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Duque RH, Andrade CVC, Campos VR, Moulaz IR, Albertino LF, de Oliveira Gavi MBR. Cross-sectional study of psychiatric disorders in patients with chronic musculoskeletal pain and individuals without pain. Adv Rheumatol 2024; 64:40. [PMID: 38730423 DOI: 10.1186/s42358-024-00375-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
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.
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Affiliation(s)
- Ruben Horst Duque
- Rheumatology Department, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Carla Vasconcelos Cáspar Andrade
- Neuromusculoskeletal Unit, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Valdir Ribeiro Campos
- Psychiatry Service, Internal Medicine Department, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Vitoria, ES, Brazil
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2
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Fanninger S, Plener PL, Fischer MJM, Kothgassner OD, Goreis A. Water temperature during the cold pressor test: A scoping review. Physiol Behav 2023; 271:114354. [PMID: 37717684 DOI: 10.1016/j.physbeh.2023.114354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/19/2023]
Abstract
The cold pressor test (CPT) is a commonly used method to induce pain and stress in experimental settings. Previous research has found that the temperature of the water used in the test significantly affects outcome measures such as pain tolerance. Variations in CPT protocols, specifically regarding temperature, have been criticized. Hence, our objective is to investigate water temperature and associated methodological factors through a scoping review of the CPT in adults. Among 331 included trials, the most commonly reported temperature was 1°C (33.8°F). Reporting of the water temperature was adequate (93% of all trials), but a precise range within which the temperature was maintained was reported only in 27% of all trials. Pain measurement was the primary focus for most studies (90%), predominantly utilizing pain tolerance as the main outcome (78%). Water circulation was reported in 44% of studies, and 10% reported manually agitating the water. The most common maximum immersion time (i.e., ceiling time) was 180 s; notably, 64% of trials lacked information on participant awareness of this limit specification. The limb most immersed was the hand (76%). Overall, multiple methodological factors significantly impacting outcome measures were inconsistently implemented or reported. For future studies, we advocate for precise standardization of the water temperature used during the CPT. We suggest using 1°C (33.8°F), especially when assessing pain tolerance. A cooling apparatus allowing precise temperature control and continuous water circulation is advised. At the bare minimum, the temperature should be monitored continuously. While other decisions regarding the implementation of the CPT may differ depending on the specific aims of the respective study, it remains essential to standardize the water temperature and to provide a comprehensive report of the experimental protocol.
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Affiliation(s)
- Selina Fanninger
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Michael J M Fischer
- Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria.
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3
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Kwon CY, Lee B. Prevalence of suicidal behavior in patients with chronic pain: a systematic review and meta-analysis of observational studies. Front Psychol 2023; 14:1217299. [PMID: 37842717 PMCID: PMC10576560 DOI: 10.3389/fpsyg.2023.1217299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Chronic pain is a leading cause of disability, severely impairing an individual's daily activity and quality of life. In addition, this condition may contribute to suicidal thoughts by leading to neuropsychological impairments, a perceived lack of meaning in life, and pain-related catastrophizing. This systematic review aimed to comprehensively investigate the prevalence and associated factors of suicidal behaviors (SBs) including suicidal ideation (SI) and suicide attempt (SA) or its complete, in individuals with chronic pain. Methods Five electronic databases were searched up to October 4, 2022. Only observational studies investigating the prevalence of SB in individuals with chronic pain were included. The methodological quality of the included studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. A meta-analysis was conducted to quantify the prevalence of SB in the population, and the command "Metaprop" was used in STATA/MP 16. In addition, factors explaining the association between chronic pain and SB identified through regression analysis were investigated. Results A total of 19 studies were included in this review (N = 3,312,343). The pooled lifetime prevalence of SI and SA was 28.90% (95% confidence interval, 17.95 to 41.26%) and 10.83% (5.72 to 17.30%), respectively, in a mixed sample comprising various chronic pain conditions. Importantly, the pooled prevalence of past 2-week SI was as high as 25.87% (18.09 to 34.50%). The methodological quality of the included studies was not optimal, and studies using validated SB assessment tools were lacking. Potential protective factors against SB in this population included pain coping and self-efficacy, older age, certain race/ethnicity groups, and marriage. Conclusion This systematic review and meta-analysis demonstrated the high prevalence of SB in individuals with chronic pain. Specifically, around 1 in 4 individuals with chronic pain had SI within the last 2 weeks. However, there was considerable heterogeneity in the pooled prevalence of SB in this population.
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-Eui University College of Korean Medicine, Busan, Republic of Korea
| | - Boram Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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4
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Boni M, Ciaramella A. Role of Personality and Psychiatric Disorders in the Perception of Pain. Psychiatr Q 2023:10.1007/s11126-023-10026-x. [PMID: 37266830 DOI: 10.1007/s11126-023-10026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/03/2023]
Abstract
Although previous studies have shown that psychiatric and personality disorders are more prevalent in chronic pain than in pain-free groups, few studies have investigated the prevalence of personality disorders (PerDs) in patients with chronic pain with and without a psychiatric comorbidity. The aim of the present study was therefore designed to investigate the burden of PerDs on the prevalence and perception of chronic pain in patients with and without psychiatric comorbidity. 232 patients from the Gift Institute for Integrative Medicine in Pisa, Italy, of which n = 161 (69.4%) were patients with chronic pain, were administered the SCID II for personality disorders and MINI for DSM IV-TR criteria. Both psychiatric and personality disorders were more prevalent in the chronic pain group than in the pain-free group (χ2 = 5.9, p = .015, φ = .16; χ2 = 7.2, p = .007, φ = .18). Cluster A and C PerDs were more prevalent in patients with chronic pain than in subjects without pain (χ2 = 8.1, p = .004, φ = .19; χ2 = 4.7, p = .030, φ = .14, respectively). Unlike Cluster C PerDs, however, Cluster A PerDs were more prevalent in the absence of psychiatric comorbidity (χ2 = 5.0, p = .024, φ = .29), and by themselves worsened the pain perceived. An appropriate PerD diagnosis can be helpful in the treatment of patients with chronic pain.
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Affiliation(s)
- Melania Boni
- Education Programme Partner, Aplysia APS, University of Pisa, Florence, Italy.
| | - Antonella Ciaramella
- Education Programme Partner, Aplysia APS, University of Pisa, Florence, Italy
- GIFT Institute of Integrative Medicine, Pisa, Italy
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5
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From Low-Grade Inflammation in Osteoarthritis to Neuropsychiatric Sequelae: A Narrative Review. Int J Mol Sci 2022; 23:ijms232416031. [PMID: 36555670 PMCID: PMC9784931 DOI: 10.3390/ijms232416031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Nowadays, osteoarthritis (OA), a common, multifactorial musculoskeletal disease, is considered to have a low-grade inflammatory pathogenetic component. Lately, neuropsychiatric sequelae of the disease have gained recognition. However, a link between the peripheral inflammatory process of OA and the development of neuropsychiatric pathology is not completely understood. In this review, we provide a narrative that explores the development of neuropsychiatric disease in the presence of chronic peripheral low-grade inflammation with a focus on its signaling to the brain. We describe the development of a pro-inflammatory environment in the OA-affected joint. We discuss inflammation-signaling pathways that link the affected joint to the central nervous system, mainly using primary sensory afferents and blood circulation via circumventricular organs and cerebral endothelium. The review describes molecular and cellular changes in the brain, recognized in the presence of chronic peripheral inflammation. In addition, changes in the volume of gray matter and alterations of connectivity important for the assessment of the efficacy of treatment in OA are discussed in the given review. Finally, the narrative considers the importance of the use of neuropsychiatric diagnostic tools for a disease with an inflammatory component in the clinical setting.
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6
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Favaretto E, Gögele M, Bedani F, Hicks AA, Erfurth A, Perugi G, Pramstaller PP, Melotti R. Pain sensitivity is modulated by affective temperament: Results from the population-based CHRIS Affective Disorder (CHRIS-AD) study. J Affect Disord 2022; 316:209-216. [PMID: 35952933 DOI: 10.1016/j.jad.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/06/2022] [Accepted: 08/06/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Nociceptive pain modulation is related to psychological and psychiatric conditions. Evidence from clinical studies backs innate temperaments as potential precursors of mood symptoms and disorders, and pain sensitivity. Our study examines the modulation effect of affective temperaments on pain sensitivity in a general population adult sample, accounting for possible intervening mood symptoms, lifetime anxiety and depression, and pain treatments. METHODS The sample is part of the CHRIS-AD study, Italy. Primary outcomes were the pain sensitivity questionnaire PSQ-total intensity score and the experimental pressure pain threshold (PPT). Affective temperaments were evaluated with the TEMPS-M. Lifetime depression, anxiety, current mood disorders, and treatments were self-reported via rating-scales. Directed acyclic graphs theory guided linear and mixed linear regression model analyses. RESULTS Among 3804 participants (aged 18-65; response rate 78.4 %, females 53.3 %, mean age 38.4 years) for any given temperament, both the PSQ-total and the PPT were associated with temperament. The TEMPS-M four cyclothymic-related temperaments aligned on the pain-sensitive pole and the hyperthymic on the pain-resilient pole. The inclusion of current or lifetime mood symptoms, or pain drug use, as possible intervening pathways only partly diluted these associations, with stronger evidence for an effect of trait anxiety. LIMITATIONS The main limitations were the lack of experimental measures of suprathreshold pain intensity perception, and detailed information on affective disorders in the study population. CONCLUSIONS These findings support the hypothesis of a biological dichotomous diathesis of affective temperaments towards pain sensitivity; hyperthymic suggesting protection, whereas cyclothymic suggesting predisposition.
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Affiliation(s)
| | - Martin Gögele
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy
| | - Fulvio Bedani
- Department of Psychiatry, General Hospital, Bressanone, Italy
| | - Andrew A Hicks
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy
| | - Andreas Erfurth
- Klinik Hietzing, Department of Psychiatry and Psychotherapeutic Medicine, Vienna, Austria
| | - Giulio Perugi
- Section of Psychiatry, Department of Experimental and Clinic Medicine, University of Pisa, Pisa, Italy
| | - Peter P Pramstaller
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy; Department of Neurology, General Central Hospital, Bolzano, Italy
| | - Roberto Melotti
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy
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Rosa ACF, Leão ER. Pain in the bipolar disorder: prevalence, characteristics and relationship with suicide risk. Rev Lat Am Enfermagem 2021; 29:e3463. [PMID: 34190952 PMCID: PMC8253371 DOI: 10.1590/1518-8345.4737.3463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/26/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: to know the prevalence and characteristics of pain, to verify how pain
management has been carried out by the health services, and to correlate
suicide risk with pain intensity in patients with bipolar disorder. Method: an observational study with a quantitative approach. The study included
people with bipolar disorder assessed by the McGill-Reduced Pain
Questionnaire, Body Diagram, Visual Numerical Scale, and the Suicidal
Ideation Scale (Beck). Results: the sample of 60 participants was mainly composed of women with a mean age of
40 years old and a mean psychiatric treatment time of approximately 13
years. Of these, 83% reported feeling pain at the time of the interview.
Half of the participants indicated that pain interferes with routine and 80%
did not receive care in health institutions. The main descriptors that
qualify the painful experience were as follows: painful, heavy and sensitive
for the sensory descriptors, tiring and punishing in the affective category.
Suicide attempt was reported by 57% of the participants. There was a
correlation between suicide risk and pain intensity. Conclusion: pain presented a high prevalence. Suicide risk was identified in more than
half of the participants. Pain intensity showed a significant correlation
with suicide risk.
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Affiliation(s)
- Ana Carolina Ferreira Rosa
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
| | - Eliseth Ribeiro Leão
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
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8
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Costello CA, Liu M, Furey A, Rahman P, Randell EW, Zhai G. Association Between Epidemiological Factors and Nonresponders to Total Joint Replacement Surgery in Primary Osteoarthritis Patients. J Arthroplasty 2021; 36:1502-1510.e5. [PMID: 33288389 DOI: 10.1016/j.arth.2020.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/27/2020] [Accepted: 11/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND While total joint replacement (TJR) is the most effective treatment for end-stage osteoarthritis (OA), one-third of patients do not experience clinically important improvement in pain or function following the surgery. Thus, it is important to identify factors for nonresponders and develop strategies to improve TJR outcomes. METHODS Study participants were patients who underwent TJR (hip/knee) due to OA and completed the WOMAC before and on average 4 years after surgery. Nonresponders (pain nonresponders, function nonresponders, pain and function nonresponders) were determined using the WOMAC change score from baseline to follow-up under two previously reported criteria. Eighty-eight self-reported factors collected by a general health questionnaire were examined for associations with nonresponders. RESULTS A total of 601 patients (30.8% hip and 69.2% knee replacement) were included; 18% of them were found to be either pain or function nonresponders. Nine factors were identified in the univariable analyses to be associated with nonresponders, and 5 of them (clinical depression, multisite musculoskeletal pain [MSMP], younger age, golfer's elbow, and driving more than 4 hours on average per working day) remained significant in the multivariable analyses in at least one of six categories. Clinical depression, having MSMP, and younger age were the major factors to be independently associated with nonresponders across five categories. In addition, two factors (age at menopause and age at hysterectomy) were significantly associated with female nonresponders. CONCLUSION Our data suggested potential roles of pain perception, widespread pain sensitization, patient expectations, and early menopause in females in TJR outcomes, warranting further investigation.
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Affiliation(s)
- Christie A Costello
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Ming Liu
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Andrew Furey
- Division of Orthopaedic Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Proton Rahman
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Edward W Randell
- Discipline of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Guangju Zhai
- Division of Biomedical Sciences (Genetics), Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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9
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González JL, Prabhakar R, Marks J, Vigen CLP, Shukla J, Bannister B. Reducing the Pain Behind Opioid Prescribing in Primary Care. PAIN MEDICINE 2020; 21:1377-1384. [PMID: 32022892 DOI: 10.1093/pm/pnz365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the efficacy of a comprehensive approach aimed at reducing opioid prescribing in an internal medicine resident clinic. DESIGN Retrospective observational study. SETTING Internal medicine primary care resident clinic at a large urban academic medical center. SUBJECTS All patients receiving opioid prescriptions from the primary care clinic. METHODS We reviewed pharmacy dispensing data for two hospital-affiliated pharmacies for resident primary care patients filling opioid prescriptions between July 2016 and July 2018. We instituted a comprehensive set of interventions that included resident education, limiting supervision of encounters for long-term opioid therapy (LTOT) to a fixed set of faculty champions, and providing alternate modalities for pain control. We calculated the change in number of opioid prescriptions dispensed, number of patients receiving opioid prescriptions, morphine milligram equivalents (MMEs) dispensed, and average per-patient daily MMEs dispensed. RESULTS We observed an average monthly reduction of 2.44% (P < 0.001) in the number of prescriptions dispensed and a 1.83% (P < 0.001) monthly reduction in the number of patients receiving prescriptions. Over the two-year period, there was a 74.3% reduction in total MMEs prescribed and a 66.5% reduction in the average MMEs prescribed per patient. CONCLUSIONS Our findings demonstrate a significant reduction in opioid prescribing after implementation of a comprehensive initiative. Although our study was observational in nature, we witnessed a nearly threefold decrease in opioid prescribing compared with national trends. Our results offer important insights for other primary care resident clinics hoping to engender safe prescribing practices and curb high-dose opioid prescribing.
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Affiliation(s)
- José Luis González
- University of Southern California, Los Angeles, California.,LAC+USC Medical Center, Los Angeles, California.,USC Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles, California
| | - Radhika Prabhakar
- University of Southern California, Los Angeles, California.,LAC+USC Medical Center, Los Angeles, California
| | - Jennifer Marks
- University of Southern California, Los Angeles, California.,LAC+USC Medical Center, Los Angeles, California
| | - Cheryl L P Vigen
- University of Southern California, Los Angeles, California.,Biostatistics, Epidemiology, and Research Design (BERD), University of Southern California, Los Angeles, California.,Southern California Clinical and Translational Science Institute (SC CTSI)
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10
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Wu H, Wu C, Wu F, Zhan Q, Peng H, Wang J, Zhao J, Ning Y, Zheng Y, She S. Covariation between Childhood-Trauma Related Resting-State Functional Connectivity and Affective Temperaments is Impaired in Individuals with Major Depressive Disorder. Neuroscience 2020; 453:102-112. [PMID: 32795554 DOI: 10.1016/j.neuroscience.2020.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 06/25/2020] [Accepted: 08/03/2020] [Indexed: 01/23/2023]
Abstract
Affective temperaments and childhood-trauma experiences are associated with major depressive disorder (MDD). So far, how the covariation between distinct affective temperaments and childhood-trauma insulted brain functional connectivities (FCs) contribute to MDD remains unclear. Here, we aimed to investigate whether certain brain FC patterns are related to certain affective temperaments and whether the FCs contribute to depressive symptom dimensions of MDD patients. Twenty-nine medication-free MDD patients and 58 healthy controls underwent magnetic resonance imaging scanning and completed the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS). Two multivariate analyses of partial least squares (PLS) regression were used to explore the associations among childhood-trauma related resting-state FCs, affective temperaments and depressive symptom dimensions. In all participants, a linear combination of 81 FCs (involving parahippocampus, amygdala, cingulate cortex, insula, frontal-temporal-parietal-occipital cortex, pallidum, and cerebellum) were associated with a linear combination of increased depressive, irritable, anxious, and cyclothymic temperaments. Moreover, the covariation between the PLS FC profile and the PLS affective-temperament profile were enhanced in the MDD patients compared to healthy controls. In MDD participants alone, the affective-temperament modulated FC profile (mainly of the lingual and temporal cortex) was associated with the somatization symptom dimension when age, sex, ill-duration, age-of-onset, and HARS scores were adjusted. The findings imply possible neural correlates of affective temperaments and may find applications in intervention of the somatization-depression symptoms by stimulation of the related neural correlates.
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Affiliation(s)
- Huawang Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China
| | - Chao Wu
- School of Nursing, Peking University Health Science Center, Beijing 100091, China
| | - Fengchun Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China
| | - Qianqian Zhan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou 510370, China
| | - Hongjun Peng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China
| | - Jiaojian Wang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 625014, China
| | - Jingping Zhao
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou 510370, China; The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China
| | - Yingjun Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou 510370, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou 510370, China.
| | - Shenglin She
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou 510370, China.
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11
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Bravo L, Llorca-Torralba M, Suárez-Pereira I, Berrocoso E. Pain in neuropsychiatry: Insights from animal models. Neurosci Biobehav Rev 2020; 115:96-115. [PMID: 32437745 DOI: 10.1016/j.neubiorev.2020.04.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 04/11/2020] [Accepted: 04/23/2020] [Indexed: 02/08/2023]
Abstract
Pain is the most common symptom reported in clinical practice, meaning that it is associated with many pathologies as either the origin or a consequence of other illnesses. Furthermore, pain is a complex emotional and sensorial experience, as the correspondence between pain and body damage varies considerably. While these issues are widely acknowledged in clinical pain research, until recently they have not been extensively considered when exploring animal models, important tools for understanding pain pathophysiology. Interestingly, chronic pain is currently considered a risk factor to suffer psychiatric disorders, mainly stress-related disorders like anxiety and depression. Conversely, pain appears to be altered in many psychiatric disorders, such as depression, anxiety and schizophrenia. Thus, pain and psychiatric disorders have been linked in epidemiological and clinical terms, although the neurobiological mechanisms involved in this pathological bidirectional relationship remain unclear. Here we review the evidence obtained from animal models about the co-morbidity of pain and psychiatric disorders, placing special emphasis on the different dimensions of pain.
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Affiliation(s)
- Lidia Bravo
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, 11003 Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Avda. Ana de Viya 21, 11009 Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Meritxell Llorca-Torralba
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, 11003 Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Avda. Ana de Viya 21, 11009 Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Irene Suárez-Pereira
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, University of Cádiz, 11003 Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Avda. Ana de Viya 21, 11009 Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Berrocoso
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, INiBICA, Hospital Universitario Puerta del Mar, Avda. Ana de Viya 21, 11009 Cádiz, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Neuropsychopharmacology and Psychobiology Research Group, Department of Psychology, University of Cádiz, 11510 Puerto Real, Cádiz, Spain.
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Kessing LV, Rytgaard HC, Gerds TA, Berk M, Ekstrøm CT, Andersen PK. New drug candidates for bipolar disorder-A nation-wide population-based study. Bipolar Disord 2019; 21:410-418. [PMID: 30873730 DOI: 10.1111/bdi.12772] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Drug repurposing is an increasingly promising idea in many fields of medicine. We systematically used Danish nation-wide population-based registers to investigate whether continued use of non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs), low-dose aspirin, high-dose aspirin, statins, allopurinol, and angiotensin agents decrease the rate of incident mania/bipolar disorder. METHODS A nation-wide population-based longitudinal study using Poisson regression analyses including all persons in Denmark who purchased the exposure medication of interest and a random sample of 30% of the Danish population. The follow-up period comprised a 10 years period from 2005 to 2015. Two different outcome measures were included, (1) a diagnosis of mania/bipolar disorder at a psychiatric hospital contact as inpatient or outpatient and (2) a combined measure of a diagnosis of mania/bipolar disorder or initiation of lithium use. RESULTS A total of 1,605,365 subjects were exposed to one of the six drugs of interest during the exposure period from 2005 to 2015, median age 57 years [quartiles: 43;69], and female proportion of 53.1%. Continued use of low-dose aspirin, statins, and angiotensin agents were associated with decreased rates of incident mania/bipolar disorder on both outcome measures. Continued uses of non-aspirin NSAIDs as well as high-dose aspirin were associated with an increased rate of incident bipolar disorder. There were no statistically significant associations for allopurinol. CONCLUSIONS The study supports the potential of agents acting on inflammation and the stress response system in bipolar disorder and illustrates that population-based registers can be used to systematically identify drugs with repurposing potentials.
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Affiliation(s)
- Lars V Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Helene C Rytgaard
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Michael Berk
- School of Medicine, Deakin University, Melbourne, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry, Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Claus T Ekstrøm
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Per K Andersen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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Abstract
Chronic pain is a frequent condition that affects an estimated 20% of people worldwide, accounting for 15%-20% of doctors' appointments (Treede et al., 2015). It lacks the acute warning function of physiologic nociception, and instead involves the activation of multiple neurophysiologic mechanisms in the somatosensory system, a complex neuronal network under the control of powerful autoregulatory loops and able to undergo rapid neuroplastic alteration (Verdu et al., 2008). There is a growing body of research suggesting that some such pathways are shared by major psychologic disorders such as depression and anxiety, opening new avenues in co-treatment strategies. In particular, besides anticonvulsants, which are today used as analgesics, other psychopharmaceuticals, such as the tricyclic antidepressants, are displaying efficacy in the treatment of neuropathic and nociceptive chronic pain. The state of the art regarding the mechanisms of nociception and the pharmacology of both the neurotransmitters involved and the wide range of psychoactive compounds that may be useful in the treatment of chronic pain are discussed.
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The onset of treatment with the antidepressant desipramine is critical for the emotional consequences of neuropathic pain. Pain 2018; 159:2606-2619. [DOI: 10.1097/j.pain.0000000000001372] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Han X, Liu X, Li L, Xie B, Fan B, Qiu Y, Liu T, Li L. Neural Activation During Tonic Pain and Interaction Between Pain and Emotion in Bipolar Disorder: An fMRI Study. Front Psychiatry 2018; 9:555. [PMID: 30459652 PMCID: PMC6232121 DOI: 10.3389/fpsyt.2018.00555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
Objective: Pain and affective disorders have clear clinical relevance; however, very few studies have investigated the association between pain and bipolar disorder. This study investigated the brain activity of patients with bipolar disorder (BPs) undergoing tonic pain and assessed the interaction between pain and emotion. Methods: Ten BPs and ten healthy controls (HCs) were exposed to emotional pictures (positive, neutral, or negative), tonic pain only (pain session), and emotional pictures along with tonic pain (combined session). A moderate tonic pain was induced by the infusion of hypertonic saline (5% NaCl) into the right masseter muscle with a computer-controlled system. Whole-brain blood oxygenation level dependent (BOLD) signals were acquired using 3T functional resonance imaging (fMRI). Results: Ten BPs and ten healthy participants were included in the final analysis. During the pain session, BPs accepted more saline, but showed lower pain rating scores than HCs. When experiencing pain, BPs showed a significant decrease in the BOLD signal in the bilateral insula, left inferior frontal gyrus (IFG), and left cerebellum as compared with HCs. In the combined session, the activated regions for positive mood (pain with positive mood > baseline) in BPs were the left cerebellum, right temporal gyrus, and left occipital gyrus; the activated regions for negative mood (pain with negative mood > baseline) were the right occipital gyrus, left insula, left IFG, and bilateral precentral gyrus. Conclusions: This study presents the preliminary finding of the interaction between pain and emotion in BPs. BPs exhibited lower sensitivity to pain, and the activation of insula and IFG may reflect the interaction between emotion and pain stimulus.
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Affiliation(s)
- Xue Han
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Xiaowu Liu
- Neuroengineering Center, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Linling Li
- Health Science Center, School of Biomedical Engineering, Shenzhen University, Shenzhen, China.,Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen, China
| | - Bo Xie
- Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Beifang Fan
- Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yunhai Qiu
- Research Center for Intelligent Biosensing, Research Institute of Tsinghua University in Shenzhen, Shenzhen, China
| | - Tiebang Liu
- Shenzhen Key Lab for Psychological Healthcare, Shenzhen Mental Health Centre, Shenzhen, China
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China.,Shenzhen Key Lab for Psychological Healthcare, Shenzhen Mental Health Centre, Shenzhen, China.,Clinical Psychiatry Center, National Technology Institute of Psychiatry, Changsha, China.,Key Laboratory of Psychiatry and Mental Health of Hunan Province, Changsha, China
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