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      Chronic pain in long-lived elderly: prevalence, characteristics, measurements and correlation with serum vitamin D level Translated title: Dor crônica em idosos longevos: prevalência, características, mensurações e correlação com nível sérico de vitamina D

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          ABSTRACTBACKGROUND AND OBJECTIVES:Chronic pain considerably worsens quality of life of the elderly, giving relevance to studies addressing it in such individuals, especially those long-lived. Recently, vitamin D deficiency, very prevalent among the elderly, has been correlated to chronic pain. This study aimed at estimating the prevalence of chronic pain among community long-lived elderly with functional independence, at evaluating its characteristics and at correlating this pain to serum vitamin D levels.METHODS:Cross-sectional study of the “Long-Lived Project”, with elderly aged 80 years or above, of both genders, with functional independence. Socio-demographic data were collected, referred chronic pains were measured and serum vitamin D levels were obtained.RESULTS:We have evaluated 330 participants of the “Long-Lived Project” and pain prevalence was 20.9%, especially nociceptive, continuous, moderate to severe and lumbar pain. Among pain intensity measurement tools, faces and verbal numeric scales were preferred. There has been high prevalence of vitamin D deficiency among long-lived elderly with chronic pain (87%); deficiency and insufficiency levels were 49 and 38%, respectively, however such levels were not significantly correlated to chronic pain.CONCLUSION:There has been high prevalence of chronic pain among the elderly. Moderate to severe and low back pain were the most frequent. There has been high prevalence of vitamin D deficiency among studied long-lived elderly; however there has been no significant correlation between low serum vitamin D levels and chronic pain.

          Translated abstract

          RESUMOJUSTIFICATIVA E OBJETIVOS:A dor crônica diminui consideravelmente a qualidade de vida dos idosos, dando relevância aos estudos que a abordam nesses indivíduos, sobretudo nos longevos. Recentemente, a hipovitaminose D, muito prevalente entre idosos, tem sido relacionada à dor crônica. O objetivo deste estudo foi estimar a prevalência de dor crônica entre os longevos da comunidade com independência funcional, avaliar suas características e correlacionar essa dor com os níveis séricos de vitamina D.MÉTODOS:Estudo transversal do “Projeto Longevos”, com idosos de 80 anos ou mais, de ambos os gêneros, com independência funcional. Foram apurados os dados sócio-demográficos, avaliadas e mensuradas as dores crônicas apresentadas e obtidos os níveis séricos da vitamina D.RESULTADOS:Foram avaliados 330 participantes do “Projeto Longevos”, e encontrada prevalência de 20,9% de dor crônica, sendo essa principalmente do tipo nociceptiva, contínua, de intensidade moderada a intensa, de localização lombar. Dentre os instrumentos de mensuração da intensidade dolorosa, os preferidos foram as escalas de faces e numérica verbal. Observou-se alta prevalência de hipovitaminose D nos longevos com dor crônica (87%); níveis de deficiência e insuficiência em 49 e 38%, respectivamente, porém tais níveis não se correlacionaram significativamente com a presença de dor crônica.CONCLUSÃO:A prevalência de dor crônica entre os longevos foi alta. Intensidade moderada e intensa e localização lombar foram as mais frequentes. Houve alta prevalência de hipovitaminose D entre os longevos estudados, porém não se observou correlação significativa entre baixos níveis séricos de vitamina D e dor crônica.

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          Most cited references 32

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          Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes.

          Recent evidence suggests that vitamin D intakes above current recommendations may be associated with better health outcomes. However, optimal serum concentrations of 25-hydroxyvitamin D [25(OH)D] have not been defined. This review summarizes evidence from studies that evaluated thresholds for serum 25(OH)D concentrations in relation to bone mineral density (BMD), lower-extremity function, dental health, and risk of falls, fractures, and colorectal cancer. For all endpoints, the most advantageous serum concentrations of 25(OH)D begin at 75 nmol/L (30 ng/mL), and the best are between 90 and 100 nmol/L (36-40 ng/mL). In most persons, these concentrations could not be reached with the currently recommended intakes of 200 and 600 IU vitamin D/d for younger and older adults, respectively. A comparison of vitamin D intakes with achieved serum concentrations of 25(OH)D for the purpose of estimating optimal intakes led us to suggest that, for bone health in younger adults and all studied outcomes in older adults, an increase in the currently recommended intake of vitamin D is warranted. An intake for all adults of > or =1000 IU (25 microg) [DOSAGE ERROR CORRECTED] vitamin D (cholecalciferol)/d is needed to bring vitamin D concentrations in no less than 50% of the population up to 75 nmol/L. The implications of higher doses for the entire adult population should be addressed in future studies.
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            Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation.

            Epidemiologically-based rheumatology healthcare needs assessment requires an understanding of the incidence and prevalence of musculoskeletal disorders in the community, of the reasons why people consult in primary care, and of the proportion of people who would benefit from referral to secondary care and paramedical services. This paper reports the first phase of such a needs assessment exercise. To estimate the relative frequency of musculoskeletal pain in different, and multiple, anatomical sites in the adult population. Three general practices in the former Tameside and Glossop Health Authority, Greater Manchester, UK, a predominantly urban area. Population survey. An age and sex stratified sample of 6000 adults from the three practices was mailed a questionnaire that sought data on demographic factors, musculoskeletal symptoms (pain in the past month lasting for more than a week), and physical disability (using the modified Health Assessment Questionnaire--mHAQ). The areas of pain covered were neck, back, shoulder, elbow, hand, hip, knee, and multiple joints. The Carstairs index was used as a measure of social deprivation of the postcode sector in which the person lived. The response rate after two reminders was 78.5%. Non-responders were more likely to live in areas of high social deprivation. People who lived in more deprived areas were also more likely to report musculoskeletal pain, especially backpain. After adjusting for social deprivation the rates of musculoskeletal pain did not differ between the practices and so their results were combined. After adjustment for social deprivation, the most common site of pain was back (23%; 95% CI 21, 25) followed by knee (19%; 95% CI 18, 21), and shoulder (16%; 95% CI 14, 17). The majority of subjects who reported pain had pain in more than one site. The prevalence of physical disability in the community rose with age. It was highest in those with multiple joint problems but was also high in those with isolated back or knee pain. Musculoskeletal pain is common in the community. People who live in socially deprived areas have more musculoskeletal symptoms. Estimates of the overall burden of musculoskeletal pain that combine the results of site specific surveys will be too high, those that do not adjust for socioeconomic factors will be too low.
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              The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties.

              Altogether 553 children (195 first graders, mean age 6.8 years, and 358 third graders, mean age 8.7 years) participated in the development of a self-report measure to assess the intensity of children's pain. The first step was the derivation, from children's drawings of facial expressions of pain, of 5 sets of 7 schematic faces depicting changes in severity of expressed pain from no pain to the most pain possible. With the set of faces that achieved the highest agreement in pain ordering, additional studies were conducted to determine whether the set had the properties of a scale. In one study, children rank-ordered the faces on 2 occasions, separated by 1 week. All 7 faces were correctly ranked by 64% (retest 1 week later, 61%) of grade 1 children and by 86% (retest 89%) of grade 3 children. In a second study, the faces were presented in all possible paired combinations. All 7 faces were correctly placed by 62% (retest 86%) of the younger and by 75% (retest 71%) of the older subjects. A third study asked children to place faces along a scale: a procedure allowing a check on the equality of intervals. The fourth study checked on whether pain was acting as an underlying construct for ordering the faces in memory. We asked whether children perceived the set as a scale by asking if memory for an ordered set of faces was more accurate than for a random set. The final study checked, with 6-year-old children, the test-retest reliability of ratings for recalled experiences of pain. Overall, the faces pain scale incorporates conventions used by children, has achieved strong agreement in the rank ordering of pain, has indications that the intervals are close to equal, and is treated by children as a scale. The test-retest data suggest that it may prove to be a reliable index over time of self-reported pain.

                Author and article information

                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Revista Dor
                Rev. dor
                Sociedade Brasileira para o Estudo da Dor (São Paulo )
                September 2015
                : 16
                : 3
                : 171-175
                [1 ] Universidade Federal de São Paulo Brazil


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                CLINICAL NEUROLOGY


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