Change in number of pain sites - which factors are important? A 12-year prospective cohort study.

BACKGROUND: Pain in multiple body sites is common and often persistent. The purpose of this prospective study was to examine the change in the number of pain sites (NPS) over time and to evaluate to which extent clinical, demographic, lifestyle and health-related factors predict a change in NPS. METHODS: This was a population-based longitudinal cohort study of adults (n = 2,357). Data on pain, demographic, lifestyle, and health-related variables were collected by questionnaires in 2008 and 2020 and register data from 2006 to 2017. Data was analysed with linear regression. RESULTS: We found a mean decrease in NPS over the 12-year follow-up period (-0.36 (95% CI; -0.44; -0.27) and 56% of this sample reported no change or only one pain site increase/decrease over 12 years. While participants reporting pain for less than 3 months at baseline had almost no change in NPS (-0.04 (95% CI; -0.18; 0.10)), participants with pain for longer than 3 months decreased by -0.51 (95% CI; -0.62; -0.41). Age at baseline (20-49 years), pain intensity, and obesity (BMI ≥ 30) were associated with an increase in NPS over the follow-up period. CONCLUSIONS: NPS is relatively stable over time. We found a small mean decrease in NPS over 12 years varying between participants with pain for longer than 3 months and pain for less than 3 months respectively. The results also indicate that pain intensity, age, and obesity could be relevant factors to consider when predicting change in NPS.

How do people with chronic pain explain their use, or non-use, of pain-related healthcare services? A qualitative study of patient experiences.

PURPOSE: This study aims to explore how people with chronic pain explain their use or non-use of pain-related healthcare services and their expectations of the healthcare provider, and explore how explanations and expectations vary between different levels of pain-related healthcare use. MATERIALS AND METHODS: We conducted 20 individual semi-structured interviews with purposely sampled adults between 39 and 77 years of age with chronic pain. All interviews were audio-recorded, transcribed and analysed using a thematical template analysis approach. RESULTS: Four key drivers for pain-related healthcare use were identified: (1) the healthcare system facilitates clinical pathways, (2) appraisal of pain-related healthcare initiatives influences future use, (3) autonomy, beliefs and values determine healthcare behaviour, and (4) recommendations from others impact healthcare behaviour. Comparing explanations across different pain-related healthcare user groups (high, medium and low) showed that perceived needs, beliefs and values, and appraisal of previous healthcare experiences differed between these groups. CONCLUSIONS: Beliefs, pain characteristics, recommendations, and the search for a diagnostic label, often initiate pain-related healthcare use. Healthcare is modified by two interconnected systems: (1) perceived needs, beliefs and values and (2) previous healthcare experiences. Differences related to these systems could explain some of the variance in pain-related healthcare use.Implications for RehabilitationDifferent use of pain-related healthcare services for people with chronic pain could be related to differences in perceived needs, beliefs and values and appraisal of previous healthcare.It may be helpful to explore the perceived needs and beliefs of those seeking healthcare due to chronic pain.Previous healthcare experiences may impact and should be explored.

Trajectories of Musculoskeletal Healthcare Utilization of People with Chronic Musculoskeletal Pain - A Population-Based Cohort Study.

BACKGROUND AND AIM: Chronic musculoskeletal pain is common and associated with more general healthcare-seeking. However, musculoskeletal-related healthcare utilization is under-explored. This study aimed to explore, describe and profile trajectories of long-term musculoskeletal healthcare for people reporting chronic musculoskeletal pain. METHODS: This exploratory prognostic cohort study combined survey and national health register data from a representative group of adult Danes reporting chronic musculoskeletal pain (N = 2929). Trajectories of long-term musculoskeletal healthcare use were generated using latent class growth analysis. Types of healthcare-seeking, individual, sociodemographic, health, belief and work-related factors were used to describe and profile identified trajectories. RESULTS: We identified five distinct trajectories of long-term musculoskeletal healthcare utilization (low stable, low ascending, low descending, medium stable and high stable). The low stable trajectory group (no or almost no annual contacts) represented 39% of the sample, whereas the high stable trajectory group (consistent high number of annual contacts) represented 8%. Most healthcare-seeking was in primary healthcare settings (GP/physiotherapy/chiropractor). Opioid consumption was primarily in the high stable trajectory group, and surgery was rare. There were statistically significant differences across the five trajectory groups in individual, sociodemographic, health, belief and work-related profiles. CONCLUSION: Long-term use of musculoskeletal healthcare services varied in this chronic musculoskeletal pain population. Almost 40% coped without seeking care, whereas 8% had consistent high use of healthcare services. Chronic musculoskeletal pain was mostly managed in primary care settings, which aligns with musculoskeletal guidelines, as did the use of pain medication and surgery. People with different musculoskeletal healthcare trajectories had different individual, sociodemographic, health, belief and work-related profiles.

Socio-demographic, clinical and psychological predictors of healthcare utilization among patients with musculoskeletal disorders: a prospective cohort study.

BACKGROUND: Musculoskeletal disorders are common in the general population and a leading cause for care seeking. Despite the large number of patients with musculoskeletal disorders seeking care, little is known of the clinical course, pathways and predictors of healthcare utilization among these patients. The purposes of the study were to 1) describe the clinical course and related healthcare utilization in primary care physiotherapy and secondary healthcare among patients with neck, shoulder and low-back pain treated in physiotherapy practice, and 2) identify independent clinical, socio-demographic, psychological and general health predictors of healthcare utilization. METHODS: The study was a prospective cohort study of patients seeking physiotherapy treatment for neck, shoulder, or low-back pain in physiotherapy practices across Denmark. A total of 759 physiotherapy patients completed questionnaires containing information on clinical course and potential predictors of healthcare utilization. Healthcare utilization was obtained from the Danish National Health Service Register and National Patient Register. Associations between potential predictors and low/high primary care physiotherapy utilization and hospital contacts in relation to specific neck, shoulder or low-back disorders were analysed using binomial regression analyses and adjusted for age, sex, duration of pain and comorbidity. RESULTS: During 6 months follow-up, patients experienced clinically relevant improvements in pain, fear avoidance and psychological wellbeing. Patients with higher baseline pain and disability and who were on sickness leave were more likely to have high primary care physiotherapy utilization. Hospital contacts were predicted by higher levels of pain, disability and low psychological wellbeing. CONCLUSIONS: Clinical factors and sickness leave seems to be the main predictors of primary care physiotherapy utilization, whereas for secondary care contacts, psychological factors may also be of importance. The study contributes to the on-going research into clinical pathways and may identify future target areas to reduce healthcare utilization in patients with musculoskeletal disorders.

The scapular dyskinesis test: Reliability, agreement, and predictive value in patients with subacromial impingement syndrome.

STUDY DESIGN: Prospective cohort. INTRODUCTION: Assessment of scapular dysfunction is considered important in the clinical evaluation and treatment of patients with symptoms of subacromial impingement. However, sparse research has been conducted into the reliability and predictive value of clinical tests with which to identify scapular dyskinesis. PURPOSE OF THE STUDY: To evaluate intrarater and interrater reliability and predictive value of the Scapular Dyskinesis Test (SDT) in patients with subacromial impingement syndrome. METHODS: Forty-five patients with subacromial impingement syndrome were included. The presence of scapular dyskinesis was classified by 2 raters using the SDT. Intrarater and interrater reliabilities were examined and compared. Patients with and without scapular dyskinesis were compared in terms of Oxford Shoulder Score and EQ-5D-5L scores at baseline and 3 months, as well rating of overall improvement in shoulder condition. RESULTS: SDT could not be performed in 5 patients, leaving 40 patients for further analysis. Kappa with squared weights was 0.64 for rater A and 0.86 for rater B; the intrarater agreement was 88% for A and 96% for B. For interrater comparison, the Kappa value was 0.59 and agreement 86%. No statically significant differences in Oxford Shoulder Score and EQ-5D-5L baseline and change scores or overall improvement in shoulder condition at 3 months were observed between patients with or without scapular dyskinesis. CONCLUSIONS: Intrarater and interrater reliability and agreement of the SDT were determined. The findings that functional impairment and outcomes did not differ between patients with or without the presences of scapular dyskinesis may question the clinical value of the SDT in patients with subacromial impingement syndrome. LEVEL OF EVIDENCE: 1b.

Widespread pain - do pain intensity and care-seeking influence sickness absence? - A population-based cohort study.

BACKGROUND: Both musculoskeletal pain-intensity in relation to a specific location (e.g. lower back or shoulder) and pain in multiple body regions have been shown to be associated with impaired function and sickness absence, but the impact of pain intensity on the association between widespread pain and sickness absence has not been studied. Additionally it is unknown whether care-seeking in general practice due to musculoskeletal disorders has a positive or negative impact on future absenteeism. The purpose of this study was to examine the influence of pain intensity on the association between number of musculoskeletal pain sites and sickness absence, and to analyze the impact on absenteeism from care-seeking in general practice due to musculoskeletal disorders. METHODS: 3745 Danish adults registered with eight General Practitioners (GPs) in one primary medical center reported location and intensity of experienced musculoskeletal pain in seven different body regions in February 2008. Outcome was duration of sickness absence based on register data divided into long-term (>52 weeks during follow-up) and sickness absence of shorter duration (12-52 weeks during follow-up) over a period of 4 years. Data on pain-intensity were analyzed at three different cut-off levels for each body region: i) > 1 (any pain), ii) > 2 (bothersome pain), iii) > 3 (very bothersome pain). Analyses were stratified and compared between participants without GP contact and participants with GP contact due to musculoskeletal disorders. RESULTS: Musculoskeletal pain in more than two body regions was strongly associated with long-term sickness absence in an exposure-response pattern. Different cut-off levels of pain intensity and adjustment for age, sex, educational level and work environmental factors did not alter the results. Similar findings were observed for sickness absence of shorter duration, although the association was weaker. Care-seeking in general practice due to musculoskeletal disorders did not overall alter the odds of later sickness absence. CONCLUSION: Pain intensity and care-seeking due to musculoskeletal disorders did not seem to influence the association between the number of pain sites and later sickness absence. The number of musculoskeletal pain sites seems to be a strong risk factor for later sickness absence.