Telephone‐based management of chronic pain in older adults in an integrated care program

Objective

Few studies have explored behavioral strategies for managing chronic pain in older adults. Pain Care Management (PCM) is a telephone‐based behavioral intervention for chronic pain. The present study examined chronic pain characteristics among older adults and tested the delivery of PCM as an adjunct to depression and anxiety care management.

Methods

Participants were drawn from a state‐sponsored program offering care management services to community members aged 65 and older who were prescribed a psychotropic medication by a primary care provider. Chronic pain information was collected for all participants in the state program (N = 250) and treatment outcome data were collected for a subset with significant chronic pain. Eighty participants with high chronic pain interference were offered PCM and compared to 80 participants with chronic pain who received monitoring only on depression, anxiety, and pain interference outcomes.

Results

Chronic pain was identified in 14% of older adults newly prescribed a psychotropic medication. Compared to monitoring only, PCM participants had higher odds of seeing a reduction of 2 or more points in pain interference at 6 months. Pain care management participants' anxiety scores significantly decreased over the study period.

Conclusions

Older adults treated with psychotropic medications often also experience chronic pain that interferes with daily activities. A telephone‐based care management intervention is acceptable and feasible with an older community‐based population and can lead to improvements in anxiety symptoms and interference from chronic pain. Further research will help to refine interventions that may help improve symptoms and increase functioning with this population.     

Multiple Health Behavior Changes and Co-variation in a Telephone Counseling Trial

Background  

Delivering effective multiple health behavior interventions to large numbers of adults with chronic conditions via primary care settings is a public health priority.     

Executive Function and Survival in the Context of Chronic Illness

Background  

Individual differences in executive function (EF) have been shown to predict risk factors for chronic illness. It is not currently known whether EFs also predict survival time following a diagnosis of a chronic illness.     

Long‐term lithium treatment increases intracellular and extracellular brain‐derived neurotrophic factor (BDNF) in cortical and hippocampal neurons at subtherapeutic concentrations

Objectives

The putative neuroprotective effects of lithium treatment rely on the fact that it modulates several homeostatic mechanisms involved in the neurotrophic response, autophagy, oxidative stress, inflammation, and mitochondrial function. Lithium is a well‐established therapeutic option for the acute and long‐term management of bipolar disorder and major depression. The aim of this study was to evaluate the effects of subtherapeutic and therapeutic concentrations of chronic lithium treatment on brain‐derived neurotrophic factor (BDNF) synthesis and secretion.

Methods

Primary cultures of cortical and hippocampal neurons were treated with different subtherapeutic (0.02 and 0.2 mM) and therapeutic (2 mM) concentrations of chronic lithium treatment in cortical and hippocampal cell culture.

Results

Lithium treatment increased the intracellular protein expression of cortical neurons (10% at 0.02 mM) and hippocampal neurons (28% and 14% at 0.02 mM and 0.2 mM, respectively). Extracellular BDNF of cortical neurons increased 30% and 428% at 0.02 and 0.2 mM, respectively and in hippocampal neurons increased 44% at 0.02 mM.

Conclusion

The present study indicates that chronic, low‐dose lithium treatment up‐regulates BDNF production in primary neuronal cell culture.     

Alexithymia and anxiety in female chronic pain patients

Objectives  

Alexithymia is highly prevalent among chronic pain patients. Pain is a remarkable cause for high levels of chronic anxiety. The purpose of this study was to investigate the prevalence of alexithymia and to determine anxiety levels among DSM-IV somatoform pain disorder (chronic pain) female patients and to examine the relationship between alexithymia and the self-reporting of pain.     

Education and Levels of Salivary Cortisol Over the Day in US Adults

Background  

Dysregulation of the hypothalamic–pituitary–adrenal axis is hypothesized to be an important pathway linking socioeconomic position and chronic disease.     

Factors associated with emotional distress among caregivers of patients with schizophrenia in Katsina,Nigeria

Background  

Caregivers play an important role in the management of chronic mental illness in the community. Caring for patients with chronic mental illness like schizophrenia can cause emotional distress in the caregivers. However, the magnitude of the problem remains largely unknown in Sub-Saharan Africa and other developing countries.     

Stress Is Associated with Unfavorable Patterns of Dietary Intake Among Female Chinese Immigrants

Background  

Chinese immigrants experience increased risk for weight gain and chronic disease after US migration. Whether psychosocial stress affects their eating behavior is unknown.     

Chronicity of sleep problems in children with chronic illness: a longitudinal population-based study

Background  

The aim of this study was to examine the chronicity of sleep problems in children with chronic illness, and potential predictors of sleep problems.     

Experiencing multiple concurrent functional gastrointestinal disorders is associated with greater symptom severity and worse quality of life in chronic constipation and defecation disorders

Background

Recent community-based studies have demonstrated that experiencing multiple concurrent functional gastrointestinal disorders (FGIDs) is associated with increased somatization, worse quality of life (QoL), and greater health care utilization. However, the presence of multiple overlapping FGIDs is unstudied specifically in chronic constipation and functional defecation disorders (FDD). We investigated the prevalence and impact of additional nonconstipation FGIDs on constipation severity, anorectal physiology, anxiety and depression, and QoL, in patients with chronic constipation and FDD.

Methods

One-hundred and forty-six consecutive patients with functional constipation or irritable bowel syndrome (IBS-C/IBS-M) presenting to a tertiary referral Neurogastroenterology Clinic were studied. In addition, 90/146 (62%) qualified for FDD due to abnormal defecatory physiology. Patients underwent comprehensive baseline assessment comprising anorectal physiology, Bristol Stool Chart, Rome questionnaire, Knowles-Eccersley-Scott-Symptom (KESS) constipation score, Hospital Anxiety, and Depression Scale, and modified 36-Item Short Form Health Survey (SF-36) for QoL. Additional FGIDs were diagnosed using Rome III criteria.

Key Results

Additional nonconstipation FGIDs occurred in 85% of patients, with a mean of 2.1 (SD 1.6) additional FGIDs. Patients with four or more additional FGIDs experienced greater constipation severity compared to those with no additional FGIDs (p = 0.004). Comorbid FGIDs were associated with worse SF-36 scores for physical functioning (p < 0.001), role-physical (p = 0.005), bodily pain (p < 0.001), vitality (p = 0.008), social functioning (p = 0.004), and mental health index (p = 0.031).

Conclusions and Inferences

Functional gastrointestinal disorders comorbidity is highly prevalent in chronic constipation and defecatory disorders, and this is associated with greater symptom severity and worse QoL. Multimodal treatments targeting comorbid FGIDs may lead to superior outcomes.     

C-Reactive Protein and Pain Sensitivity: Findings from Female Twins

Background  

Systemic inflammation and pain sensitivity may contribute to the development and maintenance of chronic pain conditions.     

Domains of Chronic Stress,Lifestyle Factors,and Allostatic Load in Middle-Aged Mexican-American Women

Background  

Little research has examined how chronic stress in different domains relates to allostatic load (AL).     

Convulsive liability of bupropion hydrochloride metabolites in Swiss albino mice

Background  

It is known that following chronic dosing with bupropion HCl active metabolites are present in plasma at levels that are several times higher than that of the parent drug, but the possible convulsive effects of the major metabolites are not known.     

The association between chronic illness,multimorbidity and depressive symptoms in an Australian primary care cohort

Purpose  

To assess the link between multimorbidity, type of chronic physical health problems and depressive symptoms     

Chronic medical conditions mediate the association between depression and cardiovascular disease mortality

Purpose  

To determine whether chronic medical conditions mediate the association between depression and cardiovascular disease (CVD) mortality.     

Central Pontine Myelinolysis in a Patient with Hyperosmolar Hyperglycemia and Consistently Normal Serum Sodium

Introduction  

Central pontine myelinolysis (CPM) is almost always described in association with a disturbance in sodium homeostasis, most commonly rapid correction of chronic hyponatremia. It has only rarely been described in patients with disturbances of serum osmolality in the absence of abnormal serum sodium concentrations.     

Risk Factors and Outcome of Seizures After Chronic Subdural Hematoma

Background  

Seizures are important neurologic complications of chronic subdural hematoma (CSDH). A better understanding of risk factors of seizures following CSDH is needed to identify the patient who will require treatment.     

Perceived Weight Discrimination Amplifies the Link Between Central Adiposity and Nondiabetic Glycemic Control (HbA<Subscript>1c</Subscript>)

Background  

While the preclinical development of type 2 diabetes is partly explained by obesity and central adiposity, psychosocial research has shown that chronic stressors such as discrimination have health consequences as well.     

Changes in autonomic balance in patients with decompensated chronic heart failure

Objective  

In chronic heart failure (CHF) episodes of decompensation may be linked to derangements within cardiovascular reflex control. We investigated changes in autonomic tone in patients with decompensated CHF.     

Self-reported drunkenness among adolescents in four sub-Saharan African countries: associations with adverse childhood experiences

Background  

Consumption of alcohol is associated with acute and chronic adverse health outcomes. There is a paucity of studies that explore the determinants of alcohol use among adolescents in sub-Saharan Africa and, in particular, that examine the effects of adverse childhood experiences on alcohol use.