Chronic pain disorders and headache chronification

A control study on pain characteristics and influencing factors in patients with depressive disorders-based on a 5-year follow-up report from the epidemiological survey of mental disorders in Shandong Province, China

BACKGROUND

This study extends from the 2015 Shandong Province Epidemiological Survey of Mental Disorders in adults aged 18 and above. Over five years, it investigates pain characteristics and influencing factors in individuals with depressive disorders in Shandong Province.

METHODS

The study encompasses 871 individuals who met DSM-IV criteria for depressive disorders in 2015. Using 1:1:1 matching by gender, age, and residence, 825 non-afflicted individuals were selected as high-risk controls, and 825 screening-negative individuals became low-risk controls. A follow-up study in 2020 involved 1848 participants. Survey tools included a general information questionnaire, General Health Questionnaire-12 (GHQ-12), SCID-I/P, Global Pain Scale (GPS), Quality of Life Questionnaire (QLQ), PSQI, MoCA, and clinical data questionnaire.

RESULTS

GPS scores in the current depressive group were higher than in non-current depressive group (Z = 14.36, P < 0.01). GPS scores in study group exceeded those in high-risk and low-risk control groups (H = 93.71, P < 0.01). GPS scores in non-remission group were higher than in the remission group (Z = 8.90, P < 0.01). Regression analysis revealed positive correlations between GPS scores and physical illnesses, current depression, incumbency, GHQ-12 total score, and PSQI total score. Negative correlations were observed with QLQ total score and MoCA total score.

LIMITATIONS

The study could not assess pain during the 2015 survey, limiting controlled pain analysis before and after five years.

CONCLUSION

Depression sufferers may experience prolonged heightened pain, potentially relieved when depression subsides. Individual pain is influenced by depression, physical illnesses, sleep quality, quality of life, cognitive function, gender, residence, and occupation.

Chronic craniomandibular pain after craniotomy: A long-term clinical study

OBJECTIVE

Chronic craniomandibular/cervical pain and temporomandibular disorders have not been studied in patients who had a craniotomy several years previously. The aim of the current clinical work was to address these issues.

METHODS

A total group of 150 ambulant patients who had a previous craniotomy was subclassified according to whether or not the temporalis muscle was manipulated.

RESULTS

The average incidence of multiple subsite regional head and neck pain was 69.3% a number of years after a craniotomy. Evidence of internal derangement of the temporomandibular joint was significantly higher in the group that required manipulation of the temporalis muscle during the procedure.

CONCLUSION

The pattern of chronic craniomandibular/cervical pain experienced years after a craniotomy supports the brain neuromatrix theory of pain.

Interrelationships between chronic tension-type headache, musculoskeletal pain, and vitamin D deficiency: Is osteomalacia responsible for both headache and musculoskeletal pain?

Background:

Headache, musculoskeletal symptoms, and vitamin D deficiency are common in the general population. However, the interrelations between these three have not been delineated in the literature.

Materials and Methods:

We retrospectively studied a consecutive series of patients who were diagnosed as having chronic tension-type headache (CTTH) and were subjected to the estimation of serum vitamin D levels. The subjects were divided into two groups according to serum 25(OH) D levels as normal (>20 ng/ml) or vitamin D deficient (<20 ng/ml).

Results:

We identified 71 such patients. Fifty-two patients (73%) had low serum 25(OH) D (<20 ng/dl). Eighty-three percent patients reported musculoskeletal pain. Fifty-two percent patients fulfilled the American College of Rheumatology criteria for chronic widespread pain. About 50% patients fulfilled the criteria for biochemical osteomalacia. Low serum 25(OH) D level (<20 ng/dl) was significantly associated with headache, musculoskeletal pain, and osteomalacia.

Discussion:

These suggest that both chronic musculoskeletal pain and chronic headache may be related to vitamin D deficiency. Musculoskeletal pain associated with vitamin D deficiency is usually explained by osteomalacia of bones. Therefore, we speculate a possibility of osteomalacia of the skull for the generation of headache (osteomalacic cephalalgia?). It further suggests that both musculoskeletal pain and headaches may be the part of the same disease spectrum in a subset of patients with vitamin D deficiency (or osteomalacia), and vitamin D deficiency may be an important cause of secondary CTTH.

Headaches secondary to psychiatric disorders (HSPD): a retrospective study of 87 patients

OBJECTIVE

We describe a sample of patients receiving a diagnosis of headache attributed to psychiatric disorder (HSPD).

BACKGROUND

The international literature to date provides only a few case reports of patients presenting with HSPD.

METHOD

A retrospective study of the medical records of all patients having received HSPD when consulting at a headache emergency center during 2009.

RESULTS

Out of a total of 8479 patients seen during one year, 25 men and 62 women received an HSPD diagnosis (1.02%), mean age 40.3 ± 14 years. The psychiatric disorders concerned were: depressive disorder (n = 37), generalized anxiety (n = 25), panic disorder (n = 5), psychotic disorder (n = 5) undifferentiated somatoform disorder (n = 4), somatization disorder (n = 1), and posttraumatic stress disorder (n = 1). Data were missing for 10 patients. Whether the headache had occurred only during the evolution of a psychiatric disorder was not recorded for any of the patients. Headache description was tension type (n = 45), atypical (n = 23), and migraine (n = 19). Half of the sample were chronic daily headaches (n = 44), but only 14.8% (n = 13) presented with medication overuse. One-fourth of the patients suffered from pain in other parts of the body (n = 21), 40% had already had complementary investigations and consultations for their headache.

CONCLUSION

This study shows that in practice HSPD diagnosis is rarely used. When used, International Classification of Headache Disorders, 2nd edition criteria are not strictly applied. The criterion "headache occurring only during the evolution of the psychiatric disorder" is not checked. Not only are atypical headaches considered but, in the majority of cases, HSPD diagnosis is given with tension-type or migraine-type headache. Even though psychotic disorder and somatization disorder are the only psychiatric disorders accepted for HSPD in the classification itself (International Classification of Headache Disorders, 2nd edition code 12), in clinical practice they are not frequently involved whereas depression and generalized anxiety are. It may call for the removal of those appendix diagnoses in the classification itself.

Chronic headaches and the neurobiology of somatization

Pain sensitivity is an adaptive process affected by expectation, mood, coping, operant conditioning, and the preconscious allocation of attention. Underlying mechanisms may include encoding of similar experiences (eg, depression, loss, pain-distress) in overlapping patterns of activation, failure of common regulatory mechanisms, direct top-down activation of the pain matrix, and changes in descending pain facilitatory and inhibitory tone. In theory, the combination of glial cell activation from psychological stress and neural firing from nociceptive input may be particularly likely to lead to pain sensitization and long-term structural changes in pain processing regions of the brain. In these ways, headaches in which chronicity, diffuseness, and distress seem better accounted for by psychological than by medical variables can be understood in neurobiological terms. This can allow psychological treatment of physical distress to be objective, nonthreatening, and relatively precise.