Bem-estar subjetivo e dor musculoesquelética crônica no ELSA-Brasil musculoesquelético

Abstract

Little is known about the relationship between subjective well-being and chronic musculoskeletal pain (CMP). Subjective well-being is an enduring affective state, which is composed by positive affect, negative affect, and the evaluation of one’s overall life or life satisfaction. CMP is generally defined as pain lasting for more than 6 months, being classified as primary if conceived as a disease, or secondary if it is part of an underlying illness affecting the bones, joints, muscles. The present thesis investigated the association of two components of subjective well-being, depressive symptoms and life satisfaction, with knee CMP accompanied or not by disability (original article 1). The association between life satisfaction and the presence and severity of CMP located in at least one of nine evaluated body sites was also investigated (original article 2). Methods: Two cross-sectional studies were performed using data collected at baseline (2012- 2014) of the ELSA-Brasil Musculoskeletal cohort (ELSA-Brasil MSK). In the original article 1, knee CMP accompanied or not by disability was assessed by a question on pain-related limitations to perform everyday activities (overall), WOMAC’s physical function subscale (daily tasks) and five-times sit-to-stand test (objective). In original article 2, CMP at one or more sites was characterized by the presence of overall disability, requirement of healthcare utilization (troublesome CMP) and spreadness (multisite CMP and generalized CMP). Depressive symptoms were assessed by Clinical Interview Schedule, Revised (CIS-R), and life satisfaction by the Satisfaction with Life Scale. Associations were estimated by binomial logistic regressions for CMP at the knee and at any site (original article 1 and 2, respectively), and by multinomial logistic regressions for all other response variables. Results: The sample included approximately 3,000 participants, with mean age of 56 +/- 9 years-old and slight predominance of women (53%). After adjustment for sociodemographic and clinical factors, depressive symptoms were positively associated with knee CMP accompanied by daily tasks disability, assessed by WOMAC’s physical function subscale (OR: 2.30; 95% CI 1.45 - 3.66) and objective disability, assessed by five-times sit-to-stand test (OR: 1.95; 95% CI 1.29 - 2.93). In original article 1, life satisfaction was inversely associated with knee CMP, irrespectively of the presence of disability (measured by any instrument), although associations of stronger magnitude had been observed when knee CMP was accompanied by disabling. A similar result was observed in original article 2, where life satisfaction was inversely associated with CMP at any site (OR: 0.95; 95% IC: 0.94-0.97), with associations of stronger magnitude being observed for more severe CMP: CMP accompanied by overall disability (OR: 0.94; 95%IC: 0.92-0.96); multisite CMP (OR: 0.93; 95% IC:0.91-0.95); generalized CMP (OR: 0.93; IC95%: 0.90-0.96). Conclusion: Findings from the studies included in this thesis indicate the importance of addressing negative aspects of subjective well-being (depressive symptoms), as well as its positive aspects (life satisfaction), during the assessment of individuals with CMP, especially in the presence of more severe clinical presentations.