Prevalence Of Chronic Pain Conditions Research Articles

Move to health-a holistic approach to the management of chronic low back pain: an intervention and implementation protocol developed for a pragmatic clinical trial

BackgroundThe prevalence of chronic pain conditions is growing. Low back pain was the primary cause of disability worldwide out of 156 conditions assessed between 1990 and 2016, according to the Global Burden of Disease Study. Conventional medical approaches have failed to identify effective and long-lasting approaches for the management of chronic pain, and often fail to consider the multiple domains that influence overall health and can contribute to the pain experience. Leading international organizations that focus on pain research have stated the importance of considering these other domains within holistic and multidisciplinary frameworks for treating pain. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice.MethodsThe purpose of this manuscript is to describe an implementation protocol that is being used to deliver a complex holistic health intervention at multiple sites within a large government health system, as part of a larger multisite trial for patients with chronic low back pain. The Move to Health program developed by the US Army Medical Command was tailored for specific application to patients with low back pain and begins by providing an empirical link between eight different health domains (that include physical, emotional, social, and psychological constructs) and chronic low back pain. Through a six-step process, a health coach leverages motivational interviewing and information from a personal health inventory to guide the patient through a series of conversations about behavioral lifestyle choices. The patient chooses which domains they want to prioritize, and the health coach helps implement the plan with the use of SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goals and a series of resources for every domain, triaged from self-management to specialist referral.DiscussionComplex interventions described in clinical trials are often challenging to implement because they lack sufficient details. Implementation protocols can improve the ability to properly deliver trial interventions into regular clinical practice with increased fidelity.Trial registrationImplementation of this intervention protocol was developed for a clinical trial that was registered a priori (clinicaltrials.gov #NCT04172038).

Cannabinoids, Pain, and Opioid Use Reduction: The Importance of Distilling and Disseminating Existing Data.

The high prevalence of chronic pain conditions combined with an over-reliance on opioid prescriptions has resulted in an opioid epidemic and a desperate need for solutions. There is some debate about whether cannabis might play a role in addressing chronic pain conditions as well as the opioid epidemic. Recent surveys suggest that a large number of people are using cannabis as a treatment for pain and to reduce use of opioids, and cannabis-derived products demonstrate at least modest efficacy in the treatment of pain in randomized controlled trials. In addition, surveillance studies from countries that have approved the use of Sativex, which is a cannabis-based product, have demonstrated that a combination of Δ9-tetrahydrocannabinol and cannabidiol has low potential for harm, is well tolerated, and is helpful to patients. Given the number of people in the United States who are already using cannabis to manage pain and opioid use in state-regulated markets, it is imperative to conduct additional research in these areas, and to disseminate information on how to minimize harm and maximize any benefits of using cannabinoids to mitigate pain and reduce opioid use. The purpose of this article is to call attention to the fact that cannabis is being used in the management of chronic pain. Thus, this article also provides a set of guidelines on how to approach using cannabis to treat pain.

Chronic pulmonary disease is associated with pain spreading and restless legs syndrome in middle-aged women\u2014a population-based study

IntroductionRecent studies suggest an increased prevalence of chronic pain conditions and restless legs syndrome (RLS) in patients with chronic pulmonary disease (CPD). We analyzed the prevalence and risk factors for pain and RLS in a population-based sample of females with comorbid CPD.MethodQuestionnaire-based data from 2745 women aged 18–64 years were analyzed regarding comorbid CPD status (severe bronchitis, emphysema, asthma). Pain status was assessed according to symptoms reflecting severity (Visual Analogue Scale, VAS rating 0–10) and duration and spreading (limited spread or widespread) of pain. A diagnosis of RLS was defined by four validated diagnostic criteria. Anthropometrics and co-morbidities were assessed as covariates in univariate and multivariate analyses.ResultsWidespread pain was overrepresented in women with CPD (44.6 vs. 24.6%, p < 0.001). The odds ratio for widespread pain in women with CPD was 1.6 (95% confidence interval (CI) 1.2–2.2, p < 0.001) in the fully adjusted model. Severe pain (VAS rating ≥ 7) was more prevalent in females with known CPD (28.8 vs. 15.4%, p < 0.001, odd ratio 1.4 (95% CI 1.0–1.9, p = 0.029)). The prevalence of RLS was 37.4 and 23.8% in subjects with or without CPD, respectively (p < 0.001). In multivariate analysis, CPD was associated with a 30% risk increase for RLS (odds ratio 1.3 (95% CI 1.0–1.7, p = 0.04)).ConclusionThis population-based study identified CPD as an independent risk factor for severe and widespread pain as well as for RLS. Further research addressing pathophysiological mechanisms linking CPD and chronic pain conditions/RLS is warranted.

Pain sensitivity and cardiovascular reactivity to the experimental induced cold pressor pain during different phases of menstrual cycle in young Indian females

Background: Many previous research studies have shown a higher prevalence of chronic pain conditions as well as more pain sensitivity or lesser pain thresholds (PTh) among women as compared to men. It might be related to the effect of female reproductive hormones, as these hormones produce its effect on various aspects of physiological systems. Aims and Objectives: The aim of this study is to find the differences in the pain responses as well as cardiovascular reactivity during cold pressor test in different phases of menstrual cycle. Materials and Methods: Following physical parameters were measured in 75 apparently healthy young Indian females during the three phases of menstrual cycle and utilized for data analysis: Response to cold-induced experimental pain in the form of PTh, pain tolerance (PTo), pain rating on visual analogous scale, pulse reactivity (PRe), systolic blood pressure reactivity (SBPRe), and diastolic BPRe (DBPRe). Results: Mean PRe was significantly higher during luteal phase as compared to menstrual as well as follicular phase. Mean SBPRe and mean DBPRe were found to be significant higher during luteal phase as compared to the menstrual and follicular phase. Mean PTh and mean PTo were significantly higher during follicular phase as compared to menstrual as well as luteal phase. Conclusion: This is concluded from above findings that the pain responses vary across the menstrual cycle as shown by higher PTh and tolerance during follicular phase of menstrual cycle. The cardiovascular reactivity to cold pressor pain also varies. The hormonal fluctuation and the differences in the physiological responses, mainly autonomic nervous system reactivity due to these fluctuations, would be the underlying mechanism for these findings.

Military Sexual Trauma in Female Veterans is Associated With Chronic Pain Conditions.

Little is known about the impact of MST on chronic pain conditions among female Veterans. The primary objective of this study was to compare the prevalence of chronic pain conditions among U.S. female veterans with a history of military sexual trauma (MST) to those without a history of MST. We anticipated that female Veterans with a history of MST would have higher associations with chronic pain conditions than the female Veterans without a history of MST. This was a large-scale, retrospective study using the Veterans' Health Administration Corporate Data Warehouse with institutional approval (15-H175). International Classification of Diseases, 9th Revision codes from the outpatient visits, outpatient problem lists, and inpatient discharge diagnoses were used to identify chronic pain diagnoses. Baseline demographic data including date of birth, self-identified race/ethnicity, and body mass index were obtained. Significant findings in the univariate analysis were then placed into a multivariable logistic regression model to adjust the effect of each predictor for the presence of others. Significance was set at p < 0.01 because of multiple comparisons made. For the entire cohort (516,950 women), 28.9% (149,540) were diagnosed with headaches, 18.3% (94,393) with chronic pelvic pain, 14.4% (74,216) with chronic back pain, 10.5% (54,302) with nonspecific joint pain, 9% (48,509) with fibromyalgia, 6.2% (32,037) with generalized abdominal pain, 4.2% (21,911) with irritable bowel syndrome, and 3.2% (16,309) with dyspareunia. Most women had more than one chronic pain diagnosis. At baseline, women with a history of MST were younger (63.3 ± 15.9 vs. 67.4 ± 17.9 years p < 0.001), heavier (29.5± 6.2 vs. 28.8 ± 6.1 kg/m2 p < 0.001), smokers (49.3 vs. 38.8% p < 0.001), and more likely to be non-Hispanic white (56.3 vs. 52.3% p < 0.001) than women without a history of MST. Women with a history of MST had more pain diagnoses than those without the history of MST (all p < 0.001). The adjusted odds ratio of women with history of MST presenting with any pain condition compared to a women without a history of MST was 1.26 (95% confidence interval 1.24-1.28). In the multivariable model there remained an association between MST and chronic pain conditions including irritable bowel syndrome, chronic pelvic pain, back pain, chronic joint pain, fibromyalgia, dyspareunia, chronic abdominal pain, and headaches after adjusting for baseline differences in age, body mass index, smoking, and ethnicity. Importantly, drug abuse, and overdose were also associated with MST. A history of MST is associated with chronic pain diagnoses. Weaknesses of this study are those applicable to analyses of any retrospective database study. Specifically, the data are limited by the accuracy of physician coding and reporting. The strength of this study is that it represents a comprehensive, retrospective evaluation of potential sources for chronic pain within the female veteran population. In summary, we found that female veteran survivors of MST face an increased burden of chronic pain, including a broad range of pain conditions independent of the psychological effects of MST.

Individual differences in pain: understanding the mosaic that makes pain personal.

The experience of pain is characterized by tremendous inter-individual variability. Multiple biological and psychosocial variables contribute to these individual differences in pain, including demographic variables, genetic factors, and psychosocial processes. For example, sex, age and ethnic group differences in the prevalence of chronic pain conditions have been widely reported. Moreover, these demographic factors have been associated with responses to experimentally-induced pain. Similarly, both genetic and psychosocial factors contribute to clinical and experimental pain responses. Importantly, these different biopsychosocial influences interact with each other in complex ways to sculpt the experience of pain. Some genetic associations with pain have been found to vary across sex and ethnic group. Moreover, genetic factors also interact with psychosocial factors, including stress and pain catastrophizing, to influence pain. The individual and combined influences of these biological and psychosocial variables results in a unique mosaic of factors that contributes pain in each individual. Understanding these mosaics is critically important in order to provide optimal pain treatment, and future research to further elucidate the nature of these biopsychosocial interactions is needed in order to provide more informed and personalized pain care.

Prevalence of Chronic Pain in a Large Integrated Healthcare Delivery System in the U.S.A.

There is a paucity of published data on the prevalence of chronic pain conditions within large, integrated healthcare organizations in the U.S.A. Such data are essential to inform the development of appropriate treatment programs. Twenty-five selected pain conditions were used to identify patients receiving care within the Henry Ford Health System (HFHS) who were enrolled in the Health Alliance Plan (HAP), a subsidiary of HFHS. Patients aged ≥18years, enrolled in HAP in 2010, and having ≥2 encounters, ≥30days apart, with an ICD-9-CM diagnosis code for a pain condition of interest during 2010 were counted. Variables included in the study were as follows: age, gender, body mass index (BMI), and Charlson comorbidity conditions and index score. Altogether, 14,784 persons (11.6% of the total adult population) met the criteria for having a chronic pain condition. Overall, the study population was 64.4% female and had mean age (SD) of 61.2 (15.6) years and mean BMI of 31.4 (7.2) kg/m(2) . Musculoskeletal pain conditions were the most common diagnoses, comprising 75.4% of all pain diagnoses. Diabetes and chronic pulmonary disease were the most common medical comorbidities. In this comprehensive analysis of 2years of data from a large, vertically integrated metropolitan health system, chronic pain was identified in 12% of adult patients. Approximately 75% of chronic pain conditions were musculoskeletal. The triad of age ≥60years, BMI≥30, and female sex were the most salient demographic characteristics of patients with chronic pain conditions. These diagnostic and demographic data may be used to inform treatment program development.

Sex differences in cerebellar mechanisms involved in pain-related safety learning

Recent studies have suggested that the cerebellum contributes to the central processing of pain, including pain-related learning and memory processes. As a complex experience with multiple emotional and cognitive facets, the response to pain and its underlying neural correlates differ between men and women. However, it remains poorly understood whether and to what extent sex differences exist in the cerebellar contribution to pain-related associative learning processes. In the present conditioning study with experimental abdominal pain as unconditioned stimuli (US), we assessed sex-dependent differences in behavioral and neural responses to conditioned warning and safety cues in healthy volunteers. The results revealed that in response to visual stimuli signaling safety from abdominal pain (CS−), women showed enhanced cerebellar activation in lobules I–IV, V, VI, VIIIa, IX and X as well as Crus II and the dentate nucleus, which are mostly representative of somatomotor networks. On the other hand, men showed enhanced neural activation in lobules I–IV, VI, VIIb, VIIIb, IX as well as Crus I and II in response to CS−, which are representative of frontoparietal and ventral attention networks. No sex differences were observed in response to pain-predictive warning signals (CS+). Similarly, men and women did not differ in behavioral measures of conditioning, including conditioned changes in CS valence and contingency awareness. Together, we could demonstrate that the cerebellum is involved in associative learning processes of conditioned anticipatory safety from pain and mediates sex differences in the underlying neural processes. Given the high prevalence of chronic pain conditions in women, these results may contribute to improve our understanding of the acquisition and manifestation of chronic abdominal pain syndromes.

Sex-related differences in acute and chronic pain: a bench to bedside perspective

Chronic pain affects the daily lives of millions. It has been estimated that nearly one-quarter of the world’s population suffers from chronic pain, making it the most common human health problem. The most recent estimates of the prevalence of chronic pain in Canada indicate that approximately 29% of the population experiences chronic pain, with nearly 80% of these people reporting their pain as moderate to severe. Interestingly, there is increased pain sensitivity and a higher prevalence of chronic pain conditions in females than in males. To date, however, there has been little basic research examining these sex differences from a mechanistic standpoint, with researchers either doubting or simply ignoring the evidence. Nevertheless, numerous studies and a recent review of the literature provide convincing evidence that there are indeed sex differences relating to chronic and acute pain. Sex differences have been examined in many areas of biological research, particularly in the field of molecular neuroscience. Numerous studies have shown somatic and hormonal sex differences at a molecular level, and these molecular differences between sexes are often reflected by differences in the outcome and progression of disease. This can been seen in Alzheimer’s disease, depression, Huntington’s disease, and cerebral ischemia, as well as in models of cognitive ability. Despite the well-described sex differences in pain and in other disease models, basic pain research has been slow to adopt systematic study of these differences. Common barriers to the study of sex differences in the basic mechanisms of pain include doubt for the need to study sex differences (an impact by conflicting studies devaluing the importance of sex studies), possible complications from different hormonal influences on behaviour, and the complexity of trying to determine the interacting roles of sex, pain, and the secondary factors associated with pain (e.g., depression). Dr. Jeffery Mogil of McGill University addressed these concerns in a recent review of both clinical and basic studies examining sex differences. Dr. Mogil presents strong evidence that there is indeed a prevalence of bias in pain towards females. Although not all studies found a statistically significant difference between the sexes, when examining the overall trends present in the data, the results overwhelmingly indicate that females suffer more than men from chronic pain disorders (e.g., back pain, migraine, osteoarthritis, widespread pain, and musculoskeletal, oral, and neuropathic pain). Also, trends in basic pain sensitivity in healthy human subjects have shown that females experience increased sensitivity to electrical stimulation, ischemic pain, cold and heat pain, pressure pain, and muscle pain. These findings are in contrast with a review of 122 studies examining sex differences in laboratory pain sensitivity where the results showed no overall sex differences . Dr. Mogil points out, however, that, upon closer examination of the review, it can be argued that rather stringent inclusion criteria were used to indicate a K. A. Mifflin, BSc B. J. Kerr, PhD Centre for Neuroscience, University of Alberta, Edmonton, AB, Canada

Functional limitations and physical symptoms of individuals with chronic pain

Objectives: Chronic pain is a debilitating condition that may cause additional symptoms affecting the sufferers’ working capacity and quality of life. Studying the prevalence and consequences of chronic pain in various populations remains important for a complete picture of the global burden imposed by chronic pain conditions.Methods: We investigated the prevalence of self-reported chronic pain conditions in Iceland in addition to symptoms and functional limitations within the group, using a population-based random sample. A questionnaire was mailed to 9807 Icelanders aged 18–79 years and, of these, 5906 participated in the study. Chronic pain was considered manifest in people reporting chronic low back pain, chronic neck symptoms, and/or fibromyalgia. Prevalence calculations were weighted with respect to gender, age, and residential area to represent the underlying population. Associations of chronic pain conditions with symptoms and functional limitations were measured with adjusted logistic regression models, contrasting symptoms in individuals reporting any of the three pain conditions with those who did not.Results: The population-estimated prevalence of chronic pain condition was 19.9% with distinct gender differences (men = 15.2%, women = 24.7%). Several symptoms and functional limitations in daily life were strongly associated with chronic pain, including deficient energy and muscular discomfort, physical mobility limitations, lifting groceries, climbing stairs, and stooping. Women, but not men, with chronic pain tended to refrain from physical activity.Conclusions: Chronic pain is a prevalent condition and those who report chronic pain generally suffer from ill health and limitations in their daily life compared to individuals not suffering from the condition.

Pharmacoeconomic Impact of Adverse Events of Long-Term Opioid Treatment for the Management of Persistent Pain

Opioids are the most powerful analgesic drugs currently available and consequently form an essential part of the treatment options for malignant and non-malignant chronic pain. However, the benefits of these medications can be offset by gastrointestinal adverse events such as nausea, vomiting and constipation, as well as adverse events affecting the CNS. These occur relatively frequently in patients receiving long-term opioids for pain relief and are a cause of additional patient suffering and reduced work and social functioning, measured as reductions in quality-of-life outcomes. Consequently, adverse events are often the cause of treatment non-compliance or discontinuation (non-persistence). A literature search was conducted using BIOSIS Previews, EMBASE, Cochrane Collaboration and MEDLINE databases to identify references with specific relevance to the measurement of health outcomes related to adverse events of long-term opioid treatment of chronic pain. The results of this search highlighted that clinical interventions required to manage adverse events associated with opioids, and to provide alternative methods of pain control, both incur direct costs. These are largely driven by the cost of medical consults and drug supplies. Indirect costs are generated from work absences and reduced social functioning. Estimated preference ratings, providing an insight into the trade-off between effective pain control and adverse events, have shown that utility decrements associated with an increase in adverse-event severity were similar in size to those caused by a shift from well controlled to poorly controlled pain. Given the rising prevalence of chronic pain conditions (affecting one in five adult Europeans), the direct and indirect costs incurred from the management of adverse events with long-term opioids are likely to be multiplied, contributing to the socioeconomic burden of chronic pain. For this reason, the adverse-event profile of opioid-based analgesics should be improved to achieve more efficient long-term pain control.

Common Chronic Pain Conditions in Developed and Developing Countries: Gender and Age Differences and Comorbidity With Depression-Anxiety Disorders

Although there is a growing body of research concerning the prevalence and correlates of chronic pain conditions and their association with mental disorders, cross-national research on age and gender differences is limited. The present study reports the prevalence by age and gender of common chronic pain conditions (headache, back or neck pain, arthritis or joint pain, and other chronic pain) in 10 developed and 7 developing countries and their association with the spectrum of both depressive and anxiety disorders. It draws on data from 18 general adult population surveys using a common survey questionnaire (N = 42,249). Results show that age-standardized prevalence of chronic pain conditions in the previous 12 months was 37.3% in developed countries and 41.1% in developing countries, with back pain and headache being somewhat more common in developing than developed countries. After controlling for comorbid chronic physical diseases, several findings were consistent across developing and developed countries. There was a higher prevalence of chronic pain conditions among females and older persons; and chronic pain was similarly associated with depression-anxiety spectrum disorders in developed and developing countries. However, the large majority of persons reporting chronic pain did not meet criteria for depression or anxiety disorder. We conclude that common pain conditions affect a large percentage of persons in both developed and developing countries. Chronic pain conditions are common in both developed and developing countries. Overall, the prevalence of pain is greater among females and among older persons. Although most persons reporting pain do not meet criteria for a depressive or anxiety disorder, depression/anxiety spectrum disorders are associated with pain in both developed and developing countries.