Dataset Information

Clinical Phenotyping of Youth With New-Onset Musculoskeletal Pain: A Controlled Cohort Study.

ABSTRACT: The course of pediatric musculoskeletal pain from acute to chronic has not been well described and there is limited understanding of how to identify individuals with new-onset pain who may be predisposed to developing persisting symptoms. Thus, the purpose of this study was to describe the clinical phonotype of treatment-seeking youth with new-onset musculoskeletal pain compared with youth with and without chronic pain. Further, we tested predictors of pain-related disability and pain sensitivity in the new-onset pain sample.Participants were 191 youth, ages 10 to 17 years, representing 3 cohorts (new-onset musculoskeletal pain, chronic musculoskeletal pain, and a comparison group without chronic pain). Participants completed questionnaire measures of pain characteristics, psychological functioning, sleep, and pain-related disability. They also attended a laboratory visit to complete an experimental pain assessment using heat and cold stimuli to assess pain sensitivity and conditioned pain modulation.Findings revealed youth with new-onset musculoskeletal pain had a distinct clinical phenotype where symptoms of pain and disability were in the mid-range between those of youth with diagnosed chronic musculoskeletal pain and youth in the community without chronic pain. Linear regressions within the new-onset pain sample demonstrated poorer sleep quality and higher pain fear predicted greater pain-related disability, and pain catastrophizing predicted cold pressor sensitivity.Clinical phenotyping of youth with new-onset musculoskeletal pain highlights factors relevant to the pain experience. Future research can examine the roles of these variables in predicting longitudinal risk for chronic pain and disability.

SUBMITTER: Lewandowski Holley A

PROVIDER: S-EPMC5140689 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Clinical Phenotyping of Youth With New-Onset Musculoskeletal Pain: A Controlled Cohort Study.

Lewandowski Holley Amy A Wilson Anna C AC Cho Elise E Palermo Tonya M TM

The Clinical journal of pain 20170101 1

<h4>Objectives</h4>The course of pediatric musculoskeletal pain from acute to chronic has not been well described and there is limited understanding of how to identify individuals with new-onset pain who may be predisposed to developing persisting symptoms. Thus, the purpose of this study was to describe the clinical phonotype of treatment-seeking youth with new-onset musculoskeletal pain compared with youth with and without chronic pain. Further, we tested predictors of pain-related disability ...[more]

PMID: 27340913

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Project description:BACKGROUND:Chronic musculoskeletal pain (MSP) is frequent in adolescents and has major medical and social consequences. In many cases, when no cause has been clearly established, this pain may be considered to be chronic idiopathic MSP. Our study seeks to identify general criteria for this type of pain through the experience of professionals from tertiary care centers with expertise in pediatric and adolescent chronic MSP. METHODS:Cross-sectional multicenter qualitative study. Semi-structured interviews of 25 professionals at a rheumatology reference center and in its network for pain management, including diverse specialists and professions. Interpretative Phenomenological Analysis is used to explore the data. RESULTS:This approach led us to identify 10 themes organized around three superordinate themes covering different stages of the diagnostic process: 1) the medical pain history up to the consultation at the reference center; 2) the professional's subjective feelings about the clinical presentation; 3) from the clinical examination to diagnosis and treatment of chronic idiopathic MSP. The main elements guiding this diagnosis do not come from the physical examination but from the medical history and the professionals' subjective feelings, that is, their clinical judgment. The professionals' impression of uneasiness and frustration, induced by patients and their parents, is of major importance. CONCLUSION:The principal elements guiding the diagnosis of chronic idiopathic MSP do not come primarily from the physical examination but rather from the pain history and the health professional's subjective feelings. Our results suggest that the concept of Juvenile Fibromyalgia (JFM) does not appear to cover all situations of chronic idiopathic MSP in adolescence. A constellation of non-organic criteria enables diagnosis of the latter; these criteria should be validated to avoid medical nomadism and multiple investigations and to shorten the interval until patients receive optimal pain management. CLINICAL TRIAL REGISTRATION:clinicaltrials.gov, NCT03171792, https://clinicaltrials.gov/ct2/show/NCT03171792?term=LACHAL&cntry=FR&city=paris&rank=1.

Project description:BACKGROUND:Chronic musculoskeletal pain has a vast global prevalence and economic burden. Conservative therapies are universally recommended but require patient engagement and self-management to be effective. OBJECTIVE:This study aimed to evaluate the efficacy of a 12-week digital care program (DCP) in a large population of patients with chronic knee and back pain. METHODS:A longitudinal observational study was conducted using a remote DCP available through a mobile app. Subjects participated in a 12-week multimodal DCP incorporating education, sensor-guided exercise therapy (ET), and behavioral health support with 1-on-1 remote health coaching. The primary outcome was pain measured by the visual analog scale (VAS). Secondary measures included engagement levels, program completion, program satisfaction, condition-specific pain measures, depression, anxiety, and work productivity. RESULTS:A total of 10,264 adults with either knee (n=3796) or low back (n=6468) pain for at least three months were included in the study. Participants experienced a 68.45% average improvement in VAS pain between baseline intake and 12 weeks. In all, 73.04% (7497/10,264) participants completed the DCP into the final month. In total, 78.60% (5893/7497) of program completers (7144/10,264, 69.60% of all participants) achieved minimally important change in pain. Furthermore, the number of ET sessions and coaching interactions were both positively associated with improvement in pain, suggesting that the amount of engagement influenced outcomes. Secondary outcomes included a 57.9% and 58.3% decrease in depression and anxiety scores, respectively, and 61.5% improvement in work productivity. Finally, 3 distinct clusters of pain response trajectories were identified, which could be predicted with a mean 76% accuracy using baseline measures. CONCLUSIONS:These results support the efficacy and scalability of a DCP for chronic low back and knee pain in a large, diverse, real-world population. Participants demonstrated high completion and engagement rates and a significant positive relationship between engagement and pain reduction was identified, a finding that has not been previously demonstrated in a DCP. Furthermore, the large sample size allowed for the identification of distinct pain response subgroups, which may prove beneficial in predicting recovery and tailoring future interventions. This is the first longitudinal digital health study to analyze pain outcomes in a sample of this magnitude, and it supports the prospect for DCPs to serve the overwhelming number of musculoskeletal pain sufferers worldwide.

Project description:ObjectiveShoulder pain is a common health problem coexisting with other musculoskeletal pain. However, the effects of pre-existing musculoskeletal pain on the development of shoulder pain are not clear. The present study aimed to elucidate the association between coexisting musculoskeletal pain at other body sites and new-onset shoulder pain among survivors of the Great East Japan Earthquake (GEJE).DesignThis is a longitudinal study.SettingThe study was conducted at the severely damaged coastal areas in Ishinomaki and Sendai cities.ParticipantsThe survivors who did not have shoulder pain at 3 years after the GEJE were followed up 1 year later (n=2131).InterventionsMusculoskeletal pain (low back, hand and/or foot, knee, shoulder and neck pain) was assessed using self-reported questionnaires.Main outcome measuresThe outcome of interest was new-onset shoulder pain, which was defined as shoulder pain absent at 3 years but present at 4 years after the disaster. The main predictive factor for new-onset shoulder pain was musculoskeletal pain in other body parts at 3 years after the GEJE; this was categorised according to the number of pain sites (0, 1, ≥2). Multiple regression analyses were conducted to calculate the odds ratio (OR) and 95% confidence interval (CI) for new-onset shoulder pain due to musculoskeletal pain in other body parts.ResultsThe incidence of new-onset shoulder pain was 6.7% (143/2131). Musculoskeletal pain in other body parts was significantly associated with new-onset shoulder pain. Using the survivors without other musculoskeletal pain as reference, the adjusted OR and 95% CI for new-onset shoulder pain were 1.86 (1.18 to 2.94) for those with one body part and 3.22 (2.08 to 4.98) for those with ≥2 body parts presenting with musculoskeletal pain (p<0.001).ConclusionsPre-existing musculoskeletal pain in other body parts was significantly associated with new-onset shoulder pain among survivors; this provides useful information for clinical and public health policies.

Dataset Information

Clinical Phenotyping of Youth With New-Onset Musculoskeletal Pain: A Controlled Cohort Study.

Publications

Clinical Phenotyping of Youth With New-Onset Musculoskeletal Pain: A Controlled Cohort Study.

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