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Pain Medicine (Malden, Mass.) Mar 2019Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of...
OBJECTIVE
Thirty percent of adults with fibromyalgia receive an opioid, but the prevalence of opioid prescribing in pediatric chronic musculoskeletal pain is unknown. The aims of this study were to determine the prevalence of and factors associated with opioid exposure and polypharmacy among children with chronic musculoskeletal pain.
METHODS
In this retrospective cohort study using health care claims data from 2000 to 2013, the index date was the first ICD-9 code 729.1. Included subjects were ≥ 2 and < 18 years old at the index date with two or more codes within 12 months and 18 months of continuous enrollment. Subjects with burns, sickle cell disease, or malignancy were excluded. Opioid exposure was defined as one or more prescriptions within six months before or any time after the index date. Polypharmacy was considered minor (2-4 medications) or major (≥5 medications).
RESULTS
Of 25,321 included subjects, 20% received an opioid and 26% experienced minor polypharmacy. Opioid exposure was associated with female sex (odds ratio [OR] = 1.27, P < 0.01), Caucasian race (OR = 1.27, P < 0.01), hospitalization (OR = 1.20, P < 0.01), and visit with anesthesiology (OR = 1.97, P < 0.01) or orthopedics (OR = 1.09, P < 0.05). Mental health codes were associated with decreased odds of opioid exposure (all P < 0.05). Children seen by a chiropractor or physiatrist had a reduced odds of receipt of an opioid (OR = 0.42 and 0.84, respectively, both P < 0.01).
CONCLUSIONS
Twenty percent of children with chronic musculoskeletal pain received an opioid. Twenty-six percent experienced polypharmacy, with the majority receiving 2-4 medications. Increased availability of psychological and nonpharmacologic services are potential strategies to reduce opioid exposure.
Topics: Adolescent; Analgesics, Opioid; Child; Chronic Pain; Cohort Studies; Comorbidity; Female; Humans; Male; Musculoskeletal Pain; Neurodevelopmental Disorders; Pain Management; Polypharmacy; Practice Patterns, Physicians'; Retrospective Studies
PubMed: 29905842
DOI: 10.1093/pm/pny116 -
American Journal of Physical Medicine &... Mar 2022Obtaining a diagnosis is an essential and integral part of physical and rehabilitation medicine in practice and research. Standardized psychometric properties are...
Obtaining a diagnosis is an essential and integral part of physical and rehabilitation medicine in practice and research. Standardized psychometric properties are required of any classifications, diagnostic criteria, and diagnostic rules used. Physicians and researchers, in physical and rehabilitation medicine, need to understand these properties to determine the accuracy and consistency of their diagnosis. Although chronic musculoskeletal pain disorders are among the highly prevalent disorders seen in physical and rehabilitation medicine, limitations regarding existing diagnostic criteria for chronic musculoskeletal pain disorders still exist. Hence, the quest for developing diagnostic tools for chronic musculoskeletal pain that align with the standard properties remains open. These are discussed with an example for existing diagnostic criteria for fibromyalgia. This article primarily aimed to provide an overview of standard psychometric properties. A secondary aim was to critically appraise the tools currently used to diagnose chronic musculoskeletal pain disorders. The challenges and limitations of existing diagnostic tools are discussed. Potential approaches on how to improve the conceptualization of the construct of musculoskeletal pain disorders are also discussed. Adopting a network perspective, for example, can better constitute the disease instead of a single known underlying etiology for persistent or recurrent pain symptoms.
Topics: Chronic Disease; Chronic Pain; Fibromyalgia; Humans; Musculoskeletal Pain; Physical Examination; Physical and Rehabilitation Medicine; Psychometrics
PubMed: 33901044
DOI: 10.1097/PHM.0000000000001768 -
BMC Pediatrics Jul 2022Lifestyle behaviour in children and adolescents has become increasingly sedentary and occupied with digital work. Concurrently, there has been an increase in the...
BACKGROUND
Lifestyle behaviour in children and adolescents has become increasingly sedentary and occupied with digital work. Concurrently, there has been an increase in the prevalence of headache, neck- and low back pain, which are leading causes of disability globally. Extensive near work and use of digital devices are demanding for both the visual system and the upper body head-stabilizing musculature. Uncorrected vision problems are present in up to 40% of Nordic school children, and a lack of corrective eye wear may cause eyestrain, musculoskeletal pain and headache. The aim of this study was to investigate associations between laboured reading, musculoskeletal pain, uncorrected vision, and lifestyle behaviours in children and adolescents.
METHODS
This was a cross-sectional study with a total of 192 Norwegian school children aged 10-11 and 15-16 years. As a part of a school vision testing program, the children completed an online questionnaire about general and ocular health, socioeconomic status, academic ambition, near work and related symptoms, upper body musculoskeletal pain, and physical and outdoor activities.
RESULTS
The 15-16-year-olds had a more indoor, sedentary, digital-based lifestyle with higher academic demands, compared with the 10-11-year-olds. Concurrently, reading became more laboured and upper body musculoskeletal pain increased with age. Girls reported more symptoms, higher academic ambitions, and more time spent on schoolwork and reading, compared with boys. Non-compliance in wearing prescribed eye wear (glasses or contact lenses), increased use of near digital devices, and experiencing visual stress (glare) were positively associated with laboured reading and upper body musculoskeletal pain.
CONCLUSIONS
A screen-based lifestyle with high academic demands challenges the ability to sustain long hours of static, intensive near work. Extensive near work tires the visual system and upper body musculature and provokes laboured reading and musculoskeletal pain symptoms. This study emphasizes the importance of regular eye examinations in school children, and the need to raise awareness among children, parents, and school- and health personnel about the importance of optimal vision and visual environment for academic performance and health.
Topics: Adolescent; Child; Cross-Sectional Studies; Female; Headache; Humans; Life Style; Male; Musculoskeletal Pain; Reading
PubMed: 35831809
DOI: 10.1186/s12887-022-03465-1 -
Prosthetics and Orthotics International Dec 2021Musculoskeletal pain (MSP) is a substantial societal and personal burden resulting in loss of employment and reduced productivity. Prosthetics and orthotics...
BACKGROUND
Musculoskeletal pain (MSP) is a substantial societal and personal burden resulting in loss of employment and reduced productivity. Prosthetics and orthotics professionals working in Australia have previously reported a high prevalence of MSP; however, little is known about the prosthetic and orthotic communities in other countries.
OBJECTIVES
To explore the prevalence and range of workplace exposures associated with MSP in a convenience sample of the international prosthetic and orthotic profession.
STUDY DESIGN
A cross-sectional study using a convenience sample was conducted with prosthetists and orthotists worldwide.
METHODS
Prosthetists and orthotists were invited to participate in a survey to explore work-related factors associated with MSP. Bivariate and regression modelling was used to examine associations between self-reported demographic and workplace characteristics including job satisfaction, work-life balance, and physical and psychosocial hazards.
RESULTS
Seventy-six percent of respondents (n = 173) reported MSP in the previous 6 months. However, MSP was associated with different factors in Australia compared with other countries. Among Australia-based prosthetists and orthotists, MSP was associated with sex, physical hazards, and psychosocial hazards. For the international sample, MSP was only associated with length of employment.
CONCLUSIONS
Three-quarters of all respondents reported having MSP. Differences in associations between MSP and other factors by respondents' geographical location suggest the need for context-specific identification of hazards to enable the development of targeted and contextually appropriate prevention strategies.
Topics: Allied Health Personnel; Cross-Sectional Studies; Humans; Musculoskeletal Pain; Occupational Diseases; Workplace
PubMed: 34759257
DOI: 10.1097/PXR.0000000000000051 -
Physical Medicine and Rehabilitation... Aug 2014Upper extremity pain in persons with spinal cord injury is a common cause of morbidity. Ultrasound of nerve, muscle, and tendon has the potential to become a valuable... (Review)
Review
Upper extremity pain in persons with spinal cord injury is a common cause of morbidity. Ultrasound of nerve, muscle, and tendon has the potential to become a valuable modality in assessing this population, and has the advantage of reduced health care costs, portability, and use in populations that cannot tolerate MRI. It has the potential to detect issues before the onset of significant morbidity, and preserve patient independence. Upper extremity ultrasound already has many studies showing its utility in diagnosis, and newer techniques have the potential to enhance its use in the diagnosis and management of musculoskeletal conditions.
Topics: Elasticity Imaging Techniques; Humans; Musculoskeletal Pain; Peripheral Nerves; Spinal Cord Injuries; Tendons; Upper Extremity
PubMed: 25064787
DOI: 10.1016/j.pmr.2014.04.009 -
Physical Therapy May 2018There has been growing interest in psychologically oriented pain management over the past 3 to 4 decades, including a 2011 description of psychologically informed... (Review)
Review
There has been growing interest in psychologically oriented pain management over the past 3 to 4 decades, including a 2011 description of psychologically informed practice (PIP) for low back pain. PIP requires a broader focus than traditional biomechanical and pathology-based approaches that have been traditionally used to manage musculoskeletal pain. A major focus of PIP is addressing the behavioral aspects of pain (ie, peoples' responses to pain) by identifying individual expectations, beliefs, and feelings as prognostic factors for clinical and occupational outcomes indicating progression to chronicity. Since 2011, the interest in PIP seems to be growing, as evidenced by its use in large trials, inclusion in scientific conferences, increasing evidence base, and expansion to other musculoskeletal pain conditions. Primary care physicians and physical therapists have delivered PIP as part of a stratified care approach involving screening and targeting of treatment for people at high risk for continued pain-associated disability. Furthermore, PIP is consistent with recent national priorities emphasizing nonpharmacological pain management options. In this perspective, PIP techniques that range in complexity are described, considerations for implementation in clinical practice are offered, and future directions that will advance the understanding of PIP are outlined.
Topics: Disability Evaluation; Humans; Musculoskeletal Pain; Pain Management; Pain Measurement; Physical Therapy Modalities; Psychophysiology; Psychotherapy; Risk Assessment
PubMed: 29669084
DOI: 10.1093/ptj/pzy024 -
JAMA Pediatrics Mar 2017Low back pain (LBP) in children and adolescents is a common problem. The differential diagnosis of LBP in this population is broad and different from that seen in the... (Review)
Review
IMPORTANCE
Low back pain (LBP) in children and adolescents is a common problem. The differential diagnosis of LBP in this population is broad and different from that seen in the adult population. Most causes of LBP are musculoskeletal and benign in their clinical course. Clinicians should have an understanding of the relevant anatomy and the most commonly encountered etiologic factors of LBP in children and adolescents to provide effective care.
OBSERVATIONS
Low back pain is rarely seen in youth before they reach school age. Subsequently, rates of LBP rise until age 18 years, at which age the prevalence of LBP is similar to that in adults. The differential diagnosis of LBP in this population is broad, and individual etiologic factors are most often associated with musculoskeletal overuse or trauma. Sinister etiologic factors are rare. The patient's history and physical examination are the foundation of evaluating a child with LBP. The indication for and timing of specific imaging or other studies will vary depending on the etiologic factor of concern. Most treatment of LBP in this population is centered on relative rest, rehabilitation, and identification of predisposing risk factors. Pharmacologic treatment may be used but is typically a brief course. Orthopedic, rheumatologic, and other subspecialty referrals may be considered when indicated, but most of these patients can be managed by a general pediatrician with a good understanding of the principles described in this article.
CONCLUSIONS AND RELEVANCE
Low back pain in children and adolescents is a common problem. It is most often nonspecific, musculoskeletal, and self-limiting. Pediatricians should recognize the importance of a proper history, physical examination, and general knowledge of the lumbar spine and pelvic anatomy relevant to the child in their evaluation with this presenting symptom.
Topics: Adolescent; Child; Diagnosis, Differential; Female; Humans; Low Back Pain; Lumbar Vertebrae; Male; Musculoskeletal Pain; Prevalence; Risk Factors
PubMed: 28135365
DOI: 10.1001/jamapediatrics.2016.3334 -
Journal of Bodywork and Movement... Apr 2018In recent times there have been, concurrently, increasing volumes of research questioning whether biomechanics have any relevance at all to musculoskeletal medicine; and...
In recent times there have been, concurrently, increasing volumes of research questioning whether biomechanics have any relevance at all to musculoskeletal medicine; and a blossoming field of Pain Science identifying that perception of, and context for, pain is often more important than the tissues generating the pain in the first instance. From the academic world to social media, much excitement has been generated in supporting this new direction. However, most of the great work arising from the Pain Science arena is focused on pain itself and on the patients' conscious beliefs around their pain. A redirection of focus toward function beyond the pain, and awareness of how unconscious behavioral programming accounts for the majority of lifestyle habits and perceptions, may facilitate more effective outcomes. Other unconscious processes which are known to contribute to persistent pain, yet are still largely unacknowledged in musculoskeletal practice, are those involved in central sensitivity. A plethora of systemic and visceral conditions are known to contribute to central sensitivity yet are barely considered in typical clinical screening or management. The more that is understood about the complexity of these and other interacting factors in pain, the more the inadequacies of our prevailing research and clinical methodologies are exposed. The question posed is, are unconscious processes the next key field of exploration and "harvest" in musculoskeletal medicine and, if so, how can we most effectively address them?
Topics: Aging; Awareness; Behavior; Biomechanical Phenomena; Biomedical Research; Dance Therapy; Emotions; Health Status; Holistic Health; Humans; Life Style; Mental Health; Models, Theoretical; Musculoskeletal Pain; Spirituality
PubMed: 29861247
DOI: 10.1016/j.jbmt.2018.02.019 -
Journal of Clinical Rheumatology :... Sep 2021Chronic musculoskeletal pain (CMP) causes significant health loss worldwide. Given that cultural factors may affect pain processing, it is key to have more information...
OBJECTIVES
Chronic musculoskeletal pain (CMP) causes significant health loss worldwide. Given that cultural factors may affect pain processing, it is key to have more information regarding CMP epidemiology in Latin America. In this study, we aimed to determine the prevalence of CMP and chronic widespread pain (CWP) in Chile.
METHODS
This was a cross-sectional survey study. We used data recollected in the 2016-2017 Chilean National Health Survey, a nationwide household survey. Our study population included subjects older than 14 years living in urban and rural Chile. We defined CMP as nontraumatic pain with a duration of longer than 3 months. Chronic widespread pain was defined by the presence of CMP in 5 body regions. The association between CMP and CWP and potential risk factors was investigated through univariate and multivariate logistic regression models.
RESULTS
After excluding subjects with missing information our final sample constituted 4045 subjects. Chronic musculoskeletal pain was present in 21.8% (95% confidence interval, 19.6%-24.1%) and CWP in 4.2% (95% confidence interval, 3.3%-5.1%). Significant risk factors in multivariate analysis were older age, female sex, lower educational level, and depressive symptoms. Factors associated with a reduced risk of CMP were not being married and moderate alcohol consumption.
CONCLUSIONS
One of 5 Chilean people has chronic pain, and 1 of 20 has CWP. Data regarding alcohol and pain have been controversial in previous studies; therefore, this decreased risk in moderate consumers should be further explored. Chronic widespread pain shared risk factors and protective factors with CMP but with a higher magnitude of association.
Topics: Aged; Chile; Chronic Pain; Cross-Sectional Studies; Female; Health Surveys; Humans; Musculoskeletal Pain; Prevalence
PubMed: 33252393
DOI: 10.1097/RHU.0000000000001642 -
Pain Medicine (Malden, Mass.) Jun 2017Based on several previous clinical studies, we hypothesized that ornithine levels are different among subjects with persistent musculoskeletal pain compared with other...
OBJECTIVE
Based on several previous clinical studies, we hypothesized that ornithine levels are different among subjects with persistent musculoskeletal pain compared with other subjects in the population.
DESIGN
The study sample consisted of 221 adults with nonpersistent pain, 76 with persistent pain, and 61 with no pain. Concentrations of glutamic acid, ornithine, citrulline, arginine, proline, and spermidine were analyzed using a mass spectrometer.
SETTING
Lapinlahti municipality in Finland.
RESULTS
For the subjects with no pain, nonpersistent pain, and persistent pain, the ornithine concentrations for men were 85.3 µmol/L (SD = 28.9 µmol/L), 98.9 µmol/L (SD = 37.8 µmol/L), and 102.1 µmol/L (SD = 37.1 µmol/L; P = 0.033), respectively. The corresponding concentrations for women were 82.8 µmol/L (SD = 25.2 µmol/L), 83.7 µmol/L (SD = 27.8 µmol/L), and 103.2 µmol/L (SD = 34.9 µmol/L; P = 0.0031). There were no significant differences between the pain groups for any of the other investigated amino acids. Relative sex-specific ornithine concentration adjusted for age, glomerular filtration rate, smoking, body mass index, physical activity, and depressive symptoms was associated with pain ( P = 0.025), the ornithine level being higher in the persistent pain group than in the no pain ( P = 0.006) and nonpersistent pain ( P = 0.032) groups.
CONCLUSION
Ornithine levels are elevated in general population subjects with persistent pain.
Topics: Adult; Aged; Biomarkers; Cohort Studies; Cross-Sectional Studies; Female; Finland; Humans; Male; Middle Aged; Musculoskeletal Pain; Ornithine; Population Surveillance
PubMed: 28034972
DOI: 10.1093/pm/pnw285