Validity of the Visual Trajectories Questionnaire for Pain (VTQ-Pain)

Researchers have identified trajectories of pain derived using statistical techniques on longitudinal data. These trajectories have potential to be of use clinically but the repeated data collection required is currently impractical for such situations. Our aim was to investigate the validity of a self-report (Visual Trajectories Questionnaire-Pain) for pain. Analysis included participants from 2 prospective cohorts of people seeking primary health care for back pain (n = 622). A question was developed asking people to classify their pain experience into one of a number of trajectories using visual and word descriptions. Overall 98% of participants completed the question; criterion validity was established by comparing self-report trajectories and trajectories derived using longitudinal latent class analysis, and construct validity was established by comparing responses to the questionnaire against an existing model of back pain stages. As expected variables such as pain intensity and widespreadness, other symptoms, and psychological distress showed an increasing trend of severity across trajectory categories in line with the hypothesized model. In conclusion, the self-report single-item Visual Trajectories Questionnaire-Pain is acceptable to patients and supported by evidence of face, criterion, and construct validity. Further research is needed to investigate the clinical usefulness of the question

Identifying patients with chronic widespread pain in primary care.

Chronic widespread pain (CWP) is common in the general population. It is unclear how people reporting this problem present in primary care; they may regularly consult for regional pains without being recognized as having a generalized condition. Our objectives were to determine the prevalence of people consulting in primary care for musculoskeletal conditions in different body regions on different occasions (recurrent regional pain consultation), the proportion with diagnosed generalized pain and survey-reported widespread pain, and if they have features characteristic of CWP. Phase 1 used electronic records from 12 general practices in North Staffordshire (Consultations in Primary Care Archive) from 2005 to 2009. Phase 2 used linked self-reported health and primary healthcare data from 8,286 people aged 50 plus in eight general practices (North Staffordshire Osteoarthritis Project) between 2002 and 2005. In Phase 1, 11% of registered patients fulfilled criteria for recurrent regional pain consultation. Three-quarters had no recorded CWP-related generalized pain condition (e.g. fibromyalgia). In Phase 2, 53% of recurrent regional pain consulters had survey-reported widespread pain and 88% had consulted for somatic symptoms. Self-reported general health was worse in recurrent regional pain consulters than in single-region consulters, and poorest in those who also reported persistent widespread pain. Recurrent regional pain consulters are a heterogeneous group of frequent consulters sharing features with CWP (e.g. somatic symptoms) but including those less severely affected. They lie on the spectrum of polysymptomatic distress characteristic of CWP and represent a group whose needs may be better met by earlier diagnosis of multi-site pain.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Average symptom trajectories following incident radiographic knee osteoarthritis: data from the Osteoarthritis Initiative

Introduction Previous research has identified the existence of a prodromal phase of symptom worsening beginning on average 2–3 years prior to the first appearance of radiographic knee osteoarthritis (OA). The current study extends these observations to investigate the trajectory of self-reported pain, stiffness, function and other symptoms following the incidence of radiographic OA. Methods Data were from the incidence cohort of the Osteoarthritis Initiative public use data sets. Cases were defined as knees without symptoms at enrolment, which developed incident radiographic OA (Kellgren and Lawrence grade ≥2) at any of the first 4 annual follow-up visits. Symptoms investigated were knee-specific Western Ontario & McMaster Universities Osteoarthritis Index and Knee injury and Osteoarthritis Outcome Score subscale scores and individual items, available up to 3 years before and 5 years after the incidence of radiographic OA. Trajectories of having at least one of the symptoms from a subscale, and for each individual symptom over time, were fitted using multilevel logistic regression models. Results The probability of symptoms following the initial prodromal phase generally stabilised, whereas the probability of moderate, severe or extreme symptoms was consistently low. Two exceptions were pain frequency, which increased greatly in the lead up to incidence, then decreased slightly, and audible joint sounds, which had a much higher overall probability, and after increasing prior to incident radiographic OA, stabilised then started to increase again at 5 years. Conclusions Following an increase in the risk of symptoms during the prodromal phase, this risk does not continue to increase in the period up to 5 years after the incidence of radiographic OA

Distinctiveness of long-term pain that does not interfere with life: an observational cohort study.

BACKGROUND: Reporting of pain that does not interfere with life is common in the older population but little is known about people with such long-term non-interfering pain. OBJECTIVES: To assess whether non-interfering pain can be a long-term state, and to compare this group with those who continuously report no pain, and with those with chronic pain that interferes with life. METHODS: This was a prospective general population cohort study set within the North Staffordshire Osteoarthritis Project (NorStOP). People aged 50 plus were sent baseline, 3-year and 6-year questionnaires. Those who reported the same pain status (no pain, non-interfering pain, interfering pain) at each time point were compared on pain intensity, widespread pain and medication, and on sociodemographic and co-morbid characteristics at 6 years. RESULTS: Forty percent of responders reported the same pain status at each time point; 12% reported long-term non-interfering pain. Fifty-nine percent of those with non-interfering pain reported at least one site of high pain intensity, 33% reported widespread pain, and 90% had used pain medication in the past 4 weeks. This group was similar to the no-pain group but distinct on sociodemographic and co-morbid measures from those with pain that interfered. CONCLUSIONS: Long-term non-interfering pain is common, but despite often suffering from high pain intensity and widespread pain, those within this group seem to be able to control their pain without allowing it to affect their everyday lives. Future work is needed to assess how people with long-term pain ensure it does not cause interference with life

Does attrition during follow-up of a population cohort study inevitably lead to biased estimates of health status?

Attrition is a potential source of bias in cohort studies. Although attrition may be inevitable in cohort studies of older people, there is little empirical evidence as to whether bias due to such attrition is also inevitable. Anonymised primary care data, routinely collected in clinical practice and independent of any cohort research study, represents an ideal unselected comparison dataset with which to compare primary care data from consenting responders to a cohort study. Our objective was to use this method as a novel means to assess if (i) responders at follow-up stages in a cohort study remain representative of responders at baseline and (ii) attrition biases estimates of longitudinal associations. We compared primary care consultation morbidities and prescription prevalences among circa 32,000 patients aged 50+ who contribute to an anonymised general practice database (Consultations in Primary Care Archive (CiPCA)) with those from patients aged 50+ in the North Staffordshire Osteoarthritis Project (NorStOP) cohort, United Kingdom (2002-2008; n=16,159). 8,197 (51%) persons responded to the NorStOP baseline survey and consented to medical record review. 5,121 and 3,311 responded at 3- and 6-year follow-ups. Differences in consulting prevalence of non-musculoskeletal morbidities between NorStOP responders and CiPCA comparison population did not increase over the two follow-up points except for ischaemic heart disease. Differences observed at baseline for osteoarthritis-related consultations were generally unchanged at the two follow-ups (standardised prevalence ratios for osteoarthritis (1.09-1.13) and joint pain (1.12-1.23)). Age and gender adjusted associations between baseline consultation for chronic morbidity and future new osteoarthritis and related consultations were similar in CiPCA (adjusted Hazard Ratio: 1.40; 95% Confidence Interval: 1.34,1.47) and NorStOP 6-year responders (1.32; 1.15,1.51). There was little evidence that responders at follow-ups represented any further selection bias to that present at baseline. Attrition in cohort studies of older people does not inevitably indicate bias

Secular trends in work disability and its relationship to musculoskeletal pain and mental health: a time-trend analysis using five cross-sectional surveys (2002-2010) in the general population.

OBJECTIVES: International evidence suggests that rates of inability to work because of illness can change over time. We hypothesised that one reason for this is that the link between inability to work and common illnesses, such as musculoskeletal pain and mental illness, may also change over time. We have investigated this in a study based in one UK district. METHODS: Five population surveys (spanning 2002-2010) of working-age people aged >50 years and ≤65 years were used. Work disability was defined as a single self-reported item 'not working due to ill-health'. Presence of moderate-severe depressive symptoms was identified from the Mental Component Score of the Short Form-12, and pain from a full-body manikin. Data were analysed with multivariable logistic regression. RESULTS: The proportion of people reporting work disability across the surveys declined, from 17.0% in 2002 to 12.1% in 2010. Those reporting work disability, one-third reported regional pain, one-half widespread pain (53%) and two-thirds moderate-severe depressive symptoms (68%). Both factors were independently associated with work disability; their co-occurrence was associated with an almost 20-fold increase in the odds of reporting work disability compared with those with neither condition. CONCLUSIONS: The association of work disability with musculoskeletal pain was stable over time; depressive symptoms became more prominent in persons reporting work disability, but overall prevalence of work disability declined. The frequency and impact of both musculoskeletal pain and depression highlight the need to move beyond symptom-directed approaches towards a more comprehensive model of health and vocational advice for people unable to work because of illness