This research develops and evaluates a simple method of grading the severity of chronic pain for use in general population surveys and studies of primary care pain patients Measures of pain intensity, disability, persistence and recency of onset were tested for their ability to grade chronic pain severity in a longitudinal study of primary care back pain (n = 1213), headache (n = 779) and temporomandibular disorder pain (n = 397) patients A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale Pain intensity measures appeared to scale the lower range of global severity while disability measures appeared to scale the upper range of global severity Recency of onset and days in pain in the prior 6 months did not scale with pain intensity or disability Using simple scoring rules, pain severity was graded into 4 hierarchical classes: Grade I, low disability--low intensity; Grade II, low disability--high intensity; Grade III, high disability--moderately limiting; and Grade IV, high disability--severely limiting For each pain site, Chronic Pain Grade measured at baseline showed a highly statistically significant and monotonically increasing relationship with unemployment rate, pain-related functional limitations, depression, fair to poor self-rated health, frequent use of opioid analgesics, and frequent pain-related doctor visits both at baseline and at 1-year follow-up Days in Pain was related to these variables, but not as strongly as Chronic Pain Grade Recent onset cases (first onset within the prior 3 months) did not show differences in psychological and behavioral dysfunction when compared to persons with less recent onset Using longitudinal data from a population-based study (n = 803), Chronic Pain Grade at baseline predicted the presence of pain in the prior 2 weeks Chronic Pain Grade and pain-related functional limitations at 3-year follow-up Grading chronic pain as a function of pain intensity and pain-related disability may be useful when a brief ordinal measure of global pain severity is required Pain persistence, measured by days in pain in a fixed time period, provides useful additional information

Grading the severity of chronic pain.

See related commentary by Kanis, page [1829][1]

Since the publication of the Osteoporosis Canada guidelines in 2002, there has been a paradigm shift in the prevention and treatment of osteoporosis and fractures. [1][2],[2][3] The focus now is on preventing fragility fractures and their negative

/pdf/2010-clinical-practice-guidelines-for-the-diagnosis-and-4ttqfkm9wl.pdf

2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary

‘Water is life,’ so central to human life, yet over one billion people across the world have no access to safe drinking water. Of late, there has been increasing global attention focused on resolving water quality problems especially in developing countries, as the lack of access to clean water denies the most essential of all rights, the right to life. The latest estimates suggest that around 200 million people, from among 25 nations the world over, are under the dreadful fate of fluorosis. India and China, the two most populous countries of the world, are the worst affected. India is plagued with numerous water quality problems due to prolific contaminants mainly of geogenic origin and fluoride stands first among them. The weathering of primary rocks and leaching of fluoride-containing minerals in soils yield fluoride rich groundwater in India which is generally associated with low calcium content and high bicarbonate ions. The unfettered ground water tapping exacerbates the failure of drinking water so...

Fluoride in Drinking Water: A Review on the Status and Stress Effects

Background: Treatment intervention thresholds for prevention of osteoporotic fractures can be derived from reports from the World Health Organization (diagnostic criteria) and National Osteoporosis Foundation (treatment criteria). It is not known how well these thresholds work to identify women who will fracture and are therefore candidates for treatment interventions. We used data from the National Osteoporosis Risk Assessment (NORA) to examine the effect of different treatment thresholds on fracture incidence and numbers of women with fractures within the year following bone mineral density measurement. Methods: The study comprised 149 524 white postmenopausal women aged 50 to 104 years (mean age, 64.5 years). At baseline, bone mineral density was assessed by peripheral bone densitometry at the heel, finger, or forearm. New fractures during the next 12 months were self-reported. Results: New fractures were reported by 2259 women, including 393 hip fractures; only 6.4% had baseline T scores of �2.5 or less (World Health Organization definition for osteoporosis). Although fracture rates were highest in these women, they experienced only 18% of the osteoporotic fractures and 26% of the hip fractures. By National Osteoporosis Foundation treatment guidelines, 22.6% of the women had T scores of 2.0 or less, or �1.5 or less with 1 or more clinical risk factors. Fracture rates were lower, but 45% of osteoporotic fractures and 53% of hip fractures occurred in these women. Conclusions: Using peripheral measurement devices, 82% of postmenopausal women with fractures had T scores better than �2.5. A strategy to reduce overall fracture incidence will likely require lifestyle changes and a targeted effort to identify and develop treatment protocols for women with less severe low bone mass who are nonetheless at increased risk for future fractures.

/pdf/bone-mineral-density-thresholds-for-pharmacological-ei0nj7qdsn.pdf

Bone mineral density thresholds for pharmacological intervention to prevent fractures

Objectives: To assess the incidence of gastrointestinal haemorrhage associated with long term aspirin therapy and to determine the effect of dose reduction and formulation on the incidence of such haemorrhage. Design: Meta-analysis of 24 randomised controlled trials (almost 66 000 participants). Intervention: Aspirin compared with placebo or no treatment, for a minimum of one year. Main outcome measures: Incidence of gastrointestinal haemorrhage. Results: Gastrointestinal haemorrhage occurred in 2.47% of patients taking aspirin compared with 1.42% taking placebo (odds ratio 1.68; 95% confidence interval 1.51 to 1.88); the number needed to harm was 106 (82 to 140) based on an average of 28 months9 therapy. At doses below 163 mg/day, gastrointestinal haemorrhage occurred in 2.30% of patients taking aspirin compared with 1.45% taking placebo (1.59; 1.40 to 1.81). Meta-regression showed no relation between gastrointestinal haemorrhage and dose. For modified release formulations of aspirin the odds ratio was 1.93 (1.15 to 3.23). Conclusions: Long term therapy with aspirin is associated with a significant increase in the incidence of gastrointestinal haemorrhage. No evidence exists that reducing the dose or using modified release formulations would reduce the incidence of gastrointestinal haemorrhage.

https://www.bmj.com/content/bmj/321/7270/1183.full.pdf

Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis.

The authors compared seven radiologic indices of hip osteoarthritis to establish which provided the best definition of the disease for epidemiologic purposes. Hip joints were assessed from intravenous urograms taken in a British hospital between 1982 and 1987 in 1,315 men aged 60-75 years. The indices examined were an overall qualitative grading of osteoarthritis, four measures of joint space, the maximum thickness of subchondral sclerosis, and the size of the largest osteophyte. Minimal joint space (i.e., the shortest distance between the femoral head margin and the acetabulum) was the index most strongly associated with other radiologic features of osteoarthritis. Among a subset of 759 men who answered a questionnaire about symptoms, the overall qualitative grading, minimal joint space, and thickness of subchondral sclerosis were the radiologic indices most predictive of hip pain. Within- and between-observer repeatability were tested in a subset of 50 subjects. Measures of joint space were more reproducible than other indices. These data suggest that, at least in men, minimal joint space is the best radiologic criterion of hip osteoarthritis for use in epidemiologic studies.

Defining osteoarthritis of the hip for epidemiologic studies

To the Editor. — In a recent article inThe Journal, Jacobsen et al 1 demonstrated a positive ecologic association between hip fracture discharge rates in the United States and fluoride content in water supplies. In a similar study, we recently reported the ecological association of discharge rates for hip fracture and water fluoride levels in 39 county districts in England. 2 Our study was performed in response to the suggestion that fluoridation of water might serve to stem the rising tide of hip fracture in western populations. Such a strategy was supported by laboratory evidence that fluoride was a potent inducer of bone formation, and by epidemiologic studies from Finland and the United States demonstrating lower rates of hip fractures associated with higher water fluoride levels. Our analysis demonstrated no significant association between discharge rate and total fluoride concentration ( r =.16, P =.34). This lack of association was found

Water fluoridation and hip fracture.

Hip fractures in the elderly are a major public health problem.1 Their incidence is associated with osteoporosis and a tendency to fall,2 both of which may be increased by physical inactivity. Before the age of 65, occupation is a major determinant of total physical activity. To examine the influence of work on later risk of hip fracture, we have compared occupational activity at age 50 in a series of elderly men and women with hip fractures and in controls selected from the same community.

https://oem.bmj.com/content/oemed/47/1/69.full.pdf

Sedentary work in middle life and fracture of the proximal femur.

The authors examined the association of hip osteoarthritis with the presence of Heberden's nodes in a case-control study. Subjects were men aged 60-75 years who had undergone intravenous urography as out-patients. An examination of the hands was carried out in 240 patients who had a hip replacement for osteoarthritis or a joint space less than or equal to 2.5 mm, and in 290 controls whose joint space was greater than or equal to 3.5 mm in both hips. The presence of Heberden's nodes was associated with an increased risk of radiological hip osteoarthritis, the relationship being stronger in the 51 cases with severe joint-space narrowing (odds ratio = 3.4, 95% confidence interval 1.3-9.1). There was no evidence that this association differed according to the site of joint space narrowing within the hip. The finding provides further evidence that osteoarthritis of the hip can occur as part of a generalized process and does not only result from local damage to the joints.

Is the hip involved in generalized osteoarthritis

3. Statistics for Biologists, 3rd edn. By R. C. Campbell. ISBN 0 521 36095 1 (hardbound), 0 521 36932 0 (paperbound). Cambridge University Press, Cambridge, 1989. xviii + 446 pp. £30.00 (hardbound), £12.95 (paperbound).

C Wickham

Papers

Defining osteoarthritis of the hip for epidemiologic studies

Water fluoridation and hip fracture.

Sedentary work in middle life and fracture of the proximal femur.

Is the hip involved in generalized osteoarthritis

Statistics for Biologists