Startseite Lifestyle factors, mental health, and incident and persistent intrusive pain among ageing adults in South Africa
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Lifestyle factors, mental health, and incident and persistent intrusive pain among ageing adults in South Africa

  • Karl Peltzer EMAIL logo
Veröffentlicht/Copyright: 26. April 2022
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Scandinavian Journal of Pain
Aus der Zeitschrift Scandinavian Journal of Pain Band 23 Heft 1

Abstract

Objectives

The purpose of this study was to evaluate longitudinal associations with incident and persistent intrusive pain among rural South Africans.

Methods

Longitudinal data from two consecutive waves in 2014/2015 and 2018/2019 in Agincourt, South Africa, were analysed. Pain was assessed with the Brief Pain Inventory.

Results

In all, 683 adults of 3,628 participants without intrusive pain in Wave 1 (19.1%) had incident intrusive pain in Wave 2, 94 adults of 254 participants who had intrusive pain in Wave 1 (38.3%) had intrusive pain at both Wave 1 and 2 (persistent intrusive pain). Furthermore, 358 (7.2%) participants had intrusive pain at baseline. In the fully adjusted model for people without intrusive pain at baseline, the study found that obesity (AOR: 1.31, 95% CI: 1.05–1.63), depressive symptoms (AOR: 1.67, 95% CI: 1.34–2.08), PTSD (AOR: 1.71, 95% CI: 1.19–2.45), and poor sleep quality (AOR: 1.30, 95% CI: 1.04–1.62) were positively associated with incident intrusive pain. Older age was positively, and male sex and daily alcohol use were negatively associated with incident intrusive pain. Furthermore, in the final adjusted logistic regression model, this study found that older age was positively, and underweight, overweight, and high sedentary behavior were negatively associated with persistent intrusive pain.

Conclusions

Several modifiable risk factors for incident and/or persistent intrusive pain were identified.

Keywords: health behaviour; intrusive pain; longitudinal study; mental health; South Africa

Introduction

Pain symptoms can be very stressful, decrease quality of life, and increase utilization of health care, causing a significant public health impact, in particular in aging populations [1, 2, 3]. It is estimated that 20% of patients experience pain worldwide [4]. In the general population in low-resourced countries, the prevalence of persistent unspecified pain was 34% [5]. The national prevalence of chronic pain in the general population in South Africa was 18.3% [6].

In longitudinal studies factors associated with incident pain include sociodemographic factors (increasing age [7], and perceived financial strain [7]), lifestyle factors (overweight [1], obesity [8], current or ex-smoking [7], and low leisure time physical activity [9]) and poor mental health (depression [1], and anxiety [7]). In longitudinal studies factors associated with persistent pain include sociodemographic factors and lifestyle factors (overweight and obesity) [9].

Knowledge of modifiable risk factors associated with persistent and incident pain may help to improve clinical management of pain. Previous studies investigating the relationship between modifiable risk factors and incident and persistent pain have been conducted mainly in high-income countries, and it is not clear whether the previous results apply to populations in Africa. Therefore, the objective of this study was to assess longitudinal associations between modifiable risk factors and incident and persistent pain in an ageing population in South Africa.

Methods

Participants and procedures

Longitudinal data from two waves (2014–2015 and 2018–2019) of the “Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)” were analysed. Participants in wave 1 included 5,059 40 years and older adults (85.9% response rate) [10], and in wave 24,176 individuals of wave 1 (94% response rate) (“595 died during follow-up: 12%, 254 declined participation: 5%, 34 were not found: <1%”) [11]. Further sampling details have been described elsewhere [10]. Using computer-assisted personal interviewing (CAPI), trained field workers conducted the study in the homes of participants [10]. The study was approved by the “University of the Witwatersrand Human Research Ethics Committee (ref. M141159), the Harvard T.H. Chan School of Public Health, Office of Human Research Administration (ref. C13–1608–02), and the Mpumalanga Provincial Research and Ethics Committee” [10]. Written informed consent was obtained from all participants.

Measures

Outcome variable

Pain was assessed with the Brief Pain Inventory (BPI): “Now I have some questions about pain. Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains and toothaches). Have you had pain – other than these everyday kinds of pain – today?” [12] Intrusive pain was defined as having pain today which interfere with general activities.

Covariates

Sociodemographic information included age, sex, and asset-based household wealth status [10].

Substance use items included daily alcohol use of at least one alcoholic drink, “such as beer, wine, spirits, fermented cider, thothotho, or traditional beer?” Current daily tobacco smoking and current smokeless tobacco use [10].

Moderate and high low physical activity was measured with the “General Physical Activity Questionnaire (GPAQ)” [13, 14].

Sedentary behaviour was sourced from one item from the GPAQ on the “time usually spend sitting or reclining on a typical day?” [14] and grouped into “<4 h, 4 to <8 h and 8 or more hours per day” [15].

Body mass index (BMI) was measured and calculated following criteria of the World Health Organization [16].

Depressive symptoms (scores ≥3) were assessed with the “Center for Epidemiological Studies-Depression Scale eight-item scale (CES-D 8)” [17] (Cronbach’s alpha 0.66).

Posttraumatic Stress Disorder (PTSD) symptoms were defined as ≥4 scores on a 7-item PTSD symptom scale [18] (Cronbach’s alpha 0.83).

Poor sleep quality was assessed with the “Brief Version of the Pittsburgh Sleep Quality Index (B-PSQI),” which included five domains: “self-reported sleep quality, sleep latency, sleep duration, habitual sleep efficiency and sleep disturbances” during the last month [19]. Summary scores ranged from 0 to 15, using a B-PSQI cut-off of 5 or more to define poor sleep quality [19].

HIV status was assessed by self-reported diagnosis [10].

Data analysis

Descriptive statistics were used to show the distribution of persistent and incident intrusive pain. Using logistic regression, the first longitudinal model excluded those without intrusive pain at baseline, leaving a sample of 3,628 individuals to calculate incident intrusive pain, and the second model estimated longitudinal persistent intrusive pain. Levels of p<0.05 were accepted as statistically significant. Longitudinal data included inverse probability weights taking into account mortality and attrition during follow-up [20]. StataSE 15.0 (College Station, TX, USA) was used for statistical analysis.

Results

Sample characteristics by incident and persistent intrusive pain

In all, 683 adults of 3,628 participants without intrusive pain in Wave 1 (19.1%) had incident intrusive pain in Wave 2, 94 adults of 254 participants who had intrusive pain in Wave 1 (38.3%) had intrusive pain at both Wave 1 and 2 (persistent intrusive pain). Furthermore, 358 (7.2%) participants had intrusive pain at baseline (see Table 1).

Table 1:

Sample characteristics by intrusive pain, Agincourt, South Africa, 2014–2019.

Baseline variables Sample Incident intrusive pain Persistent intrusive pain
N (%) Na (%b) Na (%b)
All 5,059 683 (19.1) 254 (38.3)
Age (in years) 40–49 884 (17.6) 75 (10.2) 8 (25.7)
50–59 1,358 (27.1) 134 (12.6) 16 (24.0)
60–69 1,274 (25.4) 204 (21.4) 21 (30.9)
70–79 918 (18.3) 163 (26.2) 31 (55.6)
80 or more 583 (11.6) 99 (36.3) 18 (57.4)
Sex Female 2,713 (53.6) 452 (23.0) 57 (35.8)
Male 2,346 (46.4) 231 (14.6) 37 (42.4)
Wealth index Low 2047 (40.5) 265 (19.1) 34 (37.0)
Middle 991 (19.6) 153 (21.9) 18 (33.8)
High 2021 (39.9) 265 (17.8) 42 (41.7)
Daily alcohol use No 4,888 (96.7) 672 (19.4) 92 (38.2)
Yes 167 (3.3) 11 (10.3) 2 (42.9)
Current daily tobacco smoking No 4,681 (92.7) 640 (19.6) 85 (37.5)
Yes 369 (7.3) 33 (13.2) 6 (38.9)
Current smokeless tobacco use No 4,716 (93.3) 622 (18.4) 84 (38.4)
Yes 339 (6.7) 61 (30.5) 10 (38.2)
Physical activity Low 221 (44.0) 308 (21.9) 62 (44.1)
Moderate 1,143 (22.7) 128 (15.2) 19 (34.7)
High 1,674 (33.3) 239 (18.2) 11 (24.6)
Sedentary behaviour Low 2,675 (55.9) 343 (17.7) 56 (40.1)
Moderate 1,632 (34.1) 234 (20.1) 29 (38.9)
High 475 (9.9) 59 (21.1) 5 (19.4)
Body mass index Normal 1719 (36.7) 209 (17.2) 30 (44.9)
Under overweight 258 (5.5) 24 (16.3) 2 (13.3)
Obesity 1,328 (28.3) 183 (18.2) 18 (29.5)
1,384 (29.5) 243 (22.7) 37 (39.8)
Depressive symptoms No 4,092 (83.0) 533 (17.3) 67 (40.5)
Yes 837 (17.0) 149 (29.5) 26 (33.6)
PTSD symptoms No 4,697 (95.2) 632 (18.5) 82 (36.9)
Yes 238 (4.8) 50 (30.7) 11 (48.4)
Poor sleep quality No 3,904 (83.0) 490 (17.4) 70 (37.4)
Yes 801 (17.0) 130 (24.6) 15 (36.1)
HIV status Negative 4,402 (87.6) 612 (19.8) 84 (37.8)
Positive 623 (12.4) 69 (14.4) 10 (43.8)

  1. aUnweighted N; bWeighted %.

Correlates of incident intrusive pain

In the fully adjusted model for people without intrusive pain at baseline, this study found that obesity (AOR: 1.31, 95% CI: 1.05–1.63), depressive symptoms (AOR: 1.67, 95% CI: 1.34–2.08), PTSD (AOR: 1.71, 95% CI: 1.19–2.45), and poor sleep quality (AOR: 1.30, 95% CI: 1.04–1.62) were positively associated with incident intrusive pain. Older age was positively, and male sex and daily alcohol use were negatively associated with incident intrusive pain (see Table 2).

Table 2:

Longitudinal associations with incident intrusive pain, Agincourt, South Africa, 2014–2019.

Baseline variables COR (95% CI) AOR (95% CI)
Age group in years 40–49 1 (Reference) 1 (Reference)
50–59 1.27 (0.96, 1.69) 1.27 (0.94, 1.72)
60–69 2.41 (1.84, 3.15)*** 2.32 (1.34, 2.08)***
70–79 3.12 (2.36, 4.12)*** 3.10 (2.38, 4.21)***
≥80 5.01 (3.68, 6.82)*** 4.73 (3.32, 6.74)***
Sex Female 1 (Reference) 1 (Reference)
Male 0.57 (0.49, 0.67)*** 059 (0.48, 0.71)***
Wealth index Low 1 (Reference) –
Middle 1.20 (0.98, 1.47)
High 0.92 (0.78, 1.10)
Daily alcohol use No 1 (Reference) 1 (Reference)
Yes 0.48 (0.28, 0.82)** 0.48 (0.26, 0.90)*
Current daily tobacco smoking No 1 (Reference) 1 (Reference)
Yes 0.62 (0.42, 0.87)** 1.28 (0.86, 1.90)
Current smokeless tobacco use No 1 (Reference) 1 (Reference)
Yes 1.95 (1.45, 2.57)*** 1.18 (0.85, 1.65)
Physical activity Low 1 (Reference) 1 (Reference)
Moderate 0.64 (0.52, 0.78)*** 0.84 (0.67, 1.05)
High 0.79 (0.67, 0.94)** 1.10 (0.90, 1.34)
Sedentary behaviour Low 1 (Reference) –
Moderate 1.18 (0.99, 1.39)
High 1.25 (0.95, 1.65)
General body weight Normal 1 (Reference) 1 (Reference)
Under 0.94 (0.62, 1.41) 1.02 (0.64, 1.61)
Overweight 1.08 (0.88, 1.31) 0.99 (0.79, 1.23)
Obesity 1.42 (1.18, 1.71)*** 1.31 (1.05, 1.63)*
Depressive symptoms No 1 (Reference) 1 (Reference)
Yes 2.00 (1.65, 2.42)*** 1.67 (1.34, 2.08)***
PTSD symptoms No 1 (Reference) 1 (Reference)
Yes 1.96 (1.44, 2.68)*** 1.71 (1.19, 2.45)**
Poor sleep quality No 1 (Reference) 1 (Reference)
Yes 1.55 (1.27, 1.90)*** 1.30 (1.04, 1.62)*
HIV status Negative 1 (Reference) 1 (Reference)
Positive 0.68 (0.53, 0.87)** 1.03 (0.78, 1.35)

  1. COR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval; *p<0.05; **p<0.01; ***p<0.001.

Correlates of persistent intrusive pain

Table 3 provides longitudinal models with people who had intrusive pain in wave 1 and in wave 2. In the final adjusted logistic regression model, this study found that older age was positively associated, and underweight, overweight, and high sedentary behaviour were negatively associated with persistent intrusive pain (see Table 3).

Table 3:

Longitudinal associations with persistent intrusive pain, Agincourt, South Africa, 2014–2019.

Baseline variables COR (95% CI) AOR (95% CI)
Age group in years 40–49 1 (Reference) 1 (Reference)
50–59 0.95 (0.38, 2.41) 0.95 (0.35, 2.63)
60–69 1.33 (0.54, 3.26) 1.26 (0.47, 3.38)
70–79 3.79 (1.76, 9.26)** 3.40 (1.24, 9.31)*
≥80 4.02 (1.55, 10.46)** 7.11 (2.22, 22.64)**
Sex Female 1 (Reference) –
Male 1.34 (0.84, 1.78)
Wealth index Low 1 (Reference) –
Middle 0.89 (0.47, 1.68)
High 1.22 (0.78, 2.04)
Daily alcohol use No 1 (Reference) –
Yes 1.04 (0.21, 5.11)
Current daily tobacco smoking No 1 (Reference) –
Yes 1.11 (0.42, 2.97)
Current smokeless tobacco use No 1 (Reference) –
Yes 1.02 (0.49, 2.10)
Physical activity Low 1 (Reference) 1 (Reference)
Moderate 0.67 (0.38, 1.18) 0.95 (0.50, 1.81)
High 0.40 (0.20, 0.79)** 0.53 (0.24, 1.13)
Sedentary behaviour Low 1 (Reference) 1 (Reference)
Moderate 0.95 (0.57, 1.57) 0.78 (0.43, 1.42)
High 0.37 (0.15, 0.95)* 0.27 (0.09, 0.81)*
General body weight Normal 1 (Reference) 1 (Reference)
Under 0.23 (0.05, 0.96)* 0.15 (0.03, 0.74)*
Overweight 0.50 (0.26, 0.95)* 0.46 (0.22, 0.95)*
Obesity 0.81 (0.46, 1.43) 1.06 (0.56, 2.05)
Depressive symptoms No 1 (Reference) –
Yes 0.74 (0.45, 1.20)
PTSD symptoms No 1 (Reference) –
Yes 1.60 (0.76, 3.36)
Poor sleep quality No 1 (Reference) –
Yes 0.95 (0.53, 1.70)
HIV status Negative 1 (Reference) –
Positive 1.25 (0.60, 2.61)

  1. COR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval; *p<0.05; **p<0.01; ***p<0.001 [21].

Discussion

In this first longitudinal study among an ageing population in Africa, this study found that obesity, depressive symptoms, PTSD symptoms, poor sleep quality, older age and female sex were associated with incident intrusive pain among middle-aged and older adults in South Africa. Several previous studies [1, 7, 8] also showed associations between obesity, poor mental health, and incident pain. Likewise previous research [7] found that female sex and increasing age increased the odds of incident pain. While other studies also found an association between other lifestyle factors (current or ex-smoking) [7], and low leisure time physical activity [9] and incident pain, this study only found a weak positive association between current smokeless tobacco use and incident intrusive pain, and weak negative associations between current daily tobacco smoking, higher physical activity, and incident intrusive pain. Daily alcohol use was inversely associated with incident intrusive pain in this study. In a six-country study among middle-aged and older adults, recent pain was associated with moderate alcohol use [22], and in a review “moderate alcohol use was observed to be associated with positive pain-related outcomes (e.g., greater quality of life)” [23]. So, it is possible that people used alcohol to medicate pain, especially in the context limited access to medical treatment [22]. Similarly, the weak inverse relationship between daily smoking and incident intrusive pain could be explained. Some research seems [23, 24] to show that for both alcohol and tobacco use a bidirectional relationship with pain exists.

It is not clear how poor mental health leads to incident intrusive pain [1, 25], while obesity can increase weight on lower limps, lower back and joints, leading to increased incident intrusive pain [1, 8, 26]. This study found that incident intrusive pain increased with age, which may be related to the likely increase in chronic pain conditions with age [27]. The preponderance of intrusive pain in women may be related to greater pain sensitivity among women compared to men [28]. Current smokeless tobacco use was weakly associated with incident intrusive pain. It is possible that the commonly used snuff (a form of smokeless tobacco) in the study region was used for medicinal reasons, including for pain conditions [29]. Unlike some previous studies [1] that found an association between lower socioeconomic status and incident intrusive pain, this study did not find a significant association.

Furthermore, this study found that older age was positively, and underweight, overweight, and high sedentary behaviour were negatively associated with persistent intrusive pain. In contrast to previous longitudinal research [9] that found a positive association between overweight and obesity and persistent pain, this study found a negative association between overweight and a nonsignificant association between obesity and persistent pain. A previous review [21] found a positive association between sedentary behaviour and musculoskeletal pain, while this study found an inverse associated between high sedentary behaviour and persistent intrusive pain. Further research is needed to explain the abnormal findings in terms of sedentary behaviour and overweight.

Study limitations

The limitations of the study include that only the current not chronification of pain was assessed. Due to the low prevalence of pain in specific body parts and multi-site pain this was not further analysed. Furthermore, depression, PTSD, and sleep quality were only assessed with brief screening questionnaires and not with a diagnostic psychiatric evaluation. The alcohol measure used in this study did not assess the amount of alcohol consumed per day. Moreover, participants who were negative for pain in wave 1 may have had pain before.

Conclusions

Several modifiable risk factors, including body weight, sedentary behavior, substance use, and poor mental health, were identified for incident and/or persistent intrusive pain.

Corresponding author: Karl Peltzer, Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa; and Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan, E-mail:

Funding source: National Institute on Aging (HAALSI)

Award Identifier / Grant number: 1P01AG041710-01A1

Funding source: The Wellcome Trust, UK, The University of the Witwatersrand and South African Medical Research Council (The Agin court HDSS)

Award Identifier / Grant number: 058893/Z/99/A

Award Identifier / Grant number: 069683/Z/02/Z

Award Identifier / Grant number: 085477/Z/08/Z

Award Identifier / Grant number: 085477/B/08/Z

  1. Research funding: HAALSI (Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa) is sponsored by the National Institute on Aging (grant number 1P01AG041710-01A1) and is conducted by the Harvard Center for Population and Development Studies in partnership with Witwatersrand University. The Agincourt HDSS was supported by the Wellcome Trust, UK (058893/Z/99/A, 069683/Z/02/Z, 085477/Z/08/Z and 085477/B/08/Z), the University of the Witwatersrand and South African Medical Research Council.

  2. Author contributions: Karl Peltzer: Conceived and designed the experiments; performed the experiments; analyzed and interpreted the data; contributed reagents, materials, analysis tools or data; wrote the paper.

  3. Competing interests: Author states no conflict of interest.

  4. Informed consent: Informed consent has been obtained from all individuals included in this study.

  5. Ethical approval: The study was approved by the “University of the Witwatersrand Human Research Ethics Committee (ref. M141159), the Harvard T.H. Chan School of Public Health, Office of Human Research Administration (ref. C13–1608–02), and the Mpumalanga Provincial Research and Ethics Committee,” and “complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as amended in 2013).”

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Received: 2022-01-17
Accepted: 2022-04-13
Published Online: 2022-04-26
Published in Print: 2023-01-27

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial Comment
  3. What do we mean by “mechanism” in pain medicine?
  4. Topical Reviews
  5. Topical review – salivary biomarkers in chronic muscle pain
  6. Tendon pain – what are the mechanisms behind it?
  7. Systematic Review
  8. Psychological management of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review
  9. Topical Review
  10. Predicting pain after standard pain therapy for knee osteoarthritis – the first steps towards personalized mechanistic-based pain medicine in osteoarthritis
  11. Clinical Pain Researches
  12. Neuropathy and pain after breast cancer treatment: a prospective observational study
  13. Neuropeptide Y and measures of stress in a longitudinal study of women with the fibromyalgia syndrome
  14. Nociceptive two-point discrimination acuity and body representation failure in polyneuropathy
  15. Pain sensitivity in relation to frequency of migraine and tension-type headache with or without coexistent neck pain: an exploratory secondary analysis of the population study
  16. Clinician experience of metaphor in chronic pain communication
  17. Observational studies
  18. Chronic vulvar pain in gynecological outpatients
  19. Male pelvic pain: the role of psychological factors and sexual dysfunction in a young sample
  20. A bidirectional study of the association between insomnia, high-sensitivity C-reactive protein, and comorbid low back pain and lower limb pain
  21. Burden of disease and management of osteoarthritis and chronic low back pain: healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS): study design and patient characteristics of a real world data study
  22. Factors influencing quality of life in patients with osteoarthritis: analyses from the BISCUITS study
  23. Prescription patterns and predictors of unmet pain relief in patients with difficult-to-treat osteoarthritis in the Nordics: analyses from the BISCUITS study
  24. Lifestyle factors, mental health, and incident and persistent intrusive pain among ageing adults in South Africa
  25. Inequalities and inequities in the types of chronic pain services available in areas of differing deprivation across England
  26. Original Experimentals
  27. Conditioned pain modulation is not associated with thermal pain illusion
  28. Association between systemic inflammation and experimental pain sensitivity in subjects with pain and painless neuropathy after traumatic nerve injuries
  29. Endometriosis diagnosis buffers reciprocal effects of emotional distress on pain experience
  30. Educational Case Reports
  31. Intermediate cervical plexus block in the management of treatment resistant chronic cluster headache following whiplash trauma in three patients: a case series
  32. Trigeminal neuralgia in patients with cerebellopontine angle tumors: should we always blame the tumor? A case report and review of literature
  33. Short Communication
  34. Less is more: reliability and measurement error for three versions of the Tampa Scale of Kinesiophobia (TSK-11, TSK-13, and TSK-17) in patients with high-impact chronic pain
https://doi.org/10.1515/sjpain-2022-0013
Schlagwörter für diesen Artikel
health behaviour; intrusive pain; longitudinal study; mental health; South Africa

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial Comment
  3. What do we mean by “mechanism” in pain medicine?
  4. Topical Reviews
  5. Topical review – salivary biomarkers in chronic muscle pain
  6. Tendon pain – what are the mechanisms behind it?
  7. Systematic Review
  8. Psychological management of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review
  9. Topical Review
  10. Predicting pain after standard pain therapy for knee osteoarthritis – the first steps towards personalized mechanistic-based pain medicine in osteoarthritis
  11. Clinical Pain Researches
  12. Neuropathy and pain after breast cancer treatment: a prospective observational study
  13. Neuropeptide Y and measures of stress in a longitudinal study of women with the fibromyalgia syndrome
  14. Nociceptive two-point discrimination acuity and body representation failure in polyneuropathy
  15. Pain sensitivity in relation to frequency of migraine and tension-type headache with or without coexistent neck pain: an exploratory secondary analysis of the population study
  16. Clinician experience of metaphor in chronic pain communication
  17. Observational studies
  18. Chronic vulvar pain in gynecological outpatients
  19. Male pelvic pain: the role of psychological factors and sexual dysfunction in a young sample
  20. A bidirectional study of the association between insomnia, high-sensitivity C-reactive protein, and comorbid low back pain and lower limb pain
  21. Burden of disease and management of osteoarthritis and chronic low back pain: healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS): study design and patient characteristics of a real world data study
  22. Factors influencing quality of life in patients with osteoarthritis: analyses from the BISCUITS study
  23. Prescription patterns and predictors of unmet pain relief in patients with difficult-to-treat osteoarthritis in the Nordics: analyses from the BISCUITS study
  24. Lifestyle factors, mental health, and incident and persistent intrusive pain among ageing adults in South Africa
  25. Inequalities and inequities in the types of chronic pain services available in areas of differing deprivation across England
  26. Original Experimentals
  27. Conditioned pain modulation is not associated with thermal pain illusion
  28. Association between systemic inflammation and experimental pain sensitivity in subjects with pain and painless neuropathy after traumatic nerve injuries
  29. Endometriosis diagnosis buffers reciprocal effects of emotional distress on pain experience
  30. Educational Case Reports
  31. Intermediate cervical plexus block in the management of treatment resistant chronic cluster headache following whiplash trauma in three patients: a case series
  32. Trigeminal neuralgia in patients with cerebellopontine angle tumors: should we always blame the tumor? A case report and review of literature
  33. Short Communication
  34. Less is more: reliability and measurement error for three versions of the Tampa Scale of Kinesiophobia (TSK-11, TSK-13, and TSK-17) in patients with high-impact chronic pain
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Heruntergeladen am 21.9.2025 von https://www.degruyterbrill.com/document/doi/10.1515/sjpain-2022-0013/html
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