Impact of musculoskeletal pain on insomnia onset : a prospective cohort study

Objective. Pain, the most common manifestation of rheumatological conditions, is highly prevalent among older adults, with worse health outcomes found in those with co-morbid insomnia. Proactive prevention of insomnia may reduce the overall disease burden of pain and rheumatological conditions. To inform such development, this study examined the role of pain, physical limitation and reduced social participation in predicting and mediating insomnia onset. Methods. A prospective cohort study was conducted involving 6676 individuals ≥50 years of age who completed questionnaires at baseline and a 3-year follow-up. Participants were classified into none, some and widespread pain according to the ACR criteria. Logistic regression was used to examine the relationship between baseline pain and insomnia onset at 3 years. Path analysis was used to test for the mediating role of physical limitation and social participation restriction. Results. Some [adjusted odds ratio (AOR) 1.57 (95% CI 1.15, 2.13)] and widespread [2.13 (1.66, 3.20)] pain increased the risk of insomnia onset at 3 years, after adjusting for age, gender, socio-economic class, education, anxiety, depression, sleep and co-morbidity at baseline. The combination of physical limitation and reduced social participation explained up to 68% of the effect of some pain on insomnia onset and 66% of the effect of widespread pain on insomnia onset. Conclusions. There was a dose–response association between the extent of pain at baseline and insomnia onset at 3 years that was substantially mediated by physical limitation and reduced social participation. Targeting physical limitation and social participation in older people with pain may buffer co-morbid insomnia, reducing the overall disease burden

Onset of Work Restriction in Employed Adults with Lower Limb Joint Pain: Individual Factors and Area-Level Socioeconomic Conditions

Purpose To examine individual and area-level socioeconomic factors that predict the onset of work restriction in employed persons with lower limb joint pain. Methods Population-based prospective cohort study. Adults were aged 50–59, reported hip, knee, foot pain or a combination and maintained employment through 3 year follow-up (n = 716). Work restriction was measured as inability to participate in work as desired. Multi-level logistic regression was used to assess the associations of work restriction onset with baseline factors: health (severity of knee pain/functional limitation, comorbidity, anxiety, depression, cognitive impairment, abnormal weight), demographic socio-economic, environment and area-level employment deprivation. Results 108 (15.1 %) reported the onset of work restriction over 3 years. Severe lower limb joint pain and functional limitation, number of affected body sites and area employment deprivation were independently associated with onset. Significant interactions indicated a greater effect of area employment deprivation on older and more depressed workers. Conclusions Results suggest that effectively preventing work disability in those with OA will require both condition-specific interventions to decrease pain and maintain function, and providing alternative employment opportunities for those with progressive functional limitations. Results in older workers are particularly concerning, as retirement ages are expected to increase in the general population

Incidence of prostate, breast, lung and colorectal cancer following new consultation for musculoskeletal pain: A cohort study among UK primary care patients

Musculoskeletal pain has been linked with subsequent cancer. The objective was to investigate associations between pain sites and specific cancers, and investigate the hypothesis that musculoskeletal pain is an early marker, rather than cause, of cancer. This was a cohort study in the General Practice Research Database. From a cohort of 46,656 people aged ≥50 years with a recorded musculoskeletal problem in 1996 but not during the previous 2 years, patients with a new consultation for back, neck, shoulder or hip pain in 1996 were selected and compared with 39,253 persons who had had no musculoskeletal consultation between 1994 and 1996. Outcome was incidence of prostate, breast, lung and colorectal cancer up to 10 years after baseline consultation. Strongest associations with prostate cancer were in the first year of follow-up for males consulting initially with back (adjusted hazard ratio 5.42; 95% CI 3.31, 8.88), hip (6.08; 2.87, 12.85) or neck problems (3.46; 1.58, 7.58). These associations remained for back and neck problems over 10 years. Significant associations existed with breast cancer up to 5 years after consultation in females with hip problems, and with breast and lung cancer in the first year after presentation with back problems. Previously observed links between pain and cancer reflect specific associations between pain sites and certain cancers. One explanation is liability for bony metastases from primary sites, and that pain represents a potential early marker of cancer. However, older patients with uncomplicated musculoskeletal pain seen in clinical practice have a low absolute excess cancer risk

Reasons why multimorbidity increases the risk of participation restriction in older adults with lower extremity osteoarthritis: a prospective cohort study in primary care

Objective: to determine why multimorbidity causes participation restriction in adults ages ≥50 years who consult primary care with lower extremity osteoarthritis (OA).Methods: this was a population-based prospective cohort study of 1,053 consulters for lower extremity OA who were free of participation restriction at baseline. Path analysis was used to test proposed mechanisms by examining for mediation of the association between multimorbidity at baseline, defined by self-report and consultation data separately, and incident participation restriction at 3 years by lower extremity pain severity, obesity, locomotor disability, and depression.Results: multimorbidity was associated with incident participation restriction (adjusted odds ratio [OR] 2.83, 95% confidence interval [95% CI] 2.03–3.94 for multimorbidity [self-report]; OR 1.59, 95% CI 1.15–2.21 for multimorbidity [consultation data]). The extent of mediation of the association of baseline multimorbidity, defined by self-report, and incident participation restriction was greater for severe lower extremity pain than obesity (standardized beta coefficients for indirect effect 0.032 [SE 0.015] and 0.020 [SE 0.019], respectively). The addition of depression and locomotor disability increased the amount of mediation (0.115 [SE 0.028]) and reduced the proportion explained by severe lower extremity pain (0.014 [SE 0.015]) and obesity (0.006 [SE 0.010]). Locomotor disability was the strongest mediator.Conclusion: the additional impact on participation in social and domestic life that multimorbidity places on individuals with lower extremity OA appears to be mediated through further restriction of locomotor disability, as well as through depression. The results suggest that the effect of multimorbidity on the daily lives of people with lower extremity OA will be ameliorated by active management of depression and locomotor disability.</p

Reasons why multimorbidity increases the risk of participation restriction in older adults with lower extremity osteoarthritis: a prospective cohort study in primary care.

Objective: to determine why multimorbidity causes participation restriction in adults ages ≥50 years who consult primary care with lower extremity osteoarthritis (OA).Methods: this was a population-based prospective cohort study of 1,053 consulters for lower extremity OA who were free of participation restriction at baseline. Path analysis was used to test proposed mechanisms by examining for mediation of the association between multimorbidity at baseline, defined by self-report and consultation data separately, and incident participation restriction at 3 years by lower extremity pain severity, obesity, locomotor disability, and depression.Results: multimorbidity was associated with incident participation restriction (adjusted odds ratio [OR] 2.83, 95% confidence interval [95% CI] 2.03–3.94 for multimorbidity [self-report]; OR 1.59, 95% CI 1.15–2.21 for multimorbidity [consultation data]). The extent of mediation of the association of baseline multimorbidity, defined by self-report, and incident participation restriction was greater for severe lower extremity pain than obesity (standardized beta coefficients for indirect effect 0.032 [SE 0.015] and 0.020 [SE 0.019], respectively). The addition of depression and locomotor disability increased the amount of mediation (0.115 [SE 0.028]) and reduced the proportion explained by severe lower extremity pain (0.014 [SE 0.015]) and obesity (0.006 [SE 0.010]). Locomotor disability was the strongest mediator.Conclusion: the additional impact on participation in social and domestic life that multimorbidity places on individuals with lower extremity OA appears to be mediated through further restriction of locomotor disability, as well as through depression. The results suggest that the effect of multimorbidity on the daily lives of people with lower extremity OA will be ameliorated by active management of depression and locomotor disability.</p

The role of pain, physical disability, and reduced social participation in insomnia onset in community dwelling older adults : a prospective cohort study

Background Most patients with chronic pain have insomnia that warrants clinical attention. This study examined the role of pain, physical disability, and reduced social participation in predicting and mediating insomnia onset in community dwelling older adults. Theories of pain-related insomnia identify activity dysregulation as a behavioural mechanism augmenting sleep disturbance. Participation in social and physical activities was hypothesised to be sleep promoting because engagement in activities generates sleep pressure and brings the exposure to light and stimulation that entrain the circadian rhythm. Methods We undertook a prospective cohort study based in North Staffordshire, UK (approved by the North Staffordshire Research Ethics Committee). 13 986 individuals aged at least 50 years were recruited from six general practices. 9457 respondents to the baseline questionnaire consented to further contact. 7230 completed responses were received at 3 years. Of these, 6676 had data at both timepoints and were used for the analysis. Pain was assessed by a body manikin. Participants were classified into no pain, regional pain, and widespread pain according to the American College of Rheumatology criteria of fibromyalgia, which count the number of reported pain sites. Insomnia was measured with the Jenkins sleep questionnaire. Mediators were physical disability and reduced social participation, respectively measured by the 36-item short form physical function subscale (PFS) and Keele Assessment of Participation (KAP). The association between baseline pain and insomnia onset at 3 years was examined with logistic regression among those who did not have insomnia at baseline. Path analysis was used to test the mediating role of physical disability and reduced social participation in the pain—insomnia relation. Findings At baseline, 1767 (26·5%) of 6676 participants had no pain, 3074 (46·0%) had regional pain, and 1835 (27·5%) had widespread pain. 491 (28·9%) of 1698 participants in the no pain group, 1814 (61·7%) of 2939 in the regional pain group, and 1515 (85·6%) of 1771 participants in the widespread pain group were moderately (50·1—84·9) or severely (0—50) disabled based on their PFS scores. 237 (13·4%) of 1767 of participants in the no pain group, 749 (24·3%) of 3074 in the regional pain group, and 766 (41·7%) of 1835 participants in the widespread pain group reported at least two social participation restrictions on the KAP. Regional pain (adjusted odds ratio 1·83, 95% CI 1·54—2·18) and widespread pain (2·86, 2·35—3·48) increased the risk of developing insomnia at 3 years, after adjustment for age, sex, social economic class, education attainment, anxiety, depression, and sleep at baseline. The combination of physical disability and reduced social participation explained up to 74% of the total effect of regional pain and 70% of the effect of widespread pain on insomnia onset. Probability weighted analyses to assess the effect of attrition suggested no differences in the reported association between the weighted and unweighted analyses. Interpretation There was a dose—response association between the extent of pain at baseline and insomnia onset at 3 years. The effect of pain on subsequent insomnia onset was mediated by physical disability and reduced social participation. If these two factors are reasonable proxies of reduced engagement in activities, interventions that strengthen them in older adults with pain may buffer the risk of insomnia onset. These interpretations, however, are based on self-reported data and might not generalise to communities of different cultural and demographic characteristic

Impact of musculoskeletal pain on insomnia onset: a prospective cohort study

Objective. pain, the most common manifestation of rheumatological conditions, is highly prevalent among older adults, with worse health outcomes found in those with co-morbid insomnia. Proactive prevention of insomnia may reduce the overall disease burden of pain and rheumatological conditions. To inform such development, this study examined the role of pain, physical limitation and reduced social participation in predicting and mediating insomnia onset.Methods. a prospective cohort study was conducted involving 6676 individuals ≥50 years of age who completed questionnaires at baseline and a 3-year follow-up. Participants were classified into none, some and widespread pain according to the ACR criteria. Logistic regression was used to examine the relationship between baseline pain and insomnia onset at 3 years. Path analysis was used to test for the mediating role of physical limitation and social participation restriction.Results. some [adjusted odds ratio (AOR) 1.57 (95% CI 1.15, 2.13)] and widespread [2.13 (1.66, 3.20)] pain increased the risk of insomnia onset at 3 years, after adjusting for age, gender, socio-economic class, education, anxiety, depression, sleep and co-morbidity at baseline. The combination of physical limitation and reduced social participation explained up to 68% of the effect of some pain on insomnia onset and 66% of the effect of widespread pain on insomnia onset.Conclusion. there was a dose–response association between the extent of pain at baseline and insomnia onset at 3 years that was substantially mediated by physical limitation and reduced social participation. Targeting physical limitation and social participation in older people with pain may buffer co-morbid insomnia, reducing the overall disease burden

Widespread pain and depression are key modifiable risk factors associated with reduced social participation in older adults: a prospective cohort study in primary care

In older adults, reduced social participation increases the risk of poor health-related quality of life, increased levels of inflammatory markers and cardiovascular disease, and increased mortality. Older adults frequently present to primary care, which offers the potential to deliver interventions at the point of care to increase social participation. The aim of this prospective study was to identify the key modifiable exposures that were associated with reduced social participation in a primary care population of older adults.The study was a population-based prospective cohort study. Participants (n = 1991) were those aged ≥65 years who had completed questionnaires at baseline, and 3 and 6-year follow-ups. Generalized linear mixed modeling framework was used to test for associations between exposures and decreasing social participation over 6 years.At baseline, 44% of participants reported reduced social participation, increasing to 49% and 55% at 3 and 6-year follow-up. Widespread pain and depression had the strongest independent association with reduced social participation over the 6-year follow-up period. The prevalence of reduced social participation for those with widespread pain was 106% (adjusted incidence rate ratio 2.06, 95% confidence interval 1.72, 2.46), higher than for those with no pain. Those with depression had an increased prevalence of 82% (adjusted incidence rate ratio 1.82, 95% confidence interval 1.62, 2.06). These associations persisted in multivariate analysis.Population ageing will be accompanied by increasing numbers of older adults with pain and depression. Future trials should assess whether screening for widespread pain and depression, and targeting appropriate treatment in primary care, increase social participation in older people