变性和性别多元化人群的慢性疼痛负担:来自美国大型临床数据库的证据。

IF 3.5 2区 医学 Q1 ANESTHESIOLOGY
Tomasz Tabernacki, David Gilbert, Stephen Rhodes, Kyle Scarberry, Rachel Pope, Megan McNamara, Shubham Gupta, Swagata Banik, Kirtishri Mishra
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引用次数: 0

摘要

背景:慢性疼痛影响着全球约 20% 的人口,是导致全球残疾的主要原因。变性人与双性恋人群相比,面临的慢性疼痛风险因素不成比例。本研究比较了变性人和同性人的慢性疼痛发病率,并研究了性别肯定激素疗法、焦虑和抑郁对慢性疼痛的影响:研究分析了 TrinetX 数据库中 56,470 名变性男性和 41,882 名变性女性的医疗记录数据。研究建立了六个队列:接受雌激素或不接受干预的变性女性、接受睾酮或不接受干预的变性男性,以及顺性别男性和女性队列。计算未匹配的年龄调整发病率。然后根据 22 个与慢性疼痛相关的协变量对队列进行配对,并比较接受激素治疗者与未接受激素治疗者新诊断出慢性疼痛的比率:结果:我们观察到变性人的慢性疼痛发病率明显高于同性人。与未接受激素治疗的人相比,接受睾丸激素治疗的变性男性和接受雌激素治疗的变性女性被诊断为慢性疼痛的可能性更高。患有焦虑症和抑郁症的人更有可能被诊断为慢性疼痛:这项研究表明,变性人的慢性疼痛负担很重,接受激素治疗的变性人患慢性疼痛的风险更高。我们的研究是首次对变性人患者的慢性疼痛进行评估,为激素治疗与慢性疼痛诊断风险之间的潜在关联提供了支持。我们需要进一步研究,以了解其因果机制,并改进变性人慢性疼痛的筛查和管理:我们的研究汇集了迄今为止最大的变性和性别多元化(TGD)人群,揭示了变性和性别多元化人群(尤其是接受激素治疗的变性和性别多元化人群)与顺性别人群在慢性疼痛方面的严重差异。它强调了对这一弱势群体进行专门筛查和治疗以及研究激素治疗对疼痛的影响的迫切需要。这些见解旨在促进更有效、更个性化的医疗保健,提高 TGD 群体的福祉和生活质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The burden of chronic pain in transgender and gender diverse populations: Evidence from a large US clinical database.

Background: Chronic pain, affecting approximately 20% of the global population, is the leading cause of disability worldwide. Transgender individuals are disproportionately exposed to chronic pain risk factors compared with the cisgender population. This study compares the incidence of chronic pain between transgender and cisgender individuals and examines the impact of gender affirming hormone therapy, anxiety, and depression on chronic pain.

Methods: The study analysed medical records data of 56,470 transgender men and 41,882 transgender women in the TrinetX database. Six cohorts were created: transgender women either receiving oestrogen or no intervention, transgender men receiving testosterone or no intervention and cohorts of cisgender males and females. Unmatched age-adjusted incidence rates were calculated. Then cohorts were matched on 22 chronic pain-associated covariates and the rate of new chronic pain diagnoses was compared between those receiving hormone therapy and those without.

Results: We observed significantly higher rates of chronic pain among transgender individuals compared with cisgender counterparts. Transgender men on testosterone therapy and transgender women on oestrogen therapy exhibited an increased likelihood of chronic pain diagnoses compared with those not receiving hormone therapy. Individuals with anxiety and depression were more likely to be diagnosed with chronic pain.

Conclusion: This study demonstrates a significant burden of chronic pain in transgender individuals, with an increased risk among those receiving hormone therapy. Our study, the first to assess chronic pain in a large cohort of transgender patients, provides support for a potential association between hormone therapy and risk of chronic pain diagnosis. Further research is required to understand causal mechanisms and to develop improved screening and management of chronic pain in transgender populations.

Significance statement: Our study, featuring the largest cohort of Transgender and Gender Diverse (TGD) individuals assembled to date, reveals critical disparities in chronic pain among TGD populations, notably those on hormone therapy, compared with the cisgender population. It highlights the urgent need for specialized screening and treatment for this vulnerable population, and research into hormone therapy's impact on pain. These insights aim to foster more effective, personalized healthcare, enhancing the well-being and quality of life for the TGD community.

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来源期刊
European Journal of Pain
European Journal of Pain 医学-临床神经学
CiteScore
7.50
自引率
5.60%
发文量
163
审稿时长
4-8 weeks
期刊介绍: European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.
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