Article

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

ABSTRACT

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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    • "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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    • "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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