Kofman, R. (Rianne) (2013) Multiple regions of pain in adolescents; heritability and related comorbidities. A twin family case control study. thesis, Medicine.
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Abstract
Introduction and aims: The focus of this study was on common pain disorders of childhood without disease which are characterized by their easily provoked or spontaneous onset. These disorders are commonly recurrent and are frequently associated with each other simultaneously or serially. The initial aim of this study was to investigate potential genetic influence on one month prevalence of self reported regional pain in adolescents. Further aims were to investigate associations between the self reported current regional pains and life prevalence of common pain disorders of childhood without disease and other potential comorbidities. Methods: In phase 1 and 2, a cross-sectional random survey by questionnaire of 3909 twin families (twins aged 3-18 years, including parents and siblings) was distributed through the ATR. Questionnaires, validated for RLS, GP, migraine, headache, anxious depression (ASEBA Behavioural Checklist subset), multiple sensory sensitivity and screening questions for other conditions were sent. In phase 3, 1377 twin families (twins aged 11-18 years) received a questionnaire distributed through the ATR which included a body map with a request to indicate regions of pain if present for most of the past month and questions about LBP. A twin family case-control design was employed, comparing families with at least one twin having reported pain in the last month to families where neither twin had reported pain. Analyses of casewise concordance and case control data were conducted using χ2, odds ratios and 95% CIs. Bivariate correlation analyses were applied to determine the relation between the number of reported pain sites and anxious depression and sensory sensitivity scores. Logistic regression was used to determine the influence of gender and age on the different pain sites. Results: From 481 (34.9%) twin family responses to the questionnaires to date, there were 211 twin pairs in which at least one twin reported pain in one or more regions for most of the previous month. The monozygous (MZ) twin pairs had significantly higher casewise concordance than dizygous (DZ) twins for reporting at least one region of pain [casewise concordance 0.61 (SE 0.04) and 0.26 (SE 0.04) respectively, χ2=7.6, OR = 2.2 (1.2-4.2), P=0.009]. For the individual reported pain sites, back pain was found to be more highly concordant in MZ twins than DZ twins [casewise concordance 0.46 (SE 0.05) and 0.11 (SE 0.04) respectively, χ2=6.6, OR = 6.5 (1.2-45.7), P=0.02]. OR for other individual pain sites including neck 3.27 (0.6-18.5), legs 2.17 (0.89-5.30) and head 1.3 (0.14-13.5), while abdominal pain and chronic widespread pain showed MZ concordance but no DZ concordance (low numbers). Pain in at least one region in twin individuals was associated with life prevalence of recurrent abdominal pain, migraine and low backpain. Family members of case families had a greater number of pain sites than control family members and this was highly statistically significant. The correlations between mean number of reported pain sites, anxious depression score and sensory sensitivity scores were small and not meaningful. The numbers of pain sites increased with age and with female gender (the model accounted for 19% of variance with gender P = 0.001 and age P = 0.013). In a regression analysis, mothers were associated with a higher number of pain sites than fathers (P = 0.002). Discussion & Conclusions: Under the assumptions of the classic twin model, the data are consistent with genetic influence on reporting of regional pain occurring during most of the preceding month. The foremost genetic influence was seen with back pain, consistent with previous results from this unit for life prevalence of LBP. Older adolescent age and female gender were associated with a higher number of pain sites, which is consistent with published literature.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Professor Dr. P.L.P. Brand and Isala Clinics, Zwolle and Champion, Associate Professor Dr. G.D. and Sydney Children’s Hospital, Randwick and New South Wales, Australia |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1818 |
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