Muthuri Stella G, Kuh Diana, Bendayan Rebecca, Macfarlane Gary J, Cooper Rachel
MRC Unit for Lifelong Health and Ageing, UCL, London, United Kingdom.
Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.
Pain. 2016 Oct;157(10):2382-2389. doi: 10.1097/j.pain.0000000000000663.
This study aimed to examine the associations between serious illness in earlier life and risk of pain in old age using data from a large nationally representative British birth cohort, the Medical Research Council (MRC) National Survey of Health and Development (NSHD). Serious illness was defined as any experience of illness before age 25 requiring hospital admission of ≥28 days. Pain was self-reported at age 68, with chronic widespread pain (CWP) defined according to American College of Rheumatology criteria. Multinomial logistic regression was used to test associations of serious illness in early life with CWP, chronic regional pain (CRP), and other pain, with no pain as the referent category. Adjustment was made for sex, socioeconomic position, adult health status, health behaviours, and psychosocial factors. Of 2401 NSHD participants with complete data, 10.5% reported CWP (13.2% of women and 7.7% of men), 30.2% reported CRP, and 14.8% other pain. Compared with those with no history of serious illness, those who experienced serious illness in early life had a higher likelihood of CWP (relative risk ratio [RRR] = 1.62 [95% CI: 1.21-2.17]) and of CRP (RRR = 1.25 [95% CI: 1.01-1.54]) after adjusting for sex. In fully adjusted models, serious illness in early life remained associated with CWP (RRR = 1.43 [95% CI: 1.05-1.95]), but associations with CRP were attenuated (RRR = 1.19 [95% CI: 0.96-1.48]). There were no associations with other pain. These findings suggest that those who have experienced serious illness in earlier life may require more support than others to minimise their risk of CWP in later life.
本研究旨在利用来自具有全国代表性的大型英国出生队列——医学研究理事会(MRC)全国健康与发展调查(NSHD)的数据,探讨早年患重病与老年疼痛风险之间的关联。重病定义为25岁之前任何需要住院≥28天的疾病经历。在68岁时进行疼痛的自我报告,慢性广泛性疼痛(CWP)根据美国风湿病学会标准定义。采用多项逻辑回归分析早年患重病与CWP、慢性局部疼痛(CRP)及其他疼痛之间的关联,以无疼痛作为参照类别。对性别、社会经济地位、成人健康状况、健康行为和心理社会因素进行了调整。在2401名有完整数据的NSHD参与者中,10.5%报告有CWP(女性为13.2%,男性为7.7%),30.2%报告有CRP,14.8%报告有其他疼痛。与无重病史者相比,早年患重病者在调整性别后发生CWP的可能性更高(相对风险比[RRR]=1.62[95%置信区间:1.21 - 2.17]),发生CRP的可能性也更高(RRR = 1.25[95%置信区间:1.01 - 1.54])。在完全调整模型中,早年患重病仍与CWP相关(RRR = 1.43[95%置信区间:1.05 - 1.95]),但与CRP的关联减弱(RRR = 1.19[95%置信区间:0.96 - 1.48])。与其他疼痛无关联。这些发现表明,早年经历过重病的人可能比其他人需要更多支持,以将其晚年发生CWP的风险降至最低。