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Spatiotemporal aspects of pain in the general population; factors associated with the presence, development and distribution: Results from the HUNT2 and HUNT3 studies

Mundal, Ingunn Pernille
Doctoral thesis
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PhD (Locked)
URI
http://hdl.handle.net/11250/276489
Date
2014
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  • Institutt for nevromedisin og bevegelsesvitenskap [2260]
Original version
Disputas 19 Desember, 2014  
Abstract
Background

Chronic musculoskeletal pain among adults is a common burden to the individual, the

health care system, and society, and has been estimated to affect approximately onefifth

of the European population. Such pain is characterized by various periodic or

continuous pain symptoms, and is associated with complex medical conditions and

prominent negative consequences, and may result from many factors. The term chronic

pain has several different meanings in pain medicine and is often used without a

specific criterion. Chronic pain is frequently defined within temporal, spatial,

qualitative, and quantitative aspects but without describing pathologic processes or

identifying pain mechanisms. Spatial and temporal aspects, rather than quantity and

quality aspects, of pain in the general population are the focus of this thesis.

Aims

To estimate the level of persistence of self-reported chronic widespread pain

(CWP) at a given time (1995–1997), how many have continued having CWP at

11-year follow-up (2006–2008), and what predicts CWP persistence (Paper I).

To identify how many without CWP at a given time (1995–1997) develops

CWP after 11-years (2006–2008) and what predicts the development of CWP

over 11 years (Paper II).

To study the 11-year course of pain sites and pain locations in persons with

chronic pain, and study if mood, lifestyle, and other health variables influence

possible long-term changes (Paper III).

With these objectives we wanted to obtain knowledge of the natural history of chronic

pain over time in the general population, to obtain an overview of important prognostic

psychosocial and lifestyle factors, and to study the extent to which chronic pain is

stable.

Method

The papers included in this thesis are based on data from the Health Study of Nord-

Trøndelag (HUNT), which is a large population-based survey consisting of three health

surveys carried out at 11-year intervals. All papers used longitudinal prospective

designs based on baseline data from the HUNT2 (1995–1997) survey and outcome data

from the HUNT3 (2006–2008) survey.

The population in the first two studies was restricted to those who completed both the

first and second questionnaires in both HUNT2 and HUNT3. To explore our research

questions we used logistic regression analyses, with baseline information on age, sex,

separate anxiety and depression measures from the Hospital Anxiety and Depression

Scale (HADS), alcohol use, smoking status, sleeping problems and body mass index

(BMI). Variables also included education, marital status, exercise and chronic disease

observed in the HUNT2 period. In the third study we added pulse as a variable of

interest and used multi-level linear regression analyses, with also estimating withinsubject

association. Except for BMI and pulse, all information was self-reported without

objective confirmation. Chronic pain was defined as having pain and/or stiffness in

muscles and limbs lasting for at least three months during the last year. CWP was

defined as having chronic pain in all of the following three body areas: trunk, lower

limbs and upper limbs.

Results

First, within an 11-year period, CWP persisted in 53% of the study participants. CWP

persistence was strongly associated with those who reported sleeping problems, obesity,

and having a chronic disease, while depression, anxiety, and the frequency of alcohol

use were not substantial outcome predictors. Those of 60 years or older had a lower

odds of CWP persistence.

Second, from a baseline population free of CWP, 12% developed chronic widespread

pain 11 years later. Symptoms of anxiety and/or depression, sleeping problems, and

underweight/overweight/obesity appeared to be important precursors for CWP development, whereas moderate alcohol use was revealed to have a small preventive

influence.

Third, from the final study in the thesis, an analysis of an 11-year course of pain sites

and pain locations demonstrated that differences in the mean number of pain sites were

strongly associated with all variables of interest, of which alcohol use and male sex

appeared as protective within the total population analyses. Changes in the number of

pain sites within individuals were moderately influenced by age from 30 to 69 years,

and having both anxiety and depression symptoms, sleeping problems, and chronic

disease. While smoking behaviour, alcohol use, and overweight/obesity influenced the

mean differences in the number of pain sites between individuals in the total population,

such lifestyle factors were not of importance within individuals. The same patterns

appeared when examining CWP in the total population and within individuals.

Conclusions

Chronic musculoskeletal pain including CWP is common in the general population and

is particularly prevalent among females. Only sleeping problems, obesity and chronic

disease predicted persistent CWP, and additionally, anxiety and/or depression, smoking

behaviour and being underweight/overweight substantially increased the odds of

developing it. Across the 11-year time period, differences in the mean number of pain

sites within the total population was influenced by the same psychosocial, lifestyle and

demographic factors of interests. Yet, in contrast to other findings we discovered that

the number of pain sites remained unchanged or slightly decreased among the

population across the time period. However, within individuals, the number of pain sites

also remained constant and was influenced by aging, symptoms of both anxiety and

depression, and having sleeping problems and a chronic disease
Publisher
NTNU
Series
Doctoral theses at NTNU;2014:377

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