Articles: back-pain.
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Individually unique dynamics of cortical connectivity reflect the ongoing intensity of chronic pain.
Chronic pain diseases are characterised by an ongoing and fluctuating endogenous pain, yet it remains to be elucidated how this is reflected by the dynamics of ongoing functional cortical connections. In this study, we investigated the cortical encoding of 20 patients with chronic back pain and 20 chronic migraineurs in 4 repeated fMRI sessions. A brain parcellation approach subdivided the whole brain into 408 regions. ⋯ Of interest, the group results were not mirrored by the individual patterns of pain-related connectivity, which rejects the idea of a common neuronal core problem for chronic pain diseases. The diversity of the individual cortical signatures of chronic pain encoding results adds to the understanding of chronic pain as a complex and multifaceted disease. The present findings support recent developments for more personalised medicine.
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Higher body mass and obesity are associated with bodily pain, and rates of chronic pain increase among older adults. Most past studies are cross-sectional, precluding determination of the temporal relationship between body mass and pain. A longitudinal study of body mass and pain among middle-aged adults found that higher body mass index (BMI) led to greater lower back pain. ⋯ In addition, the relationship changed with age, until approximately age 80 years, increasing joint pain contributed to higher BMI, but after that time increasing joint pain contributed to lower BMI. In addition, sex differences in the relationship between BMI and pain appeared after age 70 years. Thus, joint pain contributes to changes in BMI among middle-aged and older adults, but the relationship may change by age and sex.
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We assessed the joint effects of back pain and mental health conditions on healthcare utilization and costs in a population-based sample of adults in Ontario. We included Ontario adult respondents of the Canadian Community Health Survey between 2003 and 2012, followed up to 2018 by linking survey data to administrative databases. Joint exposures were self-reported back pain and mental health conditions (fair/poor mental health, mood, and anxiety disorder). ⋯ There was no evidence of synergism for all-cause utilization or costs. Combined effects of back pain and mental health conditions on back pain-specific utilization or opioid prescription were greater than expected, with evidence of synergism. Health services targeting back pain and mental health conditions together may provide greater improvements in outcomes.
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Low back pain is the worldwide leading cause of disability and, even though women's pain experience is more severe, frequent, and enduring, female patients are often underdiagnosed and undertreated. Health professionals' gender stereotypes and social norms may underlie the downgrading of pain. ⋯ Both sexism and gender role ideology could undermine the legitimation of low back pain, the willingness to offer support, and credibility only in female patients. The results showed a possible gender bias in low back pain assessment in health professionals. Low gender sensitivity and high sexism must be treated as modifiable risk factors for health inequities in pain care.