Association of Short-term Pain and Chronic Pain Intensity With Cardiometabolic Multimorbidity Progression: A Multistate Markov Model Analysis.

IF 4.6 2区医学 Q1 ANESTHESIOLOGY Anesthesia and analgesia Pub Date : 2024-10-09 DOI:10.1213/ANE.0000000000007228

Dongze Chen, Yali Zhang, Yi Zhou, Zhisheng Liang

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Abstract

Background: The impact of pain intensity on the progression trajectories of cardiometabolic multimorbidity (CMM) is not well understood. We attempted to dissect the relationship of short-term pain (STP) and chronic pain intensity with the temporal progression of CMM.

Methods: We conducted a prospective cohort study based on the UK Biobank participants. Incident cases of cardiometabolic diseases (CMDs) were identified based on self-reported information and multiple health-related records in the UK Biobank. CMM was defined as the occurrence of at least 2 CMDs, including heart failure (HF), ischemic heart disease (IHD), stroke, and type 2 diabetes (T2D). The pain intensity was categorized into 5 levels based on pain duration and the number of sites involved, including chronic widespread pain (CWSP), chronic multilocation pain (CMLP), chronic single-location pain (CSLP), STP, and free-of-pain (FOP). Multistate models were used to assess the impact of pain intensity on the CMM trajectories from enrollment to initial cardiometabolic disease (ICMD), subsequently to CMM, and ultimately to death.

Results: A total of 429,145 participants were included. Over the course of a 12.8-year median follow-up, 13.1% (56,137/429,145) developed ICMD, 19.6% (10,979/56,137) further progressed to CMM, and a total of 5.3% (22,775/429,145) died. Compared with FOP, CMLP (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.06-1.17) and CWSP (HR, 1.26; 95% CI, 1.13-1.42) elevated the risk of transitioning from ICMD to CMM. STP (HR, 0.89; 95% CI, 0.82-0.96), CSLP (HR, 0.88; 95% CI, 0.82-0.95), and CMLP (HR, 0.87; 95% CI, 0.81-0.93) lowered the risk of transition from ICMD to mortality, and STP also reduced the risk of transition from enrollment to mortality (HR, 0.94; 95% CI, 0.89-0.98). The results of disease-specific transitions revealed that the influence of pain intensity varied across transitional stages. Specifically, CMLP and CWSP heightened the risk of conversion from T2D or IHD to CMM, whereas only CWSP substantially elevated the transition risk from HF to CMM.

Conclusions: Our results highlighted reductions in chronic pain may mitigate both the onset and progression of CMM, potentially having an important impact on future revisions of cardiometabolic and pain-related guidelines.

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短期疼痛和慢性疼痛强度与心脏代谢多病性进展的关系：多态马尔可夫模型分析

背景：疼痛强度对心脏代谢性多病（CMM）进展轨迹的影响尚不十分清楚。我们试图剖析短期疼痛（STP）和慢性疼痛强度与 CMM 的时间进展之间的关系：我们在英国生物库参与者的基础上开展了一项前瞻性队列研究。根据英国生物库中的自我报告信息和多种健康相关记录，确定了心脏代谢疾病（CMDs）的发病病例。CMM的定义是至少发生2种CMD，包括心力衰竭（HF）、缺血性心脏病（IHD）、中风和2型糖尿病（T2D）。疼痛强度根据疼痛持续时间和涉及部位的数量分为 5 级，包括慢性广泛性疼痛 (CWSP)、慢性多部位疼痛 (CMLP)、慢性单部位疼痛 (CSLP)、STP 和自由疼痛 (FOP)。多态模型用于评估疼痛强度对 CMM 轨迹的影响，这些轨迹包括从注册到最初的心脏代谢疾病 (ICMD)、随后的 CMM 以及最终的死亡：结果：共纳入 429 145 名参与者。在12.8年的中位随访过程中，13.1%（56,137/429,145）的人患上了ICMD，19.6%（10,979/56,137）的人进一步发展为CMM，共有5.3%（22,775/429,145）的人死亡。与 FOP 相比，CMLP（危险比 [HR]，1.11；95% 置信区间 [CI]，1.06-1.17）和 CWSP（HR，1.26；95% 置信区间 [CI]，1.13-1.42）增加了从 ICMD 转为 CMM 的风险。STP（HR，0.89；95% CI，0.82-0.96）、CSLP（HR，0.88；95% CI，0.82-0.95）和CMLP（HR，0.87；95% CI，0.81-0.93）降低了从ICMD转为死亡的风险，STP还降低了从入院转为死亡的风险（HR，0.94；95% CI，0.89-0.98）。特定疾病过渡的结果显示，疼痛强度对不同过渡阶段的影响各不相同。具体而言，CMLP和CWSP增加了从T2D或IHD转变为CMM的风险，而只有CWSP大幅增加了从HF转变为CMM的风险：我们的研究结果表明，减少慢性疼痛可减轻CMM的发生和发展，这可能对未来心血管代谢和疼痛相关指南的修订产生重要影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anesthesia and analgesia 医学-麻醉学

CiteScore

9.90

自引率

7.00%

发文量

817

审稿时长

2 months

期刊介绍： Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.