Musculoskeletal Pain as a Marker of Health Quality. Findings from the Epidemiological Sleep Study among the Adult Population of São Paulo City

Suely Roizenblatt, Altay L Souza, Luciana Palombini, Luciana M Godoy, Sergio Tufik, Lia Rita A Bittencourt, Suely Roizenblatt, Altay L Souza, Luciana Palombini, Luciana M Godoy, Sergio Tufik, Lia Rita A Bittencourt

Abstract

Background: We are witnessing the growth of urban populations, particularly in the developing world. São Paulo, the largest city in South America, continues to grow, and this growth is dramatically effecting the environment and human health. The aim of this study was to estimate the point prevalence of chronic pain in São Paulo city dwellers and to explore the influence of aspects related to urbanicity.

Methods: A two-stage cluster randomized sample included 1100 individuals of the city of Sao Paulo, representing the population proportionally in terms of gender, age and social classes in 2007. For this observational cross-sectional study, the household sample was interviewed using validated questionnaires for sociodemographic aspects, the Beck inventories for anxiety and depression, the WHOQoL-REF for quality of life, the Chalder Fatigue Scale. Musculoskeletal pain was defined as diffuse pain or pain located in the back, joints or limbs. Data regarding sleep complaints and polysomnography were obtained from the Epidemiologic Sleep Study conducted in São Paulo city in 2007.

Results: The prevalence estimate of chronic musculoskeletal pain was approximately 27%, with a female/male ratio of approximately 2.6/1. The predictors were being in the age-range of 30-39 years, low socioeconomic and schooling levels, obesity, sedentarism, fatigue, non-restorative sleep, daytime sleepiness, poor sleep quality, poor life quality, anxiety and depression symptoms. Psychological wellbeing was the main discriminator between responders with chronic musculoskeletal pain and the controls, followed by depression for the participants with poor psychological wellbeing, and fatigue, for the remaining ones. Insomnia syndrome was the third-level discriminator for those with fatigue, whereas sleep quality for those without fatigue.

Conclusions: Musculoskeletal pain was frequently reported by São Paulo city dwellers and its correlates with psychological and sleep aspects are suggestive of a response to urbanicity.

Trial registration: ClinicalTrials.gov NCT00596713.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Discriminators between responders with musculoskeletal…
Fig 1. Discriminators between responders with musculoskeletal pain (MP group) and controls. Percentage of pain individuals in each node of CHAID Tree Analysis.

References

    1. Andrade LH, Wang YP, Andreoni S, Silveira CM, Alexandrino-Silva C, Siu ER, et al. Mental disorders in megacities: findings from the Sao Paulo megacity mental health survey, Brazil. PLoS One. 2012;7(2):e31879 10.1371/journal.pone.0031879
    1. Santos-Silva R, Bittencourt LR, Pires ML, de Mello MT, Taddei JA, Benedito-Silva AA, et al. Increasing trends of sleep complaints in the city of Sao Paulo, Brazil. Sleep Med. 2010;11(6):520–4. 10.1016/j.sleep.2009.12.011 .
    1. Santos-Silva R, Castro LS, Taddei JA, Tufik S, Bittencourt LR. Sleep disorders and demand for medical services: evidence from a population-based longitudinal study. PLoS One. 2012;7(2):e30085 10.1371/journal.pone.0030085
    1. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med. 2010;11(5):441–6. 10.1016/j.sleep.2009.10.005 .
    1. Castro LS, Poyares D, Leger D, Bittencourt L, Tufik S. Objective prevalence of insomnia in the Sao Paulo, Brazil epidemiologic sleep study. Ann Neurol. 2013;74(4):537–46. 10.1002/ana.23945 .
    1. Cintra F, Bittencourt LR, Santos-Silva R, Andersen M, de Paola A, Poyares D, et al. The association between the Framingham risk score and sleep: a Sao Paulo epidemiological sleep study. Sleep Med. 2012;13(6):577–82. 10.1016/j.sleep.2011.12.016 .
    1. Moraes W, Poyares D, Zalcman I, de Mello MT, Bittencourt LR, Santos-Silva R, et al. Association between body mass index and sleep duration assessed by objective methods in a representative sample of the adult population. Sleep Med. 2013;14(4):312–8. 10.1016/j.sleep.2012.11.010 .
    1. Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study. Eur J Pain. 2010;14(4):380–6. 10.1016/j.ejpain.2009.07.006 .
    1. Dominick CH, Blyth FM, Nicholas MK. Unpacking the burden: understanding the relationships between chronic pain and comorbidity in the general population. Pain. 2012;153(2):293–304. 10.1016/j.pain.2011.09.018 .
    1. Naughton F, Ashworth P, Skevington SM. Does sleep quality predict pain-related disability in chronic pain patients? The mediating roles of depression and pain severity. Pain. 2007;127(3):243–52. 10.1016/j.pain.2006.08.019 .
    1. Hauser W, Wolfe F, Henningsen P, Schmutzer G, Brahler E, Hinz A. Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population—a cross-sectional survey. BMC Public Health. 2014;14:352 10.1186/1471-2458-14-352
    1. Croft P BF, van der Windt D. Chronic pain as a topic for epidemiology and public health In: Croft P BF, van der Windt D, editors, editor. Chronic pain epidemiology From aetiology to public health. Oxford: Oxford University Press; 2010. p. 1–8.
    1. van Hecke O, Torrance N, Smith BH. Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2013;111(1):13–8. 10.1093/bja/aet123 .
    1. Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11:770 10.1186/1471-2458-11-770
    1. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581–624. 10.1037/0033-2909.133.4.581 .
    1. Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539–52. 10.1016/j.jpain.2013.08.007
    1. Santos-Silva R, Tufik S, Conway SG, Taddei JA, Bittencourt LR. Sao Paulo Epidemiologic Sleep Study: rationale, design, sampling, and procedures. Sleep Med. 2009;10(6):679–85. 10.1016/j.sleep.2008.11.001 .
    1. Associação Brasileira de Empresas de Pesquisa–ABEP. Critério de Classificação Econômica Brasil (CCEB), (; 2003.).
    1. Pires ML, Benedito-Silva AA, Mello MT, Pompeia Sdel G, Tufik S. Sleep habits and complaints of adults in the city of Sao Paulo, Brazil, in 1987 and 1995. Braz J Med Biol Res. 2007;40(11):1505–15. .
    1. Bertolazi AN, Fagondes SC, Hoff LS, Dartora EG, Miozzo IC, de Barba ME, et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med. 2011;12(1):70–5. 10.1016/j.sleep.2010.04.020 .
    1. Bittencourt LRA SR, Conway SG. Laboratório do sono–Estrutura física e pessoal, técnica polissonográfica, questionário de sono e banco de dados Sao Paulo: Associacao Fundo de Incentivo a Psicofarmacologia–AFIP; 2005.
    1. Matsudo S, Araújo T, Marsudo V, Andrade D, Andrade E, Braggion G. Questinário internacional de atividade f1sica (IPAQ): estudo de validade e reprodutibilidade no Brasil. Rev bras ativ fís saúde. 2001;6(2):05–18.
    1. JA C. Manual da versão em português das Escalas Beck. Sao Paulo. 2001.
    1. Fleck MPA LS, Xavier M, Chachamovich E, Vieira G, Santos L, Pinzon V. Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Revista de Saúde Pública2000. p. 178–83.
    1. Cho HJ, Costa E, Menezes PR, Chalder T, Bhugra D, Wessely S. Cross-cultural validation of the Chalder Fatigue Questionnaire in Brazilian primary care. J Psychosom Res. 2007;62(3):301–4. 10.1016/j.jpsychores.2006.10.018 .
    1. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol. 2009;35(9):877–83. .
    1. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. 10.1016/j.ejpain.2005.06.009 .
    1. Wong WS, Fielding R. The co-morbidity of chronic pain, insomnia, and fatigue in the general adult population of Hong Kong: Prevalence and associated factors. J Psychosom Res. 2012;73(1):28–34. 10.1016/j.jpsychores.2012.04.011 .
    1. Poleshuck EL, Green CR. Socioeconomic disadvantage and pain. Pain. 2008;136(3):235–8. 10.1016/j.pain.2008.04.003
    1. Tripp DA, VanDenKerkhof EG, McAlister M. Prevalence and determinants of pain and pain-related disability in urban and rural settings in southeastern Ontario. Pain Res Manag. 2006;11(4):225–33.
    1. Salazar A, Duenas M, Ojeda B, Failde I. Association of painful musculoskeletal conditions and migraine headache with mental and sleep disorders among adults with disabilities, Spain, 2007–2008. Prev Chronic Dis. 2014;11:E30 10.5888/pcd11.130144
    1. Smith MT, Edwards RR, McCann UD, Haythornthwaite JA. The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep. 2007;30(4):494–505. .
    1. Kamaleri Y, Natvig B, Ihlebaek CM, Bruusgaard D. Localized or widespread musculoskeletal pain: does it matter? Pain. 2008;138(1):41–6. 10.1016/j.pain.2007.11.002 .
    1. Lavigne GJ. Effect of sleep restriction on pain perception: towards greater attention! Pain. 2010;148(1):6–7. 10.1016/j.pain.2009.10.013 .
    1. Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8(2):119–32. 10.1016/S1087-0792(03)00044-3 .

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