Interdisciplinary rehabilitation of patients with chronic widespread pain: Primary endpoint of the randomized, nonblinded, parallel-group IMPROvE trial

IntroductionThe association between chronic widespread pain (CWP) and disability is well established. Although research support large interindividual differences in functional outcomes, limited studies are available on the socio-economic consequences of offering stratified treatment based on prognostic factors. Identification of predictors of long-term functional outcomes such as work disability as a critical consequence, could assist early and targeted personalised interventions. The primary objective of this cohort study is to identify prognostic factors for the primary endpoint work status (employed and working vs not working) in patients with CWP assessed 3 years from baseline, that is, at referral for specialist care.Methods and analysesData are collected at the diagnostic unit at Department of Rheumatology, Frederiksberg Hospital. The first 1000 patients ≥18 years of age registered in a clinical research database (DANFIB registry) with CWP either ‘employed and working’ or ‘not working’ will be enrolled. Participants must meet the American College of Rheumatology 1990 definition of CWP, that is, pain in all four body quadrants and axially for more than 3 months and are additionally screened for fulfilment of criteria for fibromyalgia. Clinical data and patient-reported outcomes are collected at referral (baseline) through clinical assessment and electronic questionnaires. Data on the primary endpoint work status at baseline and 3 years from baseline will be extracted from the Integrated Labour Market Database, Statistics Denmark and the nationwide Danish DREAM database. Prognostic factor analysis will be based on multivariable logistic regression modelling with the dichotomous work status as dependent variable.Ethics and disseminationSensitive personal data will be anonymised according to regulations by the Danish Data Protection Agency, and informed consent are obtained from all participants. Understanding and improving the prognosis of a health condition like CWP should be a priority in clinical research and practice. Results will be published in international peer-reviewed journals.Trial registration numberNCT04862520.

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Body consciousness and Norwegian psycho motor physiotherapy. Experiences from patients with chronic widespread pain

PsycEXTRA Dataset ◽

10.1037/e573062012-040 ◽

2006 ◽

Author(s):

T. Dragesund ◽

M. Raheim

Keyword(s):

Chronic Widespread Pain ◽

Widespread Pain ◽

Body Consciousness

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Common Pains: Study Indicates Same Genes May Play A Role In Neuropathic And Chronic Widespread Pain

10.31988/scitrends.13089 ◽

2018 ◽

Author(s):

Paul Enck ◽

Nicole Simon

Keyword(s):

Chronic Widespread Pain ◽

Widespread Pain

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Brain-Derived Neurotrophic Factor and Immune Cells in Osteoarthritis, Chronic Low Back Pain, and Chronic Widespread Pain Patients: Association with Anxiety and Depression

Medicina ◽

10.3390/medicina57040327 ◽

2021 ◽

Vol 57 (4) ◽

pp. 327

Author(s):

Dominique Josephine Dimmek ◽

Christoph Korallus ◽

Sabine Buyny ◽

Gutenbrunner Christoph ◽

Ralf Lichtinghagen ◽

...

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Immune Cells ◽

Chronic Widespread Pain ◽

Anxiety And Depression ◽

Low Back ◽

Widespread Pain ◽

Chronic Pain Patients ◽

Pain Patients

Background and Objectives: Musculoskeletal dysfunction can induce several types of chronic pain syndromes. It is of particular interest to elucidate the pathomechanism of different forms of chronic pain. It is possible that patients who have developed chronic widespread pain (CWP) may endure different pathomechanisms as compared to those who suffer from local pain (osteoarthritis, OA) and regional pain (chronic low back pain, cLBP), especially with regard to pain regulation and its related biomediators. The aim of this study was to determine the differences in pathomechanisms among these patients by measuring pain-related biomediators, particularly brain-derived neurotrophic factor (BDNF). Additionally, subpopulations of immune cells were determined in parallel. Materials and Methods: Patients and healthy subjects (HSs) were recruited (age and gender-matched). BDNF was measured from serum samples of patients and HSs and the data of body composition parameters were recorded. Additionally, both patients and HSs were asked to fill in questionnaires related to pain intensity, anxiety, and depression. Results: Our results highlight that the levels of both free and total BDNF are significantly lower in pain patients compared to HSs, with p values of 0.041 and 0.024, respectively. The number of CD3− CD56bright natural killer (NK) cells shows significant differences between the groups. Comparing all chronic pain patients with HSs reveals a significantly lower number of CD4+ CD8+ T cells (p = 0.031), CD3− CD56bright NK cells (p = 0.049) and CD20+ CD3− cells (p = 0.007). Conclusions: To conclude, it seems that a general conformity between the pathomechanisms of different chronic pain diseases exists, although there are unique findings only in specific chronic pain patients.

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“My private theory is that it’s all in the head”: Understandings of chronic widespread pain among social workers from municipality job centers in Denmark

Health Psychology Open ◽

10.1177/2055102921995367 ◽

2021 ◽

Vol 8 (1) ◽

pp. 205510292199536

Author(s):

Rikke Schultz ◽

Peter la Cour ◽

Marius Brostrøm Kousgaard ◽

Annette Sofie Davidsen

Keyword(s):

Social Support ◽

Qualitative Study ◽

Case Management ◽

Social Workers ◽

Chronic Widespread Pain ◽

Health Condition ◽

Widespread Pain ◽

Sickness Benefits ◽

To Receive

People with chronic widespread pain (CWP) are often unfit for work, and consequently they are dependent on the municipality job center to receive social support and sickness benefits. The job center’s case management is based on a social worker’s assessment of the citizen’s health condition. This qualitative study investigates social workers’ understandings of CWP. Interviews were carried out with 12 social workers. The results showed that the participants predominantly experienced the citizens’ illnesses as psychosocially mediated—referring to trauma, or a lack of meaning in the citizens’ lives. Only a few participants mentioned possibilities for somatic explanations of CWP.

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Are sleep problems and non-specific health complaints risk factors for chronic pain? A prospective population-based study with 17 year follow-up

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2012.04.001 ◽

2012 ◽

Vol 3 (4) ◽

pp. 210-217 ◽

Cited By ~ 26

Author(s):

Anne K. Nitter ◽

Are H. Pripp ◽

Karin Ø. Forseth

Keyword(s):

Risk Factors ◽

Chronic Pain ◽

Sleep Problems ◽

Population Based ◽

Chronic Widespread Pain ◽

Health Complaints ◽

Widespread Pain ◽

Population Based Study ◽

Specific Health

AbstractIntroductionChronic musculoskeletal pain represents a significant health problem among adults in Norway. The prevalence of chronic pain can be up to 50% in both genders. However, the prevalence of chronic widespread pain is significantly higher in females than in males. Chronic widespread pain is seen as the end of a continuum of pain. There is rather sparse knowledge about the incidence of pain in initially pain free individuals and the course of self-reported pain over time. Moreover, little is known about risk factors for incidence of chronic pain or prognostic factors for the course of self-reported pain. We believe that such knowledge may contribute to develop strategies for treatment at an early stadium of the pain condition and thereby reduce the prevalence of chronic pain included chronic widespread pain.Aims of the studyThe aims of this study were threefold: (1) to calculate the incidence of self-reported musculoskeletal pain in a female cohort, (2) to describe the course of pain and (3) to investigate whether or not health complaints and sleep problems are predictive factors for onset of pain or prognostic factors for the course of pain.MethodsThis is a prospective population-based study of all women between 20 and 50 years who were registered in Arendal, Norway, in 1989 (N = 2498 individuals). A questionnaire about chronic pain (pain >3 months duration in muscles, joints, back or the whole body), modulating factors for pain, sleep problems and seven non-specific health complaints was mailed to all traceable women, in 1990 (N =2498), 1995 (n = 2435) and 2007 (n = 2261). Of these, 1338 responded on all three occasions. Outcome measures were presence and extent of chronic pain.ResultsThe prevalence of chronic pain was 57% in 1990 and 61% in 2007. From 1990 to 2007, 53% of the subjects changed pain category. The incidence of chronic pain in initially pain free individuals during follow-up was 44%, whereas the recovery rate was 25%. Impaired sleep quality predicted onset of chronic pain. There was a linear association between the number of health complaints and the incidence of chronic pain in initially pain free individuals. Equivalent results were found for persistence of pain and worsening of pain.ConclusionThe prevalence of chronic pain was rather stable throughout the follow-up period, but the prevalence of chronic widespread pain increased. Individual changes in pain extent occurred frequently. The presence of sleep disturbances and number of health complaints predicted onset, persistence and worsening of pain.ImplicationsSleep problems must be thoroughly addressed as a possible risk factor for onset or worsening of pain. Elimination of sleep problems in an early phase is an interesting approach in treating chronic pain. More research is needed to illuminate the possible pathogenetic relations between pain, non-specific health complaints, sleep problems and also depression.

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