to community-dwelling older adults, nursing home residents experienced musculoskeletal pain more frequently and at more sites in the body. Higher pain intensity and number of pain sites were associated with worse clinical variables, mainly in nursing home residents. This study highlights the importance of regular pain assessment, especially in nursing home care settings.

Effect of central sensitization inventory on the number of painful sites and pain severity in a Japanese regional population cohort

BackgroundTo investigate the association between the central sensitization inventory (CSI), a screening tool for central sensitization, and the number of painful sites and the severity of pain in locomotive organs in an epidemiological study in the elderly. MethodsA total of 379 individuals who underwent musculoskeletal disease screening were enrolled in this study. The CSI was used to assess symptoms of central sensitization. The number and location of painful sites and the severity of pain were evaluated using pain mapping and a numerical rating scale (NRS) at 37 sites. We investigated the association between the number of painful sites and CSI score, and the association between the severity of low back pain or knee pain and CSI score. ResultsThere was a positive correlation between CSI score and the number of painful sites. The CSI score was significantly higher in those with significant low back pain than in those without pain, and the high-CSI group tended to have a greater number of painful sites. Comparison of CSI scores between participants with low back pain alone and those with low back pain and posterior lower leg pain showed that the latter group had a significantly higher CSI score than the former group. The CSI score in participants with radiographic evidence of knee osteoarthritis was significantly higher in those with knee pain than in those without pain. ConclusionsThe results of this study suggest that participants with significant low back pain and a higher number of painful sites are more susceptible to the influence of central sensitization. In addition, CSI score was higher in participants with low back pain and posterior lower leg pain than in those with low back pain alone, suggesting that the spread of pain may be due to central sensitization.

Associations of Pain Characteristics with Long-term Trajectories of Physical Capacity among Older Adults in the United States

Bothersome and multisite pain are common and strongly associated with low physical functioning in older adults. Although these associations are well established in cross-sectional studies, few population-based studies have examined the impact of pain on physical functioning over time. Accordingly, we sought to determine the associations of pain characteristics with longitudinal trajectories of performance-based measures of physical capacity in older adults. Data on 6,783 community-dwelling adults aged ≥65 years who participated in the 2011-2017 National Health and Aging Trends Study were analyzed. Physical capacity was measured annually using the Short Physical Performance Battery. Group-based trajectory modeling was used to identify groups with similar longitudinal patterns of physical capacity. Baseline pain characteristics included report of bothersome pain in the past month, activity-limiting pain, location of pain, and pain medication use. Multinomial logistic regression was used to examine associations of pain characteristics with trajectories of physical capacity, adjusting for demographic and health characteristics. The cohort was 57% female, 68% white, and 58% were ≥75 years. Four distinct physical capacity trajectories were identified: “persistently low” (12% of cohort), “low, declining” (16%), “moderate, declining” (29%), and “persistently high” (43%). Participants who reported bothersome pain, activity-limiting pain, greater number of pain sites, and more frequent pain medication use at baseline were significantly more likely to demonstrate either “persistently low” or a declining physical capacity trajectory. For example, compared to those not reporting bothersome pain participants who reported bothersome pain were 79% (adjusted relative risk [RR]=1.79 [95%CI:1.26-2.55]), 75% (RR=1.75 [95%CI:1.42-2.16]), and 24% (RR=1.24 [95%CI:1.01-1.51]) more likely to have a “persistently low”, “low declining”, and “moderate declining” physical capacity trajectory, respectively. Among older adults in the US, bothersome pain and other pain characteristics were significantly associated with poor and worsening trajectories of physical capacity over a 6-year period. National Institute on Aging/NIH U01AG032947 and Scan Design Foundation.

Painful Temporomandibular Disorder Is Associated With Migraine in Adolescents: A Case-Control Study

Some types of primary headaches and temporomandibular disorders (TMD) are comorbid in adults and highly prevalent in adolescents. Herein, we investigated the association of painful TMD with specific headache diagnoses (migraine, tension-type headache) and with headache frequency in adolescents. We also explored the association of headache diagnosis with the number of painful sites in the trigeminal area. Painful TMD was assessed using the Research Diagnostic Criteria for TMD. We conducted a case-control study of adolescents from 13 to 15 years old who were recruited among participants in a previous epidemiologic study conducted in Araraquara, SP, Brazil. Headaches were classified according to the second edition of the International Classification for Headache Disorders. Logistic, multinomial logistic and linear regression models were used to test associations. Of 149 individuals, 55.7% presented painful TMD. Adolescents with painful TMD (cases) were more likely to have migraine compared with those without TMD (controls; odds ratio = 3.0, 95% confidence interval = 1.47-6.19, P = .033). Significant differences were not observed for probable tension-type headache (P = .307) or tension-type headache (P = .834). Painful TMD was also associated with an increase in headache frequency (linear-by-linear association = 8.051; P = .005). Only migraine was associated with a greater number of painful sites on palpation in the trigeminal area (P = .001). Migraine and frequency of headache were associated with painful TMD in adolescents. PERSPECTIVE: Migraine and headache frequency were strongly associated with painful TMD in adolescents, and causality must be determined. For now, the presence of 1 condition should raise suspicion of the other and warrants collaboration between orofacial pain specialists and neurologists.

Normative data for common pain measures in chronic pain clinic populations: closing a gap for clinicians and researchers.

Normative data for chronic pain questionnaires are essential to the interpretation of aggregate scores on these questionnaires, for both clinical trials and clinical practice. In this study, we summarised data from 13,343 heterogeneous patients on several commonly used pain questionnaires that were routinely collected from 36 pain clinics in Australia and New Zealand as part of the electronic Persistent Pain Outcomes Collaboration (ePPOC) including the Brief Pain Inventory (BPI); the Depression Anxiety and Stress Scales (DASS); the Pain Self-Efficacy Questionnaire (PSEQ); and the Pain Catastrophizing Scale (PCS). The data are presented as summarised normative data, broken down by demographic (age, sex, work status, etc) and pain site/medical variables. The mean BPI severity score was 6.4 (moderate-severe), and mean interference score was 7.0. The mean DASS depression score was 20.2 (moderate-severe), mean DASS anxiety was 14.0 (moderate), and mean DASS stress was 21.0 (moderate). The mean PCS scores were 10.0, 5.9, 14.1, and 29.8 for rumination, magnification, helplessness, and total, respectively. The mean PSEQ score was 20.7. Men had slightly worse scores than women on some scales. Scores tended to worsen with age until 31 to 50 years, after which they improved. Scores were worse for those who had a greater number of pain sites, were unemployed, were injury compensation cases, or whose triggering event was a motor vehicle accident or injury at work or home. These results and comparisons with data on the same measures from other countries, as well as their uses in both clinical practice and clinical trials, are discussed.

Headache attributed to TMD Is Associated With the Presence of Comorbid Bodily Pain: A Case-Control Study.

The objective of this case-control study is to investigate the phenotypic characteristics of chronic TMD with and without TMDH. We hypothesize that chronic TMD with TMDH is associated with increased number of bodily pain conditions, more painful sites in the head and neck region, and greater TMD pain intensity. This is a retrospective cross-sectional review of the medical records of consecutive patients who sought treatment at the University of North Carolina Orofacial Pain Clinic between 2013 and 2014. The inclusion criterion was a diagnosis of myalgia or arthralgia according to the Research Diagnostic Criteria for Temporomandibular Disorders. In addition, cases had a diagnosis of TMDH according to the ICHD-3 criteria. Data on the presence and the number of self-reported bodily pain conditions (such as fibromyalgia and low back pain), pain intensity, number of painful sites in the head and neck upon palpation, and TMD pain onset were analyzed. A total of 295 records were reviewed. Thirty-four (29.3%) patients fulfilled inclusion criteria for cases (TMD+TMDH) and 82 (70.7%) for controls (TMD-TMDH). Cases reported greater number of bodily pain conditions than controls, with a mean of 1.97±1.50 and 1.26±1.28 of bodily pain conditions, respectively (P=.012, OR=1.43 [95% CI 1.07-1.92]). In fact, 55.9% of cases reported at least 2 comorbid pain conditions compared to 37.8% controls (P=.044). Compared to controls (8.65±5.32), cases (13.05±4.46) exhibited greater number of painful sites upon palpation in the head and neck region (P<.0001, OR=1.18 [95% CI 1.09-1.30]), and greater TMD pain intensity, with a mean of 6.00±2.17 for cases and 5.09±2.14 for controls (P=.041, OR=1.22 [95% CI 1.01-1.47]). In a population of patients with chronic TMD seeking pain management, TMDH was significantly associated with an increased number of self-reported bodily pain conditions, a greater number of painful sites in the head and neck regions, and higher TMD pain intensity.

The Trajectories of the Number of Pain Sites and Their Associated Factors in Older Adults: Results from the Korean Longitudinal Study of Ageing

Background: The aging of the population will result in an increase in demand for pain management. Pain adversely affects physical and mental functioning in older adults and accounts for a considerable proportion of all medical expenses. Objectives: This study was performed to investigate the patterns of changes in the trajectories of the number of pain sites in older adults and the factors that affect these patterns according to gender. Methods: Data were extracted for subjects that participated in the Korean Longitudinal Study of Ageing from 2006 to 2014. The study population consisted of 2,839 individuals (1,190 men and 1,649 women) ≥60 years old. A group-based trajectory model was used to determine the optimal number of subgroups and the trajectories of the number of pain sites according to gender. A multinomial regression analysis was conducted to identify factors that affect the probability of inclusion in each trajectory group. Results: The trajectories of the number of pain sites were consistent in both genders. Almost all women had one or more pain symptom, and a greater number of pain sites than men. Older age, longest-duration occupation requiring manual labor, lack of physical activity, depressive symptoms, and poor self-rated health were associated with a greater number of pain sites in both genders. A lower level of education, married status, and experience of injury were associated with the number of pain sites in men but not in women, while household income and chronic diseases were associated with the number of pain sites only in women. Conclusions: The pain status at the early stage is predictive of future pain. In this study, we identified gender differences in the trends of the number of pain sites and associated factors. Further comprehensive studies on pain intensity and duration are required.

Pain and Function in Home Care: A Need for Treatment Tailoring to Reduce Disparities?

To describe racial/ethnic group differences in pain presentation and the prevalence of psychosocial factors among patients admitted to home health care, and to determine the extent of racial/ethnic group differences in the association of psychosocial factors with pain intensity and pain-related disability. We analyzed cross-sectional data on 588 patients with activity-limiting pain admitted to home care for physical therapy. Three psychosocial factors were assessed: depressive symptoms, pain self-efficacy, and health literacy. Statistical methods included estimation of general linear models of pain intensity and pain-related disability. Hispanics and non-Hispanic blacks report a greater number of pain sites, worse pain intensity, and higher levels of pain-related disability than non-Hispanic whites and others. Racial/ethnic minority group patients also have a higher prevalence of adverse psychosocial factors than others, with evidence that race/ethnicity interacts with pain self-efficacy and depressive symptoms in their association with mean pain intensity and pain-related disability, respectively. The substantial racial/ethnic difference in the psychosocial profiles of older adults with activity-limiting pain highlights the importance of screening for these modifiable risk factors and tailoring interventions accordingly. Direct attention to the psychosocial needs of patients could help to address racial/ethnic disparities in pain outcomes.

Associations Between Fat Mass and Multisite Pain: A Five-Year Longitudinal Study.

Pain is common in older adults and typically involves multiple sites. Obesity is an important risk factor in the pathogenesis of pain and multisite pain (MSP). This study aimed to examine longitudinal associations between fat mass and MSP, and to explore the potential mechanisms of any associations. Data from a longitudinal population-based study of older adults (n = 1,099) were utilized with measurements at baseline and after 2.6 and 5.1 years. At each time point, presence/absence of pain at the neck, back, hands, shoulders, hips, knees, and feet was assessed by questionnaire. Fat mass was assessed by dual x-ray absorptiometry, and height and weight were measured. Participants were of mean age 63 years, mean body mass index (BMI) 27.9 kg/m2 , and 51% women. Participants reporting greater number of painful sites had greater fat mass, fat mass index (FMI), and BMI both cross-sectionally and longitudinally. In multivariable analyses, fat mass was associated with MSP (odds ratio [OR] 1.06 per SD; 95% confidence interval [95% CI] 1.02-1.10) and pain at the hands, knees, hips, and feet (OR 1.29-1.99 per SD, P < 0.05 for all). Results were similar for FMI and BMI, although the latter was also associated with back pain (OR 1.25 per SD, 95% CI 1.02-1.54). Fat mass, FMI, and BMI are associated with MSP and pain at all lower-extremity sites and hand pain, independent of sociodemographic, physical activity, and psychological factors. This suggests that both loading and systemic inflammatory factors may have an important role in the pathogenesis of fat-related MSP.

Differences in Mexican Americans' Prevalence of Chronic Pain and Co-Occurring Analgesic Medication and Substance Use Relative to Non-Hispanic White and Black Americans: Results from NHANES 1999-2004.

Little is known about the burgeoning Mexican American (MA) population's pain experience. Using 1999-2004 National Health and Nutrition Examination Survey (NHANES) data, prevalence of chronic pain, analgesic medication use, and substance use were examined among MA, non-Hispanic White (NHW), and non-Hispanic Black (NHB) respondents. Logistic and linear regression models examined racial/ethnic differences in: 1) chronic pain prevalence among all respondents, 2) location and number of pain sites among respondents with chronic pain, and 3) analgesic medication and substance use among respondents with chronic pain. Compared to NHWs and NHBs, MAs were less likely to report any chronic pain. Among respondents with chronic pain, MAs had higher odds of reporting headache, abdominal pain, and a greater number of pain sites than NHWs. Compared to NHWs, MAs with chronic pain had lower odds of reporting past-month analgesic medication and COX-2 inhibitor use. MAs with chronic pain had lower odds of being a current cigarette smoker and heavy alcohol drinker but had similar street drug/cocaine use relative to NHWs. Results suggest that: 1) MAs are less likely to develop chronic pain than NHWs, 2) MAs with chronic pain report greater headache and abdominal pain than NHWs, and 3) MAs with chronic pain are less likely to use analgesic medications and other substances compared to NHWs. These results suggest that providers should consider taking extra time to discuss analgesic medications with MAs. Future investigations should examine reasons underlying these racial/ethnic differences in chronic pain, as well as differences in the use of other substances, such as marijuana.

Understanding the biomechanical “spread” of joint pain: knee pain predicts subsequent shoulder pain and this is mediated by leg weakness. Data from the osteoarthritis initiative

Joint pain is common in older adults; typically multiple joints are involved. A greater number of painful sites is associated with higher levels of pain intensity in affected joints, more functional impairment and poorer quality of life. However, little is known about the pattern of multi-site joint pain development. We aimed to assess whether the number of painful joints increases over time, whether pain in certain joints precedes pain in others, and to assess whether the association is mediated by weakness in a cohort of older adults with painful knee osteoarthritis or at risk of knee osteoarthritis in the NIH Osteoarthritis Initiative (OAI).

Association Between Physical Activity and Sleep in Adults With Chronic Pain: A Momentary, Within-Person Perspective

Individuals with chronic pain consider improved sleep to be one of the most important outcomes of treatment. Physical activity has been shown to have beneficial effects on sleep in the general population. Despite these findings, the physical activity-sleep relationship has not been directly examined in a sample of people with chronic pain. This study aimed to examine the association between objective daytime physical activity and subsequent objective sleep for individuals with chronic pain while controlling for pain and psychosocial variables. An observational, prospective, within-person study design was used. A clinical sample of 50 adults with chronic pain was recruited. Participation involved completing a demographic questionnaire followed by 5 days of data collection. Over this period, participants wore a triaxial accelerometer to monitor their daytime activity and sleep. Participants also carried a handheld computer that administered a questionnaire measuring pain, mood, catastrophizing, and stress 6 times throughout the day. The results demonstrated that higher fluctuations in daytime activity significantly predicted shorter sleep duration. Furthermore, higher mean daytime activity levels and a greater number of pain sites contributed significantly to the prediction of longer periods of wakefulness at night. The small sample size used in this study limits the generalizability of the findings. Missing data may have led to overestimations or underestimations of effect sizes, and additional factors that may be associated with sleep (eg, medication usage, environmental factors) were not measured. The results of this study suggest that engagement in high-intensity activity and high fluctuations in activity are associated with poorer sleep at night; hence, activity modulation may be a key treatment strategy to address sleep complaints in individuals with chronic pain.

The Mediating Effect of Chronic Pain on the Relationship Between Obesity and Physical Function and Disability in Older Adults

To determine the extent to which bodily pain mediates the effect of obesity on disability and physical function. Cross-sectional analysis. Population-based sample of residents in the greater Boston area. Community-dwelling adults aged 70 and older (N=736). Body mass index (BMI), obtained from measured height and weight, was categorized as normal weight (19.0-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (≥30.0 kg/m2). Main outcome measures were the Physical Component Summary of the Medical Outcomes Study 12-item Short-Form Survey (PCS), activity of daily living (ADL) disability, and Short Physical Performance Battery (SPPB) score. Chronic pain was assessed according to the number of weight-bearing joint sites that had pain (hips, knees, feet and pain all over). Older obese adults had greater ADL disability and lower SPPB and PCS scores than their nonobese counterparts, although in sex-stratified adjusted analyses, obesity was adversely associated with outcomes only in women. Obesity was associated with greater number of pain sites; and more pain sites were associated with greater odds of disability. Mediation analysis suggests that pain is a significant mediator (22-44%) of the adverse effect of obesity on disability and physical function in women. Bodily pain may be an important treatable mediator of the adverse effect of obesity on disability and physical function in women.

A greater number of somatic pain sites is associated with poor mental health in adolescents: a cross-sectional study

BackgroundIdentifying indicators of poor mental health during adolescence is a significant public health issue. Previous studies which suggested an association between the number of somatic pains and depression have mainly focused on adults or have employed samples with a narrow age range. To date, results from previous studies have been inconsistent regarding the association between somatic pain and academic impairment. Therefore, the main aims of the present study were to 1) investigate the association between the number of somatic pain sites and poor mental health using a community sample of adolescents aged 12 to 18 years and employing a simple method of assessment, and 2) examine the association between the number of somatic pain sites and perceived academic impairment.MethodsData analysis was conducted using a large cross-sectional survey of adolescents in grades 7 to 12. The one-month prevalence rates for three sites of somatic pain including head, neck and shoulders, and abdomen were examined. Poor mental health was evaluated using the General Health Questionnaire, and perceived academic impairment was measured using a self-report questionnaire.ResultsA total of 18,104 adolescents participated in the survey. A greater number of pain sites was associated with poor mental health, and this association was consistent across age and gender. There was no difference in effect on mental health between any of the pain sites. Although there was an association between the number of somatic pain sites and perceived academic impairment, the results suggested that the association was mediated by poor mental health.ConclusionsSimple reporting methods for assessing the number of pain sites may be a feasible indicator of poor mental health in adolescents. Professionals working with adolescents should consider the possibility of poor mental health, especially when students report multiple somatic pains.