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The Symptomatic Outcomes of Cholecystectomy for Gallstones. J Clin Med 2023; 12:jcm12051897. [PMID: 36902684 PMCID: PMC10004100 DOI: 10.3390/jcm12051897] [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: 02/07/2023] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/08/2023] Open
Abstract
Cholecystectomy is the definite treatment for symptomatic gallstones, and rates are rapidly rising. Symptomatic complicated gallstones are generally treated with cholecystectomy, but there is no consensus on the clinical selection of patients with symptomatic uncomplicated gallstones for cholecystectomy. The aim of this review is to describe symptomatic outcomes before versus after cholecystectomy in patients with symptomatic gallstones as reported in prospective clinical studies and to discuss patient selection for cholecystectomy. Following cholecystectomy, resolution of biliary pain is high and reported for 66-100%. Dyspepsia has an intermediate resolution of 41-91% and may co-exist with biliary pain but may also develop following cholecystectomy with an increase of 150%. Diarrhea has a high increase and debuts in 14-17%. Persisting symptoms are mainly determined by preoperative dyspepsia, functional disorders, atypical pain locations, longer duration of symptoms, and poor psychological or physical health. Patient satisfaction following cholecystectomy is high and may reflect symptom alleviation or a change in symptoms. Comparison of symptomatic outcomes in available prospective clinical studies is limited by variations in preoperative symptoms, clinical presentations, and clinical management of post-cholecystectomy symptoms. When selecting patients with biliary pain only in a randomized controlled trial, 30-40% still have persisting pain. Strategies for the selection of patients with symptomatic uncomplicated gallstones based on symptoms alone are exhausted. For the development of a selection strategy, future studies should explore the impact of objective determinants for symptomatic gallstones on pain relief following cholecystectomy.
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Identifying the Presence of Ethics Concepts in Chronic Pain Research: A Scoping Review of Neuroscience Journals. NEUROETHICS-NETH 2022. [DOI: 10.1007/s12152-022-09499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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3
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Elberling J. Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gong Y, Liu K, Hu N, Sun M, Huang M. Reliability and validity of the Chinese version of the mental vulnerability questionnaire for the undergraduate students. Perspect Psychiatr Care 2020; 56:409-414. [PMID: 31691293 DOI: 10.1111/ppc.12449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/04/2019] [Accepted: 10/19/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to assess the validity and reliability of the Chinese version of mental vulnerability questionnaire (MVQ) for undergraduate students. DESIGN AND METHODS A cross-sectional design was conducted in a sample of 1217 undergraduate students. FINDINGS The Cronbach's α of the overall scale was 0.901, the split-half reliability coefficient was 0.742, and the test-retest reliability coefficient was 0.935. Three-factors model was got by using exploratory factor analysis, the communalities of the items were 0.646 to 0.848, explaining 75.736% variance. With confirmatory factor analysis the fit indices were chi-square/degree of freedom (CMIN/DF) = 2.796, comparative fit index (CFI) = 0947, GFI = 0.920, adjustedgoodness of fit index (AGFI) = 0.902, incremental fit index (IFI) = 0.947, root mean squareerror of approximation (RMSEA) = 0.055, Tucker Lewis index (TLI) = 0.940, root mean residual (RMR) = 0.051. PRACTICE IMPLICATIONS The Mental Vulnerability Questionnaire has a good reliability and validity, it can be considered as a tool to evaluate the mental vulnerability for undergraduate students.
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Affiliation(s)
- Yuxin Gong
- Nursing College, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Kun Liu
- Nursing College, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Na Hu
- Nursing College, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Mengyuan Sun
- Nursing College, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Mina Huang
- Nursing College, Jinzhou Medical University, Jinzhou, Liaoning, China
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Jørgensen TSH, Wium-Andersen MK, Jørgensen MB, Osler M. The impact of mental vulnerability on the relationship between cardiovascular disease and depression. Eur Psychiatry 2020; 63:e16. [PMID: 32093792 PMCID: PMC7315880 DOI: 10.1192/j.eurpsy.2020.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background. The mechanisms linking cardiovascular disease (CVD) and depression are still not established. We investigated the impact of mental vulnerability on the relationship between CVD and depression. Methods. A total of 19,856 individuals from five cohorts of random samples of the background population in Copenhagen were followed from baseline (1983–2011) until 2017 in Danish registries. Additive hazard and Cox proportional hazard models were used to analyze the effects of confounding by mental vulnerability as well as interactions between mental vulnerability and CVD on the risk of depression. Results. During follow-up, 15.3% developed CVD, while 18.1% experienced depression. A strong positive association between CVD and depression (hazard ratio: 3.60 [95% confidence intervals (CI): 3.30; 3.92]) corresponding to 35.4 (95% CI: 31.7; 39.1) additional cases per 1,000 person-years was only slightly attenuated after adjustment for mental vulnerability in addition to other confounders. Synergistic interaction between CVD and mental vulnerability was identified in the additive hazard model. Due to interaction between CVD and mental vulnerability, CVD was associated with 50.9 more cases of depression per 1,000 person-years among individuals with high mental vulnerability compared with individuals with low mental vulnerability. Conclusions. Mental vulnerability did not explain the strong relationship between CVD and depression. CVD was associated with additional cases of depression among individuals with higher mental vulnerability indicating that this group holds the greatest potential for intervention, for example, in rehabilitation settings.
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Affiliation(s)
- Terese Sara Høj Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marie Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Department O, Psychiatric Center Copenhagen, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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6
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Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_23-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ahn IY, Lee SJ, Han YS, Park CS, Kim BJ, Lee CS, Cha B, Seo JY, Choi JW, Lee D. Effects of Emotional Stability on Insomnia through Anxiety in Patients with Cataracts. Psychiatry Investig 2019; 16:93-96. [PMID: 30605992 PMCID: PMC6354042 DOI: 10.30773/pi.2018.11.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022] Open
Abstract
This study investigated the effect of emotional stability (ES) on insomnia through anxiety in preoperative patients with cataracts. Fifty-four subjects completed a self-questionnaire that included the Insomnia Severity Index (ISI), the International Personality Item Pool (IPIP) for ES, and the Hospital Anxiety and Depression scale (HADS). Pathway analysis was performed to analyze the mediating effects of ES, the anxiety subscale scores of the HADS, and the ISI scores. The low-ES group exhibited an insomnia severity that was significantly higher than that of the high-ES group (p=0.048). According to the pathway analysis, the significant indirect effect of ES on the ISI scores was mediated by the scores on the anxiety subscale of the HADS. Cataract patients with low ES waiting to undergo surgery have a high risk of experiencing insomnia due to anxiety. Before surgery, it is essential to identify patients' personality characteristics and provide appropriate intervention.
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Affiliation(s)
- In-Young Ahn
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - So-Jin Lee
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Yong-Seop Han
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Chul-Soo Park
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Bong-Jo Kim
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Cheol-Soon Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.,Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Boseok Cha
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Department of Psychiatry, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Ji-Yeong Seo
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae-Won Choi
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Dongyun Lee
- Department of Psychiatry, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Abstract
PURPOSE OF REVIEW The development of acute to chronic pain involves distinct pathophysiological changes in the peripheral and central nervous systems. This article reviews the mechanisms, etiologies, and management of chronic pain syndromes with updates from recent findings in the literature. RECENT FINDINGS Chronic post-surgical pain (CPSP) is not limited to major surgeries and can develop after smaller procedures such as hernia repairs. While nerve injury has traditionally been thought to be the culprit for CPSP, it is evident that nerve-sparing surgical techniques are not completely preventative. Regional analgesia and agents such as ketamine, gabapentinoids, and COX-2 inhibitors have also been found to decrease the risks of developing chronic pain to varying degrees. Yet, given the correlation of central sensitization with the development of chronic pain, it is reasonable to utilize aggressive multimodal analgesia whenever possible. Development of chronic pain is typically a result of peripheral and central sensitization, with CPSP being one of the most common presentations. Using minimally invasive surgical techniques may reduce the risk of CPSP. Regional anesthetic techniques and preemptive analgesia should also be utilized when appropriate to reduce the intensity and duration of acute post-operative pain, which has been correlated with higher incidences of chronic pain.
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DosSantos MF, Moura BDS, DaSilva AF. Reward Circuitry Plasticity in Pain Perception and Modulation. Front Pharmacol 2017; 8:790. [PMID: 29209204 PMCID: PMC5702349 DOI: 10.3389/fphar.2017.00790] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 10/19/2017] [Indexed: 12/30/2022] Open
Abstract
Although pain is a widely known phenomenon and an important clinical symptom that occurs in numerous diseases, its mechanisms are still barely understood. Owing to the scarce information concerning its pathophysiology, particularly what is involved in the transition from an acute state to a chronic condition, pain treatment is frequently unsatisfactory, therefore contributing to the amplification of the chronic pain burden. In fact, pain is an extremely complex experience that demands the recruitment of an intricate set of central nervous system components. This includes cortical and subcortical areas involved in interpretation of the general characteristics of noxious stimuli. It also comprises neural circuits that process the motivational-affective dimension of pain. Hence, the reward circuitry represents a vital element for pain experience and modulation. This review article focuses on the interpretation of the extensive data available connecting the major components of the reward circuitry to pain suffering, including the nucleus accumbens, ventral tegmental area, and the medial prefrontal cortex; with especial attention dedicated to the evaluation of neuroplastic changes affecting these structures found in chronic pain syndromes, such as migraine, trigeminal neuropathic pain, chronic back pain, and fibromyalgia.
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Affiliation(s)
- Marcos F. DosSantos
- Laboratório de Morfogênese Celular, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Brenda de Souza Moura
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandre F. DaSilva
- Headache and Orofacial Pain Effort, Department of Biologic and Materials Sciences, School of Dentistry, Center for Human Growth and Development, Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States
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10
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Sequeira CADC, Barbosa ENM, Nogueira MJC, Sampaio FMC. Evaluation of the Psychometric Properties of the Mental Vulnerability Questionnaire in Undergraduate Students. Perspect Psychiatr Care 2017; 53:243-250. [PMID: 27198975 DOI: 10.1111/ppc.12164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/16/2016] [Accepted: 03/04/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Translate, adapt the language, and assess the psychometric properties of the Mental Vulnerability Questionnaire (MVQ) in a Portuguese population sample of young adults. DESIGN AND METHODS A psychometric validation study was performed. The sample comprised 166 undergraduate students. Factor analysis was applied to extract three indicators. FINDINGS The MVQ showed divergent validity with the Positive Mental Health Questionnaire (p < .001) and convergent validity with the Mental Health Inventory including five items (p < .001). Reliability was verified through the assessment of internal consistency, evidencing positive outcomes (Cronbach's α = 0.81). PRACTICE IMPLICATIONS The MVQ shows psychometric properties enabling its adaptation to clinical practice and research, essential to an effective screening of mental vulnerability.
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Affiliation(s)
- Carlos Alberto da Cruz Sequeira
- Coordinator Professor at Porto Nursing School, Scientific Pedagogical Unit "Management of Signs and Symptoms,", Porto, and Coordinator of the Research Group "NurID: Innovation and Development in Nursing-CINTESIS-FMUP,", Porto, Portugal
| | | | | | - Francisco Miguel Correia Sampaio
- Registered Nurse at the Psychiatry Department, Hospital de Braga, Braga, and an Invited Assistant at Porto Nursing School, Porto, Portugal
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Guimaraes-Pereira L, Valdoleiros I, Reis P, Abelha F. Evaluating Persistent Postoperative Pain in One Tertiary Hospital: Incidence, Quality of Life, Associated Factors, and Treatment. Anesth Pain Med 2016; 6:e36461. [PMID: 27252908 PMCID: PMC4886451 DOI: 10.5812/aapm.36461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 11/16/2022] Open
Abstract
Background Persistent postoperative pain (PPP) is defined as persistent pain after surgery of greater than three months’ duration. Objectives Identify the incidence of PPP in our hospital and its associated factors; evaluate quality of life (QoL) and treatment of patients. Patients and Methods We conducted an observational prospective study in adults proposed to various types of surgery using the brief pain inventory short form preoperatively (T0), one day after surgery, and three months later (T3). If the patient had pain at T3 and other causes of pain were excluded, they were considered to have PPP, and the McGill Pain Questionnaire Short Form was applied. QoL was measured with the EuroQol 5-dimension questionnaire (EQ-5D). Results One hundred seventy-five patients completed the study. The incidence of PPP was 28%, and the affected patients presented lower QoL. The majority referred to a moderate to severe level of interference in their general activity. Cholecystectomies were less associated with PPP, and total knee/hip replacements were more associated with it. Preoperative pain, preoperative benzodiazepines or antidepressants, and more severe acute postoperative pain were associated with the development of PPP. Half of the patients with PPP were under treatment, and they refer a mean symptomatic relief of 69%. Conclusions This study, apart from attempting to better characterize the problem of PPP, emphasizes the lack of its treatment.
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Affiliation(s)
- Luis Guimaraes-Pereira
- Department of Anesthesiology, Centro Hospitalar Sao Joao, Alameda Professor Hernani Monteiro, Oporto, Portugal
- Corresponding author: Luis Guimaraes-Pereira, Department of Anesthesiology, Centro Hospitalar Sao Joao, Alameda Professor Hernani Monteiro, Oporto, Portugal. Tel: +35-1917534860, E-mail:
| | - Ines Valdoleiros
- Department of Anesthesiology, Centro Hospitalar Sao Joao, Alameda Professor Hernani Monteiro, Oporto, Portugal
| | - Pedro Reis
- Department of Anesthesiology, Centro Hospitalar Sao Joao, Alameda Professor Hernani Monteiro, Oporto, Portugal
| | - Fernando Abelha
- Department of Anesthesiology, Centro Hospitalar Sao Joao, Alameda Professor Hernani Monteiro, Oporto, Portugal
- Department of Surgery, Faculty of Medicine, Alameda Professor Hernani Monteiro, University of Porto, Oporto, Portugal
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Abstract
Chronic pain after surgery is common.Surgery is widely performed therefore the at risk population is large.The mechanisms of chronic pain after surgery are complex.There are many risk factors associated with onset of chronic post-surgical pain: demographic, genetic and medical.Unnecessary and inappropriate surgery should be avoided.
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Affiliation(s)
- Michael Je Neil
- Consultant Anaesthetists, The Pain Service, Ninewells Hospital and Medical School, Dundee, DD1 9SY
| | - William A Macrae
- Consultant Anaesthetists, The Pain Service, Ninewells Hospital and Medical School, Dundee, DD1 9SY
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13
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Blichfeldt-Eckhardt MR, ϕrding H, Andersen C, Licht PB, Toft P. Early visceral pain predicts chronic pain after laparoscopic cholecystectomy. Pain 2014; 155:2400-7. [DOI: 10.1016/j.pain.2014.09.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/18/2014] [Accepted: 09/11/2014] [Indexed: 12/31/2022]
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Kim GH, Lee HD, Kim M, Kim K, Jeong Y, Hong YJ, Kang ES, Han JH, Choi JW, Park SM. Fate of dyspeptic or colonic symptoms after laparoscopic cholecystectomy. J Neurogastroenterol Motil 2014; 20:253-60. [PMID: 24840378 PMCID: PMC4015198 DOI: 10.5056/jnm.2014.20.2.253] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/AIMS Gallbladder diseases can give rise to dyspeptic or colonic symptoms in addition to biliary pain. Although most biliary pain shows improvement after cholecystectomy, the fates of dyspeptic or colonic symptoms still remain controversial. This study as-sessed whether nonspecific gastrointestinal symptoms improved after laparoscopic cholecystectomy (LC) and identified the char-acteristics of patients who experienced continuing or exacerbated symptoms following surgery. METHODS Sixty-five patients who underwent LC for uncomplicated gallbladder stones or gallbladder polyps were enrolled. The patients were surveyed on their dyspeptic or colonic symptoms before surgery and again at 3 and 6 months after surgery. Patients' mental sanity was also assessed using a psychological symptom score with the Symptom Checklist-90-Revised questionnaire. RESULTS Forty-four (67.7%) patients showed one or more dyspeptic or colonic symptoms before surgery. Among these, 31 (47.7%) and 36 (55.4%) patients showed improvement at 3 and 6 months after surgery, respectively. However, 18.5% of patients showed continuing or exacerbated symptoms at 6 months after surgery. These patients did not differ with respect to gallstone or gall-bladder polyps, but differed in frequency of gastritis. These patients reported lower postoperative satisfaction. Patients with ab-dominal symptoms showed higher psychological symptom scores than others. However, poor mental sanity was not related to the symptom exacerbation. CONCLUSIONS Elective LC improves dyspeptic or colonic symptoms. Approximately 19% of patients reported continuing or exacerbated symp-toms following LC. Detailed history-taking regarding gastritis before surgery can be helpful in predicting patients' outcome after LC.
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Affiliation(s)
- Gi Hyun Kim
- Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
| | - Hyo Deok Lee
- Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
| | - Min Kim
- Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
| | - Kyeongmin Kim
- Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
| | - Yusook Jeong
- Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
| | - Yong Joo Hong
- Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
| | - Eun Seok Kang
- Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
| | - Joung-Ho Han
- Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
| | - Jae-Woon Choi
- Departments of Surgery, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
| | - Seon Mee Park
- Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea
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15
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Chirurgische Patienten mit chronischem Schmerz oder chronisch-postoperativem Schmerz. Schmerz 2013; 27:597-604. [DOI: 10.1007/s00482-013-1365-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Background Surgical injury can frequently lead to chronic pain. Despite the obvious importance of this problem, the first publications on chronic pain after surgery as a general topic appeared only a decade ago. This study tests the hypothesis that chronic postsurgical pain was, and still is, represented insufficiently. Methods We analyzed the presentation of this topic in journal articles covered by PubMed and in surgical textbooks. The following signs of insufficient representation in journal articles were used: (1) the lack of journal editorials on chronic pain after surgery, (2) the lack of journal articles with titles clearly indicating that they are devoted to chronic postsurgical pain, and (3) the insufficient representation of chronic postsurgical pain in the top surgical journals. Results It was demonstrated that insufficient representation of this topic existed in 1981–2000, especially in surgical journals and textbooks. Interest in this topic began to increase, however, mostly regarding one specific surgery: herniorrhaphy. It is important that the change in the attitude toward chronic postsurgical pain spreads to other groups of surgeries. Conclusion Chronic postsurgical pain is still a neglected topic, except for pain after herniorrhaphy. The change in the attitude toward chronic postsurgical pain is the important first step in the approach to this problem.
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Affiliation(s)
- Igor Kissin
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Grover M. When is irritable bowel syndrome not irritable bowel syndrome? Diagnosis and treatment of chronic functional abdominal pain. Curr Gastroenterol Rep 2012; 14:290-296. [PMID: 22644880 DOI: 10.1007/s11894-012-0270-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Functional abdominal pain syndrome (FAPS) is a distinct chronic gastrointestinal (GI) pain disorder characterized by the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits, or menstrual periods. The pain experience in FAPS is predominantly centrally driven as compared to other chronic painful GI conditions such as inflammatory bowel disease and chronic pancreatitis where peripherally acting factors play a major role in driving the pain. Psychosocial factors are often integrally associated with the disorder and can pose significant challenges to evaluation and treatment. Patients suffer from considerable loss of function, which can drive health care utilization. Treatment options are limited at best with most therapeutic regimens extrapolated from pain management of other functional GI disorders and chronic pain conditions. A comprehensive approach to management using a biopsychosocial construct and collaboration with pain specialists and psychiatry is most beneficial to the management of this disorder.
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Affiliation(s)
- Madhusudan Grover
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
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Mertens MC, Roukema JA, Scholtes VPW, De Vries J. Trait anxiety predicts outcome 6 weeks after cholecystectomy. A prospective follow-up study. Ann Behav Med 2011; 41:264-9. [PMID: 21104460 PMCID: PMC3052448 DOI: 10.1007/s12160-010-9245-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background A substantial group of patients with gallstone disease experience negative outcome after surgical removal of the gallbladder (cholecystectomy). Early identification of these patients is important. Purpose The aim of the study is to identify predictors (clinical symptoms and trait anxiety) of negative symptomatic outcomes at 6 weeks after cholecystectomy. Methods Consecutive patients (n = 133), 18–65 years, with symptomatic gallstone disease, completed symptom checklists and the state-trait anxiety inventory preoperatively and at 6 weeks after cholecystectomy. Results High trait anxiety was the only predictor of persistence of biliary symptoms at 6 weeks after cholecystectomy (OR = 6.88). Conclusion In addition to clinical symptoms, high trait anxiety is a predictor of negative symptomatic outcome at 6 weeks after cholecystectomy. Trait anxiety should be evaluated to aim at a patient-tailored approach in gallstone disease.
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Affiliation(s)
- Marlies C Mertens
- Department of Medical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands
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Jeffery AE, Wylde V, Blom AW, Horwood JP. "It's there and I'm stuck with it": patients' experiences of chronic pain following total knee replacement surgery. Arthritis Care Res (Hoboken) 2011; 63:286-92. [PMID: 20890979 DOI: 10.1002/acr.20360] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To gain insight into patients' experiences of adjustment to chronic pain following recovery from total knee replacement (TKR) surgery. METHODS Participants were purposively sampled and comprised 28 individuals, 18 women and 10 men, ages 57-87 years, who had undergone a TKR between 2 and 5 years previously. Semistructured interviews explored participants' perceptions of their condition and its impact, including its causes and consequences. Thematic analysis, using the constant comparison technique, was used to identify and analyze patterns and themes from the transcripts. RESULTS Although some individuals expressed acceptance of their continuing pain, others reported that it caused them considerable distress. Variation in expressed acceptance and distress was not related to self-reported pain severity. Various factors relating to adjustment emerged, including perceived improvement or deterioration in circumstances since TKR, surgeon input pre- and postsurgery, and beliefs about pain in the context of an individual's life. Participants described a sense of abandonment following TKR and discussed the support they felt they should have received. CONCLUSION The data suggest that adjustment to chronic pain following recovery from TKR surgery is influenced by biomedical and psychosocial factors, including an individual's pain-related illness cognitions, beliefs, and their perceptions of their condition in a social context. Patient care could be improved by clinicians utilizing a biopsychosocial framework to acknowledge the impact of osteoarthritis of the knee as a multidimensional health condition.
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Affiliation(s)
- Alison E Jeffery
- University of Bristol, and Musculoskeletal Research Unit, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK.
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Abstract
The transition from acute to chronic pain appears to occur in discrete pathophysiological and histopathological steps. Stimuli initiating a nociceptive response vary, but receptors and endogenous defence mechanisms in the periphery interact in a similar manner regardless of the insult. Chemical, mechanical, and thermal receptors, along with leucocytes and macrophages, determine the intensity, location, and duration of noxious events. Noxious stimuli are transduced to the dorsal horn of the spinal cord, where amino acid and peptide transmitters activate second-order neurones. Spinal neurones then transmit signals to the brain. The resultant actions by the individual involve sensory-discriminative, motivational-affective, and modulatory processes in an attempt to limit or stop the painful process. Under normal conditions, noxious stimuli diminish as healing progresses and pain sensation lessens until minimal or no pain is detected. Persistent, intense pain, however, activates secondary mechanisms both at the periphery and within the central nervous system that cause allodynia, hyperalgesia, and hyperpathia that can diminish normal functioning. These changes begin in the periphery with upregulation of cyclo-oxygenase-2 and interleukin-1β-sensitizing first-order neurones, which eventually sensitize second-order spinal neurones by activating N-methyl-d-aspartic acid channels and signalling microglia to alter neuronal cytoarchitecture. Throughout these processes, prostaglandins, endocannabinoids, ion-specific channels, and scavenger cells all play a key role in the transformation of acute to chronic pain. A better understanding of the interplay among these substances will assist in the development of agents designed to ameliorate or reverse chronic pain.
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Affiliation(s)
- C Voscopoulos
- Department of Anesthesiology, Critical Care, and Pain Medicine, University at Buffalo, Buffalo, NY, USA
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Khan RS, Ahmed K, Blakeway E, Skapinakis P, Nihoyannopoulos L, Macleod K, Sevdalis N, Ashrafian H, Platt M, Darzi A, Athanasiou T. Catastrophizing: a predictive factor for postoperative pain. Am J Surg 2011; 201:122-31. [DOI: 10.1016/j.amjsurg.2010.02.007] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 02/16/2010] [Accepted: 02/16/2010] [Indexed: 11/30/2022]
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Elberling J. Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2011. [DOI: 10.1007/978-3-642-03827-3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Functional abdominal pain syndrome (FAPS) is a relatively less common functional gastrointestinal (GI) disorder defined by the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits, or menstrual periods (Drossman Gastroenterology 130:1377-1390, 2006), which points to a more centrally targeted (spinal and supraspinal) basis for the symptoms. However, FAPS is frequently confused with irritable bowel syndrome and other functional GI disorders in which abdominal pain is associated with eating and bowel movements. FAPS also differs from chronic abdominal pain associated with entities such as chronic pancreatitis or chronic inflammatory bowel disease, in which the pain is associated with peripherally acting factors (eg, gut inflammation or injury). Given the central contribution to the pain experience, concomitant psychosocial disturbances are common and strongly influence the clinical expression of FAPS, which also by definition is associated with loss of daily functioning. These factors make it critical to use a biopsychosocial construct to understand and manage FAPS, because gut-directed treatments are usually not successful in managing this condition.
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Affiliation(s)
- Madhusudan Grover
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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EPLOV LENEFALGAARD, PETERSEN JANNE, JøRGENSEN TORBEN, JOHANSEN CHRISTOFFER, BIRKET-SMITH MORTEN, LYNGBERG ANNCHRISTINE, MORTENSEN ERIKLYKKE. The Mental Vulnerability Questionnaire: A psychometric evaluation. Scand J Psychol 2010; 51:548-54. [DOI: 10.1111/j.1467-9450.2010.00834.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE To identify predictors of negative symptomatic outcomes at 6 months after cholecystectomy, surgical removal of the gallbladder, which is the preferred treatment for gallstone disease. After cholecystectomy, a substantial number of patients report persistence of symptoms. METHODS In this prospective follow-up study, consecutive patients (n = 172) diagnosed with symptomatic gallstone disease and indicated for elective cholecystectomy were investigated. Preoperatively and at 6 months, patients completed self-report symptom checklists. The Spielberger State-Trait Anxiety Inventory scale was completed preoperatively and patients with a score of > or = P 80 were considered having High Trait Anxiety (HTA). Multivariate regression analyses were used to investigate independent predictors of persisting symptoms. RESULTS Six months after cholecystectomy, patients with HTA were more likely to report persisting biliary symptoms than patients without HTA (NHTA) (45.5% versus 14.3%; chi(2) = 8.78, p = .002). HTA was identified as an independent predictor of persisting biliary symptoms at 6 months (odds ratio [OR], 3.08, p = .047; 95% confidence interval [CI], 1.02-9.34), in addition to the report of nonspecific symptoms (OR, 6.16, p = .024; 95% CI, 1.27-29.82), and the use of psychotropic medication (OR, 4.76, p = .023; 95% CI, 1.24-18.34). CONCLUSION Patients with HTA have a three times higher risk at persisting biliary symptoms at 6 months after cholecystectomy than NHTA patients. Both clinical factors and the patient's personality should be considered in clinical decision making and risk estimation in elective cholecystectomy.
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Hinrichs-Rocker A, Schulz K, Järvinen I, Lefering R, Simanski C, Neugebauer EAM. Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) - a systematic review. Eur J Pain 2008; 13:719-30. [PMID: 18952472 DOI: 10.1016/j.ejpain.2008.07.015] [Citation(s) in RCA: 289] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 07/06/2008] [Accepted: 07/28/2008] [Indexed: 11/29/2022]
Abstract
Chronic post-surgical pain (CPSP) is a serious problem. Incidence as high as 50% has been reported, depending on type of surgery undergone. Because the etiology of chronic pain is grounded in the bio-psychosocial model, physical, psychological, and social factors are implicated in the development of CPSP. Biomedical factors such as pre-operative pain, severe acute post-operative pain, modes of anesthesia, and surgical approaches have been extensively examined, therefore this systematic review focuses on psychosocial elements. A systematic search was performed using the PubMed, PsychINFO, Embase, and Cochrane Databases. Fifty relevant publications were selected from this search, in which psychosocial predictors for and correlates to CPSP were identified. The level of evidence was assessed for each study, and corresponding score points were awarded for ease of comparison. The grade of association with CPSP for each predictor/correlate was then determined. Depression, psychological vulnerability, stress, and late return to work showed likely correlation with CPSP (grade of association=1). Other factors were determined to have either unlikely (grade of association=3) or inconclusive (grade of association=2) correlations. In addition, results were examined in light of the type of surgery undergone. This review is intended as a first step to develop an instrument for identifying patients at high risk for CPSP, to optimize clinical pain management.
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Affiliation(s)
- Anke Hinrichs-Rocker
- Institute for Research in Operative Medicine, Faculty of Medicine, Chair for Surgical Research, University of Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany
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Halldestam I, Kullman E, Borch K. Defined indications for elective cholecystectomy for gallstone disease. Br J Surg 2008; 95:620-6. [PMID: 18161899 DOI: 10.1002/bjs.6020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study examined symptomatology and quality of life following elective cholecystectomy for symptomatic gallstone disease with defined indications for surgery. METHODS In this prospective study of 200 consecutive patients (161 women; median age 46.5 (range 24-79) years), strict indications for elective cholecystectomy were stipulated. Digestive symptoms and quality of life were recorded with a self-administered questionnaire before and at 3 and 12 months after surgery. RESULTS Of 149 patients who experienced abdominal pain with typical location before surgery, 136 (91.3 per cent) reported total remission or reduced frequency of that type of pain 12 months later. Of 35 patients who reported atypical or multiple pain location before operation, 27 (77 per cent) experienced reduced frequency or disappearance of that type of pain. Frequency of pain episodes, atypical or multiple pain location, specific food intolerance and frequency of disturbing abdominal gas at baseline correlated positively with the frequency of abdominal pain episodes at 12 months after surgery. There was a tendency towards an inverse relation to age. CONCLUSION The frequency of persistent abdominal pain after elective cholecystectomy was low among patients with typical pain location before surgery. Atypical pain location, and frequent pain episodes before operation significantly reduced the chance of becoming pain-free.
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Affiliation(s)
- I Halldestam
- Department of Surgery, University Hospital of Linköping, SE-58185 Linköping, Sweden.
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Sperber AD, Morris CB, Greemberg L, Bangdiwala SI, Goldstein D, Sheiner E, Rusabrov Y, Hu Y, Katz M, Freud T, Neville A, Drossman DA. Development of abdominal pain and IBS following gynecological surgery: a prospective, controlled study. Gastroenterology 2008; 134:75-84. [PMID: 18166349 DOI: 10.1053/j.gastro.2007.10.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 10/11/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) develops after bacterial enteritis that causes injury to the bowel mucosa. It's unclear whether abdominal pain or IBS results from gynecological surgery that could injure abdominopelvic nerves. The aim of this prospective, controlled study was to assess the incidence of pain or IBS in women undergoing elective gynecological surgery compared to non-surgical controls and to identify factors associated with their development. METHODS One hundred thirty-two women without GI symptoms undergoing elective gynecological surgery for non-painful conditions were compared with 123 non-surgery controls without GI symptoms. Socio-demographic, psychosocial, and surgery-related variables were potential predictor variables of pain at 3 and/or 12 months. RESULTS Three surgical patients (2.7%), but no controls, developed IBS at 12 months. Significantly more surgical patients had abdominal pain at 3 or 12 months (15.3% vs 3.6%, P=.003). No socio-demographic or surgery-related variables predicted pain development, but it was predicted by psychosocial factors including anticipation of difficult recovery from surgery (P=.01), perception of severity/constancy of illness (P=.04), and reduced sense of coherence (P=.01). CONCLUSIONS Among women undergoing gynecological for non-pain indications the development of IBS was not significantly greater than controls. However, abdominal pain did develop in 17% of women in the surgical group, suggesting that surgery facilitated its development. Notably, only psychosocial variables predicted pain development, implying that pain development associated with central registration and amplification of the afferent signal (via cognitive and emotional input) must be considered along with the peripheral injury itself. These findings contribute to understanding the pathophysiology of functional GI pain.
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Affiliation(s)
- Ami D Sperber
- Department of Gastroenterology, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Bech P, Lunde M, Bech-Andersen G, Lindberg L, Martiny K. Psychiatric outcome studies (POS): does treatment help the patients? A Popperian approach to research in clinical psychiatry. Nord J Psychiatry 2007; 61 Suppl 46:4-34. [PMID: 17365777 DOI: 10.1080/08039480601151238] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- P Bech
- Psychiatric Research Unit, Frederiksborg General Hospital, 48, Dyrehavevej, DK-3400 Hillerød, Denmark.
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Eplov LF, Jørgensen T, Birket-Smith M, Petersen J, Johansen C, Mortensen EL. Mental vulnerability--a risk factor for ischemic heart disease. J Psychosom Res 2006; 60:169-76. [PMID: 16439270 DOI: 10.1016/j.jpsychores.2005.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Accepted: 05/24/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study is to examine whether mental vulnerability is a risk factor for the development of ischemic heart disease (IHD) after adjustment for well-established risk factors. METHODS In three prospective cohort studies in Copenhagen County, Denmark, we recorded the level of mental vulnerability and possible risk factors to IHD at baseline. For follow-up, the sample was linked to relevant registries to identify all cases of fatal and nonfatal IHD. The relationship between mental vulnerability and IHD was examined using both Kaplan-Meir and Cox proportional hazard models adjusting for possible confounding factors. RESULTS Mental vulnerability was significantly associated with the risk for IHD (medium mental vulnerability: hazard ratio 1.41, 95% confidence interval 1.04-1.91; and high mental vulnerability: hazard ratio 2.05; 95% confidence interval 1.46-2.88), after adjusting for confounders. CONCLUSION Our results imply that mental vulnerability is an independent risk factor for IHD.
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Affiliation(s)
- Lene Falgaard Eplov
- Copenhagen County Research Centre for Prevention and Health, Glostrup University Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark.
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Meyhoff CS, Thomsen CH, Rasmussen LS, Nielsen PR. High Incidence of Chronic Pain Following Surgery for Pelvic Fracture. Clin J Pain 2006; 22:167-72. [PMID: 16428951 DOI: 10.1097/01.ajp.0000174266.12831.a2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the incidence of chronic pain after surgery for pelvic fracture using a strict definition and measures of intensity and health-related quality of life. METHODS In April 2004, a questionnaire was sent to 221 patients who underwent surgery for pelvic fracture in the period 1996 to 2000. Chronic pain was defined as pain at present that related back to the pelvic fracture and was not a consequence of other disease. Health-related quality of life was measured using the 15D questionnaire. RESULTS The response rate was 72.9% after a median follow-up of 5.6 years. Chronic pain was seen in 48.4% (95% confidence interval, 40.7%-56.2%). These patients had a combination of somatic nociceptive, visceral nociceptive, and neuropathic pain and had significantly lower health-related quality of life. Also, the use of opioids (14.1% vs. 4.8%) and nonsteroidal anti-inflammatories/paracetamol (57.7% vs. 21.7%), the request for financial compensation (75.6% vs. 45.8%), and complications related to leg function (62.8% vs. 20.5%) were significantly higher in the group with chronic pain than in the group without chronic pain. CONCLUSIONS Chronic pain after pelvic fracture is a major problem that affects a patient's quality of life. The use of analgesics was higher in these patients, and they had more complications. Chronic pain after surgery for pelvic fracture deserves more attention.
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Affiliation(s)
- Christian Sylvest Meyhoff
- Department of Anaesthesia, Center of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark
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Bisgaard T, Rosenberg J, Kehlet H. From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis. Scand J Gastroenterol 2005; 40:1358-64. [PMID: 16334446 DOI: 10.1080/00365520510023675] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The pathogenesis and risk of chronic pain after cholecystectomy are unknown. In this prospective study of 150 consecutive patients undergoing laparoscopic cholecystectomy, the preoperative clinical data, cold pressor test, state of neuroticism and early postoperative pain intensity were assessed. MATERIAL AND METHODS Follow-up questionnaires were sent to all patients 1 year after surgery. Patients with moderate/severe chronic pain were interviewed and invited to participate in a structured examination programme. RESULTS The questionnaire response rate was 100%. Twenty patients reported moderate or severe chronic pain. The 1-year in-office interview revealed that two patients without chronic pain had misinterpreted the questionnaire. Sixteen patients were enrolled for the examination programme. Demonstrable pathology explained the aetiology of chronic pain in 8 patients (5%); another 8 patients with moderate (n=6) or severe (n=2) chronic pain were without pathological findings. In total, 132 patients had no chronic pain. Chronic pain patients suffered significantly more intense acute postoperative pain compared with those without chronic pain (p < or =0.05). The incidence of chronic pain patients was higher in the group of patients with intense acute postoperative pain than in patients with low acute postoperative pain (p = 0.030-0.063). Development of chronic pain was not statistically related to a preoperative cold pressor nociceptive stimulus, preoperative state of neuroticism or to any other variables examined. CONCLUSIONS The risk of significant chronic pain after laparoscopic cholecystectomy for symptomatic cholecystolithiasis is low but was significantly associated with the intensity of acute postoperative pain. Patients should be carefully examined to exclude somatic causes of chronic pain after laparoscopic cholecystectomy.
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Affiliation(s)
- Thue Bisgaard
- Department of Surgical Gastroenterology, H:S Hvidovre Hospital, Hvidovre, Denmark.
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Joshi GP, Ogunnaike BO. Consequences of Inadequate Postoperative Pain Relief and Chronic Persistent Postoperative Pain. ACTA ACUST UNITED AC 2005; 23:21-36. [PMID: 15763409 DOI: 10.1016/j.atc.2004.11.013] [Citation(s) in RCA: 294] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Inadequately controlled pain has undesirable physiologic and psychologic consequences such as increased postoperative morbidity, delayed recovery, a delayed return to normal daily living, and reduced patient satisfaction. Importantly, the lack of adequate postoperative pain treatment may lead to persistent pain after surgery, which is often overlooked. Overall, inadequate pain management increases the use of health care resources and health care costs. This article reviews the physiologic and psychologic consequences of inadequately treated pain, with an emphasis on chronic persistent postoperative pain.
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Affiliation(s)
- Girish P Joshi
- Perioperative Medicine and Ambulatory Anesthesia, University of Texas, Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9068, USA.
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Cohen L, Fouladi RT, Katz J. Preoperative coping strategies and distress predict postoperative pain and morphine consumption in women undergoing abdominal gynecologic surgery. J Psychosom Res 2005; 58:201-9. [PMID: 15820849 DOI: 10.1016/j.jpsychores.2004.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2003] [Accepted: 07/20/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of the present study was to predict postoperative pain and morphine consumption based on preoperative psychosocial factors. METHODS One hundred and twenty-two women completed measures of distress and coping 1 week before major abdominal gynecological surgery by laparotomy. Forty-eight hours after surgery, measures of pain and negative affect (NA) were completed, and morphine consumption was recorded from a patient-controlled analgesia pump. Four weeks after surgery, measures of pain and NA were completed. RESULTS Multivariate analyses revealed that preoperative self-distraction coping (P=.039) positively predicted postoperative pain levels in the hospital, after accounting for the effects of age, concurrent NA, and morphine consumption. Emotional support (P=.031) and religious-based coping (P=.036) positively predicted morphine consumption in the hospital, after accounting for the effects of age, concurrent NA, and pain levels. Preoperative distress (P<.04 to .008) and behavioral disengagement (P=.034), emotional support (P=.049), and religious-based coping (P=.001) positively predicted pain levels 4 weeks after surgery, after accounting for the effects of age and concurrent NA. CONCLUSION The results suggest that preoperative psychosocial factors are associated with postoperative pain and morphine consumption.
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Affiliation(s)
- Lorenzo Cohen
- Department of Behavioral Science, The University of Texas, M.D. Anderson Cancer Center, Box 243, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Elberling J, Linneberg A, Mosbech H, Dirksen A, Frølund L, Madsen F, Nielsen NH, Johansen JD. A link between skin and airways regarding sensitivity to fragrance products? Br J Dermatol 2004; 151:1197-203. [PMID: 15606515 DOI: 10.1111/j.1365-2133.2004.06251.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exposure to volatile fragrances is commonplace and may be related to various eye and airway symptoms. Skin exposure to fragrances is known to cause perfume contact allergy and eczema, but it is unknown whether eye or airway symptoms elicited by fragrance products are associated with contact allergy or eczema. OBJECTIVES To investigate if eye and airway symptoms elicited by fragrance products are associated with perfume contact allergy or hand eczema in a population-based sample. METHODS A questionnaire on eye and airway symptoms elicited by fragrance products was mailed to 1189 individuals who had recently participated in a Danish population-based study of allergic diseases. Results from the questionnaire about localization and character of the symptoms were compared with data on patch testing and 1-year prevalence of hand eczema collected during the health examination. RESULTS Positive, independent and significant (P < 0.05) associations were found between eye and airway symptoms elicited by fragrance products and perfume contact allergy (adjusted odds ratios 2.0-3.7) and hand eczema (adjusted odds ratios 1.6-2.6). In further analysis, similar and consistent results were found regarding severity of the symptoms. No associations were found between nickel contact allergy and the symptoms. Female sex and psychological vulnerability were independently associated with eye and airway symptoms elicited by fragrance products, but adjustment in multivariate analysis did not change the results regarding perfume contact allergy and hand eczema. CONCLUSIONS Individuals with perfume contact allergy and/or hand eczema, as opposed to those without, have more frequent and more severe eye or airway symptoms after exposure to volatile fragrance products. Having hand eczema has the greatest impact on reporting eye and airway symptoms elicited by fragrance products.
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Affiliation(s)
- J Elberling
- The National Allergy Reseasrch Centre for Consumer Products, Department of Dermatology, Gentofte University Hospital, Ledreborg Alle 40,1, DK-2820 Gentofte, Denmark.
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Vetrhus M, Søreide O, Eide GE, Solhaug JH, Nesvik I, Søndenaa K. Pain and quality of life in patients with symptomatic, non-complicated gallbladder stones: results of a randomized controlled trial. Scand J Gastroenterol 2004; 39:270-6. [PMID: 15074398 DOI: 10.1080/00365520310008502] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cholecystectomy is intended to relieve symptoms of gallstones, but unfortunately some patients will experience postcholecystectomy symptoms, including pain. There is limited information in the literature on gallstone-related pain and its influence on quality of life. The aim of this study was to examine how pain and quality of life in patients with symptomatic, uncomplicated gallbladder stones were affected by observation of their condition compared with removal of the gallbladder. METHODS One-hundred and thirty-seven patients were randomized to observation (watchful waiting; n = 69) or cholecystectomy (n = 68) and answered questionnaires on pain, quality of life (PGWB index and NHP Part II) at randomization and fixed intervals (6, 12 and 60 months). All gallstone-related events (hospital admission for pain, complications of gallstone disease and cholecystectomy) and crossover between treatment groups were recorded. RESULTS Of patients randomized to observation, 35 of 69 patients (51%) eventually underwent a cholecystectomy. Significant improvements in quality of life and pain scores were detected regardless of surgical treatment. Patients that subsequently experienced gallstone-related events had significantly higher pain scores at randomization than patients that did not experience any subsequent events, and this difference was maintained throughout follow-up. CONCLUSIONS Unexpectedly, in the majority of patients symptoms did abate without any significant differences between groups in pain and quality of life. Patients that had high intensity and frequency of pain at randomization had a higher risk of experiencing subsequent events.
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Affiliation(s)
- M Vetrhus
- Rogaland Central Hospital, Stavanger, Norway.
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Kovács F, Gyökeres T, Elek G, Pap A. [Sphincter of Oddi dysfunction--prolonged medical therapy or early endoscopic sphincter ablation]. Orv Hetil 2003. [PMID: 12638309 DOI: 10.1007/s10880-005-7824-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Sphincter of Oddi dysfunction is a real challenge from both diagnostic and therapeutic point of view. PATIENTS AND METHODS In the last two years the authors have performed ERCP and EST in 29 patients with positive evocative test results, who had important enzyme elevations and/or did not respond to prolonged medical treatment. RESULTS Endoscopic findings were positive in 25/29 patients (86.2%): 8 adenoma of p. Vateri, 17 papillitis were identified, and in 4 cases the papilla was intact. Histopathology obtained in 12 patients supported the diagnosis. In 6 patients, who underwent a postpapillotomy evocative test, after an average of 10 months follow up the results have been converted from positive to negative response in all but two cases. The two patients continued to have abdominal symptoms with persistent positive provocation tests because of restenosis, were treated with repapillotomy. CONCLUSIONS The Debray and Nardi tests are useful screening tests for hypertonic biliary or pancreatic dyskinesia. Structural endoscopic and histological findings are frequent already in the functional cases. Early sphincter ablation should be considered in failure of medical therapy for preventing the transformation of this functional disorder into an organic, potentially precancerous state.
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Schapiro IR, Nielsen LF, Jørgensen T, Boesen EH, Johansen C. Psychic vulnerability and the associated risk for cancer. Cancer 2002; 94:3299-306. [PMID: 12115364 DOI: 10.1002/cncr.10601] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Psychic vulnerability has been associated with a number of physical symptoms and diseases. This study was designed to estimate the incidence of cancer in a random sample of persons in the general Danish population in relation to a personality characteristic measured by the Test of Psychic Vulnerability. METHODS The authors examined the cancer incidence in a cohort of 5136 randomly sampled persons age > 25 years living in Copenhagen County, Denmark. The responses to questionnaires and the results of examinations, including the Test of Psychic Vulnerability, were collected during 1982-1984 and during 1991-1992. The observed numbers of cancers were compared with the numbers that would have been expected if the cohort members had experienced the same risk of cancer as the population of Copenhagen County. Regression analyses were performed with the Cox proportional hazards model to adjust for well-known risk factors for cancer. RESULTS A total of 403 cancers were observed, and 412.02 were expected, yielding a standardized incidence ratio of 0.98 (95% confidence interval [95% CI], 0.88-1.19). The authors did not observe a significant increase in the risk of site specific cancers. The risk for cancer was not influenced by the type of vulnerability in a multivariate analysis (hazards ratio, 1.16; 95% CI, 0.85-1.57). CONCLUSIONS The authors found no increased risk for cancer among psychically vulnerable persons compared with nonvulnerable persons; however, the results indicate that behavior and certain life-style factors may be determined by personality, which, in turn, may determine the risk for cancer.
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Affiliation(s)
- Ina R Schapiro
- Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark
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Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 2001; 90:261-269. [PMID: 11207398 DOI: 10.1016/s0304-3959(00)00406-1] [Citation(s) in RCA: 305] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Small-scale studies have suggested a large inter-individual variation in early postoperative pain after laparoscopic cholecystectomy, emphasizing the need for improved analgesic treatment and valid predictors. We investigated prospectively the association between a preoperative nociceptive stimulus by ice water (cold pressor test), neuroticism, dyspepsia, patient history of biliary symptoms, intraoperative factors, and demographic information in 150 consecutive patients undergoing uncomplicated laparoscopic cholecystectomy for their influence on early postoperative pain. During the first postoperative week patients registered overall pain, incisional, visceral, and shoulder pain on a visual analogue scale and verbal rating scale, and daily analgesic requirements were noted. Throughout the first postoperative week overall pain showed a pronounced inter-individual variability. Incisional pain dominated in incidence and intensity compared with visceral pain, which in turn dominated over shoulder pain. In a multivariate analysis model, preoperative neuroticism, sensitivity to cold pressor-induced pain, and age were identified as independent risk factors for early postoperative pain. Our results suggest that future analgesic studies after laparoscopic cholecystectomy should focus on reduction of incisional pain.
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Affiliation(s)
- Thue Bisgaard
- Department of Surgical Gastroenterology 435, University of Copenhagen, Hvidovre Hospital, DK- 2650 Hvidovre, Denmark
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Svebak S, Søndenaa K, Hausken T, Søreide O, Hammar A, Berstad A. The significance of personality in pain from gallbladder stones. Scand J Gastroenterol 2000; 35:759-64. [PMID: 10972182 DOI: 10.1080/003655200750023453] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to investigate the association between personality factors related to coping styles and reported pain due to gallstones. METHODS Personality trait measures were completed by 28 consecutive gallstone patients to provide estimates of positive coping resources (Life Regard Index, Sense of Coherence Scale, Sense of Humor Questionnaire) and negative coping resources (Eysenck Personality Questionnaire on Neuroticism, Tension, and Effort Stress Inventory). An overall index of gallstone-related complaints (pain) over the past 7 days/6 months was also obtained. Ultrasonography confirmed the gallstone condition. Multiple regression analyses tested the hypothesis that pain would be moderated by positive coping resources and mediated by negative coping resources. RESULTS Reported pain was less severe with positive coping resources (39% of pain variance explained) and more severe with negative coping resources (45% of pain variance explained). CONCLUSION The results confirm that mental coping resources have a significant role in pain differences among gallstone patients.
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Affiliation(s)
- S Svebak
- Dept. of Behavioral Sciences in Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim
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Abstract
BACKGROUND Although laparoscopic cholecystectomy (LC) results in less pain than open chole-cystectomy, it is not a pain-free procedure. Many methods of analgesia for pain after laparoscopy have been evaluated. METHODS Forty-two randomized controlled trials assessing interventions to reduce pain after LC are reviewed, as are the mechanisms and nature of pain after this procedure. RESULTS Non-steroidal anti-inflammatory drugs, wound local anaesthetic, intraperitoneal local anaesthetic, intraperitoneal saline, a gas drain, heated gas, low-pressure gas and nitrous oxide pneumo-peritoneum have been shown to reduce pain after LC. The clinical significance of this pain reduction is questionable. CONCLUSION Pain after LC is multifactorial. Although many methods of analgesia produce short-term benefit, this does not equate with earlier discharge or improved postoperative function. However, single trials evaluating low-pressure insufflation, heated gas and multimodal analgesia suggest that clinically relevant benefits can be achieved.
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Affiliation(s)
- V L Wills
- Upper Gastrointestinal Surgical Unit, Level 5, Suite 1, St George Private Medical Centre, South Street, Kogarah, 2217 New South Wales, Australia
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