In spite of further lockdown, the group has still been busy producing papers of our latest research. Here are a selection of some of our recent publications from the first quarter of 2021.
Maintaining Musculoskeletal Health using a behavioural therapy approach: a population-based randomised controlled trial (The MAmMOTH study)
Chronic widespread pain (CWP) is pain which people experience long-term all over their body – it is one of the characteristic features of the conditions known as fibromyalgia. Previous studies have shown telephone based cognitive-behavioural therapy (tCBT) to be effective at managing CWP. This study examined whether a similar approach could be used to prevent the onset of CWP in people who we thought were at high risk of developing this condition. Precenting the onset of CWP might be a better approach than trying to treat it after it has developed.
We surveyed adults who were registered with participating GP practices. These were based throughout Scotland, including the cities of Glasgow and Aberdeen as well as more rural locations in Grampian and the Highlands. People who were eligible reported some localised pain(s) and had been to see their GP recently. They also reported problems with sleeping; other bodily symptoms and/or specific things they had done as a result of their symptoms. Those who agreed to take part were randomised to one of two groups; one group who received a six-week course of CBT delivered via telephone, and one group who continued to receive “usual care” that is whatever care (if any) their GP thought appropriate. Participants were followed up at 3, 12 and 24 months later.
We found that at 12 months there was no difference in the onset of CWP between those in the tCBT group and those receiving usual care, however the former were more likely to report better quality of life. Furthermore, the intervention was found to be very cost-effective when considering quality-adjusted life-years. In the UK we often approve new medicines or interventions who can give patients, on average, an extra year of full quality of life at a cost of less than £20,000 – our intervention did so at a cost of less than £2,000.
The study shows that while a short course of tCBT did not prevent onset of CWP in adults at high risk, it did seem to improve quality of life, and a low-cost, short-duration intervention was found to benefit those at risk of CWP.
Read the full article here.
Characterization of Preoperative, Postsurgical, Acute and Chronic Pain in High Risk Breast Cancer Patients
Pain after breast cancer surgery remains largely unexplained and inconsistently quantified. This paper looks at the perioperative pain patterns in patients with breast cancer, up to two years after surgery.
This study was a pre-planned sub-study of the Ketorolac in Breast Cancer (KBC) trial; a multicentre, prospective, double-blind, placebo-controlled, randomised trial of a single dose of 30 mg of ketorolac just before breast cancer surgery, aiming to test its effect on recurrences. This sub-study focuses only on pain outcomes, with structured questionnaires delivered by telephone after one and two years, exploring the presence, location, permanence, and frequency of pain.
Researchers in the study found no difference in pain between the ketorolac and the placebo group. The largest category was musculoskeletal pain and permanent pain was mainly described in patients in this category. The description of pain changed for most patients during the second postoperative year, for example, pain moved from one category to another (no pain, permanent, or non-permanent pain, but also, the localisation).
This study highlights that pain is a complex phenomenon, but also a fragile and unstable endpoint. Pain after breast cancer surgery does not necessarily mean breast pain but can also include musculoskeletal and other pains, while the permanence of pain and the pain phenotype can change over time.
Read the full article here.
Sleep disturbance moderates the association between physical activity and pain onset in older American adults
This study examined whether sleep disturbance changes the association between physical activity and later pain reporting.
The data source was the Health and Retirement Study, a survey of Americans aged 50 years and older, conducted via household interviews every two years. Responses to questions about troublesome pain, time spent in moderate and/or vigorous physical activity, and frequency of sleep disturbances were analysed
38% of a pain-free sample in 2014 participated in moderate or vigorous physical activity once a week or less. 19% went on to report troublesome pain in 2016. Each one-point higher on a physical activity scale in 2014 was associated with a reduced likelihood of incident pain in 2016 for those who never or rarely reported sleep disturbance, but not for those who endorsed sleep disturbance most of the time.
The results of this study suggest that while there may be a beneficial association of physical activity on reduced likelihood of later troublesome pain, this benefit may be negated by the presence of frequent sleep disturbance.
Read the full article here.
Quantifying and predicting the effect of anti-TNF therapy on axSpA-related fatigue: Results from the BSRBR-AS registry and meta-analysis
How to effectively manage the symptoms of fatigue in people with axial spondyloarthritis (axSpA)-is a major clinical challenge . Anti-TNF therapy (one of the so-called “biologic therapies”) may reduce fatigue levels, but we don’t know by how much and we also don’t know whether they improve fatigue for everyone or only in some people, and predictors of any such improvements are unknown.
The British Society of Rheumatology Register in Axial Spondyloarthritis (BSRBR-AS) recruited people with axSpA from across the UK and followed them over the course of a year. We recorded what happened to their fatigue and compared those treated with anti-TNF therapy and those who continued with their routine (non-biologic) therapy.
Of the 998 people who provided the data required, 310 had started anti-TNF therapy. One-year later there was a clear difference between the groups: those on anti-TNF therapy reported a modest reduction in fatigue, while those not taking anti-TNF therapy reported a slight worsening. Of participants with significant fatigue who commenced anti-TNF therapy, the ones who were most likely to derive benefit were those who originally told us that they had poor sleep quality.
This study suggests that anti-TNF therapy results in a modest reduction in fatigue amongst axSpA patients, with those reporting that they had poor sleep quality most likely to report improvement. We therefore concluded that the use of anti-TNF therapies on their own is not sufficient to treat the fatigue associated with axSpA and we will need to identify additional therapies to target fatigue
Additional note: We are currently conducting the LIFT trial which is testing both graded exercise and a cognitive behavioural approach to target fatigue in people with inflammatory arthritis. We expect the results to be available during 2021.
Read the full article here.
The role of metrology in axSpA: does it provide unique information in assessing patients and predicting outcome? Results from the BSRBR-AS registry
This study sought to investigate amongst patients with axial spondyloarthritis which factors were most associated with decreased spinal mobility, and whether poor mobility might be a predictor of a patient’s response to anti-TNFα therapy.
Using data from the British Society for Rheumatology Biologics Register in Axial Spondyloarthritis (BSRBR-AS), researchers determined the clinical and patient-reported factors which were independently associated with spinal mobility, as measured by a patient’s Bath AS Metrology Index (BASMI) score. Poorer spinal mobility was found to be associated with poorer function, meeting X-ray criteria for AS, longer symptom duration, higher levels of inflammation (as measured by CRP), older age, male gender, not currently being in employment and lower levels of education. Poorer mobility was an independent predictor of not meeting response criteria for ASAS20, ASAS40, quality of life, but was not related to meeting ASDAS response criteria.
These results show that BASMI was estimated moderately well by other routinely measured factors, and was further an independent predictor of response to biologics in some, but not all, commonly used measures.
Read the full article here.