Associations between pain and current smoking status among cancer patients

There is growing empirical and clinical interest in purported associations between smoking and the aggravation of cancer symptoms and treatment side effects, such as pain. Both pain and smoking are highly prevalent among persons with cancer, and there is recent evidence to suggest that cancer patients who continue to smoke despite their diagnosis experience greater pain than nonsmokers. Accordingly, the main goal of this cross-sectional study was to examine associations between multiple levels of smoking status and several pain-related outcomes among a sample of 224 cancer patients about to begin chemotherapy. Patients completed self-report measures of pain severity, pain-related distress, and pain-related interference, as well as a demographics questionnaire. Results indicated that persons who continued to smoke despite being diagnosed with cancer reported more severe pain than never smokers, F (2, 215) = 3.47, p < .05. Current smokers also reported greater interference from pain than either former or never smokers, F (2, 215) = 5.61, p < .01. Among former smokers, an inverse relation between pain severity and the number of years since quitting smoking was observed, r (104) = −.26, p < .01. These data suggest that continued smoking despite a cancer diagnosis is associated with greater pain severity and interference from pain; however, future research is warranted to determine the directionality of this relationship.     

Cognitive complaints are associated with depression, fatigue, female sex, and pain catastrophizing in patients with chronic pain

OBJECTIVE: To examine the relation between demographic, pain-related, psychosocial, affective, and treatment factors and complaints of cognitive dysfunction among patients with chronic pain. DESIGN: Cross-sectional survey. SETTING: A university hospital outpatient multidisciplinary chronic pain program. PARTICIPANTS: Chronic pain patients (N=222; 135 women, 87 men) completed a battery of psychometric questionnaires as part of an initial evaluation on referral to the program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cognitive impairment was assessed with items from the Brief Symptom Inventory; measures of depressive symptoms, pain intensity, posttraumatic stress disorder (PTSD), and pain catastrophizing were obtained from the Beck Depression Inventory (negative affect, negative self, somatic/physical function), McGill Pain Questionnaire, Modified Posttraumatic Chronic Pain Test, and Coping Strategies Questionnaire, respectively; and measures of subjective sleep disturbance, fatigue, opiate use, compensation/litigation status, pain location, and relevant demographic data were obtained from an open-ended questionnaire. RESULTS: Correlational analysis indicated that female sex, pain intensity, PTSD symptoms, depressive symptoms, catastrophizing, pain location (neck), and fatigue were all positively related to cognitive complaints. Simultaneous regression analysis showed that all factors combined accounted for 52% of the variance in self-report of cognitive difficulties and that 6 variables had a significant unique contribution to the report of cognitive complaints in the following order of importance: depression-negative affect (beta=.28, P <.05), fatigue (beta=.17, P <.05), depression-somatic/physical function (beta=.16, P <.05), depression-negative self (beta=.14, P =.05), pain catastrophizing (beta=.12, P =.08), and female sex (beta=.12, P <.05). CONCLUSIONS: Complaints of cognitive impairment among chronic pain patients appear to be associated with multiple factors, with particular attention to depressive symptoms, fatigue, and catastrophizing. Our results also suggest that women with chronic pain are particularly vulnerable to cognitive dysfunction.     

The effects of anxiety and depression on weekly pain in women with arthritis

This study examined the effects of anxiety and depression on pain in women with rheumatoid arthritis (RA; n = 82) or osteoarthritis (OA; n = 88). Anxiety and depression symptoms were assessed at the beginning of the study. Arthritis pain, interpersonal stress, negative affect, and positive affect were assessed weekly for 11 consecutive weeks. Multilevel analyses were conducted to investigate direct, indirect, and interactive effects of anxiety and depression on weekly changes in pain. When entered separately into the prediction equations, anxiety and depression were both related to elevations in current and next week pain, although the effects were nearly twice as large for anxiety. In addition, both anxiety and depression were indirectly related to current pain through negative and positive affect and depression interacted with stress to predict current pain in the RA group. When entered together into the prediction equations, anxiety alone was still related to elevations in current and next week pain. In addition, anxiety alone was indirectly related to current pain through negative affect and depression alone was indirectly related to current pain through positive affect. These results highlight the need for careful study of the differential effects of anxiety and depression and treatments that target their unique mechanisms.     

Gender moderates the association between depression and disability in chronic pain patients.

Pain-related anxiety and depression are important correlates of disability amongst chronic pain patients. Furthermore, women may differ in their experience of pain, anxiety and depression when compared to men. The aim of the current study was to determine the relative contribution of anxiety and depression on disability in male and female chronic pain patients. The sample consisted of 260 patients (101 males, 159 females) referred to the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases in Bath, UK. As part of an initial assessment, all patients completed measures of depression, pain-related anxiety and disability. As predicted, both anxiety and depression were found to be significant positive predictors of pain, number of medications used and disability. Although gender did not significantly predict disability, it did moderate the relationship between depression and disability, in that when depression was high, women report greater disability than men. Gender was also found to moderate the relationship between depression and number of medications used, in that a positive association was found for men, but not women. However, gender did not significantly moderate the relationship between anxiety and disability. Together these results not only suggest that gender is an important moderator of the relationship between emotional responses and disability, but that such associations may be related more to depression than anxiety.     

The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis

The objective of this article is to assess the contribution of disease activity, pain, and psychological factors to self-reported sleep disturbance in patients with rheumatoid arthritis (RA), and to evaluate whether depression mediates the effects of pain on sleep disturbance. The sample included 106 patients with confirmed RA who participated in an assessment of their disease activity, pain, psychological functioning, and sleep disturbance during a baseline evaluation prior to participating in a prospective study to help them manage their RA. Self-measures included the Rapid Assessment of Disease Activity in Rheumatology, the SF-36 Pain Scale, the Helplessness and Internality Subscales of the Arthritis Helplessness Index, the Active and Passive Pain Coping Scales of the Pain Management Inventory, the Center for Epidemiological Studies Depression Scale, and the Pittsburgh Sleep Quality Index. Hierarchical multiple regression analysis confirmed that higher income, pain, internality, and depression contributed independently to higher sleep disturbance. A mediational analysis demonstrated that depression acted as a significant mechanism through which pain contributed to sleep disturbance. Cross-sectional findings indicate that pain and depression play significant roles in self-reported sleep disturbance among patients with RA. The data suggest the importance of interventions that target pain and depression to improve sleep in this medical condition.     

Neuropsychological effects of long-term opioid use in chronic pain patients

Opioids are thought to worsen the performance of psychomotor tasks due to their sedating and mental-clouding effects. As a result, some safety regulations currently restrict the use of opioids when driving or using heavy equipment. We investigated the psychomotor effects of long-term opioid use in 144 patients with low back pain. All subjects were administered two neuropsychological tests (Digit Symbol and Trail Making Test-B) before being prescribed opioids for pain; tests were re-administered at 90- and 180-day intervals. Test scores significantly improved while subjects were taking opioids for pain, which suggests that long-term use of oxycodone with acetaminophen or transdermal fentanyl does not significantly impair cognitive ability or psychomotor function.     

Escitalopram is associated with reductions in pain severity and pain interference in opioid dependent patients with depressive symptoms

Pain is common among opioid-dependent patients, yet pharmacologic strategies are limited. The aim of this study was to explore whether escitalopram, a selective serotonin reuptake inhibitor, was associated with reductions in pain. The study used longitudinal data from a randomized, controlled trial that evaluated the effects of escitalopram on treatment retention in patients with depressive symptoms who were initiating buprenorphine/naloxone for treatment of opioid dependence. Participants were randomized to receive escitalopram 10 mg or placebo daily. Changes in pain severity, pain interference, and depression were assessed at 1-, 2-, and 3-month visits with the visual analog scale, Brief Pain Inventory, and the Beck Depression Inventory II, respectively. Fixed-effects estimators for panel regression models were used to assess the effects of intervention on changes in outcomes over time. Additional models were estimated to explore whether the intervention effect was mediated by within-person changes in depression. In this sample of 147 adults, we found that participants randomized to escitalopram had significantly larger reductions on both pain severity (b = −14.34, t = −2.66, P < .01) and pain interference (b = −1.20, t = −2.23, P < .05) between baseline and follow-up. After adjusting for within-subject changes in depression, the estimated effects of escitalopram on pain severity and pain interference were virtually identical to the unadjusted effects. This study of opioid-dependent patients with depressive symptoms found that treatment with escitalopram was associated with clinically meaningful reductions in pain severity and pain interference during the first 3 months of therapy.     

Cigarette smoking and pain: depressive symptoms mediate smoking-related pain symptoms

Numerous studies have shown an association between smoking and pain, with smokers reporting more pain and worse functioning. However, little is known about factors that impact this complex relationship. This study investigated the association between smoking, pain, and depressive symptoms. Participants were new patients seen at a multidisciplinary pain clinic. All patients were mailed an intake packet of validated questionnaires as part of an ongoing research and clinical care initiative. Of the 497 patients evaluated, 426 had valid smoking data. Among these patients, 32.6% (n = 139) reported being current smokers, 31.7% (n = 135) were classified as former smokers, and 35.7% (n = 152) were never smokers. A multivariate analysis of covariance (smoking status, age, gender, education) revealed a main effect for pain severity (F = 7.36, P<0.001), pain interference (F = 4.03, P = 0.001), and depressive symptoms (F = 7.87, P<0.001). Current smokers demonstrated higher pain severity, pain interference, and depressive symptoms compared with former smokers and never smokers (P<0.01 for all analyses), while there were no differences between the former-smoker and never-smoker groups. However, the effect of smoking on pain severity (P = 0.06) and pain interference (P = 0.22) was no longer significant after controlling for depressive symptoms in a mediation model. Additionally, among former smokers, longer quit duration was associated with less pain severity. In conclusion, smoking rates were high and smoking was associated with a worse chronic pain phenotype. Importantly, depressive symptoms emerged as a critical mediating factor in helping to explain the relationship between smoking and pain.     

Effects of mood on pain responses and pain tolerance: an experimental study in chronic back pain patients

Although chronic pain and depression commonly co-occur, causal relationships have yet to be established. A reciprocal relationship, with depression increasing pain and vice versa, is most frequently suggested, but experimental evidence is needed to validate such a view. The most straightforward approach would be a demonstration that increasing or decreasing depressed mood predictably modifies pain responses. The current experiment tested whether experimentally induced depressed and happy mood have differential effects on pain ratings and tolerance in 55 patients suffering from chronic back pain. Participants were randomly assigned to depressed, neutral (control) or elated mood induction conditions. They completed a physically passive baseline task prior to receiving mood induction, then a clinically relevant physically active task (holding a heavy bag) to elicit pain responses and tolerance. Measures were taken immediately after the baseline task and immediately after the mood induction to assess the changes in mood, pain ratings and tolerance before and after the experimental manipulation. Results indicate that the induction of depressed mood resulted in significantly higher pain ratings at rest and lower pain tolerance, whilst induced happy mood resulted in significantly lower pain ratings at rest and greater pain tolerance. Correlations between changes in mood on the one hand and changes in pain response and pain tolerance on the other hand were consistent with these findings. It is concluded that, in chronic back pain patients, experimentally induced negative mood increases self-reported pain and decreases tolerance for a pain-relevant task, with positive mood having the opposite effect.     

Combined effects of major depression, pain and somatic disorders on general functioning in the general adult population

This study was carried out to assess the prevalence of major depressive disorder (MDD) in persons suffering from pain symptoms in various locations, both with and without comorbid somatic disorders and to analyze the single and combined effects of MDD, pain symptoms and somatic disorders on general functioning in the community. The 12-month prevalence of MDD, somatic disorders and pain symptoms, grouped according to location, were determined among 4181 participants from a community sample. Depression was assessed utilising the Composite International Diagnostic Interview. Pain symptoms were self-reported by participants whereas medical diagnoses were validated by medical examinations. General functioning was evaluated utilising the established MOS-SF-36 scale. The prevalence of MDD was significantly increased for persons with pain in any location. In the absence of a somatic disorder, MDD prevalence was highest in persons with abdominal/chest pain (9.3%) and arm or leg pain (7.9%) and lowest in persons with back pain (6.2%). Mental and physical well-being were lowest for persons with both MDD and a somatic disorder, irrespective of pain locations. Increasing numbers of pain locations impaired mental and physical well-being across all groups, but the effect on mental well-being was most marked in participants with MDD and comorbid somatic disorders. The presence of pain increases risk of associated MDD. The number of pain locations experienced, rather than the specific location of pain, has the greatest impact on general functioning. Not only chronic pain, but pain of any type may be an indicator of MDD and decreased general functioning.     

维持性血液透析患者动静脉内瘘穿刺疼痛程度及其与抑郁的相关性研究

目的探讨维持性血液透析患者动静脉内瘘穿刺疼痛程度及其与抑郁的关系。方法采用疼痛视觉模拟评分法和自评抑郁量表对59例维持性血液透析患者进行问卷调查。结果维持性血液透析患者动静脉内瘘穿刺疼痛程度得分为0．5～8分,平均（3．12±1．65）分,抑郁严重程度得分为0．3～0．8分,平均（0．50±0．10）分;相关分析显示内瘘穿刺疼痛程度与抑郁呈低度正相关关系;多元逐步回归分析显示内瘘穿刺疼痛程度与抑郁得分以及透析时间有关。结论维持性血液透析患者内瘘穿刺疼痛程度大部分在可接受范围内,但仍有部分患者疼痛程度为比较痛。医护人员应该重视血液透析患者内瘘穿刺疼痛的护理,尤其是对于初期血液透析以及抑郁情绪较重者。     

慢性失眠患者失眠程度、抑郁情绪与生活质量的相关性

目的 通过探讨慢性失眠患者失眠严重程度、抑郁情绪与生活质量的相关性,评估影响患者生活质量的主要因素.方法 连续收集126例成年慢性失眠患者,根据失眠严重程度指数量表(ISI)得分分为亚临床、中度、重度失眠三组,根据贝克抑郁问卷(BDI)得分分为伴和不伴抑郁两组,用SF-36健康调查量表(SF-36)评分,分别对生活质量进行比较.结果 失眠程度重的患者SF-36(除机体疼痛外)得分低(P<0.01);伴有抑郁情绪的患者SF-36(除机体疼痛外)得分低(P<0.05);相关性分析得出ISI得分与SF-36(除机体疼痛外)得分呈负相关(P<0.05),BDI得分与SF-36得分呈显著负相关(P<0.01);控制BDI变量偏相关分析,ISI得分与SF-36(生理功能、生理职能、总体健康、活力和生理健康)得分呈负相关(P<0.05);控制ISI变量偏相关分析,BDI得分与SF-36得分(除生理机能和机体疼痛外)呈显著负相关(P<0.01).结论 慢性失眠患者失眠严重程度与生活质量相关,但与慢性失眠相关的抑郁情绪起到主要作用,这提示慢性失眠治疗中应注重改善患者情绪问题.     

The use of intermittent subcutaneous injections of oxycodone for opioid rotation in patients with cancer pain

 Oxycodone is a strong opioid that has been available for at least 70 years. At present, commercially prepared parenteral oxycodone is only available in Finland. We report in this paper our experience of administering oxycodone s.c. From 21 October 1996 to 31 July 1998, 63 advanced cancer patients received intermittent s.c. injections of oxycodone via the Edmonton Injector, a simple, low-cost mechanical device. Local tolerance and systemic toxicity were followed prospectively. Only 2 patients developed s.c. injection site intolerance, and in both cases doses of 50 mg/ml or more were being administered. Most of the patients in this study were rotated to oxycodone because of opioid toxicity, and in 34% of those patients their delirium subsided. A subgroup of 19 patients who underwent rotation to oxycodone SC from morphine and hydromorphone were studied for equivalent analgesia with oxycodone. We found a ratio (mean ± SD) of 1.2±0.4 for morphine s.c. to oxycodone s.c. and a mean ratio of 0.5±0.4 for hydromorphone s.c. to oxycodone s.c. When hydromorphone s.c. was converted to a morphine s.c. equivalent dose and the results for these patients were added to those for the morphine s.c. group, the mean and median overall ratios of morphine s.c. equivalent dose to oxycodone were 1.9±1.5 and 1.4, respectively. The cost of the oxycodone s.c. was also evaluated and was found to be comparable to that of morphine s.c. and lower than that of hydromorphone s.c. We conclude that s.c. oxycodone can be an effective, safe and inexpensive alternative opioid agonist.     

抑郁障碍伴慢性功能性疼痛患者认知特征分析

目的：探讨抑郁障碍伴慢性功能性疼痛患者的认知特征。方法将32名抑郁障碍伴慢性功能性疼痛患者设为研究组,49名非抑郁障碍慢性功能性疼痛患者设为对照组,采用自动思维问卷、功能失调性态度问卷和疼痛应对方式问卷对两组患者的自动思维、功能失调性态度、疼痛应对方式进行测评分析。结果研究组自动思维问卷总均分、功能失调性态度问卷的7个因子分均显著高于对照组（P＜0．01）,认知哲学因子分显著低于对照组（P＜0．01）;疼痛应对方式问卷的灾难化、祈祷因子分均显著高于对照组（P＜0．01）,转移注意力因子分显著低于对照组（P＜0．05）。结论抑郁障碍伴慢性功能性疼痛患者存在显著的负性自动思维和功能失调性态度,对躯体疼痛症状更多地采用消极应对方式。     

Electroconvulsive therapy in patients with depression and fibromyalgia

The effect of electroconvulsive therapy (ECT) on depression and other symptoms of fibromyalgia was studied in a prospective 3‐month trial in 13 patients with fibromyalgia and concomitant depression. All the patients met the DSM‐IV diagnostic criteria for Major Depressive Disorder and fulfilled the American College of Rheumatology diagnostic criteria for fibromyalgia. The Montgomery and Åsberg Depression Rating Scale (MADRS) and the clinical global impression scale (CGI) were used to assess the severity of depression and the clinical change of the patients. The fibromyalgia impact questionnaire (FIQ) was used to evaluate the severity of the fibromyalgia symptoms. The intensity of pain was evaluated using a 6‐point scale (0=no pain, 5=very severe pain), and tender point palpation. All assessments were performed at baseline and at follow‐up visits, which took place one week, one month and three months after ECT. There was a significant improvement in depression after ECT according to MADRS. Using CGI, six patients were much or very much improved, while four patients were minimally improved and three patients had no change. There was significant improvement in four out of ten FIQ item scores, “feel good”, “fatigue”, “anxiety” and “depression”. No significant change was found in the FIQ item scores “physical function”, “pain”, “stiffness” and “morning tiredness” or number of tender points and self‐reported pain. We conclude that ECT is a safe and effective treatment for depression in fibromyalgia patients, but has no effect on the pain or other physical symptoms of these patients.     

Adult attachment variables predict depression before and after treatment for chronic pain.

The complex relationship between chronic pain and depression has long been of clinical and empirical interest. Although attachment theory has been described as a "theory of affect regulation", and has been lauded as a developmental framework for chronic pain, surprisingly little research specifically considers the links between adult attachment variables and pain-related depression. A sample of 99 participants with chronic pain of non-cancer origin was evaluated before and after pain rehabilitation. Results demonstrated that two attachment dimensions (comfort with closeness and relationship anxiety) were related to pre- and post-treatment depression. Of particular interest was the finding that comfort with closeness was the unique predictor of lower levels of post-treatment depression, usurping pain intensity and pre-treatment depression. These results are discussed in terms of clinical implications, and suggest that adult attachment theory may prove a valuable perspective in pain treatment programs.     

健康教育对抑郁症患者近期疗效的影响

目的:探讨健康教育对慢性功能性疼痛的辅助治疗作用。方法:87例同时符合抑郁症及慢性疼痛诊断标准的门诊患者随机分为2组。入组前及治疗后的第7、14、28天分别进行HAMD、HAMA、VAS评定。以减分率作为疗效评定指标,减分率≥50%者为有效。结果:治疗第7天观察组的HAMD、HAMA、VAS得分迅速下降。并显著低于对照组(P<0.05、P<0.01)。治疗第28天两组HAMD、HAMA、VAS得分与入组时比较差异显著(P<0.01)。观察组的HAMD、HAMA、VAS得分显著低于对照组,有效率也显著地好于对照组(P<0.01)。结论:健康教育可以显著提高抑郁症伴随慢性疼痛患者的临床近期疗效。     

The burden of chronic pain: A cross-sectional survey focussing on diseases,immigration, and opioid use

Chronic pain is currently considered a public health problem with high costs to the individual and society. To improve prevention and treatment of chronic pain, epidemiologic studies are mandatory for assessing chronic pain. The aims of this study were to estimate the prevalence of chronic pain in the adult Danish population and to analyze associated factors such as diseases, immigration, and opioid use. This cross-sectional survey combines individual-based information from the Danish Health Survey (2010) and official Danish health and socioeconomic, individual-based registers. The simple random sample consisted of 25000 individuals (?16 years old) living in Denmark. In all, 60.7% completed a mailed or online questionnaire. Associations were examined with multiple logistic regression analysis. The study population consisted of 14925 individuals in whom a high prevalence of chronic pain (26.8%, 95% confidence interval: 26.1 to 27.5) and a high prevalence of opioid consumption (4.5%) were observed. Other aspects of particular note: (1) a higher prevalence of chronic pain occurred among individuals with cardiovascular and chronic pulmonary diseases than among individuals with cancer; and (2) individuals with a non-Western background reported a higher pain prevalence, higher pain intensities, and more widespread pain than individuals with Danish background; however, opioids were more frequently used by native Danes. The prevalence of chronic pain as well as opioid use in Denmark are alarmingly high, and the relevance of opioid consumption is unknown.