The relationship between chronic pain and cardiovascular disease: Squaring the circle?

AbstractBackground and AimsChronic pain is a potentially disabling condition affecting one in three people through impaired physical function and quality of life. While the psychosocial impact of chronic pain is already well established, little is known about the potential biological consequences. Chronic pain may be associated with an increased prevalence of cardiovascular disease, an effect that has been demonstrated across a spectrum of chronic pain conditions including low back pain, pelvic pain, neuropathic pain and fibromyalgia. The aim of this study was to review and summarize the evidence for a link between chronic pain and cardiovascular disease. We sought to clarify the nature of the relationship by examining the basis for a dose-response gradient (whereby increasing pain severity would result in greater cardiovascular disease), and by evaluating the extent to which potentially confounding variables may contribute to this association.MethodsMajor electronic databases MEDLINE, EMBASE, Psychinfo, Cochrane, ProQuest and Web of Science were searched for articles reporting strengths of association between chronic pain (pain in one or more body regions, present for three months or longer) and cardiovascular outcomes (cardiovascular mortality, cardiac disease, and cerebrovascular disease). Meta-analysis was used to pool data analysing the association between chronic pain and the three principal cardiovascular outcomes. The impact of pain severity, and the role of potentially confounding variables were explored narratively.ResultsThe searches generated 11,141 studies, of which 25 matched our inclusion criteria and were included in the review. Meta-analysis (of unadjusted study outcomes) demonstrated statistically significant associations between chronic pain and mortality from cardiovascular diseases: pooled odds ratio 1.20, (95% confidence intervals 1.05–1.36); chronic pain and cardiac disease: pooled odds ratio 1.73 (95% confidence intervals 1.42–2.04); and chronic pain and cerebrovascular disease: pooled odds ratio 1.81 (95% confidence intervals 1.51–2.10). The systematic review also found evidence supporting a dose-response relationship, with greater pain intensity and distribution producing a stronger association with cardiovascular outcomes.All of the included studies were based on observational data with considerable variation in chronic pain taxonomy, methodology and study populations. The studies took an inconsistent and incomplete approach in their adjustment for potentially confounding variables, making it impossible to pool data after adjustments for confounding variables, so it cannot be concluded that these associations are causal.ConclusionsOur review supports a possible dose-response type of association between chronic pain and cardiovascular disease, supported by a range of observational studies originating from different countries. Such research has so far failed to satisfactorily rule out that the association is due to confounding variables. What is now needed are further population based longitudinal studies that are designed to allow more robust exploration of a cause and effect relationship.ImplicationsGiven the high prevalence of chronic pain in developed and developing countries our results highlight a significant, but underpublicized, public health concern. Greater acknowledgement of the potentially harmful biological consequences of chronic pain may help to support regional, national and global initiatives aimed at reducing the burden of chronic pain.

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Literature Review: Immune System and Its Relation to Depression

Jurnal Psikiatri Surabaya ◽

10.20473/jps.v10i2.28416 ◽

2021 ◽

Vol 10 (2) ◽

pp. 46

Author(s):

Wati Evilia ◽

Anak Ayu Sri Wahyuni ◽

Luh Alit Aryani

Keyword(s):

Rheumatoid Arthritis ◽

Cardiovascular Disease ◽

Chronic Pain ◽

Immune System ◽

Literature Review ◽

Environmental Conditions ◽

Biological Responses ◽

Increase Risk ◽

Maladaptive Response ◽

The Relationship

It has been shown that the immune system and mental status are interrelated. Psychoneuroimmunology is a field that studies these two relationships, one of the most studied is the relationship between the immune system and depression. Psychological stress can substantially increase inflammatory activity and increase risk for various health problems. Socioal-environmental conditions trigger biological responses that may lead to an increase in the proinflammatory phenotype which is hypothesized to be a key phenomenon driving the pathophysiology and relapse of depression, as well as the overlap of depression with several somatic conditions such as rheumatoid arthritis, chronic pain, cardiovascular disease, and neurodegeneration. The immune system and depression have a bidirectional link that influences each other. Exposure to chronic stressful situations can cause a maladaptive response by the immune system, which will be involved in the pathophysiology of depression.

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The relationship between pain-related fear and hypervigilance in patients with chronic pain

PsycEXTRA Dataset ◽

10.1037/e536932011-113 ◽

2002 ◽

Author(s):

J. Roelofs

Keyword(s):

Chronic Pain ◽

The Relationship

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The Relationship between Immigration Status and Cardiovascular Disease Risk Factors in United States Adults with Diabetes—A 14-Year Study

Diabetes ◽

10.2337/db18-1491-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1491-P

Author(s):

APRILL DAWSON ◽

EMMA GARACCI ◽

MUKOSO N. OZIEH ◽

REBEKAH J. WALKER ◽

LEONARD E. EGEDE

Keyword(s):

United States ◽

Risk Factors ◽

Cardiovascular Disease ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Cardiovascular Disease Risk Factors ◽

Immigration Status ◽

The Relationship

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New Views on the Relationship of Plasma Lipids to Cardiovascular Disease

Circulation ◽

10.1161/01.cir.95.6.1347 ◽

1997 ◽

Vol 95 (6) ◽

pp. 1347-1348 ◽

Cited By ~ 5

Author(s):

Russell P. Tracy ◽

Paula B. Tracy

Keyword(s):

Cardiovascular Disease ◽

Plasma Lipids ◽

Relationship Of ◽

The Relationship

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THE RELATIONSHIP OF OBESITY AND LOW HANDGRIP STRENGTH OR SARCOPENIC OBESITY AS A PREDICTOR OF THE PRESENCE OF CARDIOVASCULAR DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)32913-2 ◽

2020 ◽

Vol 75 (11) ◽

pp. 2286

Author(s):

Jose Patricio Lopez ◽

Patricio Lopez-Jaramillo ◽

Paul A. Camacho ◽

Darryl Leong ◽

Sumathy Rangarajan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Handgrip Strength ◽

Sarcopenic Obesity ◽

Relationship Of ◽

The Relationship

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Cardiovascular disease and osteoporosis: is there a link between lipids and bone?

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1258/0004563021902134 ◽

2002 ◽

Vol 39 (3) ◽

pp. 203-210 ◽

Cited By ~ 37

Author(s):

John R Burnett ◽

Samuel D Vasikaran

Keyword(s):

Cardiovascular Disease ◽

Bone Density ◽

Vascular Calcification ◽

Cholesterol Biosynthesis ◽

Hormone Replacement ◽

Plasma Lipid ◽

Clinical Effects ◽

Cardiovascular Morbidity And Mortality ◽

The Relationship

Atherosclerotic heart disease and osteoporosis are both diseases of old age. Evidence is accumulating for a link between vascular and bone disease. Calcification is a common feature of atherosclerotic plaques, and osteoporosis is associated with both atherosclerosis and vascular calcification. However, the relationship of vascular calcification to the pathogenesis of atherosclerosis remains incompletely understood. Hormone replacement therapy has beneficial effects in the prevention of both atherosclerosis and osteoporosis. Bisphosphonates inhibit bone resorption and are used in the treatment of osteoporosis, whereas the statins inhibit cholesterol biosynthesis and are used for the treatment of atherosclerosis. We have reviewed recent advances in the knowledge of the actions of bisphosphonates and statins at the cellular, molecular and end-organ levels in order to examine the relationship between cardiovascular disease and osteoporosis and to explore the link between lipids and bones. These studies suggest that the mechanism of actions of these two classes of drugs at the cellular level may not be mutually exclusive. There are some early clinical data to complement these findings, suggesting that statins increase bone density and bisphosphonates may have a beneficial effect in vivo on plasma lipid levels and on the atherosclerotic process. Properly designed prospective studies that examine the effect of statins on bone density and fractures, as well as the effects of bisphosphonates on lipid profiles, atherosclerotic progression and cardiovascular morbidity and mortality are needed to define clearly the clinical effects and potential new roles for these agents.

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HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries

BMC Public Health ◽

10.1186/s12889-021-11218-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Leonard E. Egede ◽

Rebekah J. Walker ◽

Patricia Monroe ◽

Joni S. Williams ◽

Jennifer A. Campbell ◽

...

Keyword(s):

South Africa ◽

Cardiovascular Disease ◽

Health Survey ◽

Survey Design ◽

Logistic Models ◽

Population Data ◽

Demographic And Health Survey ◽

Sub Saharan Africa ◽

Sub Saharan ◽

The Relationship

Abstract Background Investigate the relationship between two common cardiovascular diseases and HIV in adults living in sub-Saharan Africa using population data provided through the Demographic and Health Survey. Methods Data for four sub-Saharan countries were used. All adults asked questions regarding diagnosis of HIV, diabetes, and hypertension were included in the sample totaling 5356 in Lesotho, 3294 in Namibia, 9917 in Senegal, and 1051 in South Africa. Logistic models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome and HIV status as the primary independent variable. Models were adjusted for age, gender, rural/urban residence and BMI. Complex survey design allowed weighting to the population. Results Prevalence of self-reported diabetes ranged from 3.8% in Namibia to 0.5% in Senegal. Prevalence of self-reported hypertension ranged from 22.9% in Namibia to 0.6% in Senegal. In unadjusted models, individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08–3.73), however the relationship lost significance after adjustment. Individuals with HIV were less likely to have self-reported diabetes after adjustment in Namibia (OR = 0.29, 95% CI 0.12–0.72) and less likely to have self-reported hypertension after adjustment in Lesotho (OR = 0.63, 95% CI 0.47–0.83). Relationships were not significant for Senegal or South Africa. Discussion HIV did not serve as a risk factor for self-reported cardiovascular disease in sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease, it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV. Conclusions The odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.

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Evaluating the Relationship Between Initial Injury, Referral to A Pain Clinic, and Medical Retirement from the Army: A Retrospective Analysis

Military Medicine ◽

10.1093/milmed/usaa463 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 502-505

Author(s):

Justin J Stewart ◽

Diane Flynn ◽

Alana D Steffen ◽

Dale Langford ◽

Honor McQuinn ◽

...

Keyword(s):

Chronic Pain ◽

Retrospective Analysis ◽

Extended Period ◽

Pain Clinic ◽

Outcome Variable ◽

Future Research ◽

Curvilinear Relationship ◽

The Impact ◽

Pain Care ◽

The Relationship

ABSTRACT Introduction Soldiers are expected to deploy worldwide and must be medically ready in order to accomplish their mission. Soldiers unable to deploy for an extended period of time because of chronic pain or other conditions undergo an evaluation for medical retirement. A retrospective analysis of existing longitudinal data from an Interdisciplinary Pain Management Center (IPMC) was used to evaluate the temporal relationship between the time of initial duty restriction and referral for comprehensive pain care to being evaluated for medical retirement. Methods Patients were adults (>18 years old) and were cared for in an IPMC at least once between May 1, 2014 and February 28, 2018. A total of 1,764 patients were included in the final analysis. Logistic regression was used to evaluate the impact of duration between date of first duty restriction documentation and IPMC referral to the outcome variable of establishment of a permanent 3 (P3) profile. Results The duration between date of first duty restriction and IPMC referral showed a curvilinear relationship to probability of a P3 profile. According to our model, a longer duration before referral is associated with an increased probability of a subsequent P3 profile with the highest probability peaking at 19 months. The probability of P3 declines gradually for those who were referred later. Discussion This is the first time the relationship between time of initial duty restriction, referral to an IPMC, and subsequent P3 or higher profile has been tested. Future research is needed to examine medical conditions listed on the profile to see how they might contribute to the cause of referral to the IPMC. Conclusion A longer duration between initial duty restriction and referral to IPMC was associated with higher odds of subsequent P3 status for up to 19 months. Referral to an IPMC for comprehensive pain care early in the course of chronic pain conditions may reduce the likelihood of P3 profile and eventual medical retirement of soldiers.

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Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan

Healthcare ◽

10.3390/healthcare9060630 ◽

2021 ◽

Vol 9 (6) ◽

pp. 630

Author(s):

Satoshi Shimo ◽

Yuta Sakamoto ◽

Takashi Amari ◽

Masaaki Chino ◽

Rie Sakamoto ◽

...

Keyword(s):

Chronic Pain ◽

Elderly People ◽

Physical Disability ◽

The Elderly ◽

Daily Basis ◽

Community Dwelling ◽

Negative Effects ◽

The Relationship ◽

Elderly Healthcare ◽

Disability Research

Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.

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