Pain-related anxiety mediates the relationship between depressive symptoms and pain interference in veterans with hepatitis C

Prescription Opioid Misuse, Pain Interference, Resilience, and Anxiety Among Chinese People Living with HIV: A Moderated Mediation Model

Prescription opioid misuse (POM) is a concern in people living with HIV (PLWH). Pain interference is a robust factor, and its influences would occur through anxiety and resilience. Limited POM studies attend to Chinese PLWH. This study examined POM and its underlying psychological mechanism using data of PLWH with pain (n = 116) from a cohort study in Guangxi. The PROCESS macro was employed to examine a hypothesized moderated mediation model among pain interference, resilience, anxiety, and POM. Results showed 10.3% PLWH engaged in past-three-month POM. After controlling for demographics, HIV-related clinical outcomes, and pain severity, anxiety mediated the association between pain interference and POM (β = 0.46, 95% CI = 0.01 to 10.49), and the mediation was moderated by resilience (moderated mediation index = - 0.02, 95% CI = - 0.784 to - 0.001). Chinese PLWH seem to misuse opioids to cope with pain-related anxiety. Resilience appears to offer protection.

Depression explains the association between pain intensity and pain interference among adults with neurofibromatosis

INTRODUCTION

Neurofibromatoses (NFs; NF1, NF2 and Schwannomatosis) are incurable genetic syndromes characterized by nerve sheath tumors and often accompanied by substantial emotional distress (e.g., depression and anxiety). Pain is also common but understudied in adults with NF and interferes with daily living. In other medical populations, depression and anxiety have a strong association with pain interference. However, research has not explored the relationship of depression and anxiety to pain interference among adults with NF experiencing pain. The aim of this study was to test the hypothesis that depression and anxiety will mediate the association between pain intensity and pain interference among geographically diverse adults with NF who endorse pain.

METHODS

We used baseline data from an RCT of a mind-body intervention aimed at improving quality of life in adults with NF. Participants (N = 214) who endorsed pain completed measures of demographics, clinical characteristics, baseline pain intensity, pain interference, depression, and anxiety. We constructed a multiple mediation model in R using the lavaan package to test our hypothesis.

RESULTS

Preliminary analyses showed differences in pain interference by NF diagnostic subtype (F(2, 206) = 6.82, p = 001). In a model that controlled for NF diagnostic subtype, we found that depression (β = .07, p = .017), but not anxiety (β = -.003, p = .878), partially mediated the association between pain intensity and pain interference.

CONCLUSION

Improving depression has the potential to decrease pain interference among people with NF who experience pain.

TRIAL REGISTRATION

Clinicaltrials.gov Registration #: NCT03406208.

Non-pharmacological interventions for anxiety in burn patients: A systematic review and meta-analysis of randomized controlled trials

AIM

Present review aimed to conduct a comprehensive review of the effectiveness of non-pharmacological interventions (NPIs) on reducing anxiety in adult burn patients.

METHOD

We searched PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases through September 2019 for randomized clinical trials comparing NPIs to a control group. The primary outcomes were general anxiety and pain anxiety. The Cochrane Risk of Bias Tool was used to assess the risk of bias. All data was pooled with Revman 5.3.

RESULTS

20 studies were eligible for quantitative synthesis. Compared to routine care, Music (4 Randomized Clinical Trials (RCTs), Standardized Mean Difference (SMD) = -2.00, 95 % Confidence Interval (CI) = -3.21 to -0.79), massage (4 RCTs, SMD= -1.84, 95 % CI= -2.77 to -0.91), hypnosis (2 RCTs, SMD= -1.06, 95 % CI= -2.90 to 0.78), relaxation (2 RCTs, SMD= -0.77, 95 %CI= -1.52 to -0.02), transcranial direct current stimulation (1 RCT, SMD= -1.92, 95 %CI= -2.54 to -1.30), and therapeutic touch practices (1 RCT, SMD=-0.45 95 %CI= -0.86 to -0.04), were associated with a significant effect on the anxiety of burn patients. Aromatherapy interventions and virtual reality showed no evidence of a reduction in the anxiety. A large amount of heterogeneity exist among trials. Risk of bias varied across studies. Only one study reported on safety issues.

CONCLUSION

Due to weak evidence, we are unable to make strong recommendations in favor of NPIs for burn anxiety. Further well-designed large sample size randomized clinical trials are warranted.

Characterising the association between positive hepatitis C virus antibody and pain among people who inject drugs

INTRODUCTION AND AIMS

People who inject drugs (PWID) are a key group within the hepatitis C virus (HCV) pandemic. Chronic pain is a common condition among PWID as these individuals are often exposed to soft tissue infections due to injections and violence. This study aims to characterise the relationship between HCV exposure and pain among PWID.

DESIGN AND METHODS

Data were derived from three prospective cohorts of PWID in Vancouver, Canada, between December 2011 and November 2016. The primary outcome was pain severity, which was defined based on the Euroqol EQ-5D-3L pain subscale. A bivariable and multivariable ordinal generalised estimating equations model was used to quantify the association between HCV exposure and pain among participants.

RESULTS

One thousand and twelve of 2038 participants (50%) reported moderate/extreme pain at baseline. In total, 1473 (72%) participants were HCV-antibody positive. In unadjusted analyses, HCV exposure was positively associated with increased pain [odds ratio (OR) = 1.47; 95% confidence interval (CI): 1.20-1.81]. However, once adjusted for known confounders in multivariable analyses, HCV exposure did not remain significantly associated with increased pain (adjusted OR = 1.00; 95%CI: 0.78-1.28).

DISCUSSION AND CONCLUSIONS

In this sample of PWID, HCV exposure was not significantly associated with pain once other factors were considered. These various factors may explain the elevated risk of pain among PWID and should be addressed in future initiatives when managing pain among PWID with HCV exposure. Future studies should also examine whether pain changes with changes in HCV status (i.e. active vs. cleared infection).

Impact of Cigarette Smoking Status on Pain Intensity Among Veterans With and Without Hepatitis C

Objective

Chronic pain is a significant problem in patients living with hepatitis C virus (HCV). Tobacco smoking is an independent risk factor for high pain intensity among veterans. This study aims to examine the independent associations with smoking and HCV on pain intensity, as well as the interaction of smoking and HCV on the association with pain intensity.

Design/Particpants

Cross-sectional analysis of a cohort study of veterans of Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) who had at least one visit to a Veterans Health Administration (VHA) primary care clinic between 2001 and 2014.

Methods

HCV was identified using ICD-9 codes from electronic medical records (EMRs). Pain intensity, reported on a 0-10 numeric rating scale, was categorized as none/mild (0-3) and moderate/severe (4-10).

Results

Among 654,841 OEF/OIF/OND veterans (median age [interquartile range] = 26 [23-36] years), 2,942 (0.4%) were diagnosed with HCV. Overall, moderate/severe pain intensity was reported in 36% of veterans, and 37% were current smokers. The adjusted odds of reporting moderate/severe pain intensity were 1.23 times higher (95% confidence interval [CI] = 1.14-1.33) for those with HCV and 1.26 times higher (95% CI = 1.25-1.28) for current smokers. In the interaction model, there was a significant Smoking Status × HCV interaction (P = 0.03). Among veterans with HCV, smoking had a significantly larger association with moderate/severe pain (adjusted odds ratio [OR] = 1.50, P < 0.001) than among veterans without HCV (adjusted OR = 1.26, P < 0.001).

Conclusions

We found that current smoking is more strongly linked to pain intensity among veterans with HCV. Further investigations are needed to explore the impact of smoking status on pain and to promote smoking cessation and pain management in veterans with HCV.

A Survey on the Prevalence of Depression in Blood Donors with Hepatitis C in Shiraz

BACKGROUND

Depression is the most common psychiatric disorder associated with hepatitis C.

OBJECTIVES

This study aimed to survey the prevalence rate of depression in patients with Hepatitis C Virus (HCV) before they were aware of their HCV test result.

METHODS

This cross-sectional study was conducted on all blood donors with confirmed positive HCV test results who donated blood between March 21, 2012 to March 21, 2013 at Fars blood transfusion center in Iran as case group and age- and sex-matched blood donors with negative screening test results as control group. A semi-structured interview based on DSM IV-TR depressive disorder criteria and Beck depression inventory (BDI) was conducted. BDI contained 21 items, each scored from 0 to 3 and total score of 0 to 63 for the whole scale computed by summing up all the items. A cut-off score of ≥ 19 indicated clinically significant depressive symptoms. The prevalence rate and risk factors of depression were determined.

RESULTS

The most frequent risk factors for HCV infection were intravenous drug abuse (59.3%), unsafe sexual contact (30.5%), and history of being imprisoned (25.4%). The prevalence rate of depression in the HCV group was 55.9 % (95% CI: 42.99% - 68.87%) that was significantly higher than the corresponding rate of the control group as 17.7 % ( 95% CI: 8.49% - 28.79%) (P < 0.001). The severity of depression was also more in the HCV group (P < 0.001). Besides, the prevalence rate of depression was higher among HCV patients with lower education level, previous history of drug abuse, unsafe sexual contact, and previous history of psychiatric diseases. The prevalence rate of depression was higher in the case group even after adjusting for other variables.

CONCLUSIONS

Our study underlined the remarkable prevalence of depression among HCV patients. Therefore, designing depression screening tests is suggested to help such patients before starting the treatment.

Development and Preliminary Evaluation of an Integrated Cognitive-Behavior Treatment for Chronic Pain and Substance Use Disorder in Patients with the Hepatitis C Virus

OBJECTIVE

Individuals with the hepatitis C virus (HCV) have high rates of both chronic pain and substance use disorder (SUD). Despite high comorbidity, there are limited data available on effective methods of treatment for co-occurring chronic pain and SUD. In this study, we sought to develop and conduct preliminary testing of an integrated cognitive-behavior therapy (CBT) for chronic pain and SUD in patients with HCV.

DESIGN

Descriptive, including pretreatment, posttreatment, and follow-up testing.

SETTING AND PATIENTS

Outpatient clinic as part of one VA Medical Center.

PARTICIPANTS

Veterans with chronic pain, SUD, and HCV.

INTERVENTION

Eight-session integrated group CBT for chronic pain and SUD in patients with HCV.

METHODS

Participants completed standardized measures of pain, function, depression severity, and alcohol and substance use at baseline, post-treatment, and 3-month follow-up.

RESULTS

Generalized estimating equations identified improvements in pain interference, reducing cravings for alcohol and other substances, and decreasing past-month alcohol and substance use. The proportion of participants who met diagnostic criteria for current SUD demonstrated a four-fold decrease over the course of the study from 24% at baseline to 15% at post-treatment and 6% at 3-month follow-up. On response to a global impression of change, 94% of participants noted improvement from baseline.

CONCLUSIONS

Results from this pilot study suggest that a customized CBT for patients with both chronic pain and SUD (CBT-cp.sud) may be beneficial in improving important pain and addiction-related outcomes in patients with HCV. Larger scale investigations of this intervention appear warranted.