Frequency of mental disorders among chronic pain patients with or without fibromyalgia in Japan

Psychological Pain, Hopelessness and Suicide Ideation in Female Patients with Fibromyalgia

Objective

Objective: The aim of this study was to investigate if psychache and hopelessness may serve as reliable predictors of suicidal ideation among female fibromyalgia (FM) patients.

Method

This was a cross-sectional study of 50 women with FM, examining the relationship between psychological pain, hopelessness, depressive symptoms, and suicidal ideation. FM diagnosis was confirmed by the American College of Rheumatology (ACR) criteria. Demographic data, the Mini International Neuropsychiatric Interview (MINI 7.0.2), the Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), the Pittsburgh Sleep Quality Index (PSQI) and the Psychache Scale were utilized to assess these relationships and their predictive value for suicidality.

Results

The mean age of the participants was 50.2 years (±8.7). Thirty-two (64%) patients had current major depression, 11 (22%) had bipolar disorder, 20 (40%) presented passive suicidal ideation and 14 (28%) presented active suicidal ideation. Psychological pain correlated with both depressive symptoms (p<0.01; r= 0.648) and hopelessness (p=0.029; r=0.312) but did not predict suicidal ideation. Logistic regression analyses revealed depressive symptom severity as a predictor of passive suicidal ideation (odds ratio = 1.486; 95% CI: 1.017 - 2.170), while hopelessness predicted active suicidal ideation (odd ratio = 1.356; 95% CI, 1.049 - 1.753).

Conclusions

FM female patients showed increased prevalence of suicidal ideation. Hopelessness predicts active suicidal ideation but psychological pain did not serve as predictive factor for suicide ideation among female FM patients.

Cross-sectional study of psychiatric disorders in patients with chronic musculoskeletal pain and individuals without pain

BACKGROUND

Musculoskeletal chronic pain is a leading cause of global disability and laboral incapacity. However, there is a lack of population-based studies that investigate the relationship between chronic pain and mental disorders with a control group, particularly among low- and middle-income countries. Chronic pain is a serious public health problem in terms of human suffering, and in terms of socioeconomic implications. Frequent association with different mental disorders increases disability, decreases quality of life, and makes diagnosis and treatment challenging. The present study aimed to evaluate the presence of mental disorders in patients with chronic musculoskeletal pain and compare with a control group without pain.

METHODS

We selected 100 patients in a regular follow-up at the Musculoskeletal Pain Outpatient Clinic of the University Hospital and compared them with 100 painless individuals from the control group from June 2016 to June 2018. The instruments used were the Mini International Neuropsychiatric Interview (MINI-PLUS) and a structured questionnaire to collect sociodemographic data. Statistical analysis used t-test, chi-square, Fisher's exact test, Mann-Whitney, Kolmogorov-Smirnov tests, and multiple logistic regression.

RESULTS

In the sample evaluated, the majority of patients were women (83%), of brown color (54%), with lower-level education (51%), lower salary range (73%) and high absenteeism rate at work (60,7%). Patients with chronic pain had more psychiatric disorders (88% vs. 48% in the control group; p < 0.001). The most frequent diagnoses were anxiety disorders with panic attacks (44%), generalized anxiety (36%), mixed anxiety and depression disorder (33%), social phobia (30%), agoraphobia (29%), suicide risk (28%), and major depression (27%).

CONCLUSION

Positive correlations of mental disorders and chronic musculoskeletal pain have been documented. This suggests that psychiatric components must be taken into account in the management of chronic pain syndromes. The use of Mini Plus as a diagnostic tool for psychiatric disorders can contribute to optimizing the diagnosis and treatment of patients with chronic pain and encourage the creation of policies with strategies and criteria for quick access to Multi-professional Services.

Association between self-reported pain severity and characteristics of United States adults (age ≥50 years) who used opioids

OBJECTIVE

The aim of this study was to assess the associations between the characteristics of United States (US) adults (≥50 years) who used opioids and self-reported pain severity using a nationally representative dataset.

METHODS

This retrospective cross-sectional database study used 2019 Medical Expenditure Panel Survey data to identify US adults aged ≥50 years with self-reported pain within the past 4 weeks and ≥1 opioid prescription within the calendar year (n = 1,077). Weighted multivariable logistic regression analysis modeled associations between various characteristics and self-reported pain severity (quite a bit/extreme vs less/moderate pain).

RESULTS

The adjusted logistic regression model indicated that greater odds of reporting quite a bit/extreme pain was associated with the following: age 50-64 vs ≥65 (adjusted odds ratio [AOR] = 1.76; 95% confidence interval [CI] = 1.22-2.54), non-Hispanic vs Hispanic (AOR = 2.0; CI = 1.18-3.39), unemployed vs employed (AOR = 2.01; CI = 1.33-3.05), no health insurance vs private insurance (AOR = 6.80; CI = 1.43-32.26), fair/poor vs excellent/very good/good health (AOR = 3.10; CI = 2.19-4.39), fair/poor vs excellent/very good/good mental health (AOR = 2.16; CI = 1.39-3.38), non-smoker vs smoker (AOR = 1.80; CI = 1.19-2.71), and instrumental activity of daily living, yes vs no (AOR = 2.27; CI = 1.30-3.96).

CONCLUSION

Understanding the several characteristics associated with pain severity in US adults ≥50 years who used an opioid may help transform healthcare approaches to prevention, education, and management of pain severity in later life.

Cervical Spondylosis as a Hidden Contributing Factor to Fibromyalgia: A Case Report

The present case study describes the long-term symptomatic remission in a patient with fibromyalgia (FM) after multimodal spinal manipulation. A 44-year-old woman presented with a chronic headache, severe neck pain, shoulder pain, and back pain lasting for 2 years after experiencing domestic violence. She had sleep disorders, fatigue, and depressive mood. Her primary care physician diagnosed her with FM and comorbid depression. Despite treatment with non-steroidal anti-inflammatory drugs, muscle relaxants, anti-depressants, anti-epileptics, acupuncture, and aqua-therapy, she experienced no appreciable relief from her symptoms. The patient then sought a chiropractic evaluation and potential treatment for her symptoms. At presentation, widespread tenderness was palpable over the neck, shoulder, back, anterior chest, abdominal wall, and buttock. Radiographs showed loss of cervical lordosis, widespread degenerative spondylosis, and osteitis pubis. Surface electromyography (sEMG) revealed neck and thoracic paraspinal muscular spasms. The patient was diagnosed with FM based on the American College of Rheumatology diagnostic criteria and the associated comorbidities. Multimodal chiropractic approaches, which consisted of spinal manipulation, massage, and intermittent motorized cervical traction, were used twice weekly to relieve soft-tissues and intervertebral joints and stretch core musculatures. The patient's physical and mental complaints were mostly resolved near the end of 9 months of treatment. Her symptom alleviation was associated with corresponding change in normalized sEMG signal and cervical spine realignment at the 16th- and 26th-month follow-ups. Widespread pain in FM can lead to confused thinking and a lack of awareness of cervical spondylosis. In this example, it is assumed that the noxious cervical inputs triggered an ongoing FM process. Chiropractic treatment blocked noxious inputs coming from pain sources, corrected pain thresholds, and lowered excitability, thereby eradicating FM symptoms.

Understanding Experiences of Fibromyalgia Patients Involved in the Fimouv Study During COVID-19 Lockdown

Introduction: The COVID-19 pandemic implied a period of lockdown for the general population, increasing the risk to develop some physical or mental disorders. In fibromyalgia patients, these disorders are part of the large clinical picture of the syndrome. Fibromyalgia management is especially based on a regular practice of physical activity. Lockdown imposed a break in rhythms, requiring a restructuring of scheduling. Thus, the present study aimed to investigate the experiences of fibromyalgia patients during COVID-19 lockdown using a qualitative analysis.

Method: 19 patients (52 ± 9 years old) who completed a 3-month therapeutic education and/or supervised physical activity program were invited to participate (Fimouv study, Trial registration: ClinicalTrials.gov NCT04107948). A sociologist collected data by means of semi-structured interviews and analyzed them using thematic content analysis.

Results: Lockdown exacerbated the main symptoms of fibromyalgia, but adjusting the rhythms of life to fluctuations of these symptoms allowed a better quality of life. Patients felt the lack of physical activity and 68% found alternatives to remain physically active. The reduction of social constraints allowed them to better contend with their pathology. Fibromyalgia stopped being a main priority.

Conclusion: Lockdown was positively experienced by fibromyalgia patients. They linked the absence of physical activity with increased pain and fatigue. Nevertheless, reducing social constraints could be a key for fibromyalgia management, where symptoms seemed to take less space in everyday life.

Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04107948.

Frequency of mental disorders among chronic pain patients with or without fibromyalgia in Japan

Aim

To explore the characteristics of psychiatric morbidity in chronic pain patients who present with or without fibromyalgia.

Methods

Patients are referred to our chronic pain clinic from primary medical institutions, as we are a secondary medical institution. Although some patients have chronic pain, they have no clear organic disorder such as rheumatoid arthritis to account for the pain. Among the 367 new patients seen during the period from March 2009 to August 2012, 347 patients underwent psychiatric evaluation in face‐to‐face interviews with mental health specialists before a physical examination.

Results

Of the 347 patients examined, at least one psychiatric diagnosis was made for 94.6%. The average number of DSM‐IV‐TR diagnoses was 1.46 in the 330 chronic pain patients who had at least one psychiatric diagnosis. The breakdown of the number of psychodiagnoses was one in 60.8%, two in 27.1%, three in 4.9%, and more than three in 2.3% chronic pain patients with or without fibromyalgia. In fibromyalgia patients, the highest relative frequencies were found for somatoform disorders (76%), followed by dysthymic disorder (17%) and major depressive disorder (15%). In patients without fibromyalgia, the highest relative frequencies were found for somatoform disorders (64%), followed by major depressive disorder (15%) and dysthymic disorder (14%). Psychiatric disorders were found in 96.9% of fibromyalgia patients, and in 93.5% of chronic pain patients without fibromyalgia in Japan (no significant difference using chi‐square test).

Conclusion

Results show that chronic pain patients with or without fibromyalgia are extremely likely to be diagnosed with a psychiatric disorder.

Psychodiagnoses of fibromyalgia patients and chronic pain patients without fibromyalgia.