Pain in the low back and elsewhere: prevalence, patterns, and consequences

Cecilie Krage Øverås

doi:10.21996/bqq2-3d50

Pain in the low back and elsewhere: prevalence, patterns, and consequences

Cecilie Krage Øverås

Institut for Idræt og Biomekanik

Publikation: Afhandling › Ph.d.-afhandling

73 Downloads (Pure)

Abstract

Mange personer med længerevarende rygsmerter (LBP) har samtidig andre muskuloskeletale(MSK) smerter. Der er imidlertid begrænset viden om, i hvilke kropsregioner der oftestoptræder smerter samtidig med LBP, om disse mønstre er stabile over tid, og om de påvirkerkonsekvenserne af længerevarende LBP. Emnet for denne PhD-afhandling er MSK-smerterder optræder sammen med LBP, og deres forekomst, mønstre og konsekvenser.

Artikel I og II er en protokol og et systematisk litteraturstudie, der omhandler forekomst ogmønstre af samtidige MSK-smerter blandt voksne med længerevarende LBP. Artikel llinkluderer data fra observations undersøgelser i generelle, arbejdsaktive og kliniskepopulationer. I alt 19 studier med 34,492 personer blev inkluderet. Gennemgangen viste, atMSK smerter samtidig med LBP er almindelige. De hyppigste kropsregioner er: 1) nakke (18-58%/n=5020/10413), 2) ekstremiteter (6-50%/n=3576/9592) og 3) smerter i flere regioner(10-89%). Kvinder og personer med større funktionsnedsættelser rapporterer oftere MSKsmerter samtidig med LBP, og der var en højere gennemsnitsalder blandt dem med samtidigesmerter i ekstremiteterne. De inkluderede studier var generelt af god kvalitet, men der varbetydelig heterogenitet mellem studierne og varierende rapportering af MSK-smerteregionersamtidig med LBP. Artikel III bygger på en analyse af en serie af tværsnitsundersøgelser fraden populationsbaserede norske HUNT-undersøgelse. Med data fra 27.607 voksne medvedvarende LBP, der deltog i HUNT2 (1995-1997) og/eller HUNT3 (2006-2008) og/ellerHUNT4 (2017-2019), undersøgte vi prævalensen og latente mønstre af længerevarende LBPog samtidige MSK-smerter og konsistensen i disse mønstre over tre årtier. Vi fandt, at denaldersstandardiserede prævalens og mønstre af samtidige MSK-smerter med længerevarendeLBP var konsistente i befolkningen over tid, og at de fleste smerter var i nakke, skulder oghofte/lår. Vi identificerede fire distinkt forskellige fænotyper: "LBP alene", "LBP med smerter inakke/skulder", "LBP med smerter i nedre ekstremiteter/håndled/hånd" og "LBP medgeneraliserede smerter". Personer i fænotype 3 var lidt ældre end de øvrige, og fænotype 4havde en højere andel af kvinder og et generelt dårligere helbred. De 4 fænotyper var stabilehenover de tre årtier. Artikel VI er en sekundær analyse fra SELFBACK-studiet. Hersammenlignede vi i et randomiseret og kontrolleret forsøg en app baseret på kunstigintelligens (AI) som støtte for egen-håndtering af LBP med vanlig behandling. I forsøget blevder fundet en samlet lille, men statistisk signifikant forskel til fordel for den AI-baserede app.Samtidige MSK-smerter og multimorbiditet anses for at være mere komplekse at håndtere ogmere resistente for behandling. Derfor ønskede vi at vurdere om effekten eller resultatet afSELFBACK-appen i løbet af opfølgningsperioden på 9 måneder blev modificeret af samtidigeMSK-smerter og multimorbiditet. Vi fandt, ingen påvirkning af effekten af SELFBACK-appenvurderet på rygrelateret funktionsnedsættelse eller andre outcomes på trods af, at de medsamtidige MSK smerter og de med multimorbiditet havde dårligere baseline- ogopfølgningsscore.

Samlet set har denne afhandling vist, at MSK-smerter samtidig med længerevarende LBP ermarkant mere almindeligt end at have LBP alene. Både forekomst og mønstre af samtidigesmerter er meget stabile på populationsniveau. Endelig påvirker tilstedeværelse af MSKsmerter eller multimorbiditet samtidig med LBP ikke effekten af en m-sundhedsinterventionmod LBP

Originalsprog	Engelsk
Bevilgende institution	Syddansk Universitet
Vejledere/rådgivere	Hartvigsen, Jan, Hovedvejleder Søgaard, Karen, Bivejleder Mork, Paul Jarle, Bivejleder, Ekstern person Nilsen, Tom Ivar Lund, Bivejleder, Ekstern person
Dato for forsvar	15. jun. 2023
Udgiver	Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet
DOI	https://doi.org/10.21996/bqq2-3d50
Status	Udgivet - 22. maj 2023

Note vedr. afhandling

Den fulde afhandling kan læses på SDUs bibliotek.

Dokumenter og links

10.21996/bqq2-3d50

Open Access VersionForlagets udgivne version, 2,55 MB

3 Tidsskriftartikel

Multimorbidity and co-occurring musculoskeletal pain do not modify the effect of the selfBACK app on low back pain-related disability
Øverås, C. K., Nilsen, T. I. L., Nicholl, B. I., Rughani, G., Wood, K., Søgaard, K., Mair, F. S. & Hartvigsen, J., 8. feb. 2022, I: BMC Medicine. 20, 13 s., 53.
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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Distribution and prevalence of musculoskeletal pain co-occurring with persistent low back pain: a systematic review
Øverås, C. K., Johansson, M. S., de Campos, T. F., Ferreira, M. L., Natvig, B., Mork, P. J. & Hartvigsen, J., 18. jan. 2021, I: BMC Musculoskeletal Disorders. 22, 15 s., 91.
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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Prevalence and pattern of co-occurring musculoskeletal pain and its association with back-related disability among people with persistent low back pain: protocol for a systematic review and meta-analysis
Øverås, C. K., Johansson, M. S., de Campos, T. F., Ferreira, M. L., Natvig, B., Mork, P. J. & Hartvigsen, J., 16. dec. 2017, I: Systematic Reviews. 6, 6 s., 258.
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

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Citationsformater

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title = "Pain in the low back and elsewhere: prevalence, patterns, and consequences",

abstract = "It is common for people with persistent low back pain (LBP) to have co-occurringmusculoskeletal (MSK) pain. Still, there is limited knowledge of which pain sites mostcommonly co-occur with persistent LBP, how stable these patterns are over time and possibleconsequences. The current thesis has co-occurring MSK pain alongside LBP as the overalltopic and covers its prevalence, patterns, and consequences over time.Paper I and II was the study protocol and a systematic review dealing with the prevalence andpatterns of distribution of co-occurring MSK pain among adults with persistent LBP. Datacollection was from observational studies in general, working, and clinical populations and atotal of nineteen studies with 34,492 individuals with persistent LBP were included. Thereview found co-occurring pain to be common among people with persistent LBP, and maincategories identified were: 1) neck (18-58%/n=5020/10413), 2) extremity (6-50%/n=3576/9592), and 3) multi-site pain (10-89%). More co-occurring MSK pain sites wereobserved among females and more often reported in people with more disabilities. Cooccurring extremity pain consisted of a population with higher mean age. Despite the overalllow risk of bias, the main limitation was the considerable between-study heterogeneity andvarying reporting of co-occurring MSK pain sites.Paper III was analysis of consecutive cross-sectional studies from the population-basedNorwegian HUNT Study. With data from 27,607 adults with persistent LBP participating inHUNT2 (1995-1997), and/or HUNT3 (2006-2008) and/or HUNT4 (2017-2019), we examinedthe prevalence and latent patterns of persistent LBP and co-occurring persistent MSK painand its consistency over three decades. The age-standardized prevalence and patterns ofpersistent LBP with co-occurring MSK pain were consistent in the population over time. MSKpain most often co-occurred in the neck, shoulder, and hip/thigh. We identified four distinctphenotypes: 1) {\textquoteleft}LBP only{\textquoteright}, 2) {\textquoteleft}LBP with neck/shoulder pain{\textquoteright}, 3) {\textquoteleft}LBP with lowerextremity/wrist/hand pain{\textquoteright} and 4) {\textquoteleft}LBP with multisite pain{\textquoteright}. People in phenotype 3 wereslightly older than the others, and phenotype 4 had a higher proportion of females and,overall, more ill health. These phenotypes also appeared stable across the three decades.Paper VI was a secondary analysis from the SELFBACK trial where an artificial intelligence (AI)-based app for self-management support of LBP was developed and tested in a randomised,controlled trial. In the trial, an overall small but statistically significant benefit on LBP-relateddisability in favour of the AI-based app was found compared to usual care alone. Since cooccurring MSK pain and multimorbidity are considered more complex to manage and resilientto treat, we aimed to assess if their presence would modify the effect or influence theoutcome of the SELFBACK intervention over the 9-month follow-up period. We found thathaving co-occurring MSK pain or multimorbidity did not modify the effect of the SELFBACK appon LBP-related disability or other core outcomes, despite worse baseline and follow-up scorescompared to those without multimorbidity and fewer sites of co-occurring MSK pain.Overall, this thesis has shown that having co-occurring MSK pain alongside persistent LBP ismarkedly more common than having LBP alone and that its prevalence and the four identifieddistinct pain site phenotypes, at a population level, appear stable over the past threedecades. Lastly, co-occurring MSK pain or multimorbidity does not modify the effect of amHealth intervention. ",

keywords = "Low back pain, Co-occurring musculoskeletal pain, Multimorbidity, Systematic review, Latent class analysis, mHealth, Artificial intelligence, Self-management",

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T2 - prevalence, patterns, and consequences

AU - Øverås, Cecilie Krage

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N2 - It is common for people with persistent low back pain (LBP) to have co-occurringmusculoskeletal (MSK) pain. Still, there is limited knowledge of which pain sites mostcommonly co-occur with persistent LBP, how stable these patterns are over time and possibleconsequences. The current thesis has co-occurring MSK pain alongside LBP as the overalltopic and covers its prevalence, patterns, and consequences over time.Paper I and II was the study protocol and a systematic review dealing with the prevalence andpatterns of distribution of co-occurring MSK pain among adults with persistent LBP. Datacollection was from observational studies in general, working, and clinical populations and atotal of nineteen studies with 34,492 individuals with persistent LBP were included. Thereview found co-occurring pain to be common among people with persistent LBP, and maincategories identified were: 1) neck (18-58%/n=5020/10413), 2) extremity (6-50%/n=3576/9592), and 3) multi-site pain (10-89%). More co-occurring MSK pain sites wereobserved among females and more often reported in people with more disabilities. Cooccurring extremity pain consisted of a population with higher mean age. Despite the overalllow risk of bias, the main limitation was the considerable between-study heterogeneity andvarying reporting of co-occurring MSK pain sites.Paper III was analysis of consecutive cross-sectional studies from the population-basedNorwegian HUNT Study. With data from 27,607 adults with persistent LBP participating inHUNT2 (1995-1997), and/or HUNT3 (2006-2008) and/or HUNT4 (2017-2019), we examinedthe prevalence and latent patterns of persistent LBP and co-occurring persistent MSK painand its consistency over three decades. The age-standardized prevalence and patterns ofpersistent LBP with co-occurring MSK pain were consistent in the population over time. MSKpain most often co-occurred in the neck, shoulder, and hip/thigh. We identified four distinctphenotypes: 1) ‘LBP only’, 2) ‘LBP with neck/shoulder pain’, 3) ‘LBP with lowerextremity/wrist/hand pain’ and 4) ‘LBP with multisite pain’. People in phenotype 3 wereslightly older than the others, and phenotype 4 had a higher proportion of females and,overall, more ill health. These phenotypes also appeared stable across the three decades.Paper VI was a secondary analysis from the SELFBACK trial where an artificial intelligence (AI)-based app for self-management support of LBP was developed and tested in a randomised,controlled trial. In the trial, an overall small but statistically significant benefit on LBP-relateddisability in favour of the AI-based app was found compared to usual care alone. Since cooccurring MSK pain and multimorbidity are considered more complex to manage and resilientto treat, we aimed to assess if their presence would modify the effect or influence theoutcome of the SELFBACK intervention over the 9-month follow-up period. We found thathaving co-occurring MSK pain or multimorbidity did not modify the effect of the SELFBACK appon LBP-related disability or other core outcomes, despite worse baseline and follow-up scorescompared to those without multimorbidity and fewer sites of co-occurring MSK pain.Overall, this thesis has shown that having co-occurring MSK pain alongside persistent LBP ismarkedly more common than having LBP alone and that its prevalence and the four identifieddistinct pain site phenotypes, at a population level, appear stable over the past threedecades. Lastly, co-occurring MSK pain or multimorbidity does not modify the effect of amHealth intervention.

AB - It is common for people with persistent low back pain (LBP) to have co-occurringmusculoskeletal (MSK) pain. Still, there is limited knowledge of which pain sites mostcommonly co-occur with persistent LBP, how stable these patterns are over time and possibleconsequences. The current thesis has co-occurring MSK pain alongside LBP as the overalltopic and covers its prevalence, patterns, and consequences over time.Paper I and II was the study protocol and a systematic review dealing with the prevalence andpatterns of distribution of co-occurring MSK pain among adults with persistent LBP. Datacollection was from observational studies in general, working, and clinical populations and atotal of nineteen studies with 34,492 individuals with persistent LBP were included. Thereview found co-occurring pain to be common among people with persistent LBP, and maincategories identified were: 1) neck (18-58%/n=5020/10413), 2) extremity (6-50%/n=3576/9592), and 3) multi-site pain (10-89%). More co-occurring MSK pain sites wereobserved among females and more often reported in people with more disabilities. Cooccurring extremity pain consisted of a population with higher mean age. Despite the overalllow risk of bias, the main limitation was the considerable between-study heterogeneity andvarying reporting of co-occurring MSK pain sites.Paper III was analysis of consecutive cross-sectional studies from the population-basedNorwegian HUNT Study. With data from 27,607 adults with persistent LBP participating inHUNT2 (1995-1997), and/or HUNT3 (2006-2008) and/or HUNT4 (2017-2019), we examinedthe prevalence and latent patterns of persistent LBP and co-occurring persistent MSK painand its consistency over three decades. The age-standardized prevalence and patterns ofpersistent LBP with co-occurring MSK pain were consistent in the population over time. MSKpain most often co-occurred in the neck, shoulder, and hip/thigh. We identified four distinctphenotypes: 1) ‘LBP only’, 2) ‘LBP with neck/shoulder pain’, 3) ‘LBP with lowerextremity/wrist/hand pain’ and 4) ‘LBP with multisite pain’. People in phenotype 3 wereslightly older than the others, and phenotype 4 had a higher proportion of females and,overall, more ill health. These phenotypes also appeared stable across the three decades.Paper VI was a secondary analysis from the SELFBACK trial where an artificial intelligence (AI)-based app for self-management support of LBP was developed and tested in a randomised,controlled trial. In the trial, an overall small but statistically significant benefit on LBP-relateddisability in favour of the AI-based app was found compared to usual care alone. Since cooccurring MSK pain and multimorbidity are considered more complex to manage and resilientto treat, we aimed to assess if their presence would modify the effect or influence theoutcome of the SELFBACK intervention over the 9-month follow-up period. We found thathaving co-occurring MSK pain or multimorbidity did not modify the effect of the SELFBACK appon LBP-related disability or other core outcomes, despite worse baseline and follow-up scorescompared to those without multimorbidity and fewer sites of co-occurring MSK pain.Overall, this thesis has shown that having co-occurring MSK pain alongside persistent LBP ismarkedly more common than having LBP alone and that its prevalence and the four identifieddistinct pain site phenotypes, at a population level, appear stable over the past threedecades. Lastly, co-occurring MSK pain or multimorbidity does not modify the effect of amHealth intervention.

KW - Low back pain

KW - Co-occurring musculoskeletal pain

KW - Multimorbidity

KW - Systematic review

KW - Latent class analysis

KW - mHealth

KW - Artificial intelligence

KW - Self-management

U2 - 10.21996/bqq2-3d50

DO - 10.21996/bqq2-3d50

M3 - Ph.D. thesis

PB - Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet

ER -

Pain in the low back and elsewhere: prevalence, patterns, and consequences

Abstract

Note vedr. afhandling

Dokumenter og links

Fingeraftryk

Relaterede publikationer

Multimorbidity and co-occurring musculoskeletal pain do not modify the effect of the selfBACK app on low back pain-related disability

Distribution and prevalence of musculoskeletal pain co-occurring with persistent low back pain: a systematic review

Prevalence and pattern of co-occurring musculoskeletal pain and its association with back-related disability among people with persistent low back pain: protocol for a systematic review and meta-analysis

Citationsformater