Medically unexplained pain and suicidal ideation among US adults.

BACKGROUND: Chronic pain is an established risk factor for suicide. Pain syndromes are complex to diagnose, particularly in cases with limited evidence of injury or pathology. The goal of this study is to assess whether pain of unknown origin (i.e., medically-unexplained pain, MUEP) is more strongly associated with suicide behaviors than pain with a diagnostic explanation. METHODS: Data comes from the National Comorbidity Survey-Replication, a nationally-representative sample of US adults. Analysis was limited to participants with a lifetime history of any type of chronic pain (n = 3421), which were categorized as having medically-explained pain (MEP, e.g., pain due to a specific health condition or resulting from an injury identified in an x-ray) or MUEP. Logistic regression, using survey procedures, was used to assess the relationship between lifetime MUEP and lifetime history of suicidal ideation and attempts. RESULTS: Approximately 1 in 10 (11.6 %) adults with chronic pain had MUEP. Those with MUEP reported earlier age of pain onset and more impairment due to health problems. Suicidal ideation was reported by 18.7 % of those with MEP and 28.4 % of those with MUEP. In fully-adjusted models, MUEP was associated with 1.60 times (95 % CI: 1.17-2.18) higher odds of suicidal ideation, and 1.89 (1.25-2.83) higher odds of suicide attempt, compared to MEP. LIMITATIONS: Cross-sectional analysis; MUEP assessed by self-report. CONCLUSIONS: Among adults with chronic pain, those with MUEP are more likely to report suicide behaviors. Findings illustrate a role for diagnostic and treatment processes in the relationship between pain and suicide.

Inflammation in osteoarthritis: the latest progress and ongoing challenges.

PURPOSE OF REVIEW: The understanding of inflammation in osteoarthritis is rapidly evolving. This review highlights important basic science, mechanistic, and clinical findings since 2020 that underscore the current notion of osteoarthritis as an inflammatory disease. RECENT FINDINGS: There exists a disconnect between clinical radiographic findings and patient symptoms in osteoarthritis. Inflammation, in particular synovitis, has been put forward as a potential explanation for this disconnect. New findings have shed light on the temporal dynamics and activation states of joint-resident or systemically derived immune cell populations, notably macrophages, that participate in the inflammatory response. The intricate crosstalk in which they engage may underpin disparate pain and symptoms in patients, for instance during osteoarthritis flares. The role of biological and environmental factors such as exercise, age, and diet, have been the subject of recent studies for their protective or destructive roles in osteoarthritis inflammation. Despite these advances, no disease-modifying osteoarthritis treatments targeting inflammation have emerged. SUMMARY: Osteoarthritis is a debilitating chronic disease that manifests with widely varying symptomatology. Inflammation is now appreciated as a key pathophysiological process in osteoarthritis, but there remain considerable gaps in our understanding of its role in disease progression and how best to target the inflammatory response for therapeutic interventions.

JUE Insight: How much does COVID-19 increase with mobility? Evidence from New York and four other U.S. cities.

How effective are restrictions on mobility in limiting COVID-19 spread? Using zip code data across five U.S. cities, we estimate that total cases per capita decrease by 19% for every ten percentage point fall in mobility. Addressing endogeneity concerns, we instrument for travel by residential teleworkable and essential shares and find a 25% decline in cases per capita. Using panel data for NYC with week and zip code fixed effects, we estimate a decline of 30%. We find substantial spatial and temporal heterogeneity; east coast cities have stronger effects, with the largest for NYC in the pandemic's early stages.