The journal of pain : official journal of the American Pain Society
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In both pain research and clinical practice, patient-reported outcome measures are used to assess dimensions of health. Interpreting these instruments requires understanding their measurement error and what magnitude of change has subjective importance for patients. This study estimated the standard error of measurement (SEM), one-year minimal detectable change, and one-year minimal clinically important difference (MCID) for the Short Form-36 Health Survey physical component summary (SF-36 PCS) and mental (SF36 MCS), the Hospital Anxiety and Depression Scale anxiety symptoms (HADS-A) and depression symptoms (HADS-D) subscales, and the Numeric Rating Scale (NRS) for past-week average pain intensity. ⋯ PERSPECTIVE: This article presents estimates of minimal clinically important difference and minimal detectable change for several commonly used patient-reported outcome measures among patients with chronic pain. These estimates can help clinicians and researchers to determine when a measured health improvement is subjectively important to the patient and greater than measurement error. DATA AVAILABILITY: Data Availability Statement: The data utilized in this study are not available due to ethical considerations and the need for appropriate ethical approval.
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Insufficient and deficient vitamin D may be associated with chronic musculoskeletal pain, but study findings are conflicting, and few account for important confounding factors. This cross-sectional study explored the association between serum vitamin D status and chronic musculoskeletal pain in various body sites, adjusting for a wide range and number of potential confounding factors. Data collected at the baseline assessments of 349,221 UK Biobank participants between 2006 and 2010 were analysed. ⋯ This study suggests that while vitamin D status is not a key independent determinant of chronic regional musculoskeletal pain, severe vitamin D deficiency may be associated with chronic widespread pain. PERSPECTIVES: After counting for various confounders, severe vitamin D deficiency remained significantly associated with increased risk of experiencing chronic widespread pain. Considering the low risk and affordability of vitamin D supplements, their potential use in treating chronic widespread pain in severely vitamin D deficient individuals warrants further exploration.
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Hyperglycaemia and high adiposity are risk factors for pain in diabetes. To clarify these links with pain, the effects of a glucose load on sensory detection, pain sensitivity, conditioned pain modulation (primary aims), and autonomic and endothelial functions (secondary aims) were examined in 64 pain-free participants: 22 with normal adiposity (determined by dual-energy X-ray absorptiometry), 29 with high adiposity, and 13 with combined high adiposity and elevated glycated haemoglobin (HbA1c; including prediabetes and type 2 diabetes). Participants ingested either 37.5-g glucose or 200-mg sucralose (taste-matched) in the first session and crossed over to the other substance in the second session one month later. ⋯ The disruptive effect of hyperglycaemia on conditioned pain modulation increases in line with central obesity, which might facilitate pain in diabetes. PERSPECTIVE: Ingesting 37.5-g glucose (approximately 350-mL soft drink) interfered with pain modulation in pain-free adults with normal adiposity or with combined high adiposity and HbA1c levels. The interference was stronger alongside increasing central obesity, suggesting that controlling blood glucose and body fat mass might help preserve pain modulation.
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Pain in adolescence can lead to the development of serious mental health issues, including suicidality. This risk may be strengthened among youth exposed to more adverse childhood experiences (ACEs; abuse, neglect, household challenges). This longitudinal study examined the role of ACEs in the relationship between pain and later suicidality onset and severity among a cohort of adolescents at risk for developing mental health problems. ⋯ Findings underscore the critical need to adopt a trauma informed lens to pediatric pain prevention and treatment (e.g., screening for ACEs), and for pain to be on the child mental health agenda. PERSPECTIVE: This article provides evidence that while pain is a risk factor for future increased suicidality severity, it is a particularly strong risk factor in youth who experienced increased childhood adversity. These results may help identify youth at greatest risk for suicidality.
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In patients with low back pain, a visually identified retrospective pain trajectory often mismatches with a trajectory derived from prospective repeated measures. To gain insight into the clinical relevance of the two trajectory types, we investigated which showed a higher association with clinical outcomes. Participants were 724 adults seeking care for low back pain in Danish chiropractic primary care. ⋯ Patients' retrospective assessments seem to offer an interpretation of their pain course that is likely more clinically relevant in understanding the perceived impact of their condition than trajectories based on repeated measures. PERSPECTIVE: Prospective pain data inadequately reflect patients' clinical status. Retrospective assessments provide a more clinically valuable understanding of the impact of their condition.