Study objective-To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. Design-A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. Setting-General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. Participants-A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). Main results-Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p<0.05) consulted a physician and 7.2% (compared with 1.2%, p<0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. Chronic pain (duration more than three months) is a common problem among people in diVerent societies.
Conclusions-The
The occurrence of osteoarthritis (OA) as an indicator of physical activity was explored in two Middle Neolithic samples from Gotland (c. 3400-2300 BC) in the Baltic Sea: Ajvide (n ¼ 46) and Vä sterbjers (n ¼ 32). The difficulty in diagnosing OA is recognised and only eburnation was used as a definite criterion for OA. The relationship between eburnation lesions and Musculoskeletal Stress Markers (MSM) was investigated particularly in relation to age, but also with reference to patterns of sex, body side and site. Results show that increasing prevalence of eburnation as well as increased MSM scores was highly correlated with age. In the combined sample, females exhibited higher frequencies of eburnation, while total MSM mean scores were higher in males. Significantly higher MSM mean scores were also found in those individuals with eburnation lesions. Vä sterbjers exhibited higher frequencies of eburnation as well as higher mean MSM scores, which in part may be explained by the difference in age distribution at the two sites. However, the differences in both eburnation and MSM patterns between the sexes, and between age groups as well as between the two sites indicate that other factors also have to be considered. These may include genetic predisposition and possibly activity, although, a direct link (other than age) between eburnation and MSM was difficult to discern.
The relation between reported chronic pain and clinical findings was studied by comparing survey data six months before and eighteen months after a clinical examination. Studied individuals (n = 165) were randomly selected from subsamples of an initial survey (n = 1806) to a general population. Among individuals reporting chronic pain 85% were assessed to have chronic pain at the examination. Diagnoses were found in 22% of examined pain individuals. Myofascial pain syndrome and myalgia were the most common findings. Compared with located neck-shoulder pain, widespread pain had a greater impact on the individual, a worse prognosis regarding pain duration and working capacity, and revealed a raised serum urate level of unclear significance. Although no specific cause of pain is found in individuals with widespread pain it is important to identify and treat this group due to the great effects on functional capacity and the worse prognosis.
REFERENCES1 De Clerck LS, Degryse HR, Wouters E, Van Offel JF, De Schepper AM, Martin JJ, et al. Magnetic resonance imaging in the evaluation of patients with eosinophilic fasciitis. J Rheumatol 1989;16:1270-3. 2 Liou CH, Huang GS, Taylor JAM, Juan CJ, Gao HW, Chen CY. Eosinophilic fasciitis in a military recruit: MRI evaluation with clinical correlation. Skeletal Radiol 2003;32:52-7.
Autonomic nerve function was evaluated by deep breathing and tilt table tests in 17 patients with rheumatoid arthritis (RA) and in 24 healthy control subjects. The results showed that all RA patients had increased heart rates at rest, irrespective of the severity of the disease. Patients with severe RA had increased systolic and diastolic blood pressures before and after tilting. Pronounced abnormalities in the immediate heart rate reaction to tilting indicating autonomic neuropathy (AN) were also demonstrated in patients with severe RA. The abnormal immediate reaction to tilting was mainly the result of vagal neuropathy. From the present study it is evident that severe RA may be accompanied by AN and the consequences need to be elucidated.
Background: Determinants of ill-health have been studied far more than determinants of good and improving health. Health promotion measures are important even among individuals with chronic diseases. The aim of this study was to find predictors of positive subjective health among disability pensioners (DPs) with musculoskeletal disorders.
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