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Cardiovascular risk reduction as a population strategy for preventing pain?

  • Pekka Mäntyselkä EMAIL logo
Published/Copyright: April 1, 2017
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 15 Issue 1

Abstract

In this issue of the Scandinavian Journal of Pain, Pico-Espinosa and co-workers [1] report on the role of diabetes mellitus (DM) and hyperlipidaemia (HL) as risk factors for frequent pain in the back, neck and/or shoulders/arms (BNSP). Their study was based on a large population-based cohort with a four-year follow-up. They concluded that DM and HL may play a role in the aetiology of frequent BNSP, but this role may be different in men and women.

1 Common risk factors for musculoskeletal pain and type 2 diabetes mellitus?

According to previous epidemiological studies, cardiovascular risk factors including type 2 DM and chronic pain are common and comorbid conditions that possibly share some aetiological factors [2]. Despite the general positive trend of cardiovascular risk factors in the developed countries, there has been an increased trend in the prevalence of type 2 DM and obesity in recent years. More than 8.5% of adults worldwide have been estimated to have diabetes [3]. Painful diabetic neuropathy is a well-known consequence of long-lasting diabetes in some patients. Some studies have suggested that hyperglycaemia and diabetes are related to non-neuropathic musculoskeletal pain, as well [4,5]. For example, a study from Denmark found that patients with diabetes more commonly reported pain in the shoulder and neck or low back, or pain in the arm, hand, knee and/or hip compared with the general population [5]. One large population-based study from Norway found an increased prevalence of widespread musculoskeletal pain in people with diabetes but did not find an association between blood glucose levels and musculoskeletal pain [6].

2 The obesity-epidemic followed by type 2 DM and chronic musculoskeletal pain

One of the most important reasons for the increased prevalence of type 2 DM is the obesity epidemic. In addition to DM, obesity is linked to unaffordable lipid profiles (higher LDL cholesterol and triglycerides). About half of the adults in Europe are overweight and the average prevalence of obesity is more than 10% in adults [7]. In general, obesity has been thought to be associated with musculoskeletal pain. For example, in one large population-based follow-up study obesity was related to persistence of chronic widespread pain [8]. The evidence of a systematic review indicates that obesity is a risk factor of low back pain [9]. Also, based on a meta-analysis, it is suggested that there is a dose–response relation between weight and osteoarthritis of the knee [10]. Obesity has been linked to shoulder pain in a large cross-sectional population-based study [11]. According to a clinical study, obesity and a low level of DHL cholesterol and a high level of triglycerides have been found to be associated with upper extremity pain [12].

3 Hyperlipidaemia: a risk-factor for chronic pain?

The present study by Pico-Espinosa and co-workers [1] with 10,000 middle-aged and older adults found that hyperlipidaemia in men and women and diabetes mellitus in men increased the risk of frequent BNSP. The study was questionnaire-based. A clinical examination was not conducted. Furthermore, DM and HL were not confirmed with laboratory tests. As the authors discuss, they were not able to conduct the analysis stratified or adjusted with statin use. However, the sample size was large, the followup was conducted carefully and the researchers could take several confounding factors (e.g. body mass index) into account in their analysis. The main results of the present study are in line with the results from some previous studies. The difference between men and women in the present study is interesting. However, this may be due to the low number of cases, resulting in limited statistical power. To assess the possible biological background of the potential gender difference requires further studies to confirm this finding. As stated in the present study, DM and HL may result in a small proportion of new cases of BNSP. However, it is plausible that increasing numbers of DM and HL are increasing the incidence of BNSP.

4 Reducing risk of cardiovascular risk factors will also reduce risk of musculoskeletal pain

Based on existing scientific evidence, it can be assumed that frequent musculoskeletal pain is associated with metabolic disturbances such as type 2 DM, obesity or metabolic syndrome. These cardiovascular risk factors seem to result in increased risk for musculoskeletal pain. However, there is still a gap in knowledge in understanding the causal relationship between these conditions or their possible common biological background. Despite the limitations, the present large population-based follow-up study by Pico-Espinosa and co-workers together with previous existing scientific evidence supports the view that the population strategy for preventing frequent musculoskeletal pain should include controlling cardiovascular risk factors such as type 2 DM and hyperlipidaemia.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.11.005.

  1. Conflict of interest: None declared.

References

[1] Pico-Espinosa OJ, Skillgate E, Tettamanti G, Lager A, Holm LW. Diabetes mellitus and hyperlipidemia as risk factors for frequent pain in the back, neck, and/or shoulders/arms among adults in Stockholm 2006 to 2010 – results from the Stockholm Public Health Cohort. Scand J Pain 2017;15:1–7.Search in Google Scholar

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[9] Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol 2010;171:135–54.Search in Google Scholar

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[11] Rechardt M, Shiri R, Karppinen J, Jula A, Heliövaara M, Viikari-Juntura E. Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a population-based study. BMC Musculoskelet Disord 2010;11:165.Search in Google Scholar

[12] Rechardt M, Shiri R, Lindholm H, Karppinen J, Viikari-Juntura E. Associations of metabolic factors and adipokines with pain in incipient upper extremity soft tissue disorders: a cross-sectional study. BMJ Open 2013;3:e003036.Search in Google Scholar
Published Online: 2017-04-01
Published in Print: 2017-04-01

© 2017 Scandinavian Association for the Study of Pain

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Cardiovascular risk reduction as a population strategy for preventing pain?
  5. Observational study
  6. Diabetes mellitus and hyperlipidaemia as risk factors for frequent pain in the back, neck and/or shoulders/arms among adults in Stockholm 2006 to 2010 – Results from the Stockholm Public Health Cohort
  7. Editorial comment
  8. Exercising non-painful muscles can induce hypoalgesia in individuals with chronic pain
  9. Clinical pain research
  10. Exercise induced hypoalgesia is elicited by isometric, but not aerobic exercise in individuals with chronic whiplash associated disorders
  11. Editorial comment
  12. Education of nurses and medical doctors is a sine qua non for improving pain management of hospitalized patients, but not enough
  13. Observational study
  14. Acute pain in the emergency department: Effect of an educational intervention
  15. Editorial comment
  16. Home training in sensorimotor discrimination reduces pain in complex regional pain syndrome (CRPS)
  17. Original experimental
  18. Pain reduction due to novel sensory-motor training in Complex Regional Pain Syndrome I – A pilot study
  19. Editorial comment
  20. How can pain management be improved in hospitalized patients?
  21. Original experimental
  22. Pain and pain management in hospitalized patients before and after an intervention
  23. Editorial comment
  24. Is musculoskeletal pain associated with work engagement?
  25. Clinical pain research
  26. Relationship of musculoskeletal pain and well-being at work – Does pain matter?
  27. Editorial comment
  28. Preoperative quantitative sensory testing (QST) predicting postoperative pain: Image or mirage?
  29. Systematic review
  30. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review
  31. Editorial comment
  32. A possible biomarker of low back pain: 18F-FDeoxyGlucose uptake in PETscan and CT of the spinal cord
  33. Observational study
  34. Detection of nociceptive-related metabolic activity in the spinal cord of low back pain patients using 18F-FDG PET/CT
  35. Editorial comment
  36. Patients’ subjective acute pain rating scales (VAS, NRS) are fine; more elaborate evaluations needed for chronic pain, especially in the elderly and demented patients
  37. Clinical pain research
  38. How do medical students use and understand pain rating scales?
  39. Editorial comment
  40. Opioids and the gut; not only constipation and laxatives
  41. Observational study
  42. Healthcare resource use and costs of opioid-induced constipation among non-cancer and cancer patients on opioid therapy: A nationwide register-based cohort study in Denmark
  43. Editorial comment
  44. Relief of phantom limb pain using mirror therapy: A bit more optimism from retrospective analysis of two studies
  45. Clinical pain research
  46. Trajectory of phantom limb pain relief using mirror therapy: Retrospective analysis of two studies
  47. Editorial comment
  48. Qualitative pain research emphasizes that patients need true information and physicians and nurses need more knowledge of complex regional pain syndrome (CRPS)
  49. Clinical pain research
  50. Adolescents’ experience of complex persistent pain
  51. Editorial comment
  52. New knowledge reduces risk of damage to spinal cord from spinal haematoma after epidural- or spinal-analgesia and from spinal cord stimulator leads
  53. Review
  54. Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors
  55. Review
  56. Neuraxial blocks and spinal haematoma: Review of 166 cases published 1994 – 2015. Part 2: diagnosis, treatment, and outcome
  57. Editorial comment
  58. CNS–mechanisms contribute to chronification of pain
  59. Topical review
  60. A neurobiologist’s attempt to understand persistent pain
  61. Editorial Comment
  62. The triumvirate of co-morbid chronic pain, depression, and cognitive impairment: Attacking this “chicken-and-egg” in novel ways
  63. Observational study
  64. Pain and major depressive disorder: Associations with cognitive impairment as measured by the THINC-integrated tool (THINC-it)
https://doi.org/10.1016/j.sjpain.2017.01.003

Articles in the same Issue

  2. Scandinavian Journal of Pain
  3. Editorial comment
  4. Cardiovascular risk reduction as a population strategy for preventing pain?
  5. Observational study
  6. Diabetes mellitus and hyperlipidaemia as risk factors for frequent pain in the back, neck and/or shoulders/arms among adults in Stockholm 2006 to 2010 – Results from the Stockholm Public Health Cohort
  7. Editorial comment
  8. Exercising non-painful muscles can induce hypoalgesia in individuals with chronic pain
  9. Clinical pain research
  10. Exercise induced hypoalgesia is elicited by isometric, but not aerobic exercise in individuals with chronic whiplash associated disorders
  11. Editorial comment
  12. Education of nurses and medical doctors is a sine qua non for improving pain management of hospitalized patients, but not enough
  13. Observational study
  14. Acute pain in the emergency department: Effect of an educational intervention
  15. Editorial comment
  16. Home training in sensorimotor discrimination reduces pain in complex regional pain syndrome (CRPS)
  17. Original experimental
  18. Pain reduction due to novel sensory-motor training in Complex Regional Pain Syndrome I – A pilot study
  19. Editorial comment
  20. How can pain management be improved in hospitalized patients?
  21. Original experimental
  22. Pain and pain management in hospitalized patients before and after an intervention
  23. Editorial comment
  24. Is musculoskeletal pain associated with work engagement?
  25. Clinical pain research
  26. Relationship of musculoskeletal pain and well-being at work – Does pain matter?
  27. Editorial comment
  28. Preoperative quantitative sensory testing (QST) predicting postoperative pain: Image or mirage?
  29. Systematic review
  30. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review
  31. Editorial comment
  32. A possible biomarker of low back pain: 18F-FDeoxyGlucose uptake in PETscan and CT of the spinal cord
  33. Observational study
  34. Detection of nociceptive-related metabolic activity in the spinal cord of low back pain patients using 18F-FDG PET/CT
  35. Editorial comment
  36. Patients’ subjective acute pain rating scales (VAS, NRS) are fine; more elaborate evaluations needed for chronic pain, especially in the elderly and demented patients
  37. Clinical pain research
  38. How do medical students use and understand pain rating scales?
  39. Editorial comment
  40. Opioids and the gut; not only constipation and laxatives
  41. Observational study
  42. Healthcare resource use and costs of opioid-induced constipation among non-cancer and cancer patients on opioid therapy: A nationwide register-based cohort study in Denmark
  43. Editorial comment
  44. Relief of phantom limb pain using mirror therapy: A bit more optimism from retrospective analysis of two studies
  45. Clinical pain research
  46. Trajectory of phantom limb pain relief using mirror therapy: Retrospective analysis of two studies
  47. Editorial comment
  48. Qualitative pain research emphasizes that patients need true information and physicians and nurses need more knowledge of complex regional pain syndrome (CRPS)
  49. Clinical pain research
  50. Adolescents’ experience of complex persistent pain
  51. Editorial comment
  52. New knowledge reduces risk of damage to spinal cord from spinal haematoma after epidural- or spinal-analgesia and from spinal cord stimulator leads
  53. Review
  54. Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994–2015. Part 1: Demographics and risk-factors
  55. Review
  56. Neuraxial blocks and spinal haematoma: Review of 166 cases published 1994 – 2015. Part 2: diagnosis, treatment, and outcome
  57. Editorial comment
  58. CNS–mechanisms contribute to chronification of pain
  59. Topical review
  60. A neurobiologist’s attempt to understand persistent pain
  61. Editorial Comment
  62. The triumvirate of co-morbid chronic pain, depression, and cognitive impairment: Attacking this “chicken-and-egg” in novel ways
  63. Observational study
  64. Pain and major depressive disorder: Associations with cognitive impairment as measured by the THINC-integrated tool (THINC-it)
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