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Yasoda-Mohan A, Vanneste S. Development, Insults and Predisposing Factors of the Brain's Predictive Coding System to Chronic Perceptual Disorders-A Life-Course Examination. Brain Sci 2024; 14:86. [PMID: 38248301 PMCID: PMC10813926 DOI: 10.3390/brainsci14010086] [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: 12/12/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
The predictive coding theory is currently widely accepted as the theoretical basis of perception and chronic perceptual disorders are explained as the maladaptive compensation of the brain to a prediction error. Although this gives us a general framework to work with, it is still not clear who may be more susceptible and/or vulnerable to aberrations in this system. In this paper, we study changes in predictive coding through the lens of tinnitus and pain. We take a step back to understand how the predictive coding system develops from infancy, what are the different neural and bio markers that characterise this system in the acute, transition and chronic phases and what may be the factors that pose a risk to the aberration of this system. Through this paper, we aim to identify people who may be at a higher risk of developing chronic perceptual disorders as a reflection of aberrant predictive coding, thereby giving future studies more facets to incorporate in their investigation of early markers of tinnitus, pain and other disorders of predictive coding. We therefore view this paper to encourage the thinking behind the development of preclinical biomarkers to maladaptive predictive coding.
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Affiliation(s)
- Anusha Yasoda-Mohan
- Global Brain Health Institute, Trinity College Dublin, D02 R123 Dublin, Ireland;
- Trinity College Institute for Neuroscience, Trinity College Dublin, D02 R123 Dublin, Ireland
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, D02 R123 Dublin, Ireland
| | - Sven Vanneste
- Global Brain Health Institute, Trinity College Dublin, D02 R123 Dublin, Ireland;
- Trinity College Institute for Neuroscience, Trinity College Dublin, D02 R123 Dublin, Ireland
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, D02 R123 Dublin, Ireland
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Alhilou AM, Al-Moraissi EA, Bakhsh A, Christidis N, Näsman P. Pain after emergency treatments of symptomatic irreversible pulpitis and symptomatic apical periodontitis in the permanent dentition: a systematic review of randomized clinical trials. FRONTIERS IN ORAL HEALTH 2023; 4:1147884. [PMID: 37920592 PMCID: PMC10618681 DOI: 10.3389/froh.2023.1147884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
Background Symptomatic irreversible pulpitis (SIP) or symptomatic apical periodontitis (SAP) are two painful conditions often warranting emergency treatment. The most common emergency treatments supported by evidence are pulpotomy and pulpectomy and are normally performed under time-constrained circumstances. However, there is no strong evidence of which treatment suggested in literature a clinician can use to reduce endodontic pain effectively. Therefore, the aim of this systematic review is to investigate the present knowledge on postoperative pain related to the two types of emergency treatments available for treating SIP and SAP. Methods Randomized controlled trials investigating postoperative pain after emergency treatments (pulpotomy and/or pulpectomy) on permanent dentition with signs and symptoms of SIP and/or SAP were searched in three major databases from 1978 until 2022. Risk of bias was assessed with Cochrane's tool. Results Only five studies fulfilled the inclusion criteria. The included studies indicated that pulpotomy and pulpectomy are both suitable treatment options for SAP and SIP, as they provide sufficient alleviation of pain in permanent dentition. However, inconsistent results were found between the included trials on which emergency treatment is more effective in reducing pain. Cochrane's tool revealed that the studies had a low risk of bias. Limitations found in the design of the included randomized control trials decreased the level of evidence. None of the included studies accounted for essential confounding variables, such as factors affecting pain (including the psychological aspects). Moreover, possible non-odontogenic pain was not assessed, and therefore, it was not excluded; hence, affecting the internal validity of the studies. Conclusion There are controversies within the available randomized control trials on which treatment is most effective in reducing emergency pain. This could be due to some weaknesses in the design of the clinical trials. Thus, further well-designed studies are warranted to draw conclusions on which emergency treatment is more effective in reducing pain. Systematic Review Registration PROSPERO (CRD42023422282).
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Affiliation(s)
- Abdelrahman M. Alhilou
- Department of Restorative Dentistry, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - Abdulaziz Bakhsh
- Department of Restorative Dentistry, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neurosciences, Huddinge, Sweden
| | - Peggy Näsman
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Helou LB, Welch B, Hoch S, Gartner-Schmidt J. Self-Reported Stress, Trauma, and Prevalence of Laryngoresponders in the General Population. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-16. [PMID: 37319403 DOI: 10.1044/2023_jslhr-22-00669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION It has been proposed that some individuals are "laryngoresponders" (LRs) in that their stress manifests in the laryngeal region and laryngeal functions (e.g., voice and breathing). Preliminary data support the notion that LRs might differ from nonlaryngoresponders (NLRs) in their self-reported past trauma and recent stress. The purpose of this study was to establish the point prevalence of self-identified LRs in the general population. METHOD Using a web-based questionnaire, participants reported up to 13 stress-vulnerable bodily regions and described symptom nature and severity for each region. At the end of the questionnaire, they were explicitly prompted to report whether their laryngeal region or its functions were affected by stress. Participants were categorized a posteriori as Unprompted LRs, Prompted LRs, Inconsistent LRs, or NLRs. We compared LR and NLR groups on the Perceived Stress Scale (PSS-10) and the Childhood Trauma Questionnaire (CTQ-SF). We also redistributed the survey to a subset of participants to establish grouping reliability. RESULTS A total of 1,217 adults responded to the survey, and 995 provided complete data sets. Of those, 15.7% were classified as Unprompted LRs, 26.7% as Prompted LRs, 3% as Inconsistent LRs, and 54.6% as NLRs. Unprompted LRs demonstrated significantly higher/worse PSS-10 and CTQ-SF scores than all other groups. Reliability of LR classification was moderate upon follow-up, κ = .62, 95% confidence interval [0.47, 0.77]. CONCLUSIONS Unprompted LRs described their symptoms in ways that were indistinguishable from patients with functional voice disorders (e.g., throat clenches, voice gets tired easily, lose my voice, voice gets hoarse). The method of self-report solicitation impacted the resulting response. Specifically, the report of larynx-related symptoms differed substantially depending on whether or not the participants were directly prompted to consider the larynx and its related functions.
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Affiliation(s)
- Leah B Helou
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
| | - Brett Welch
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
| | - Sarah Hoch
- Department of Otolaryngology, Heersink School of Medicine, The University of Alabama at Birmingham
| | - Jackie Gartner-Schmidt
- Department of Speech-Language Pathology, College of Health and Wellness, Carlow University, Pittsburgh, PA
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Efremov A. Eliminating Psychosomatic Pain and Negative Emotions with Dehypnosis. JOURNAL OF ORGANIZATIONAL BEHAVIOR RESEARCH 2023. [DOI: 10.51847/rnrhuqmtqy] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Becker DR, Welch B, Monti E, Sullivan H, Helou LB. Investigating Past Trauma in Laryngoresponders Versus Non-Laryngoresponders: Piloting New Methods in an Exploratory Study. J Voice 2022:S0892-1997(22)00144-8. [PMID: 35701254 DOI: 10.1016/j.jvoice.2022.05.011] [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: 01/25/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES/HYPOTHESIS This exploratory pilot study aimed to probe the relationship between past experiences of trauma in people who self-identify as "laryngoresponders" compared to those who do not. It also explored the communicative context of past traumatic events in laryngoresponders versus non-laryngoresponders. STUDY DESIGN Prospective, within-subjects experimental design. METHODS 29 vocally healthy cisgender women (ages 19 to 56) completed a battery of validated self-report measures relating to their past traumatic experiences. Participants also completed two original self-report measures designed to provide insight about (1) where stress tends to manifest in their body and (2) communicative settings of participants' past trauma. RESULTS Six participants (21%) self-identified a predictable laryngeal and/or vocal response to acute stress and thus comprise the laryngoresponders group. Laryngoresponders exhibited worse scores on 75% of all trauma-related variables compared to non-laryngoresponders, and Emotional Neglect was disproportionately represented in laryngoresponders. Participants with a reported history of childhood Emotional Neglect (83% of laryngoresponders, 35% of nonlaryngoresponders) reported quantitatively "less ideal" communication experiences in the context of past traumatic experiences. CONCLUSIONS Other investigators identify the larynx as a "vulnerable body pathway" for some women. This pilot study of adult women without voice complaints revealed several commonalities amongst self-reported laryngoresponders, and compels further exploration of the voice-trauma relationship.
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Affiliation(s)
| | - Brett Welch
- Department of Communication Science and Disorders, The University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elisa Monti
- Department of Psychology, The New School, New York City, New York
| | | | - Leah B Helou
- Department of Communication Science and Disorders, The University of Pittsburgh, Pittsburgh, Pennsylvania.
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The Relationship of Intimate Partner Violence With Psychiatric Disorders and Severity of Pain Among Female Patients With Fibromyalgia. Arch Rheumatol 2019; 34:245-252. [PMID: 31598588 DOI: 10.5606/archrheumatol.2019.7090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/27/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to compare the prevalence of intimate partner violence and comorbid psychiatric disorders among patients with fibromyalgia syndrome (FMS) and healthy controls and also to investigate the relationship of intimate partner violence with psychiatric disorders and severity of pain in FMS patients. Patients and methods The study group consisted of 136 females including 68 patients with FMS (mean age 43±10.4 years; range, 25 to 70 years) and 68 FMS-free healthy females (mean age 38.5±11.3 years; range, 22 to 70 years). Following a Structured Clinical Interview for Diagnostic and Statistical Manual-IV Axis I Disorders by a psychiatrist experienced in psychological trauma, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Visual Analog Scale (VAS) for the severity of pain and Domestic Violence Against Women Scale (DVAWS) were applied. Results In FMS group, 85% of the patients were diagnosed with mood or anxiety disorder. Almost half of these patients had major depressive disorder. The total scores of DVAWS and all subscales were significantly higher in the FMS group than in the control group (p<0.01). The severity of domestic violence were related to the presence of any psychiatric disorder only in FMS patients (p<0.01). Almost half of the FMS patients with high DVAWS score had comorbid mood and anxiety disorders. There was a significant positive correlation between the total scores of DVAWS, HDRS, HARS, and VAS (p<0.01). Conclusion Although the etiology of FMS is still uncertain, psychosocial factors may play role as risk factors. Therefore, a multidisciplinary approach to the treatment should be considered.
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MO O. A Multidisciplinary Approach to the Assessment and Management of Pre-school Age Neuro-developmental Disorders: A Local Experience. CLINICAL JOURNAL OF NURSING CARE AND PRACTICE 2017; 1:001-012. [DOI: 10.29328/journal.hjncp.1001001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Wong JYH, Fong DYT, Lai V, Tiwari A. Bridging intimate partner violence and the human brain: a literature review. TRAUMA, VIOLENCE & ABUSE 2014; 15:22-33. [PMID: 23878144 DOI: 10.1177/1524838013496333] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Past studies mainly focused on the physical and structural brain injuries in women survivors with a history of intimate partner violence (IPV), but little attention has been given to the biological impact and cognitive dysfunction resulting from such psychological stress. In this article, we aim to establish the connection between IPV and the brain by reviewing current literature examining (1) the biological mechanisms linking IPV, stress, and the brain; (2) the functional and anatomical considerations of the brain in abused women; and (3) the abused women's behavioral responses to IPV, including fear, pain, and emotion regulation, by utilizing functional neuroimaging. The major significance of this study is in highlighting the need to advance beyond self-reports and to obtain scientific evidence of the neurological impact and cognitive dysfunction in abused women with a history of IPV, an area in which current literature remains at a descriptive level.
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Affiliation(s)
- Janet Yuen-Ha Wong
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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Jacobs MS. Psychological Factors Influencing Chronic Pain and the Impact of Litigation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0015-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Picard M, Sabiston CM, McNamara JK. The Need for a Transdisciplinary, Global Health Framework. J Altern Complement Med 2011; 17:179-84. [DOI: 10.1089/acm.2010.0149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Martin Picard
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
- Montreal Institute of Classical Homeopathy, Montreal, Quebec, Canada
| | - Catherine M. Sabiston
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
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Psychologic factors in the development of complex regional pain syndrome: history, myth, and evidence. Clin J Pain 2010; 26:258-63. [PMID: 20173441 DOI: 10.1097/ajp.0b013e3181bff815] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The present paper examines the literature that addresses psychologic aspects involved in complex regional pain syndrome from a historic perspective to provide a rationale for the emergence of psychologic theories to explain its pathogenesis. The support of such perspective is then analyzed through the review of evidence-based studies. METHODS A review of the literature from a historic perspective was presented since its first description to the present time, including the clinical presentation and associated symptoms. An evidence-based approach was used to review the literature on complex regional pain syndrome and psychologic factors associated with the etiology or as predictors in the development of the disorder. RESULTS After reviewing the literature on the history and the myths associated with complex regional pain syndrome, a hypothesis is provided based on an analysis of the Zeitgeist in the development of the psychologic theory associated with the disorder. We also concluded there is no evidence to support a linear relationship that establishes a psychologic predisposition to develop the disorder. DISCUSSION An analysis of the Zeitgeist when complex regional pain syndrome was first described helps to understand the long-standing theories associated with a psychological theory of its etiology. This understanding should help to undermine the perpetuation of such claims which may contribute to undertreatment and misdiagnosis. To be consistent with todays Zeitgeist we must incorporate psychologic aspects, which while not causal in nature or exclusive of complex regional pain syndrome, are strongly associated with a wide spectrum of chronic pain disorders.
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Sansone RA, Wiederman MW, McLean JS. The relationship between childhood trauma and medically self-sabotaging behaviors among psychiatric inpatients. Int J Psychiatry Med 2009; 38:469-79. [PMID: 19480359 DOI: 10.2190/pm.38.4.f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was designed to explore the relationship between five forms of childhood trauma and medically self-sabotaging behaviors (i.e., the intentional induction, exaggeration, and/or exacerbation of medical symptoms). METHOD Using a cross-sectional sample of convenience, 120 psychiatric inpatients were surveyed about childhood sexual, physical, and emotional abuses, the witnessing of violence, and physical neglect, as well as 19 medically self-sabotaging behaviors (i.e., intentional behaviors that represent attempts to sabotage medical care). RESULTS As expected, in this sample there were high prevalence rates of trauma (62.5% emotional abuse, 58.3% witnessing of violence, 46.7% physical abuse, 37.5% sexual abuse, 28.3% physical neglect). Simple correlations demonstrated statistically significant relationships between sexual abuse and physical neglect and medically self-sabotaging behaviors. Using multiple regression analysis, only physical neglect remained a unique predictor of medically self-sabotaging behaviors. CONCLUSIONS These findings indicate that among psychiatric inpatients there appears to be a relationship between physical neglect in childhood and the generation of medically self-sabotaging behaviors in adulthood. Perhaps physical neglect in childhood contributes to the generation of somatic behaviors in adulthood for the purpose of eliciting caring responses from others.
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Clasificación de la fibromialgia. Revisión sistemática de la literatura. ACTA ACUST UNITED AC 2009; 5:55-62. [DOI: 10.1016/j.reuma.2008.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 07/30/2008] [Indexed: 12/23/2022]
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Rosenzweig TM, Thomas TM. An Update on Fibromyalgia Syndrome: The Multimodal Therapeutic Approach. Am J Lifestyle Med 2009. [DOI: 10.1177/1559827609331557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fibromyalgia is a chronic, musculoskeletal, noninflammatory pain disorder. Patients frequently suffer from sleep disturbances, headaches, anxiety, morning stiffness, and a poor sense of well-being. It is estimated that approximately 6 million Americans live with this condition. Fibromyalgia is characterized by the presence of at least 11 tender points, as well as widespread bilateral pain for at least 3 months. If left untreated, it may lead to a significant impairment in patients' quality of life or even disability. Although the exact pathophysiology of fibromyalgia remains a source of speculation, several treatment modalities are available to patients with this condition. Among nonpharmacological options, cognitive-behavioral therapy, patient education, exercise, physical therapy, and diet have all been found effective in reducing the symptoms of fibromyalgia. Pregabalin, a second-generation anticonvulsant, and duloxetine (a selective serotonin and norepinephrine reuptake inhibitor) are the only pharmacological agents approved by the Food and Drug Administration for the treatment of fibromyalgia. However, other medications such as tricyclic antidepressants, selective serotonin reuptake inhibitors, anticonvulsants, and tramadol have been investigated in clinical trials and shown to be effective treatment options. Currently, the recommended management strategy for patients with fibromyalgia is a combination of pharmacological and nonpharmacological treatment modalities.
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Affiliation(s)
- Tamara M. Rosenzweig
- Clinical Pharmacy Services, Commonwealth Medicine, University of Massachusetts Medical School, Shrewsbury, Massachusetts,
| | - Tara M. Thomas
- Clinical Pharmacy Services, Commonwealth Medicine, University of Massachusetts Medical School, Shrewsbury, Massachusetts
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Central Sensitivity Syndromes: A New Paradigm and Group Nosology for Fibromyalgia and Overlapping Conditions, and the Related Issue of Disease versus Illness. Semin Arthritis Rheum 2008; 37:339-52. [DOI: 10.1016/j.semarthrit.2007.09.003] [Citation(s) in RCA: 410] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2007] [Revised: 08/13/2007] [Accepted: 09/09/2007] [Indexed: 11/17/2022]
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Moric M, Buvanendran A, Lubenow TR, Mehta A, Kroin JS, Tuman KJ. Response of chronic pain patients to terrorism: the role of underlying depression. PAIN MEDICINE 2007; 8:425-32. [PMID: 17661856 DOI: 10.1111/j.1526-4637.2006.00177.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study seeks to identify characteristics of the chronic pain patient population that may increase vulnerability to vicariously experienced psychological trauma. DESIGN Characteristics, including demographics and psychological measures, were evaluated by modeling change in visit rates to a university pain center immediately after the terrorist attacks of September 11, 2001. SETTING University pain center. PATIENTS A total of 570 patients with chronic pain. OUTCOME MEASURES Visit rates, psychologists evaluation of depression, Beck Depression Inventory. RESULTS Evaluation of psychological measures showed that depression was the most effective predictor of the postattack visit rate increase in chronic pain patients. The visit rate for nondepressed patients did not change significantly after the attacks, but approximately doubled for depressed patients. A more detailed analysis, performed by categorizing patients into one of four levels of depression, found that patients classified as "Mild to Moderately" depressed were most likely to show an increase in visits after the attacks. CONCLUSIONS Chronic pain patients represent a vulnerable population, and the current study posits the possibility of predicting the most vulnerable individuals within that population. With information commonly contained in medical records, target populations may be identified for potential psychological trauma intervention to reduce the sequelae of vicariously experienced psychological trauma.
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Affiliation(s)
- Mario Moric
- Department of Anesthesiology, Rush Medical College at Rush University Medical Center, Chicago, Illinois 60612, USA
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Balousek S, Plane MB, Fleming M. Prevalence of interpersonal abuse in primary care patients prescribed opioids for chronic pain. J Gen Intern Med 2007; 22:1268-73. [PMID: 17641933 PMCID: PMC2219781 DOI: 10.1007/s11606-007-0257-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 04/30/2007] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Interpersonal abuse is associated with clinical problems including chronic pain disorders. OBJECTIVES The objective of this study is to describe 30-day and lifetime prevalence of emotional, physical, and sexual abuse found in men and women prescribed opioids for chronic pain. DESIGN Cross-sectional interview is the design of this study. PARTICIPANTS Patients, 1,009, currently prescribed opioids for chronic noncancer pain. They were recruited from the practices of 235 Family Physicians and Internists in Wisconsin. The most common pain diagnoses were arthritis, low back pain, headache, and fibromyalgia/myofascial pain. MEASUREMENT Data for this secondary analysis on rates of interpersonal abuse were based on 3 questions from the Addiction Severity Index (ASI) regarding 30-day and lifetime emotional, physical, and sexual abuse. RESULTS Forty-seven percent of women and 22% of men reported a history of lifetime physical abuse. Thirty -five percent of women and 10% of men reported lifetime sexual abuse. Binary logistic regression identified the following variables associated with lifetime physical abuse: female gender (RR 2.81, CI 2.01-3.94), age 31-50 (RR1.77, CI 1.30-2.41), Caucasian (RR1.67, CI 1.19-2.35), increased psychiatric symptoms as measured by the ASI (RR 2.14, CI 1.56-2.94), and lifetime suicide attempts (RR 3.98, CI 2.76-5.74). CONCLUSIONS This study reports prevalence of abuse in both men and women prescribed opioids for chronic pain in primary care settings. Subjects who report experiencing interpersonal abuse also report significantly higher rates of suicide attempts and score higher on the ASI psychiatric scale. Screening patients taking opioids for chronic pain for interpersonal abuse may lead to a better understanding of contributors to their physical and mental health.
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Affiliation(s)
- Stacey Balousek
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Mary Beth Plane
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Michael Fleming
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
- 777 South Mills St., Madison, WI 53715 USA
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