Associations of metabolic factors and adipokines with pain in incipient upper extremity soft tissue disorders: a cross-sectional study

Abstract

ObjectivesEarlier studies have suggested associations between metabolic factors and musculoskeletal pain or disorders. We studied the associations of obesity, lipids, other features of the metabolic syndrome and adipokines (adiponectin, leptin, resistin, visfatin) with upper extremity pain in a clinical population with incipient upper extremity soft tissue disorders (UESTDs).DesignA cross-sectional study.SettingPrimary healthcare (occupational health service) with further examinations at a research institute.ParticipantsPatients (N=163, 86% were women) seeking medical advice in the occupational health service due to incipient upper extremity symptoms with symptom duration of <1 month were referred for consultation to the Finnish Institute of Occupational Health from Spring 2006 to Fall 2008. We included all actively working subjects meeting diagnostic criteria based on physical examination. We excluded subjects meeting predetermined conditions.Outcome measurePain intensity was assessed with visual analogue scale and dichotomised at the highest tertile (cut-point 60).ResultsObesity (adjusted OR for high waist circumference 2.9, 95% CI 1.1 to 7.3), high-density lipoprotein cholesterol (OR 3.9, 95% CI 1.4 to 10.1 for low level) and triglycerides (OR 2.6, 95% CI 1.0 to 6.8 for high level) were associated with pain intensity. Of four adipokines studied, only visfatin was associated with upper extremity pain (adjusted OR 1.4, 95% CI 1.0 to 2.1 for 1SD increase in level).ConclusionsAbdominal obesity and lipids may have an impact on pain intensity in UESTDs. They may intensify pain through proinflammatory pain-modifying molecular pathways or by causing soft tissue pathology and dysfunction of their supplying arteries. Of four adipokines studied only one (visfatin) was associated with pain intensity. In the future, further studies are required to better understand the relationship between metabolic factors and UESTDs.

Systematic review of biochemical biomarkers for neck and upper-extremity musculoskeletal disorders

“…Fourteen studies examined biochemical mediators and markers related to inflammatory processes (33, 34, 40-42, 59, 61-63, 67, 69-72). Seven found significant associations between inflammatory markers and MSD (34,40,42,59,62,63,69), while seven did not (33,41,61,67,(70)(71)(72). Where associations were found, all had increased levels of inflammatory substances in MSD cases or with increased MSD severity, except for two studies in which reduced levels of IL-8 and IL-18 were observed in cases (41,59).…”

“…No association was observed between serum CRP and rotator cuff tendinitis, adhesive capsulitis, or a mix of MSD of <1 month duration (33,34,41). No association was found between serum TNF-α levels (an acute inflammatory cytokine) and chronic neck pain (69), between serum IL-1 and IL-6 levels (a pleiotropic cytokine and myokine) and late stage carpal tunnel syndrome (70), or between four acute phase cytokines (IL-1α, IL-1β, IL6, TNF-α) and a mix of MSD as each were below detectable levels (41). Results were less mixed when using local sampling methods, eg, assays of analytes from muscle extracellular fluid obtained using microdialysis.…”

“…Please reference appendix 3 for definitions and descriptions of abbreviations and biomarker analyses presented in the tables. Four studies examined upper-extremity MSD or symptoms without further specifying a particular body region (38,(40)(41)(42). Referent groups ranged from healthy controls to patient groups with conditions presumed to be sufficiently unrelated to the biomarker(s) under investigation.…”

“…Three reported extremely wideranging MSD durations (49, 50, 66) (66: 7-120 months; 49: 7-360 months; 50: 9-288 months). Five studied patients with an average symptom duration of <1 year (33,40,41,54,56).…”

Association of Fat Mass and Adipokines With Foot Pain in a Community Cohort

“…The association of obesity with painful, nonweightbearing joints, such as the hand (20), is not in keeping with the mechanical overload pathway and suggests that the metabolic effect of obesity may be an important consideration systemically. Despite investigations into the significance of adipokines in other regions of the body (21,22), their association with foot pain has not been formally investigated. The aim of this study was therefore to investigate the association of fat mass and adipokines with prevalent and future foot pain in a large communitydwelling cohort of adults.…”