An Exploration of the Relationships between Chronic Pain, Inflammation, and Herbal Medicine

Introduction: Inflammation is often a component of chronic pain, yet its potential role in fibromyalgia syndrome (FMS) remains inconclusive. FMS is a complex chronic pain condition affecting ~2% of the population; management is challenging and treatment options remain limited. Many herbs contain anti-inflammatory properties, and herbs indicated for analgesia and rheumatic conditions have traditionally been used in Appalachia. Despite the popularity of herbs in the US, determinants and patterns of herbal use with regard to pain management have not been well studied, particularly in Appalachia, where prevalence of chronic pain and related comorbid conditions is high and access to medical care is often reduced. In this series of three studies, we investigate the: 1) relation of FMS to serum C-reactive protein (CRP) in a large Appalachian population; 2) demographic, lifestyle, and health-related correlates of herbs and other complementary health approaches (CHAs) used for pain in a sample of Appalachian chronic pain patients, using a newly developed survey instrument; and, 3) the relation of herbal supplement use to FMS in two nationally representative samples of U.S. adults (NHIS 2007 and 2012), as well as trends in patterns of herbal use over time.;Methods: All participants completed comprehensive health surveys in these three cross-sectional studies. To investigate the relation between diagnosed FMS and serum levels of the proinflammatory marker CRP (Study 1), we used data on 52,535 adult Ohio Valley residents (FMS =1,125), collected in 2005-2006 as part of the C8 Health Project. Medical history, including physician diagnosis of FMS, was ascertained via self-report. To determine the correlates and patterns of herbal and other CHAs used specifically for pain in an Appalachian chronic pain population (Study 2), we collected data on 301 patients from four WV pain and rheumatology clinics using our newly developed survey instrument, the Complementary Health Approaches for Pain Survey (CHAPS) (2014-2016); correlates relating specifically to pain were measured using the Short-Form Global Pain Scale (SF-GPS). To assess the relation of diagnosed FMS to herbal supplement use (at 30 days, past 12 months, and ever) and to examine potential changes in the patterns of use over time (Study 3), we used data from the 2007 and 2012 National Health Interview Surveys (NHIS) (N = 20127 and N = 30672 adults, respectively). Logistic and linear regression (complete-case analysis) were used to examine associations and to evaluate the potential modifying influence of gender and number of health conditions; multivariate models were adjusted for an array of demographic, lifestyle, and health factors. To account for missing data (Study 2), we also conducted additional sensitivity analyses using multiple imputation.;Results: Study 1. In this large Appalachian population, mean serum CRP was significantly higher among participants reporting a diagnosis of FMS than those without FMS (5.54+/- 9.8 vs.3.75+/-7.2 mg/L, p\u3c0.0001)). CRP serum level showed a strong, positive association with FMS (unadjusted OR for highest vs. lowest quartile=2.5 (CI 2.1,3.0; P for trend(p\u3c0.0001); adjustment for demographics and lifestyle factors attenuated but did not eliminate this association (adjusted odds ratio (AOR) for highest vs. lowest quartile = 1.4, (CI 1.1, 1.6). The addition of body mass index (BMI) and comorbidities to the model further weakened the relationship between CRP and FMS (AORs, respectively, for highest vs lowest CRP quartile=1.2 (CI 1.0,1.4) and 1.1 (CI 0.9, 1.3), suggesting that these factors may partially explain the observed associations. Study 2: In our sample of 301 WV chronic pain patients, 8% reported using herbs and 58.8% reported using other CHAs, including mind-body practices (28.9%),; acupuncture, manipulative treatments, massage, and/or movement therapies (28.1%), and non-herbal dietary supplements (53.6%). Herbal use in this sample was marginally, inversely associated with age (OR adjusted for education=0.97 (CI 0.94,1.01) and positively associated with education (OR adjusted for age=4.94 (CI 1.6,15.3); Herbal use also showed strong positive associations with use of other CHAs ( (AOR=11.5 (CI 1.5,87.9); specific CHA AORs ranging from 2.4 to 10.3). Use of other CHAs was marginally, inversely associated with age (OR adjusted for education/exercise=0.98 (CI 0.96,1.0), and significantly and positively associated with education and physical activity (AOR\u27s for Bachelor\u27s+ vs

Nonvitamin, Nonmineral Dietary Supplement Use among Adults with Fibromyalgia: United States, 2007–2012

Background. Fibromyalgia (FMS) is a pain condition affecting 2–6% of US adults; effective treatment remains limited. Determinants of nonvitamin, nonmineral dietary supplement (NVNM) use among adults with FMS are not well-studied. We investigated the relation of NVNM use to FMS, and trends, in two nationally representative samples of US adults ≥18 years. Methods. Data were drawn from 2007 and 2012 National Health Interview Surveys (’s = 20127 and 30672, resp.). Logistic regression was used to examine associations of FMS to NVNM use (past 12 months) and evaluate potential modifying influences of gender and comorbidities. Multivariate models adjusted for sampling design, demographic, lifestyle, and health-related factors. Results. FMS was significantly higher in 2012 than in 2007 (1.7% versus 1.3%), whereas NVNM use decreased (57% versus 41%; ). Adults reporting diagnosis were more likely to use NVNMs within 12 months, 30 days, or ever relative to adults without; positive associations remained significant after controlling for demographics, lifestyle characteristics, medical history, and other confounders (ranges: 2007 and 2012 AORs = 2.3–2.7; 1.5–1.6, resp.; ’s \u3c 0.0001).Conclusion. In this cross-sectional study of two national samples, NVNM use was strongly and positively associated with FMS, highlighting the need for further study

Nonvitamin, Nonmineral Dietary Supplement Use among Adults with Fibromyalgia: United States, 2007–2012

Background. Fibromyalgia (FMS) is a pain condition affecting 2–6% of US adults; effective treatment remains limited. Determinants of nonvitamin, nonmineral dietary supplement (NVNM) use among adults with FMS are not well-studied. We investigated the relation of NVNM use to FMS, and trends, in two nationally representative samples of US adults ≥18 years. Methods. Data were drawn from 2007 and 2012 National Health Interview Surveys (N’s = 20127 and 30672, resp.). Logistic regression was used to examine associations of FMS to NVNM use (past 12 months) and evaluate potential modifying influences of gender and comorbidities. Multivariate models adjusted for sampling design, demographic, lifestyle, and health-related factors. Results. FMS was significantly higher in 2012 than in 2007 (1.7% versus 1.3%), whereas NVNM use decreased (57% versus 41%; p<0.0001). Adults reporting diagnosis were more likely to use NVNMs within 12 months, 30 days, or ever relative to adults without; positive associations remained significant after controlling for demographics, lifestyle characteristics, medical history, and other confounders (ranges: 2007 and 2012 AORs = 2.3–2.7; 1.5–1.6, resp.; p’s < 0.0001). Conclusion. In this cross-sectional study of two national samples, NVNM use was strongly and positively associated with FMS, highlighting the need for further study

Potential Mediators between Fibromyalgia and C-Reactive protein: Results from a Large U.S. Community Survey.

Background: Fibromyalgia, a potentially debilitating chronic pain syndrome of unknown etiology, may be characterized by inflammation. In this study, we investigated the relation of FMS to serum C-reactive protein (CRP) in a large population of adults (18+) and investigated the influence of other factors on this relationship, including BMI, comorbidities, as well as mood and sleep disturbance. Methods: Participants were 52,535 Ohio Valley residents (Fibromyalgia n = 1125). All participants completed a comprehensive health survey (2005–2006) part of the C8 Health Project; serum levels of CRP were obtained, as was history of Fibromyalgia physician diagnosis. Logistic and linear regressions were used for this cross-sectional analysis. Results: Mean CRP was higher among participants reporting Fibromyalgia than those without (5.54 ± 9.8 vs.3.75 ± 7. 2 mg/L, p \u3c .0001)). CRP level showed a strong, positive association with FMS (unadjusted odds ratio (OR) for highest vs. lowest quartile = 2.5 (CI 2.1,3.0;p for trend \u3c .0001)); adjustment for demographic and lifestyle factors attenuated but did not eliminate this association (AOR for highest vs. lowest quartile = 1.4 (CI 1.1,1.6;p for trend \u3c .0001)). Further addition of body mass index (BMI) and comorbidities to the model markedly weakened this relationship (AORs, respectively, for highest vs lowest CRP quartile = 1.2 (CI 1.0,1.4) and 1.1 (CI 0.9,1.3). In contrast, inclusion of mood and sleep impairment only modestly reduced the adjusted risk estimate (AORs for highest vs. lowest quartile = 1.3 (CI 1.1,1.5) for each)). Conclusions: Findings from this large cross-sectional study indicate a significant positive cross-sectional association of Fibromyalgia to serum C-reactive protein may be explained, in part, by BMI and comorbidity. Prospective research is needed to confirm this, and clarify the potential mediating influence of obesity and comorbid conditions on this relationship

On saturation effect for linear shape-preserving approximation in Sobolev spaces

Objectives Little is known about patterns and correlates of Complementary Health Approaches (CHAs) in chronic pain populations, particularly in rural, underserved communities. This article details the development and implementation of a new survey instrument designed to address this gap, the Complementary Health Approaches for Pain Survey (CHAPS). Design Following pilot-testing using pre-specified criteria to assess quality and comprehension in our target population, and after feedback regarding face-validity from content experts and stakeholders, the final cross-sectional self-report survey required 10–12 minutes to complete. It contained 69 demographic, lifestyle and health-related factors, and utilized a Transtheoretical Model (TTM) underpinning to assess short- and long-term use of 12 CHAs for pain management. Twenty additional items on pain severity, feelings, clinical outcomes, and activities were assessed using the Short-Form Global Pain Scale (SF-GPS); Internal reliability was assessed using Cronbach’s alpha. Settings/location Investigators conducted consecutive sampling in four West Virginia pain management and rheumatology practices. Participants 301 Appalachian adult patients seeking conventional care for pain management. Results Response rates were high (88% ± 4.1%). High quality and comprehension deemed the CHAPS an appropriate measurement tool in a rural population with pain. Missing data were unrelated to patient characteristics. Participants predominantly experienced chronic pain (93%), had five or more health conditions (56%, Mean = 5.4±3.1), were white (92%), female (57%), and middle-aged (Mean = 55.6 (SD = 13.6) years). Over 40% were disabled (43%) and/or obese (44%, Mean BMI = 33.4±31.5). Additionally, 44% used opioids, 31% used other prescription medications, and 66% used at least one CHA for pain, with 48% using CHAs for greater than 6 months. There was high internal reliability of the SF-GPS (alpha = .93) and satisfactory internal reliability for each of the five TTM stages across (all) twelve CHAs: precontemplation (0.89), contemplation (0.72), preparation (0.75), action (0.70), and maintenance (0.70). Conclusions The CHAPS is the first comprehensive measurement tool to assess CHA use specifically for pain management. Ease of administration in a population with pain support further use in population- and clinic-based studies in similar populations

Potential Mediators between Fibromyalgia and C-Reactive protein: Results from a Large U.S. Community Survey

Background Fibromyalgia, a potentially debilitating chronic pain syndrome of unknown etiology, may be characterized by inflammation. In this study, we investigated the relation of FMS to serum C-reactive protein (CRP) in a large population of adults (18+) and investigated the influence of other factors on this relationship, including BMI, comorbidities, as well as mood and sleep disturbance. Methods Participants were 52,535 Ohio Valley residents (Fibromyalgia n = 1125). All participants completed a comprehensive health survey (2005–2006) part of the C8 Health Project; serum levels of CRP were obtained, as was history of Fibromyalgia physician diagnosis. Logistic and linear regressions were used for this cross-sectional analysis. Results Mean CRP was higher among participants reporting Fibromyalgia than those without (5.54 ± 9.8 vs.3.75 ± 7.2 mg/L, p \u3c .0001)). CRP level showed a strong, positive association with FMS (unadjusted odds ratio (OR) for highest vs. lowest quartile = 2.5 (CI 2.1,3.0;p for trend \u3c .0001)); adjustment for demographic and lifestyle factors attenuated but did not eliminate this association (AOR for highest vs. lowest quartile = 1.4 (CI 1.1,1.6;p for trend \u3c .0001)). Further addition of body mass index (BMI) and comorbidities to the model markedly weakened this relationship (AORs, respectively, for highest vs lowest CRP quartile = 1.2 (CI 1.0,1.4) and 1.1 (CI 0.9,1.3). In contrast, inclusion of mood and sleep impairment only modestly reduced the adjusted risk estimate (AORs for highest vs. lowest quartile = 1.3 (CI 1.1,1.5) for each)). Conclusions Findings from this large cross-sectional study indicate a significant positive cross-sectional association of Fibromyalgia to serum C-reactive protein may be explained, in part, by BMI and comorbidity. Prospective research is needed to confirm this, and clarify the potential mediating influence of obesity and comorbid conditions on this relationship

Potential Mediators between Fibromyalgia and C-Reactive protein: Results from a Large U.S. Community Survey

Abstract Background Fibromyalgia, a potentially debilitating chronic pain syndrome of unknown etiology, may be characterized by inflammation. In this study, we investigated the relation of FMS to serum C-reactive protein (CRP) in a large population of adults (18+) and investigated the influence of other factors on this relationship, including BMI, comorbidities, as well as mood and sleep disturbance. Methods Participants were 52,535 Ohio Valley residents (Fibromyalgia n = 1125). All participants completed a comprehensive health survey (2005–2006) part of the C8 Health Project; serum levels of CRP were obtained, as was history of Fibromyalgia physician diagnosis. Logistic and linear regressions were used for this cross-sectional analysis. Results Mean CRP was higher among participants reporting Fibromyalgia than those without (5.54 ± 9.8 vs.3.75 ± 7.2 mg/L, p < .0001)). CRP level showed a strong, positive association with FMS (unadjusted odds ratio (OR) for highest vs. lowest quartile = 2.5 (CI 2.1,3.0;p for trend < .0001)); adjustment for demographic and lifestyle factors attenuated but did not eliminate this association (AOR for highest vs. lowest quartile = 1.4 (CI 1.1,1.6;p for trend < .0001)). Further addition of body mass index (BMI) and comorbidities to the model markedly weakened this relationship (AORs, respectively, for highest vs lowest CRP quartile = 1.2 (CI 1.0,1.4) and 1.1 (CI 0.9,1.3). In contrast, inclusion of mood and sleep impairment only modestly reduced the adjusted risk estimate (AORs for highest vs. lowest quartile = 1.3 (CI 1.1,1.5) for each)). Conclusions Findings from this large cross-sectional study indicate a significant positive cross-sectional association of Fibromyalgia to serum C-reactive protein may be explained, in part, by BMI and comorbidity. Prospective research is needed to confirm this, and clarify the potential mediating influence of obesity and comorbid conditions on this relationship

Complementary Health Approaches (CHAs) used for pain among Appalachian patients seeking conventional pain management by Health behavior stage of change, Complementary Health Approaches for Pain Survey (CHAPS), WV, 2014–2016.

<p>Complementary Health Approaches (CHAs) used for pain among Appalachian patients seeking conventional pain management by Health behavior stage of change, Complementary Health Approaches for Pain Survey (CHAPS), WV, 2014–2016.</p

Complementary Health Approaches (CHAs) used for pain among Appalachian patients seeking conventional pain management by Health behavior stage of change, Complementary Health Approaches for Pain Survey (CHAPS), WV, 2014–2016.

<p>Complementary Health Approaches (CHAs) used for pain among Appalachian patients seeking conventional pain management by Health behavior stage of change, Complementary Health Approaches for Pain Survey (CHAPS), WV, 2014–2016.</p

The study flow chart.

<p>The study flow chart.</p