Prevalent migraine as a predictor of incident hypertension.

BACKGROUND: Migraine has been associated with several diseases. This population-based prospective Finnish postal survey Health and Social Support Study explored whether self-reported migraine predicted incident hypertension independently in a working-age population by utilizing two data sources: the baseline survey from the year 1998 in combination with the follow-up survey data from the years 2003 and 2012 with linkage to the national Social Insurance Institution registry data of the special reimbursement medication for hypertension from 1999 to 2013. The survey follow-up reached until the second follow-up in the year 2012. The register follow-up also included the year 2013. METHODS: The present population-based prospective cohort study, utilizing two different data sources, included 8593 respondents (22.7% response rate) who participated in 1998, 2003, and 2012 but who did not report hypertension at the baseline in 1998, and whose responses could be linked with the Social Insurance Institution registry data from the beginning of 1999 to the end of 2013. The multivariable logistic regression analysis was based on the combined two data sets. RESULTS: A significant association of self-reported migraine and incident hypertension (odds ratio 1.37; 95% confidence interval 1.20-1.57) prevailed in the multiple logistic regression analysis adjusted for central socio-demographic and health behaviour variables. CONCLUSION: Extra attention should be paid to prevention and control of hypertension in working-age migraine patients.

Migraine predicts hypertension--a cohort study of the Finnish working-age population.

BACKGROUND: Migraine has been suggested to be associated with hypertension. The aim of the present 5-year prospective cohort study was to examine whether self-reported migraine in 1998 predicted hypertension in 2003 in a Finnish working-age population. METHODS: This cohort study consisted of 13 454 randomly selected initially non-hypertensive working-age participants of the prospective postal survey of the Health and Social Support. A total of 13 426 responses of the initial participants were linked with the register data of the Social Insurance Institution on the special reimbursement medication for hypertension. The outcome variable, hypertension, was determined according to the survey data and the register data of the Social Insurance Institution. The statistical analysis was carried out using logistic regression. RESULTS: In a multivariate model adjusted for gender, age, occupational training, living alone, metabolic equivalent of task, body mass index and alcohol consumption, self-reported migraine predicted hypertension (odds ratio 1.39; 95% confidence interval 1.19-1.64) for the self-reported and (odds ratio 1.42; 95% confidence interval 1.13-1.77) for the register data of the Social Insurance Institution. CONCLUSION: The findings may indicate a focus on hypertension screening for the working-age population with migraine.

Frequent analgesic use at population level: prevalence and patterns of use.

Statistics and prescription database studies show that analgesics are widely utilized, but do not tell anything about either the factors behind analgesic use or how over-the-counter (OTC) analgesics are being used. We aimed to study the prevalence of frequent use of prescribed and OTC analgesics. We also investigated the background factors related to frequent analgesic use and assessed rationality of analgesic usage patterns. We addressed a postal survey to a random stratified population sample of 6500 Finnish people aged 15-74 years. The response rate was 71% (n=4542) after exclusion of unobtainable addressees (n=68). Individuals reporting analgesic use 'daily' or 'a few times a week' were categorized as frequent users. After adjusting for age and sex, the overall prevalence of daily analgesic use was 8.5%, and the prevalence of analgesic use a few times a week 13.6%. The adjusted prevalence of using exclusively prescribed analgesics daily or a few times a week was 8.7%, and that of utilizing purely OTC analgesics 8.8%. The overall prevalence of concomitant frequent use of both prescribed and OTC analgesics was 4.6%. Multinominal logistic regression analyses showed that frequent analgesic use was related especially to daily or continuous pain and high pain intensity. Low mood and not being employed also increased the probability for daily analgesic use. Frequent analgesic use seems to be common at population level. Concomitant use of both prescribed and OTC analgesics can be considered irrational, as it increases the risk of adverse events.

Balancing pain and analgesic treatment in the home-dwelling elderly.

BACKGROUND: In elderly persons, pain is a common problem, and analgesic medicines are among the most frequently used drugs. OBJECTIVE: To describe the use of analgesic medication and its relation to daily pain and morbidity in home-dwelling elderly people aged at least 75 years. METHODS: A random sample of 700 subjects aged at least 75 years was drawn from the total population of Kuopio, Finland. A geriatrician and nurse carried out structured clinical examinations and interviews with 601 persons, 523 of whom were living at home. RESULTS: Seventy percent (n = 364) of the elderly people were taking at least one analgesic, including most of those who suffered from daily interfering pain (85%) and nearly all of those experiencing daily pain at rest (93%). Nonsteroidal antiinflammatory drugs (NSAIDs; n = 226, 51%) and acetaminophen (n = 118, 23%) were the most commonly used analgesics. The use of opioids became more common with age, accounting for 16% of the drugs in the oldest patients (> or =85 y) and 6% among those aged 75-79 years. Analgesics were mainly taken when needed. Only 13% of NSAID users, 18% of acetaminophen users, and 21% of opioid users took these preparations regularly. CONCLUSIONS: Although analgesics are commonly used by elderly patients, it appeared that many patients were still experiencing daily interfering pain and pain at rest.

How do people ease their pain? A population-based study.

UNLABELLED: We investigated how a general population treat their pain and determined factors affecting use of different pain management strategies. From the respondents of a cross-sectional postal survey we selected those who had experienced pain during the past 7 days (n = 3641) and analyzed how they had tried to manage their pain during the past 6 months. The most common pain management strategies were use of over-the-counter medicines (53% of 3641 respondents), physical exercise (52%), prescription medicines (35%), and visiting a physician (33%). The location of pain was related to which pain management strategy was chosen. Use of multiple (>4) treatments was related to prolonged pain, having several (>3) painful locations, high intensity and frequency of pain. PERSPECTIVE: This study indicates that people with pain are active in trying different treatments. Self-care strategies, especially over-the-counter medicines and physical exercise, are common ways to manage pain at the population level.

Chronic pain and poor self-rated health.

CONTEXT: Chronic pain is common in Western societies. Self-rated health is an important indicator of morbidity and mortality, but little is known about the relation between chronic pain and self-rated health in the general population. OBJECTIVE: To analyze the association between chronic pain and self-rated health. DESIGN, SETTING, AND POPULATION: A questionnaire survey carried out during the spring of 2002 of an age- and sex-stratified population sample of 6500 individuals in Finland aged 15 to 74 years, with a response rate of 71% (N = 4542) after exclusion of those with unobtainable data (n = 38). Chronic pain was defined as pain with a duration of at least 3 months and was graded by frequency: (1) at most once a week; (2) several times a week; and (3) daily or continuously. On the basis of a 5-item questionnaire on self-rated health, individuals were classified as having good, moderate, or poor health. Multinominal logistic regression analysis was used to assess the determinants of health. Analysis included sex, age, education, working status, chronic diseases, and mood. MAIN OUTCOME MEASURES: Perceived chronic pain graded by frequency and self-rated health status. RESULTS: The prevalence of any chronic pain was 35.1%; that of daily chronic pain, 14.3%. The prevalence of moderate self-rated health was 26.6% and of poor health, 7.6%. For moderate self-rated health among individuals having chronic pain at most once a week compared with individuals having no chronic pain, the adjusted odds were 1.36 (95% confidence interval [CI], 1.05-1.76); several times a week, 2.41 (95% CI, 1.94-3.00); and daily, 3.69 (95% CI, 2.97-4.59). Odds for poor self-rated health were as follows: having chronic pain at most once a week, 1.16 (95% CI, 0.65-2.07); several times a week, 2.62 (95% CI, 1.76-3.90); and daily, 11.82 (95% CI, 8.67-16.10). CONCLUSION: Chronic pain is independently related to low self-rated health in the general population.

Direct and indirect costs of managing patients with musculoskeletal pain-challenge for health care.

Musculoskeletal pain is an outstanding symptom among the patients of primary health care. However, there are few studies of management and costs of musculoskeletal pain at primary health care level. The aim of this study was to describe the diagnostic investigations, management, referral rate and sick leaves related to visits prompted by musculoskeletal pain as well as to assess their costs. A total of 28 general practitioners (GPs) at 25 randomly selected health centres throughout Finland collected the data for this 4 week study, which covered 1 week from each of the four seasons. All visits, except those occurring after hours, were recorded. Altogether 1123 patients visited GPs because of musculoskeletal pain. Laboratory tests were ordered for 12% and imaging investigations for 24%. A total of 16% of the patients suffering from musculoskeletal pain received a prescription for physiotherapy, and analgesics were prescribed to 61% of them. Physicians referred 7% of the pain patients to specialist care. One out of every four patients was prescribed sick leave. The mean cost of the investigations, therapy, referrals, and sick leaves was as high as 530 EUR per visit, with absenteeism from work constituting two-fifths of the total costs. Musculoskeletal pain is not just a frequent complaint but also has extensive economic consequences for society. Investigations and therapy at the primary health care level play a minor role in the costs as compared with specialist care and sick leaves.