- Email: [email protected]
Associations among smoking and chronic musculoskeletal pain in young adult twins
Abstracts (148) Participation of healthy infants in genetic pain research L Hatfield and M Lowenthal; University of Pennsylvania, Philadelphia, PA
The Journal of Pain
S13
(150) Home opioid use in sickle cell disease and relationship to pain and psychosocial variables: the PiSCES project
For some time now, genetic research has been conducted on infants who are atrisk or potential carriers of genetic conditions. The primary healthcare and parental justification for the donation of DNA from these at-risk infants has been that the medical benefits to the infant outweigh the potential risks. The donation of DNA from healthy infants is regarded as more problematic than the donation from at-risk infants due to parental attitudes and concerns about the risks for their healthy infant. There is a paucity of peer-reviewed academic research investigating parental willingness to donate their healthy infant’s DNA for minimal risk genetic research. Identifying parental attitudes that influence their decision to donate DNA from their healthy infant is critical for the future of genetic research in pediatric pain. Recognizing and understanding parental attitudes has the potential to facilitate further pediatric pain genetic research directed towards the development of coherent and concise informed consent and other institutional review board (IRB) procedures such as recruitment and study design. This presentation will examine the process parents utilized to arrive at a decision to donate their healthy infant’s DNA for a minimal risk genetic research. Examining parental knowledge of genetic research, their willingness to enroll their infants in genetic research, and the potential concerns, areas of misunderstanding of genetic research is essential for supporting ethically sound, prospective, cohort studies of genes/environment interaction and increasing the well-being of infants who become research subjects at the start of their lives.
W Smith, D McClish, B Dahman, J Levenson, I Aisiku, V Citero, V Bovbjerg, J Roberts, L Penberthy, S Roseff, M Scherer, and M Weaver; Virginia Commonwealth University, Richmond, VA
A08 Pain Epidemiology
(151) Prevalence rates of pain diagnoses in US military service members, 2006-2010: comparison by age, sex, and enrollment status
(149) Associations among smoking and chronic musculoskeletal pain in young adult twins A Lewandowski, E Law, S Tham, M Myaing, C Noonan, and T Palermo; University of Washington, Seattle, WA Chronic musculoskeletal pain is common in adolescents and young adults, and is associated with physical limitations and poor psychosocial functioning. Prevalence of smoking is highest in this age group, highlighting the importance of interrelations between chronic pain and potentially modifiable health-risk behaviors like smoking. We conducted a secondary data analysis from a large twin cohort to determine if genetics and shared environmental factors affect the association between smoking and chronic musculoskeletal pain. Participants were monozygotic and same-sex dizygotic twins (834 pairs) ages 18-30 years (M=23.2,SD=3.1) who completed measures of current smoking, chronic musculoskeletal pain history, perceived stress, and depression. Generalized estimating equation regressions accounting for clustering of twin pairs were used to model the association between smoking and chronic pain. A history of chronic musculoskeletal pain was reported by 10.7% of participants. These participants also reported higher current pain intensity (p<.001) and higher prevalence of current smoking (p<.001). Current smoking was significantly associated with chronic musculoskeletal pain history after adjusting for age, sex, education, depression, and perceived stress (OR 1.97, 1.35-2.87, p<.01). Specifically, individual twins who smoked had two-fold greater odds of chronic musculoskeletal pain than those who did not smoke. Within-pair analyses that adjust for potential confounding due to genetics and shared environmental factors were conducted using only monozygotic twins (n = 607 pairs). The within-pair association between smoking and chronic musculoskeletal pain remained significant (OR 1.98, 1.20-3.28, p<.01) for the monozygotic sub-sample suggesting that familial factors do not confound this association. Rather, non-shared factors (e.g., attitudes, behaviors) and possibly the direct effects of smoking on pain perception may play a role. Longitudinal studies of these non-shared factors and recruitment of younger participants prior to smoking initiation and chronic pain onset will better identify causal associations.
Little is published about the relationship of daily opioid use in sickle cell disease (SCD) to pain and psychosocial health. We report among cohort of SCD adults (n=219) who completed daily pain diaries for up to 6 months and had at least one home pain day, the relationship between daily home opioid use, controlled for daily pain intensity (Likert scale 0-9), and psychosocial variables. We measured use of long- or short-acting opioids, other analgesics, or adjuvants, the proportion of home days, home pain days, and home crisis days with opioid use, and these two outcomes according to patient characteristics. Patients used opioids on 12,311 (78%) of 15,778 home pain days. Compared to non-users, opioid users reported higher daily pain intensity (3.04 6 2.10 vs 0.39 6 0.66, p<0.0001), and pain frequency (65.5% vs 15.3%, p<0.0001). Significant relationships were found between any opioid use and: somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL), but not depression/anxiety or alcoholism. The relationship with SCD stress and physical QOL remained when controlled for mean pain. Similar associations were found between frequency of opioid use among users and somatic symptom burden, active coping, positive coping, and physical QOL. We conclude that opioids were used on the majority of home days for these adults with SCD, and use was associated with psychosocial variables, even when controlled for pain. Cognitive-behavioral therapy in SCD could target these variables.
S Quraishi, D Jeffery, and M Kloc; Center for Healthcare Management Studies, Defense Health Cost Assessment and Program Evaluation (DHCAPE), TRICARE Management Activity, Department of Defense, Falls Church, VA Acute and chronic pain conditions have implications for military preparedness and healthcare delivery within the Military Health System (MHS). Previous findings indicate that 26% of active duty personnel have received one or more doses of prescribed opioids in fiscal year (FY) 2010. To examine how this rate corresponds to the prevalence of pain conditions, we examined TRICARE claims data from FY 2006-2010 extracted from the Military Data Repository for 2.4 million military personnel, active duty (AD) or retired. Prevalence rates for pain diagnoses were determined within FY by age, sex and enrollment status. Pain was defined using pain-related ICD-9 codes listed within the first three diagnostic codes on the claim. In 2010, 52% of AD males and 57% of AD females submitted a claim that included a pain diagnosis, up from 49% and 53% in 2006, respectively. Corresponding rates for military retired were 47% of males and 54% of females in 2010, and 43% and 50% in 2006, respectively. For lower back pain alone, in 2010, 14% of AD and 12% of retired males and 16% of AD and 14% of retired females had a relevant diagnosis, an increase from 2006 rates (11% AD, 10% retired males; 12% AD and retired females). These findings indicate that the prevalence of all pain conditions among military personnel has steadily increased over the past five years, in both sexes and enrollment categories. Rates in retirees remain high, suggesting that pain conditions experienced while on active duty persist after retirement. Comparing rates of military personnel being prescribed opioids to rates of pain diagnoses, it appears that non-opioid pain management is used in more than half the AD population with pain conditions. Primary and secondary prevention strategies within the military are necessary in order to prevent the continual increase in rates of pain conditions. (Altarum Institute, Alexandria, VA 22302; Center for Healthcare Management Studies, Defense Health Cost Assessment and Program Evaluation [DHCAPE], TRICARE Management Activity, Department of Defense, Falls Church, VA 22041.) The opinions or assertions herein are those of the authors and do not necessarily reflect the view of the United States Department of Defense. DoD sponsorship of this study is through the Defense Health Cost Assessment and Program Evaluation (DHCAPE), Office of the Chief Financial Officer, TRICARE Management Activity.
The Journal of Pain
S13
(150) Home opioid use in sickle cell disease and relationship to pain and psychosocial variables: the PiSCES project
For some time now, genetic research has been conducted on infants who are atrisk or potential carriers of genetic conditions. The primary healthcare and parental justification for the donation of DNA from these at-risk infants has been that the medical benefits to the infant outweigh the potential risks. The donation of DNA from healthy infants is regarded as more problematic than the donation from at-risk infants due to parental attitudes and concerns about the risks for their healthy infant. There is a paucity of peer-reviewed academic research investigating parental willingness to donate their healthy infant’s DNA for minimal risk genetic research. Identifying parental attitudes that influence their decision to donate DNA from their healthy infant is critical for the future of genetic research in pediatric pain. Recognizing and understanding parental attitudes has the potential to facilitate further pediatric pain genetic research directed towards the development of coherent and concise informed consent and other institutional review board (IRB) procedures such as recruitment and study design. This presentation will examine the process parents utilized to arrive at a decision to donate their healthy infant’s DNA for a minimal risk genetic research. Examining parental knowledge of genetic research, their willingness to enroll their infants in genetic research, and the potential concerns, areas of misunderstanding of genetic research is essential for supporting ethically sound, prospective, cohort studies of genes/environment interaction and increasing the well-being of infants who become research subjects at the start of their lives.
W Smith, D McClish, B Dahman, J Levenson, I Aisiku, V Citero, V Bovbjerg, J Roberts, L Penberthy, S Roseff, M Scherer, and M Weaver; Virginia Commonwealth University, Richmond, VA
A08 Pain Epidemiology
(151) Prevalence rates of pain diagnoses in US military service members, 2006-2010: comparison by age, sex, and enrollment status
(149) Associations among smoking and chronic musculoskeletal pain in young adult twins A Lewandowski, E Law, S Tham, M Myaing, C Noonan, and T Palermo; University of Washington, Seattle, WA Chronic musculoskeletal pain is common in adolescents and young adults, and is associated with physical limitations and poor psychosocial functioning. Prevalence of smoking is highest in this age group, highlighting the importance of interrelations between chronic pain and potentially modifiable health-risk behaviors like smoking. We conducted a secondary data analysis from a large twin cohort to determine if genetics and shared environmental factors affect the association between smoking and chronic musculoskeletal pain. Participants were monozygotic and same-sex dizygotic twins (834 pairs) ages 18-30 years (M=23.2,SD=3.1) who completed measures of current smoking, chronic musculoskeletal pain history, perceived stress, and depression. Generalized estimating equation regressions accounting for clustering of twin pairs were used to model the association between smoking and chronic pain. A history of chronic musculoskeletal pain was reported by 10.7% of participants. These participants also reported higher current pain intensity (p<.001) and higher prevalence of current smoking (p<.001). Current smoking was significantly associated with chronic musculoskeletal pain history after adjusting for age, sex, education, depression, and perceived stress (OR 1.97, 1.35-2.87, p<.01). Specifically, individual twins who smoked had two-fold greater odds of chronic musculoskeletal pain than those who did not smoke. Within-pair analyses that adjust for potential confounding due to genetics and shared environmental factors were conducted using only monozygotic twins (n = 607 pairs). The within-pair association between smoking and chronic musculoskeletal pain remained significant (OR 1.98, 1.20-3.28, p<.01) for the monozygotic sub-sample suggesting that familial factors do not confound this association. Rather, non-shared factors (e.g., attitudes, behaviors) and possibly the direct effects of smoking on pain perception may play a role. Longitudinal studies of these non-shared factors and recruitment of younger participants prior to smoking initiation and chronic pain onset will better identify causal associations.
Little is published about the relationship of daily opioid use in sickle cell disease (SCD) to pain and psychosocial health. We report among cohort of SCD adults (n=219) who completed daily pain diaries for up to 6 months and had at least one home pain day, the relationship between daily home opioid use, controlled for daily pain intensity (Likert scale 0-9), and psychosocial variables. We measured use of long- or short-acting opioids, other analgesics, or adjuvants, the proportion of home days, home pain days, and home crisis days with opioid use, and these two outcomes according to patient characteristics. Patients used opioids on 12,311 (78%) of 15,778 home pain days. Compared to non-users, opioid users reported higher daily pain intensity (3.04 6 2.10 vs 0.39 6 0.66, p<0.0001), and pain frequency (65.5% vs 15.3%, p<0.0001). Significant relationships were found between any opioid use and: somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL), but not depression/anxiety or alcoholism. The relationship with SCD stress and physical QOL remained when controlled for mean pain. Similar associations were found between frequency of opioid use among users and somatic symptom burden, active coping, positive coping, and physical QOL. We conclude that opioids were used on the majority of home days for these adults with SCD, and use was associated with psychosocial variables, even when controlled for pain. Cognitive-behavioral therapy in SCD could target these variables.
S Quraishi, D Jeffery, and M Kloc; Center for Healthcare Management Studies, Defense Health Cost Assessment and Program Evaluation (DHCAPE), TRICARE Management Activity, Department of Defense, Falls Church, VA Acute and chronic pain conditions have implications for military preparedness and healthcare delivery within the Military Health System (MHS). Previous findings indicate that 26% of active duty personnel have received one or more doses of prescribed opioids in fiscal year (FY) 2010. To examine how this rate corresponds to the prevalence of pain conditions, we examined TRICARE claims data from FY 2006-2010 extracted from the Military Data Repository for 2.4 million military personnel, active duty (AD) or retired. Prevalence rates for pain diagnoses were determined within FY by age, sex and enrollment status. Pain was defined using pain-related ICD-9 codes listed within the first three diagnostic codes on the claim. In 2010, 52% of AD males and 57% of AD females submitted a claim that included a pain diagnosis, up from 49% and 53% in 2006, respectively. Corresponding rates for military retired were 47% of males and 54% of females in 2010, and 43% and 50% in 2006, respectively. For lower back pain alone, in 2010, 14% of AD and 12% of retired males and 16% of AD and 14% of retired females had a relevant diagnosis, an increase from 2006 rates (11% AD, 10% retired males; 12% AD and retired females). These findings indicate that the prevalence of all pain conditions among military personnel has steadily increased over the past five years, in both sexes and enrollment categories. Rates in retirees remain high, suggesting that pain conditions experienced while on active duty persist after retirement. Comparing rates of military personnel being prescribed opioids to rates of pain diagnoses, it appears that non-opioid pain management is used in more than half the AD population with pain conditions. Primary and secondary prevention strategies within the military are necessary in order to prevent the continual increase in rates of pain conditions. (Altarum Institute, Alexandria, VA 22302; Center for Healthcare Management Studies, Defense Health Cost Assessment and Program Evaluation [DHCAPE], TRICARE Management Activity, Department of Defense, Falls Church, VA 22041.) The opinions or assertions herein are those of the authors and do not necessarily reflect the view of the United States Department of Defense. DoD sponsorship of this study is through the Defense Health Cost Assessment and Program Evaluation (DHCAPE), Office of the Chief Financial Officer, TRICARE Management Activity.