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Background: Chronic widespread pain (CWP) has a negative impact on health status, but results have varied regarding gender-related differences and reported health status. The aim was to study the impact of CWP on health status in women and men aged 35–54 years in a sample of the general population. The aim was further to investigate lifestyle-related predictors of better health status in those with CWP in a 12- and 21-year perspective. Method: A general population cohort study including 975 participants aged 35–54 years, with a 12- and 21-year follow-up. CWP was measured with a pain mannequin, and the questionnaire included questions on lifestyles factors with SF-36 for measurement of health status. Differences in health status were analysed with independent samples t-test and health predictors with logistic regression analysis. Results: The prevalence of CWP was higher in women at all time points, but health status was reduced in both women and men with CWP (p < 0.001) with no gender differences of clinical relevance. At the 12-year follow-up, a higher proportion of women than men had developed CWP (OR 2.04; CI 1.27–3.26), and at the 21-year follow-up, a higher proportion of men had recovered from CWP (OR 3.79; CI 1.00–14.33). In those reporting CWP at baseline, a better SF-36 health status (Physical Functioning, Vitality or Mental Health) at the 12-year follow-up was predicted by male gender, having personal support, being a former smoker, and having no sleeping problems. In the 21-year follow-up, predictors of better health were male gender, a weekly intake of alcohol, and having no sleeping problems. Conclusion: Women and men with CWP have the same worsening of health status, but men recover from CWP to a greater extent in the long-term. Being male, having social support, being a former smoker, and having no sleeping problems were associated with better health status in those with CWP. Keywords: Chronic widespread pain, Gender differences, Health predictors, Health status Background and people with chronic pain show a higher level of Chronic pain is a common health problem  and the depression, anxiety, helplessness, and dissatisfaction term refers to pain that persists or recurs for more than [8, 9]. Chronic pain has a negative impact on daily three months . The prevalence of chronic pain in the living and work activity [5, 8]. It affects the ability to general population ranges from 13 to 25% [3–5], being do household chores, walk, exercise, drive a car, con- higher in women [3, 4, 6], and increasing with age [3, 5, 6]. centrate, sleep, and it also affect sexual relations, the Chronic pain is associated with poorer general health [6–8], possibility of attending social activities, and the ability to maintaining an independent lifestyle [5, 8]. Chronic widespread pain (CWP) is a more severe form * Correspondence: email@example.com of chronic pain, it is usually defined according to the Spenshult Research and Development Centre, Bäckagårdsvägen 47, SE-302 American College of Rheumatology (ACR) criteria as 74 Halmstad, Sweden School of Health and Welfare, Halmstad University, Halmstad, Sweden pain lasting for a minimum of three months, present on Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Sylwander et al. BMC Musculoskeletal Disorders (2020) 21:36 Page 2 of 11 both sides of the body, below and above the waist, and of the general population. The aim was further to inves- in the axial skeleton . The average estimated preva- tigate lifestyle-related predictors of better health status lence of CWP ranges from 10 to 15% [11, 12], and CWP in those with CWP in a 12- and 21-year perspective. causes not only suffering for the individual but also costs to society, with a high frequency of sick leave [8, 13]. Method There are several risk factors for development of CWP— Design and subjects for example, older age [12, 13], female gender [12, 13], a The present study was a part of a 21-year prospective lower level of education , smoking [15, 16], excessive population-based cohort study, the EPIPAIN study . body mass [16, 17], lack of social support , sleep dis- Participants of the EPIPAIN study constituted a repre- orders [18, 19], and anxiety and/or depression . Re- sentative sample (n = 3928) from the general population, versely, male gender, younger age, higher socioeconomic from two municipalities in the southwest of Sweden. status, having emotional support, and suitable sleeping Every eighteenth man and woman aged 20–74 years was habits are associated with a better health status in those selected from the computerised Swedish national popu- with CWP . lation register . Of these, all participants aged 35–54 Research on pain and gender has increased markedly years in 1995 were included in the present study. since 1995 , but even so, little is known about the Baseline data at 1995 included 975 participants (men/ causes of the differences in prevalence and experiencing women n= 442/533) with a 12-year follow-up (n =734, of pain [20–22]. Many attempts have been made to find 328/406) and a 21-year follow-up (n = 622, 268/354) answers, but with contradictory results. Biological factors (Fig. 1). At the 21-year follow-up, the response rate was such as hormones and neurochemistry [20, 23], psycho- 64%. The non-responders (n=354)wereyounger (44.5± social [23, 24], and methodological bias  are all part 5.7 years) than the responders (45.3 ± 5.7 years, p =0.05), of the current explanations. One study showed that after there were no difference in gender (p =0.071), and a an educational programme including definitions and higher proportion of people with CWP were non- pathophysiology of chronic pain, the difference in preva- responders (p = 0.002). Why former participants decided lence between genders was no longer statistical signifi- not to respond in the follow-ups is not known. Data were cant . These results regarding unawareness are collected via a postal questionnaire over the 21 years, with supported by Järemo et al.  arguing a need for a better follow-ups in 1998, 2003, 2007, and 2016. The data from understanding of CWP since results showed that pa- 1998 and 2003 were not used in this study. In 2016, a tients who had constraining beliefs about their chronic web-based questionnaire was available, and two reminders pain also had a lower health status. were sent out on each occasion. The study followed the It is recognised that people with CWP have a substan- Strengthening the Reporting of Observational Studies in tially worse health status [6, 7, 9], but there have been Epidemiology (STROBE) guidelines . few studies on possible differences between men and women. Most studies have only examined chronic pain, Questionnaire and these results have been contradictory. For example, The questionnaire consisted of the standard version of one study found no gender differences of clinical relevance the Short-Form General Health Survey (SF-36)  and regarding health status , another study found that questions about socio-demographic, pain, and lifestyle men with chronic pain had a lower self-reported quality of factors . The Swedish validated standard version of life than women with chronic pain , and a third found the SF-36 and interpretation manual was used . The that such women reported having anxiety and depression questionnaire has 36 items, 35 of which are grouped in more often than their male counterparts . eight different health concepts: Physical Functioning There have not been any gender differences found re- (PF), Role function – Physical aspect (RP), Bodily Pain garding the impact of chronic pains on daily activities, (BP), General Health perception (GH), Vitality (VT), So- apart from the ability to perform daily chores where cial Functioning (SF), Role function – Emotion aspect men reported less of an effect . Furthermore, no gen- (RE), and Mental Health (MH). Each health concept has der differences have been found regarding how much a scoring from 0 to 100 where a higher score indicates a the participants were bothered by pain . Healthy better health status [30, 31]. Questions about pain used lifestyle-related behaviour could reduce the risk of devel- a pain mannequin with 18 predefined regions to localise oping chronic pain and improve health status when suf- pain regions and to determine whether the duration of fering from chronic pain , but little is known about pain was more than three months. Lifestyle factors mea- gender differences regarding the impact of CWP on sured were personal support, circle of friends, smoking, health status and health predictors in people with CWP. alcohol intake, physical activity, and sleeping habits . The aim was to study the impact of CWP on health The questions remained the same on each occasion, ex- status in women and men aged 35–54 years in a sample cept questions regarding alcohol intake and physical Sylwander et al. BMC Musculoskeletal Disorders (2020) 21:36 Page 3 of 11 Fig. 1 Flow-chart of participation in the study. M, men; W, women activity, which were updated in 2007―and physical ac- . It was approved by the Regional Ethical Review tivity once again in 2016 according to the standards of Board, Faculty of Medicine, University of Lund, Sweden the Swedish National Board of Health and Welfare based (Dnr LU 389–94; Dnr 2016/132). on Haskell et al. . Statistical analysis Definitions Descriptive statistics represented baseline variables in Chronic pain was defined as pain that persisted or re- 1995, including age, gender, education level, social sup- curred for more than 3 months . Furthermore, CWP port, circle of friends, smoking habits, alcohol intake, was defined according to the ACR 1990 criteria for physical activity, sleeping habits, the eight subscales of fibromyalgia, as pain lasting for a minimum of 3 months, SF-36, and the different pain groups NCP, CRP, and present on both sides of the body, below and above the CWP. To test differences between groups, the two-tailed waist, and in the axial skeleton . An introductory key independent-samples t-test was used for continuous var- question in the questionnaire “Have you experienced iables, and the χ2 test (chi-square test) was used for pro- pain lasting more than three months during the last 12 portions. Gender differences in transitions to and from months?” identified cases with chronic pain. The key two different pain groups (NCP/CRP and CWP) during question together with the pain mannequin was the the 12- and 21-year follow-up were analysed using logis- basis of the three pain categories used in this study: tic regression analysis, presented as odds ratios (ORs) CWP, chronic regional pain (CRP) if the criterion for and 95% confidence intervals (CIs) and controlled for CWP was not met, and no chronic pain (NCP). age. Differences in the impact of CWP on health status were measured using the SF-36 and analysed using the Ethics Swedish manual , and mean scores in the eight sub- Written informed consent was obtained from all partici- subscales of the SF-36 at baseline and at the follow-ups pants and the study adhered to the Helsinki Declaration were compared using two-tailed independent-samples t- Sylwander et al. BMC Musculoskeletal Disorders (2020) 21:36 Page 4 of 11 test. Gender differences were analysed within and be- CWP (OR 1.22; CI 0.42–357; p = 0.717). At the 21-year tween the NCP/CRP and CWP groups. follow-up, no significant gender difference was found re- Logistic regression analyses were used to study pos- garding the development of CWP (OR 1.43; CI 0.88– sible predictors of better health status, as measured by 2.35; p = 0.151) but men recovered from CWP to a the SF-36 in those with CWP at baseline. The dependent greater extent than women (OR 3.79; CI 1.00–14.33; p = variables were three subscales from the SF-36―PF, VT, 0.050). and MH—which were dichotomised on the best tertiary score versus all others. Independent possible predictors Impact of CWP on health status were lifestyle factors (personal support, circle of friends, People with CWP reported having a lower health status smoking, alcohol intake, physical activity, and sleeping in all eight SF-36 sub-subscales compared to the NCP/ habits) controlled for age and gender. Due to the small CRP group (p < 0.001) (Fig. 3). Within each of the two number of the outcome CWP, controlling for more con- pain groups, there were no gender differences regarding founders by multivariable-adjusted regression analysis health status at baseline, nor at the 21-year follow-up. was not possible. The three categories were chosen as At the 12-year follow-up, there were statistically signifi- primary outcomes for being of most relevance and rep- cant gender differences in the CWP group regarding BP resentative of different aspects of health status . The (mean difference δ = 6.54; p = 0.049), GH (δ = 10.26; p = predictors are presented with their respective ORs and 0.015), VT (δ = 11.20; p = 0.008), and SF (δ = 10.0; p = 95% CIs. Results were considered to be statistically sig- 0.036), with women reporting worse scores. nificant if p < 0.05. The sample size used would permit detection of differences of ten points in the SF-36 with a Predictors of health power of at least 80% in the cross-sectional analysis, Altogether, 83 subjects (3 missing due to incomplete based on the minimal clinically relevant differences, cal- questionnaire) with CWP at baseline answered the ques- culated by multiplying the standard deviation at baseline tionnaire at the 12-year follow-up and were included in by 0.5 . Missing data has not been replaced or ana- the logistic regression analysis. For the 21-year follow- lysed further. The analyses were performed using the up, 63 subjects were included (5 missing due to incom- IBM SPSS 25 statistical package for Macintosh (released plete questionnaire). All predictors were controlled for 2017; IBM Corp., Armonk, NY, USA). age and gender, except for age (which was controlled for gender) and gender (which was controlled for age). Male Results gender was predictive of better health status regarding Altogether, 975 subjects were included in the study and VT (OR 3.03; CI 1.02–9.00) at the 12-year follow-up and of these, 954 subjects fully responded to the pain ques- almost significant for PF (OR 2.91; CI 0.98–8.26) but not tions (21 missing) and were categorised into two groups for MH. Being a previous smoker was associated with depending on pain status at baseline: NCP/CRP (n = better PF (OR 5.21; CI 1.12–23.03) and VT (OR 4.38; CI 831) and CWP (n = 123). In the follow-up 12 years later 1.04–18.44) compared to being a current smoker. (2007), 713 subjects fully responded (21 missing): NCP/ Personal support was associated with better VT (OR CRP (n = 573), and CWP (n = 140). In the 21-year 9.27; CI 1.02–54.47), and having no sleeping problems follow-up in 2016, 621 subjects participated: NCP/CRP was predictive of having a better health status regarding (n = 507), and CWP (n = 114). In the whole sample, there VT (OR 4.76; CI 1.38–16.46) and MH (OR 3.48; CI were significant gender differences in the baseline char- 1.07–11.34) (Table 2). acteristics regarding education level, pain group, alcohol For the 21-year follow-up, male gender was predictive intake, and physical activity, and close to significant dif- of better health status for PF (OR 6.76; CI 1.82–25.13) ferences regarding sleeping problems. These differences and VT (OR 5.71; CI 1.53–21.34). Being a previous were not seen in the CWP group, but there was a signifi- smoker was found to be a predictor of better PF (OR cant difference in having a circle of friends, which was 7.83; CI 1.05–58.46) and also weekly intake of alcohol more common in women. The baseline characteristics (OR 4.94; CI 1.05–23.33) in the 21-year follow-up. Hav- are presented in Table 1. ing no sleeping problems was found to be a predictor of At baseline, more women than men reported having better MH (OR 4.45; CI 1.05–18.80) (Table 3). CWP and a higher proportion of women than men remained in the CWP group at the 12- and 21-year Discussion follow-up (Fig. 2). Of those with NCP/CRP at baseline, a The aim of this study was to investigate the impact of higher proportion of women than men developed CWP CWP on health status in women and men, and to inves- at the 12-year follow-up (OR 2.04; CI 1.27–3.26; p = tigate lifestyle predictors of better health status in those 0.003). In women and men with CWP at baseline, no with CWP at baseline, with a 12- and 21-year follow-up. significant difference was found regarding recovery from The results showed a more than double the prevalence Sylwander et al. BMC Musculoskeletal Disorders (2020) 21:36 Page 5 of 11 Table 1 Descriptive statistics for the whole sample and the CWP group at baseline in 1995 All Men Women p-value gender All CWP Men Women p-value gender n = 975 n = 442 n = 533 difference n = 123 n =33 n =90 difference Age, years (1995) 0.981 0.602 Mean (sd) 44 (6) 45 (6) 48 (6) 47 (5) 48 (5) 46 (6) Education , n (%) 0.010 0.894 No more than 2 years 548 (56.4) 246 (55.9) 302 (56.9) 87 (71.3) 23 (69.7) 64 (71.9) > 2 years 121 (12.5) 71 (16.1) 50 (9.4) 10 (8.2) 3 (9.1) 7 (7.9) University 222 (22.9) 91 (20.7) 131 (24.7) 15 (12.3) 5 (15.2) 10 (11.2) Other 80 (8.2) 31 (7.3) 48 (9.0) 10 (8.2) 2 (6.1) 8 (9.0) Personal support, n (%) 0.773 0.287 Yes 806 (82.9) 364 (82.5) 442 (83.2) 94 (76.4) 23 (69.7) 71 (78.9) No 166 (17.1) 77 (17.5) 89 (16.8) 29 (23.6) 10 (30.3) 19 (21.1) Circle of friends, n (%) 0.380 0.026 Yes 615 (63.5) 273 (62) 342 (64.8) 64 (52.9) 12 (36.4) 52 (59.1) No 353 (36.5) 167 (38) 186 (35.2) 57 (47.1) 21 (63.6) 36 (40.9) Pain group, n (%) 0.000 NCP 593 (62.2) 289 (67.1) 304 (58.1) CRP 238 (24.9) 109 (25.3) 129 (24.7) CWP 123 (12.9) 33 (7.7) 90 (17.2) Smoking habits, n (%) 0.325 0.918 No, never smoked 452 (46.5) 194 (44) 258 (48.6) 55 (44.7) 15 (45.5) 40 (44.4) No, have stopped 281 (28.9) 136 (30.8) 145 (27.3) 33 (26.8) 8 (24.2) 25 (27.8) Yes, smoker 239 (24.6) 111 (25.2) 128 (24.1) 35 (28.5) 10 (30.3) 25 (27.8) Alcohol intake, n (%) 0.000 0.125 Never/almost never 313 (32.2) 96 (21.9) 217 (40.8) 70 (56.9) 17 (51.5) 53 (58.9) Every month 407 (41.9) 198 (45.1) 209 (39.3) 36 (29.3) 8 (24.2) 28 (31.1) Every week 246 (25.3) 143 (32.6) 103 (19.4) 17 (13.8) 8 (24.2) 9 (10.0) > 4 times a week 5 (0.5) 2 (0.5) 3 (0.6) 0 (0) 0 (0) 0 (0) Physical activity , n (%) 0.002 0.582 Never 463 (28) 237 (54.2) 226 (42.9) 54 (43.9) 17 (51.5) 37 (41.1) Moderate 337 (35) 134 (30.7) 203 (38.5) 42 (34.1) 10 (30.3) 32 (35.6) Active 164 (17) 66 (15.1) 98 (18.6) 27 (22) 6 (18.2) 21 (23.3) Sleeping problems , n (%) 0.053 0.731 No 495 (52.9) 240 (56.3) 255 (50) 20 (16.8) 6 (18.8) 14 (16.1) Yes 441 (47.1) 186 (43.7) 255 (50) 99 (83.2) 26 (81.3) 73 (83.9) Highest finished education: No more than 2 years = after elementary school; > 2 years = more than 2 years after elementary school; University = education at university level; Other = all others Never = < 30 min/day; Moderate =1–2 times/week or 30–90 min/week; Active = > 2 times/week or > 120 min/week No = no or minor sleeping problems; Yes = moderate to severe sleeping problems of CWP in women than in men, a result that is in line shown contradictory results over a shorter period of with previous research [11, 12]. time (3 and 7 years) where women with NCP or CRP did During the 12-year follow-up, women developed CWP not develop CWP or persistent CWP more than men to a greater extent than men, but no gender difference [36, 37]. However, an 11-year follow-up found that men was found in recovery from CWP. During the 21-year had half of the odds of having persistent CWP compared follow-up, the results were the opposite and women did to women . This could indicate that men have CWP not develop CWP more than men but recovered to a for a shorter time than 21 years, and that they recover to lesser extent from CWP than men. Previous studies have a greater extent than women some time after 7–12 years Sylwander et al. BMC Musculoskeletal Disorders (2020) 21:36 Page 6 of 11 Fig. 2 Transitions between the two different pain groups during the 12- and 21-year follow-up, n (%); W, woman; M, man of persistent CWP. Why women would have more pro- reported having more pain locations than men (CWP longed of CWP is not known, but this has been found in was more frequent in women and CRP in men), the other studies [16, 20, 37]. women reported being more satisfied with their social The present study showed that both women and life and with life in general than men, and men had men with CWP had reduced health status compared lower self-reported mental health than women . to the NCP/CRP group, which corroborates the re- Gender differences in health status when studying sultsofpreviousstudies [7, 9, 34, 38]. There were no chronic pain vary [4, 25, 26], highlighting the import- gender differences in health status at baseline or at ance to separate different types of pain when studying the 21-year follow-up in those with CWP, indicating health status and gender differences. The higher that menand womenwithCWP have thesamewors- prevalence of CWP in women could be one explan- ened health status. During the 12-year follow-up, ation as to why some studies have reported a worse there were some gender differences in health status, health status for women than for men, and that men however, only the vitality (VT) result was clinically handle pain better when studying only chronic pain relevant. This could be explained by the fact that the and not taking the presence of CWP into account. individuals moved between the different pain groups In the present study, male gender was found the be a in the different time points. predictor of better VT in both the 12-year and the 21-year Most previous studies have examined the impact follow-up, and a predictor of better physical function (PF) that chronic pain has on health status, and not specif- in the 21-year follow-up. Male gender has been reported ically the condition CWP when comparing the gen- to be a predictor of health in previous studies [6, 16]. Why ders [3, 6, 28, 36, 39]. This study is one of the first male gender would be such a predictor is not fully known, to focus on gender differences regarding the effect but explanations put forward have been, for example, hor- that CWP has on health status. However, one previ- monal factors —and that women tend to be more will- ous study found that despite the fact that women ing to report pain than men . Sylwander et al. BMC Musculoskeletal Disorders (2020) 21:36 Page 7 of 11 Fig. 3 Results from the cross-sectional analysis of health status in the NCP/CRP and CWP groups, men and women separate, presenting the eight different SF-36 sub-subscales at baseline and at the 12- and 21-year follow-up. The SF-36 sub-scales are: physical function (PF); role function – physical aspect (RP); bodily pain (BP); general health perception (GH); vitality (VT), social functioning (SF); role function – emotional aspect (RE), and mental health (MH) Having personal support was a decisive health factor with a negative interference with life enjoyment . regarding VT in the 12-year follow-up. No previous stud- There is a dose-response relationship between smoking ies have investigated the association between personal on the one hand and pain intensity and duration on the support and health status in the long-term when living other when having chronic pain , and reversibility of with CWP. However, another study from the EPIPAIN co- pain intensity in the long-term is presumed when stop- hort with the larger sample found a similar result with an ping smoking [15, 41]. Since giving up smoking im- eight-year follow-up, where personal support was associ- proves the physical health , it could explain the ated with increased health status in VT and mental health result of better PF in former smokers, and would also (MH) in those with chronic pain at baseline . The lack explain why non-smokers do not show any change in of research on the association between social support and PF. However, the study has not taken into consideration health status together with the results of the present study when the participants stopped smoking or numbers of indicates that more research will be required to under- years smoking, so no further conclusions can be drawn. stand this possibly beneficial association. Consumption of alcohol every week was found to be a During the 12-year follow-up, being a former smoker health predictor regarding PF in the 21-year follow-up. was a predictor of better health regarding PF and VT, Previous research has shown that low to moderate alco- compared to being a current smoker. In the 21-year hol intake is associated with a better quality of life in follow-up, the prediction of better health was only people with fibromyalgia . Another study found that present for PF. It has been found that smokers report consuming alcohol more than eight times a month had a having higher pain intensity, which is in turn associated protective factor against the persistence of CWP . Sylwander et al. BMC Musculoskeletal Disorders (2020) 21:36 Page 8 of 11 Table 2 Health predictors at the 12-year follow-up for people with CWP at baseline in 1995, n =83 Predictors Physical Functioning (PF) Vitality (VT) Mental Health (MH) OR (95% CI) p OR (95% CI) p OR (95% CI) p Age 0.96 (0.88–1.05) 0.415 0.93 (0.86–1.02) 0.114 1.00 (0.91–1.09) 0.902 Gender Woman 1 1 1 Man 2.91 (0.98–8.62) 0.053 3.03 (1.02–9.00) 0.046 1.67 (0.56–4.98) 0.360 Personal support No 1 1 1 Yes 1.98 (0.52–7.51) 0.317 9.27 (1.58–54.47) 0.014 2.48 (0.61–10.07) 0.204 Circle of friends No 1 1 1 Yes 2.21 (0.76–6.43) 0.148 0.28 (0.64–4.89) 0.276 1.09 (0.40–2.95) 0.862 Smoking Yes 1 1 1 No, never 1.44 (0.38–5.50) 0.598 1.62 (0.46–5.72) 0.456 1.82 (0.50–6.63) 0.363 No, have stopped 5.21 (1.12–23.03) 0.030 4.38 (1.04–18.44) 0.044 2.36 (0.56–10.05) 0.244 Alcohol intake Never/rarely 1 1 1 Every month 1.37 (0.47–4.01) 0.569 1.26 (0.44–3.59) 0.666 1.25 (0.44–3.57) 0.675 Every week 2.01 (0.53–7.69) 0.309 2.17 (0.57–8.28) 0.255 1.02 (0.25–4.09) 0.982 > 4 times/week –– – Physical activity Never 1 1 1 Moderate 0.57 (0.19–1.72) 0.316 0.87 (0.30–2.56) 0.802 0.65 (0.21–2.02) 0.453 Active 1.27 (0.35–4.62) 0.716 1.67 (0.46–6.03) 0.434 2.49 (0.70–8.83) 0.158 Sleeping problems Yes 1 1 1 No 2.22 (0.68–7.28) 0.187 4.76 (1.38–16.46) 0.014 3.48 (1.07–11.34) 0.038 There was no-one with CWP in this group and “every week” became the reference Never = < 30 min/day; Moderate =1–2 times/week or 30–90 min/week; Active = > 2 times/week or > 120 min/week Yes = moderate to severe sleeping problems; No = no or minor sleeping problems. Controlled for age and gender, except for age (which was controlled for gender) and gender (which was controlled for age) Moreover, moderate intake of alcohol has been shown that sleep is a critical factor for improvement of mental to reduce pain severity, and it has been suggested that health when living with long-term CWP. Improving re- the pain-relieving effects of alcohol improve the physical storative sleep is associated with the resolution of CWP function when having chronic pain , which could be where less pain is reported , which in turn gives bet- one explanation for the current study results. Further- ter health . In previous studies, sleeping problems more, the association found could also be due to positive have also been reported as a predictor of the onset of social factors linked to alcohol consumption  and/or CWP  and the persistence of CWP . It is there- that people with illnesses refrain from drinking alcohol fore a challenge to find out whether it is the pain that . However, the quantity consumed was not taken causes sleeping problems and therefore worse health, or into consideration in the present study, and therefore no whether the sleeping problems cause the pain and there- further conclusions can be made. fore worse health. Having no sleeping problems was found to be a pre- Two major strengths of the present study were that dictor of better health regarding VT and MH in the 12- the study was based on a larger cohort and therefore year follow-up, compared to having sleeping problems. had a large sample size with a long-term follow-up of In the 21-year follow-up, having no sleeping problems 21-years. The age range was chosen because it repre- was associated with better MH. These results suggest sents mid-life, and is the time in life before and during Sylwander et al. BMC Musculoskeletal Disorders (2020) 21:36 Page 9 of 11 Table 3 Health predictors at the 21-year follow-up for people with CWP at baseline in 1995, n =63 Predictors Physical Functioning (PF) Vitality (VT) Mental Health (MH) OR (95% CI) p OR (95% CI) p OR (95% CI) p Age 0.93 (0.84–1.04) 0.201 1.05 (0.95–1.17) 0.310 1.06 (0.96–1.17) 0.284 Gender Woman 1 1 1 Man 6.76 (1.82–25.13) 0.004 5.71 (1.53–21.34) 0.010 3.35 (0.92–11.54) 0.056 Personal support No 1 1 1 Yes 1.19 (0.26–5.41) 0.825 2.01 (0.47–9.26) 0.333 2.40 (0.52–11.00) 0.260 Circle of friends No 1 1 1 Yes 0.47 (0.14–1.56) 0.214 1.41 (0.44–4.51) 0.562 0.89 (0.29–2.73) 0.839 Smoking Yes 1 1 1 No, never 4.23 (0.65–27.56) 0.131 0.67 (0.15–3.02) 0.602 0.99 (0.22–4.39) 0.990 No, have stopped 7.83 (1.05–58.46) 0.045 1.50 (0.31–7.38) 0.616 1.32 (0.27–6.52) 0.736 Alcohol intake Never/rarely 1 1 1 Every month 2.55 (0.62–10.45) 0.193 1.40 (0.40–4.93) 0.603 0.55 (0.15–2.03) 0.367 Every week 4.94 (1.05–23.33) 0.044 1.39 (0.34–5.79) 0.647 0.88 (0.22–3.59) 0.862 > 4 times/week –– – Physical activity Never 1 1 1 Moderate 0.77 (0.20–2.97) 0.698 1.02 (0.27–3.82) 0.977 2.96 (0.70–12.48) 0.139 Active 0.35 (0.07–1.82) 0.212 0.87 (0.21–3.60) 0.848 3.05 (0.66–14.06) 0.154 Sleeping problems Yes 1 1 1 No 2.01 (0.47–8.63) 0.346 3.45 (0.80–14.85) 0.096 4.45 (1.05–18.80) 0.042 There was no-one with CWP in this group and “every week” became the reference Never = < 30 min/day; Moderate =1–2 times/week or 30–90 min/week; Active = > 2 times/week or > 120 min/week Yes = moderate to severe sleeping problems; No = no or minor sleeping problems. Controlled for age and gender, except for age (which was controlled for gender) and gender (which was controlled for age) which chronic pain becomes more prevalent (at 40–50 responders had a higher proportion of people with CWP years) [8, 12, 21]. This was therefore considered a which is considered a limitation and could affect the strength. The study used an established questionnaire to generalisability. However, with the large sample size and measure health status [30, 31], and the other questions no or minimal differences in non-responders regarding had been tested and resulted in good content, criterion, gender and age it is still considered possible to general- and face validity as well as test-retest reliability . The ise the results to men and women with CWP in mid-life. study only examined pain according to pain location and duration, which can be considered to be both a strength Conclusions (since CWP seems to be an important subgroup of The study showed that more women than men had per- chronic pain) and a limitation (since pain intensity was sistent CWP in a 12- and 21-year time frame, but when not part of the analysis). Another limitation could be suffering from CWP, health status was equally as bad in that it due to sample size was not possible to control for women and men. This suggests that even though men all possible confounding factors. The long follow-up have a lower prevalence of CWP, the condition should time, although being a strength, might also decrease the be regarded as having the same impact on men and causality between baseline predictors and outcome. women in health care. 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BMC Musculoskeletal Disorders – Springer Journals
Published: Jan 16, 2020
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