PONE-D-21-29758The Consequences of Chronic Pain in Mid-Life Evidence from the National Child Development SurveyPLOS ONE

Dear Dr. Bryson,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

The manuscript has been evaluated by two reviewers, and their comments are available below.

You may see that reviewer 2 has made references related to the novelty of the work. Please note that PLOS ONE does not judge mansucript based on perceived novelty, and we have not taken this into consideration during the decision-making progress. However, the reviewer has also recommended discussions in the Introduction explaining how the current study further contributes to scientific understanding. We encourage that attention is paid to this aspect of the reviewer's comments during revision.

Furthermore reviewer 1 has also identified potential causal language used throughout the conclusions as this is s cross sectional study we do not believe that the study design can infer causation. Please note that our publication criteria 4 requires that the conclusions of a manuscript are presented in an appropriate fashion and are supported by the data (http://journals.plos.org/plosone/s/criteria-for-publication#loc-4).

Could you please revise the manuscript to carefully address the concerns raised?

Please submit your revised manuscript by Jun 25 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Lucinda Shen, MSc

Staff Editor

PLOS ONE

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf.

2. Thank you for stating the following financial disclosure:

“Alex Bryson thanks the Health Foundation for funding (grant number 789112).”

Please state what role the funders took in the study.  If the funders had no role, please state: ""The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.""

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

3. Thank you for stating the following in the Acknowledgments Section of your manuscript:

“Alex Bryson thanks the Health Foundation for funding (grant number 789112). We thank the ESRC Data Archive for access to the National Child Development Survey data.”

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

“Alex Bryson thanks the Health Foundation for funding (grant number 789112).”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

4. Thank you for stating the following in your Competing Interests section: 

“there are no competing interests”

Please complete your Competing Interests on the online submission form to state any Competing Interests. If you have no competing interests, please state ""The authors have declared that no competing interests exist."", as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now

 This information should be included in your cover letter; we will change the online submission form on your behalf.

5. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

We will update your Data Availability statement to reflect the information you provide in your cover letter.

6. Please note that in order to use the direct billing option the corresponding author must be affiliated with the chosen institute. Please either amend your manuscript to change the affiliation or corresponding author, or email us at plosone@plos.org with a request to remove this option.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This manuscript deals with the consequences of short and chronic pain in mid-life using data from all those born in a single week in Britain in 1958.

Comments:

-Please make the codes/programs publicly available with a readme file, and provide a link in the manuscript.

-Typos: I found just a few typos throughout. See, for instance, p.1 to suffer

-Please remove all causal claims throughout. For instance, p.1 "The partial associations between chronic pain and subsequent health and labor market outcomes are credibly causal since they persist even in the presence of lagged pain measured earlier in life". To me this is not causal, but fascinating correlations.

-Pain is self-reported, so be careful with sentences such as "with pain incidence being highest among those not in the labor force".

-For attrition, discuss magnitude for key variables and not only statistical significance. For instance, "We find that those whose mothers were single with no husband were especially unlikely to respond to the BMS, as were those whose fathers were unskilled workers at the time of their birth." Is the effect large in magnitude? This will help the readers better understand if attrition is a serious concern.

-Could you provide a table similar to table 4 (in the appendix or extra columns in Table 4) where the sample is balanced for all columns?

-Sometimes you write 50, sometimes fifty. Similarly for 44 and other numbers, Why? I am not a native speaker, but it seems to me that only numbers below 10 should be written in letters. That's obviously a detail and there might be a good reason for that.

-Show or mention that the results are robust to using ordered probit (e.g., Table 5) or probit/logit (e.g., Table 6).

-Do not drop statistically insignificant results from the tables (e.g., keep Pain at age 16 in Table 7).

-Interpret the point estimates instead or in addition to reporting the coefficient (e.g., -0.03, p.11).

-"This paper supports the conclusion in a recent Lancet editorial that “chronic pain is real [and] deserves to be taken more seriously” (Lancet, 2021)." I do not see how your paper supports this statement. More generally, do not overstate your findings in the conclusion and focus on what your paper informs us rather than vague statements about how big of a deal chronic pain is.

Reviewer #2: Referee report of "The Consequences of Chronic Pain in Mid-Life Evidence from the National Child Development Survey”

Summary:

Using the National Child Development Survey, this paper examines: (i) the persistence of pain over the life cycle and (ii) how pain in adulthood predicts health, wellbeing and labor market outcomes later in life.

General comments:

This paper studies an important topic. Pain has become a worldwide issue and deserves to be taken seriously. However, I have some major reservations with the paper in its current form.

1) Contribution

The first key point of the paper is to document the persistence of pain over the life cycle. Specifically, the authors estimate the relationship between pain experienced in childhood at age 16 and pain in adulthood measured at ages 44, 50 and 55. This is an important point, but not novel. As stated by the authors, previous studies have already emphasized the association between pain in childhood and subsequent pain in adulthood.

The second key point is to show that pain in adulthood affects a wide range of health, wellbeing and labor force participation outcomes 5 to 10 years later. This component of the paper is more novel than the first, but again, it is not new. There are some studies which document the relationships between pain and subsequent health, wellbeing and labor market participation outcomes. This begs the question, what is the contribution from this work? Most previous studies rely on cross-sectional variations or panel data which only examine short-term effects of pain over a few years. Documenting that the results extend over a decade is valuable, but the main substantive point (that pain is related to lower health, unemployment and unhappiness) has already been made in existing work. I strongly suggest the authors to spell out the advantages of the cohort data in more detail and what new do we really learn from their analysis that we did not know before? While I agree cohort data can be helpful to investigate long-term relationships, I think that the same analysis could be done using panel data over 10 years and would have the advantage to control for unobserved individual time-invariant differences through person fixed effects. It would also allow to test for adaptation, which is not the case here.

2) Presentation

Overall, I find the paper not very well written. The authors need to clearly state (i) what are the main questions they are addressing in the paper, (ii) at which ages the different variables (pain, health, labor market outcomes, etc.) are measured, and (iii) what are the equations they are estimating. To do so, I would recommend the authors to include a table or a timeline which depicts the different variables available at the different ages. I would also include a method section, which would clearly describe the different equations estimated in the tables. Throughout the paper, I was always confused about exactly what relationships we are looking at and at which ages.

Related to the previous point, I would recommend to use always the same set of variables and controls in the regressions when looking at the long-term effects of pain on health, wellbeing, paid work, and sleep. Even if some variables become not significant, it would help for consistency. I would also suggest to present the results in a consistent way: either depicting all coefficients or presenting only a subset of them (with full tables in an appendix for instance).

3) Data & attrition

The authors provide some information about the NCDS data and the variables used. However, I would have liked to see a table with some descriptive statistics of the main variables used in the analysis for the estimated sample.

As the authors acknowledge, attrition could be an issue here if those who remain in the sample are individuals which are less likely to suffer from chronic pain. This would downwardly bias the estimates. However, the way these attrition tests are introduced is a bit odd. We don’t have any explanation of why the authors are doing these tests. Moreover, there is no attempt to deal with this problem in the main analysis. For instance, the authors could have introduced inverse probability weighting to give more weights to individuals more likely to attrit from the sample.

4) Empirical strategy

The authors argue in the introduction that “the partial associations between chronic pain and subsequent health and labor market outcomes are credibly causal since they persist even in the presence of lagged pain measured earlier in life and having controlled for parental and familial background in childhood, as well as a wide range of physical and mental health ailments reported in mid-life”. Although I agree that cohort data allow to somewhat deal with reverse causality, we could still argue that omitted variables and self-reporting bias are likely to affect the results. For instance, as most of the variables are self-reported we may expect some spurious correlations due to this. Although as pain is largely persistent over the life cycle, it could well be the case that unhappy people are more likely to suffer from pain, which in turn increases unhappiness. We would not be able to disentangle the cause from the effect using these cohort data. Therefore, I would suggest the authors to be more careful in their analysis, and acknowledge that they only capture correlations here.

5) Variable choices

The authors investigate the relationship between father’s social class in childhood and pain in adulthood. The paper should discuss in more detail why the authors chose to focus on this relationship and why not including other family characteristics, like father’s and mother’s health outcomes, employment status, income, marital status, etc.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-21-29758R1Chronic Pain: Evidence from the National Child Development SurveyPLOS ONE

Dear Dr. Bryson,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

The manuscript has been re-evaluated by two reviewers, and their comments are available below.

The reviewers have raised a few concerns that need attention. They request additional information on methodological aspects such as the inclusion of equations and revisions to the study reporting.

Could you please revise the manuscript to carefully address the concerns raised?

<o:p></o:p>

Please submit your revised manuscript by Aug 29 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Johannes Stortz

Staff Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

********** 

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

********** 

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

********** 

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

********** 

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

********** 

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: I would like to thank the authors for their revisions and for having taken into account most of my comments. I still have some remarks, which are listed below:

- At the end of the literature review section, I miss a paragraph clearly stating the contribution of this paper with respect to previous studies

- I would also have liked to see some equations. It will help the readers to understand: what controls are included in the regressions (lags, personal characteristics, region, etc.) and what is the empirical strategy.

- Sometimes you write column two, sometimes column 2. This is a minor comment but I would suggest to be consistent.

********** 

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Chronic Pain: Evidence from the National Child Development Survey

PONE-D-21-29758R2

Dear Dr. Bryson,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Sincerely yours,

Yann Benetreau, PhD

Division Editor, PLOS ONE

Additional Editor Comments (optional):

Please note the final comments from reviewer 2, which you may take into account for the final version of your manuscript.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Thanks for taking into account my remarks. A last one: in equation 1, you decided to indicate that the dependent variable is defined at the individual level, with small i. I would then indicate that age, education, etc... are also defined at the individual level, adding a small i to these variables, or I would delete it from P (to be consistent with your other equations). You could also have included error terms in all your equations.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

**********