Chronic pain, cardiovascular health and related medication use in ageing African Americans with osteoarthritis

Abstract

Aim and objectives To describe the (a) prevalence and perceptions of cardiovascular disease and related health conditions in African Americans with osteoarthritis pain, (b) their knowledge of cardiovascular safety of commonly prescribed analgesics for osteoarthritis and (c) frequency of high‐risk analgesic use. Background African Americans have more disabling osteoarthritis pain and an excessive burden of cardiovascular disease than any other US racial group. However, minimal research has investigated the relationship between chronic pain and cardiovascular disease and subsequent medication knowledge and use in African Americans. Consolidated Criteria for Reporting Qualitative and Srengthening the Reporting of Observational studies in Epidemiology checklists were followed. Design A descriptive, secondary mixed‐methods analysis. Methods A convenience sample of 110 African American adults (50–94 years and older) completed surveys and individual qualitative interviews. Data were analysed using descriptive statistics, chi‐square or Fisher's exact test, t test, Mann–Whitney U and a qualitative content analysis. Results Hypertension was the most common cardiovascular condition reported, and African Americans with hypertension reported greater pain than those without. The survey questions revealed that most participants did not possess accurate knowledge about the appropriateness of analgesics in heart failure and other cardiovascular‐related diseases; however, during the interviews, some did acknowledge a general understanding of the negative effects of some medications. Still, many older adults were taking nonsteroidal anti‐inflammatory drugs despite having hypertension. Conclusions There was evidence of multimorbidity in our sample; based on our data, chronic osteoarthritis pain and hypertension are two highly comorbid conditions, suggesting a possible syndemic. More disparate is the lack of knowledge that African Americans possess as it relates to safe use of analgesic medications when cardiovascular disease is present. Relevance to clinical practice Chronic pain and cardiovascular‐related diseases are common and often co‐occur and should be evaluated in all older adults, particularly African Americans. Both issues are important to manage, including the safe and appropriate use of medications, to prevent adverse effects.

A Mixed-Methods Systematic Review on Syndemics in Rheumatology

“…The prevalence of hypertension was 80.9%, consistent with the high burden of CVDs in the African American population in general. The average pain score of patients with hypertension was not significantly higher than those without hypertension or the overall sample, 13 and we identified the lack of reliable measurements of exposure and its limited statistical approach. The qualitative section of this study was exploratory, using semistructured interviews to determine the perception of CVDs and associated health conditions by African American participants with pain caused by osteoarthritis.…”

“…The fourth study was an MMS of the convergent parallel type, 13 which means that the quantitative and qualitative strands of the research are performed independently but simultaneously, and their results are brought together in the overall interpretation. 5,14 The objective of the quantitative section was to evaluate the prevalence and perceptions of cardiovascular diseases (CVDs) and related health conditions in a US African American population with osteoarthritis pain phenotype.…”

“…The MMS by Booker and Content 13 could not document syndemics due to the deficient execution of the methodological design, the lack of sociodemographic data in the quantitative part, and solely conducting interviews in the qualitative component, which produced only descriptive data and analysis of comorbidities. Syndemics cannot be demonstrated by descriptive analyses alone; the interaction of different factors must be considered.…”

Muscarinic receptor regulation of chronic pain-induced atrial fibrillation

“…Multiple pieces of evidence indicate that chronic pain is associated with abnormal psychological stresses (9)(10)(11), and patients with chronic pain presented ECG changes including AF (12). In fact, acute or chronic pain is associated with an increased risk of cardiovascular disease (13)(14)(15). A systematic review demonstrated that chronic pain was significantly associated with mortality caused by cardiovascular disorders and implicated a possible dose-response relationship (16).…”

Opportunities and challenges of pain-related myocardial ischemia-reperfusion injury

“…The largescale genome-wide association study (GWAS) of CAD (coronary artery disease) and migraine pointed out the common susceptibility gene locus PHACTR1 (encoding phosphatase and actin regulator 1 protein) of the common mechanism of the two diseases (Winsvold et al, 2017a). Chronic pain and CVD often occur simultaneously, but the mechanisms of comorbidities remain unclear (Birnbaum et al, 1997;Winsvold et al, 2015b;Winsvold et al, 2017b;Tesarz et al, 2019;Booker and Content, 2020). The relationship between pain and CVD is not well defined.…”