Chronic pain is prevalent in LMICs, and where there was sufficient evidence, generally more prevalent in EGP and W. This meta-analysis reveals the spectrum of chronic pain without clear etiology in LMICs. Steps should be taken to reduce heterogeneity in the assessment of global chronic pain. Possible actions may include standardization of chronic pain definition, widespread adoption of validated questionnaires across cultures, attention to inequitably burdened populations, and inclusion of queries regarding known associations of chronic pain with social and psychological factors that, in combination, increase the global burden of noncommunicable disease and disability.

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Background Although a single dose of etomidate can cause relative adrenal insufficiency the impact of etomidate exposure on postoperative outcomes is not known. The objective of this study was to examine the association between a single induction dose of etomidate and clinically important postoperative outcomes following cardiac surgery. Methods We retrospectively examined the association between etomidate exposure during anesthetic induction and postoperative outcomes in patients undergoing cardiac surgery from January 2007 to December 2009 using multivariate logistic regression analyses and Cox proportional hazards regression analyses. Postoperative outcomes of interest were severe hypotension, mechanical ventilation hours, hospital length of stay and in-hospital mortality. Results Sixty-two percent of 3,127 patients received etomidate. Etomidate recipients had a higher incidence of preoperative congestive heart failure (23.0% vs. 18.3%, p = 0.002) and a lower incidence of preoperative cardiogenic shock (1.3% vs. 4.0%, p < 0.001). The adjusted odds ratio for severe hypotension and in-hospital mortality associated with receiving etomidate was 0.80 (95% CI: 0.58 to 1.09) and 0.75 (95% CI: 0.45 to 1.24) respectively, and the adjusted hazard ratio for time to mechanical ventilation removal and time to hospital discharge were 1.10 (95% CI: 1.00 to 1.21) and 1.07 (95% CI: 0.97 to 1.18) respectively. Propensity score analysis did not change the association between etomidate use and postoperative outcomes. Conclusions In this study, there was no evidence to suggest that etomidate exposure was associated with severe hypotension, longer mechanical ventilation hours, longer length of hospital stay or in-hospital mortality. Etomidate should remain an option for anesthetic induction in cardiac surgery patients.

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Globally, 8 of the top 12 disabling conditions are related either to chronic pain or to the psychological conditions strongly associated with persistent pain. In this narrative review, we explore the demographic and psychosocial associations with chronic pain exclusively from low- and middle-income countries (LMICs) and compare them with current global data. One hundred nineteen publications in 28 LMICs were identified for review; associations with depression, anxiety, posttraumatic stress, insomnia, disability, gender, age, rural/urban location, education level, income, and additional sites of pain were analyzed for each type of chronic pain without clear etiology. Of the 119 publications reviewed, pain was described in association with disability in 50 publications, female gender in 40 publications, older age in 34 publications, depression in 36 publications, anxiety in 19 publications, and multiple somatic complaints in 13 publications. Women, elderly patients, and workers, especially in low-income and low-education subgroups, were more likely to have pain in multiple sites, mood disorders, and disabilities. In high-income countries, multisite pain without etiology, female gender, and association with mood disturbance and disability may be suggestive of a central sensitization syndrome (CSS). Because each type of prevalent chronic pain without known etiology reviewed had similar associations in LMICs, strategies for assessment and treatment of chronic pain worldwide should consider the possibility of prevalent CSS. Recognition is especially critical in resource-poor areas, because treatment of CSS is vastly different than localized chronic pain.