Is the report of widespread body pain associated with long-term increased mortality? Data from the Mini-Finland Health Survey

Aberdeen Pain Research Collaboration, Epidemiology Group, University of Aberdeen, Scotland, UK.
Rheumatology (Impact Factor: 4.48). 05/2007; 46(5):805-7. DOI: 10.1093/rheumatology/kel403
Source: PubMed


To determine whether an observation in a UK study, that persons with chronic widespread pain are at long-term increased risk of cancer mortality, can be replicated in a different setting.
Subjects were participants aged >or=30 yrs in the Mini-Finland Health Survey conducted between 1979 and 1980. Information collected included prevalent pains at different joints throughout the body, demographic, anthropometric, lifestyle and occupational factors. During follow-up, until 1994, information on vital status and cause of death was obtained.
7182 persons participated (89.8%). The prevalence of widespread body pain (pain at four or more sites) was 20% in females and 12% in males, and during follow-up there were a total of 1647 deaths. The risk of death was not elevated amongst those with widespread pain [relative risk (RR): 0.86; 95% confidence interval (CI): 0.74-1.00], and in particular, those with widespread pain were at a slightly lower risk of several disease-specific causes of death and cancer death (RR: 0.64; 95% CI: 0.46-0.91).
This study of multiple pains has not confirmed a previous observation of an association between the reporting of widespread pain and subsequent increased risk of cancer death. Differences in the definitions used or, more probably, the population studied, in particular, a larger rural population with more multiple pains related to physical activity may account for the differences.

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Available from: Gary Macfarlane
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    • "Initially, the reason given for such instability was simply inconsistent recall[40]but more recent work such as the 11 year follow up study of people with medically unexplained symptoms in Norway[41]shows that in addition to inconsistent recall there is over time a transition of medically unexplained symptoms to medically explained symptoms, a finding that has been confirmed[42]. Furthermore in one prospective primary care eight year follow-up study from United Kingdom, there was a two fold increase in mortality mostly from cancer of people originally diagnosed with medically unexplained regional and chronic widespread pain[43]although the results were not confirmed in a similar study performed in Finland[44]. Taken with the results from a recent trial of reattribution in primary care[23], GPs and patients with MUS are correct to remain vigilant about the finding of MUS over time because in a proportion these may become medically explained symptoms. "
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    ABSTRACT: Medically unexplained symptoms (MUS) refer to bodily symptoms without a physical health explanation. In the context of MUS, reattribution is a process of attributing physical symptoms to a psychological cause. We review the use of a consultation model which employs reattribution, and which has been extensively utilised in teaching and research in primary care. Literature search for studies utilising the reattribution model. Narrative review of the results. Data was extracted from 25 publications from 13 studies. The model has been modified over time and comparison between studies is limited by differences in methodology. The skills of the model can be acquired by training, which also improves practitioners' attitudes to MUS. However impact on clinical outcomes has been mixed and this can be explained in part from the findings of nested qualitative studies. The reattribution model is too simplistic in its current form to address the needs of many people presenting with MUS in primary care. Reattribution of physical symptoms to psychological causes is often unnecessary. Further research is required into the effectiveness of stepped and collaborative care models in which education of primary care practitioners forms one part of a complex intervention. The consultation process is best seen as both a conversation and ongoing negotiation between doctor and patient in which there are no certainties about the presence or absence of organic pathology.
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    • "Despite the possible lack of pathological findings, chronic musculoskeletal pain and especially CWP is known to have a great impact on self-reported health and also to be a common cause for visits in primary care [5-7]. CWP has been reported to be associated with increased cancer mortality [8], due to both a higher incidence of cancer and a reduced cancer survival [9], but this was not confirmed in a more recent report from a large population study [10]. "
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    ABSTRACT: The aim was to examine if self reported chronic regional pain (CRP) and chronic widespread pain (CWP) predicted inpatient care due to serious medical conditions such as cerebrovascular diseases, ischemic heart diseases, neoplasms and infectious diseases in a general population cohort over a ten year follow-up period. A ten-year follow up of a cohort from the general adult population in two health care districts with mixed urban and rural population in the south of Sweden, that in 1995 participated in a survey on health and musculoskeletal pain experience. Information on hospitalisation for each subject was taken from the regional health care register. Multiple logistic regression analyses were used to study the associations between chronic musculoskeletal pain and different medical conditions as causes of hospitalisation. A report of CRP (OR = 1.6; p < 0.001) or CWP ( OR = 2.1; p < 0.001) predicted at least one episode of inpatient care over a ten year period, with an increased risk in almost all diagnostic subgroups, including cerebrovascular diseases, ischemic heart diseases, and infectious diseases. There was however no increased risk of hospitalisation due to neoplasms. The presence of especially CWP was associated with hospital inpatient care due to several serious medical disorders. This may imply a general vulnerability to different medical conditions that has to be addressed in the assessment and management of subjects with chronic musculoskeletal pain.
    Full-text · Article · Jun 2010 · BMC Musculoskeletal Disorders
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    • "There have also been previous studies of the outcome of specific symptoms in primary care including chronic fatigue (Kroenke et al., 1988), dizziness (Kroenke et al., 1992), diarrhoea (Hawkins and Cockel, 1971) and palpitations (Sox Jr et al., 1981) suggesting that serious organic disease rarely emerges. Whilst one study reported an association between unexplained widespread pain and increased mortality (Macfarlane et al., 2001), a recent and similar study did not (Macfarlane et al., 2007). "
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    ABSTRACT: It has been previously reported that a substantial proportion of newly referred neurology out-patients have symptoms that are considered by the assessing neurologist as unexplained by 'organic disease'. There has however been much controversy about how often such patients subsequently develop a disease diagnosis that, with hindsight, would have explained the symptoms. We aimed to determine in a large sample of new neurology out-patients: (i) what proportion are assessed as having symptoms unexplained by disease and the diagnoses given to them; and (ii) how often a neurological disorder emerged which, with hindsight, explained the original symptoms. We carried out a prospective cohort study of patients referred from primary care to National Health Service neurology clinics in Scotland, UK. Measures were: (i) the proportion of patients with symptoms rated by the assessing neurologist as 'not at all' or only 'somewhat explained' by 'organic disease' and the neurological diagnoses recorded at initial assessment; and (ii) the frequency of unexpected new diagnoses made over the following 18 months (according to the primary-care physician). One thousand four hundred and forty-four patients (30% of all new patients) were rated as having symptoms 'not at all' or only 'somewhat explained' by 'organic disease'. The most common categories of diagnosis were: (i) organic neurological disease but with symptoms unexplained by it (26%); (ii) headache disorders (26%); and (iii) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow-up only 4 out of 1030 patients (0.4%) had acquired an organic disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients' original symptoms. Eight patients had died at follow-up; five of whom had initial diagnoses of non-epileptic attacks. Seven other types of diagnostic change with very different implications to a 'missed diagnosis' were found and a new classification of diagnostic revision is presented. One-third of new neurology out-patients are assessed as having symptoms 'unexplained by organic disease'. A new diagnosis, which with hindsight explained the original symptoms, rarely became apparent to the patient's primary care doctor in the 18 months following the initial hospital consultation.
    Full-text · Article · Oct 2009 · Brain
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