European Journal of Pain最新文献

{"title":"Comment on ‘A sham-controlled, randomized trial of spinal cord stimulation for the treatment of pain in chronic pancreatitis’ by Gulisano et al.","authors":"Jan Willem Kallewaard, Rui V. Duarte, Sam Eldabe, Simon Thomson","doi":"10.1002/ejp.4715","DOIUrl":"10.1002/ejp.4715","url":null,"abstract":"<p>We read with interest the sham-controlled randomized trial of spinal cord stimulation (SCS) to assess pain response in patients with chronic pancreatitis (Gulisano et al., <span>2024</span>). We are grateful to and applaud the authors' efforts who have conducted a challenging study in a population not routinely considered for SCS and for which there is scarce evidence on the use of this intervention, limited to case reports and small case series (Bieze et al., <span>2024</span>). Despite the authors' best efforts and unquestionable value of this addition to the SCS literature, we have some concerns with the study that should be highlighted.</p><p>We are unaware of any studies that evaluated high-frequency SCS (1000 Hz or other) in patients with chronic pancreatitis and as such its efficacy for this population is unknown. Besides the ability to produce paraesthesia-free stimulation and therefore enable patient blinding, we are unsure as to why this frequency was selected by the authors if no evidence of potential effect was previously available. We would also query whether stimulation at 75% subthreshold of sensation would be as effective as at the level of or above sensation threshold. A main limitation of the current evidence base of SCS and sham-controlled trials is that spinal cord fibre activation has not been evaluated; how is it possible to determine if what the patients received was actually an ‘active intervention’ if it was not confirmed whether spinal cord activation occurred (Mekhail et al., <span>2024</span>)?</p><p>We note there was no eligibility criterion for baseline pain intensity. An entry criterion of ≥4 for chronic pain clinical trials has been recommended (Langford et al., <span>2023</span>). The baseline pain score in Gulisano et al. was 5.2 ± 1.9 and while we acknowledge that patients with pain intensity levels ≥5 are considered for SCS in routine clinical practice, these baseline scores are considerably lower than previous reports in the same population (Bieze et al., <span>2024</span>) or SCS studies in a neuropathic pain population evaluated in sham-controlled trials (Duarte et al., <span>2020</span>). Despite already low pain intensity levels at baseline, patients in the study reported approximately 40% reduction in pain intensity during the open-label extension to 12-month follow-up. This reduction represents a clinically meaningful change and as the authors mention, larger than a 20% response observed during sham-controlled phases of pain therapies. Due to the limited evidence of SCS in this population, it would be of interest to understand if clinically meaningful improvements were also observed in other patient-reported outcomes measures collected (Levy et al., <span>2023</span>).</p><p>We note that after anatomical positioning and on-table testing of paraesthesia pain mapping topography, the stimulation was left ‘activated’ until the next day. Only following confirmation of adequate mapping and x-ray position wa","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.4715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vicarious facilitation of facial responses to pain: Does the others' expression need to be painful?","authors":"Peter J Göller, Philipp Reicherts, Stefan Lautenbacher, Miriam Kunz","doi":"10.1002/ejp.4709","DOIUrl":"https://doi.org/10.1002/ejp.4709","url":null,"abstract":"<p><strong>Introduction: </strong>Prior exposure to others' facial expressions of pain can lead to a facilitation of pain responses, including its corresponding response channel, namely facial responses to pain. It has been questioned, however, whether this vicarious pain facilitation occurs only when observing others' pain or whether the observation of other negative expressions can trigger similar facilitation of facial responses to pain. The study aimed to test this, by comparing the impact of viewing others' facial expressions of pain versus another negative expression (sadness) and two control expressions (neutral, happiness) on facial responses to pain.</p><p><strong>Method: </strong>Participants (N = 56; 31 females), watched short video clips of computer-generated facial expressions (pain, sadness, neutral & happiness) before they received painful and non-painful heat stimuli. Facial responses were analysed using the Facial Action Coding System. In addition, subjective and autonomic responses were assessed.</p><p><strong>Results: </strong>The prior exposure to others' expressions of pain and sadness versus neutral did not lead to significantly increased facial responses to pain. Likewise, subjective and autonomic pain responses were not facilitated. However, viewing others' expressions of happiness, consistently reduced facial as well as subjective and autonomic responses to pain compared to others' negative or neutral expressions. This dampening effect was not observed for non-painful heat.</p><p><strong>Discussion: </strong>Facial and other pain responses were most strongly affected by prior exposure to others' facial expressions of happiness, which led to a pain-dampening effect. In contrast, the evidence for vicarious facilitation of pain was rather weak in the present study, with no evidence of pain-specificity.</p><p><strong>Significance statement: </strong>Facial responses to pain - along with subjective and autonomic responses - are reduced when observing others' expressions of happiness, demonstrating pain modulation by positive affective social signals, which may also transfer to clinical contexts.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central sensitization inventory is associated with psychological functioning but not with psychophysical assessment of pain amplification.","authors":"Rafaela Stocker Salbego, Paulo César Rodrigues Conti, Flávia Fonseca Carvalho Soares, Dyna Mara Araújo Oliveira Ferreira, Matheus Herreira-Ferreira, Beatriz Amaral de Lima-Netto, Yuri Martins Costa, Leonardo Rigoldi Bonjardim","doi":"10.1002/ejp.4713","DOIUrl":"https://doi.org/10.1002/ejp.4713","url":null,"abstract":"<p><strong>Background: </strong>The central sensitization inventory (CSI) is a questionnaire that has been widely used as a tool for assessing symptoms associated with sensitization. However, its ability to identify individuals with this phenomenon has recently been questioned. The aim of this study was to assess the correlation of CSI with psychosocial and psychophysical factors in patients with painful TMD diagnosed according to diagnostic criteria for temporomandibular disorders (DC/TMD) and asymptomatic controls, as well as to determine the influence of these variables on the CSI scores variations.</p><p><strong>Methods: </strong>This cross-sectional study with 77 patients diagnosed with painful TMD according to DC/TMD and 101 asymptomatic controls realized correlations between CSI, WUR, PPT, CPM and psychosocial questionnaires (HADS, PSQI, PCS and PSS). In cases where significant correlations existed, the potential influence of these variables on CSI variation was explored through linear regression analysis.</p><p><strong>Results: </strong>It has been found that the CSI correlates with psychosocial variables (anxiety, depression, catastrophizing, sleep and stress) (p < 0.0006) regardless of the presence of TMD, and that 68.9% of the variation in CSI scores can be influenced by all these variables (except stress). On the contrary, the CSI does not correlate with psychophysical parameters indicative of pain amplification (wind-up ratio and conditioned pain modulation) (p > 0.320).</p><p><strong>Conclusion: </strong>CSI is more associated with psychosocial factors than with more robust indicators of probable central sensitization (CS), thus limiting its utility in detecting this phenomenon both in TMD patients and healthy individuals.</p><p><strong>Significance statement: </strong>The research highlights a noteworthy relationship between the central sensitization inventory and psychological factors, emphasizing their substantial influence on inventory values. This correlation offers crucial insights into mental health markers within the questionnaire. Additionally, the lack of connection with pain amplification implies a necessary re-evaluation of the inventory's diagnostic suitability, especially in cases of painful temporomandibular disorders. Thus, caution is urged in its application for identifying CS in these individuals.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical capsaicin modulates the two-point discrimination threshold-Modulation depends on stimulation modality and intensity.","authors":"Ken Steffen Frahm, Ole Kæseler Andersen, Lars Arendt-Nielsen, Sabata Gervasio, Carsten Dahl Mørch","doi":"10.1002/ejp.4701","DOIUrl":"https://doi.org/10.1002/ejp.4701","url":null,"abstract":"<p><strong>Background: </strong>Spatial acuity concerns the ability to localize and discriminate sensory input and is often tested using the two-point discrimination threshold (2PDT). Sensitization of the pain system can affect the spatial acuity, but it is unclear how 2PDTs of different testing modalities are affected. The aim was to investigate if the 2PDTs for mechanical and heat stimulation at different intensities were modulated by topical capsaicin sensitization.</p><p><strong>Methods: </strong>30 healthy subjects were divided into either a capsaicin or a placebo group. The 2PDT was tested using two different modalities, mechanical and thermal (laser) delivered at innocuous and noxious intensities. The 2PDT were determined at baseline and re-assessed 48 h later. In the follow-up session, the subjects either had a capsaicin patch (8%) or placebo patch placed in the testing area for 30 min before re-testing the 2PDT.</p><p><strong>Results: </strong>The 2PDT was highly dependent on stimulation modality and intensity. The lowest 2PDT was found for innocuous mechanical stimuli (40.0 mm, 95% CI 38.1-41.9 mm), and the highest 2PDT was found for innocuous thermal stimuli (81.7 mm, 95% CI 73.9-89.5 mm). Topical capsaicin generally increased the 2PDT, but this was only significant for innocuous mechanical stimuli. The perceived intensity of the stimuli was increased following capsaicin and was generally higher for noxious stimuli than for innocuous stimuli (ANOVA, p < 0.001).</p><p><strong>Conclusions: </strong>This study showed that capsaicin provoked pain sensitization increased the 2PDT. The 2PDT tested using innocuous mechanical stimuli showed less variable results indicating that this test is most suitable to detect this aspect of spatial acuity.</p><p><strong>Significance statement: </strong>This study investigated how the two-point discrimination threshold (2PDT) can be modulated by topical capsaicin. The 2PDT was assessed for two different modalities (thermal and mechanical) and for two different intensities (innocuous and noxious) before and after capsaicin. The results showed that the 2PDT was generally impaired following capsaicin, but this was only significant for mechanical innocuous stimuli. Furthermore, it was shown that mechanical innocuous stimuli assessed the 2PDT with lower variability than other combinations.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlates of chronic pain onset and recovery in the CoLaus cohort.","authors":"Giada Dirupo, Jean-Benoît Rossel, Nicolas Fournier, Audrey D'Andrea, Peter Vollenweider, Isabelle Decosterd, Marc René Suter, Chantal Berna","doi":"10.1002/ejp.4712","DOIUrl":"https://doi.org/10.1002/ejp.4712","url":null,"abstract":"<p><strong>Background: </strong>Only few previous cohort studies examined simultaneously predictors of chronic pain (CP) onset and recovery. Furthermore, these studies used various sociodemographic and pain-related characteristics, without standardized measures of sleep and depression. The present study aimed at expanding and strengthening these findings in a large Swiss population.</p><p><strong>Methods: </strong>We analysed data from a longitudinal cohort (n = 4602) collected at two time points separated by 5 years in Lausanne, Switzerland. We studied through two independent multivariable logistic regression models, the predictors of CP onset and recovery, including socio-demographic data as well as standardized measures of sleep and mood.</p><p><strong>Results: </strong>Chronic pain was reported by 43.1% and 44.4% of participants, with 11.6% at the second follow-up reporting moderate or intense pain. Neuropathic pain, regardless of intensity, had a more negative impact on quality of life. An inferential model (n = 1331) identified the male sex as predictive for recovering from CP. Older age, being overweight or obese (compared to normal weight), higher depression scores and pain medication intake were predictive for sustained pain at the second follow-up. A second model (n = 1886) identified being overweight or obese (compared to normal weight), low quality of sleep and being a former smoker (compared to a non-smoker) as predictive for developing CP, while the male sex was lowering the risk.</p><p><strong>Conclusions: </strong>While sex and weight are associated with both recovery and new CP onset, separate variables also need to be considered in these processes, underlining specific factors to be addressed, depending on the context, whether preventive or therapeutic.</p><p><strong>Significance statement: </strong>Multivariable models in a Swiss cohort (N = 4602) associate male sex, not taking pain medication, normal weight, lower depression scores and younger age with recovery from chronic pain, while females, obese or overweight, having worse sleep and former smokers are associated with onset of new chronic pain. These common and separate factors need to be considered in treatment and prevention efforts.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the association between patient-drawn pain diagrams and psychological and physical health variables: A large-scale study of patients with low back pain.","authors":"Steen Harsted, Natalie H S Chang, Casper Nim, James J Young, David T McNaughton, Søren O'Neill","doi":"10.1002/ejp.4711","DOIUrl":"https://doi.org/10.1002/ejp.4711","url":null,"abstract":"<p><strong>Background: </strong>Despite the use of Patient-Drawn Pain Drawings (PDPDs) in clinical settings, their validity as indicators of psychological distress remains debated. We aimed to assess the association between PDPD areas and physical health and psychological variables.</p><p><strong>Methods: </strong>This study analysed digitally-drawn PDPDs from 15,345 chronic low back pain (LBP) patients at a Danish outpatient hospital unit. We employed a novel quantitative approach to calculate four log-transformed geometric pain areas for each PDPD. We assessed six psychological constructs and seven physical health variables. Associations were modelled using multivariable linear regression.</p><p><strong>Results: </strong>Increasing leg pain intensity (estimates from 0.12 to 0.25), disability (estimates from 0.3 to 0.14), and pain duration (estimates from 0.10 to 0.33) had the strongest associations with increasing pain areas. Conversely, increasing fear of movement (estimates from -0.02 to -0.05) and catastrophizing (estimates from -0.02 to -0.03) were associated with slight reductions in pain areas. Anxiety and depression had the weakest and most uncertain relationships to pain area size.</p><p><strong>Conclusions: </strong>Increasing levels of leg pain intensity, pain duration, and pain-related disability were consistently associated with larger geometric pain areas in PDPDs. Conversely, the associations between the psychological constructs and the geometric pain areas exhibited varying directions and were notably weaker. Clinicians are encouraged to focus on the association of PDPDs with physical symptoms rather than psychological conditions during clinical assessments.</p><p><strong>Significance statement: </strong>This large-scale study demonstrates that extensive pain areas in pain drawings drawn by LBP patients do not signify psychological distress. Our findings reveal that these pain representations are more closely linked to increased pain intensity, pain duration, and disability rather than being independently associated with psychological factors. Clinicians are encouraged to focus on the association of extensive pain areas with physical symptoms rather than psychological distress during clinical assessments.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Fabry disease in patients with chronic pain: Lessons from the DOUFAB and DOUFABIS studies.","authors":"Chloé Angelini, Claire Bar, Marie Pierre Baudier, Patricia Fergelot, Gwenaëlle Lancelot, Caroline Rooryck, Dominique P Germain, Firas Jabbour, Anne-Sophie Blanchet, Alexandre Cauchie, Elisabeth Sarrazin, Rémi Bellance, Jean-Pascal Lefaucheur, Julie Bismuth, Stéphanie Ranque-Garnier, Virginie Corand, Isabelle Coupry, Cyril Goizet","doi":"10.1002/ejp.4708","DOIUrl":"https://doi.org/10.1002/ejp.4708","url":null,"abstract":"<p><strong>Background: </strong>Fabry disease (FD) is a rare X-linked lysosomal disorder caused by alpha-galactosidase deficiency consecutive to a pathogenic variant in the GLA gene. Age at onset is highly variable, with a wide clinical spectrum including frequent renal, cardiac, skin and nervous system manifestations. Since pain can be an indicator of underlying FD, we wanted to estimate the prevalence of FD in a population of chronic pain patients.</p><p><strong>Methods: </strong>Two studies, DOUFAB and DOUFABIS, were carried out in expert centers for chronic pain to assess the prevalence of FD by measuring alpha galactosidase A activity in men and analysing the GLA gene in women.</p><p><strong>Results: </strong>Analysis of 893 patients, essentially adults, led to the diagnosis of FD in one female patient, now treated with enzyme replacement therapy.</p><p><strong>Conclusions: </strong>The prevalence of FD is estimated about 1/1000 in our population of men and women suffering from various chronic pain. This is nearly the prevalence of FD observed in other previously screened high-risk populations with renal failure.</p><p><strong>Significance: </strong>Although a systematic search for FD does not seem relevant in the context of unexplained chronic pain in adults, a positive family history of FD or the presence of additional FD related organ features must lead to consider this rare disease diagnosis. Therefore, pain specialists need to be aware of main features of FD, including pain characteristics.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The measurement of \"high-impact chronic pain\": Limitations and alternative methods.","authors":"Daniel L Riddle, Levent Dumenci","doi":"10.1002/ejp.4710","DOIUrl":"https://doi.org/10.1002/ejp.4710","url":null,"abstract":"<p><strong>Objective: </strong>Chronic pain is known to be an important construct in clinical practice and a particular form of chronic pain, high-impact chronic pain (HICP), has gained recent interest and attention by pain clinicians, epidemiologists, and clinical researchers. The purpose of our Topical Review is to describe the historical development of measures of HICP and to explore the psychometric properties of HICP as well as to present alternative measurement methods.</p><p><strong>Methods: </strong>We identified strengths and weaknesses of the psychometric characteristics of HICP measures. Limitations of existing HICP measures were discussed and summarized and alternatives to current methods were proposed.</p><p><strong>Results: </strong>HICP operational definitions show variability across studies. All definitions cannot be correct, but which ones are incorrect cannot be determined as there is no gold standard. Random measurement error and recall bias are among the other limitations of current HICP measures. Model-based definitions of HICP, the discrete (for epidemiologic applications) and continuous (for clinical applications) latent variable models are discussed as likely superior alternatives to current methods.</p><p><strong>Conclusions: </strong>Limitations of existing HICP methods are discussed and alternative development approaches to HICP measures are presented. The use of either discrete or continuous latent variable models would improve upon the psychometric characteristics of current HICP evidence. Examples are used to illustrate the benefits of latent variable models over traditional observed variable conceptualizations as the measurement of HICP continues to develop.</p><p><strong>Significance statement: </strong>This work takes the position that current methods of measuring high impact chronic pain (HICP) likely contain substantial error. We have endorsed an alternative approach for several psychometrically grounded reasons. We recommend that future work consider the discrete latent variable framework for dichotomous measures of HICP and the continuous latent variable framework for continuous measures of HICP. The paper provides illustrative examples of these methods for a different patient reported measure that is lacking a gold standard, much like HICP measures.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of opioid use among patients with low back pain: Association to work absence.","authors":"Johan Liseth Hansen, Knut Reidar Wangen","doi":"10.1002/ejp.4706","DOIUrl":"https://doi.org/10.1002/ejp.4706","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is a leading reason for opioid use and a closer examination of opioid use and productivity losses among these patients is needed. We identify opioid use trajectories using a group-based trajectory model (GBTM) and estimate productivity losses across the trajectories.</p><p><strong>Methods: </strong>Patients diagnosed with LBP in Swedish specialty care between 2011 and 2015, between the ages of 20 and 60, were included. Two GBTMs were estimated on monthly opioid use (converted to oral morphine equivalents) during the two 12-month periods preceding and following diagnosis. Productivity losses were estimated using the human-capital approach.</p><p><strong>Results: </strong>In total, 147,035 patients were included. The mean age at diagnosis was 43 years of age and 49% of the patients were male. A qualitative assessment of the identified groups in the GBTM models was made based on the patterns of opioid use. We chose three pre-diagnosis groups characterized as 'Pre-low' (N = 109,492), 'Pre-increase' (N = 27,336) and 'Pre-high' (N = 10,207). Similarly, four post-diagnosis groups were chosen and characterized as 'Post-low' (N = 73,287), 'Post-decrease' (N = 39,446), 'Post-moderate' (N = 20,001) and 'Post-high' (N = 13,595). Only 50% of the patients in the 'Pre-high' group were in the 'Post-high' group. The total productivity losses by the pre-diagnosis groups were more than 2.7 billion Euros over the total 6-year study period.</p><p><strong>Conclusion: </strong>This study highlights how patients with LBP and high use of opioids are highly correlated before and after diagnosis. Patients with high use of opioids also exhibit high work absence and productivity losses.</p><p><strong>Significance statement: </strong>This was the first study to estimate trajectories of opioids in the two time periods before and after a diagnosis of low back pain. For the first time, productivity losses were also estimated across the identified opioid use trajectories.</p>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporomandibular disorder pain is associated with increased sick leave and reduced health related quality of life","authors":"S. Vallin, P. Liv, B. Häggman‐Henrikson, C. M. Visscher, F. Lobbezoo, A. Lövgren","doi":"10.1002/ejp.2314","DOIUrl":"https://doi.org/10.1002/ejp.2314","url":null,"abstract":"BackgroundTemporomandibular disorders (TMD) are the most common reason for chronic pain in the orofacial area and significantly impact the lives of those affected. The role of lifestyle factors in TMD, however, remains less explored. This cohort study aims to estimate TMD prevalence by addressing potential selection biases and to evaluate the association between TMD and lifestyle factors with a specific focus on sick leave and health related quality of life.MethodsBy linking data on TMD in the general population in Västerbotten, northern Sweden (<jats:italic>n</jats:italic> = 180,000) to health survey data (<jats:italic>n</jats:italic> = 120,000), information on sociodemographic factors and quality of life was available for 52,961 individuals (50.6% women) with a mean age of 53 years. We applied inverse probability weighting to adjust for selection bias and Poisson regression to explore associations with TMD.ResultsTMD prevalence was 9.2% during the study period, being higher in women (12.9%) than men (5.4%). Weighting for varying visiting frequencies did not affect TMD prevalence (average difference 0.4% points). Individuals with TMD, especially women, reported more sick leave and use of pain medication, with a significant association between TMD and increased sick leave (prevalence ratio 1.89, 95% CI: 1.78–2.01) among both women and men. In addition, TMD was associated with a lower health related quality of life (<jats:italic>p</jats:italic> &lt; 0.001).ConclusionThe association of TMD with sick leave highlights the condition's profound impact on the lives of affected individuals. These findings underscore the influence of TMD on work life and the burden of TMD on the societal level.Significance StatementThe findings provide insight into how TMD affect individuals, by incorporating lifestyle factors, social determinants and the impact of sick leave at a population level. By incorporating these areas into the study of TMD, we can deepen our understanding of how TMD affects individuals' lives. This approach may also create opportunities to develop more comprehensive strategies to address TMD, focusing on broader implications beyond the clinical symptoms.","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141777309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}