A Novel Measure of Pain Location in Adults with Sickle Cell Disease

BackgroundPain intensity remains a primary focus clinically for sickle cell disease pain assessment despite the fact that pain quality and pain location and distribution are critical for clinical diagnosis and treatment of its etiology. However, in part because of measurement issues, scant evidence is available about pain location or its relationship to intensity and quality in adults with SCD.AimOur study aim was to examine sickle cell disease pain location for relationships with pain quality and intensity measured in outpatient and inpatient settings.MethodsWe used an existing longitudinal dataset prospectively collected with the valid and reliable tablet-based PAINReportIt^?. Adults with sickle cell disease (n = 99) reported pain location, intensity, and quality during a routine outpatient clinic visit and again during a subsequent hospitalization. From their digital body outline drawings and using the ImageJ software, we computed the pain-affected body surface area. With Pearson's correlations and paired t tests, we examined relationships between pain-affected body surface area and other pain variables across outpatient and inpatient visits.ResultsThe mean pain-affected body surface area was 14.4% ± 15.0% of the total body surface area for outpatient visits (min-max: 0.0%-90.2%) and 13.5% ± 14.7% (min-max: 0.0%-73.0%) for inpatient stay. Pain-affected body surface area was positively correlated with pain quality scores for both visits but not significantly correlated with pain intensity at either visit. Compared with the outpatient visit, mean pain intensity for inpatient stay was higher (p < .001); pain quality (p = .12) and pain-affected body surface area (p = .60) did not differ significantly between visits.ConclusionsUnknown is the explanation for pain-affected body surface area association with SCD pain quality but not pain intensity at outpatient and inpatient visits. Additional research is warranted to explore these findings and examine the clinical utility of pain-affected body surface area for chronic sickle cell disease pain and acute sickle cell disease crisis pain.     

Evaluating Associations between Average Pain Intensity and Genetic Variation in People with Sickle Cell Disease: An Exploratory Study

BackgroundPain is one of the most common and deleterious symptoms experienced by individuals with sickle cell disease (SCD). There is a paucity of studies identifying potential genetic mechanisms of pain in this population.AimExamine associations between 11 functional single nucleotide polymorphisms in 9 candidate genes with reports of average pain intensity in individuals with sickle cell disease.MethodCross-sectional analyses were performed on data and blood samples collected through the Duke SCD Implementation Consortium Registry. Participants were asked to rate their pain “on the average” using an 11-point numeric rating scale (0 = no pain; 10 = pain as bad as you can imagine). We genotyped 11 single nucleotide polymorphisms in 9 pain-related genes using TaqMan® Genotyping Assays. Associations between each polymorphism and reports of average pain were evaluated.ResultsThe 86 participants (mean age: 28.7 years; 64% female) included in this study reported moderate pain on average (Mean = 4, Standard Deviation = 2.4). ICAM1 rs1799969 was the only genetic polymorphism that was significantly associated with pain (p = .01). Individuals with one or more minor alleles had lower average pain (Mean = 1.25, Standard Deviation = 1.50) than individuals without a minor allele (Mean = 4.13, Standard Deviation = 2.25). The effect size for ICAM1 rs1799969 was 1.30, which is considered large. The effect sizes for all other single nucleotide polymorphisms ranged from small to medium (range: 0–0.3).ConclusionsOur findings provide preliminary evidence that the minor allele in ICAM1 rs1799969 had protective effects against experiencing more severe pain in sickle cell disease.     

Investigating the effects of weather on headache occurrence using a smartphone application and artificial intelligence: A retrospective observational cross-sectional study

Objective

To investigate the relationship between weather and headache occurrence using big data from an electronic headache diary smartphone application with recent statistical and deep learning (DL)-based methods.

Background

The relationship between weather and headache occurrence remains unknown.

Methods

From a database of 1 million users, data from 4375 users with 336,951 hourly headache events and weather data from December 2020 to November 2021 were analyzed. We developed statistical and DL-based models to predict the number of hourly headache occurrences mainly from weather factors. Temporal validation was performed using data from December 2019 to November 2020. Apart from the user dataset used in this model development, the physician-diagnosed headache prevalence was gathered.

Results

Of the 40,617 respondents, 15,127/40,617 (37.2%) users experienced physician-diagnosed migraine, and 2458/40,617 (6.1%) users had physician-diagnosed non-migraine headaches. The mean (standard deviation) age of the 4375 filtered users was 34 (11.2) years, and 89.2% were female (3902/4375). Lower barometric pressure (p < 0.001, gain = 3.9), higher humidity (p < 0.001, gain = 7.1), more rainfall (p < 0.001, gain = 3.1), a significant decrease in barometric pressure 6 h before (p < 0.001, gain = 11.7), higher barometric pressure at 6:00 a.m. on the day (p < 0.001, gain = 4.6), lower barometric pressure on the next day (p < 0.001, gain = 6.7), and raw time-series barometric type I (remaining low around headache attack, p < 0.001, gain = 10.1) and type II (decreasing around headache attack, p < 0.001, gain = 10.1) changes over 6 days, were significantly associated with headache occurrences in both the statistical and DL-based models. For temporal validation, the root mean squared error (RMSE) was 13.4, and the determination coefficient (R²) was 52.9% for the statistical model. The RMSE was 10.2, and the R² was 53.7% for the DL-based model.

Conclusions

Using big data, we found that low barometric pressure, barometric pressure changes, higher humidity, and rainfall were associated with an increased number of headache occurrences.     

Pain catastrophizing predicts pain intensity during a neurodynamic test for the median nerve in healthy participants

Psychological factors within the Fear-Avoidance Model of Musculoskeletal Pain (FAM) predict clinical and experimental pain in both symptomatic and asymptomatic individuals. Clinicians routinely examine individuals with provocative testing procedures that evoke symptoms. The purpose of this study was to investigate which FAM factors were associated with evoked pain intensity, non-painful symptom intensity, and range of motion during an upper-limb neurodynamic test. Healthy participants (n = 62) completed psychological questionnaires for pain catastrophizing, fear of pain, kinesiophobia, and anxiety prior to neurodynamic testing. Pain intensity, non-painful sensation intensity, and elbow range of motion (ROM) were collected during testing and served as dependent variables in separate simultaneous regression models. All the psychological predictors in the model accounted for 18% of the variance in evoked pain intensity (p = .02), with only pain catastrophizing (β = .442, p < .01) contributing uniquely to the model. Psychological predictors did not explain significant amounts of variance for the non-painful sensation intensity and ROM models. These findings suggest that pain catastrophizing contributed specifically to evoked pain intensity ratings during neurodynamic testing for healthy subjects. Although these findings cannot be directly translated to clinical practice, the influence of pain catastrophizing on evoked pain responses should be considered during neurodynamic testing.     

Acceptability and Feasibility of a Mindfulness-Based Intervention for Pain Catastrophizing among Persons with Sickle Cell Disease

BackgroundFew investigators have developed and tested nonpharmacological interventions for helping persons with sickle cell disease (SCD) manage persistent pain.AimsThe purpose of this pilot study was to examine the feasibility and acceptability of a mindfulness-based intervention (MBI) in adults with SCD and chronic pain and to gather preliminary data on its efficacy.DesignData on feasibility and acceptability, including recruitment, retention, and attendance rates, were collected during a single-site, randomized control trial. Participants were randomly assigned to either a 6-session group telephonic MBI or a wait-listed control. Pain catastrophizing was assessed at baseline and at weeks 1, 3, and 6.SettingOutpatient, comprehensive, interdisciplinary sickle cell disease center in the Southeast.Participants/SubjectsAdults at least 18 years of age with a self-reported diagnosis of sickle cell disease who self-identified as having chronic, non-cancer pain that persisted on most days for at least 6 months and adversely affected function and/or well-being.MethodsSeventy-eight adults were recruited; 18 (23%) declined to participate; 60 were randomly assigned to either the MBI (N = 40) or control (N = 20). Of those, 14 (35%) from the MBI and 12 (60%) from the control group withdrew immediately after random allocation, resulting in 34 evaluable cases (MBI: N = 26; control: N = 8).ResultsAmong the 26 assigned to MBI, the median number of sessions attended per person was 4; 7 (27%) attended all six sessions. Qualitative findings indicated that MBI participants viewed the program as acceptable and liked the telephonic format, community, and content. Reductions in pain catastrophizing outcomes were identified after intervention.ConclusionsAn MBI is feasible and acceptable for persons with SCD experiencing chronic pain. A larger randomized controlled trial to establish MBI efficacy on pain and related outcomes for SCD will provide nonpharmacologic, behavioral pain management options for nurses and other clinicians caring for persons with SCD and chronic pain.     

Depression and anxiety are not related to nummular headache

Nummular headache (NH) is a clinical picture characterized by head pain that is exclusively felt in a round, elliptical, or oval area of the head. Although there is evidence supporting an organic origin for NH, some authors question this origin, hypothesizing a potential role for psychological factors. Our aims were to investigate the differences in anxiety and depression between NH patients and healthy controls, and to analyse if these conditions were related to pain parameters in NH patients. The Beck depression inventory (BDI-II) and the trait anxiety scale from state-trait anxiety inventory (STAI) were administered to 26 patients with NH and 34 comparable matched controls. No significant interactions between group (NH patients, controls) in either depression (U = 391; p = 0.443) or anxiety levels (U = 336; p = 0.113) were found. Both groups showed similar scores in the BDI-II (patients: 3.9 ± 2.9; controls: 3.46 ± 3.15) and STAI (patients: 17.23 ± 10.3; controls: 13.5 ± 7.9). Moreover, neither depression nor anxiety showed association with mean pain intensity, pain intensity in exacerbations, size of pain area, or pain frequency. Our study demonstrated that self-reported depression and anxiety were not related to the presence of NH. Further, longitudinal studies are still needed to elucidate the role of mood state in the course of NH.     

Do Children with Sickle Cell Disease Receive Disparate Care for Pain in the Emergency Department?

Background: There may be disparities in pain management practice in the emergency department (ED) for sickle cell disease patients (SCD) with vaso-occlusive episodes (VOE). Objectives: To compare pain management practice for children who presented to the ED with VOE to those with isolated long bone fractures (LBF). Methods: Children who presented with a VOE or a LBF to a children's hospital ED during 2005 were included. A retrospective medical chart review was conducted for each patient visit. Data collected included demographics, pain scores, time from triage to analgesia, and analgesic intervention. Results: Seventy-seven patients with SCD had 152 visits to the ED for pain, and 219 patients had 221 visits for LBF. Fifty-five patients (108 visits) with SCD and 123 patients (124 visits) with LBF received opiates. Subsequent analysis was done on these groups. Patients with SCD were older, less likely to be male and more likely to be African-American than the LBF group. Patients with SCD had higher triage pain scores (7.7 ± 2.5 vs. 6.7 ± 3.0, p = 0.005) and spent less time in the waiting room (7.4 ± 9.0 vs. 12.1 ± 26.8 min, p = 0.10), were given higher initial opiate doses (0.09 ± 0.03 vs. 0.07 ± 0.03 mg/kg morphine, p < 0.001); however, time from triage to analgesic intervention did not differ (69.0 ± 42.6 vs. 70.4 ± 57.1 min, p = 0.92). Conclusions: No disparities in care for children with sickle cell pain were identified. More timely administration of opiates needs to be encouraged, assuming other factors such as time of day, ED census, and acuity permit.     

Impact of HLA-G +3142C>G on the development of antibodies to blood group systems other than the Rh and Kell among sensitized patients with sickle cell disease

BackgroundPatients' inflammatory history is an important factor underlying red blood cell (RBC) alloimmunization, which is a frequent transfusion complication among individuals with sickle cell disease (SCD). HLA-G has been associated with different inflammatory and auto - immune diseases. Our goal was to verify whether the HLA-G + 3142 C>G and 14-bp Ins/Del variations are associated with RBC antibody development among SCD patients.MethodsThis was a single-center case-control study. SCD patients were randomly selected for the study and divided into two groups: ‘Alloimmunized’ and ‘Nonalloimmunized’ depending on the presence of irregular antibodies. The ‘Alloimmunized’group was further divided into two subgroups according to the presence of only antibodies against the Rh and Kell blood group systems or the existence of antibodies to antigens of the other blood group systems.ResultsA total of 213 patients were included in the study (110 alloimmunized and 103 non-alloimmunized). The ‘Alloimmunized’ and ‘Non-alloimmunized’ groups did not differ statistically regarding the HLA-G + 14 bp Ins/Del ( p = 0.494) and + 3142 C>G ( p = 0.334). Individuals who had only antibodies against the Rh and Kell antigens had a frequency of HLA-G + 3142GG genotype almost twice as high compared to the groupwith antibodies against less immunogenic antigens ( p = 0.043).ConclusionsThe genotype frequency of HLA-G + 3142 C>G differs among alloimmunized SCD patients, depending on the presence of antibodies against low immunogenic RBC antigens. This highlights a possible role played by the HLA-G molecule in the RBC alloimmunization process.     

The Effects of Psychological Interventions on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis

BackgroundPsychological interventions are effective at ameliorating the experience of pain in conditions such as rheumatoid arthritis and chronic back pain. However, their effect on diabetic peripheral neuropathy (DPN) pain has yet to be establishedAimTo assess the effectiveness of psychological interventions on pain and related outcomes in adults with DPN.DesignSystematic review.SettingsCommunity, hospital in-patient and out-patient.Participants/SubjectsAdults with diabetic peripheral neuropathy.MethodsMedline, Embase, PsychInfo, and CINAHL databases together with grey literature and trial registers were searched. A meta-analysis and narrative synthesis of included studies were undertaken.ResultsNine studies were selected from 1610 citations. At short-term follow-up psychological therapies showed a large effect on pain severity (SMD = –0.94, 95%CI [–1.50, –0.37], p = .001), a small effect on pain interference (SMD = –0.39, 95%CI [–0.73, –0.05], p = .02), and a moderate effect on depressive symptoms (SMD = –0.58, 95%CI [–0.95, –0.21], p = .002). Quality of life significantly improved in experimental subjects, (MD = –2.35, 95%CI [–3.99, –0.71], p = .005).At medium-term follow-up there was a large effect on pain severity (SMD = –1.26, 95%CI [–1.76, –0.77], p < .00001) and on pain interference (SMD = –0.91, 95%CI [–1.61, –0.21], p = .01) and a moderate effect on depressive symptoms (SMD = –0.76, 95%CI [–1.48, –0.05], p = .04).At long-term follow-up, improvements in pain interference, mood, and self-care behaviors were reported.ConclusionsThese findings demonstrate that the relationship between pain and perceived control identified in other groups who experience chronic pain may also be replicated in the DPN population. This is an important outcome that can guide further research and associated service developments.     

Investigation of Factors Associated With Pain Intensity in Office Workers With Non-Specific Low Back Pain

BackgroundLow back pain is an important health problem causing serious physical, psychological, and economic losses in developed and developing countries.AimThe aim of this study is to investigate comprehensively the factors related to the intensity of pain in office workers with non-specific low back pain (NSLBP).MethodsThe study included 71 university office workers with NSLBP, aged 21-55 years. In addition to evaluating the sociodemographic and clinical characteristics of office workers with NSLBP, visual analog scale (VAS), Short-Form 36 (SF-36), Minnesota Satisfaction Questionnaire (MSQ), Oswestry Disability Index (ODI), Tampa Kinesiophobia Scale (TKS), Beck Depression Inventory (BDI), and Timed Up and Go (TUG) outcome measurements were applied.ResultsThere was a statistically significant association between the intensity of pain and TUG test (p = .000), job satisfaction (p = .015), percentages of disability (p = .000), quality of life (role difficulty due to physical limitation, p = .010; pain, p = .000; social the function, p = .044), and depression (p = .004).ConclusionsWhile the functional performance, job satisfaction level, and quality of life in office workers with NSLBP with severe-intensity pain were lower, level of disability, depression were higher in office workers with NSLBP with mild-to-moderate-intensity pain.     

Migraine is comorbid with multiple sclerosis and associated with a more symptomatic MS course

The objectives of this study were: (1) to assess relative frequency of migraine in multiple sclerosis (MS) patients using the validated self-administered diagnostic questionnaire, and to compare the migraine rates in MS outpatients to age- and gender-matched historical population controls; (2) to compare clinical and radiographic characteristics in MS patients with migraine and headache-free MS patients. We conducted a cross-sectional study to assess the demographic profiles, headache features and clinical characteristics of MS patients attending a MS clinic using a questionnaire based on the American Migraine Prevalence and Prevention (AMPP) study. We compared the relative frequency of migraine in MS clinic patients and AMPP cohort. We also compared clinical and radiographic features in MS patients with migraine to an MS control group without headache. Among 204 MS patients, the relative frequency of migraine was threefold higher than in population controls both for women [55.7 vs. 17.1%; prevalence ratio (PR) = 3.26, p < 0.001] and men (18.4 vs. 5.6%; PR = 3.29, p < 0.001). In a series of logistic regression models that controlled for age, gender, disease duration, β-interferon use, and depression, migraine in MS patients was significantly associated (p < 0.01) with trigeminal and occipital neuralgia, facial pain, Lhermitte’s sign, temporomandibular joint pain, non-headache pain and a past history of depression. Migraine status was not significantly associated with disability on patient-derived disability steps scale or T2 lesion burden on brain MRI. Migraine is three-times more common in MS clinic patients than in general population. MS–migraine group was more symptomatic than the MS–no headache group.     

Anxiety,pain intensity,and decision regret of living liver donors during postoperative period

AimThe aim of this study was to explore and examine the relationship between anxiety, acute pain intensity, and decision regret of living liver donors in the postoperative stage.MethodsThis is a prospective correlational study. Data were collected consecutively for one year (from September 2017 to September 2018) at a medical center in northern Taiwan. Information about anxiety and acute pain intensity was collected preoperatively and on postoperative day (POD) 3 and POD 7. Satisfaction with pain management and decision regret was inquired about on POD 7.ResultsData of 57 consecutive living liver donors (56.1 % male, mean age 34.12 ± 9.92 years) were analyzed. Living liver donors experienced moderate anxiety and acute pain levels in the postoperative period. The mean score of decision regret was 12.63 (range 0–60), indicating a low level of regret. The acute pain intensity decreased significantly between POD 3 and POD 7 (p < .001); however, the anxiety level slightly increased (p = .031). Older and married living liver donors had higher anxiety levels. The satisfaction level of pain management was negatively correlated with the POD 7 acute pain intensity (r = −0.26, p = .049) and decision regret (r = −0.37, p = .005), but it was positively correlated with POD 7 anxiety (r = 0.38, p = .004).ConclusionsThe postoperative period was hard for living liver donors as they would experience moderate acute pain and anxiety. Although the decision regret was low, the satisfaction level of pain management would negatively affect it. Therefore, the effectiveness of pain management and anxiety management should be continually ensured in the postoperative period.     

Effect of Cognitive-Behavioral Therapy or Mindfulness Therapy on Pain and Quality of Life in Patients with Diabetic Neuropathy: A Systematic Review and Meta-Analysis

ObjectivesThis study aimed to evaluate the effectiveness of cognitive behavioral therapy (CBT) and mindfulness therapy (MT) for pain relief and quality of life (QOL) in patients with diabetic neuropathy.Review/Analysis methodsFour databases were systematically searched from their respective inception dates to 29 June 2021. Relevant randomized controlled trials (RCTs) were screened and assessed for risk of bias. Eight RCTs evaluating CBT or MT were included. Statistical analysis was performed using Review Manager 5.4.ResultsEight RCTs involving 384 patients with painful diabetic neuropathy (PDN) tested psychological interventions, including three CBT and five MT studies. The results showed that patients’ pain severity (standardized mean difference [SMD] = -0.60, 95% confidence interval [CI; -0.93 to -0.27], P = .0003) and QOL (SMD = -0.43, 95% CI [-0.83 to -0.04], p = .03) were improved immediately after treatment. Besides, the pain intensity (SMD = -0.67, 95% CI [-1.37 to 0.03], p = .06), pain interference (SMD = -0.75, 95% CI [-1.20 to -0.30], p = .001) and depressive symptoms (SMD = -0.62, 95% CI [-0.96 to -0.28], p = .0003) were superior to the control group after follow up. The subgroup analysis results of different intervention type showed that the CBT group could immediately improve pain (SMD = -0.44, 95% CI [-0.78 to -0.10], p = .01) after treatment. However, there was no statistically significant difference in the CBT group after follow-up (SMD = -0.15, 95% CI [-0.52 to 0.22], p = .42).ConclusionsCognitive behavioral therapy or MT is effective for treating pain in patients with diabetic peripheral neuropathy, improving the QOL, and reducing depressive symptoms. However, large-scale, multi-centre, rigorously designed RCTs are needed to further verify the long-term effects.     

Biological Correlates of the Effects of Auricular Point Acupressure on Pain

BackgroundTo identify candidate inflammatory biomarkers for the underlying mechanism of auricular point acupressure (APA) on pain relief and examine the correlations among pain intensity, interference, and inflammatory biomarkers.DesignThis is a secondary data analysis.MethodsData on inflammatory biomarkers collected via blood samples and patient self-reported pain intensity and interference from three pilot studies (chronic low back pain, n = 61; arthralgia related to aromatase inhibitors, n = 20; and chemotherapy-induced neuropathy, n = 15) were integrated and analyzed. This paper reports the results based on within-subject treatment effects (change in scores from pre- to post-APA intervention) for each study group (chronic low back pain, cancer pain), between-group differences (changes in scores from pre- to post-intervention between targeted-point APA [T-APA] and non-targeted-point APA [NT-APA]), and correlations among pain intensity, interference, and biomarkers.ResultsWithin-group analysis (the change score from pre- to post-APA) revealed statistically significant changes in three biomarkers: TNF-α (cancer pain in the APA group, p = .03), β-endorphin (back pain in the APA group, p = .04), and IL-2 (back pain in the NT-APA group, p = .002). Based on between-group analysis in patients with chronic low back pain (T-APA vs NT-APA), IL-4 had the largest effect size (0.35), followed by TNF-α (0.29). A strong positive monotonic relationship between IL-1β and IL-2 was detected.ConclusionsThe current findings further support the potential role of inflammatory biomarkers in the analgesic effects of APA. More work is needed to gain a comprehensive understanding of the underlying mechanisms of APA on chronic pain. Because it is simple, inexpensive, and has no negative side effects, APA can be widely disseminated as an alternative to opioids.     

Higher hydroxyurea adherence among young adults with sickle cell disease compared to children and adolescents

BackgroundSickle cell disease (SCD) results in severe complications, such as anaemia and pain episodes. Hydroxyurea (HU) is efficacious in SCD, yet adherence remains low.ObjectiveTo assess the relationship of HU adherence to health care utilization and patients’ characteristics.MethodsThis is a 5-year retrospective chart review. Patients’ demographics and medical history were collected from the electronic medical record (EMR). HU adherence was evaluated using foetal haemoglobin “HbF%”, mean corpuscular volume “MCV”, and absolute neutrophil count “ANC”. Age groups included children (<12 years), adolescents (12–17 years), and young adults (≥18 years).ResultsA total of 113 SCD patients on HU were included (median age 14 years, IQR 10–20; 50% female; 88% HbSS). Young adults had significantly higher HU adherence compared to adolescents and children, including higher median HbF% (24.2 vs. 12.4 vs. 8.6, p = .003), MCV (fl) (106.4 vs. 96.2 vs. 95.4, p = .01) and lower ANC (10³/ml) (3.25 vs. 4.9 vs. 4.2, p = .01), respectively. Patients with chronic pain had lower HU adherence (HbF% 15.3 vs. 10.7, p = .04; ANC 3.6 vs. 6.3, p = .002; MCV 102.3 vs. 93.1, p = .1). Patients with higher HbF or MCV and lower ANC had significantly less frequent emergency room visits (r_s=–0.26, p = .01; r_s=–0.23, p = .01; r_s=0.24, p = .01) and hospitalizations (r_s=–0.27, p = .01; r_s=–0.31, p = .01; r_s=0.21, p = .02) as well as shorter length of stays (r_s=–0.27, p = .0045; r_s=–.34, p = 0.004; r_s=0.23, p = .02), respectively. Similar trends in HU adherence and health care utilization were seen in subgroup analysis of only HbSS patients. There was no significant association of HU adherence to patients’ sex, socio-economic status, distance from hospital, and HU duration.ConclusionsYoung adults with SCD had significantly higher HU adherence compared to children and adolescents. Patients with lower HU adherence and/or chronic pain had increased health care utilization. Future studies examining barriers to adherence and evaluating interventions to optimize HU adherence in SCD are warranted.

KEY MESSAGES

1. Young adults with SCD had significantly higher HU adherence, as reflected in their laboratory markers, compared to children and adolescents.
2. Patients with higher HU adherence and/or those without chronic pain had lower or less frequent health care utilization.
3. No significant association of HU adherence to patients’ sex, socio-economic status and distance from hospital.

     

Predictors of outcome in a cohort of women with chronic pelvic pain – A follow‐up study

Background: Chronic pelvic pain (CPP) in women is a long‐lasting condition. Aims: To explore changes in pain intensity, adjustment to pain, pain appraisal and coping strategies as well as to evaluate whether baseline pain appraisals and coping strategies and their changes were associated with outcome in the long term. Methods: A follow‐up study was conducted on all consecutive women who had visited a CPP‐team of a university hospital. After an average period of 3.2 years 64% of them (N=84) completed questionnaires at baseline and follow‐up. Results: A reduction in pain intensity (p<.001, d=.6), improvement in adjustment to pain (SF‐36 Physical Component Summary (p<.001, d=.4) and depressive symptoms (p<.01, d=.2)), as well as a reduction in catastrophizing pain (p<.01, d=.4) and an increase in perceived pain control (p<.01, d=.3) were observed. Neither biographic nor clinical variables were related with these changes. Pain appraisal and coping strategies at baseline did not predict changes from baseline in pain intensity. However, baseline levels of perceived pain control correlated with a change in depressive symptoms (r=⁻.27, p<.05), also after adjustment for pain intensity at baseline (r=⁻.28, p<.05). Changes from baseline in levels of catastrophizing pain were associated with changes in pain intensity (r=.44, p<.01), SF‐36 Physical Component Summary (r=⁻.34, p<.01) and depressive symptoms (r=.71, p<.01). Conclusion: At a 3 year follow‐up, improvement in pain intensity in women with CPP was not associated with baseline pain appraisals and coping strategies. A reduction in catastrophizing was related to better outcome in the long term.     

Chronic Pain and Depression are Increased in Outpatient Adults with Somatic Symptoms from Secondary Health Care Services

BackgroundSomatic symptom disorder is described as excessive thoughts, feelings, or behaviors related to physical symptoms. The presence of somatic symptoms has been associated with depression, alexithymia, and the presence of chronic pain. Individuals with somatic symptom disorder are frequent attenders of primary health care services.AimWe focused on investigating if the presence of psychological symptoms, alexithymia, or pain could be risk factors for somatic symptoms in a secondary health care service.MethodsA cross-sectional and observational study. A total of 136 Mexican individuals who regularly attend a secondary health care service were recruited. The Visual Analogue Scale for Pain Assessment, the Symptom Checklist 90, and the Patient Health Questionnaire-15 were applied.ResultsOf all the participants, 45.2% showed somatic symptoms. We observed that these individuals more frequently presented with complaints of pain (χ² = 18.4, p < .001), as well as more severe (t = –4.6, p < .001), and prolonged (χ² = 4.9, p = 0.02). They also exhibited higher severity in all psychological dimensions assessed (p < .001). Finally, cardiovascular disease (t = 2.52, p = .01), pain intensity (t = 2.94, p = .005), and SCL-90 depression (t = 7.58, p < .001) were associated with somatic symptoms.ConclusionsIn this study, we observed a high frequency of somatic symptoms in outpatients attending secondary health care services. They may be accompanied by comorbid cardiovascular conditions, higher pain intensity, and other mental health-related symptoms, which may aggravate the general clinical picture presented by the patient seeking health care. The presence and severity of somatization should be taken into consideration in the first and second level health care services for an early mental state evaluation and treatment of these outpatients to have a better clinical assessment and health outcome.