Prevalence of pain, analgesic self-medication and mental health in German pre-hospital emergency medical service personnel: a nationwide survey pilot-study

Cut-off scores of the Depression Anxiety Stress Scale-8: Implications for improving the management of chronic pain

AIM

Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management.

DESIGN

This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13-71 years).

METHODS

Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist.

RESULTS

Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake.

CONCLUSION

CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities.

IMPLICATIONS FOR PATIENT CARE

At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.

Pathophysiology, Clinical Implications and Management of Orofacial Neuropathic Pain- with special attention to Trigeminal neuralgia: A Narrative Review

Background: It is a widely held belief that if the trigeminal nerve is damaged, the victim would experience agonising and unrelenting external pain. A lesion to the trigeminal nerve may have a wide-reaching effect, such as on one side of the face in particular, or it might have a more localised effect, such as on some or all of your gums. The risk of damage increases the likelihood that it will be difficult to speak and swallow. This nerve provides sensation to a part of your face that may be constantly aching or tingling for some people. However, the trigeminal nerve injury-related persistent orofacial pain might be brought on by a wide variety of unknown triggers. Aim: In this study investigate the clinical manifestations of chronic orofacial pain brought on by a damage to the trigeminal nerve, as well as the diagnostic and therapeutic approaches available to treat this condition. Methodology Through the use of search phrases such as "Trigeminal nerve injury," "Trigeminal ganglion," "Trigeminal spinal subnucleus caudalis," "Craniofacial pain," "Oral prognosis," and "treatment," the computerised databases for the last twenty years have been investigated. There are now two hundred objects in total that have been accumulated. There have been around fifty of them that are pertinent to the discussion that is going on in this work. Majority of the patients fair enough with the pharmacology treatment/drugs like the carbamazepine & oxcarbazepine which forms the first line treatment options followed by lamotrigine & baclofen encompassing the second line of drugs along with adjuvant drug support of topiramate, levetiracetam, gabapentin, pregabalin. As the field of science has explored &advanced for the latest treatment options include microvascular decompression, gamma knife radiosurgery, percutaneous rhizotomies variable based on the evidences & guidelines 54 Conclusion: New diagnostic criteria and treatment alternatives have become available for people who suffer from trigeminal neuropathy and orofacial neuropathic pain as a result of recent developments in fundamental animal research that have led to their development. Despite the results, more research needs to investigate a greater variety of distinct non-neuronal cell feature approaches.

Der Einfluss von Frequent Usern auf das Rettungsfachpersonal: Ergebnisse einer Umfrage

Hintergrund

Frequent User (FU) nutzen den Rettungsdienst vermehrt in kürzester Zeit und können so direkten Einfluss auf Einsatzaufkommen und -charakter nehmen. Aus diesem Grund war das Ziel dieser Studie, die Wahrnehmung von Rettungskräften zu FU in Deutschland zu untersuchen.

Methoden

Es wurde eine deutschlandweite Querschnittstudie als Befragung von Rettungskräften durchgeführt. Die Auswertung der Daten erfolgte deskriptiv unter Berechnung von Häufigkeiten. Unterschiede zu FU im ländlichen und städtischen Bereich wurden mittels Chi2-Test und unter Berechnung von Odds Ratios (OR) und dazugehörigen 95 %-Konfidenzintervallen (95 %-KI) ermittelt.

Ergebnisse

Insgesamt wurden 1142 Rettungskräfte (36,69 % Frauen, 62,87 % Männer) in die Studie eingeschlossen. Die beiden häufigsten wahrgenommenen Einsatzorte im Zusammenhang mit FU waren bestimmte Privatadressen (32,75 %) und Pflegeheime (29,99 %), so wie die häufigsten Ursachen für Rettungsdiensteinsätze Versorgungsprobleme (44,66 %) und Intoxikationen (24,34 %) sind. Auf dem Land waren ebenfalls bestimmte Privatadressen (42,51 %) die häufigsten Einsatzorte, wohingegen in der Stadt bestimmte Stadtteile im Vordergrund standen (34,94 %). FU hatten einen negativen Einfluss auf das Verhalten, die Stimmung und die Geduld der Rettungskräfte. Im ländlichen Raum war zudem die Tendenz zu einer weniger sorgfältigen Untersuchung der FU niedriger (OR: 0,61 [95 %-KI: 0,48; 0,78]) und dass FU keine Versorgung wünschen, da die Alarmierung durch Dritte erfolgte (OR: 0,67 [95 %-KI: 0,53; 0,84]). Dagegen schätzen die FU ihre Symptome auf dem Land häufiger bedrohlicher ein als notwendig (OR: 1,95 [95 %-KI: 1,37; 2,77]) und Einsätze zu FU waren häufiger außerhalb der Öffnungszeiten von Versorgungseinrichtungen (OR: 1,65 [95 %-KI: 1,30; 2,09]).

Schlussfolgerung

Diese Studie zeigt, dass Frequent User sich negativ auf die Stimmung sowie die Arbeitsweise der Rettungskräfte auswirken und dass sowohl in dieser Hinsicht als auch bezogen auf die häufigsten Einsatzorte Unterschiede in der Stadt- und Landrettung bestehen.

[Incapacity to work in prehospital German emergency medical services staff]

Background

The determination of incapacity to work is a central approach for analyses of absence due to sickness. Nevertheless, no data are yet available for incapacity to work and associated factors in the German prehospital emergency medical services (EMS) staff.

Objective

The aim of this analysis was to identify the proportion of EMS staff with at least one incapacity for work (AU) in the previous 12 months and associated factors.

Material and methods

This was a nationwide survey study with rescue workers. Factors associated with work disability were identified using multivariable logistic regression, calculating odds ratios (OR) and associated 95% confidence intervals (95% CI).

Results

Included in this analysis were 2298 employees of the German emergency medical services (female 42.6%, male 57.2%). Overall, 60.10% of female participants and 58.98% of male participants reported an incapacity for work in the previous 12 months. Incapacity for work was significantly associated with having a high school diploma (high school diploma: OR: 0.51, 95% CI 0.30; 0.88, p = 0.016; reference: secondary school diploma), working in a rural environment (OR: 0.65, 95% CI 0.50; 0.86, p = 0.003) or urban environment (OR: 0.72, 95% CI: 0.53; 0.98, p = 0.037). Furthermore, hours worked per week (OR: 1.01, 95% CI: 1.00; 1.02, p = 0.003) and 5-< 10 years of service (OR: 1.40, 95% CI: 1.04; 1.89, p = 0.025) were associated with higher odds of work disability. Neck and back pain, depression, osteoarthritis, and asthma in the previous 12 months also showed a significant association with work disability in the same time period.

Conclusion

This analysis shows that chronic diseases, educational attainment, area of assignment, years of service, and hours worked per week, among others, were associated with incapacity for work in the previous 12 months in German EMS staff.

[Pain, analgesic intake and mental health of German intensive care unit nurses]

BACKGROUND AND AIM

Since nurses in general are frequently affected by pain and depressive episodes, the aim of this study was to analyze the prevalence of pain, frequency of analgesic intake and the mental health of intensive care nurses.

METHODS

This study was a survey study of German intensive care nurses and the questionnaire comprised self-developed items and the short version of the Depression Anxiety Stress Scale (DASS-21).

RESULTS

A total of 432 intensive care nurses (82.97% female) were included in the analysis. Recurrent pain was reported by 36.81% (95% confidence interval [CI]: 31.31%; 42.99%) of study participants and chronic pain by 18.52% (95% CI: 14.68%; 23.05%). Body weight (adjusted odds ratio (AOR): 1.02 [95% CI: 1.01; 1.03]; p = 0.006) and sex (male AOR: 0.33 [95% CI: 0.14; 0.78]; p = 0.012) were significantly associated with chronic pain, and sex (male AOR: 0.59 [95% CI: 0.31; 1.00]; p = 0.049) and the presence of sleeping problems (AOR: 2.16 [95% CI: 1.41; 3.31]; p ≤ 0.001) with recurrent pain. Analgesics were used by 52.61% of study participants with chronic/recurrent pain (most frequently used substance: ibuprofen [81.67%]). Study participants with chronic and recurrent pain indicated significantly higher depression, anxiety and stress levels compared to those without pain.

CONCLUSION

This study indicates that a large number of participating intensive care nurses are suffering from chronic and recurrent pain. Pain in this population was associated with a variety of factors.

Investigation of Psychological Stress and Sleep Quality of Emergency Medical Technicians in Taiwan Fire Department during the COVID-19 Pandemic

When the coronavirus disease 2019 (COVID-19) began to ravage the world in 2019, the World Health Organization became concerned. The epidemic has a high mortality and contagion rate, with severe health and psychological impacts on frontline emergency medical service system practitioners. There are many hospital staff surveys, but few have covered the stress among emergency medical technicians. DASS-21, PSQI, and AUDIT questionnaires were used to evaluate the sources of psychological stress factors of firefighters in Taiwan. Multiple logistic regression was used to analyze the questionnaire content. We conducted questionnaire surveys from May 2022 to July 2022. Our sample comprised 688 participants. The odds ratios of increased depression, anxiety, and stress levels due to reduced family or peer understanding and support were 2.72 (95% CI: 1.50−4.92), p = 0.001; 2.03 (95% CI: 1.11−3.68), p = 0.021; and 3.27 (95% CI: 1.83−5.86), p < 0.001, respectively. The odds ratios of poor sleep quality due to depression, anxiety, and increased stress levels were 5.04 (3.18−7.99), p < 0.001; 2.44 (95% CI: 1.57−3.81), p < 0.001; and 4.34 (95% CI: 2.76−6.82), p-value < 0.001, respectively. During the COVID-19 pandemic, poor sleep quality and a lack of understanding and support from the Taiwan firefighting agency staff, family, or peers resulted in increased depression, anxiety, and stress levels.

Pain and associated factors in German occupational therapists: a nationwide cross-sectional survey study

Background

Back pain is a common event in the general German population, but little is known about pain prevalence among occupational therapists (OT).

Objective

The aim of this study was to estimate the prevalence of pain and associated factors in German OTs.

Methods

We conducted a cross-sectional survey study. The prevalence of acute, chronic, and recurrent pain was calculated, and factors associated with chronic and recurrent pain were identified using multivariate logistic regression analysis.

Results

A total of 444 OTs (89.41% female) with a mean age of 37.78 (SD = 11.63) years were included into the final analysis. Prevalence of acute pain was 3.83% (95% confidence interval [95% CI]: 2.25%; 6.06%), of chronic pain 15.54% (95% CI: 12.30%; 19.25%), and of recurrent pain 43.02% (95% CI: 38.36%; 47.77%). The most frequently affected pain site was the lumbar spine. Significantly associated with chronic pain was the level of depression (adjusted odds ratio [AOR]: 1.05 [95% CI 1.00; 1.10]; p ≤ 0.042) of study participants. Recurrent pain was significantly associated with a standing working position, working in geriatrics, stress level, and the level of graduation in multivariate analysis.

Conclusion

This study estimated the prevalence of pain and identified factors associated with chronic and recurrent pain in participating OTs. To provide prevention measures and to identify more factors, further studies should be conducted.

Prevalence of Pain and Its Risk Factors Among ICU Personnel in Tertiary Hospital in China: A Cross-Sectional Study

Background

Although pain is commonly observed among medical staff, studies on pain among intensive care unit personnel are uncommon, especially intensive care unit (ICU) doctors and workers. Moreover, few studies have focused on the prevalence of pain and the associated factors.

Purpose

The aim of this study was to estimate the prevalence of pain among ICU personnel (including doctors, nurses and workers) and explore the risk factors for their pain.

Methods

We conducted an online survey that included sociodemographic and work-related items and questions about pain, ergonomics, and psychological factors. We used the short version of the validated Depression-Anxiety-Stress Scale (DASS-21) to assess the relationship between pain and mental disorders. All ICU personnel at West China Hospital of Sichuan University participated in this study.

Results

A total of 356 ICU personnel were included in the final analysis. The prevalence of pain was 72.2% among ICU nurses, 64.4% among ICU doctors and 52.9% among ICU workers. The most frequent location of pain was the lower back among nurses (65.9%) and workers (47.1%) and the neck among doctors (49.1%). The factors contributing to pain among ICU personnel were bending or twisting the neck, high levels of psychological fatigue, low self-perceived health status, female sex and high body mass index (BMI). Moreover, participants with pain indicated significantly higher depression (p ≤ 0.001), anxiety (p ≤ 0.001), and stress levels (p = 0.002) than those without pain.

Conclusion

This study indicates that ICU personnel exhibit a high prevalence of pain. Many factors, especially psychosocial and ergonomic factors, contribute to pain levels among ICU personnel and the poorer mental health levels observed in those experiencing pain. Therefore, disease prevention and health promotion measures are needed to protect the health of ICU personnel.

The prevalence of diseases in German emergency medical services staff: A survey study

For the general German population, the GEDA study is the main health monitoring study. Since nothing comparable is existing regarding the health of emergency medical services (EMS) staff, the aim of the present study was to estimate the 12-months prevalence of socially relevant diseases and symptoms among German pre-hospital EMS staff. This was a nationwide survey study. For retrieval of information on the health status of participating EMS staff items from the GEDA2014/2015 study were used. Afterwards, 12-months prevalence or proportions and corresponding 95% confidence intervals (95% CI) were calculated. Overall, 2,313 German pre-hospital EMS staff (42.6% female/57.2% male) with a median age of 25.0 (min. 18.0; max. 63.0) years were included into the final analysis. Obesity based on BMI was present in 25.9% (95% CI: 23.5%; 28.4%) of male compared to 15.7% (95% CI: 13.5%; 18.1%) of female study participants. Highest 12-months prevalence in the full study sample were calculated for lower back pain (41.1% [95%: 39.1%; 43.2%]), cervical pain (32.9% [95% CI: 30.9%; 34.8%]), allergies (32.6% [95% CI: 30.7%; 34.6%], depression (13.7% [95% CI: 12.4%; 15.2%]), and hypertension (11.5% [95% CI: 10.3%; 12.9%]). The 12-months prevalence in specific age-/gender-groups were higher for asthma, depression, hypertension, increased blood lipids, and osteoarthritis among study participants compared to the general German population (GEDA study) with the same age and gender (ratio ≥ 1.5). This study indicates that the prevalence of obesity, depression, hypertension, and other disorders is high among study participants and disease prevention measures for pre-hospital EMS staff are needed.

Influence of acid-sensing ion channel blocker on behavioral responses in a zebrafish model of acute visceral pain

Acid-sensing ion channels (ASICs) play significant roles in numerous neurological and pathological conditions, including pain. Although acid-induced nociception has been characterized previously in zebrafish, the contribution of ASICs in modulating pain-like behaviors is still unknown. Here, we investigated the role of amiloride, a nonselective ASICs blocker, in the negative modulation of specific behavioral responses in a zebrafish-based model of acute visceral pain. We verified that intraperitoneal injection (i.p.) of 0.25, 0.5, 1.0, and 2.0 mg/mL amiloride alone or vehicle did not change zebrafish behavior compared to saline-treated fish. Administration of 2.5% acetic acid (i.p.) elicited writhing-like response evidenced by the abnormal body curvature and impaired locomotion and motor activity. Attenuation of acetic acid-induced pain was verified at lower amiloride doses (0.25 and 0.5 mg/mL) whereas 1.0 and 2.0 mg/mL abolished pain-like responses. The protective effect of the highest amiloride dose tested was evident in preventing writhing-like responses and impaired locomotion and vertical activity. Collectively, amiloride antagonized abdominal writhing-like phenotype and aberrant behaviors, supporting the involvement of ASICs in a zebrafish-based model of acute visceral pain.

Pain in German physiotherapists: an analysis of pain prevalence and analgesics intake

Background Healthcare professionals of different occupations report pain, in particular back pain. It is known that the handling of patients and standing for long periods of time – like physiotherapists do, as well as working in bent posture – are causes of back pain. A high prevalence of low back pain (LBP) in German physiotherapists is to be expected.

Objective To determine pain point prevalence, severity of pain, type of pain (acute, chronic, recurrent), most affected body locations and extent of analgesics intake in German physiotherapists.

Method This was a nationwide online survey with German physiotherapists. Univariable and multivariable methods were applied to identify associations between sociodemographic variables and pain, type of pain and pain location as well as analgesic intake by type of pain. In addition, severity of pain by type was examined using the Kruska-Wallis Test.

Results A total of 550 physiotherapists were included in the analysis. Prevalence of pain was 63.09 % (acute: 4.18 %, chronic: 15.27 %, recurrent: 43.64 %). Most frequently mentioned pain locations were lumbar spine (49.27 %), cervical spine (48.39 %) and head (40.47 %). Participants with chronic pain reported a higher pain severity than physiotherapists with recurrent pain. Analgesics were used by 35.29 % of study participants with pain. Participants with chronic pain indicated a significantly higher probability of using analgesics compared to physiotherapists with recurrent pain.

Conclusion This study indicates a high prevalence of pain and analgesics intake in participating physiotherapists. Therefore, measures are needed to reduce pain in German physiotherapists.