Number Of Painful Areas Research Articles

Central sensitization patients present different characteristics compared with other musculoskeletal patients: A case–control study

The aims of this study were to identify the prevalence of a clinical dominance of musculoskeletal pain type and to compare pain characteristics among patients with musculoskeletal disorders. A case-sectional study was conducted at a physiotherapy outpatient service in 149 consecutive patients with complaints of musculoskeletal pain. Participants completed a sociodemographic and pain characteristics questionnaire. The dominance of nociceptive (NO), peripheral neuropathic (PN) and central sensitization (CS) mechanisms of musculoskeletal pain was based on clinical classification. The most prevalent clinical predominance was NO pain (53.57%), followed by PN (25.00%) and CS (21.43%). Age, gender and sedentary behaviour did not show differences between pain groups. Patients with CS predominance had a higher number of separated areas (CS 8.1 vs NO 3.0 vs PN 4.9; p < 0.001) and widespread pain (CS 0.52 cm2 vs NO 0.14 cm2 vs PN 0.28 cm2; p = 0.001). Patients with CS predominance had an average pain intensity of 7.90, and the majority of patients were classified as having severe pain. In conclusion, patients with a predominance of CS pain showed higher pain intensity, pain duration and number of pain areas and more widespread pain than those with PN and NO. Chronicity of pain is not sufficient to distinguish CS predominance.

The Relationship Between Physical Activity Levels and Pain in Children with Juvenile Idiopathic Arthritis

Pain and reduced physical activity levels are common in children with juvenile idiopathic arthritis (JIA). Currently, there is no consensus about the role of physical activity in managing pain in JIA. The purpose of our study was to assess the relationship between physical activity level and pain in children ages 11 to 18 years with JIA. A random sample of 50 patients with JIA were approached by mailed questionnaires. Physical activity was determined using the Physical Activity Questionnaire (PAQ). Pain measures included the Numerical Rating Scale (pain severity), SUPER-KIDZ body diagram (number of painful areas), and the Child Activities Limitations Inventory-21 (pain interference). Generalized linear models were used to assess the relationship between physical activity and pain, as well as the roles of sex and age. The response rate was 84%. Thirty-four respondents completed the questionnaire package. The median age was 15 years. The mean PAQ score was 2.16/5. Physical activity declines with increasing age in youth with JIA (r = 0.53, p = 0.0014). Lower physical activity is associated with greater pain interference (r = 0.39, p = 0.0217) and more severe pain (r = 0.35, p = 0.0422). Children with JIA report significantly less activity than healthy children based on PAQ scores, with physical activity declining throughout adolescence. Physical activity is inversely related to pain interference and severity in children with JIA. Our findings suggest that physical activity interventions may play an important role in the management of pain in JIA.

Mechanical and Heat Hyperalgesia Highly Predict Clinical Pain Intensity in Patients With Chronic Musculoskeletal Pain Syndromes

Multiple abnormalities in pain processing have been reported in patients with chronic musculoskeletal pain syndromes. These changes include mechanical and thermal hyperalgesia, decreased thresholds to mechanical and thermal stimuli (allodynia), and central sensitization, all of which are fundamental to the generation of clinical pain. Therefore, we hypothesized that quantitative sensory tests may provide useful predictors of clinical pain intensity of such patients. Our previous studies of fibromyalgia (FM) patients have shown statistically significant correlations of quantitative sensory test results with clinical pain intensity, including mechanical spatial summation, number of pain areas, wind-up, and wind-up aftersensations. Although these tests predicted up to 59% of the variance in FM clinical pain intensity, their expense and technical complexities limited widespread use in clinical practice and trials. Thus, we developed practical tests of primary (mechanical) and secondary (heat) hyperalgesia that also strongly predict clinical pain intensity in patients with chronic musculoskeletal pain disorders. Thirty-six individuals with FM, 24 with local musculoskeletal pain, and 23 normal controls underwent testing of mechanical and heat hyperalgesia at the shoulders and hands. All subjects rated experimental pains using an electronic visual analog scale. Using either heat or pressure pain ratings as well as tender point counts and negative affect as predictors, up to 49.4% of the patients' variance of clinical pain intensity could be estimated. Results of this study emphasize the important contributions of peripheral and central factors to both local and widespread chronic pain. Overall, measures of mechanical and heat hyperalgesia in combination with tender point and negative affect provided powerful predictors of clinical pain intensity in chronic musculoskeletal pain patients that can be readily used in clinical practice and trials. PerspectiveSimple tests of mechanical and heat hyperalgesia can predict large proportions of the variance in clinical pain intensity of chronic musculoskeletal pain patients and thus are feasible to be included in clinical practice and clinical trials.

Predicting clinical pain in patients with chronic musculoskeletal pain syndromes

Multiple abnormalities in pain processing have been reported in patients with chronic musculoskeletal pain syndromes. These changes include mechanical and thermal hyperalgesia, decreased thresholds to mechanical and thermal stimuli (allodynia) as well as central sensitization, all of which are fundamental to the generation of clinical pain. Therefore, we hypothesized that quantitative sensory tests (QST) may provide useful predictors of clinical pain intensity of such patients. Our previous studies of fibromyalgia (FM) patients have shown statistically significant correlations of QST results with clinical pain intensity, including mechanical spatial summation, number of pain areas, windup (WU), and WU after-sensations.

Musculoskeletal Pain and Psychological Distress in Hospital Patient Care Workers

The aim of the study was to assess the association of psychological distress and musculoskeletal pain, how it is related to pain interference with work and multiple pain areas, and potential differences between the different pain areas in hospital patient care workers. Data were collected from a cross-sectional survey of patient care workers (n = 1,572) from two large hospitals. Patient care workers with musculoskeletal pain reported significantly more psychological distress than those without pain. Psychological distress was significantly related to pain interference with work, even after adjusting for pain and demographics (OR = 1.05; CI = 1.01-1.09). The association was strongest for those with both upper- and lower body pain (OR = 1.12; CI = 1.06-1.18). Psychological distress was also independently associated with multiple pain areas. Psychological distress was found to be higher in workers with musculoskeletal pain, and highest among workers with both upper and lower body pain. Distress was further significantly associated with pain interference with work as well as number of pain areas. The findings may be followed up with a longitudinal design to better determine the direction of the associations, and to investigate if psychological distress increases the risk of work disability and injuries.

地域在住高齢者の運動機能低下に関連する身体の痛み

To examine the associations among the presence, level, and the duration of pain, the number of painful areas and physical function in elderly patients. The participants in this study were 351 men and women aged 75 years orolder who were living in the community. Participants were interviewed about the presence, level, number of painful areas and duration of pain. Physical function was self-assessed using a questionnaire. The presence of pain was higher in women than men. No significant differences in the level, number of affected areas and duration of pain were observed between men and women. Physical function was significantly associated with the presence of pain (odds ratio[OR]: 1.75), presence of pain in the upper and lower extremities (OR: 5.15), pain in more than 3 areas of the body (OR: 11.56), presence of strong pain (OR: 4.65), and pain with a duration of over 5 years (OR: 3.35). It is insufficient to assess the association between physical function and pain solely by the presence of pain. These findings suggest that it is necessary to assess the association between physical function and pain by the presence and level of pain, number of painful areas and duration of pain.

Piecework, musculoskeletal pain and the impact of workplace psychosocial factors

To investigate the impact of piecework on musculoskeletal pain and general health, and the influence of perceived workplace psychosocial factors on any such associations, in a general UK population. A questionnaire was mailed to an age-stratified random sample of 10 000 adults aged 18-75 in North Staffordshire, UK. Respondents reporting a current main job were asked if this job was paid by a piecework system. Health measures were (i) number of pain areas according to a body manikin and (ii) general health (SF-12v2). Other measures included questions on occupational history and psychosocial aspects of the work environment. The adjusted response was 54%. A total of 1193 respondents reported a current main job, of whom 201 (17%) reported piecework. Pieceworkers were more likely to be older (P < 0.05), male (P < 0.001) and in lower socioeconomic groups (P < 0.001) than non-pieceworkers. Piecework was associated with perceptions of a poor psychosocial working environment, more pain areas (P < 0.05), more elbow (P < 0.01), forearm (P < 0.001) and hand pain (P < 0.05), and a lower physical health score (SF-12v2; P < 0.01), but no difference in mental health score (P = 0.60), compared with non-pieceworkers. After controlling for psychosocial factors, and socioeconomic group, the associations between piecework and pain areas, or physical health, were no longer statistically significant. These results show that piecework was associated with poorer self-reported general physical health and more areas of pain, which may be attributed to low socioeconomic group, and workplace perceptions of little job control, high physical demand and little supervisor support.

Impaired health status, sleep disorders, and pain in the craniomandibular and cervical spinal regions

This study investigated the relationship between health status (i.e., physical well-being and quality of life), sleep disorders (e.g., insomnia, sleep-related depression and anxiety), and musculoskeletal pain in the craniomandibular and cervical spinal regions. The number of painful body areas below the cervical spine (i.e., widespread pain) was also taken into account. Two questionnaires, viz., the RAND 36-item Health Survey Questionnaire and the Dutch Sleep Disorders Questionnaire (SDQ), were administered to 103 persons who could unequivocally be classified into one of four mutually exclusive groups: No pain, craniomandibular pain (CMP), cervical spinal pain (CSP), and both CMP and CSP. Body drawings were used for the self-report of widespread pain. Multivariate analysis of variance showed effects of gender, group, and widespread pain on the questionnaire scales; not of age. As shown by univariate analysis of variance, men suffered more from sleep apnea than did women. No other gender differences were found. Simple contrast analyses following univariate analyses of the group and widespread pain effects showed that, in general, more questionnaire scales, both of the RAND-36 and of the SDQ, reached statistical significance with an increase in the number of painful areas. It was concluded that both musculoskeletal pain in the trigemino-cervical area and widespread body pain are associated with an increased impairment of health status. Also, sleep disorders are frequently found in patients with chronic pain in the craniomandibular and cervical spinal regions as well as in patients with widespread pain. The more painful areas there are, the likelier it is that sleep disorders are present.

The course of non-malignant chronic pain: a 12-year follow-up of a cohort from the general population

The high prevalence of chronic pain (duration >3 months) reported from different populations indicates a public health problem. Knowledge of the long-term course of chronic non-malignant pain is incomplete and scarce. This paper describes a follow-up of a cohort recruited from a survey in the general population. The cohort ( n=214) consisted initially of individuals with widespread or located (neck–shoulder) pain or without chronic pain. The individuals were initially examined and replied to questionnaires on pain, social factors, lifestyle, medication and health care after two and 12 years. The deaths during the period were obtained from the population register. Complete data exist for 77% of the eligible individuals. After 12 years one-third of the individuals initially without pain reported chronic pain, and among those with initial chronic pain 85% still reported chronic pain. The number of painful areas was the strongest predictor of chronic pain 12 years later (OR 15.8; >3 locations vs. 0) whereas a social factor (having a close friend) decreased the risk (OR 0.44). The onset of chronic pain during the same period was related to the physical workload (work with bent positions; OR 5.31; yes vs. no). Mortality was significantly higher in the group initially reporting widespread pain compared with the other groups. The chronicity of widespread chronic pain supports early and intense intervention among individuals with located pain. The association between chronic widespread pain and increased mortality needs further investigation but may deepen the view of chronic pain as a public health problem.

Pain Location, Distribution, and Intensity After Cardiac Surgery

To study the location, distribution, and intensity of pain in a sample of adult cardiac surgery patients during their postoperative hospital stay. In a prospective study, pain location, distribution (number of pain areas per patient), and intensity (0 to 10 numerical rating scale) were documented on the first, second, third, and seventh postoperative day (POD). Patient characteristics (age, sex, size, and body mass index) were analyzed for their impact on pain intensity. A university hospital. Two hundred consecutive adult patients who underwent median sternotomy for open heart surgery. There were 121 male and 79 female patients, with a mean (+/- SD) age of 60.9 +/- 19.2 years. The maximal pain intensity was significantly higher on POD 1 and 2 (3.7 +/- 2 and 3.9 +/- 1.9, respectively) and lower on POD 3 and 7 (3.2 +/- 1.5 and 2.6 +/- 1.8, respectively). The pain distribution did not vary significantly throughout the hospital stay, but the location did, with more shoulder pain on POD 7. Only age was found to have an impact on pain intensity, with patients < 60 years having a higher pain intensity than older patients on POD 2 (4.3 +/- 2.2 vs 3.6 +/- 2.4; p = 0.02). In this patient population, the pain intensity diminished from POD 3 onward, although its distribution did not vary significantly during the first postoperative week. Moreover, pain location changed with time, with more osteoarticular type pain at the end of the first postoperative week. Among the patients' characteristics, only younger age had an impact on pain intensity, with a higher value on POD 2.

Bodily pain, sleep problems and mental distress in schoolchildren

It has been suggested that childhood pain could be the beginning of a career with chronic disabling pain. Bodily pain is frequent in children. We examined the association between self‐reported bodily pain, mental distress and sleep problems in schoolchildren to test the following hypotheses: (i) that self‐reported bodily pain is associated with mental distress and sleep problems, (ii) that the association is dependent on the localization of pain, and (iii) that the association increases with number of painful areas. Eighty‐six percent of the pupils (569) in the 4th form (mean age 10.5 y), 7th form (mean age 13.5 y) and 9th form (mean age 15.5 y) from all the schools in a local community answered a questionnaire about self‐esteem, body‐image, physical activity and bodily pain. We found a strong association between the reporting of pain, mental distress and sleep problems. Pain in the knees was the only problem reported more frequently by boys than by girls, and knee pain did not show the same association with mental distress and sleep problems as pain from other regions.Conclusions: A possible cause‐effect relationship between pain, mental distress and sleep problems is discussed, and the possibility that all the complaints are the simultaneous signs of a multisymptom syndrome is introduced.

Bodily pain, sleep problems and mental distress in schoolchildren.

It has been suggested that childhood pain could be the beginning of a career with chronic disabling pain. Bodily pain is frequent in children. We examined the association between self-reported bodily pain, mental distress and sleep problems in schoolchildren to test the following hypotheses: (i) that self-reported bodily pain is associated with mental distress and sleep problems, (ii) that the association is dependent on the localization of pain, and (iii) that the association increases with number of painful areas. Eighty-six percent of the pupils (569) in the 4th form (mean age 10.5 y), 7th form (mean age 13.5 y) and 9th form (mean age 15.5 y) from all the schools in a local community answered a questionnaire about self-esteem, body-image, physical activity and bodily pain. We found a strong association between the reporting of pain, mental distress and sleep problems. Pain in the knees was the only problem reported more frequently by boys than by girls, and knee pain did not show the same association with mental distress and sleep problems as pain from other regions. A possible cause-effect relationship between pain, mental distress and sleep problems is discussed, and the possibility that all the complaints are the simultaneous signs of a multisymptom syndrome is introduced.

Pathological mechanisms implicated in localized female trapezius myalgia.

Myalgia localized to the neck and shoulder in women is a growing problem both in the general population and in the industrial world. The aim of this study was to investigate the mechanisms involved in work-related myalgia. In 21 women (age, 38.7+/-5.5 years), muscle biopsies were obtained from the upper part of the trapezius and the morphologic and metabolic characteristics of muscle fibres were analyzed. The patients indicated the number of painful areas on a pain drawing and the intensity of pain was assessed using a visual analogue scale (VAS). Two groups were formed on the basis of the median values: lower pain level and higher pain level. Trapezius muscles were characterized by the large size of type I fibres and the low capillary to fibre area ratio for both type I and type IIA fibres. Patients with the highest pain scores had the lowest capillary to fibre area ratio for type I fibres (coefficient correlation r = -0.45 and P < 0.05). Moreover, the proportion of cytochrome c oxidase (COX)-negative fibres seen in the cross-sections was significantly higher in the group of patients which had the higher pain and more painful areas than in the group of patients with lower pain level and painful areas (P < 0.05). The significant increase (P < 0.05) of the size of the type I fibres in trapezius myalgia point to the special strain imposed upon type I muscle fibres during work tasks. Cytochrome oxidase c deficiency which is indicative of an energy crisis within muscle cells and the low capillary to fibre area ratio which might impair oxygen delivery and removal of metabolites in the working muscles are both associated with pain in the trapezius muscle.

A method for scoring the pain map of the McGill Pain Questionnaire for use in epidemiologic studies.

Identifying and quantifying the location of pain may be important for understanding specific functional impairments in elderly populations. The purpose of the present analysis was two-fold: first, to describe the reliability of a scoring method for the McGill Pain Map (MPM), and second, to validate the method of scoring the MPM as a tool for assessing areas of body pain in an epidemiologic study. In interviews performed at the subjects' homes, 411 community dwelling Mexican-American and non-Hispanic white subjects aged 65-74 from the San Antonio Longitudinal Study of Aging (SALSA) were asked to describe the location of their pain on the map of the human body included in the McGill Pain Questionnaire. The location of pain was scored by overlaying the survey figures with a MPM template divided into 36 anatomical areas. Inter- and intra-rater agreement among three raters was measured by calculating a kappa statistic for each of the body areas, and an intraclass correlation coefficient for the total number of painful areas (NPA). Internal validity was measured by Spearman's rho between the NPA and the Present Pain Index (PPI) and Pain Rating Index (PRI) of the McGill Pain Questionnaire, and external validity by correlation between NPA and the Perceived Health (PH), Amount of Bodily Pain (APB), and Pain Interference with Work (PIW) items of the Medical Outcomes Study, and the Perceived Physical Health (PPH) question of the San Antonio Heart Study. Average inter-rater agreement for individual MPM areas was 0.92 +/- 0.01, and average agreement for NPA was 0.96 +/- 0.01. Intra-rater agreement for individual areas averaged 0.94 +/- 0.01, and for NPA = 0.99 +/- 0.001. Pain in one or more areas was present in 47.7% of the subjects. For the whole sample, correlations between NPA and the validation indices were: PPI (0.91), PRI (0.89), PH (0.25), ABP (0.64), PIW (0.49), and PPH (0.20). Among the 196 subjects with pain, correlations were: PPI (0.34), PRI (0.34), PH (0.19), ABP (0.21), PIW (0.38), and PPH (0.19)-p < 0.01 for all correlations. In conclusion, we have developed a reliable method of scoring the MPM and have shown evidence of its validity in a community-based sample of elderly subjects. Patterns of painful body areas may be associated with specific diseases and functional impairments.