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Chen C, Xiao B, He X, Wu J, Li W, Yan M. Prevalence of low back pain in professional drivers: a meta-analysis. Public Health 2024; 231:23-30. [PMID: 38603976 DOI: 10.1016/j.puhe.2024.03.007] [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: 10/23/2023] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE This meta-review aimed to investigate the prevalence of low back pain (LBP) in professional drivers. STUDY DESIGN This study is a meta-analysis. METHODS PubMed, Scopus, Embase, and Web of Science were searched for cross-sectional studies on the prevalence of LBP in professional drivers up to August 2023. The Agency for Healthcare Research and Quality was utilized for cross-sectional analytical studies. Statistical analysis of the included outcome indicators was conducted using Stata 16.0. The prevalence of LBP among professional drivers was measured using the random effects model, and heterogeneity was evaluated utilizing subgroup analysis. This meta-analysis review was registered with PROSPERO on April 28, 2023, under the registration number CRD42023422205. RESULTS In total, 1, 558 results met the inclusion and exclusion criteria, and 53 studies were included. The meta-analysis results indicated that professional drivers had a LBP prevalence of 35.0%, 95%CI (0.266, 0.433) for one week, 33.80%, 95%CI (0.233, 0.443) for one month, and 55.30%, 95%CI (0.503,0.603) for one year. In the global population of professional drivers, the prevalence of LBP was 56.0%, 95%CI (0.472, 0.648) and 54.5%, 95%CI (0.488, 0.602) without and with a history and high risk of LBP, respectively. CONCLUSIONS LBP remains prevalent among international drivers and has multiple contributing factors, highlighting the urgent need for increased awareness and prevention strategies.
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Affiliation(s)
- Chunshuo Chen
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China; Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, China
| | - Bin Xiao
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, China
| | - Xiongda He
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Junle Wu
- Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, China
| | - Wankang Li
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Maosheng Yan
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China; Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangzhou, Guangdong, China.
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Cengiz G, Şaş S, Kaplan H, Özsoy S, Çalış M. The influence of alexithymia on disease activity and quality of life in patients with axial spondyloarthritis: A cross-sectional study. Int J Rheum Dis 2023. [PMID: 37186380 DOI: 10.1111/1756-185x.14704] [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: 01/26/2023] [Revised: 03/16/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To evaluate the prevalence of alexithymia and its influence on disease activity, quality of life, and clinical outcomes in axial spondyloarthritis (axSpA) patients. PATIENTS AND METHODS This cross-sectional study included 110 (59 men and 51 women) consecutive axSpA patients who agreed to participate at our rheumatology outpatient clinic. Patient demographics, pain, disease activity measures, functionality, quality of life, alexithymia, psychological status, neuropathic pain, and fibromyalgia were evaluated. Patients were divided into 2 groups (without vs with alexithymia) and compared. The risk factors for alexithymia were evaluated. RESULTS The prevalence of alexithymia in axSpA patients was 31.8% according to a Toronto Alexithymia Scale-20 cutoff of ≥61. The mean age and body mass index of patients were 41.25 ± 9.64 years and 27.73 ± 4.51 kg/m2 , respectively. Most patients with alexithymia were women. Patients with alexithymia had significantly high scores for depression, anxiety, fibromyalgia, disease activity, enthesitis, worse quality of life, and poor functionality (all P < 0.05). Female gender (odds ratio [OR] = 22.359), patient global assessment (OR = 7.873), Bath Ankylosing Spondylitis Functional Index (OR = 1.864), and fibromyalgia symptom severity (OR = 1.303) were found to be independent risk factors for alexithymia. CONCLUSION The present study results showed that about one-third of axSpA patients had alexithymia, and the patients with alexithymia had higher disease activity, worse quality of life, and worse functional status than those without alexithymia. Female gender, patient global assessment, functional status, and fibromyalgia symptom severity were found to be important contributing factors to alexithymia.
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Affiliation(s)
- Gizem Cengiz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Senem Şaş
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Hüseyin Kaplan
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Saliha Özsoy
- Department of Psychiatry, Erciyes University School of Medicine, Kayseri, Turkey
| | - Mustafa Çalış
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
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Pei JH, Wang X, Ma T, Du Y, Dou X. Alexithymia in a Chinese Patient with Chronic Pain and Associated Factors: A Cross-Sectional Study. Pain Manag Nurs 2023:S1524-9042(23)00024-3. [PMID: 36774311 DOI: 10.1016/j.pmn.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Alexithymia is more prevalent among those with patients living with chronic pain. Information on the prevalence of alexithymia in Chinese patients with chronic pain and associated factors is limited. AIM The primary objective of this study was to determine the prevalence of alexithymia, as defined by a score of 61 or greater in the 20-item Toronto Alexithymia Scale (TAS-20), in a Chinese patient with chronic pain. The secondary objective was to investigate the relationship between alexithymia and the clinical and psychological aspects of chronic pain. METHODS A cross-sectional observational study used the TAS-20 to assess alexithymia of Chinese patients with chronic pain. Sociodemographic and clinical information were obtained and participants filled in the Fear Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and General Self-efficacy Scale. RESULTS Of the 346 patients screened, 321 patients living with chronic pain were enrolled into the study. The prevalence of alexithymia among the study population (TAS-20 score ≥61) was 19.6% (95% confidence interval [CI]: 15.3-24.0). The findings showed anxiety (odds ratio [OR] = 2.474; 95% CI, 1.241-4.935), pain catastrophizing (2.649; 1.014-6.921), and self-efficacy (0.952; 0.908-0.988) as independent predictors of alexithymia in patients living with chronic pain. CONCLUSIONS Patients with chronic pain exhibiting alexithymia were at higher risk of pain catastrophizing, anxiety, and lower self-efficacy, compared with patients without alexithymia. It is important to identify and pay a special attention in clinical practice to patients with chronic pain exhibiting alexithymia, as these individuals are unable to properly express their emotions.
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Affiliation(s)
- Ju-Hong Pei
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China; The first clinical medical college, Lanzhou University, Lanzhou, Gansu, China
| | - Xinglei Wang
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Tong Ma
- Spine minimally invasive orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Yehui Du
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xinman Dou
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China; School of nursing, Lanzhou University, Lanzhou, Gansu, China.
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Cross-cultural adaptation and psychometric properties of the Italian version of the Body Perception Questionnaire. PLoS One 2021; 16:e0251838. [PMID: 34043660 PMCID: PMC8158925 DOI: 10.1371/journal.pone.0251838] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE The purpose of this study was to cross-culturally adapt the Body Perception Questionnaire Short Form (BPQ-SF) into Italian and to assess its psychometric properties in a sample of Italian subjects. METHODS A forward-backward method was used for translation. 493 adults were recruited for psychometric analysis. Structural validity was assessed with confirmatory factor analysis and a hypothesis testing approach. Internal consistency was assessed by Cronbach's alpha and McDonald's omega. Measurement invariance analysis was applied with an age-matched American sample. RESULTS The single-factor structure fit the awareness subscale (RMSEA = .036, CFI = .983, TLI = .982). Autonomic reactivity (ANSR) was well-described by supra- and sub-diaphragmatic subscales (RMSEA = .041, CFI = .984, TLI = .982). All subscales were positively correlated (r range: .50-.56) and had good internal consistency (McDonald's Omega range: .86-.92, Cronbach's alpha range: .88-.91). Measurement invariance analysis for the Awareness model showed significant results (p<0.001) in each step (weak, strong and strict) whereas the ANSR showed significant results (p<0.001) only for the strong and strict steps. CONCLUSIONS Our results support the Italian version of the BPQ as having consistent psychometric properties in comparison with other languages.
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Iyar MM, Kealy D, Giannone Z, Ogrodniczuk J, Abbass A, Joyce AS. Where does it hurt? Location of pain, psychological distress, and alexithymia among outpatients seeking psychotherapy. Int J Psychiatry Clin Pract 2019; 23:293-296. [PMID: 31271073 DOI: 10.1080/13651501.2019.1617883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objectives: Physical pain is prevalent among psychiatric outpatients, yet there has been little research regarding the types of pain reported. The purpose of this study was to survey outpatients seeking psychotherapy regarding pain locations and to examine associations between number of pain locations and psychiatric distress and alexithymia.Methods: Two hundred and seventeen patients were recruited from three Canadian hospitals that offer outpatient psychiatry services and short-term therapies. Participants were surveyed about their current physical pain using the Brief Pain Inventory. Participants also completed measures of psychiatric distress (Brief Symptom Inventory-18) and alexithymia (Toronto Alexithymia Scale-20).Results: The three most commonly reported pain locations were lower back, head, and neck. Findings revealed that anxiety, depression and alexithymia were associated with number of reported pain locations. Specifically, participants with three or more pain locations reported significantly higher depression, anxiety and alexithymia in comparison to those with no pain.Conclusions: Back, head and neck pains are highly prevalent among psychiatric outpatients. Multiple pain sites may reflect higher levels of psychiatric distress and greater impairment in emotional processing among psychiatric outpatients.
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Affiliation(s)
- Megumi M Iyar
- St. Paul's Hospital Eating Disorders Program, Vancouver, Canada.,Department of Psychology, University of British Columbia, Kelowna, Canada
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Zarina Giannone
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, Canada
| | - John Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allan Abbass
- Department of Psychiatry, The Centre for Emotions and Health, Dalhousie University, Halifax, Canada
| | - Anthony S Joyce
- Department of Psychiatry, University of Alberta, Edmonton, Canada
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Vivekanantham A, Edwin C, Pincus T, Matharu M, Parsons H, Underwood M. The association between headache and low back pain: a systematic review. J Headache Pain 2019; 20:82. [PMID: 31307372 PMCID: PMC6734435 DOI: 10.1186/s10194-019-1031-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/05/2019] [Indexed: 12/11/2022] Open
Abstract
Background To systematically review studies quantifying the association between primary chronic headaches and persistent low back pain (LBP). Main text We searched five electronic databases. We included case-control, cross-sectional and cohort studies that included a headache and back pain free group, reporting on any association between persistent LBP and primary headache disorders. Methodological quality was assessed using Newcastle-Ottawa Scale. Our primary outcome was the association between primary headache disorders and persistent LBP. Our secondary outcomes were any associations between severity of LBP and severity of headache, and the relationship between specific headache sub-types classified as per International Classification of Headache Disorders (ICHD) criteria and persistent LBP. We included 14 studies. The sizes of the studies ranged from 88 participants to a large international study with 404, 206 participants. Odds ratios for the association were between 1.55 (95% confidence interval (CI) 1.13–2.11) and 8.00 (95% CI 5.3–12.1). Study heterogeneity meant statistical pooling was not possible. Only two studies presented data investigating persistent LBP and chronic headache disorders in accordance with ICDH criteria. Conclusions We identified a positive association between persistent LBP and primary headache disorders. The quality of the review findings is limited by diversity of populations, study designs and uncertainly about headache and LBP definitions. Trial registration PROSPERO 2018 CRD42018086557. Electronic supplementary material The online version of this article (10.1186/s10194-019-1031-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arani Vivekanantham
- University of Warwick, Coventry, UK. .,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. .,Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.
| | - Claire Edwin
- University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Manjit Matharu
- University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Helen Parsons
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Eger Aydogmus M, Hamilton JC. Ego Depletion as a Measure of Emotion Processing Deficits among MUS Patients. The Journal of General Psychology 2019; 146:234-257. [PMID: 30741112 DOI: 10.1080/00221309.2018.1562416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Previous studies have found a link between emotion processing deficits and medically unexplained physical symptoms (MUS). The majority of previous studies have used self-report measures of emotional processing, with the majority focusing on alexithymia, and have produced inconsistent and contradictory results. In the present study, we investigated the role of emotion-processing deficits in MUS by assessing emotion regulation performance and the effects of performance on ego depletion. Participants with high or low levels of self-reported MUS watched emotion-evoking videos under instructions to allow or suppress their emotional reactions, and then performed an anagram task to measure their effort and perseverance. Contrary to the research with self-report measures, experimental analysis of emotion-processing revealed that MUS is correlated with the inability to regulate negative emotions. Unexpected self-regulatory tendencies of the participants with high symptom levels were discussed.
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Kim HJ, Choo J. Emotional Labor: Links to Depression and Work-Related Musculoskeletal Disorders in Call Center Workers. Workplace Health Saf 2016; 65:346-354. [DOI: 10.1177/2165079916667512] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little evidence links emotional labor to either psychological or physical health. This study determined whether the two types of emotional labor (i.e., surface vs. deep acting) were significantly associated with depressive symptoms and work-related musculoskeletal disorders in call center workers. A cross-sectional study was conducted with 274 workers recruited from a call center in Seoul, South Korea. In adjusted regression models, levels of surface, but not deep, acting were significantly and positively associated with depressive symptoms. Higher surface acting levels were significantly and positively associated with low back pain; higher deep acting levels were significantly and inversely associated with low back pain. Study findings could inform occupational health nurses as they delineate differentiated strategies, according to the nature of surface and deep acting, to promote psychological and physical health in call center workers.
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Saariaho AS, Saariaho TH, Mattila AK, Joukamaa MI, Karukivi M. The role of alexithymia: An 8-year follow-up study of chronic pain patients. Compr Psychiatry 2016; 69:145-54. [PMID: 27423355 DOI: 10.1016/j.comppsych.2016.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/24/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The aim of this 8-year follow-up study was to ascertain changes in alexithymia, depressiveness and pain situation in a sample of chronic pain patients and to explore the impact of alexithymia and depression on the outcome. METHODS Participants (n=83) were chronic non-malignant pain patients who completed self-report study questionnaires before their first visit to the pain clinic and again 8years later. Study variables consisted of pain intensity measured by the Visual Analogous Scale, the Pain Disability Scale, the Toronto Alexithymia Scale and the Beck Depression Inventory. The moderate improvement in the pain situation was estimated as a decrease of 30% or more in pain intensity or pain disability. RESULTS In the whole sample there was a significant decrease in pain intensity, pain disability and depressiveness, but only some of the patients achieved moderate improvement in their pain situation. Alexithymia remained stable during the 8-year period. The alexithymic patients had poorer pain situation and more depressiveness both at baseline and at follow-up. Unfavorable outcome in the pain situation was connected with male gender and alexithymia at baseline but not with depressiveness. Alexithymia and depressiveness were closely related to each other and the connection strengthened during the follow-up period. CONCLUSION Alexithymic depressive chronic pain patients represent a special, more disabled subgroup among chronic pain patients. The authors recommend screening for and identifying alexithymia and depression in chronic pain patients. Structural treatment protocols such as cognitive-behavioral therapy may benefit these patients. More research is needed to develop treatment interventions for alexithymic patients.
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Affiliation(s)
- Anita S Saariaho
- Pain Clinic, Raahe Hospital, P.O. BOXs 25, 92101, Raahe, Finland.
| | - Tom H Saariaho
- Pain Clinic, Oulu University Hospital, P.O. BOX 21, FIN-OUH, Oulu, Finland.
| | - Aino K Mattila
- Department of Psychiatry, Tampere University Hospital, P.O. BOXs 2000, 33521 Tampere, Finland.
| | - Matti I Joukamaa
- School of Health Sciences, Tampere University, 33014 Tampere, Finland.
| | - Max Karukivi
- Unit of Adolescent Psychiatry, Satakunta, Hospital District, Antinkatu 15A, 28100 Pori, Finland.
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Sohn HS, Lee DH, Lee KJ, Noh EC, Choi SH, Jang JH, Kim YC, Kang DH. Impaired Empathic Abilities among Patients with Complex Regional Pain Syndrome (Type I). Psychiatry Investig 2016; 13:34-42. [PMID: 26766944 PMCID: PMC4701683 DOI: 10.4306/pi.2016.13.1.34] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aims of this study were to evaluate differences in empathic abilities between patients with complex regional pain syndrome (CRPS) Type I and healthy control subjects (HCs) and to assess correlations between empathic abilities and multidimensional aspects of pain. METHODS Empathic ability was measured in 32 patients with CRPS Type I and in 36 HCs using the Interpersonal Reactivity Index (IRI). A comprehensive assessment of pain was conducted in the patient group using the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Psychiatric symptoms were assessed using the Beck Depression and Anxiety Inventories (BDI and BAI), and quality of life was evaluated using the WHO Quality of Life (WHOQOL-BREF) questionnaire. RESULTS Patients with CRPS showed impaired cognitive and emotional empathic abilities compared with HCs. Significantly lower levels of perspective taking and empathic concern and higher levels of personal distress on the IRI were exhibited by the patient group. Perspective taking and personal distress were associated with affective distress and poor quality of life in social contexts (BDI, BAI, and WHOQOL). However, empathic concern was positively correlated with pain severity and social support from others (WHYMPI). CONCLUSION A tendency toward self-oriented distress in social cognition was exhibited among patients with CRPS Type I. Impaired empathic ability was shown to have potentially negative effects on subjective emotional outcomes and social performance in the lives of patients. Interventions to improve emotional awareness and theory of mind would be beneficial for enhancing social functioning in patients with CRPS Type I.
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Affiliation(s)
- Hong-Suk Sohn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Hyeong Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Jun Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Chung Noh
- Interdisciplinary Program of Neuroscience, Seoul National University, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Hwan Jang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Chul Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Hyung Kang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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Saariaho AS, Saariaho TH, Mattila AK, Karukivi M, Joukamaa MI. Alexithymia and Early Maladaptive Schemas in chronic pain patients. Scand J Psychol 2015; 56:428-37. [DOI: 10.1111/sjop.12226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 03/18/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Aino K. Mattila
- School of Health Sciences; Tampere University; Tampere Yliopisto Finland
- Department of Psychiatry; Tampere University Hospital; Tampere Finland
| | - Max Karukivi
- Unit of Adolescent Psychiatry; Satakunta Hospital District; Pori Finland
| | - Matti I. Joukamaa
- School of Health Sciences; Tampere University; Tampere Yliopisto Finland
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12
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Wager TD, Kang J, Johnson TD, Nichols TE, Satpute AB, Barrett LF. A Bayesian model of category-specific emotional brain responses. PLoS Comput Biol 2015; 11:e1004066. [PMID: 25853490 PMCID: PMC4390279 DOI: 10.1371/journal.pcbi.1004066] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/30/2014] [Indexed: 01/20/2023] Open
Abstract
Understanding emotion is critical for a science of healthy and disordered brain function, but the neurophysiological basis of emotional experience is still poorly understood. We analyzed human brain activity patterns from 148 studies of emotion categories (2159 total participants) using a novel hierarchical Bayesian model. The model allowed us to classify which of five categories--fear, anger, disgust, sadness, or happiness--is engaged by a study with 66% accuracy (43-86% across categories). Analyses of the activity patterns encoded in the model revealed that each emotion category is associated with unique, prototypical patterns of activity across multiple brain systems including the cortex, thalamus, amygdala, and other structures. The results indicate that emotion categories are not contained within any one region or system, but are represented as configurations across multiple brain networks. The model provides a precise summary of the prototypical patterns for each emotion category, and demonstrates that a sufficient characterization of emotion categories relies on (a) differential patterns of involvement in neocortical systems that differ between humans and other species, and (b) distinctive patterns of cortical-subcortical interactions. Thus, these findings are incompatible with several contemporary theories of emotion, including those that emphasize emotion-dedicated brain systems and those that propose emotion is localized primarily in subcortical activity. They are consistent with componential and constructionist views, which propose that emotions are differentiated by a combination of perceptual, mnemonic, prospective, and motivational elements. Such brain-based models of emotion provide a foundation for new translational and clinical approaches.
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Affiliation(s)
- Tor D. Wager
- Department of Psychology and Neuroscience and the Institute for Cognitive Science, University of Colorado, Boulder, Colorado, United States of America
| | - Jian Kang
- Department of Biostatistics and Bioinformatics, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, United States of America
| | - Timothy D. Johnson
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Thomas E. Nichols
- Department of Statistics and Warwick Manufacturing Group, University of Warwick, Coventry, United Kingdom
- Functional Magnetic Resonance Imaging of the Brain (FMRIB) Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Ajay B. Satpute
- Department of Psychology, Northeastern University, Boston, Massachusetts, United States of America
| | - Lisa Feldman Barrett
- Department of Psychology, Northeastern University, Boston, Massachusetts, United States of America
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
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13
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Margalit D, Ben Har L, Brill S, Vatine JJ. Complex regional pain syndrome, alexithymia, and psychological distress. J Psychosom Res 2014; 77:273-7. [PMID: 25280824 DOI: 10.1016/j.jpsychores.2014.07.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/18/2014] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aims to elucidate the relationships between alexithymia, psychological distress, and pain in persons with complex regional pain syndrome (CRPS). METHODS Participants were 60 Israeli adults ages 19-65. This is a cross sectional study with a comparison group. Alexithymia, psychological distress, and pain were assessed in 30 individuals with CRPS in comparison to 30 gender- and age-matched persons with lower back pain (LBP). Assessments included the Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale, and two subscales of the McGill Pain Questionnaire. RESULTS Persons with CRPS had significantly higher ratings of psychological distress and of alexithymia when compared to LBP controls. Pain severity was significantly associated with higher levels of alexithymia and psychological distress among persons with CRPS, but not among controls. Alexithymia and pain severity correlations were significantly different between the two groups. In persons with CRPS, the relationships between alexithymia and pain severity and between difficulty identifying feelings and pain were not confounded by psychological distress. CONCLUSIONS To our knowledge, this is the first cross sectional study providing empirical evidence on the relationship between alexithymia and CRPS. From the perspective of conceptualizing alexithymia as an outcome of CRPS, findings highlight the importance of early CRPS diagnosis and support the provision of care that addresses pain-related psychological distress and alexithymia among CRPS patients. Also, findings underscore the need to generate alternative, non-physical avenues, such as learning to identify feelings for processing pain, in order to reduce pain among persons with CRPS.
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Affiliation(s)
| | - Laura Ben Har
- Department of Behavioral Sciences, Ariel University, Israel; Reuth Rehabilitation Hospital, Tel Aviv, Israel.
| | - Silviu Brill
- Institute for Pain Medicine, Sourasky Medical Center, Tel Aviv, Israel
| | - Jean-Jacques Vatine
- Reuth Rehabilitation Hospital, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Junqueira D, Ferreira M, Refshauge K, Maher C, Hopper J, Hancock M, Carvalho M, Ferreira P. Heritability and lifestyle factors in chronic low back pain: Results of the Australian Twin Low Back Pain Study (The AUTBACK study). Eur J Pain 2014; 18:1410-8. [DOI: 10.1002/ejp.506] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 12/17/2022]
Affiliation(s)
- D.R.G. Junqueira
- Discipline of Physiotherapy, Faculty of Health Sciences; The University of Sydney; Sydney Australia
- Departamento de Farmácia Social, Centro de Estudos do Medicamento (CEMED) & Departamento de Análises Clínicas e Toxicológicas - Faculdade de Farmácia; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - M.L. Ferreira
- The George Institute for Global Health, Sydney Medical School; The University of Sydney; Sydney Australia
| | - K. Refshauge
- Discipline of Physiotherapy, Faculty of Health Sciences; The University of Sydney; Sydney Australia
| | - C.G. Maher
- The George Institute for Global Health, Sydney Medical School; The University of Sydney; Sydney Australia
| | - J.L. Hopper
- Australian Twin Registry, Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology; The University of Melbourne; Melbourne Australia
| | - M. Hancock
- Discipline of Physiotherapy, Faculty of Human Sciences; Macquarie University; Sydney Australia
| | - M.G. Carvalho
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia; Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - P.H. Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences; The University of Sydney; Sydney Australia
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Shibata M, Ninomiya T, Jensen MP, Anno K, Yonemoto K, Makino S, Iwaki R, Yamashiro K, Yoshida T, Imada Y, Kubo C, Kiyohara Y, Sudo N, Hosoi M. Alexithymia is associated with greater risk of chronic pain and negative affect and with lower life satisfaction in a general population: the Hisayama Study. PLoS One 2014; 9:e90984. [PMID: 24621785 PMCID: PMC3951296 DOI: 10.1371/journal.pone.0090984] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/06/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chronic pain is a significant health problem worldwide, with a prevalence in the general population of approximately 40%. Alexithymia -- the personality trait of having difficulties with emotional awareness and self-regulation -- has been reported to contribute to an increased risk of several chronic diseases and health conditions, and limited research indicates a potential role for alexithymia in the development and maintenance of chronic pain. However, no study has yet examined the associations between alexithymia and chronic pain in the general population. METHODS We administered measures assessing alexithymia, pain, disability, anxiety, depression, and life satisfaction to 927 adults in Hisayama, Japan. We classified the participants into four groups (low-normal alexithymia, middle-normal alexithymia, high-normal alexithymia, and alexithymic) based on their responses to the alexithymia measure. We calculated the risk estimates for the criterion measures by a logistic regression analysis. RESULTS Controlling for demographic variables, the odds ratio (OR) for having chronic pain was significantly higher in the high-normal (OR: 1.49, 95% CI: 1.07-2.09) and alexithymic groups (OR: 2.56, 95% CI: 1.47-4.45) compared to the low-normal group. Approximately 40% of the participants belonged to these two high-risk groups. In the subanalyses of the 439 participants with chronic pain, the levels of pain intensity, disability, depression, and anxiety were significantly increased and the degree of life satisfaction was decreased with elevating alexithymia categories. CONCLUSIONS The findings demonstrate that, in the general population, higher levels of alexithymia are associated with a higher risk of having chronic pain. The early identification and treatment of alexithymia and negative affect may be beneficial in preventing chronic pain and reducing the clinical and economic burdens of chronic pain. Further research is needed to determine if this association is due to a causal effect of alexithymia on the prevalence and severity of chronic pain.
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Affiliation(s)
- Mao Shibata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| | - Kozo Anno
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yonemoto
- Biostatistics Center, Kurume University, Fukuoka, Japan
| | - Seiko Makino
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Rie Iwaki
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yamashiro
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiyuki Yoshida
- Department of Speech and Hearing Sciences, International University of Health and Welfare, School of Health Sciences at Fukuoka, Fukuoka, Japan
| | - Yuko Imada
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chiharu Kubo
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yutaka Kiyohara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- * E-mail:
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16
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Saariaho AS, Saariaho TH, Mattila AK, Karukivi MR, Joukamaa MI. Alexithymia and depression in a chronic pain patient sample. Gen Hosp Psychiatry 2013; 35:239-45. [PMID: 23333032 DOI: 10.1016/j.genhosppsych.2012.11.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 11/18/2012] [Accepted: 11/20/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the present study was to assess the prevalence of alexithymia in a sample of general chronic pain patients, to explore possible differences in depression and pain variables between alexithymic and nonalexithymic chronic pain patients and to analyze if depression is a mediator between alexithymia and pain disability. METHODS Two hundred and seventy-one patients making their first visit to a pain clinic completed the study questionnaire including various pain measures, the Beck Depression Inventory-II (BDI-II) and the 20-item Toronto Alexithymia Scale (TAS-20). The sample was dichotomized to alexithymic and nonalexithymic groups. The means of the study variables were compared between the groups. The correlation analysis of the variables was carried out separately in both groups. Path analysis was done to ascertain the mediation effect of BDI-II between the TAS-20 and pain disability. RESULTS Every fifth chronic pain patient was alexithymic. The BDI-II and pain variable scores were significantly higher in the alexithymic group than in the nonalexithymic group. Pain variables were not associated with alexithymia when BDI-II was controlled for. BDI-II worked as a full mediator between TAS-20 and pain disability. CONCLUSION The alexithymic patient group was more morbid than the nonalexithymic group. The results suggest that depression is the main factor in pain conditions of alexithymic chronic pain patients. The authors recommend screening and treatment of depression in alexithymic chronic pain patients.
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Ferreira PH, Beckenkamp P, Maher CG, Hopper JL, Ferreira ML. Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples. Eur J Pain 2013; 17:957-71. [PMID: 23335362 DOI: 10.1002/j.1532-2149.2012.00277.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 12/17/2022]
Abstract
Twin studies are becoming popular to investigate risk factors for low back pain (LBP) because they consider the genetic factor and allow for more precise estimates of risks. We aimed to identify and summarize the results of studies based on twin samples investigating risk factors for LBP. The MEDLINE, CINAHL, LILACS, Web of Science and EMBASE databases were searched. Prospective and cross-sectional observational studies of LBP involving twins were included. The exposure factors could be genetics (heritability) or environmental such as smoking, alcohol consumption, body mass index and medical history. Pooling was attempted using an inverse variance weighting and fixed effects model. Twenty-seven studies were included. Estimates of heritability effects ranged from 21% to 67%. The genetic component was higher for more chronic and disabling LBP than acute and less disabling LBP. Smoking was significantly associated with LBP [pooled odds ratio (OR) = 3.0; 95% confidence interval (CI) 2.8-3.3] with a longitudinal and a cross-sectional study also identifying a dose-response relationship in people with chronic LBP. Obesity was associated with LBP (pooled OR = 1.9; 95% CI 1.6-2.2) with a cross-sectional study identifying a dose-response relationship. No association between alcohol consumption and LBP was identified. Co-morbidities such as asthma, diabetes and osteoarthritis were associated with LBP (pooled OR ranging from 1.6 to 4.2). The contribution of genetics to LBP appears to be dependent on the severity of the condition. Twin studies could be better used to explore possible causation paths between lifestyle factors, co-morbidities and LBP.
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Affiliation(s)
- P H Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
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Kojima M. Alexithymia as a prognostic risk factor for health problems: a brief review of epidemiological studies. Biopsychosoc Med 2012; 6:21. [PMID: 23244192 PMCID: PMC3546882 DOI: 10.1186/1751-0759-6-21] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 12/13/2012] [Indexed: 11/30/2022] Open
Abstract
The number of articles on alexithymia has been steadily increasing since the word “alexithymia” was coined in the 1970s to denote a common characteristic that is observed among classic psychosomatic patients in whom therapy was unsuccessful. Alexithymia, a disorder of affect regulation, has been suggested to be broadly associated with various mental and physical health problems. However, most available evidence is based on anecdotal reports or cross-sectional observations. To clarify the predictive value of alexithymia for health problems, a systematic review of prospective studies was conducted. A search of the PubMed database identified 1,507 articles on “alexithymia” that were published by July 31, 2011. Among them, only 7 studies examined the developmental risks of alexithymia for health problems among nonclinical populations and 38 studies examined the prognostic value of alexithymia among clinical populations. Approximately half of the studies reported statistically significant adverse effects, while 5 studies demonstrated favorable effects of alexithymia on health outcomes; four of them were associated with surgical interventions and two involved cancer patients. The studies that showed insignificant results tended to have a small sample size. In conclusion, epidemiological evidence regarding alexithymia as a prognostic risk factor for health problems remains un-established. Even though alexithymia is considered to be an unfavorable characteristic for disease control and health promotion overall, some beneficial aspects are suggested. More prospective studies with sufficient sample sizes and follow-up period, especially those involving life course analyses, are needed to confirm the contribution of alexithymia to health problems.
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Affiliation(s)
- Masayo Kojima
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
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Baeza-Velasco C, Carton S, Almohsen C, Blotman F, Gély-Nargeot MC. Alexithymia and emotional awareness in females with Painful Rheumatic Conditions. J Psychosom Res 2012; 73:398-400. [PMID: 23062815 DOI: 10.1016/j.jpsychores.2012.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 08/09/2012] [Accepted: 08/10/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Research about the deficit of emotional regulation in Painful Rheumatic Conditions (PRC) indicates that these patients have alexithymic characteristics, as revealed by the Toronto Alexithymia Scale (TAS-20). However, the use of a unique measure to assess alexithymic trends has been questioned. The aim of the present study is twofold: to compare the levels of alexithymia and emotional awareness in females with and without PRC; and to test the predictive validity of alexithymia measures beyond negative emotions. METHOD Thirty-nine women with PRC of diverse etiology and twenty-two healthy females responded to the TAS-20, the Levels of Emotional Awareness Scale (LEAS) and questionnaires of anxiety and depression. RESULTS The total score, factor 1 (difficulty identifying feelings) and factor 2 (difficulty describing feelings) scores of TAS-20 were significantly higher among women with PRC than controls. Females with PRC had lower scores in the subscale "self" of the LEAS (capacity to describe their own emotional experience) than the control group. Only the LEAS significantly predicted the status group after adjusting for anxiety and depression. CONCLUSION Our results highlighted the impairment of emotion processing in patients with PRC and the importance of using a multimodal assessment of emotional regulation in future research.
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Affiliation(s)
- Carolina Baeza-Velasco
- Epsylon, Laboratory Dynamic of Human Abilities and Health Behaviors, Montpellier, France.
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20
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Agar-Wilson M, Jackson T. Are emotion regulation skills related to adjustment among people with chronic pain, independent of pain coping? Eur J Pain 2012; 16:105-14. [PMID: 21669543 DOI: 10.1016/j.ejpain.2011.05.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although emotion regulation capacities have been linked to adjustment among people with chronic pain, researchers have yet to determine whether these capacities are related to functioning independent of established facets of pain coping. The present study was designed to address this gap. A sample 128 Australian adults with chronic pain (44 men, 84 women) completed self-report measures of adjustment (quality of life, negative affect, and pain-related disability), pain coping, and features of emotion regulation (emotion appraisal, perceived efficacy in emotion regulation, emotion utilization). Hierarchical multiple regression analyses indicated that efficacy in emotion regulation was related to quality of life and reduced negative affect even after statistically controlling for effects of other measures of adjustment, pain coping efficacy, and pain coping. Conversely, features of emotion regulation did not improve the prediction model for pain-related disability. Findings suggest emotion regulation capacities may have a unique role in the prediction of specific facets of adjustment among people with chronic pain.
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Affiliation(s)
- M Agar-Wilson
- Key Laboratory of Cognition & Personality, Southwest University, Chongqing, 715400, PR China
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21
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De Vries AMM, Forni V, Voellinger R, Stiefel F. Alexithymia in cancer patients: review of the literature. PSYCHOTHERAPY AND PSYCHOSOMATICS 2012; 81:79-86. [PMID: 22261927 DOI: 10.1159/000330888] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 07/14/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To summarize the literature on alexithymia in cancer patients. METHODS The empirical literature published between 1972 and January 2010 was searched through MEDLINE, PSYINFO, EMBASE and the Cochrane Library. Key words were: alexithymia, affective symptoms, cancer, neoplasms. RESULTS The search identified 16 relevant studies which are methodologically problematic and show conflicting results. However, several interesting hypotheses emerge such as a possible link between alexithymia and the immune system, between alexithymia and quality of life, or between alexithymia, anxiety and depression. The question to what degree alexithymia in cancer patients is a trait or a state cannot be answered by these studies. CONCLUSIONS A lack of methodologically sound studies and the large variations of results among studies suggest that the role of alexithymia in patients with cancer deserves more systematic research. Consequently, studies are needed which investigate the nature (state or trait) of alexithymia, its impact on cancer development and progression, as well as its influence on compliance and on the underestimation of psychological distress and psychiatric outcome in cancer patients.
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Affiliation(s)
- A M M De Vries
- Department of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
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Porcelli P, Tulipani C, Di Micco C, Spedicato MR, Maiello E. Temporal stability of alexithymia in cancer patients following a psychological intervention. J Clin Psychol 2011; 67:1177-87. [PMID: 22052601 DOI: 10.1002/jclp.20839] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The state-trait nature of alexithymia is not fully resolved. The aim of this article was to evaluate the temporal stability of alexithymia in cancer patients after psychological intervention. DESIGN Absolute and relative stability of alexithymia was evaluated in 104 cancer patients who received multicomponent psychological treatment or usual medical care. RESULTS Alexithymia scores significantly decreased in treated patients and increased in the control group, thus showing that the lack of absolute stability (i.e., the change of personality scores over time) likely was because of the effect of the treatment versus the control condition. The relative stability (i.e., the extent to which the inter-individual differences remain the same over time) of alexithymia after 6 months was, however, demonstrated with multiple regressions, after controlling for anxiety, depression, and cancer-related pain. CONCLUSIONS This study confirms the relative stability of alexithymia and that the lack of absolute stability of the construct is influenced by psychological intervention in cancer patients.
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Affiliation(s)
- Piero Porcelli
- Department of Medical Oncology, IRCCS Casa Sollievo della Sofferenza Hospital, S.Giovanni Rotondo, Italy.
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Wood RL, Maclean L, Pallister I. Psychological factors contributing to perceptions pain intensity after acute orthopaedic injury. Injury 2011; 42:1214-8. [PMID: 20705288 DOI: 10.1016/j.injury.2010.07.245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 05/31/2010] [Accepted: 07/12/2010] [Indexed: 02/02/2023]
Abstract
Psychological factors are capable of influencing an individual's perception of pain and may mediate the evolution from acute to chronic pain. Personality characteristics, such as alexithymia and anxiety sensitivity, can also influence perception of pain by somatising psychological distress associated with acute pain. The aim of this study was to understand if alexithymia and anxiety sensitivity interact with psychological distress at an early stage of recovery from orthopaedic injury, to accentuate perception of pain intensity and potentially mediate the development of chronic pain disorder. 62 patients who had recently suffered orthopaedic injury completed the British Pain Society Pain Rating Scale plus the Hospital Anxiety and Depression Scale, as well as measures of alexithymia and anxiety sensitivity. Pain intensity correlated with each of the psychological measures but a regression analysis found that only depression, in combination with anxiety sensitivity, contributed to a significant amount of the variance in pain scores. The authors suggest that early screening after orthopaedic injury could identify those vulnerable to developing persisting pain disorders. This could lead to effective early intervention using psychological methods of pain management to reduce the risk of acute pain evolving into a chronic pain disorder.
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Affiliation(s)
- Rodger Ll Wood
- School of Human & Health Sciences, Swansea University, UK.
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The relationship between alexithymia and psychological factors in systemic lupus erythematosus. Compr Psychiatry 2011; 52:754-62. [PMID: 21193176 DOI: 10.1016/j.comppsych.2010.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 11/04/2010] [Accepted: 11/14/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Alexithymia has been described as an important dimension in several medical diseases. Systemic lupus erythematosus (SLE) is a chronic condition characterized by unpredictable clinical manifestations. Our aim is to reveal which factors (psychological factors and quality of life dimensions) are associated with alexithymia in SLE patients. METHODS Fifty-three sequential SLE patients (ACR criteria) and 41 asthma patients were studied by means of validated scales for alexithymia (Toronto Alexithymia Scale), psychopathology (Brief Symptom Inventory, Hospital Anxiety and Depression Scale), personality dimensions (NEO-FFI), and quality of life (Short Form-36 Health Survey). Systemic lupus erythematosus patient's clinical and laboratorial evaluation was performed by indicators of activity (Systemic Lupus Erythematosus Disease Activity Index) of accumulated damage (Systemic Lupus International Collaborating Clinics/ACR Damage Index), length of disease, and therapy. RESULTS An association between alexithymia and psychopathological symptoms, and personality and quality of life dimensions was found. By means of multiple regression analysis, openness and depression were the 2 predictors for alexithymia in SLE patients. We found a high prevalence rate of alexithymia in SLE patients; however, when controlling for depression symptoms (Hospital Anxiety and Depression Scale-Depression, <7), we found a lower percentage of alexithymic traits than that of the total sample of SLE. CONCLUSION Alexithymia was associated with psychological distress and with quality of life impairment. Understanding the role of psychological factors in SLE patients may contribute to a more comprehensive perspective of the disease, its impact on patient's daily routine, and how patients adapt emotionally to a chronic disease.
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Tuzer V, Bulut SD, Bastug B, Kayalar G, Göka E, Beştepe E. Causal attributions and alexithymia in female patients with fibromyalgia or chronic low back pain. Nord J Psychiatry 2011; 65:138-44. [PMID: 20874000 DOI: 10.3109/08039488.2010.522596] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Our general objective was to assess the psychological symptoms and the types of causal attributions linked to the symptoms among women chronic pain. METHODS 70 fibromyalgia (FM) patients, 56 chronic low back pain (CLBP) patients and 72 healthy controls were assessed within a general hospital setting, using the Toronto Alexithymia Scale, Brief Symptom Inventory and Symptom Interpretation Questionnaire. Three-way analysis of variance and chi-square tests were used for inter-group comparisons, followed by multivariate correlation, covariate analysis and linear regression. RESULTS Alexithymia, somatization, depression, anxiety and hostility scores were significantly higher in FM patients relative to CLBP patients and healthy controls (P < 0.05). Alexithymia was linked to psychological attributions in FM patients and to somatic attributions in CLBP patients. Psychological attributions, the number of symptoms and difficulty in describing emotions were related to increased anxiety in FM patients. Depression, anxiety and somatization were significantly increased in subjects with high alexithymia scores in the FM group. There was no difference between groups regarding causal attributions. CONCLUSIONS Causal attributions do not seem to have distinctive features between functional somatic syndromes like FM and CLBP, though differences might exist between groups as to the effects of coexisting psychological distress symptoms like anxiety and depression.
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Affiliation(s)
- Verda Tuzer
- Numune Training and Research Hospital, First Psychiatry Clinic, Ankara, Turkey.
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Chen J, Xu T, Jing J, Chan RCK. Alexithymia and emotional regulation: A cluster analytical approach. BMC Psychiatry 2011; 11:33. [PMID: 21345180 PMCID: PMC3050802 DOI: 10.1186/1471-244x-11-33] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 02/23/2011] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Alexithymia has been a familiar conception of psychosomatic phenomenon. The aim of this study was to investigate whether there were subtypes of alexithymia associating with different traits of emotional expression and regulation among a group of healthy college students. METHODS 1788 healthy college students were administered with the Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20) and another set of questionnaires assessing emotion status and regulation. A hierarchical cluster analysis was conducted on the three factor scores of the TAS-20. The cluster solution was cross-validated by the corresponding emotional regulation. RESULTS The results indicated there were four subtypes of alexithymia, namely extrovert-high alexithymia (EHA), general-high alexithymia (GHA), introvert-high alexithymia (IHA) and non-alexithymia (NA). The GHA was characterized by general high scores on all three factors, the IHA was characterized by high scores on difficulty identifying feelings and difficulty describing feelings but low score on externally oriented cognitive style of thinking, the EHA was characterized by high score on externally oriented cognitive style of thinking but normal score on the others, and the NA got low score on all factors. The GHA and IHA were dominant by suppressive character of emotional regulation and expression with worse emotion status as compared to the EHA and NA. CONCLUSIONS The current findings suggest there were four subtypes of alexithymia characterized by different emotional regulation manifestations.
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Affiliation(s)
- Jie Chen
- Department of Maternal and Child Health, school of Public Health, Sun Yat-Sen University, Guangzhou, PR China,Neuropsychology and Applied Cognitive Neuroscience Laboratory; Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China,Mental Health Education & Counseling Center, Sun Yat-sen University, Guangzhou, PR China
| | - Ting Xu
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China,Graduate School, Chinese Academy of Sciences, Beijing, PR China
| | - Jin Jing
- Department of Maternal and Child Health, school of Public Health, Sun Yat-Sen University, Guangzhou, PR China
| | - Raymond CK Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China
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Alexithymia and fear of pain independently predict heat pain intensity ratings among undergraduate university students. Pain Res Manag 2009; 14:299-305. [PMID: 19714270 DOI: 10.1155/2009/468321] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alexithymia is a disturbance in awareness and cognitive processing of affect that is associated with over-reporting of physical symptoms, including pain. The relationship between alexithymia and other psychological constructs that are often associated with pain has yet to be evaluated. OBJECTIVES The present study examined the importance of alexithymia in the pain experience in relation to other integral psychological components of Turk's diathesis-stress model of chronic pain and disability, including fear of pain, anxiety sensitivity, pain avoidance and pain catastrophizing. METHODS Heat pain stimuli, using a magnitude estimation procedure, and five questionnaires (Anxiety Sensitivity Index, Fear of Pain Questionnaire III, Pain Catastrophizing Scale, avoidance subscale of the Pain Anxiety Symptoms Scale-20 and Toronto Alexithymia Scale-20) were administered to 67 undergraduate students (44 women) with a mean (+/- SD) age of 20.39+/-3.77 years. RESULTS Multiple linear regression analysis revealed that sex, fear of pain and alexithymia were the only significant predictors of average heat pain intensity (F[6, 60]=5.43; R2=0.35; P=0.008), accounting for 6.8%, 20.0% and 9.6% of unique variance, respectively. Moreover, the difficulty identifying feelings and difficulty describing feelings subscales, but not the externally oriented thinking subscale of the Toronto Alexithymia Scale-20 significantly predicted average heat pain intensity. CONCLUSIONS Individuals with higher levels of alexithymia or increased fear of pain reported higher average pain intensity ratings. The relationship between alexithymia and pain intensity was unrelated to other psychological constructs usually associated with pain. These findings suggest that difficulties with emotion regulation, either through reduced emotional awareness via alexithymia or heightened emotional awareness via fear of pain, may negatively impact the pain experience.
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Physical Self-Efficacy and Alexithymia in Women with Chronic Intractable Back Pain. Pain Manag Nurs 2009; 10:116-23. [DOI: 10.1016/j.pmn.2008.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 12/09/2008] [Indexed: 11/24/2022]
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Barbosa F, Mota C, Alves M, Alcântara C, Rossiñol B, Patrício P, Barbosa A, Ferreira C. Alexithymia in Systemic Lupus Erythematosus Patients. Ann N Y Acad Sci 2009; 1173:227-34. [DOI: 10.1111/j.1749-6632.2009.04640.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gil FP, Weigl M, Wessels T, Irnich D, Baumüller E, Winkelmann A. Parental Bonding and Alexithymia in Adults With Fibromyalgia. PSYCHOSOMATICS 2008; 49:115-22. [DOI: 10.1176/appi.psy.49.2.115] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rief W, Broadbent E. Explaining medically unexplained symptoms-models and mechanisms. Clin Psychol Rev 2007; 27:821-41. [PMID: 17716793 DOI: 10.1016/j.cpr.2007.07.005] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Revised: 03/27/2006] [Accepted: 03/27/2006] [Indexed: 10/23/2022]
Abstract
We summarize the psychological mechanisms that have been linked to the development and maintenance of medically unexplained symptoms (MUS). Many models postulate that patients with MUS misinterpret physical sensations and show other cognitive abnormalities (e.g., an over-exclusive concept of health) that play a major role in symptom development. While there is strong evidence for the role of cognitive aspects, there is less evidence for their interaction with perceptual features (e.g., perceptual sensitivity, lowered perceptual threshold). Modern neuroimaging techniques show that the expectation of symptoms leads to the activation of brain areas corresponding to symptom perception, while distraction from symptoms reduces brain activity in perception areas. The frequently postulated monocausal organic attribution for physical sensations by patients with MUS needs to be modified, as many patients report multiple symptom attributions, including psychological. Symptom attributions and causal models depend on memorized concepts, and so memory processes need to be investigated in more detail. Aberrations in memory processes not only offer a link to understanding perceptual processes, but are also involved in doctor-patient interaction. This encounter is characterized by unsuccessful medical reassurance, which again involves memory processes. We conclude that psychological mechanisms such as expectation, distraction, and memory processes need to be integrated with biological models to aid understanding of MUS.
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Affiliation(s)
- Winfried Rief
- Department of Clinical Psychology, University of Marburg, Gutenbergstrasse 18, 35032 Marburg, Germany.
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Nagasu M, Sakai K, Ito A, Tomita S, Temmyo Y, Ueno M, Miyagi S. Prevalence and risk factors for low back pain among professional cooks working in school lunch services. BMC Public Health 2007; 7:171. [PMID: 17650300 PMCID: PMC1971070 DOI: 10.1186/1471-2458-7-171] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 07/24/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of self-reported low back pain among professional cooks was estimated to examine the effects of daily life conditions, job-related factors, and psychological factors on this disorder. METHODS Data was collected using a mailed self-administered questionnaire. RESULTS Of 7100 cooks, 5835 (82%) replied to the questionnaire, including 1010 men and 4825 women. The mean age was 41.4 for men and 47.5 for women. The prevalence of low back pain during a 1-month period was 72.2% among men and 74.7% among women, with no significant differences between groups. By logistic regression analyses, factors significantly associated with the prevalence of low back pain in 1 month were female gender (prevalence ratio [PR] 1.32; 95% CI, 1.03-1.68), current smoking (PR 1.57; 95% CI, 1.24-1.98), and past smoking (PR 1.35; 95% CI, 1.01-1.79). As for job-related factors, the number of cooked lunches per person (PR 1.28; 95% CI, 1.05-1.56), breaks in the morning session (PR 1.33; 95% CI, 1.13-1.56), kitchen environment (PR 1.09; 95%, CI, 1.03-1.15), and height of cooking equipment (PR 1.13; 95% CI, 1.08-1.19) were associated with the prevalence of low back pain. As for psychological factors, job satisfaction (PR 1.22; 95% CI, 1.03-1.45), stress at work (PR 1.68; 95% CI, 1.42-1.99), financial constraints (PR 1.23; 95% CI, 1.03-1.47), health-related stress (PR 1.31; 95% CI, 1.08-1.59) and worries about the future (PR 1.24; 95% CI, 1.01-1.52) were similarly associated. CONCLUSION Daily life conditions, job-related factors, and psychological factors are associated with the occurrence of low back pain. It is important to take comprehensive preventive measures to address a range of work and life conditions that can be improved to decrease the incidence of low back pain for professional cooks.
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Affiliation(s)
- Miwako Nagasu
- Department of Health Sciences, Kagawa Nutrition University, Saitama, Japan
- The Institute for Science of Labour, Kanagawa, Japan
| | | | - Akiyoshi Ito
- School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shigeru Tomita
- School of Medicine, Dokkyo Medical University, Tochigi, Japan
| | | | - Mitsuo Ueno
- Institute of Occupational Safety and Health, All-Japan Prefectural and Municipal Workers' Union, Tokyo, Japan
| | - Shigeji Miyagi
- Department of Health Sciences, Kagawa Nutrition University, Saitama, Japan
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Mehling WE, Krause N. Alexithymia and 7.5-year incidence of compensated low back pain in 1207 urban public transit operators. J Psychosom Res 2007; 62:667-74. [PMID: 17540224 PMCID: PMC1955468 DOI: 10.1016/j.jpsychores.2007.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Alexithymia, a lack of emotional awareness, was positively associated with self-reported low back pain (LBP) in cross-sectional studies. We assessed the association of alexithymia with 7.5-year incidence of LBP prospectively in a cohort study of 1207 San Francisco transit operators. METHODS Alexithymia was measured by the 20-item Toronto Alexithymia Scale (TAS-20). LBP was assessed by physician-confirmed diagnoses from administrative workers' compensation data. Cox proportional hazards analyses controlled for demographic, behavioral, and physical and psychosocial job factors measured by questionnaire and interview. RESULTS Of all drivers, 27.7% (n=334) filed compensated claims for LBP injuries with workers' compensation insurance during the 7.5-year observation time. The hazard ratios from the fully adjusted model were 0.73 (0.56-0.96) for the TAS-20 scale and 0.82 (0.69-0.98) for the subscale "difficulty describing feelings." Alexithymia scores did not predict the duration of compensated work disability. CONCLUSION In contrast to previous cross-sectional positive associations between alexithymia and LBP, alexithymia is negatively associated with compensated LBP claims. We hypothesize that shame and reporting behavior may explain these inconsistent results.
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Affiliation(s)
- Wolf E Mehling
- Department of Family and Community Medicine, Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, USA
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Porcelli P, Tulipani C, Maiello E, Cilenti G, Todarello O. Alexithymia, coping, and illness behavior correlates of pain experience in cancer patients. Psychooncology 2007; 16:644-50. [PMID: 17094162 DOI: 10.1002/pon.1115] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper aimed to investigate the role played by key psychological factors in the experience of pain in cancer. One hundred and eight consecutive cancer patients were administered validated scales for pain, alexithymia, coping with cancer, and illness behavior. Two groups of patients with (n=45, 42%) and without (n=63, 58%) current pain were compared. Pain was associated to tumor sites and status, poor adjustment to cancer, and higher disease conviction and perception, but not to global alexithymia. However, the component of difficulty identifying feelings (DIF) of the alexithymia construct was significantly higher in pain patients compared to pain-free patients (t=2.88, p<0.01), constituted one of the independent predictors of pain (r=0.37; beta=0.27, p<0.01), and correlated with quality descriptors of pain (r=0.33, p<0.05). The present findings showed for the first time that although alexithymia was not globally related to cancer pain, the DIF component was however associated to pain dimensions, thus suggesting it might be involved in the way patients describe their pain experience, together with maladaptive coping and abnormal illness behavior. Cancer patients experiencing pain should be helped to adopt a more adaptive coping with the disease by identifying more accurately the source of their feelings.
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Affiliation(s)
- Piero Porcelli
- Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Bari, Italy.
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Greiner BA, Krause N. Observational stress factors and musculoskeletal disorders in urban transit operators. J Occup Health Psychol 2006; 11:38-51. [PMID: 16551173 DOI: 10.1037/1076-8998.11.1.38] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Associations and pathways between observed (rather than self-reported) job stressors and musculoskeletal disorders in 66 transit operators were investigated to determine specific stressors and vulnerable body regions affected, while adjusting for physical workload. Job stressors, defined as barriers to progress with work, comprised 7 categories and the sum of stressors. Outcomes included back and neck pain, low back pain, neck pain, pain of the upper extremities and the lower extremities, and any combination of these. Stressors were significantly associated with the combined musculoskeletal disorders category (odds ratio [OR] = 1.55), back and neck pain (OR = 1.41), low back pain (OR = 1.46), and pain in the lower extremities (OR = 1.44) after controlling for confounders. Five barrier categories had at least 1 significant association with outcomes. Results provide specific intervention targets by avoiding common method variance bias.
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Affiliation(s)
- Birgit A Greiner
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
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