A low cortisol response to stress is associated with musculoskeletal pain combined with increased pain sensitivity in young adults: A longitudinal cohort study

Background: In this study, we investigated whether an abnormal hypothalamic-pituitary-adrenal (HPA) axis response to psychosocial stress at 18 years of age is associated with musculoskeletal (MS) pain alone and MS pain combined with increased pain sensitivity at 22 years of age. Methods: The study sample included 805 participants from the Western Australian Pregnancy Cohort (Raine) Study who participated in the Trier Social Stress Test (TSST) at age 18 years. Number of pain sites, pain duration, pain intensity and pain frequency were assessed at age 22 to measure severity of MS pain. Cold and pressure pain thresholds were determined at age 22. Group-based trajectory modeling was applied to establish cortisol response patterns based on the TSST. Logistic regression was used to study the association of TSST patterns with MS pain alone and MS pain combined with increased cold or pressure pain sensitivity, adjusted for relevant confounding factors. All analyses were stratified by sex. Results: The mean (standard deviation) age during the TSST was 18.3 (0.3) years, and during MS pain assessment it was 22.2 (0.6). Forty-five percent of the participants were female. Three cortisol response patterns were identified, with cluster 1 (34 % of females, 21 % of males) reflecting hyporesponse, cluster 2 (47 %, 54 %) reflecting intermediate response and cluster 3 (18 %, 24 %) reflecting hyperresponse of the HPA axis. MS pain was reported by 42 % of females and 33 % of males at age 22 years. Compared with females in cluster 2, females in cluster 1 had an increased likelihood of having any MS pain (odds ratio 2.3, 95 % confidence interval 1.0-5.0) and more severe MS pain (2.8, 1.1-6.8) if their cold pain threshold was above the median. In addition, females in cluster 1 had an increased likelihood (3.5, 1.3-9.7) of having more severe MS pain if their pressure pain threshold was below the median. No statistically significant associations were observed in males. Conclusions: This study suggests that a hyporesponsive HPA axis at age 18 years is associated with MS pain at 22 years in young females with increased pain sensitivity

Musculoskeletal pain is associated with restless legs syndrome in young adults

Background - In recent years, there is considerable evidence of a relationship between the sensorimotor disorder restless legs syndrome (RLS) and pain disorders, including migraine and fibromyalgia. An association between multi-site pain and RLS has been reported in adult women. In the current study, we explored the association between musculoskeletal (MSK) pain and RLS in a large cohort of young adults. Methods - Twenty two year olds (n = 1072), followed since birth of part of the Western Australian Pregnancy Cohort (Raine) Study, provided data on MSK pain (duration, severity, frequency, number of pain sites). RLS was considered present when 4 diagnostic criteria recommended by the International Restless Legs Syndrome Study Group were met (urge to move, dysaesthesia, relief by movement, worsening symptoms during the evening/night) and participants had these symptoms at least 5 times per month. Associations between MSK pain and RLS were analyzed by multivariable logistic regression with bias-corrected bootstrapped confidence intervals, with final models adjusted for sex, psychological distress and sleep quality. Results - The prevalence of RLS was 3.0 % and MSK pain was reported by 37.4 % of the participants. In multivariable logistic regression models, strong associations were found between RLS-diagnosis and long duration (three months or more) of MSK pain (odds ratio 3.6, 95 % confidence interval 1.4–9.2) and reporting three or more pain sites (4.9, 1.6–14.6). Conclusions - Different dimensions of MSK pain were associated with RLS in young adults, suggestive of shared pathophysiological mechanisms. Overlap between these conditions requires more clinical and research attention

Multi-site musculoskeletal pain in adolescence: occurrence, determinants, and consequences

Abstract Recent studies in adults have shown that musculoskeletal (MS) pains are often experienced at several body sites. The number of pain sites has been shown to be proportional to poor health outcomes, such as functional ability and health-related quality of life (HRQoL). This study investigated the occurrence and persistence of MS pain in multiple locations, determinants of multiple-site pain, and the impact of multiple-site pain on HRQoL and health care use among adolescents aged 16 to 19. The data were based on three inquiries that were administered to the adolescents of the Northern Finland Birth Cohort 1986. MS pain was common and often occurred at multiple sites. Moreover, the majority of adolescents with multiple-site pain at 16 reported multiple-site pain also at 18. Multiple-site MS pains were strongly associated with psychosocial complaints, but also with high physical activity level, long sitting time, short sleeping time, smoking, and overweight. Emotional problems, behavioral problems, and high sitting time among males, and emotional problems, high physical activity level, short sleeping time, and smoking among females were predictive factors for the persistence of multiple-site pain. The likelihood of reduced HRQoL increased according to the number of MS pain sites. A trend toward an increase in health care use with the number of pain sites was also observed. Reporting pain in multiple sites in adolescence may have both peripheral (tissue origin) and central (pain experience) causes. As multiple-site pain in adolescence may predict subsequent MS morbidity, the adolescents who are at highest risk and also at the highest need of health promotion should be identified in further studies.Tiivistelmä Aikuisväestössä tehtyjen tutkimusten perusteella tuki- ja liikuntaelimistön kivut esiintyvät tavallisesti usealla kehon alueella samanaikaisesti. Monikipuisuudella näyttää olevan epäedullisia vaikutuksia useisiin terveyteen liittyviin ilmiöihin kuten toiminta- ja työkykyyn sekä elämänlaatuun. Tässä tutkimuksessa tarkasteltiin monipaikkaisen tuki- ja liikuntaelinkivun esiintyvyyttä, pysyvyyttä ja riskitekijöitä sekä sen vaikutusta terveyteen liittyvään elämänlaatuun ja terveyspalvelujen käyttöön 16–19 –vuotiailla nuorilla. Tutkimuksen aineisto perustui kolmeen kyselyyn, jotka lähetettiin Pohjois-Suomen syntymäkohortti 1986:n nuorille. Tuki- ja liikuntaelinkipu oli yleistä ja esiintyi tavallisimmin usealla kehon alueella. Suurin osa nuorista, jotka raportoivat monen paikan kipua 16-vuotiaana, raportoivat sitä myös 18-vuotiaana. Monen kehon alueen tuki- ja liikuntaelinkipu yhdistyi voimakkaasti psykososiaalisiin tekijöihin, mutta myös korkeaan liikunta-aktiivisuuteen, runsaaseen istumiseen, vähäiseen uneen, tupakointiin ja ylipainoon. Käyttäytymisen- ja tunne-elämän häiriöt sekä runsas istuminen pojilla, ja tunne-elämän häiriöt, korkea liikunnallinen aktiivisuus, vähäinen uni sekä tupakointi tytöillä ennustivat monen kehon alueen kivun pysyvyyttä. Todennäköisyys heikentyneeseen terveyteen liittyvään elämänlaatuun lisääntyi suhteessa kipualueiden määrään. Myös terveyspalvelujen käytön ja kipualueiden lukumäärän välillä havaittiin yhteys. Monen paikan tuki- ja liikuntaelinkipua selittänevät sekä kudostasoiset että keskushermostolliset syyt. Koska laaja-alainen kipuoireilu nuoruudessa voi ennustaa myöhempiä tuki- ja liikuntaelinongelmia, riskiryhmiä ja samalla eniten terveyden edistämistä tarvitsevia nuoria tulisi pyrkiä jatkossa tarkemmin tunnistamaan

Determinants of responsiveness to multidisciplinary chronic pain management interventions:protocol for a systematic review and meta-analysis

Abstract Introduction: The current manuscript presents a protocol for a systematic review and meta-analysis of the evidence regarding the determinants of responsiveness to multidisciplinary management of chronic pain, with pain intensity, pain-related interference, physical functioning and health-related quality of life as the main outcomes, with consideration to multiple secondary outcomes. Methods and analysis: To identify relevant studies, the Ovid MEDLINE, PubMed, Ovid PsycINFO, EBSCO CINAHL and Scopus databases will be searched for all studies exploring factors associated with responsiveness to multidisciplinary pain management from study inception to the present. Cohorts, case–control studies and randomised controlled trials will be included. Independent screening for eligible studies will be completed by a total of four researchers using defined criteria. Data extraction will be executed by two researchers. Study heterogeneity will be estimated using the I2 index. A meta-analysis will be performed using random effects models. Publication bias will be evaluated by means of funnel plots and Egger’s test. Ethics and dissemination: The proposed study does not involve collection of primary data. Therefore, no ethical approval is required. The results of the systematic review and meta-analysis will be presented in a peer-reviewed journal and at conferences

Maternal smoking trajectory during pregnancy predicts offspring’s smoking and substance use:the Northern Finland birth cohort 1966 study

Abstract The aim was to characterize the association of maternal smoking trajectory during pregnancy with offspring’s smoking, alcohol and substance use behavior. We used the prospective Northern Finland Birth Cohort 1966 study including 11,653 mothers and their offspring followed up from mothers’ mid-pregnancy to age of 46 years. Main exposure was number of smoked cigarettes per day at each month of pregnancy. Outcome measures were offspring’s smoking, alcohol and drug use at age 14, starting age of smoking, ever-smoking, and smoked pack-years until age 46. Four maternal smoking trajectories during pregnancy were identified with latent class trajectory modelling, namely “non-smokers” (86.0% of mothers), “early quitters” (2.0%), “late quitters” (2.1%), and “consistent smokers” (9.9%). In comparison to non-smokers, all maternal smoking was associated with offspring’s increased odds of lifetime smoking adjusted for sex of the child, father’s smoking, occupational status and place of residence of family, marital status and mood of mother, and desirability of pregnancy. The consistent smoker’s class was associated with offspring’s number of smoked pack years by midlife (median [interquartile range]: 8.3 [1.4–17.4] vs. 4.8 [0.0–13.0], p = 0.028), and alcohol use in young age (odds ratio 1.23 [95% confidence interval 1.05–1.43]). Overall, to prevent parent-offspring transmission of smoking, the cessation support should target women planning pregnancy. Negative effects of maternal continuous smoking during pregnancy include all substance use and reach up to offspring’s middle age

Chronotypes and disabling musculoskeletal pain:a Finnish birth cohort study

Abstract Background: It has been suggested that chronotype, the individual preference for 24-h circadian rhythms, influences health. Sleep problems and mental distress are amongst the greatest risk factors for musculoskeletal (MS) pain. The aims of this study were first, to explore the associations between chronotypes and MS pain, with special reference to disabling MS pain and second, to test whether mental distress and insomnia have a modifying role in the associations between chronotypes and MS pain. Methods: The dataset of 4961 individuals was composed of Northern Finns surveyed on MS pain, chronotypes and confounding factors (sex, insomnia, sleep duration, smoking, mental distress, occupational status, education level and number of coexisting diseases) at 46 years. The relationships between chronotypes (evening [E], intermediate [I] and morning [M]) and MS pain were evaluated using multinomial logistic regression. To address the second aim, we included an interaction term (chronotype*mental distress, chronotype*insomnia) in the logistic model. Results: Compared to the M-types, both the E- and I-types had increased odds of suffering ‘disabling pain’ in the unadjusted model (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.37–2.33; OR 1.54, 95% CI 1.29–1.84, respectively). However, the association remained statistically significant only after adjusting for all covariates amongst the I-types (OR 1.39, 95% CI 1.15–1.67). Neither mental distress nor insomnia was found to modify the chronotype–MS pain association. Conclusions: The results highlight the importance of chronotypes for individuals’ MS health but suggest the presence of confounding factors in the interplay between these factors. Significance: This study shows that evening and intermediate chronotypes are associated with disabling MS pain, but that mental distress, insomnia and coexisting diseases also play a role in these associations

Smoking trajectories and risk of stroke until age of 50 years:the Northern Finland Birth Cohort 1966

Abstract Background: Smoking is a well-known risk factor for stroke. However, the relationship between smoking trajectories during the life course and stroke is not known. Aims: We aimed to study the association of smoking trajectories and smoked pack-years with risk of ischemic and haemorrhagic strokes in a population-based birth cohort followed up to 50 years of age. Methods: Within the Northern Finland Birth Cohort 1966, 11,999 persons were followed from antenatal period to age 50 years. The smoking behaviour was assessed with postal questionnaires at ages 14, 31 and 46 years. Stroke diagnoses were collected from nationwide registers using unique study number linkage. The associations between smoking behaviour and stroke risk were estimated using Cox regression models. Results: Six different patterns in smoking habits throughout the life course were found in trajectory modelling. During 542,140 person-years of follow-up, 352 (2.9%) persons had a stroke. Continuous smoking during the life course was associated with increased stroke risk (HR = 1.69; 95% CI 1.10–2.60) after adjusting for sex, educational level, family history of strokes, leisure-time physical activity, body mass index, alcohol consumption, hypertension, hypercholesterolemia, and diabetes. Per every smoked pack-year the stroke risk increased 1.04-fold (95% CI 1.03–1.06). Other smoking trajectories were not significantly associated with stroke risk, nor were starting or ending age of smoking. Conclusion: Accumulation of smoking history is associated with increased risk of stroke until age of 50 years. The increased stroke risk does not depend on the age at which smoking started. Given that the majority starts smoking at young age, primary prevention of strokes should focus on adolescent smoking

Lifelong smoking trajectories of Northern Finns are characterized by sociodemographic and lifestyle differences in a 46-year follow-up

Abstract Smoking remains among the leading causes of mortality worldwide. Obtaining a comprehensive understanding of a population’s smoking behaviour is essential for tobacco control. Here, we aim to characterize lifelong smoking patterns and explore underlying sociodemographic and lifestyle factors in a population-based birth cohort population followed up for 46 years. Our analysis is based on 5797 individuals from the Northern Finland Birth Cohort 1966 who self-reported their tobacco smoking behaviour at the ages of 14, 31 and 46. Data on sex, education, employment, body mass index, physical activity, alcohol consumption, and substance addiction were also collected at the follow-ups. We profile each individual’s annual smoking history from the age of 5 to 47, and conduct a latent class trajectory analysis on the data. We then characterize the identified smoking trajectory classes in terms of the background variables, and compare the heaviest smokers with other classes in order to reveal specific predictors of non-smoking and discontinued smoking. Six smoking trajectories are identified in our sample: never-smokers (class size 41.0%), youth smokers (12.6%), young adult quitters (10.8%), late adult quitters (10.5%), late starters (4.3%), and lifetime smokers (20.7%). Smoking is generally associated with male sex, lower socioeconomic status and unhealthier lifestyle. Multivariable between-class comparisons identify unemployment (odds ratio [OR] 1.28–1.45) and physical inactivity (OR 1.20–1.52) as significant predictors of lifetime smoking relative to any other class. Female sex increases the odds of never-smoking and youth smoking (OR 1.29–1.33), and male sex increases the odds of adult quitting (OR 1.30–1.41), relative to lifetime smoking. We expect future initiatives to benefit from our data by exploiting the identified predictors as direct targets of intervention, or as a means of identifying individuals who may benefit from such interventions

Cerebrovascular disease at young age is related to mother’s health during the pregnancy:the Northern Finland Birth Cohort 1966 study

Abstract Background and purpose: For prevention of cerebrovascular diseases at younger age, it is important to understand the risk factors occurring early in life. We investigated the relationship between mothers’ general health during pregnancy and the offspring’s risk of cerebrovascular disease in age of 15 to 52 years. Methods: Within the population-based prospective Northern Finland Birth Cohort 1966, 11,926 persons were followed from antenatal period to 52 years of age. Information on their mother’s ill health conditions, i.e., hospitalizations, chronic diseases, medications, vitamin or iron supplement, fever, anemia, mood, and smoking was collected from 24th gestational week onwards. Ischemic and hemorrhagic cerebrovascular diseases of the offspring were identified from national registers in Finland. Cox proportional hazard models were used to estimate the association of mother’s health conditions with incidence of cerebrovascular disease in the offspring, with adjustments for potential confounders. Results: During 565,585 person-years of follow-up, 449 (2.8%) of the offspring had a cerebrovascular disease. Hospitalization during pregnancy was associated with an increased risk of cerebrovascular disease in the offspring (hazard ratio (HR) = 1.49; 95% confidence interval (CI) 1.06–2.08) after adjustment for confounders, as was having more than three ill health conditions (HR = 1.89; CI 1.14–3.11). Not using vitamin or iron supplement was associated with increased risk for cerebrovascular disease in the offspring (HR = 1.39; CI 1.01–1.89). Conclusions: The results suggest that the risk of cerebrovascular disease may start as early as during the antenatal period, and the health characteristics of mothers during pregnancy may play a role in cerebrovascular disease risk of the offspring

Pregnancy risk factors as predictors of offspring cerebrovascular disease:the Northern Finland Birth Cohort Study 1966

Abstract Background and Purpose: For prevention of cerebrovascular diseases, it is important to understand the risk factors occurring early in life. The aim was to investigate the relationship of maternal and offspring anthropometrics and pregnancy complications with offspring’s risk of ischemic and hemorrhagic stroke and transient ischemic attack in adulthood. Methods: Within the population-based prospective Northern Finland Birth Cohort 1966, 11 991 persons were followed from early pregnancy to 52 years of age. Information on pregnancy and birth complications were collected starting between 24th and 28th gestational week and at birth. Ischemic and hemorrhagic strokes of the offspring were identified from national registers in Finland. Cox proportional hazard models were used to estimate the association of pregnancy and birth complications with incidence of cerebrovascular disease in the offspring, with adjustments for sex, family socioeconomic status, mother’s age, and smoking during pregnancy. Results: During 568 821 person-years of follow-up, 453 (3.8%) of the offspring had a stroke or transient ischemic attack. Small and large gestational weight gain among normal weight mothers were associated with increased ischemic stroke risk in offspring (adjusted hazard ratio [aHR], 1.93 [95% CI, 1.28–2.90] and aHR, 1.54 [95% CI, 1.02–2.31], respectively). Small birth weight for gestational age and small ponderal index were associated with increased risk for ischemic stroke (aHR, 1.95 [CI, 1.21–3.13] and aHR, 1.36 [CI, 1.04–1.77], respectively). Threatening miscarriage was also associated with increased risk of any stroke (aHR, 1.64 [CI 1.14–2.37]). Maternal smoking, hypertension, or birth complications were not associated with increased risk of cerebrovascular disease in the offspring. Conclusions: The results of this study suggest that disturbances in maternal and fetal growth during pregnancy may predispose offspring to developing cerebrovascular diseases in adulthood