 |
|
|
 |
Health and Functional Status of Twins with Chronic Regional and Widespread Pain LESLIE A. AARON, LESTER M. ARGUELLES, SUZANNE ASHTON, MEGAN BELCOURT, RICHARD HERRELL, JACK GOLDBERG, WAYNE R. SMITH, and DEDRA BUCHWALD
ABSTRACT.
Methods. We identified 95 twin pairs discordant for pain in which one twin had chronic regional or widespread pain and the other denied chronic pain. Demographic data, functional and psychological status, health behaviors, and symptoms based on the 1994 criteria for chronic fatigue syndrome (CFS) were assessed by questionnaire. Psychiatric diagnoses were based on structured interview. Random effects regression modeling estimated associations between chronic regional and widespread pain and each health measure with and without adjustment for CFS. Results. Significant differences (p £ 0.05) were found within twin pairs discordant for chronic regional and widespread pain, for general health perception, and physical and mental health functioning as measured by summary scores from the Short Form-36. In addition, differences were observed within pain discordant pairs in psychological distress as measured by the General Health Questionnaire as well as the number of psychiatric diagnoses. Adjustment for CFS eliminated the association between chronic pain and mental health, but the association between chronic pain and poor general health, physical functioning, and sleep quality persisted (p £ 0.01). Only the intra-pair difference in physical functioning distinguished twins with regional vs widespread pain (p £ 0.05). Conclusion. Both chronic regional and widespread pain exact debilitating effects on perceived general health, physical functioning, and sleep quality independent of CFS. However, the psychological and psychiatric influence of chronic pain appears closely tied to CFS. Research should examine the additive role of CFS-like illnesses in patients with chronic pain, and its influence on treatment and outcome. (J Rheumatol 2002;29:2426-34) Key Indexing Terms:
TWINS
From the Department of Oral Medicine, School of Dentistry, Division of General Internal Medicine, Department of Medicine, Department of Epidemiology, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington; and Department of Biostatistics and Epidemiology, University of Illinois at Chicago, Chicago, Illinois, USA. Funded by a New Investigator Award from the Arthritis Foundation (Dr. Aaron) and by grant U19 AI38429 from the National Institutes of Health (Dr. Buchwald). L.A. Aaron, PhD, MPH, Research Scientist, Department of Oral Medicine, School of Dentistry, University of Washington; L.M. Arguelles, MS, Research Associate, Department of Biostatistics and Epidemiology, University of Illinois at Chicago; S. Ashton, BS, Research Study Supervisor, Division of General Internal Medicine, Department of Medicine, University of Washington; M. Belcourt, Research Study Assistant, Division of General Internal Medicine, Department of Medicine, University of Washington; R. Herrell, PhD, Visiting Assistant Professor, Department of Biostatistics and Epidemiology, University of Illinois at Chicago; J. Goldberg, PhD, Research Professor, Department of Epidemiology, University of Washington and Seattle VA ERIC/ VET Registry; W.R. Smith, PhD, MPH, Clinical Assistant Professor, Department of Psychiatry and Behavioral Sciences, University of Washington; D. Buchwald, MD, Professor, Division of General Internal Medicine, Department of Medicine, University of Washington. Address reprint requests to Dr. L.A. Aaron, University of Washington School of Dentistry, Box 356370, 1959 NE Pacific St., B316, Seattle, WA 98195-6370. E-mail: laaron@u.washington.edu Submitted September 19, 2001; revision accepted April 26, 2002.
|