Dissertations / Theses on the topic 'Pain epidemiology'

The principal aims of the present study were to determine, in an unselected general population: (a) whether chronic oro-facial pain co-occurs with other frequently unexplained symptoms (b) whether factors associated with chronic oro-facial pain are common across symptoms. A population-based cross-sectional study was conducted using 4200 randomly selected adults who were recruited from the age-sex register of a General Medical Practice in North West, England. The study examined the prevalence and co-occurrence of chronic oro-facial pain with three other chronic symptoms that are frequently unexplained: chronic widespread pain, Irritable bowel syndrome and chronic fatigue. Validated instruments were used to measure the occurrence of symptoms and to collect information on a variety of associated factors: demographic (age and gender), psychosocial (anxiety, depression, illness behaviour, life stressors and reporting of somatic symptoms), mechanical (teeth grinding, facial trauma, missing teeth and reporting that the teeth did not fit together properly). 2505 subjects returned completed questionnaires (adjusted response rate 72%). The prevalence of Chronic Widespread Pain was 15%. Chronic Oro-facial Pain 7%. Irritable Bowel Syndrome 9% and Chronic Fatigue 8%. The study found that 587 subjects (27%) reported one or more symptoms: 404 (18%) reported one symptom, 134 (6%) reported two, 34 (2%) reported three, whilst 15 (1%) reported all four symptoms. This study has shown that chronic symptoms (including Chronic Oro-facial pain) that are frequently unexplained co-occur in the general population and share common associated factors. These findings are consistent with the hypothesis that chronic oro-facial pain may share a common aetiology with other frequently unexplained symptoms although this needs to be confirmed in a prospective study.

Background. Pain after knee surgery has been reported as a common problem. It is highly ranked in terms of intensity and has important consequences on both quality of life and psychological well-being. However, assessment and management of postoperative pain remain a key clinical problem.
Objectives. To describe the occurrence of pain after total knee arthroplasty (TKA) and knee arthroscopy; identify the predictors of postoperative pain and evaluate the consequences of pain on quality of life and on depression status.
Methods. Patients were recruited from nine university and regional hospitals in the province of Quebec and were followed for three months after knee surgery. Time points of postoperative day 7 and month 3 were our prime interest. We used a prospective cohort design to investigate characteristics of postoperative pain and a case-control design to identify the impact of postoperative pain on quality of life and on depression. Both logistic regression and multiple linear regression models were used to analyze postoperative pain intensity and the impact of postoperative pain respectively. (Abstract shortened by UMI.)

There is currently little primary data looking at the epidemiology of back pain in older people and there are few large-scale population based studies which consider the occurrence or aetiology of back pain within this age group. Some evidence suggests that while non-disabling back pain decreases in the oldest old, the prevalence of disabling back pain may continue to increase. However, the aetiology of back pain in this group remains relatively unknown. Therefore, the overall aim of the current thesis was to investigate the epidemiology of back pain in older people, to examine the occurrence of back pain and age-related patterns in prevalence and incidence (descriptive epidemiology) and to identify potential risk factors for predicting back pain onset in those ≥75 years, specifically, to determine the role of social networks (analytical epidemiology). This was done through secondary analysis of a prospective cohort study from Cambridge looking at older people ≥75 years. It has been shown that while the prevalence of non-disabling back pain did not vary significantly across age, the prevalence of disabling back pain increased with age. In addition, it has been demonstrated, firstly, that aspects and indicators of physical health and a prior history of back pain are associated and independent predictors of back pain in older people; and secondly, that while objective measures of social contact are not risk markers for back pain, low mood, feelings of social isolation and depression are more strongly associated. These findings were further verified and confirmed in a second study, a cross-sectional survey of people ≥65 years living in rural Scotland. It can therefore be concluded that back pain is a common problem in the older population and, while mild back pain may remain constant across older age, disabling back pain continues to increase into the oldest old. The risk profile for back pain in older age is multifactorial, while some risk factors evident in younger populations remain; there is greater emphasis on the impact of mood and psychosocial factors.

Background: Epidemiological studies on chronic pelvic pain (CPP) mainly focused on women of reproductive age so it is not clear whether there is any evidence of a distinct epidemiology at older ages. Therefore, the primary aim of this study was to establish the epidemiological characteristics of CPP whilst including women beyond the reproductive age. Methods: A cross-sectional postal survey was conducted amongst 5300 randomly selected women aged ≥25 years resident in the Grampian region, UK. Factors associated with CPP, poor health state and passive/active coping strategies were assessed using logistic regression. To identify sub-groups of CPP cases, cluster analysis was performed using variables of pain severity, psychosocial factors and pain coping strategies. Results: Of 2088 participants, 309 reported CPP (prevalence 14.8%). Prevalence was higher among women of reproductive years compared to older women (20.5% v. 9.6%). CPP was significantly associated with having multiple non-pain somatic symptoms, having fatigue and depression. CPP was more strongly associated with multiple non-pain somatic symptoms among older women compared to women of reproductive age but no other factor was found to be differentially related to CPP in the post-reproductive years. Poor health states among CPP cases were not strongly associated with pain intensity and duration but associated with depression, sleep disturbance, fatigue and passive coping. Women with CPP often engage passive coping strategy which was strongly associated with severe and constant pain, fatigue and multiple somatic symptoms. Two distinct groups of CPP cases characterised by the absence/presence of psychosocial distress were identified. Conclusion: This study provides a more accurate prevalence estimate for CPP which will aid healthcare planning and resource allocation. The associations identified for CPP are similar to those often reported for chronic pain conditions suggesting that they may have similar underlying mechanism. This study offers a basis for additional comprehensive and prospective evaluation of CPP and could inform the development of CPP management strategies.

Introduction: Currently used methods to collect self-reported information on pain status in population studies have remained unchanged over the past decades. Decreasing response rates and the necessity to collect more detailed information to advance on understanding declare the importance of updating these instruments. The aims of this thesis were to (1) explore different strategies to increase response rates and (2) assess whether population estimates of pain change when participants' pain management is considered for the pain assessment. Methods: A cross-sectional study was conducted in the general population in Grampian, Scotland. 4600 potential participants were randomly selected from the NHS community health index register and sent a self-completion questionnaire. Collected information included people's health status (SF-36), pain status (manikins, chronic pain grade), pain management and estimated pain status without pain treatments (enhanced pain status questionnaire). The newly developed pain management and enhanced pain status questionnaire were validated within a small sample of the questionnaire respondents who attended a subsequent interview. Results: The response rate was not significantly increased when single-sided questionnaires were sent to potential participants (OR=1.13, 95%CI=0.998, 1.28) or when an option to reply via the internet was provided (OR=1.06, 95%CI=0.94, 1.20). Population estimates of pain changed significantly with the use of the enhanced pain status questionnaire: the pain prevalence increased from 50.5% to 56.2% (difference=5.7%, 95% CI=2.2, 9.2). Likewise, respondents with pain estimated their pain to be significantly higher when they considered the effect of their treatments. Conclusions: Neither an option to reply via the internet nor single-sided questionnaires are effective methods to increase response rates to population studies. Conclusions: Neither an option to reply via the internet nor single-sided questionnaires are effective methods to increase response rates to population studies. The burden of pain is currently underestimated in population-based pain studies which do not include an assessment of pain management. As a result of the findings, pain management information should routinely be collected and considered in epidemiological studies assessing pain.

Headache is the most frequently reported pain in children and is associated with missed schooldays, anxiety, depressive symptoms and various physical symptoms. A secular trend of increasing headache prevalence has been suggested. Few studies have focused on tension-type headache among children from the general population.

The aims of this thesis were to describe the prevalence, incidence and prognosis of tension-type headache, migraine and overall headache in schoolchildren, to identify medical, psychological and social factors associated with these headache types, and to determine whether the prevalence of headache has increased over the last decades.

In 1997, 1850 schoolchildren aged 7-15 years from the city of Uppsala participated in a questionnaire study and 1371 (74.1%) responded. Out of these, a randomly selected, stratified sample of 131 children and their parents were interviewed. Three years later, 122 children from the interview sample replied to an identical headache questionnaire.

Compared with a similar study in 1955, a significantly lower proportion of schoolchildren reported no headache. The prevalence of tension-type headache increased with age and was significantly higher in girls than boys after the age of twelve. Similar age and gender differences were obtained for migraine. A higher proportion of girls reported frequent headache than boys. Children with headache, especially those with migraine, as well as their first-degree relatives suffered from other pains and physical symptoms more frequently than headache-free children and their first-degree relatives. Although the likelihood of experiencing the same headache diagnosis and symptoms at follow-up was high, about one fifth of children with migraine developed tension-type headache and vice versa. Female gender was a predictor of migraine and frequent headache a predictor of overall headache at follow-up. The estimated annual incidence for tension-type headache, migraine and overall headache was 81, 65 and 131 per 1000 children, respectively.

In conclusion, the results indicate that headache has become increasingly common among schoolchildren over the last decades. Prevention and treatment of headache is particularly important for girls since they have high prevalence of headache, frequent headache episodes and a poor outcome. In children with headache, diagnoses and treatment should be reassessed regularly and other pains should be asked about and treated as well.

Background: Pain is the main reason patients present with Osteoarthritis (OA). There are many risk factors for increased pain but one risk factor that is the focus of this thesis is catastrophizing. There is a discrepancy between the amount of radiographic damage to the joint and the pain intensity felt by the OA patient, which leads to the hypothesis that there must be other non-structural factors such as catastrophizing that could explain this discrepancy. Objectives: (1) To assess the effect of catastrophizing on joint and body pain in individuals who have undergone total joint replacement surgery after accounting for sleep quality, anxiety and depression in people diagnosed with large joint OA and controls. X-rays and resulting K/L grade also used to account for joint damage. (2) To identify if there are specific genes and pathways that could explain the relationship between catastrophizing and pain, also whether catastrophizing is a trait in its own right which is not dependent on depression or bad quality sleep. (3) To identify genetic factors which contribute to the effect of catastrophizing on pain intensity in OA by comparing those with symptomatic OA to those with asymptomatic OA. Methods: Pain post- Total Joint Replacement (TJR) (Chapter 3): This is a case-control study design. Cases were derived from the Nottingham genetics of OA study (NGOAS) and the Genetics of Osteoarthritis and Lifestyle Study (GOAL) cohorts that have undergone joint replacement. Controls were derived from participants in the GOAL cohort that were selected as controls for OA. 1093 individuals from the NGOAS cohort who had been diagnosed with knee or hip OA were recruited from secondary care (82% post-total joint replacement (TJR) none on waiting list) and completed a questionnaire which included items on: joint pain, neuropathic pain like symptoms (using the painDETECT questionnaire), anxiety (using the hospital anxiety and depression scale (HADS) questionnaire), depression (using the HADS questionnaire) and the 13-item pain catastrophizing scale (PCS). A similar questionnaire was sent to participants from a case control OA study known as the GOAL involving 679 cases all with hip or knee OA (59.7% post-TJR, none on waiting list) and 402 non-OA controls. TJR used as cases due to this being the end point of OA with those undergoing TJR most likely in pain from OA. High pain catastrophizing was defined as being in the top tertile of the PCS (score≥9). SPSS was then used to calculate descriptive statistics such as percentage of participants that were female, mean age, BMI. This would give a picture of the cohort being used. Then binary logistic regressions were used to calculate odds ratios (ORs) for sleep, depression, anxiety and catastrophizing whilst adjusting for confounding factors such as age, BMI, gender. Genetics (Chapter 4 and 5): Quantile-Quantile (QQ) and Manhattan plots were produced using R to quality test the genomic data. A Manhattan plot is a type of scatter plot, usually used to display data with a large number of data-points - many of non-zero amplitude, and with a distribution of higher-magnitude values, for instance in genome-wide association studies (GWAS). The statistics program R (version 3.0.2) was used to create Manhattan and QQ plots using the “ggplot2” library and “qqplot” script. A genome wide association scan (GWAS) and single nucleotide polymorphism (SNP) extractions, conducted using Plink, were carried out on a subset of 1113 post TJR cases from the NGOAS cohort and pathway analysis was then conducted based on significant SNPs found in the GWAS. In chapter 4 replication and meta-analysis were then carried out using a separate cohort of 679 participants, taken from the GOAL study. Results: Pain post- total joint replacement (TJR) (Chapter 3): The prevalence of high catastrophizing was not significantly higher in OA and post TJR cases (36.8%) than in controls (33.1%)(p<0.07), however as controls were from intravenous urography (IVU) clinics they would have higher levels of cardio-vascular disease, stroke, kidney disease for example than general population. The main factors associated with catastrophizing were older age, higher body mass index, high pain intensity, anxiety, depression and multiple regional pain. High catastrophizing was associated with increased risk of severe joint (hip or knee) pain after adjustment for sleep quality, anxiety and depression (OR= 2.99, 95% CI= 2.20-4.04, p< 1.54E-12). Similarly, high catastrophizing was associated with body pain (OR=1.47, CI=1.16-1.86, P<0.0002) and neuropathic-like pain symptoms (OR=5.35, CI=4.16-6.90, P<1.42E-35). I also explored if these associations with pain were due to the presence of comorbidities which are common in OA patients and post-TJR. I did find that pain catastrophizing scores were also associated with cardiovascular disease (CVD) after adjustment for depression and sleep quality as well as BMI, age and gender (OR= 1.44, 95% CI= 1.14-1.81, p< 0.001). Genetics (Chapter 4 and 5): Several SNPs were linked to high catastrophizing scores with a p-value <0.00005. ADRA2C was the only gene associated with catastrophizing that replicated in chapter 4 after meta-analysis. This variant was associated with OR=0.67, 95% CI= 0.56-0.80, p-value=7.8x10[-6]. It is involved in the formation of adrenergic receptors and therefore the regulation of possibly many pain pathways including the sympathetic nervous system and the hypothalamic–pituitary–adrenal axis as well as being required for normal presynaptic control of transmitter release in the heart. PRR20 was another interesting finding in chapter 4. It is involved in dopamine receptors, so possibly influencing that particular pain pathway. These data demonstrate that catastrophizing does influence pain intensity and implicates certain molecular pathways that may be involved in this relationship. LEPRE1 and COL6A1 are both implicated in chapter 5. Both of these genes are involved in collagen formation and destruction thereby could affect the progression of OA and joint structure leading to pain. LEPRE1 is further known as one of the genetic causes of Osteogenesis imperfecta type VIII another bone formation disorder. Conclusion: Pain catastrophizing is associated with joint and body pain in individuals with OA after TJR and this effect is not mediated by sleep quality, anxiety or depression. Therefore catastrophizing can be said to be a trait in its own right. Many genes and pain pathways were implicated by the genetics studies, mainly involving adrenaline and dopamine, so more focus on these neurotransmitters could be suggested for future study. Another interesting finding that could be investigated further is the link between cardiovascular disorders and catastrophizing as this is a relatively unexplored area, made more interesting by the finding of ADRA2C both indicating involvement of the sympathetic nervous system and other central mechanisms.

Musculoskeletal pain often includes pain in the back, neck, knee, and hip, and is associated with a substantial financial and personal burden. Eight chapters are included in this thesis that aims to improve the understanding of the heterogeneity in treatment effects and prognosis of musculoskeletal pain. Four issues were identified: i) people with different pain phenotypes (i.e. back pain with or without neurological deficit) or with distinct underlying health conditions (e.g. pregnancy-related back pain) may respond differently to treatment strategies; ii) people with chronic back pain and presenting different radiological phenotypes may experience different course of the disease; iii) different patterns of analgesic use over time may be associated with different long term health status; iv) different types and number of sites of musculoskeletal pain may be associated with different clinical prognoses.

Inflammatory arthritis (IA) refers to a group of diseases that affect up to 3% of the population. Characterized by joint pain, swelling, and loss of function, examples of IA include rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and other forms of spondyloarthritis (SpA). In spite of significant advances in treatment over the past few decades, international studies have shown that many patients with IA continue to experience musculoskeletal pain. Untreated and under treated pain are well known to negatively impact overall well-being and increase disability. There are many contributing factors to the suboptimal pain management of patients with IA. Despite extraordinary advances in the understanding of pain mechanisms at the molecular level, there remains a lack of understanding about what actually causes joint pain. In addition, pain generating mechanisms are dynamic as well as influenced by a multiplicity of factors such as sleep, mood, past pain experiences, cultural background, and genetics of the individual. Hence, for clinicians assessing pain in patients with IA, the exact aetiology, influencers and resultant impact can often be difficult to elucidate. When managing patients with IA, clinicians have also traditionally focused on disease activity outcome measures. However, the correlation between pain intensity and measures of disease activity is poor. In fact pain has been shown to be one of the most significant predictors of discordance between patient and physician global assessment scores. This can lead to a physician believing the patient has very well controlled disease, while at the same time their patient feels that it is poorly controlled. Such miscommunications may explain why despite apparent disease control, patients continue to report pain as their predominant impairment, and pain management as their highest priority. Yet, despite being a frequent and important issue, there has been a paucity of research evaluating the prevalence, severity, impact or best management of pain in modern day patients with IA. Clinicians have had to rely upon clinical experience and inferences of therapeutic potential of pain medications from other patient groups to guide best management. This is clearly suboptimal. To understand the magnitude of the problem in Australia, the first aim of this thesis was to describe the prevalence, severity and impact of persistent pain in modern day patients with the most common IA condition, rheumatoid arthritis (RA). Data from the Australian Rheumatology Association Database (ARAD) was analysed and revealed that 95% adult patients with RA reported persistent pain in the last week, with a high proportion reporting moderate (39%) or severe (19%) levels of pain. Patients with higher levels of pain were found to have higher levels of disability and lower quality of life scores. After adjusting for confounders, the strongest associations with moderate to severe levels of pain were current use of opioid, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), joint pain, lower level of education, presence of concurrent back pain, higher disability and female sex. To better understand the current management of persistent pain in patients with IA, the second aim of this thesis was to describe the analgesic medications currently being used by patients to manage their pain. A review of ARAD data revealed that in patients with RA, paracetamol (60%) and non-steroidal anti-inflammatory drugs (37%) were the most frequently used analgesics, however, surprisingly the prevalence of opioid use was also very high (26%). Overall, there was significant variation in the number and types of analgesics being used by these patients reflecting the lack of evidence and guidelines available to guide front line clinicians and patients in best practice. The third aim, prompted by the unexpected prevalence of opioid use, was to explore the longitudinal patterns of opioid use and factors associated with starting and stopping their use. This analysis showed that the prevalence of opioid use was stable over time, but there was a linear trend for an increase in high potency opioid use from 6.1% prior to 2008 to 11.2% after 2012. This was accompanied by a concomitant decrease in low potency only opioid use. Another significant finding was that those who commenced opioids, on average, continued them for almost two years. Younger baseline age, higher pain scores, HAQ scores and oral glucocorticoid use were important determinants of change in opioid use, associated with both a higher probability of commencing opioid use, and a lower probability of cessation. Of note, use of bDMARDs was not associated with a discontinuation of opioid use. Opioid use was also associated with an increased mortality risk unrelated to opioid overdose. The fourth aim of this thesis was to review the evidence for the efficacy and safety of medications found to be commonly used to treat persistent pain in patients with IA. As part of a body of work that contributed to the international 3e (Evidence, Expertise, Exchange) initiative, four Cochrane systematic literature reviews (SLRs) for patients with RA and four SLRs in patients with IA were performed to evaluate antidepressants, neuromodulators, muscle relaxants, and opioids. This complemented other 3e research that reviewed the evidence for paracetamol, NSAIDs and corticosteroids. The SLRs evaluating antidepressants versus placebo or an active intervention comprised eight randomized controlled trials (RCTs) (652 participants) in patients with RA and one RCT in patients with AS (100 participants). All trials evaluated tricyclic antidepressants and 2 studies included a selective serotonin uptake inhibitor. All studies were small and deemed to have a high or unclear risk of bias so no reliable conclusions about efficacy were able to be drawn. In terms of safety, use of antidepressants was associated with adverse events which were generally mild and did not lead to cessation of treatment. Based on these SLRs, there was insufficient evidence to support the routine prescription of antidepressants as analgesics. A research gap was also identified with a need for more high quality trials in this area. The SLRs evaluating neuromodulators identified only four RCTs in patients with RA, with two evaluating oral nefopam and one trial each evaluating topical capsaicin with placebo and oromucosal cannabis with placebo. All trials were determined to have a high risk of bias. The review found weak evidence that oral nefopam, topical capsaicin and oromucosal cannabis were all superior to placebo in modestly reducing pain in patients with RA. However, each agent was associated with a significant side effect profile so routine use was not recommended. The SLRs evaluating muscle relaxants identified six small RCTs (126 participants) evaluating the benzodiazepines diazepam and triazolam, as well as the non-benzodiazepine zopiclone in patients with RA. No trial was longer than 2 weeks and 3 single-dose trials assessed outcomes at 24 hours only. Overall, the included trials failed to find evidence of a beneficial effect of muscle relaxants over placebo or in addition to nonsteroidal anti-inflammatory drugs on pain intensity, function, or quality of life. Data from two trials of longer than 24-hour duration found that participants who received a muscle relaxant had significantly more adverse events compared with those who received placebo. These were predominantly central nervous system side effects including dizziness and drowsiness. The reviews found there was insufficient evidence to support the use of muscle relaxants for pain management in patients with RA. The SLRs evaluating the efficacy and safety of opioids found eleven RCTs in patients with RA (672 participants) only. The risk of bias in all studies was high and no study was longer than 6 weeks in duration. Based on the available evidence, the review found that treating RA patients with weak opioids for up to six weeks may offer clinically-relevant improvement in pain, however adverse effects such as constipation, dizziness, nausea, and vomiting were common. There was insufficient evidence to draw conclusions regarding the regular use of weak oral opioids for longer than 6 weeks, the use of strong opioids for any duration, or the role of opioids in IA other than RA. Based on the available evidence for many patients, benefits of weak opioids are unlikely to outweigh the harms. Following the completion of the SLRs, the fifth aim of this thesis was to combine this evidence with expert opinion to develop national pragmatic, evidence-based guidelines to aid practitioners in the management of pain in patients with IA. The evidence from the SLRs was presented to 46 Australian and New Zealand rheumatologists for discussion. Using this evidence, their expert opinion and a Delphi process, 10 Australian and New Zealand recommendations regarding the use of pharmacotherapy for pain management in adult patients with IA were formulated. These Australian and New Zealand national recommendations, in addition to the recommendations from 16 other nations, contributed to the formation of multi-national guidelines for pain management by pharmacotherapy in patients with IA. There are numerous strengths of this thesis. This work has addressed a research gap to a prevalent problem and provided the first insights into the magnitude and severity or persistent pain in Australian patients with IA. Use of the national ARAD database allowed large numbers of real world, Australian patients with IA from a wide variety of backgrounds to be included and ensured the patient perspective was captured. This ensured that the results were meaningful, patient centric, and generalisable to the broader Australian IA population. This work was also the first to evaluate such an extensive array of potential predictors of persistent pain in patients with RA and has also thrown a spotlight, for the first time, on the unrecognised and concerning problem of high levels of use of opioid medication use in this patient population. The methodology used in the SLRs and development of the guidelines was robust. In the systematic appraisals of the evidence for the efficacy and safety of various analgesic agents in this patient population, a rigorous, reproducible, Cochrane methodological approach was used. The reviews contained in this thesis are the first published work to evaluate the efficacy and safety of anti-depressants, neuromodulators, muscle relaxants and opioids in patients with IA. In the development of the national and multinational evidence based guidelines, the inclusion of a broad range of rheumatologists and the use of a formal modified Delphi voting process ensured, that a wide range of expertise was captured, relevance of the recommendations to a broad audience and that promotion for the implementation of the guidelines occurred on a large scale. In presenting the work contained in this thesis at state, national, and international conferences and publishing the work in high impact journals, this thesis has also contributed significantly to the collaborative effort to educate the broader community about the significant issue of persistent pain in patients with IA, how it is optimally managed, and the large research gap that currently exists in this area. The guidelines are the first Australian and New Zealand evidence based guidelines published to assist front line clinicians managing pain in patients with IA. Limitations of the work included the lack of disease activity measures (ESR, CRP, tender joint count (TJC), swollen joint count (SJC)) and qualitative data present in the ARAD database to further understand the aetiology of the pain being reported by patients. The reliance on self-reporting of analgesic medications and lack of dosages of medications recorded, or indication for treatment means that accuracy of the data may be affected by recall bias, and relies on the patient’s understanding of why they are taking their pain medications. Commonly used antidepressants, neuromodulators and muscle relaxants such a duloxetine, sertraline, fluoxetine, citalopram, gabapentin, amitryptiline, pregabalin, diazepam were not specifically asked about and are likely to have been under-reported. In the SLRs, there were few high quality trials present, and the populations included were not reflective of current day patients with IA. The scope of this thesis is limited to pharmacotherapy and so non pharmacological interventions for pain management in IA have not been reviewed. The findings in this thesis highlight the need for further research to better understand the aetiology of pain as well as the optimal use of analgesic agents in patients with IA. A need for new pain management approaches taking into account current immunomodulatory strategies, novel analgesic drugs and a modern understanding of measurement and neurobiology of pain is also clear. In summary, the work contained in this thesis has shown that the prevalence of moderate to severe pain in Australian patients with IA is high, and has a significant impact on their disability and quality of life. Opioid use in this patient group is frequent and prolonged despite evidence suggesting harms outweigh the benefits. To assist front line clinician’s in managing this complex, multi-dimensional symptom, pragmatic, evidence and expertise-based Australian and New Zealand have been published. The work contained in this thesis also significantly contributed to the first published multi-national guidelines for pain management by pharmacotherapy in patients with IA. A clear research agenda to address the large knowledge gaps in this area has also been identified.

Aims: To describe the distribution and determinants of chronic pain in the community, and to assess its impact in physical, psychological and social dimensions. Design: Postal questionnaire survey. All elements of the questionnaire were tested for acceptability, reliability and validity in preliminary studies. Subjects and Setting: Two random samples of individuals from 29 general practices in Grampian, stratified for age (over 25) and gender. One sample (n=5,036) was drawn from the Community Health Index (CHI) and the other (n=4,175) was drawn from practice computer prescribing records. Outcome Measures: A Case Definition Questionnaire, the Chronic Pain Grade questionnaire, the SF-36 general health questionnaire and basic demographic questions. Results: Response rate was 84%. The sample prevalence of "any chronic pain" was 50%, and was higher among women and older age-groups. The prevalence of "significant chronic pain" was 14% in the CHI sample, and the prevalence of "severe chronic pain" was 6%. Employment status and level of the academic attainment were independently associated with the presence of chronic pain. Back pain (15%) and arthritis (14%) were the two most commonly reported causes of chronic pain in the CHI sample. Chronic pain of all causes had a significant on all dimensions of health, and on interference with work and daily activities. Social class, employment status and level of educational attainment were independently associated with greater pain-related interference with usual activities. Conclusions: A comprehensive profile of chronic pain in the community is provided. The prevalence and impact were high, as suggested by previous studies, and age and gender associations were largely confirmed. Detailed clinical and socio-demographic associations with chronic pain provide important information on areas where intervention or prevention might be effective. Common patterns of severity and impact suggest that the cause of chronic pain is relatively unimportant in determining the response to it. Areas for future research are suggested.

Context: Hundreds of thousands of Quebec residents suffer from chronic pain, for which treatment is far from optimal. Despite low back pain being the second most common reason to visit a primary care physician, management remains challenging. Additionally, chronic low back pain (CLBP) has been found to be the most common reason for patients to be referred to tertiary pain centers. Recently, there has been an increasing acceptance that bio-psycho-social factors play a crucial role the clinical course of CLBP. Objectives: The purpose of this study was to identify subgroups of CLBP patients treated in tertiary care, as defined by their changes in pain and disability over time, and to explore possible characteristics associated with these changes. Specific objectives were: 1) to establish whether there are distinct subgroups of patients with CLBP with different characteristics associated with change in pain and disability at 6, 12, and 24 months following an initial visit in a tertiary pain clinic; and 2) to identify potential social, psychological, biological, and environmental factors that may predict their responses in pain intensity and disability in accordance with the Revised Wilson and Cleary Model for Health-Related Quality of Life. Design: Observational prospective design to follow a cohort of patients who were enrolled in the web-based Quebec Pain Registry. Setting: The Quebec Pain Registry, a research database comprised of close to 5000 chronic pain patients. Eligible participants included all patients who 1) have been diagnosed with lumber without radicular pain, LBP (diagnostic code 3.1), lumbar & radicular pain, LRP (diagnostic code 3.2), or diffuse lumbar pain, DLP (diagnostic code 3.4), 2) who provided written consent for their data to be used for research purposes, and 3) have completed their initial visit to the pain clinic by May 31, 2011. Intervention: The data required for this project had previously been collected and entered in the Quebec Pain Registry. Basic descriptive results were produced using SAS® software 9.2. This analysis described the characteristics of the 917 patients included in the study at baseline. Additional data were explored to examine patterns of changes over two years for certain characteristics. A generalized estimating equations model (GEE) was used to analyze data at 6, 12, and 24 months after the initial visit. Results: 299 (32.6%) patients were diagnosed LBP, 522 (56.9%) with LRP, and 96 (10.4%) with DLP. In general, all patients were relatively comparable in terms of their characteristics with the exception of DLP, where proportions were noticeably different. Patients diagnosed with DLP had a higher pain duration median (6.0 years) and the most frequently current employment status was permanent disability (both in regards to proportions). The most common ethnicity was Caucasian among all diagnoses. Income was similarly distributed among all groups and secondary school was the highest level of education completed for all. The top three medical conditions reported other than CLBP were rheumatoid arthritis/osteoarthritis, hypertension, and depressive disorders. DLP patients reported "accident at work" as the most common circumstance surrounding their onset of pain. DLP also had noticeably different mean scores for average pain, worst pain, depression, catastrophizing, disability, mental and physical summary scores on the health-related quality of life questionnaire at baseline, 6, 12, and 24 months (in regards to proportions). Patients with higher worst pain scores, longer pain duration, and lower physical summary scores at the initial visit were significantly less likely to show improvements in pain intensity and disability at six and 12 months. Conclusions: Although modifying the analysis prohibited conclusions for a two-year follow to be made, characteristics, such as worst pain, pain duration, and lower physical summary scores at both six and 12 months were discovered.
Contexte: Des centaines de milliers de résidents du Québec souffrent de douleurs chroniques. En dépit de la douleur au bas du dos étant la deuxième cause la plus fréquente de consulter un médecin de soins primaires. . Récemment, il y a eu une acceptation croissante que les facteurs bio- psychosociale (biologiques, psychologiques et sociaux ) jouent un rôle crucial de l'évolution clinique de la lombalgie chronique , mais peu de recherches concernant la lombalgie chronique ont étés achevé plus d'un an . Objectif: Les objectifs spécifiques sont : 1) d'établir s'il existe des groupes distincts de patients atteints de lombalgie chronique avec des caractéristiques de réponse à 6, 12 et 24 mois après la visite initiale, et 2) pour identifier le potentiel social, psychologique, biologique et environnemental caractéristiques, conformément à la modèle révisée Wilson et Cleary pour la qualité liée à la santé de la vie. Conception: analyse prospective d'une cohorte historique. Cadre: Le Registre québécois de la douleur, une base de données de recherche unique composée de près de 5000 patients souffrant de douleurs chroniques de centres de la douleur tertiaires. Participants: adultes diagnostiqués avec la douleur chronique au bas du dos qui sont inscrits dans le registre de la douleur Québec. Les participants admissibles inclus tous les patients qui ont été diagnostiqués avec le bois sans douleur radiculaire , LBP (code de diagnostic 3.1), lombaire et douleur radiculaire , LRP (code de diagnostic 3.2) , ou une douleur lombaire diffuse , DLP (code de diagnostic 3.4) et ont terminé leur formation initiale visite à la clinique de la douleur avant le 31 mai 2011. Intervention: Les données nécessaires à ce projet avaient déjà été recueillies et consignées sur le registre de la douleur Québec. Résultats descriptives de base ont été produites en utilisant SAS ® 9.2 logiciel. L'analyse descriptive a décrit les 917 patients inclus dans l'échantillon de l'étude au départ, générant des scores moyens. Des données supplémentaires ont été explorées pour observer des modèles sur deux ans pour certaines caractéristiques. Un modèle des équations d'estimation généralisées (GEE) a été utilisé pour analyser des données corrélées à six, 12 et 24 mois. Résultats: 299 (32.6%) patients ont été diagnostiqués LBP, 522 (56.9%) avec LRP, et 96 (10.4%) avec DLP. En général, tous les diagnostics étaient comparables à l'exception de DLP. Les patients diagnostiqués avec DLP avaient une durée médiane de la douleur plus élevé (6,0) et l'invalidité permanente le plus fréquemment rapporté pour le statut actuel de l'emploi. L' ethnie la plus fréquente était de race blanche parmi tous les diagnostics . Le revenu a été distribué similaire dans tous les groupes, et à l'école secondaire était le plus haut niveau de scolarité atteint pour tous. Les trois conditions médicales rapportées étaient la polyarthrite rhumatoïde / arthrose, l'hypertension et les troubles dépressifs. DLP patients ont signalé « accident du travail » comme circonstance la plus courante qui entoure leur apparition de la douleur. DLP a également indiqué sensiblement différents scores moyens pour la douleur moyenne, pire douleur, la dépression, catastrophisme, le handicap, le score résumé mental, et le score résumé physique au départ, 6, 12 et 24 mois. Les patients ayant les plus mauvais scores de la douleur, la durée de la douleur plus élevé, et des scores plus bas sommaires physiques étaient significativement moins susceptibles de montrer des améliorations dans la douleur et le handicap à six et 12 mois. Conclusions: Bien que la modification des conclusions interdites d'analyse pour un suivi de deux ans à faire, des caractéristiques importantes telles que la pire douleur, la durée de la douleur, et les scores sommaires physiques inférieurs aux deux six et 12 mois ont été découverts.

This thesis aims to better the understanding of pain and injury in adolescents and young adults by investigating the prevalence, impact, risk factors, clinical course and diagnosis of common disorders. Chapters 2 and 3 presents the results of studies of large international data sets. Chapter 2 showed that back pain, headache, and stomach ache were very common in adolescents, more often coexisting with each other than occurring in isolation. In Chapter 3 investigated the association between pain and achieving 60 minutes of moderate to vigorous physical activity per day. Adolescents with pain generally had reduced odds of meeting physical activity recommendations. Chapter 4 investigated whether physical growth and development is a risk factor for musculoskeletal conditions in adolescents. A systematic review of the literature was conducted. A total of 208 estimates of association generally indicated no association or an unclear association between maturation, growth and musculoskeletal conditions in adolescents. In Chapter 5, a feasibility study was conducted to assess the recruitment, retention and response rates of weekly electronic follow-up, in adolescents with knee pain. Study feasibility was threatened by slow recruitment, participants that stopped responding prior to recovery, and high loss to follow-up. Electronic data collection alone seems insufficient to track knee pain recovery in young people. Anterior cruciate ligament injuries are common and impactful in young people. Chapter 6 reports on a systematic review conducted to evaluate the diagnostic accuracy of clinical tests for anterior cruciate ligament injury. Clinical tests in combination, but not individually, may assist the diagnosis of anterior cruciate ligament injury in clinical practice. Collectively, this thesis provides an important contribution to the body of knowledge underpinning the epidemiology of pain and injury in adolescents and young adults.

Includes abstract.
Includes bibliographical references (leaves 89-98).
Aims of this thesis: the research reported in this thesis consists of a literature review and two research parts. In the first research part, a descriptive cross-sectional survey was conducted, to investigate 1) the epidemiology and 2) the nature of LBP in cyclists, and 3) possible risk factors associated with LBP in cyclists. In the second research part, a case control study was conducted, to investigate the association between LBP in cyclists and 1) flexibility and 2) anthropometric measurements, and 3) bicycle set-up parameters.

Internationally chronic pain is recognised as a major health problem that has considerable impact individually, socially and economically. This thesis sought to: address gaps in knowledge about the prevalence and impact of chronic pain in the New Zealand general population; further elucidate understanding of the relative roles and interrelationships of prominent biological, psychological, social and material influences on chronic pain; and explore the association of chronic pain with functional outcomes within the general population. An underpinning assumption, also tested within the research, was that chronic pain is a condition in its own right. The thesis drew on concepts from social and life course epidemiology, psychology and physiology and the research questions were investigated within a mixed methods approach. The majority of the thesis was a quantitative epidemiological analysis of a nationally representative general population cross-sectional survey. A smaller qualitative study sought to generate greater understanding of the influence of social interactions on the self-management of chronic pain by individuals living in the community. Novel findings include support, from a population perspective, that chronic pain is a condition in its own right; that co-morbid load (allostatic load) is associated with chronic pain; the association of low levels of physical activity with chronic pain are likely to be confounded by chronic physical conditions and mental health conditions; levels of material resources are independently and significantly associated with chronic pain and with functional outcomes; gender although associated with use of medical treatment was not associated with reporting chronic pain; and age is not associated with chronic pain per se, rather the relationship of age with chronic pain is confounded by other factors, in particular chronic physical conditions. Reciprocal influences among factors over time could usefully be investigated in future.

This thesis begins with an overview of low back pain and sciatica epidemiology, including their characteristics, potential consequences, and management options. Additionally, twin studies are introduced and described as an emerging field of the genetic influence on spinal pain, with this methodology potentially providing more valid associations than traditional observational studies. The paucity of randomised controlled trials for low back pain within a twin population is also explored. The thesis concludes with a summary of findings and possible implications. The efficacy of interventions for sciatica is investigated in two systematic reviews, with the first review highlighting the superior, short-term effects for surgery over physical activity interventions, however these superior effects diminishing over time. The second review showed that structured exercise was superior to advice to remain active in the short-term management of sciatica, but no differences were observed in the long-term. In addition to these reviews, a short, structured commentary of a review of acupuncture is presented and showed potential for the effective management of sciatica. This thesis also utilised a discordant twin study design, enabling the examination of possible causal relationships between low back pain and various comorbidities, including early mortality. Although small associations were found between chronic low back pain and coronary heart disease, depression or anxiety symptoms in middle-aged twins, a causal path could not be elucidated. Despite an association, no causal link between spinal pain and early mortality (including cardiovascular-specific mortality) could be established in older twins aged ≥ 70 years. Finally, conducting a pilot randomised control trial within a twin study setting for the management of low back pain via sleep improvement is feasible; however lessons learnt during study recruitment and implementation suggest that modifications are required.

A neonatologia é uma subespecialidade da pediatria relativamente nova iniciando-se como uma área altamente tecnológica e que tende a ser cada vez menos invasiva. Foram vários os avanços que permitiram uma redução da mortalidade do recém-nascido prematuro: o transporte in utero, os corticóides prenatais, o "milagre" do surfactante, cuidados regionalizados (de que Portugal é um bom exemplo), ... Com a evolução dos tempos a preocupação dos neonatologistas "transferiu-se" da mortalidade para a morbilidade, os cuidados passaram de centrados no doente a centrados na família, a ventilação tornou-se não invasiva, a maior importância da nutrição, sono, redução da infecção, luz, ruído e dor, variáveis conjuntas influenciando o neurodesenvolvimento.

Moçambique é um pais que vem passando por profundas mudanças políticas e sociais nos últimos 50 anos. Dentro deste contexto, em 1996, uma Unidade de Dor foi criada no Hospital Central de Maputo. O objetivo do presente estudo foi descrever e analisar os aspectos epidemiológicos, clínicos e emocionais de pacientes com dor crónica atendidos na Unidade de Dor. Um total de 118 pacientes foram entrevistados por um período de 2 meses. Destes, 79 (66,9%) eram mulheres e 39 (33,1%) eram homens. A média de idade foi de 52,4 anos, com um desvio padrão de 13,7. Cento e sete (90,7%) eram negros. Quarenta pacientes (33,9%) tiveram o diagnóstico da dor neuropática, 40 (33,9%) apresentaram dor osteomuscular, 8 (6,8%) tiveram dor relacionada com a SIDA, 17 (14,4%) tiveram dor oncológica. A média da escala numérica de dor foi 8,37 e a media de duração da dor crónica foi 41,75 meses. Entre os medicamentos abortivos para a dor, o paracetamol foi o mais utilizado e amitriptilina profilático foi o mais amplamente utilizado. Independentemente do seu tratamento na unidade de dor, cinquenta e oito pacientes (49,2%) também receberam algum tratamento de curandeiros locais. Quanto aos aspectos emocionais, foram encontrados 39 (33,1%) pacientes que preenchiam os critérios do DSM-IV de transtorno depressivo maior. Estes resultados são discutidos com base nos aspectos culturais envolvidos
Mozambique is a country that has been experiencing profound political and social changes over the last 50 years. Within this context, in 1996 a Pain Unit was set up in the Central Hospital of Maputo. The objective of the present study was to describe and analyze the epidemiological, clinical and emotional aspects of patients with chronic pain attended at the Pain Unit. A total of 118 patients were interviewed over a period of 2 months. Of these, 79 (66.9%) were women and 39 (33.1%) were men. Mean patient age was 52.4 years, with a standard deviation of 13.7. Hundred seven (90.7%) were black. Forty patients (33.9%) had a diagnosis of neuropathic pain, 40 (33,9%) had ostheomuscular pain, 8 (6.8%) had pain related to AIDS, 17 (14.4%) had oncologic pain. Mean of visual analogic scale for pain was 8,37 and chronic pain duration was 41.75 months . Between the abortive medications for pain, paracetamol was the most used and prophylactic amitriptyline was the most widely used. Regardless of their treatment at the Pain Unit, fifty eight patients (49.2%) also received some treatment from local healers. When emotional aspects were considered, 39 (33.1%) patients were found to have depressive symptoms that fulfilled DSM IV criteria of depressive disorder. These results are discussed based on the cultural aspects involved

Systemic Sclerosis (SSc) is a highly heterogeneous multi-system disease characterized by vasculopathy, immune system activation and fibrosis. Patients are classified into limited or diffuse SSc disease subsets according to the extent of skin involvement. This was the first study to use a large multi-center convenience sample of SSc patients (N=585) to estimate prevalence, severity and associations between clinical variables and pain in SSc and, separately in limited and diffuse subsets. Results from the present study draw attention to the high prevalence of pain in SSc and associations between specific clinical variables and pain, including more frequent episodes of Raynaud's phenomenon, active ulcers, worse synovitis and gastrointestinal symptoms, which may represent potential clinical intervention targets. Subsetting by the extent of skin involvement was only minimally related to pain severity and did not affect associations with clinical variables. More attention to pain and how to best manage it is needed in SSc.
La sclérose systémique (SSc) se caractérise par une vasculopathie, une dysfonction auto-immune, et une fibrose diffuse. Les personnes atteintes de SSc sont classifiées comme ayant la SSc limitée ou diffuse selon l'étendue de l'atteinte cutanée. Notre étude est la première grande recherche multicentrique d'un échantillon de convenance (N=585) à estimer la prévalence, la sévérité et les associations entre les manifestations cliniques de la SSc et la douleur. Les résultats démontrent que la prévalence de la douleur est élevée, et que certaines variables cliniques sont associées à celle-ci (syndrome de Raynaud, ulcérations actives, synovites et symptômes gastro-intestinaux) et pourraient donc représenter des cibles d'intervention. L'étendue de l'atteinte cutanée affecte très peu ou pas du tout la sévérité de la douleur et les associations observées avec les variables cliniques. Plus d'attention à la douleur et à des stratégies thérapeutiques qui pourraient diminuer son intensité est nécessaire pour les personnes atteintes de SSc.

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2006.
Title from electronic title page (viewed Oct. 10, 2007). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of Public Health (Epidemiology)." Discipline: Epidemiology; Department/School: Public Health.

Intervertebral disc(IVD) degeneration is associated with low back pain (LBP).Despite the endplates are located adjacent to the IVD, the phenotypes of endplate and vertebral bone marrow changes remain unclear. The objective of this study is to assess the prevalence and the associated determinants of these phenotypes of the lumbar spine. 2449 Southern Chinese subjects (aged 10 –88 years) undergone sagittal T2-weighted magnetic resonance imaging (MRI)examination to assess the presence of endplate and vertebral bone marrow changes including Schmorl’s nodes (SN) and Modic changes (MC),respectively, and scored for additional radiographic features over the lumbar spine. Subjects’ demographics, clinical profile, and functional status were assessed by means of standardized questionnaires. Anovel6-domain SN morphological classification based on MRI was developed to further analyze the characteristics of SN and its association with disc degeneration (DD). The prevalence of SN was 16.4%. Males, taller and heavier individuals had a significantly increased likelihood of SN. Overall presence of SN was age-independent, but was significantly associated with DD, and linearly correlated with increase in severity of DD. SN were particularly associated with severe DD at the upper two lumbar levels (L1/2 – L2/3). Based on the SN classification system, specific SN characteristics and endplate linkage patterns were found. Of these, two SN types were identified:“Typical SN” and “Atypical SN”. “Typical SN” were those smaller size SN with various shapes that were frequently located at caudal endplates of L1/2–L3/4disc levels. One variant of “Atypical SN” were those rectangular shape SN, which predominantly located at the posterior region of the rostral endplates of L1/2–L2/3disc levels. The other variant of “Atypical SN” was larger size SN with irregular shape that frequently presented at the L4/5endplates, they were also likely to be associated with marrow changes. Despite “Atypical SN” only entailed 8.3% of all identified SN, they were associated with increased severity of DD than “Typical SN”. Although the overall prevalence of MC among Southern Chinese was low (5.8%), after adjustments for other confounding factors, the presence of MC was associated with the presence and severity of LBP. Interestingly, the determinants of MC at upper (L1/2 – L3/4) and lower (L4/5 – L5/S1) lumbar showed distinct difference. The presence of MC at upper lumbar levels was only associated with the disc integrity only (i.e. the presence of disc displacement, and DD score), while the presence of MC at the lower levels, apart from the disc integrity, was also associated with increasing age, the presence of SN, smoking and obesity status. This study is the largest MRI study assessing the phenotypes of endplate and vertebral bone marrow changes in-vivo. The prevalence and distribution of SN and MC vary throughout the lumbar spine, and there are level and region-specific variations regarding these phenotypes. Determinants of SN and MC may be similar but do vary, suggesting distinct etiological factors. Findings of this study broaden the understanding of the various phenotypes of the lumbar spine and its association with DD.
published_or_final_version
Orthopaedics and Traumatology
Doctoral
Doctor of Philosophy

Philosophiae Doctor - PhD
Pain is a complex biopsychosocial phenomenon that can have a profound impact on people's lives (Access Economics [AE], 2007). lts clinical relevance is well known - pain is suggestive of "actual or potential tissue damage" and plays a role in the diagnosis and clinical management of diseases and/or injury (International Association for the Study of Pain [IASP], 1986). It has both sensory and emotional aspects and is behaviourally expressed by how it is communicated by the sufferer and by its effect on the sufferer's behaviour (IASP, 1986; Linton, 2005; AE, 2007). Even though the experience of pain is associated with tissue damage or is described in terms of such damage, this association is variable so that "the size of an injury can be a poor guide as to how much an individual experiences pain" (AE, 2007). In fact, pain can exist without an objective evidence of tissue damage making pain the "ultimate subjective experience" (Odendaal, 2006). This phenomenon may relate to the fact that the interpretation of nociceptive signals as pain is influenced by a number of personal and environmental factors including past experience, integrity of the nervous system, beliefs and the situation in which tissue damage occurs (Eccleston, 2001; Turk, 2002a; Flor and Hermann, 2004; AE, 2007). As such, decisive and objective measurements are difficult to arrive at and pain is not always easily assessed by the healthcare provider. The translation of pain from acute to chronic however, means that pain and discomfort remains beyond the normal time of healing and by definition, persists either continuously or intermittently for 3 months or longer (Elliot et al., 1999). This changes the physiognomy of pain and the condition of chronic pain ensues. Chronic pain is an important but often neglected public health problem. It is disabling and associated with interference in normal activities of daily living (ADLs) such as work, home chores, family and sporting activities. Research shows that chronic pain is a key complaint that motivates many to seek health care (Crook et al., 1984, 1989; Sullivan et al., 1990; Smith et al., 1996; Mantyselka et al., 2001, 2002; Eriksen et al., 2004; AE, 2007) leading to high and ongoing consumption of treatments (AE, 2007). In fact, studies have shown that persons with chronic pain use health services up to five times more frequently than the rest of the population (Von Korff et al., 1990, 1991; Elliot et al., 1999; Eriksen et al., 2004). Side-effects of treatment are common with medication use including gastric problems such as ulcerations, nausea, constipation and mental slowing or confusion which can affect functioning. Chronic pam is also associated with mood and sleep disturbances such as depression or adjustment problems and trouble getting to sleep and/or frequent wakening during the night. For the sufferer, the effect of disuse of the aspect of the body in which pain is experienced is another manifestation of chronic pain. Muscles and joints become de-conditioned and pain sufferers may lose general body fitness (AE, 2007). Within the community, pain is a common cause of considerable suffering and disability affecting the general health and quality of life of individuals (Von Korff et al., 1990, 1992; Magni et al., 1990,1993; Walsh et al., 1992; Smith et al., 1996,2001; Verhaak et al., 1998; Elliot et al., 1999, 2002; Blyth et al., 2001; Reyes-Gibby et al., 2002; Lanteri-Minet et al., 2003). Significant amounts of working days are lost among the labour force impacting a profound economic and social toll on society (Bowsher et al., 1991; Elliot et al., 1999; Blyth et al., 2003; Igumbor et al.,2003). Simply put, "chronic pain is a human tragedy" (Odendaal, 2006). It is a serious and common problem that causes distress to patients and their caregivers, is a burden on health care professionals and health care resources and results in significant lost productivity. Chronic pain is therefore a problem of public health importance.

Hipersensibilidade dentinária (HSD) é caracterizada como uma dor dentária curta e aguda, causada em resposta a estímulos térmicos, evaporativos, táteis ou osmóticos, e que não pode ser atribuída a qualquer outro tipo de patologia. A epidemiologia da HSD ainda é pouco estuda em nível populacional. O objetivo desta dissertação foi abordar a epidemiologia da HSD através da revisão crítica da literatura e da apresentação de um estudo de base populacional sobre prevalência, extensão e indicadores de risco para essa condição.Uma amostra representativa de 1023 habitantes adultos, com mais de 35 anos de idade, residentes em Porto Alegre foi obtida através de uma amostragem probabilística proporcional estratificada de múltiplo-estágio. Os participantes do estudo responderam a um questionário estruturado a respeito de dados sociodemográficos e comportamentais e receberam um exame clínico para diagnóstico de HSD térmico (jato de ar) e tátil (sonda) aplicados na superfície vestibular de todos os dentes presentes. Comandos analíticos que consideram a amostra complexa foram utilizados para gerar estimativas em modelos de risco multivariados. Aproximadamente um terço da população foi diagnosticada com HSD (jato de ar = 33,4% / sonda = 34,2%). Dentre os indivíduos que apresentaram HSD, em média 2 a 3 dentes apresentaram HSD. Os dentes mais afetados com HSD foram pré-molares superiores, molares superiores e pré-molares inferiores. Recessão gengival foi fator determinante para a ocorrência de HSD e foi modelada separadamente das demais variáveis. Mulheres, indivíduos mais jovens, fumantes, de melhor nível educacional e aqueles que relatam tratamento periodontal tiveram significativamente mais chance de HSD. Conclui-se que a prevalência e de HSD encontrada na população estudada é alta, porém com um número pequeno de dentes afetados. A ocorrência de HSD está associada a fatores comportamentais e sociodemográficos importantes, para os quais se podem estabelecer estratégias preventivas em nível individual e populacional.
Dentine hypersensitivity (DH) is characterized by an acute and short dental pain in response to thermal, evaporative, tactile and osmotic stimuli, which cannot be attributed to any other type of pathology. The epidemiology of DH is still little studied on the population level. The aim of this thesis was to assess the epidemiology of DH by conducting a critical appraisal of the literature and presenting the findings of a population-based study about the prevalence, extent and risk indicators of this condition. A representative sample of 1,023 adult 35 years and older inhabitants of Porto Alegre was obtained using a multistage, stratified, proportional to size, probability sampling strategy. Participants answered a structured questionnaire about sociodemographic and behavioral variables and were submitted to a clinical examination to diagnose DH using a blast of air and a manual probe on the buccal surfaceof all present teeth. Analytical commands that take into consideration the complex sampling design were used to generate estimates and multivariable risk models. Approximately one third of the population was diagnosed with DH (air blast= 33.4% and probe= 34.2%). Among individuals with DH, in average 2 to 3 teeth were affected by DH. The teeth most affected by DH were maxillary premolars and molars, followed by mandibular premolars. Gingival recession was a determinant factor for the occurrence of DH and was modeled separately from the other variables. Females, younger individuals, smokers, individuals of higher education and those reporting positive history of periodontal treatment had significantly higher chances of DH. It can be concluded that the prevalence of DH found in the studied population is high, although with few teeth affected. The occurrence of DH is associated with important sociodemographic and behavioral factors for which preventive strategies may be established on individual and population levels.

Objective: To examine in a nationally representative sample (a) the differential association of specific anxiety and depressive disorders defined according to DSM-IV with pain disorder (PD) and pain symptoms, and (b) whether pain-associated anxiety and depressive disorders and their comorbidity have different implications in terms of impairment, disability, health care utilization, and substance use. Method: A nationally representative community study was conducted in Germany. Symptoms, syndromes and diagnoses of mental disorders, and pain were assessed in N = 4,181 participants aged 18–65 years using the DSM-IV/M-CIDI. Results: Logistic regressions revealed that pain is associated with both specific anxiety and depressive disorders, with increasing significant odds ratios (OR) for medically explained pain symptoms (EPS; OR range: 1.9–2.0), to unexplained pain symptoms (UPS; OR range: 2.4–7.3), to PD (OR range: 3.3–14.8). PD and UPS persistently showed associations after adjusting for comorbid other anxiety and depressive disorders and physical illnesses. All types of pain, particularly PD/UPS, are associated with decreased quality of life, greater impairment in role functioning, disability, health care utilization, and substance use. Depressive disorders, even more so anxiety disorders and their comorbidity account for a substantial proportion of variance in these functional correlates. Conclusions: Pain is strongly associated with specific anxiety and depressive disorders. In light of the individual and societal burden due to pain, and the demonstrated role of comorbid anxiety or/and depression, our results call for further investigation of the underlying mechanisms for this association as well as targeted treatments for these comorbidities.

The purpose of this study was to investigate problem areas of organists' performance as indicated by common experiences of pain. The research problems were to determine the specific areas of the body that were affected by pain, to determine the perceived level of that pain on a scale indicative of its severity, and to explore the relationship between demographic and performance-related factors within the population and specific area of reported pain. An examination of the demographic, performance-related, and pain data, as well as subject comments, indicated possible relationships of the pain experience to other factors. Organists attributed their pain to instrument characteristics, such as keyboard action, music rack height, bench design, and pedalboard shape. Pain was also associated with the time spent playing the organ, playing literature which required large reaches and rapid passage work, such as french toccatas, or playing with incorrect posture. To explore these relationships to spinal and upper extremity pain, further research is indicated.

Abstract The prevalence of coronary heart disease (CHD) and associated manifestations with ischaemic resting electrocardiogram (ECG) changes, clinical findings and sociodemographic factors were studied in 1990–1991 among an elderly population in southwestern Finland. One of the specific aims was to describe the health-related quality of life of elderly coronary heart disease patients, i.e. the associations between CHD and physical, psychological, cognitive and social functioning. 488 men and 708 women aged 64 years and over (93% of those eligible) participated in this cross-sectional epidemiological survey in the rural district of Lieto. The participants were examined and interviewed during two visits to the local health centre. An ECG and a chest x-ray were taken and a clinical examination was made by a doctor. The Rose questionnaire was used to determine the prevalence of angina pectoris (AP). The Minnesota codes were used in the analyses of ECG findings. The medical records were reviewed. The prevalence of AP was 9.1% (95% Confidence Interval 6.7–12.0) among men and 4.9% (3.5–6.8) among women. The respective figures for past myocardial infarction (MI) (based on the medical records or a major or moderate Q/QS item on ECG, codes 1.1–1.2) were 13.9% (10.9–17.0) and 6.5% (4.8–8.6). Ischaemic ECG findings (codes 1.1–1.3, 4.1–4.4, 5.1–5.3, 7.1) were common: 32.9% (28.7–37.1) of men and 39.3% (35.7–43.0) of women had such changes. The total prevalence of CHD, including AP, MI, past coronary bypass surgery or angioplasty or ischaemic ECG findings, was 37.7% (33.4–42.0) in men and 42.0% (38.3–45.6) in women. The patients and controls were mainly aged, non-institutionalized, community-living persons. The patients with CHD (AP and/or a past MI) had more difficulties in physical functioning than their age- and sex-matched controls. According to logistic regression analyses, CHD was not independently associated with difficulties in physical functioning. However, physical disability was associated with the use of cardiovascular drugs and also with old age, the use of psychotropic drugs, depression and cancer. More male patients than controls had depression measured on the Zung Self-Rating Depression Scale. The depression had often gone undiagnosed, especially among men. Among men, the most important factors associated with depression were difficulties in physical functioning and widowhood or divorce, while among women, previous depression and the use of ACE inhibitors emerged as significant. There were no differences between the patients and controls in cognitive functioning. The male patients had a higher frequency in visiting activity than the controls. Old age, difficulties in physical functioning, CHD and chronic obstructive pulmonary disease were associated with impaired social functioning. In conclusion, CHD is common in the Finnish elderly. The clinical picture of CHD in elderly people is varying. It seems that CHD has no independent impact on functional disability in the elderly. Old age, sociodemographic factors, medication and other chronic diseases are also contributors.

Background: Previous studies have addressed multiple sclerosis (MS) symptom management and improved health-related quality of life (HrQOL). Yet lowered estrogen levels in post-menopasual women with MS may further worsen physical function and symptomology and not all types of pain management have been examined. Objectives: For post-menopausal women with MS, we evaluated the extent to which smoking is associated with worsened health outcomes and HrQOL, and the extent to which menopausal hormone treatment (MHT) improves health outcomes and HrQOL. For all adult men and women with clinically diagnosed MS, we systematically reviewed pharmacological and non-pharmacological strategies for the reduction of pain. Methods: We identified 256 post-menopausal women with MS in the Women's Health Initiative Observational Study and examined changes from baseline to 3 years in activities of daily living, physical activity, SF-36 mental and physical component scales (MCS, PCS), and menopausal symptoms. In all adults, experimental studies published after 1965 were included if the sample was not restricted to participants with spasticity or trigeminal neuralgia and participant-reported pain was a primary or secondary outcome. Pain scores were reported as Cohen’s d. Results: Nine percent of post-menopausal women with MS were current smokers and 51% reported current MHT use. Smoking and MHT use had no effect on physical functioning, activities of daily living, or menopausal symptoms. Women with early age at smoking initiation experienced declines in MCS (adjusted β <20 vs. ≥ 25 years: -10.50, 95% Confidence Interval (CI) -2.1 to -18.1; adjusted β 20-24 vs. ≥ 25 years: -8.81, 95% CI: 0.6 to -17.4), but not in PCS. Relative to never MHT users, ever MHT users had higher MCS scores at year 3 compared to baseline (adjusted β: 3.0, 95% CI: 0.4 to 5.6), but no change in PCS. For all adults, transcutaneous electrical nerve stimulation (TENS; Cohen’s d: -3.34), nabixomols (Cohen’s d: -0.61), and dextromethorphan/quinidine (Cohen’s d: -0.22) were reported effective in reducing pain. Conclusions: Smoking prevention efforts should be increased for women with MS. Women with MS may also experience HrQOL gains with MHT, but contemporaneous data on MHT use is needed. TENS may be more effective than pharmacological methods in reducing MS pain.

Background: It is unclear whether generalized anxiety disorder (GAD) has a specific relationship to pain syndromes, going beyond the established association of pain with anxiety syndromes in general. Methods: Mental disorders were assessed in a community sample (N = 4181; 18–65 years) using the DSM-IV/M-CIDI. Several threshold definitions were used to define GAD and medically unexplained pain. Results: The association between pain and GAD (odds ratio, OR = 5.8 pain symptoms; OR = 16.0 pain disorder) is stronger than the association between pain and other anxiety disorders (OR = 2.4 pain symptoms; OR = 4.0 pain disorder). This association extends to subthreshold level definitions of GAD with some indication for a non-linear dose–response relationship. The GAD-pain link cannot sufficiently be explained by demographic factors, comorbid mental or physical disorders. Conclusions: The association of pain and generalized anxiety is not artifactual. Compared to other anxiety syndromes, it appears to be stronger and more specific suggesting the need to explore clinical and public health implications.

Objective: To examine in a nationally representative sample (a) the differential association of specific anxiety and depressive disorders defined according to DSM-IV with pain disorder (PD) and pain symptoms, and (b) whether pain-associated anxiety and depressive disorders and their comorbidity have different implications in terms of impairment, disability, health care utilization, and substance use. Method: A nationally representative community study was conducted in Germany. Symptoms, syndromes and diagnoses of mental disorders, and pain were assessed in N = 4,181 participants aged 18–65 years using the DSM-IV/M-CIDI. Results: Logistic regressions revealed that pain is associated with both specific anxiety and depressive disorders, with increasing significant odds ratios (OR) for medically explained pain symptoms (EPS; OR range: 1.9–2.0), to unexplained pain symptoms (UPS; OR range: 2.4–7.3), to PD (OR range: 3.3–14.8). PD and UPS persistently showed associations after adjusting for comorbid other anxiety and depressive disorders and physical illnesses. All types of pain, particularly PD/UPS, are associated with decreased quality of life, greater impairment in role functioning, disability, health care utilization, and substance use. Depressive disorders, even more so anxiety disorders and their comorbidity account for a substantial proportion of variance in these functional correlates. Conclusions: Pain is strongly associated with specific anxiety and depressive disorders. In light of the individual and societal burden due to pain, and the demonstrated role of comorbid anxiety or/and depression, our results call for further investigation of the underlying mechanisms for this association as well as targeted treatments for these comorbidities.

Sickle cell disease (SCD) is a major healthcare and societal problem that affects millions of people worldwide. Sickle cell pain is the hallmark feature of SCD and includes manageable and unmanageable persistent pain that affects every aspect of an individual's life. Most of the research on pain in SCD has focused on children with acute vaso-occlusive episodes. Consequently, significant gaps exist in our knowledge of the occurrence and characteristics of manageable and unmanageable persistent pain in adults with SCD.

The specific aims of this study in a sample of adults with SCD were to: 1) determine the occurrence of persistent SCD pain and compare those with manageable and unmanageable persistent SCD pain on demographic and clinical characteristics, as well as, pain-related measures; 2) compare those with manageable and unmanageable persistent SCD pain on coping strategies; and 3) determine which factors influence quality of life (QOL) in these patients.

One hundred and three patients who were ≥18 years with SCD completed questionnaires on demographic, clinical, and pain characteristics, as well as, the Pain Catastrophizing Scale (PCS), the Duke Religious Index (DRI), and the Medical Outcomes Study Short-Form (SF-36). Patients were divided into those with manageable (average pain intensity ≤5) and unmanageable pain (average pain intensity >5) based on established cutpoints. Final analyses were done on 94 patients.

Seventy percent of patients had manageable pain and 30% had unmanageable pain. Patients with unmanageable pain reported higher ratings for all of the items on the Pain Quality Assessment Scale (PQAS); were more likely to be taking only a short-acting opioid; reported less relief from analgesic medications, and reported significantly lower SF-36 scores. Significant negative correlations were found between pain catastrophizing and religiosity/spirituality, and physical and mental health. Several variables were found to have an influence on QOL. These findings suggest that persistent pain in adults with SCD is a significant problem. More research needs to evaluate how adults with SCD cope with persistent pain and its impact on their QOL.

Background: It is unclear whether generalized anxiety disorder (GAD) has a specific relationship to pain syndromes, going beyond the established association of pain with anxiety syndromes in general. Methods: Mental disorders were assessed in a community sample (N = 4181; 18–65 years) using the DSM-IV/M-CIDI. Several threshold definitions were used to define GAD and medically unexplained pain. Results: The association between pain and GAD (odds ratio, OR = 5.8 pain symptoms; OR = 16.0 pain disorder) is stronger than the association between pain and other anxiety disorders (OR = 2.4 pain symptoms; OR = 4.0 pain disorder). This association extends to subthreshold level definitions of GAD with some indication for a non-linear dose–response relationship. The GAD-pain link cannot sufficiently be explained by demographic factors, comorbid mental or physical disorders. Conclusions: The association of pain and generalized anxiety is not artifactual. Compared to other anxiety syndromes, it appears to be stronger and more specific suggesting the need to explore clinical and public health implications.

Disfunção temporomandibular (DTM) é um termo coletivo que engloba um largo espectro de alterações articulares e musculares no sistema estomatognático. Estas disfunções são caracterizadas por dor, ruídos articulares e funções irregulares da mandíbula, e representam a principal causa de dor não dentária da região orofacial. A prevalência de indivíduos com necessidade de tratamento está entre 5 e 12%, calcula-se que no Brasil 8,5 milhões de brasileiros precisariam ter algum tipo de intervenção. Estudos epidemiológicos sobre DTM têm se apresentado deficientes quanto à padronização de índices e classificações. Conscientes disso realizou-se um levantamento de prontuários dos pacientes atendidos no Serviço de Oclusão, Disfunção Temporomandibular e Dor Orofacial, do projeto DAPE da Faculdade de Odontologia de Ribeirão Preto USP, que realiza atendimento na área de DTM para população encaminhada pelo Sistema Único de Saúde (SUS), entre os anos de 2010 e 2011. Avaliou-se 117 prontuários de indivíduos, que foram submetidos à classificação do Índice Anamétido de Helkimo, divididos de acordo com a severidade de sinais e sintomas, em dois grupos : AiI (leves a moderados) e AiII (severos). Posteriormente os grupos foram subdivididos com relação ao gênero e faixa etária. Os dados foram coletados por meio de entrevista, onde os indivíduos foram questionados quanto à presença de hábitos parafuncionais, alterações otológicas, oftalmológicas, sistêmicas e comportamentais. Os dados foram tabulados em planilha de Excel, e submetidos à Análise Estatística, utilizando o Teste de Kruskal-Wallis e Teste de Miller, ambos com significância de 0,05. A prevalência de cada alteração também foi avaliada. Os resultados evidenciaram que indivíduos com DTM apresentaram altas prevalências nas alterações locais e sistêmicas pesquisadas.
Temporomandibular (DTM) is a collective term that encompasses a broad spectrum of clinical problems and deformations in orofacial area. These disorders are characterized by pain, joint noises and irregular functions of the jaw, and represent the leading cause of orofacial pain not dental. The prevalence of individuals in need of treatment is between 5% and 12%, it is estimated that in Brazil 8.5 million Brazilians would have some kind of intervention. Epidemiological studies on TMD have presented handicapped on the standardization of indexes and ratings. Aware of this was done a survey of medical records of patients seen in Orofacial Pain service of special Patients clinic FORP-USP, who performs service in the area of TMD for population forwarded by the Central regulating (SUS), the city of Ribeirão Preto, between the years 2010 and 2011. Assessed-if medical records of individuals, these 117 were subjected to the classification of the Anamétido Index of Helkimo, and divided according to the severity of symptoms and signs, in two groups AiI (mild to moderate) and AiII (severe). Later groups were sub-divided in relation to gender and age group. The data were collected through interview, where individuals were questioned as to the presence of parafunctional habits, changes otologicals, ophthalmologicals, systemic and behavioral. The data were tabulated into Excel spreadsheet, and subjected to statistical analysis, using the Kruskal-Wallis test, and Miller\'s Test, both with significance of 0.05. The prevalence of each change was also evaluated. The results showed that TMD patients showed a high prevalence in the surveyed local and systemic changes.

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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
Reports of pain in the preoperative period are frequent and may be influenced by socioeconomic, clinical, psychological and behavioral factors and by health conditions. However, little is known about this pain in the preoperative period of cesarean section, one of the surgeries performed more frequently in the global surgical setting. The aim of the study was to identify the prevalence, characteristics and factors associated with pain in the preoperative period immediately prior to cesarean section. This was a cross-sectional analysis of data from the baseline of research matrix, cohort study, open and prospective, the data of which were collected in the wards and apartments of a private hospital, contracted to the Health Unic System (SUS), of the city of Goiânia, Brazil. The recruitment of women (n = 1082) was made between February 2014 and July 2015. The study sample consisted of 877 women. The outcome variable investigated was the report of any pain reported by women in the immediate preoperative period. The pain characteristics include intensity, measured by means of numeric pain scale of 11 points (END) which allows the intensity measured by numbers representing the amount of pain felt (zero (0) = no pain; 1 , 2.3 and 4 = mild pain; 5:06 = moderate pain, 7.8 and 9 = severe pain, and ten (10) = worst possible pain), location; onset and duration of painful episodes. The associated variables were: symptoms of anxiety and depression, assessed through the Hospital Anxiety and Depression Scale (HADS), as well as sociodemographic, clinical and behavioral variables and health related conditions. For the statistical analysis, logistic regression was used to identify factors associated with preoperative pain. In the multivariate analysis, variables that presented p-values <0,10 were included. For all tests p-values <.05 were considered significant. The prevalence of preoperative pain was 27.5% (CI: 95%:24.6-30.5). The locations most mentioned by the women included the lower back (29.9%), pelvic/genital region (22.4%) and head (12.9%). The pain appeared with more prevalence in the final trimester of pregnancy (37.8%), being considered by the majority of the participants as a daily complaint (68.5%). The intensity was classified as strong in 44.8% of cases. Preoperative pain was associated with pregnancyrelated pain (OR: 3.50; 2.23-5.252) and symptoms of anxiety (OR: 1.61; 1.14-2.28; p=.006). The evaluation of pain in the preoperative period should include negative aspects, such as anxiety, in order to use therapies for its management proper. In the prenatal care, it is essential to evaluate the characteristics of pain that arises after the confirmation of the pregnancy, in order to implement strategies to avoid prolonged contact with this experience and consequent impairments in the postoperative period. Nurses are responsible for part of this mission, together with obstetric nurses, who can and should fulfill their role as promoters of health
Relatos de dor no período pré-operatório são frequentes e podem sofrer influência de fatores socioeconômicos, clínicos, psicológicos e de comportamentos e condições de saúde. No entanto, pouco se conhece sobre a dor referida no período pré-operatório de cesariana, uma das cirurgias realizadas com maior frequência no cenário cirúrgico mundial. O objetivo da pesquisa foi identificar a prevalência, as características e os fatores associados à dor referida no período pré-operatório imediato de cesariana. Trata-se de análise transversal de dados da linha de base da pesquisa matriz, tipo coorte, aberta e prospectiva, cujos dados foram colhidos nas enfermarias e apartamentos de um hospital privado, conveniado ao Sistema único de Saúde, no município de Goiânia, Goiás, Brasil. O recrutamento das mulheres (n=1082) foi feito entre fevereiro de 2014 e julho de 2015. A amostra deste recorte compôsse de 877 mulheres. A variável de desfecho investigada foi o relato de qualquer dor referida pelas mulheres no período pré-operatório imediato. As características da dor incluíram a intensidade, mensurada por meio da Escala Numérica de Dor de 11 pontos (END), a qual permite a medida da intensidade por meio de números que representam a quantidade de dor sentida (0 (zero)=nenhuma dor; 1,2,3 e 4=dor leve; 5 e 6=dor moderada; 7,8 e 9=dor forte; e 10 (dez)=pior dor possível), localização; início e duração dos episódios dolorosos. As variáveis de associação foram: sintomas de ansiedade e depressão, avaliados por meio da Escala Hospitalar de Ansiedade e Depressão (HADS), além de variáveis sociodemográficas, clínicas, comportamentos e condições relacionados à saúde. Para análise estatística, foi utilizada a regressão logística a fim de identificar os fatores associados à dor pré-operatória. Na análise multivariada, as variáveis que apresentaram valores de p<0,10, foram incluídas. Valores de p<0,05 foram considerados significativos para todos os testes. A prevalência de dor pré-operatória foi de 27,5% (IC:95%:24,6-30,5). Os locais mais referidos pelas mulheres incluíram a região lombar (29,9%), pélvica/genital (22,4%) e cabeça (12,9%). A dor apareceu com maior prevalência no último trimestre de gestação (37,8%), sendo considerada pela maioria das participantes como uma queixa diária (68,5%). A intensidade foi classificada como forte em 44,8% dos casos. Dor pré-operatória esteve associada com dor relacionada à gestação (OR:3,50; 2,23-5,252) e sintomatologia para ansiedade (OR:1,61;1,14-2,28; p=0,006). A avaliação da dor no período pré-operatório inclui comportamentos negativos como a ansiedade, com vistas à utilização de terapêuticas para o adequado manejo. No pré- natal é fundamental a avaliação da dor que surgiu após a constatação da gravidez e suas características, a fim de implementar estratégias que contribuam na redução de convívio com essa experiência e, consequentemente, com os prejuízos no pós-operatório. Ao enfermeiro cabe parte dessa missão, juntamente com as enfermeiras obstetrizes, que podem e devem ocupar seu papel de promotoras da saúde.

Orientador: Fausto Bérzin
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: O estudo investigou a prevalência da dor orofacial e sua associação com a auto-percepção da qualidade de vida em adultos brasileiros, residentes do município de Piracicaba, São Paulo. A amostra randomizada foi composta por 400 voluntários residentes no município de Piracicaba-SP, com faixa etária entre 20 a 50 anos de idade, sem restrição de gênero e nível econômico. Os voluntários foram avaliados em relação às características sócio-demográficas, prevalência, localização, frequência, duração e severidade da dor, e também em relação à sua auto-percepção do nível de qualidade de vida. As pessoas que compuseram a amostra foram aleatoriamente abordadas em seis diferentes pontos de passagem do município, estrategicamente selecionados como pontos de grande movimento populacional, e os dados foram obtidos por meio da aplicação de dois questionários: 1) Questionário de Dor Orofacial, que investigou a prevalência e as características da dor; 2) WHOQOL-BREF, para avaliação da qualidade de vida relativa à percepção dos domínios físico, psicológico, relações sociais e meio ambiente do indivíduo. Os dados foram analisados estatisticamente através do sistema SAS que calculou os testes qui-quadrado; Cocrham, Mantel e Haenszel; qui-quadrado de Wald; qui-quadrado de Mantel e Haenszel e Odds ratio, com nível de significância de 5%. A prevalência de dor orofacial verificada na população foi de 54,75%, com intensidade predominantemente forte (21,30%), de recorrência diária (41,10%) e presente há mais de seis meses (91,32%). As regiões mais acometidas foram a cabeça (36%), seguida dos ombros (22,25%), e a região intra-oral foi o local menos frequentemente apontado pelos voluntários (6%). Não se observou associação significativa entre a presença de dor orofacial e os fatores idade, nível econômico e escolaridade (p>0,05); no entanto, o estudo verificou significativa prevalência de dor entre as mulheres. Os resultados também permitem verificar que enquanto quase metade dos voluntários que não relataram dor consideram ter boa qualidade de vida (43,09%), apenas 21,92% das pessoas que referiram dor orofacial, consideram a qualidade de vida como boa (p<0,05); o estudo também apontou maior frequência de insatisfação com a qualidade do sono em pacientes que relataram dor (p<0,05). Entretanto, não foi observada associação significativa entre a frequência de sentimentos negativos, como depressão, ansiedade, mau humor e desespero, e a presença de dor orofacial. O estudo ressalta alta prevalência de dor orofacial com significante morbidade da população acometida por esta condição, e seu impacto sobre a auto-percepção da qualidade de vida
Abstract: The study assessed the prevalence of orofacial pain and its association with self-perceived quality of life in Brazilian adults, residents of Piracicaba-SP, São Paulo. A random sample of 400 volunteers living in Piracicaba, aged between 20-50 years of age, without restriction of gender and socioeconomic status, were evaluated in relation to socio-demographic characteristics, prevalence, location, frequency, duration and severity of pain, and also in relation to their self-perceived level of quality of life. People in the sample were randomly assessed in six different crossing points of the city, strategically selected as points of great population movement, and the data were obtained through the application of two questionnaires: 1) Orofacial Pain Questionnaire, which investigated the prevalence and characteristics of pain; 2) WHOQOL-BREF to evaluate quality of life on individual perception of physical, psychological, social relationships and personal environment aspects. Data were statistically analyzed using the SAS system that calculated the chi-square tests ; Cocrham , Mantel and Haenszel , Wald chi-square , chi -square and Mantel -Haenszel odds ratio and, with a significance level of 5 % . The prevalence of orofacial pain observed was 54.75 %, with predominantly intense pain (21.30%), daily recurrence (41.10%) and present for more than six months (91.32%). The most affected regions were the head (36%), followed by the shoulder (22.25%), and intra-oral region was the site less often pointed out by volunteers (6%). No significant association was observed between the presence of orofacial pain and age, economic status and educational level (p>0.05), however, the study found a significant prevalence of pain among women. Data also found that while nearly half of the volunteers reported no pain considered to have good quality of life (43.09%), only 21.92 % of people who reported orofacial pain, consider the quality of life as good (p<0.05). According to the study, also a higher frequency of patients who reported pain related sleep disturbance (p<0.05). However, no significant association was observed between the the presence of orofacial pain and frequency of negative psychological disability such as depression, anxiety, moodiness and despair. The study highlights the high prevalence of orofacial pain with significant morbidity of the population affected by this condition, and its impact on self-perception of quality of life
Mestrado
Anatomia
Mestra em Biologia Buco-Dental

Background: There is limited knowledge about leisure time physical activity and the body mass index (BMI) as prognostic factors for recovery from persistent back pain. The aim of this study was to assess the influence of leisure time physical activity and BMI on recovery from persistent back pain among men and women in a general population. Methods: The study population (n=1836) in this longitudinal cohort study consisted of participants reporting persistent back pain in the baseline questionnaire in 2002-2003. Data on leisure time physical activity, BMI and potential confounders were also collected at baseline. Information on recovery from persistent back pain (no back pain periods >= 7 days during the last 5 years) was obtained from the follow-up questionnaire in 2007. Log-binomial models were applied to calculate Risk Ratios with 95 percent Confidence Intervals (CI) comparing physically active and normal weight groups versus sedentary and overweight groups. Results: Compared to a sedentary leisure time, all measured levels of leisure time physical activity were associated with a greater chance of recovery from persistent back pain among women. The adjusted Risk Ratios was 1.46 (95% CI: 1.06, 2.01) for low leisure time physical activity, 1.51 (95% CI: 1.02, 2.23) for moderate leisure time physical activity, and 1.67 (95% CI: 1.08, 2.58) for high leisure time physical activity. There were no indications that leisure time physical activity influenced recovery among men, or that BMI was associated with recovery from persistent back pain either among men or among women. Conclusions: Regular leisure time physical activity seems to improve recovery from persistent back pain among women.

Introduction The aim of the research project was to examine prevalence, co-morbidity, and impact on daily life of pain and dysfunction in the jaw-face, head, and neck-shoulder regions among adult Sami women in northern Sweden. The aim of the qualitative part of the study was to explore, thoughts, experiences, and beliefs regarding temporomandibular disorders (TMD) among Sami women with and without TMD, to gain insights into their health care experiences. Methods The research project used a mixed methods approach including questionnaire analysis, a case-control study, and thematic interviews. The study population (Papers I and III) included 487 women living in the Arctic region of northern Sweden and enrolled in the register of the Swedish Sami Parliament or registered as reindeer owners or reindeer herders in the Swedish Board of Agriculture. Two years after the questionnaire study, 22 women (cases) with longstanding, intense, and frequent symptoms indicative of TMD, together with 46 age-matched women (controls) without any symptoms in the jaw–face region, underwent a clinical examination of the function of the temporomandibular joint, jaw- and neck muscles, mandibular mobility, and dental occlusion. The examiner was blind to the women’s affiliation (Paper II). Thematic interviews with a strategic subsample of 17 Sami women (Paper IV) were thereafter conducted and analyzed with a grounded theory approach. Results The prevalence of frequent symptoms indicative of TMD was 17%, of headaches 19%, and of neck-shoulder pain (NSP) 30%. Seventeen percent reported that their TMD affected daily life. Duration of jaw pain, troublesome impaired jaw opening, and neck pain, together with a low education level, affected the statement of whether TMD influenced daily life or not. Factors related to pain had the greatest influence when these Sami women rated the related impairment. There was a statistically significant relationship between TMD, frequent headaches, and frequent NSP (P <0.0001). Longstanding, intense, and frequent symptoms indicative of TMD remained essentially unchanged over the two-year follow-up period. Cases reported impaired general health and awareness of clenching teeth significantly more frequently than did controls. Variations in dental occlusion did not distinguish cases from controls. In the qualitative part of the project the core category, “Grin(d) and bear it,” summarizes the participants’ various ways and stages of processing and handling the interacting categories: (1) triggers, (2) strains, (3) distrust, and (4) reconciliation with pain and/or difficulties in life. Perpetuating factors were described as mental-physical strain and stress, and also a tooth clenching behavior. Women without TMD expressed factors that helped them to handle strains, reconcile, and stay healthy. They relied on helpful social support. Conclusion Disabling TMD, headaches, and NSP are common in Sami women. Women with TMD commonly expressed that tooth clenching was a familiar habit related to strains in life; they described an impaired general state of health and distrust in the care providers’ competence and ability to manage their problems. Women without TMD expressed confidence in their self-efficacy and were generally less concerned with strains in their lives. Rehabilitation strategies aiming at empowerment and improved self-efficacy may be a successful approach in women with disabling TMD.

A remoção dos terceiros molares é um procedimento cirúrgico amplamente realizado com diversas indicações. A prevalência do edema e da dor, no período pósoperatório, é freqüente, podendo ocasionar alteração da qualidade de vida dos pacientes. O objetivo principal foi avaliar dor, edema e qualidade de vida após a exodontia de terceiros molares e suas variações de acordo com a posição do dente. Desenvolvemos um estudo prospectivo intervencional com 86 pacientes cujo planejamento pré-operatório era extrair dois terceiros molares do mesmo lado no mesmo tempo cirúrgico. Os pacientes foram divididos em dois grupos, dependendo da posição do terceiro molar inferior, segundo a classificação de Pell-Gregory (1942) e Winter (1933). A dor, o edema e a qualidade de vida foram às variáveis avaliadas antes (pré operatório) e depois (pós-operatório por sete dias) do procedimento cirúrgico. A dor foi quantificada de acordo com uma escala visual numérica (0-4), o edema através de uma escala visual ilustrativa (A-D), e a qualidade de vida através do questionário Oral Health Impact Profile (OHIP-14). Os dados foram digitados e analisados no pacote estatístico STATA 10.0, com estatística descritiva e inferencial. O nível de significância utilizada foi de 95%. Resultados: A variação da dor, do edema e do OHIP total ao longo dos dias de pós-operatório foi significativa. A dor e o edema pós-operatórios estiveram presentes até o 5PO. Os valores de OHIP-14 foram altos no 1PO e 2PO e retornaram ao valor incial no 6PO (pré-operatório). Os domínios que apresentaram os maiores índices de pacientes com impacto foram 2, 3 e 4. Conclusão: A dor, o edema e o OHIP estão ligados a dificuldade cirúrgica de exodontia dos terceiros molares. A dor pós-operatória teve um comportamento decrescente ao longo dos dias. O edema teve um comportamento progressivo (3PO) e posteriormente decrescente. O impacto na QV ocorre no pós-operatório imediato (1 e 2PO) e retorna aos valores normais rapidamente (6PO).A pesquisa teve aprovação do Comitê de Ética em Pesquisa da FOUSP (Faculdade de Odontologia da Universidade de São Paulo) sob o número FR 266884 protocolo 108/2009.
Third molar extraction surgery is widely performed with several indications. Pain and swelling prevalence are usual after surgery with potential effects on patients quality of life. Our primary aim was to evaluate the pain, swelling and quality of life after third molar tooth extraction surgery and the effects according to its original position. We performed an interventional prospective study within 86 patients whom preoperative planning is removal of two third molar teeth from the same side at one-time procedure. Two groups of patients were divided depending on their initial positioning classification (Pell and Gregory end Winter). Pain, swelling and quality of life are the outcomes that were evaluated before and after (seven days) the surgical procedure by the main researcher. Pain was quantified according to a numeric visual score (range 0 to 4), swelling with an illustrated visual score (range A to D) and quality of life by Oral Health impact Profile questionary (OHIP-14). Data will was treated and analyzed according to STATA 10.0, software, and descriptive and inferential statistics were performed. The significance level that was used is 0,05. Results: The variation of pain, swelling and OHIP total among the days after surgery was significant. The pain and swelling after surgery were present until the fifth day after surgery. The highest OHIP scores were at the first and second days after the procedure and returned to the initial value on sixth day (preoperative). The domains that have higher rates, with impaction patients lifes were 2, 3 and 4. Conclusion: Pain, swelling and OHIP are linked to the difficulty of surgical extraction of third molars. The postoperative pain had a decreasing behavior over the day. The swelling behavior was progressive (third day) and then decreases. The impact on QoL occurs in the immediate postoperative period (first ande second days) and returns to normal quickly (6PO). The study had the approval of ethics committee from University of Sao Paulo Dental School (FR 266884- 108/2009).

O objetivo do presente estudo foi conhecer a prevalência da dor de dente e fatores associados na população de crianças de 3 e 4 anos de idade, residentes na região oeste do município de São Paulo, SP. A dor de dente foi associada à prevalência da cárie dentária, necessidade de tratamento, condições socioeconômicas e o impacto na Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) das crianças. Para isso foi realizado um estudo epidemiológico transversal de saúde bucal, no mês de novembro de 2014. A amostra de 485 crianças foi determinada pela fórmula de Kirkwood (1988). Os dados sobre a presença de dor de dente, prevalência e gravidade de cárie dentária, necessidade de tratamento, aspectos socioeconômicos e de qualidade de vida da criança e dos pais foram coletados durante o dia de Campanha Nacional de Multivacinação Infantil. As crianças foram selecionadas de forma sistemática na fila de vacinação. O Termo de Consentimento Livre e Esclarecido foi assinado pelos responsáveis legais dos participantes. Agentes comunitários treinados coletaram dados sobre a presença de dor de dente por cárie dentária utilizando a versão brasileira do Dental Discomfort Questionnaire (DDQ-B), dados socioeconômicos e dados de qualidade de vida pela versão brasileira do Early Childhood Oral Health Impact Scale (B-ECOHIS). Posteriormente, as crianças foram examinadas em consultórios odontológicos de 15 Unidades Básicas de Saúde (UBSs) por 15 cirurgiões-dentistas treinados e calibrados para o diagnóstico de cárie dentária pelos indíces ceo-d e para coletar as necessidades de tratamento pelos critérios da Organização Mundial da Saúde. Os dados foram analisados estatisticamente utilizando regressão de Poisson com variância robusta (IC 95%) para associar o desfecho do escore total do DDQ-B com prevalência de cárie dentária, necessidade de tratamento e condições socioeconômicas. Como análise complementar foi feita a associação do desfecho qualidade de vida com a presença de dor de dente. Na população estudada foi encontrada uma prevalência de dor de dente de 11,8% considerado o ponto de corte maior ou igual a 3 no escore total do DDQ-B e foi associada com a presença de cárie dentária (RTR=1,85; p<0.001). A média ± desvio padrão do DDQ-B total da amostra foi 0,81 ± 1,46. Dentre as necessidades de tratamento, a necessidade de tratamento pulpar com restauração foi a única necessidade de tratamento associada à dor de dente (RTR = 2,81; p < 0,001). As condições socioeconômicas não foram associadas com a dor de dente (p> 0,05). Adicionalmente, a baixa gravidade (ceo-d entre 1 e 5) e a alta gravidade de cárie dentária (ceo-d >=6), tanto quanto os maiores níveis de dor, foram associados a uma pior QVRSB em pré-escolares e suas famílias (RTR= 3,86, p<0,001; RTR= 9,17, p<0,001 e RTR=1,38, p<0,001, respectivamente). Portanto, na população estudada, a dor de dente é associada a presença de cárie dentária, necessidade de tratamento pulpar com restauração, e pior QVRSB em pré-escolares e suas famílias.
The aim of this study was to assess the prevalence of dental pain and associated factors in preschool children 3-4 years old, living in the western district of São Paulo City, Brazil. Dental pain was associated with prevalence of dental caries, treatment needs, socioeconomic status and the impact on the Oral Health-Related Quality of Life (OHRQoL) in preschool children. In November 2014, a cross-sectional epidemiological study of dental caries was carried on. Representative sample of 485 children was calculated by Kirkwood formula (1988). Data on dental pain prevalence, caries prevalence and severity, dental treatment needs, socioeconomic status and impact on OHRQoL were collected during the Children´s Multivaccination National Campaign Day. Children were selected systematically in the vaccination queue. The Informed Consent was signed by the participant´s parents. Trained external interviewer collected data on dental pain related to caries using the Brazilian version of Dental Discomfort Questionnaire (DDQ-B), data on socioeconomic status, and data on quality of life using the Brazilian version of Early Childhood Oral Health Impact Scale (B-ECOHIS) . After that, the children were examined in dental units of the 15 health centers, by 15 trained dentists. Dental caries was assessed according to the dmf-t criteria. The codes and criteria for dental treatment needs were those based on the WHO manual. Data analyses were performed using Poisson regression (95% CI) to associate the total DDQ-B scores to dental caries prevalence, treatment needs and socioeconomic conditions. A complementary analysis assessed the association between dental pain and impact on quality of life. In the population studied, the prevalence of dental pain was 11.8%, considering the cut-off point greater than or equal to 3 in the total DDQ-B score and it was associated with caries prevalence (RR = 1.85; p <0.001). The mean ± standard deviation of total DDQ-B was 0.81 ± 1.46. Regarding dental treatment needs, the need for pulp treatment with restoration was the only treatment need associated with dental pain (RR = 2.81, p <0.001). Socioeconomic factors were not associated to dental pain (p> 0.05). In addition, the low (dmf-t between 1 and 5 ) and high caries severity (dmft >=6), as the highest pain levels; were associated with a worse OHRQoL in preschool children and their families (RR= 3.86, p<0.001; RR= 9.17, p<0.001 e RR=1.38, p<0.001, respectively). Therefore, in this population, dental pain was associated with caries prevalence, need for pulp treatment with restoration, and a worse oral health-related quality of life in preschool children and their families.

Back pain is a chronic disease epidemic and the most common chronic painful condition in Americans. It is associated with human suffering and enormous financial and social burdens. Smoking is a prevalent and harmful health behavior and is the greatest modifiable risk factor for many chronic diseases. Cigarette smoking is associated with back pain, but there is little research on this relationship among adults in the United States. Using biopsychosocial theory, this study examined (a) the prevalence of back pain (dependent variable) among smokers, former smokers, and never smokers (independent variable), and (b) the influence of age, sex, race, body mass index, level of physical activity, level of education, depression, and anxiety on predicting the likelihood of back pain. This cross-sectional secondary analysis of the 2012 National Health Interview Survey included over 34,000 respondents and utilized chi-square distribution, t test, one-way analysis of variance, and multiple logistic regression analysis. People who self-reported being anxious or worried, had been diagnosed with depression by a health care provider, were current or former smokers, obese, or failed to meet recommended levels of physical activity were more likely to have back pain. This study has implications for social change in the United States because it shows that anxiousness, depression, smoking, obesity, and low physical activity are risk factors for back pain in Americans. Further, it indexes the need for primary studies of the relationship between smoking and back pain to determine whether smoking is causal for back pain. These studies could lead to public health interventions that develop strategies to prevent back pain and thereby alleviate some of the social burden associated with this common and costly ailment.

Introdução: Os adolescentes usam freqüentemente Computador e videogame e podem estar expostos a desenvolver dores, lesões e síndromes do sistema músculo-esquelético. Objetivos: Avaliar e caracterizar a presença de dor, síndromes e lesões do sistema músculo-esquelético em adolescentes e relacioná-las com o uso de computador e videogame. Avaliar a ergonomia do uso do computador. Métodos: A população de estudo consistiu de 833 alunos de um colégio particular da cidade de São Paulo. Neles foi realizado um estudo transversal que incluiu: 1) Questionário com dados demográficos, características do uso dos aparelhos e sintomas dolorosos; 2) exame físico do aparelho músculo esquelético e 3) avaliação de alguns aspectos ergonômicos (postura e equipamentos) durante o uso do computador na escola. As seguintes doenças foram pesquisadas: fibromialgia juvenil, síndrome de hipermobilidade articular benigna, síndrome miofascial e lesões específicas dos membros superiores (tendinites, bursites e epicondilites). Na avaliação estatística foi realizada análise univariada por meio dos testes qui-quadrado, teste exato de Fischer, teste de Mann Whitney e análise multivariada por Regressão Logística. Os teste realizados foram bicaudais e o nível de significância adotado foi de 5% (p <= 0,05). Resultados: O estudo avaliou 791 alunos. A idade média foi de 14,17 ± 1,99 anos e a relação feminino:masculino foi de 1,1:1. 99% dos alunos utilizaram computador e 67% o usaram no dia anterior à pesquisa. 58% utilizaram videogame e 30% “minigame/gameboy”. A disponibilidade e o uso dos aparelhos foi maior no sexo masculino (p < 0,001). Os alunos entre 10 e 14 anos utilizaram mais o videogame e o “minigame/gameboy” (p < 0,001) e os entre 15 e 18 o computador (p < 0,05). A utilização do videogame foi menor que o computador. Dor músculo-esquelética foi relatada por 312 alunos. 23% relataram dor na coluna vertebral, 9% nos membros superiores, 4% no músculo trapézio e 4%dor difusa. 11% dos alunos mencionaram que alguma das suas dores era desencadeada pelo uso do computador. Não foi evidenciada correlação entre a presença dor e o uso dos aparelhos. 359 alunos realizaram o exame físico, nestes a síndrome de hipermobilidade articular benigna foi encontrada em 10%, síndrome miofascial em 5%, tendinites em 2% e fibromialgia juvenil em 1%. Não foi observada correlação estatística entre a presença das entidades com a utilização dos aparelhos. A avaliação da ergonomia foi realizada em 402 alunos. Todos esses alunos apresentaram ergonomia inadequada em um ou mais dos aspectos avaliados. Conclusões: Os adolescentes usam o computador com tempo e freqüência consideráveis. A presença de dor, síndromes e lesões músculoesqueléticas não apresentou correlação com uso de computador ou videogame.Todos os alunos avaliados apresentaram ergonomia inadequada durante o uso do computador.
Introduction: Adolescents frequently use computer and video game and this may cause increased risk of pain, musculoskeletal pain syndromes and soft tissue injuries. Objectives: To evaluate and identify the presence of pain, musculoskeletal pain syndromes and soft tissue injuries in adolescents and correlate to computer and video game use. To evaluate ergonomics during computer use. Methods: The study group consisted of 833 adolescents from one private school in São Paulo, Brazil. A cross-sectional study was carried out that was composed of: a questionnaire with demographic data, use of computer and video game and presence of pain; clinical examination of the locomotor system and ergonomic evaluation of computer use. Juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, tendonitis, bursitis and epicondilitis were studied. Statistical analysis was carried out with Fisher, chi-square, Mann Whitney tests and Logistic Regression. In all of the statistical tests the level of significance was set at 5% (p <= 0.05) and were two-tailed. Results: 791 adolescent students were evaluated. The mean age was 14.17 ± 1.99 years and female/male relation was 1/1.1. The computer was used by 99% and 67% used the day before the survey, video game by 58% and minigame/gameboy by 30%. Computer and video game are more available to males and used more frequently by them (p < 0.001). The adolescents from 10 to 14 years (p < 0.001) reported more use of video game and minigame/gameboy and adolescents from 15 to 18 reported more use of computer (p < 0.05). The adolescents reported more use of computer than video game and minigame/gameboy. Pain was reported by 312 adolescents: 23% complained of back pain, 9% upper limbs pain, 4% diffuse pain and 4% pain in trapezium muscle. Pain related with computer use was reported in 11%. Statistical correlation was not observed between presence of any pain and use of either computer or video game. The clinical examination was carried out in 359 students. The musculoskeletal pain syndromes and soft tissue injuries was present in 56 students: benign joint hypermobility syndrome in 10%, myofascial syndrome in 5%, tendinitis in 2% and juvenile fibromyalgia in 1%. Statistical correlation was not observed between presence of musculoskeletal pain syndromes or soft tissue injuries and use of computer and video game. Ergonomic evaluation of computer use was carried out in 402 adolescents. All of these students presented inadequate ergonomics of computer use at school during computer class. Conclusions: Adolescents use frequently and for a considerable period of time computer and video game. Statistical correlation was not observed between presence of any pain and use of computer and video game. The presence of musculoskeletal pain syndromes and soft tissue injuries were not correlated to computer or video game use. All of the students presented inadequate ergonomics during of computer use.

Orientador: Neusa Maria Costa Alexandre
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Atualmente a literatura tem apresentado inúmeras tentativas de prevenção e controle da dor lombar. A natureza multifatorial dos fatores de risco associados a esta afecção representa considerável desafio para a determinação de estratégias de intervenção que sejam realmente efetivas no seu controle. O caráter crônico e incapacitante da lombalgia faz com que esta condição clínica tenha repercussões importantes na vida do sujeito, comprometendo de forma significativa a qualidade de vida de seus portadores. A literatura internacional tem relatado o uso do Quality of Ufe Index - Spitzer (QLI) para avaliar a qualidade de vida de pacientes portadores de dor lombar. A adaptação cultural de escalas e questionários já validados em outra língua tem sido amplamente recomendada, uma vez que facilita a troca de informações entre a comunidade científica. Dessa forma, com a finalidade de disponibilizar para a comunidade científica brasileira um instrumento de avaliação genérica de qualidade de vida, este estudo teve como objetivo realizar a adaptação cultural do instrumento Spitzer Quality of Ufe Index para a língua portuguesa do Brasil, bem como avaliar sua confiabilidade junto a pacientes portadores de dor lombar crônica. Para assegurar a qualidade da adaptação, foram seguidos os passos metodológicos recomendados por publicações especializadas: tradução do instrumento para a língua portuguesa do Brasil, retro-tradução, avaliação por um comitê de juízes, préteste, avaliação da confiabilidade e validade. Inicialmente o questionário foi traduzido por dois tradutores bilíngües de forma independente, que possuíam como língua materna a língua portuguesa do Brasil. Posteriormente, dois outros tradutores cuja língua materna era o inglês, fizeram a retro-tradução. Um comitê composto por seis especialistas revisou e comparou as traduções obtidas, desenvolvendo a versão final para a aplicação do préteste. O pré-teste foi realizado em 40 pacientes portadores de dor lombar crônica. A confiabilidade foi avaliada por meio da consistência interna e da estabilidade (testereteste). A validade foi obtida por meio da análise de correlação entre os escores do instrumento Spitzer (QLI), com o SF-36 e com o Ro/and-Morris. As propriedades psicométricas da versão traduzi da foram avaliadas auto-aplicando o instrumento 'em 120 pacientes com lombalgia crônica. Os resultados demonstraram que o instrumento é confiável apresentando consistência interna satisfatória, indicada pelo coeficiente alfa de Cronbach=0,76 para o teste e 0,77 para o reteste. No teste-reteste os resultados apontaram uma elevada correlação intraclasse ICC=0.960 (p<0,001; IC950/0: 0,943; 0,972). O coeficiente de correlação de Spearman foi de r=0,937 (p<0,001), indicando também elevada concordância entre os valores do escore do Spitzer (QLI) no teste/reteste. As correlações entre o escore do Spitzer (QLI) e as diferentes dimensões do SF-36 mostraram-se significativas. Os coeficientes de correlação mais elevados foram: Dor (r= 0,699), Aspectos Físicos (r=0,687), Capacidade Funcional (r=0,682) e Aspectos Sociais (r=0,680). Também foi constatada correlação significativa entre os escores do Spitzer (QLI) e do questionário Roland-Morris (r=0,730). Conclui-se que o processo de adaptação cultural foi realizado com sucesso e que a versão adaptada apresenta medidas psicométricas confiáveis e válidas na cultura brasileira
Abstract: The current literature has presented innumerable attempts to prevent and controllow back pain. The multifactorial nature of risk factors associated with this affection represents a considerable challenge in the determination of interventional strategies that will be truly effective to control it. The chronic and incapacitating characteristics of low back pain result in important repercussions on the patient' s life significantly compromising the quality of life of those who have this condition. The intemational literature has reported the use of the Quality of Ufe Index - Spitzer (QU) for the evaluation of the quality of life of patients with low back pain. Thecultural adaptation of scales and questionnaires validated in another language has been widely recommended, since it facilitates the scientific information exchange. In this manner, with the purpose of making available to the Brazilian scientific community an instrument for comprehensive evaluation of quality of life, this study had as objective carrying out the cultural adaptation the Spitzer Quality of Ufe Index questionnaire into the Brazilian Portuguese language, and as to evaluate its reliability in patients suffering from low back pain. In order to ensure this adaptation quality, the methodological steps recommended by specialized publications were followed: translation of the instrument into the Brazilian Portuguese language, back-translation, evaluation by a committee of judges, pretest, and reliability and validity assessment. At first, the questionnaire was independently translated by two bilingual translators, who had Brazilian Portuguese as their rnother language. Subsequently, two other translators whose mother language was English did the back-translation. A committee composed of six specialists revised and compareci the translations obtained, developing the final version for pretest application. The pretest was carried out with 40 patients suffering from low back pain. The reliability was estimated through stability (test-retest) and homogeneity assessmenl The validity was tested comparing scores 01' the obtained by means of correlation analysis among thescores of the Spitzer (QU) 'with the SF-36 and the Roland-Morris. The psychometric properties of the translated version were evaluated by the self-application instrument on 120 patients with chronic low back pain. The Cronbach's Alpha was 0.76 for the test and 0.77 for the retest, showing satisfactory internal consistency results. Using the intraclass correlation coefficient for test-retest, the reliability was ICC = 0.960 (p<0.001; IC95%: 0.943; 0.972). The reliability determined by the Spearman's Correlation Coefficient was 0.937 (p<0.001). There was significant correlation between the Spitzer (QU) scores and the different dimensions of the SF-36 questionnaire. The highest correlation coefficients were for Bodily Pain (r = 0.699), Role Functioning (r = 0.687), Physical Functioning (r = 0.682) arid Social Functioning (r = 0.680). A significant correlation was found between the Spitzer (QU) and the Roland-Morris questionnaire scores (r = 0.730). The cultural adaptation .process was conducted successfully and the adapted version presents psychometric rneasures which are reliable and valid in the Brazilian culture
Mestrado
Enfermagem e Trabalho
Mestre em Enfermagem

Background: Telework has become a frequent form of work for a large part of the workforce. However, research regarding public health aspects is lacking in this area. The purpose of this study was to examine how physical active teleworkers are and if they achieve WHO guidelines. A second aim of the study was to investigate relationships between telework and physical activity, sedentary behaviour, and musculoskeletal pain/discomfort. Method: A cross-sectional survey was performed in Sweden. In total 375 individuals were included in the sample. Logistic regressions were performed to determine association between telework and physical activity, sedentary behaviour, and musculoskeletal pain/discomfort (current and during the last 12 months). Results: 83 % of teleworkers reported physical activity levels that met the WHO guidelines. The results showed no significant relationships between telework and physical activity, sedentary behaviour, or musculoskeletal pain/discomfort. Conclusion: A large part of the studied sample of teleworkers reported achieving the WHO recommendation for physical activity. As no associations could be found between telework, and physical activity, sedentary behaviour, and musculoskeletal issues, telework could be deemed to be as safe as any other work form. However, as this was not a prospective study, with a random sample, further studies are required to investigate whether teleworking has an impact on public health.

Betyg i Ladok 210603.