Predicting new onset of widespread pain following a motor vehicle collision.

Objective: To determine, in a group of persons involved in a motor vehicle collision, the contributions of pre-collision health and psychological factors, the social environment, collision-specific factors, and post-collision symptoms, to the new onset of widespread pain (WP).

Methods: A prospective cohort study of persons, registered with an insurance company, who had recently experienced a motor vehicle collision. Participants were sent a questionnaire to assess pre-collision health, collision-specific factors, post-collision health, and WP.

Do strong opioids have a role in the early management of back pain? Recommendations from a European expert panel.

Background: Since chronic low back pain (CLBP) is a complex biopsychosocial problem the ideal treatment is multimodal and multidisciplinary. However, in many countries, primary-care physicians care for many people with CLBP and have a pivotal role in selecting patients for more intensive treatments when these are available. Guidelines on the general use of strong opioids in chronic non-cancer pain have been published but, until now, no specific guidelines were available on their use in chronic low back pain.

The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors?

Background: Syndromes for which no physical or pathological changes can be found tend to be researched and managed in isolation although hypotheses suggest that they may be one entity. The objectives of our study were to investigate the co-occurrence, in the general population, of syndromes that are frequently unexplained and to evaluate whether they have common associated factors.

Methods: We conducted a population-based cross-sectional survey that included 2,299 subjects who were registered with a General Medical Practice in North-west England and who completed full postal questionnaires (response rate 72%).

Long-term mortality amongst Gulf War Veterans: is there a relationship with experiences during deployment and subsequent morbidity?

Background: Gulf War Veterans have previously been shown to have, in the short-term, an excess risk of death from 'external' (i.e. non-disease) causes of death.

Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents.

In clinic studies, altered hypothalamic-pituitary-adrenal (HPA) axis function has been associated with fibromyalgia, a syndrome characterised by chronic widespread body pain. These results may be explained by the associated high rates of psychological distress and somatisation. We address the hypothesis that the latter, rather than the pain, might explain the HPA results.

Chronic widespread pain and fibromyalgia: Should reports of increased mortality influence management?

There have been few studies examining whether persons with chronic widespread pain or fibromyalgia are at increased risk for dying prematurely. Among the studies conducted there is little consistency in results. If there is an increased mortality risk, it is of the order of a 30% excess and it may be related to the lifestyle of patients with these symptoms, including lack of exercise.

Onset of neck pain after a motor vehicle accident: a case-control study.

Objective: To assess the relative contribution of constitutional (individual) factors, pre-accident health, psychological and workplace psychosocial factors, and accident related (mechanical) factors in the development of neck pain (whiplash) following a motor vehicle accident.

Methods: We conducted a case-control study of drivers (ages 17-70 yrs) who reported a motor vehicle accident to their insurance company. A self-report mailed questionnaire retrospectively collected information on the driver's pre- and post-accident health, details of the accident, and other exposure data.

Development and validation of the Manchester orofacial pain disability scale.

Objective: To design and validate a self-administered instrument for assessing orofacial pain related disability in the general population.

Methods: The 32-item questionnaire was developed by open-ended interviews with patients attending dental hospital clinics and was subsequently tested on 171 community subjects with self-reported orofacial pain and 48 dental hospital patients.

Results: Construct validity of the instrument was demonstrated in three ways.

Primary care consultation predictors in men and women: a cohort study.

Background: Women visit their doctors more than men, but comparatively few studies have explored gender differences in consultation in detail.

Aims: To identify the factors that predicted the number of primary care consultations in men and women over a 5-year period.

Design Of Study: Prospective cohort study with three waves of data collection by postal questionnaire.

Can one predict the likely specific orofacial pain syndrome from a self-completed questionnaire?

To estimate the prevalence of orofacial pain (OFP) by specific diagnostic subgroups in the general population. Cross-sectional population study. General medical practice in South East Cheshire, UK.

Psychological distress and premature mortality in the general population: a prospective study.

Purpose: To determine whether higher rates of mortality are observed in people reporting psychological distress, to establish the nature of any excess, and to examine the possible existence of a dose response relationship.

Methods: We conducted a prospective follow-up study of mortality over an eight-year period in the North West of England. A total of 4,501 adults were recruited from two general practices during a population-based survey conducted at the start of 1992.

Childhood experience and health care use in adulthood: nested case--control study.

Background: Few studies have considered the role of childhood experiences in adult health care use.

Aims: To examine the hypotheses that individuals frequently attending primary care report childhood adversities and illness exposures more commonly than the remainder of patients and that any association is independent of adult psychiatric disorder.

Method: A nested case-control study was carried out in a single general practice in Manchester, UK.

The Cheshire Foot Pain and Disability Survey: a population survey assessing prevalence and associations.

Previous foot studies have consistently reported high prevalence estimates in self-reported foot disorders. Few population studies, however, have attempted to assess the impact of foot problems in terms of pain and disability so that the burden associated with foot pain is unknown. A cross-sectional postal survey was conducted on a random community sample of 4780 individuals with 3417 (84%) responding.

DLC1 is unlikely to be a primary target for deletions on chromosome arm 8p22 in head and neck squamous cell carcinoma.

Allelic imbalance on chromosome arm 8p is common in head and neck squamous cell carcinoma (HNSCC). DLC1, a tumour suppressor gene inactivated in liver carcinogenesis and encoding a Rho GTPase activating protein (RhoGAP) maps to one of the deleted regions (8p21.3-22).

Mechanical injury and psychosocial factors in the work place predict the onset of widespread body pain: a two-year prospective study among cohorts of newly employed workers.

Objective: Mechanical injury has been postulated as a risk factor for widespread pain, although to date, the evidence is weak. The aim of this study was to determine whether repeated exposure to mechanical trauma in the work place predicts the onset of widespread pain and to determine the relative contribution of mechanical trauma compared with psychosocial factors.

Methods: In this prospective cohort study of 1,081 newly employed subjects in 12 diverse occupational settings, we collected detailed information on mechanical exposure, posture, physical environment, and psychosocial risk factors in the work place.

Occurrence of Raynaud's phenomenon in children ages 12-15 years: prevalence and association with other common symptoms.

Objective: Although Raynaud's phenomenon (RP) in adults is frequently reported as having been present since childhood, there have been no studies on the prevalence of RP in children. This study was undertaken to ascertain the prevalence of RP in children ages 12-15 years and to determine whether, as with other commonly reported symptoms, there were any associations with adverse psychosocial factors.

Methods: A previously validated self-administered RP questionnaire was distributed to 903 children ages 12-15 years, from 28 schools.

Incidence of cancer among UK Gulf war veterans: cohort study.

Objectives: To determine whether incidence rates of cancer are higher in UK service personnel who were deployed in the Gulf war than in those not deployed and whether any increased risk of cancer is related to self reported exposures to potentially hazardous material during the period of deployment.

Design: A cohort study with follow up from 1 April 1991 (the end of the Gulf war) to 31 July 2002.

Participants: 51 721 Gulf war veterans and 50 755 service personnel matched for age, sex, rank, service, and level of fitness who were not deployed in the Gulf (the Era cohort).

Predicting the onset of widespread body pain among children.

Objective: To determine factors associated with, and the predictors of, widespread body pain in children.

Methods: A population-based prospective study was conducted among school children in Northwest England. At baseline, subjects completed a self-report questionnaire on widespread body pain.

Predicting the onset of forearm pain: a prospective study across 12 occupational groups.

Objective: To determine, among workers free of forearm pain, the role of mechanical and psychosocial factors in predicting future onset.

Methods: A prospective cohort study was conducted among 782 newly employed workers from 12 occupational groups. At baseline, a cohort of 782 workers free of forearm pain was identified and measurement was made about physical and psychosocial aspects of their job and working environment.

Association of widespread body pain with an increased risk of cancer and reduced cancer survival: a prospective, population-based study.

Objective: To determine whether reported widespread body pain is related to an increased incidence of cancer and/or reduced survival from cancer, since our previous population surveys have demonstrated a relationship between widespread body pain and a subsequent 2-fold increase in mortality from cancer over an 8-year period.

Methods: A total of 6565 subjects in Northwest England participated in 2 health surveys during 1991-1992. The subjects were classified according to their reported pain status (no pain, regional pain, and widespread pain), and were subsequently followed up prospectively until December 31, 1999.

National study of cause-specific mortality in rheumatoid arthritis, juvenile chronic arthritis, and other rheumatic conditions: a 20 year followup study.

Objective: To quantify risks for cause-specific mortality among hospitalized patients with rheumatoid arthritis (RA), juvenile chronic arthritis (JCA), and 4 other rheumatic conditions in a nationwide, population based cohort over a 20 year period.

Methods: All subjects were identified from Scottish hospital inpatient records from 1981 to 2000 and were followed up by computer linkage to the national registry of deaths. Expected mortality was calculated from national mortality rates and was related to the observed incidence by the standardized mortality ratio (SMR) and the corresponding 95% confidence interval (95% CI).

Predictors of low back pain in British schoolchildren: a population-based prospective cohort study.

Objective: To determine the onset of low back pain (LBP) in schoolchildren and to investigate the role of mechanical and psychosocial factors as risk factors for its onset.

Methods: A prospective population-based cohort study was conducted of 1046 schoolchildren, aged 11 to 14 years at baseline, identified as being free of LBP, from 39 secondary schools in Northwest England. New onset of LBP at 1-year follow-up was measured.

Predictors of hip joint replacement in new attenders in primary care with hip pain.

Background: Studies investigating the factors associated with need for total hip replacement should ideally be based on prospective investigation of new attenders in primary care.

Aim: To determine the incidence of listing for total hip replacement, and its predictors, among attenders in primary care with a new episode of hip pain.

Design Of Study: Prospective multicentre cohort study.