European journal of pain : EJP
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Low back pain (LBP) is a widespread problem and the leading cause of disability worldwide. While the cause of LBP is multifactorial, several studies suggested that inflammatory mediators in damaged subchondral plates of degenerating discs may lead to chemical sensitization and mechanical stimulation, eventually causing pain. The goal of this study was to explore associations between such changes and LBP-related disability using dynamic contrast-enhanced MRI. ⋯ Our findings indicated that dynamic contrast-enhanced MRI signal enhancement in the cartilaginous endplate regions were associated with greater disability related to low back pain. This signal enhancement might be an indication of inflammatory changes in disc endplate regions. Therefore, advanced quantitative imaging techniques like the ones presented in this study might be needed to complement conventional radiological evaluations to identify the subset of patients who could potentially benefit from novel therapies directed towards treating the disc endplate regions.
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We examined developmental trajectories of multisite musculoskeletal pain in midlife, and their associations with mental well-being. ⋯ Four developmental trajectories of multisite pain in midlife were described over 10-12 years of follow-up: low (41% of the sample), increasing (24%), high (15%) and decreasing (20%). Common mental disorders strongly associated with these. Belonging to the highest tertile of mental disorders at baseline increased the risk of membership in the high trajectory more than fivefold. On the other hand, together with a decrease in mental disorders, the number of pain sites decreased to zero.
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Pain is common in older adults, and associated with increased morbidity and reduced quality of life. Recent research has highlighted different classes of older adults with pain, each with differing impacts on their life. It has not yet been investigated if, and how, such classes change over time and what influences individuals to prospectively transition to a profile of either improved or worsened pain impact. ⋯ This article identified differing classes of pain in older adults, using latent transition analysis. The analysis demonstrated how the pain classes of older adults are broadly consistent over time, however both improvement and deterioration in pain impact were observed. Transitions between classes were associated with several biopsychosocial factors. These results have important implications for the health and quality of life of older adults. Consideration of health, lifestyle and socio-demographic factors may enhance assessment and management of pain in older adults.
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Randomized Controlled Trial
Application of ICD-11 among individuals with chronic pain: A post hoc analysis of the Stanford Self-Management Program.
Chronic primary pain (CPP) is one of seven diagnostic groups within the proposed classification of chronic pain in ICD-11. Our aims were to apply the proposed ICD-11 criteria in a large cohort of chronic pain patients participating in the Chronic Pain Self-Management Program (CPSMP) and further investigate whether participants with CPP differed from participants with chronic secondary pain (CSP) regarding health, health expenditure and the effect of participating in the CPSMP. ⋯ The current study applies the proposed new classification of chronic pain in ICD-11 and shares the experiences of the diagnostic rating procedure of individuals with chronic pain. Furthermore, it evaluates the effect of the Stanford Self-Management Program.