The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'.
A ...multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations.
2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability).
These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.
Objective
To study the associations of sociodemographic factors, working conditions, lifestyle and previous pain in the spine with new onset chronic neck pain (NP).
Methods
The participants were ...municipal employees free of chronic NP at baseline, aged 40, 45, 50, 55 or 60 years (n = 5277, 80% women). Self‐reported data on occupational class, working conditions, body mass index, smoking, exercise, mental well‐being, sleep problems, NP and low back pain (LBP) were obtained from baseline questionnaire surveys in 2000–2002. The question on chronic NP was repeated in a follow‐up in 2007. Logistic regression analysis was used.
Results
The incidence of chronic NP was 15% in women and 9% in men. In multivariable analysis among women, acute NP odds ratio (OR) 3.8, 95% confidence interval (CI) 2.9–5.1, chronic LBP (1.6, 1.2–2.2), reporting current workplace bullying (OR 1.6, 95% CI 1.1–2.4), earlier bullying at the present workplace (1.6, 1.2–2.0), and earlier bullying in another workplace (1.8, 1.3–2.4), frequent sleep problems (1.5, 1.2–2.0), overweight (1.2, 1.0–1.5), and obesity (1.4, 1.1–1.8) predicted chronic NP at follow‐up. Men with acute NP (2.3, 1.4–3.8), chronic LBP (2.3, 1.2–4.3), manual occupational class (1.8, 1.1–3.1) and high work‐related emotional exhaustion (1.9, 1.1–3.3) at baseline had an increased risk of new onset chronic NP.
Conclusions
We found potentially modifiable predictors of chronic NP among employees: workplace bullying, sleep problems, and high body mass index in women, and work‐related emotional exhaustion in men. In both genders, previous acute NP and chronic LBP were predictive of chronic NP.
Background
Musculoskeletal pain at several sites (multisite pain) is more common than single‐site pain. Little is known on its effects on disability pension (DP) retirement.
Methods
A nationally ...representative sample comprised 4071 Finns in the workforce aged 30 to 63. Data (questionnaire, interview, clinical examination) were gathered in 2000–2001 and linked with national DP registers for 2000–2011. Pain during the preceding month in 18 locations was combined into four sites (neck, upper limbs, low back, lower limbs). Hazard ratios (HR) of DP were estimated by Cox regression.
Results
The HR of any DP (n = 477) was 1.6 (95% confidence interval 1.2–2.1) for one, 2.5 (1.9–3.3) for two, 3.1 (2.3–4.3) for three and 5.6 (4.0–7.8) for four pain sites, when adjusted for age and gender. When additionally adjusted for clinically assessed chronic diseases, the HRs varied from 1.4 (1.0–1.8) to 3.5 (2.5–4.9), respectively. When further adjusted for physical and psychosocial workload, education, body mass index, smoking, exercise and sleep disorders, the HRs were 1.3 (0.9–1.7), 1.6 (1.2–2.2), 1.8 (1.3–2.5) and 2.5 (1.8–3.6). The number of pain sites was especially strong in predicting DPs due to musculoskeletal diseases (HRs in the full model; 3.1 to 4.3), but it also predicted DPs due to other somatic diseases (respective HRs 1.3 to 2.3); pain in all four sites was also predictive of DPs due to mental disorders (full model HR 2.2).
Conclusions
The number of pain sites independently predicted DP retirement. Employees with multisite pain may need specific support to maintain their work ability.
To establish whether review articles provide consistent conclusions on associations between workplace psychosocial factors and musculoskeletal pain and, if differences exist, to explore whether this ...is related to the methods used.
Reviews, reported up to February 2007, that included consideration of workplace psychosocial factors and upper limb, back or knee pain were identified through searches of multiple databases. The specific work-related psychosocial factors considered were job demands, support, job autonomy and job satisfaction. The conclusions of each review on one or more of the psychosocial/musculoskeletal pain associations were extracted.
15 review articles were identified that considered one or more of the regional pain syndromes included in the study. For back pain, the most consistent conclusions (four reviews positive out of six) were with high job demands and low job satisfaction. The studies of upper limb pain were exclusively related to shoulder and/or neck pain, and the most consistent positive conclusions were with high and low job demands (four reviews positive out of six and two reviews positive out of three, respectively). For knee pain, only a single review was identified. For individual reviews of back and upper limb pain, there were marked differences in the number of associations concluded to be positive between reviews.
The reasons for reviews coming to different conclusions included that they were often evaluating different bodies of evidence (according to their search criteria, the year when the review was conducted, the role that quality assessment played in whether studies contributed to evidence, and the combination of risk factors addressed in individual studies), but more important was whether the review specified explicit criteria for making conclusions on strength of evidence. These conclusions emphasise the importance of developing standardised methods for conducting such evaluations of existing evidence and the importance of new longitudinal studies for clarifying the temporal relationship between psychosocial factors and musculoskeletal pain in the workplace.
Background
We investigated the separate and joint effects of multi‐site musculoskeletal pain and physical and psychosocial exposures at work on future work ability.
Methods
A survey was conducted ...among employees of a Finnish food industry company in 2005 (n = 1201) and a follow‐up survey in 2009 (n = 734). Information on self‐assessed work ability (current work ability on a scale from 0 to 10; 7 = poor work ability), multi‐site musculoskeletal pain (pain in at least two anatomical areas of four), leisure‐time physical activity, body mass index and physical and psychosocial exposures was obtained by questionnaire. The separate and joint effects of multi‐site pain and work exposures on work ability at follow‐up, among subjects with good work ability at baseline, were assessed by logistic regression, and p‐values for the interaction derived.
Results
Compared with subjects with neither multi‐site pain nor adverse work exposure, multi‐site pain at baseline increased the risk of poor work ability at follow‐up, allowing for age, gender, occupational class, body mass index and leisure‐time physical activity. The separate effects of the work exposures on work ability were somewhat smaller than those of multi‐site pain. Multi‐site pain had an interactive effect with work environment and awkward postures, such that no association of multi‐site pain with poor work ability was seen when work environment was poor or awkward postures present.
Conclusions
The decline in work ability connected with multi‐site pain was not increased by exposure to adverse physical or psychosocial factors at work.
To study the association between overweight and lumbar disc degeneration.
Population-based 4-y follow-up magnetic resonance imaging (MRI) study.
The subjects were 129 working middle-aged men selected ...to the baseline magnetic resonance imaging (MRI) study from a cohort of 1832 men representing three occupations: machine drivers, construction carpenters, and office workers. The selection was based on the paticipants' age (40-45 y) and place of residence. MR images of the lumbar spines were obtained at baseline and at 4-y follow-up.
Signal intensity of the nucleus pulposus of the discs L2/L3-L4/L5 was visually assessed by two readers using the adjacent cerebrospinal fluid as an intensity reference. The weight (at age 25 and 40-45 y) and height of the subjects, history of car driving, smoking, and back injuries were assessed by questionnaire.
Multiple regression analyses allowing for occupation, history of car driving, smoking, and back injuries showed that persistent overweight (body mass index (BMI) > or =25 kg/m(2) at both ages) associated strongly with an increased risk of the number of lumbar discs with decreased signal intensity of nucleus pulposus at follow-up, adjusted odds ratio (OR) being 4.3 (95% confidence intervals (95% CIs) 1.3-14.3). Overweight at young age (risk ratio (RR) 3.8; 95% CI 1.4-10.4) was a stronger predictor of an increase in the number of degenerated discs during follow-up than overweight in middle age (RR 1.3; 95% CI 0.7-2.7).
The study provides evidence that the BMI above 25 kg/m(2) increases the risk of lumbar disc degeneration. Overweight at young age seems to be particularly detrimental.
This meta-analysis assessed the association between overweight/obesity and low back pain. The authors systematically searched the Medline (National Library of Medicine, Bethesda, Maryland) and Embase ...(Elsevier, Amsterdam, the Netherlands) databases until May 2009. Ninety-five studies were reviewed and 33 included in the meta-analyses. In cross-sectional studies, obesity was associated with increased prevalence of low back pain in the past 12 months (pooled odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.14, 1.54), seeking care for low back pain (OR = 1.56, 95% CI: 1.46, 1.67), and chronic low back pain (OR = 1.43, 95% CI: 1.28, 1.60). Compared with nonoverweight people, overweight people had a higher prevalence of low back pain but a lower prevalence of low back pain compared with obese people. In cohort studies, only obesity was associated with increased incidence of low back pain for ≥1 day in the past 12 months (OR = 1.53, 95% CI: 1.22, 1.92). Results remained consistent after adjusting for publication bias and limiting the analyses to studies that controlled for potential confounders. Findings indicate that overweight and obesity increase the risk of low back pain. Overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain.
Pain is a strong predictor of reduced work ability and well-being, but there is little information on the prevalence of and socio-economic differences in acute, chronic and disabling chronic pain ...among employees. A questionnaire survey conducted in 2000-2002 among employees aged 40, 45, 50, 55 and 60 of the City of Helsinki (N=8970, response rate 67%) included socio-demographic and socio-economic factors and measures of current pain, pain duration and pain-related disability. Pain was acute when lasting a maximum of 3 months and chronic when persisting for more than 3 months. Disabling chronic pain was determined using the disability subscale of Von Korff's Chronic Pain Grade questionnaire. Acute pain was reported by 15% of women, chronic pain by 29% and disabling chronic pain by 7%. The corresponding figures for men were 12, 24 and 5%. Chronic and disabling chronic pain were more common in older age groups among both genders. Among women, those with secondary or basic education were more likely to report chronic or disabling chronic pain than those with higher education, and semi-professionals, routine non-manual employees and manual workers were more likely to report disabling chronic pain than managers. Among men, separated/divorced or widowed men were more likely to report acute pain than married men, and manual workers were more likely to report chronic pain than managers. Chronic pain was relatively common in this population, and those with older age, lower education and occupational class appear to be at excess risk for chronic pain, especially for disabling chronic pain.
Objectives: Available evidence suggests that genetic factors and overweight play major roles in the aetiology of osteoarthritis (OA). We analysed the association of 18 single-nucleotide polymorphisms ...(SNPs) from nine adipokine and adipokine receptor genes (LEP, LEPR, ADIPOQ, RETN, NAMPT, SERPINA12, ITLN1, RARRES2, and APLN) with radiographic hand OA.
Method: The study design was cross-sectional. Bilateral hand radiographs of 542 occupationally active Finnish female dentists and teachers aged 45-63 years were examined and classified for the presence of hand OA using reference images. Hand OA was defined as at least three finger joints with radiographic OA of grade 2-4. The genotypes were determined using polymerase chain reaction-based methods. Body mass index (BMI) was calculated based on self-reported height and measured weight. Associations of the individual SNPs and their haplotypes with hand OA were tested using logistic regression analysis.
Results: The minor allele of RETN rs10401670 was associated with a decreased odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.55-0.97, p = 0.03 and RARRES2 rs4721 with an increased (OR 1.41, 95% CI 1.07-1.87, p = 0.01) prevalence of hand OA. Also, LEPR AC (OR 1.54, 95% CI 1.01-2.35, p = 0.05) and RETN GGTT (OR 0.58, 95% CI 0.37-0.93, p = 0.02) haplotypes were associated with hand OA. These associations were modified by BMI when comparing normal and overweight women. However, the associations lost their statistical significance after adjusting for multiple testing.
Conclusion: Our results suggest weak associations between the studied variations in LEPR, RARRES2, and RETN genes and hand OA in Finnish women, and that the associations are modified by BMI. However, these associations could not be verified in the current study.
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