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Title: Chronic pain in adults : is the relationship between pain processing and number of pain sites or presence of chronic widespread pain moderated by age or sex?
Author: Brown, Deborah
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2013
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Background: Chronic pain is pain which has lasted for more than 3 months and is reported by 40 to 50% of adults in developed countries. The prevalence of chronic pain is consistently higher in women than in men. Chronic pain is more often reported by older adults than younger adults. As well as duration, pain can also be described in terms of its “widespreadness” by counting the number of body areas experiencing pain, or by the source of the pain e.g. musculoskeletal. Many social, psychological, physiological and behavioural factors have been found to be associated with pain. Altered sensitivity to stimuli may indicate aberrant pain processing mechanisms. Quantitative sensory testing (QST) evaluates responses to experimental, painful and non-painful stimuli. Although originally used in neurological conditions, QST data for people with musculoskeletal pain show differences from healthy controls. Aim: The aim of this study was to determine the relationship between sensitivity to stimuli (measured by QST), and both the number of body areas with pain and the prevalence of chronic widespread pain, and how these relationships vary with age and sex. Methods: A postal questionnaire which included questions about pain location and duration of pain, as well as known risk factors for pain, was returned by 2623 participants aged 34-101 years. A sub-group of 290 participants aged 34-97 years were selected on the basis of their responses to the pain questions and undertook a physical assessment which included QST. Regression models were used to quantify the relationships between QST factors and pain. Pain was classified as a continuum of “widespreadness” (0-29) and as “no pain”, “chronic widespread pain (CWP)” and “some pain” (i.e. pain other than CWP). Regression models with interaction terms were used to investigate whether these relationships varied between older (aged over 65 years) and younger (aged 65 years and younger) people, and between men and women. Results: There were very few differences in QST variables (except tender point count) across the two pain classifications, however, differences in several QST variables were found between the age and sex groups (Chapter 6). Three of the QST measures, tender point count, cool detection threshold at the foot and thermal sensory limen at the foot, were statistically significantly related to number of painful areas, and tender point count and cool detection threshold at the foot were also significantly different among participants with “no pain” and those with CWP (Chapter 7). None of these relationships were significantly moderated by age or sex (Chapter 8). Sleep quality and beliefs about pain duration were found to be statistically significantly related to number of pain areas and to the presence of CWP in all the analyses (Chapter 7). Conclusion: The findings from this study indicate that some QST variables are related to pain, but none of the relationships are moderated by age or sex. The importance of sleep quality and pain beliefs as risk factors for pain has been further confirmed. Further research may allow treatments for pain to be tailored to the individual in the light of these facts.
Supervisor: Mcbeth, John; Pendleton, Neil; Cordingley, Lis Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Chronic pain ; Quantitative sensory testing ; Ageing ; Sex