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Karimi R, Mallah N, Scherer R, Rodríguez-Cano R, Takkouche B. Sleep quality as a mediator of the relation between depression and chronic pain: a systematic review and meta-analysis. Br J Anaesth 2023; 130:747-762. [PMID: 37059623 DOI: 10.1016/j.bja.2023.02.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Chronic pain and depression represent two global health problems with considerable economic consequences. Although existing literature reports on the relation between depression and pain conditions, meta-analytic evidence backing the mediating role of sleep disturbance as one of the main symptoms of depression is scarce. To examine the extent to which sleep disturbance mediates the depression-chronic pain association, we conducted a systematic review and meta-analysis of the associations of chronic pain, depression, and sleep quality. METHODS We systematically searched for literature in MEDLINE and other relevant databases and identified cohort and case-control studies on depression, sleep disturbance, and chronic pain. Forty-nine studies were eligible, with a total population of 120 489 individuals. We obtained direct and indirect path coefficients via two-stage meta-analytic structural equation modelling, examined heterogeneity via subgroup analyses, and evaluated primary studies quality. RESULTS We found a significant, partial mediation effect of sleep disturbance on the relation between depression and chronic pain. The pooled path coefficient (coef.) of the indirect effect was 0.03 (95% confidence interval [CI]: 0.01-0.05) and accounted for 12.5% of the total effect of depression on chronic pain. This indirect effect also existed for cohort studies (coef. 0.02; 95% CI: 0.002-0.04), European studies (coef. 0.03; 95% CI: 0.004-0.05), and studies that adjusted for confounders (coef. 0.04; 95% CI: 0.01-0.09). CONCLUSIONS Sleep disturbance partially mediates the association between depression and pain. Although plausible mechanisms could explain this mediation effect, other explanations, including reverse causation, must be further explored. SYSTEMATIC REVIEW PROTOCOL PROSPERO CRD42022338201.
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Affiliation(s)
- Roya Karimi
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Narmeen Mallah
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; WHO Collaborating Center for Vaccine Safety, Santiago de Compostela, Spain; Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago de Compostela, Galicia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain.
| | - Ronny Scherer
- Centre for Educational Measurement at the University of Oslo (CEMO), Faculty of Educational Sciences, University of Oslo, Oslo, Norway
| | - Rubén Rodríguez-Cano
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Bahi Takkouche
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
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Yin S, Zhang ZH, Chang YN, Huang J, Wu ML, Li Q, Qiu JQ, Feng XD, Wu N. Effect of Acupuncture on the Cognitive Control Network of Patients with Knee Osteoarthritis: Study Protocol for a Randomized Controlled Trial. J Pain Res 2022; 15:1443-1455. [PMID: 35611301 PMCID: PMC9124489 DOI: 10.2147/jpr.s356044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Materials and Methods Discussion Study Registration
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Affiliation(s)
- Shuai Yin
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of China
| | - Zhen-Hua Zhang
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of China
| | - Yi-Niu Chang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People’s Republic of China
| | - Jin Huang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People’s Republic of China
| | - Ming-Li Wu
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of China
| | - Qi Li
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of China
| | - Jin-Qi Qiu
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of China
| | - Xiao-Dong Feng
- Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of China
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People’s Republic of China
- Correspondence: Xiao-Dong Feng, Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, No. 19, Renmin Road, Zhengzhou, 450000, People’s Republic of China, Tel +8615303828605, Email
| | - Nan Wu
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People’s Republic of China
- Nan Wu, School of Rehabilitation Medicine, Henan University of Chinese Medicine, No. 156, Jinshui East Road, Zhengzhou, 450046, People’s Republic of China, Tel +8613540484550, Email
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Gupta M, Malik T, Sinha C. Delivery of a Mental Health Intervention for Chronic Pain Through an Artificial Intelligence-Enabled App (Wysa): Protocol for a Prospective Pilot Study. JMIR Res Protoc 2022; 11:e36910. [PMID: 35314423 PMCID: PMC9015778 DOI: 10.2196/36910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with chronic pain often suffer from coexisting, long-term and debilitating mental health comorbidities such as depression and anxiety. Artificial Intelligence Supported Cognitive Behavioral Therapy or AI-CBT interventions could offer cost-effective, accessible, and potentially effective resources to tackle this problem. However, there is not enough research conducted about the efficacy of AI-CBT interventions for chronic pain. OBJECTIVE This prospective cohort study aims to examine the efficacy and usage of an AI-CBT intervention for chronic pain (Wysa for Chronic Pain app), using a conversational agent (with no human intervention). To the best of our knowledge, this is the first such study for chronic pain using a fully-automated, free-text-based conversational agent (CA). METHODS Participants with self-reported chronic pain (N = 500) will be recruited online on a rolling basis from April 2022 through posts on US-based internet communities within this prospective cohort. Informed consent is taken from the participants within the app and the Wysa intervention is delivered remotely for 8 weeks. Outcome measures including NPRS (Numeric Pain Rating Scale), PROMIS PI (Patient-Reported Outcomes Measurement Information System Pain Interference), GAD-7 (Generalized Anxiety Disorder), and PHQ-9 (Patient Health Questionnaire) questionnaires will be administered to test the effectiveness of the intervention on reducing levels of pain interference, depression, and anxiety. The therapeutic alliance created with the conversational agent will be assessed through the WAI-SR (Working Alliance Inventory-Short Revised). Retention and usage statistics will be observed for adherence and engagement. RESULTS The study will open for recruitment in April 2022 and data collection is expected to be completed by August 2022. The results for the primary outcomes are expected to be published by late-2022. CONCLUSIONS Mental health conversational agents driven by artificial intelligence (AI) could be effective in helping patients with chronic pain learn to self-manage their pain and deal with common comorbidities like depression and anxiety. The Wysa for Chronic Pain app is one such digital intervention that can potentially serve as a solution to the problems of affordability and scalability associated with interventions with a human therapist in loop. This prospective study examines the efficacy of the app as a treatment solution for chronic pain. It aims to inform future practices and digital mental health interventions for individuals with chronic pain. CLINICALTRIAL
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Dagnino APA, Campos MM. Chronic Pain in the Elderly: Mechanisms and Perspectives. Front Hum Neurosci 2022; 16:736688. [PMID: 35308613 PMCID: PMC8928105 DOI: 10.3389/fnhum.2022.736688] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/27/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic pain affects a large part of the population causing functional disability, being often associated with coexisting psychological disorders, such as depression and anxiety, besides cognitive deficits, and sleep disturbance. The world elderly population has been growing over the last decades and the negative consequences of chronic pain for these individuals represent a current clinical challenge. The main painful complaints in the elderly are related to neurodegenerative and musculoskeletal conditions, peripheral vascular diseases, arthritis, and osteoarthritis, contributing toward poorly life quality, social isolation, impaired physical activity, and dependence to carry out daily activities. Organ dysfunction and other existing diseases can significantly affect the perception and responses to chronic pain in this group. It has been proposed that elderly people have an altered pain experience, with changes in pain processing mechanisms, which might be associated with the degeneration of circuits that modulate the descending inhibitory pathways of pain. Aging has also been linked to an increase in the pain threshold, a decline of painful sensations, and a decrease in pain tolerance. Still, elderly patients with chronic pain show an increased risk for dementia and cognitive impairment. The present review article is aimed to provide the state-of-art of pre-clinical and clinical research about chronic pain in elderly, emphasizing the altered mechanisms, comorbidities, challenges, and potential therapeutic alternatives.
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Affiliation(s)
- Ana P. A. Dagnino
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Maria M. Campos
- Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- Programa de Pós-graduação em Odontologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- *Correspondence: Maria M. Campos, ,
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Sun W, Matsuoka T, Imai A, Oya N, Narumoto J. Effects of Hearing Impairment, Quality of Life and Pain on Depressive Symptoms in Elderly People: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212265. [PMID: 34832020 PMCID: PMC8620215 DOI: 10.3390/ijerph182212265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022]
Abstract
Reduction of the incidence of depression and improvement of quality of life (QOL) of elderly people have become important subjects. Various factors are related to depressive symptoms in elderly people, and sensory impairment is a key to health, QOL, and depressive symptoms. In this cross-sectional study, a visual acuity test and audiometry were used to examine the relationships of visual and hearing impairment and other factors with depressive symptoms in elderly people. A group of 490 community-dwelling people aged over 65 years old underwent vision and hearing tests, the Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination (MMSE), and questionnaires on social isolation, QOL, and physical condition. Logistic regression analysis was used to examine factors affecting CES-D. Multivariate logistic regression analysis indicated that hearing impairment, pain score, and satisfaction with human relationships and activities of daily living (ADL) were independent predictors of CES-D scores. Satisfaction with human relationships and ADL can reduce depressive symptoms in elderly people. Hearing impairment, pain, and social contact are also important. Therefore, improvement of social networks, interpersonal relationships, ADL, and hearing impairment may be effective in improving these symptoms in elderly people.
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Chen B, Duan J, Wen S, Pang J, Zhang M, Zhan H, Zheng Y. An Updated Systematic Review and Meta-analysis of Duloxetine for Knee Osteoarthritis Pain. Clin J Pain 2021; 37:852-862. [PMID: 34483232 PMCID: PMC8500362 DOI: 10.1097/ajp.0000000000000975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/28/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We conducted the updated systematic review and meta-analysis of the best available quantitative and qualitative evidence to evaluate the effects and safety of duloxetine for the treatment of knee osteoarthritis (OA) pain. METHODS A comprehensive literature search used 3 English and 4 Chinese biomedical databases from inception through July 10, 2020. We included randomized controlled trials of duloxetine with intervention duration of 2 weeks or longer for knee OA. The primary outcome was pain intensity measured by Brief Pain Inventory and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Secondary outcome measurements included 36-Item Short Form Health Survey, Patient's Global Impression of Improvement, Clinical Global Impressions of Severity, and adverse events (AEs). The quality of all included studies was evaluated using the Cochrane risk-of-bias criteria. The review was registered in the PROSPERO (CRD 42020194072). RESULTS Six studies totaling 2059 patients met the eligibility criteria. Duloxetine had significant reductions in Brief Pain Inventory 24 hours average pain (mean difference [MD]=-0.74; 95% confidence interval [CI], -0.92 to -0.57; P<0.00001; I2=13%; 5 trials; 1695 patients); patient general activity (MD=-0.76; 95% CI, -0.96 to -0.56; P<0.00001; I2=0%; 5 trials; 1694 patients) WOMAC physical function subscale (MD=-4.22; 95% CI, -5.14 to -3.30; P<0.00001; I2=26%; 5 trials; 1986 patients); Patient's Global Impression of Improvement (MD=-0.48; 95% CI, -0.58 to -0.37; P<0.00001; I2=29%; 5 trials; 1741 patients); and Clinical Global Impressions of Severity (MD=-0.34; 95% CI, -0.44 to -0.24; P<0.00001; I2=0%; 4 trials; 1178 patients) compared with placebo control. However, no difference on WOMAC pain subscale (standard mean difference=-1.68; 95% CI, -3.45 to 0.08; P=0.06; I2=100%; 3 trials; 1104 patients) and in serious AEs (risk ratio=0.92; 95% CI, 0.40-2.11; P=0.84; I2=0%; 5 trials; 1762 patients) between duloxetine and placebo. Furthermore, duloxetine failed to show superior effects for improving the life quality and demonstrated more treatment-emergent AEs. CONCLUSION Duloxetine may be an effective treatment option for knee OA patients but further rigorously designed and well-controlled randomized trials are warranted.
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Chang SJ, Kim HJ, Juon HS, Park H, Choi SW, Lee KE, Ryu H. A comparison of the influencing factors of chronic pain and quality of life between older Koreans and Korean-Americans with chronic pain: a correlational study. Qual Life Res 2021; 31:1179-1189. [PMID: 34462905 PMCID: PMC8960560 DOI: 10.1007/s11136-021-02983-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Chronic pain is one of the most common health problems for older adults worldwide and is likely to result in lower quality of life. Living in a different culture may also influence chronic pain and quality of life in older adults. The purpose of this study was to explore how multifaceted elements affect chronic pain and quality of life in older Koreans living in Korea and in older Korean-Americans (KAs) living in the USA. METHODS We conducted a secondary data analysis of data from 270 adults aged 65 years or over (138 Koreans and 132 KAs). We compared the effects of multifaceted elements on pain and quality of life by testing structural equation models (SEMs) for each group, using a maximum likelihood estimation and bootstrapping. RESULTS SEMs for both Korean and KAs showed that age and depressive symptoms directly affected quality of life. The number of comorbidities and depressive symptoms had mediating effects on quality of life through chronic pain in both groups. In older Koreans only, perceived financial status directly affected quality of life. In older KAs only, sleep quality indirectly affected quality of life through chronic pain. CONCLUSION The data showed that multimorbidity and depressive symptoms play critical roles for explaining chronic pain in older Koreans and KAs and ultimately negatively influence quality of life. Future intervention program to improve quality of life in older adults with chronic pain should consider the different cultural aspects affecting quality of life for Koreans and KAs.
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Affiliation(s)
- Sun Ju Chang
- College of Nursing and The Research Institute of Nursing Science, Seoul National University, Daehak-ro 103, Jongro-gu, Seoul, 406-799, Republic of Korea
| | - Hee Jun Kim
- College of Nursing and Research Institute of Nursing Science, Ajou University, 206 World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, Republic of Korea.
| | - Hee-Soon Juon
- Department of Medical Oncology, Thomas Jefferson University, Benjamin Franklin House, 834 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Hyunjeong Park
- Department of Nursing, Towson University, 8000 York Road, Towson, MD, 21252, USA
| | - Seung Woo Choi
- Department of Nursing, College of Medicine, Inha University, 100 Inha-ro Bldg 5S-322, Michuhol-gu, Incheon, Republic of Korea
| | - Kyung-Eun Lee
- College of Nursing, Seoul National University, Daehak-ro 103, Jongro-gu, Seoul, 406-799, Republic of Korea
| | - Hyunju Ryu
- College of Nursing, Seoul National University, Daehak-ro 103, Jongro-gu, Seoul, 406-799, Republic of Korea
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Danielsson L, Kvarstein G, Bergvik S. Mediators of Pain and Physical Function in Female and Male Patients with Chronic Pain. J Pain Res 2020; 13:1059-1071. [PMID: 32547171 PMCID: PMC7245456 DOI: 10.2147/jpr.s233501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/19/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Chronic pain is often multifactorial and accompanied by psychological distress, catastrophizing thoughts, reduced physical function, and socio-economic worries. In this explorative study, we investigated potential mediators in the relationships of psychological and demographic variables with chronic pain and physical function in women and men. Patients and Methods The study included 301 patients admitted to a multidisciplinary pain clinic. Prior to their first consultation, patients completed a questionnaire including items on demographics (age, education, occupational and financial situation), catastrophizing thoughts, psychological distress, pain intensity, and physical function. Hierarchical multiple regression analyses examined demographic and psychological factors associated with pain intensity and physical function. Mediation and reversed mediation models were tested and developed based on calculated relations in the regression analyses between demographic, psychological, pain intensity and physical function variables. Results Fifty-eight percent were females and mean age 43.8 and 46.0 years for women and men, respectively. In the regression analyses, psychological factors accounted better for pain intensity than demographic variables, while physical function was best accounted for by demographic variables. Among women, catastrophizing thoughts mediated significantly the relationships between education and pain intensity, and between education and physical function. Psychological distress mediated significantly the relationships between financial situation and pain intensity, and between financial situation and physical function in women. In men, the only significant mediation model was psychological distress mediating the relationship between financial situation and pain intensity. Some of the reversed models revealed indirect effects, indicating bidirectionality. Conclusion The results indicate that there might be gender-specific mediators in how demographic variables are associated with pain intensity and physical function. This suggests an awareness among clinicians of potential gender-specific factors mediating pain problems, and the need for a gender-specific, multidisciplinary approach in the treatment of chronic pain.
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Affiliation(s)
- Lena Danielsson
- Pain Clinic, Division Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
| | - Gunnvald Kvarstein
- Pain Clinic, Division Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
| | - Svein Bergvik
- Department of Psychology, UiT the Arctic University of Norway, Tromsø, Norway
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Derafshi R, Rezazadeh F, Ghapanchi J, Basandeh Sharif D, Farzin M. Prevalence of Chronic Orofacial Pain in Elderly Patients Referred to Shiraz Dental School From 2005 to 2017. Anesth Pain Med 2020; 9:e91182. [PMID: 32280612 PMCID: PMC7118676 DOI: 10.5812/aapm.91182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 10/02/2019] [Accepted: 10/24/2019] [Indexed: 11/16/2022] Open
Abstract
Background Orofacial pain is presented mainly as a pain in the front part of the head, including the oral cavity. Adult and elderly patients are important target groups affected by this chronic pain, which may cause several problems. Methods In this cross-sectional study, the characteristics of patients who suffered from orofacial pain were evaluated. The data such as patients' gender, age, pain diagnoses, treatments, responses to treatments, duration and severity of pain, and disability were collected from their records. The diagnoses were provided based on the characteristics of pain, X-ray findings, physiological findings, lab tests, nerve block injection, and a drug challenge test. Results Among all the 5,221 patients referred to Oral and Maxillofacial Medicine and Prosthodontics Department, 583 (11.16%) reported orofacial pain as the chief complaint. The frequency of orofacial pain was more prevalent among women than men. Burning mouth syndrome was the most prevalent cause of orofacial pain in the elderly, followed by temporomandibular disorder and trigeminal neuralgia. Conclusions Most cases of orofacial pain in elderly patients were burning mouth syndrome, temporomandibular disorder, and neuralgia. It was more observed in females than males with the mean age of 55.3 ± 10.7 years old.
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Affiliation(s)
- Reza Derafshi
- Department of Prosthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Rezazadeh
- Department of Oral and Maxillofacial Medicine, Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Janan Ghapanchi
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding Author: Department of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Delaram Basandeh Sharif
- Undergraduate Student, Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Farzin
- Department of Prosthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Haleem DJ. Targeting Serotonin1A Receptors for Treating Chronic Pain and Depression. Curr Neuropharmacol 2020; 17:1098-1108. [PMID: 31418663 PMCID: PMC7057205 DOI: 10.2174/1570159x17666190811161807] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 02/07/2023] Open
Abstract
The association of chronic pain with depression is becoming increasingly recognized. Treating both the conditions together is essential for an effective treatment outcome. In this regard, it is important to identify a shared mechanism involved in the association of chronic pain with depression. Central serotonin (5-hydroxytryptamine; 5-HT) neurotransmission has long been known to participate in the processing of signals related to pain. It also plays a key role in the pathogenesis and treatment of depression. Although functional responses to serotonin are mediated via the activation of multiple receptor types and subtypes, the 5-HT1A subtype is involved in the processing of nociception as well as the pathogenesis and treatment of depression. This receptor is located presynaptically, as an autoreceptor, on the perikaryon and dendritic spines of serotonin-containing neurons. It is also expressed as a heteroreceptor on neurons receiving input from serotonergic neurons. This arti-cle targets the 5-HT1A receptors to show that indiscriminate activation of pre and postsynaptic 5-HT1A receptors is likely to produce no therapeutic benefits; biased activation of the 5-HT heteroreceptors may be a useful strategy for treating chronic pain and depression individually as well as in a comorbid condition.
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Affiliation(s)
- Darakhshan Jabeen Haleem
- Neuroscience Research Laboratory, Dr. Panjwani Center for Molecular Medicine & Drug Research (PCMD), International Center for Chemical and Biological Science (ICCBS), University of Karachi, Karachi 75270, Pakistan
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Preston C, Gilpin HR, Newport R. An exploratory investigation into the longevity of pain reduction following multisensory illusions designed to alter body perception. Musculoskelet Sci Pract 2020; 45:102080. [PMID: 31747638 DOI: 10.1016/j.msksp.2019.102080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Previous research suggests that multisensory body illusions that alter the conscious bodily experience can modulate pain in osteoarthritis, which may be a result of modifying cortical misrepresentations of the painful body part. However, the longevity and underlying mechanisms of such illusion-induced analgesia is unknown. OBJECTIVES This study aimed to investigate the therapeutic potential of body illusions, specifically examining the longevity of pain relief and effects on subjective joint flexibility. We also aimed to test if illusory-induced analgesia was due to limb disownership, which is also thought to be affected by body illusions. METHOD Multisensory stretch and shrink illusions were used to manipulate mental representations in hand osteoarthritis. Experiment 1 examined longevity of analgesia by comparing pre-illusion pain ratings with post-illusion ratings taken immediately and over a period of four minutes both with and without vision of the manipulated limb. Experiment 2 compared changes in subjective flexibility between the illusion types. Experiment 3 tested whether an illusion that induced a temporary experience of hand loss would indicate limb disownership as a mechanism for modulating pain during body illusions. RESULTS Illusion-induced analgesia was found to outlast the direct application of both shrink and stretch illusions. Illusory stretching provided more clinically significant pain reduction along with increased subjective flexibility. Disownership of the limb had no effect on pain ratings. CONCLUSIONS Illusory stretching of the joints in osteoarthritis may have significant clinical potential in development of future pain treatments. The results are also compatible with theories of cortical involvement of pain in osteoarthritis.
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Affiliation(s)
- Catherine Preston
- School of Psychology, University of Nottingham, Nottingham, United Kingdom; Department of Psychology, University of York, York, United Kingdom.
| | - Helen R Gilpin
- School of Psychology, University of Nottingham, Nottingham, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Roger Newport
- School of Psychology, University of Nottingham, Nottingham, United Kingdom; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Sirsch E, Lukas A, Drebenstedt C, Gnass I, Laekeman M, Kopke K, Fischer T. Pain Assessment for Older Persons in Nursing Home Care: An Evidence-Based Practice Guideline. J Am Med Dir Assoc 2020; 21:149-163. [DOI: 10.1016/j.jamda.2019.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 10/25/2022]
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Yan Z, Lu R, Li Y, Zheng Z. Exploring the Risk Factors for Depressive Symptoms Among Chinese Rural Older Adults. J Psychosoc Nurs Ment Health Serv 2020; 58:41-47. [PMID: 31710367 DOI: 10.3928/02793695-20191030-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/03/2019] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to examine risk factors for depressive symptoms among older adults in rural China. Data were derived from the National Health Services Survey in China. A total of 2,586 rural adults age ≥60 were included in the study. Sociodemographic factors, health risk factors, and behavioral factors were measured, along with self-rated depressive symptoms. Older age (>70 years), lower education level, and living without a partner were associated with depressive symptoms. After adjusting for socioeconomic status and social support, individuals who had at least one chronic disease, experienced pain, and were unable to take care of themselves or perform household chores were more likely to report depressive symptoms (all p < 0.001). Community health care and nursing services should focus on pain control, improvement of daily physical function, and social support for older adults in rural China. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 41-47.].
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Jacobs CA, Vranceanu AM, Thompson KL, Lattermann C. Rapid Progression of Knee Pain and Osteoarthritis Biomarkers Greatest for Patients with Combined Obesity and Depression: Data from the Osteoarthritis Initiative. Cartilage 2020; 11:38-46. [PMID: 29855190 PMCID: PMC6921961 DOI: 10.1177/1947603518777577] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To compare the progression of biochemical biomarkers of osteoarthritis (OA), knee pain, and function between nonobese patients (NON), obese patients without depression (OBESE), and obese patients with comorbid depression (O + D). DESIGN Utilizing the FNIH OA Biomarkers Consortium dataset, we categorized knee OA patients into NON, OBESE, and O + D groups based on body mass index and Center for Epidemiological Studies-Depression (CES-D) scores. Subjective symptoms (Knee injury and Osteoarthritis Outcome Score Quality of Life subscale (KOOS QOL), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Physical Function scores, and the Short Form-12 (SF-12) Physical Component Score [PCS]) and objective measures of cartilage degradation and bone remodeling (urinary CTXII and CTXIα) were compared among groups at baseline and 2-year follow-up. RESULTS Of the 600 patients, 282 (47%) were NON, 285 (47.5%) OBESE, and 33 (5.5%) O + D. The O + D group had significantly worse pain and function both at baseline and 2-year follow-up (P < 0.001 for all comparisons) as evidenced by self-reported measures on KOOS QOL, WOMAC Pain, WOMAC Physical Function, and SF-12 PCS. The O + D group also demonstrated significant increases in CTXII (P = 0.01) and CTXIα (P = 0.005), whereas the NON and OBESE groups did not. CONCLUSIONS The combination of inferior knee pain, physical function, and significantly greater increases in biomarkers of cartilage degradation and bony remodelling suggest a more rapid progression for obese OA patients with comorbid depression. The link between systemic disease, inflammatory burden, and progressive cartilage degradation is in line with increasing concerns about a degenerative synovial environment in early osteoarthritic knees that progress to treatment failure with biologic restoration procedures.
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Affiliation(s)
- Cale A. Jacobs
- Department of Orthopedic Surgery and
Sports Medicine, University of Kentucky, Lexington, KY, USA,Cale A. Jacobs, Department of Orthopedic
Surgery and Sports Medicine, University of Kentucky, 740 S Limestone, Room K426,
Lexington, KY 40536-0284, USA.
| | - Ana-Maria Vranceanu
- Department of Psychology, Harvard
Medical School and Integrated Brain Health Clinical and Research Program,
Massachusetts General Hospital, Boston, MA, USA
| | | | - Christian Lattermann
- Department of Orthopaedic Surgery,
Harvard Medical School and Brigham and Women’s Hospital, Chestnut Hill, MA,
USA
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Should I've stayed or should I've gone? What residents of continuing care retirement communities and former candidates think and feel one year after their decision: a quantitative longitudinal comparison. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x1800096x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe aim of this study was to compare satisfaction with residence, wellbeing and physical health of continuing care retirement community (CCRC) residents with people who considered enrolling in the same CCRCs but elected not to move. A total of 101 participants were recruited from 13 CCRCs located in multiple cities in the United States of America. A phone interview was conducted with participants three months or less from enrolment and one year later. Compared with those who chose not to move, CCRC residents reported lower satisfaction at baseline, but higher satisfaction at one year. Wellbeing declined from baseline to follow-up for both groups, but was higher in CCRC residents both at baseline and at one year. CCRCs might consider giving new residents a longer cancellation period in order to allow sufficient time for the adjustment process. This, in turn, might both prevent an early departure and affect the decision of potential CCRC residents to move into the community.
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16
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Rubenstein W, Grace T, Croci R, Ward D. The interaction of depression and prior opioid use on pain and opioid requirements after total joint arthroplasty. Arthroplast Today 2018; 4:464-469. [PMID: 30560177 PMCID: PMC6287236 DOI: 10.1016/j.artd.2018.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 11/24/2022] Open
Abstract
Background Preoperative opioid use causes increased pain and opioid requirements after total joint arthroplasty (TJA), but the effect of depression on this relationship is not well defined. Methods We conducted a retrospective review of primary TJA patients using an institutional database. Demographic variables, inpatient opioid requirements, and discharge prescription quantities were collected and compared between patients with and without a prior diagnosis of depression in both the prior opioid-using and nonusing cohorts. Results Four hundred and three patients were analyzed between August 1, 2016, and July 31, 2017. Among prior opioid users, patients with depression experienced higher inpatient pain levels (4 vs 3; P = .001), required more inpatient opioids (117 oral morphine equivalents [OMEs] vs 70 OMEs; P = .022), were prescribed more opioids at discharge (1163 OMEs vs 750 OMEs; P = .02), and required more long-term opioid refills (57.7% vs 15.4%; P < .001) than patients without depression. However, depression was not associated with increased pain, opioid requirements, prescription quantities, or refill rates among opioid-naive patients. Conclusions Depression is not associated with increased pain or opioid requirements among opioid-naive patients after TJA but is associated with significantly higher pain and opioid requirements among patients who use opioids preoperatively. The interaction of these variables may highlight a target for preoperative counseling and risk modification in the arthroplasty population.
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Affiliation(s)
- William Rubenstein
- Department of Orthopedics, University of California San Francisco, San Francisco, CA, USA
| | - Trevor Grace
- Department of Orthopedics, University of California San Francisco, San Francisco, CA, USA
| | - Rhiannon Croci
- Department of Orthopedics, University of California San Francisco, San Francisco, CA, USA
| | - Derek Ward
- Department of Orthopedics, University of California San Francisco, San Francisco, CA, USA
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17
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Liberman O, Freud T, Peleg R, Keren A, Press Y. Chronic pain and geriatric syndromes in community-dwelling patients aged ≥65 years. J Pain Res 2018; 11:1171-1180. [PMID: 29950889 PMCID: PMC6016537 DOI: 10.2147/jpr.s160847] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background In growing elderly populations, there is a heavy burden of comorbidity and a high rate of geriatric syndromes (GS) including chronic pain. Purpose To assess the prevalence of chronic pain among individuals aged ≥65 years in the Southern District of Israel and to evaluate associations between chronic pain and other GS. Methods A telephone interview was conducted on a sample of older adults who live in the community. The interview included the Brief Pain Inventory and a questionnaire on common geriatric problems. Results Of 419 elderly individuals who agreed to be interviewed 232 (55.2%) suffered from chronic pain. Of those who reported chronic pain, 136 participants (68.6%) noted that they had very severe or unbearable pain. There were statistically significant associations between the pain itself and decline in patient’s functional status, increased falls, reduced mood, and cognitive decline. Conclusion The results of this study show that chronic pain is very common in older adults and that it is associated with other GS. There is a need to increase awareness of chronic pain in older adults and to emphasize the important role that it plays in their care.
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Affiliation(s)
- Orly Liberman
- Nursing Department, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Freud
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roni Peleg
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Pain Clinic, Clalit Health Services, Beer-Sheva, Israel
| | - Ariela Keren
- Nursing Department, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yan Press
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel.,Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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18
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Al-Maharbi S, Abolkhair AB, Al Ghamdi H, Haddara M, Tolba Y, El Kabbani A, Al Sadoun A, Pangilinan E, Joy J, Khait SA, Al-Khudhairy MW. Prevalence of depression and its association with sociodemographic factors in patients with chronic pain: A cross-sectional study in a tertiary care hospital in Saudi Arabia. Saudi J Anaesth 2018; 12:419-425. [PMID: 30100841 PMCID: PMC6044157 DOI: 10.4103/sja.sja_771_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction: Mental health issues, especially depression, are common in chronic pain patients. Depression affects these patients negatively and could lead to poor control of their pain. Some risk factors for both chronic pain and depression are known and need to be targeted as part of the management in a multidisciplinary approach. This study was conducted to estimate the prevalence of depression among chronic pain patients attending a pain clinic and to explore the association between depression in chronic pain patients and other factors such as sociodemographic features, number of pain sites, severity of pain, and types of pain. Methods: This is a cross-sectional study that carried out in a chronic pain clinic in a tertiary care hospital in Riyadh, Saudi Arabia (King Faisal Specialist Hospital and Research Centre). All chronic pain patients including cancer-related pain, apart from acute pain patients and children, were eligible to participate in the study. Association between depression and sociodemographic factors was assessed with univariate and multivariate methods. Main outcome measures were the prevalence of depression in chronic pain patients using the Patient Health Questionnaire-9 (PHQ-9) and the association with sociodemographic factors. Results: A total of 200 chronic pain patients (128 females [64%]) participated in the study. The prevalence of depression was 71% (95% confidence interval: 64.7–77.3) based on the PHQ-9 diagnostic criteria using a cutoff point of >5. Among those patients who were depressed, 9 (4.5%) had severe depression as compared to 31 (15.5%), 41 (20.5%), and 61 (30.5%) who had moderately severe, moderate, and mild depression, respectively. Depression (scored at the cutoff point of 5) in chronic pain patients was significantly associated with age, financial status, medical history of depression, and pain severity. Conclusion: Depression is common among chronic pain patients with several risk factors aggravating its presentation. Due to their increased risk of depression, psychiatric counseling that offers mental health assistance should be prioritized and made available as a multidisciplinary approach for the treatment of chronic pain patients.
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Affiliation(s)
- Sameeh Al-Maharbi
- Department of Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Bakr Abolkhair
- Department of Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hani Al Ghamdi
- Department of Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mamdouh Haddara
- Department of Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Yasser Tolba
- Department of Anesthesia, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Adwa Al Sadoun
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Evelyn Pangilinan
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Jaya Joy
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Shadi Abu Khait
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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19
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O'moore KA, Newby JM, Andrews G, Hunter DJ, Bennell K, Smith J, Williams AD. Internet Cognitive-Behavioral Therapy for Depression in Older Adults With Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 70:61-70. [DOI: 10.1002/acr.23257] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/11/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Kathleen A. O'moore
- St. Vincent's Hospital; and University of New South Wales, and The Black Dog Institute; Prince of Wales Hospital; Sydney Australia
| | - Jill M. Newby
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
| | - Gavin Andrews
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
| | - David J. Hunter
- University of Sydney; Sydney Medical School; and Royal North Shore Hospital
| | - Kim Bennell
- University of Melbourne; School of Health Sciences; Melbourne Australia
| | - Jessica Smith
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
| | - Alishia D. Williams
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
- Utrecht University; Utrecht The Netherlands
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20
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Yang Z, Zhao L, Xie X, Xu T, Zhang Y, Wang X, Du J, Wang Z, Zhou M, Li Y, Zhou S. The effectiveness of acupuncture for chronic pain with depression: A systematic review protocol. Medicine (Baltimore) 2017; 96:e8800. [PMID: 29381981 PMCID: PMC5708980 DOI: 10.1097/md.0000000000008800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic pain is a major public health problem and 30% to 45% of sufferers experience severe depression. Acupuncture is often used to treat both depression and a range of pain disorders. We aim to conduct a systematic review of randomized controlled trials (RCTs) to evaluate the efficacy of acupuncture for patients experiencing chronic pain with depression. METHODS To identify relevant RCTs, the following databases will be searched electronically from their inception to July 1, 2017: PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, the Allied and Complementary Medicine Database, the Cumulative Index to Nursing and Allied Health Literature, Chinese medical databases, and others. Manual retrieval will also be conducted. RCTs that evaluated acupuncture as the sole or adjunct treatment for patients with chronic pain and depression will be included. The primary outcomes will be based on a visual analog pain measurement scale and the Hamilton Depression Scale. The secondary outcomes will include scores on a numerical rating scale, verbal rating scale, and the Hospital Anxiety and Depression Scale. The study selection, data extraction, and study quality evaluation will be performed independently by 2 researchers. If the data permit, meta-analysis will be performed using RevMan V5.3 statistical software. If the data are not appropriate for meta-analysis, descriptive analysis or subgroup analysis will be conducted. The methodological quality of the included trials will be assessed using the Cochrane risk-of-bias criteria and the Standards for Reporting Interventions in Controlled Trials of Acupuncture checklist. RESULTS This study will provide a high-quality synthesis of current evidence of acupuncture for chronic pain with depression from several scales including visual analog pain measurement scale, the Hamilton Depression Scale, a numerical rating scale, verbal rating scale and the Hospital Anxiety and Depression Scale. CONCLUSION The conclusion of our study will provide updated evidence to judge whether acupuncture is an effective intervention for patients suffered from chronic pain with depression.
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Affiliation(s)
- Ziyi Yang
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Ling Zhao
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Xianze Xie
- College of Foreign Language & Cultures, Chengdu University of Technology, Chengdu, Sichuan, China
| | - Tao Xu
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Yutong Zhang
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Xing Wang
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Jiarong Du
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Ziwen Wang
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Mengyuan Zhou
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Ying Li
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Siyuan Zhou
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
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21
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Rashedi V, Asadi-Lari M, Foroughan M, Delbari A, Fadayevatan R. Mental Health and Pain in Older Adults: Findings from Urban HEART-2. Community Ment Health J 2017; 53:719-724. [PMID: 28124258 DOI: 10.1007/s10597-017-0082-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 01/09/2017] [Indexed: 01/11/2023]
Abstract
Pain is an important component of disability problems, and plays a key role in mental health of older adults. This study aims to investigate the relationship between mental health and pain in older adults of Tehran, Iran. This was a cross-sectional study using data on 5326 older adults aged ≥60 years old from a large population-based survey (Urban HEART-2). A multistage cluster random sampling method was used to select the participants in Tehran, Iran, in 2011. General Health Questionnaire (GHQ-28), pain questionnaire, and socioeconomic questionnaires were used to collect the data. A total of 5326 older adults, 3811 (71.6%) married and 2797 (52.5%) female, were included into the study. The mean age of the participants was 68.92 ± 7.02 years. Mean of GHQ-28 scores in the sample was 51.08 ± 10.94, which indicates of a good level of mental health. The majority of the older adults had knee and back pain (more than 50%). Regardless of the chronicity, time, and the mode of reaction to it, knee and back pain were the highly reported pains among the participants. There was a statistically significant difference between two groups of older adults, with and without pain, in terms of GHQ-28 scores. Multiple regression analysis revealed that there was a relationship between mental health and the following factors: pain in head, shoulder, teeth, upper and lower limbs, education, gender, age, and marital status. Whatever the explanation, the relation of lowered health status to pain in all body parts among older people is considerable. This renders this matter as a top priority in health policy making.
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Affiliation(s)
- Vahid Rashedi
- Iranian Research Center on Aging, Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshid Foroughan
- Iranian Research Center on Aging, Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ahmad Delbari
- Iranian Research Center on Aging, Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Fadayevatan
- Iranian Research Center on Aging, Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
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22
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Jones AKP, Brown CA. Predictive mechanisms linking brain opioids to chronic pain vulnerability and resilience. Br J Pharmacol 2017; 175:2778-2790. [PMID: 28449262 DOI: 10.1111/bph.13840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/16/2017] [Accepted: 04/18/2017] [Indexed: 12/11/2022] Open
Abstract
Chronic pain is a major global healthcare problem that is currently inadequately treated. In addition, the current use of opioids for treatment has reached far beyond the paucity of evidence for long-term benefits relative to risks. Benefit-risk models for opioid and non-opioid treatments would benefit from a rational, mechanism-based understanding of neuroplastic and neurochemical contributions to chronic pain. Here, we evaluate the findings and limitations of representative research investigating brain neuroplasticity and neurochemistry in chronic pain. In sum, the mechanisms of pain-related neuroplasticity in the brain remain poorly understood because neuroimaging studies have been largely descriptive. We argue that definition is needed of optimal (pain-resilient) and suboptimal (pain-vulnerable) functioning of the endogenous opioid system in order to identify neurochemical contributions to aberrant neuroplasticity in chronic pain. We outline the potential benefits of computational approaches that utilize evolutionary and statistical optimality principles, illustrating this approach with mechanistic hypotheses on opioid function. In particular, we discuss the role of predictive mechanisms in perceptual and associative plasticity and evidence for their modulation by endogenous opioids. Future research should attempt to utilize formal computational models to provide evidence for the clinical validity of this approach, thereby providing a rational basis for future treatment and, ideally, prevention. LINKED ARTICLES This article is part of a themed section on Emerging Areas of Opioid Pharmacology. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.14/issuetoc.
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Affiliation(s)
- Anthony Kenneth Peter Jones
- Human Pain Research Group, Division of Neuroscience & Experimental Psychology, School of Biology, University of Manchester, Manchester, UK
| | - Christopher Andrew Brown
- Human Pain Research Group, Division of Neuroscience & Experimental Psychology, School of Biology, University of Manchester, Manchester, UK.,Department of Psychological Sciences, Faculty of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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23
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Zis P, Daskalaki A, Bountouni I, Sykioti P, Varrassi G, Paladini A. Depression and chronic pain in the elderly: links and management challenges. Clin Interv Aging 2017; 12:709-720. [PMID: 28461745 PMCID: PMC5407450 DOI: 10.2147/cia.s113576] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aging is an inevitable process and represents the accumulation of bodily alterations over time. Depression and chronic pain are highly prevalent in elderly populations. It is estimated that 13% of the elderly population will suffer simultaneously from the two conditions. Accumulating evidence suggests than neuroinflammation plays a critical role in the pathogenesis of both depression and chronic pain. Apart from the common pathophysiological mechanisms, however, the two entities have several clinical links. Their management is challenging for the pain physician; however, both pharmacologic and nonpharmacologic approaches are available and can be used when the two conditions are comorbid in the elderly patients.
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Affiliation(s)
- Panagiotis Zis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Argyro Daskalaki
- Department of Neurology, Evangelismos General Hospital, Athens, Greece
| | - Ilia Bountouni
- Belgrave Liaison Team, Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
| | - Panagiota Sykioti
- Belgrave Liaison Team, Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
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Murtaugh CM, Beissner KL, Barrón Y, Trachtenberg MA, Bach E, Henderson CR, Sridharan S, Reid MC. Pain and Function in Home Care: A Need for Treatment Tailoring to Reduce Disparities? Clin J Pain 2017; 33:300-309. [PMID: 27518494 PMCID: PMC5473030 DOI: 10.1097/ajp.0000000000000410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe racial/ethnic group differences in pain presentation and the prevalence of psychosocial factors among patients admitted to home health care, and to determine the extent of racial/ethnic group differences in the association of psychosocial factors with pain intensity and pain-related disability. METHODS We analyzed cross-sectional data on 588 patients with activity-limiting pain admitted to home care for physical therapy. Three psychosocial factors were assessed: depressive symptoms, pain self-efficacy, and health literacy. Statistical methods included estimation of general linear models of pain intensity and pain-related disability. RESULTS Hispanics and non-Hispanic blacks report a greater number of pain sites, worse pain intensity, and higher levels of pain-related disability than non-Hispanic whites and others. Racial/ethnic minority group patients also have a higher prevalence of adverse psychosocial factors than others, with evidence that race/ethnicity interacts with pain self-efficacy and depressive symptoms in their association with mean pain intensity and pain-related disability, respectively. DISCUSSION The substantial racial/ethnic difference in the psychosocial profiles of older adults with activity-limiting pain highlights the importance of screening for these modifiable risk factors and tailoring interventions accordingly. Direct attention to the psychosocial needs of patients could help to address racial/ethnic disparities in pain outcomes.
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Affiliation(s)
| | | | - Yolanda Barrón
- Center for Home Care Policy & Research, Visiting
Nurse Service of NY
| | | | - Eileen Bach
- Department of Compliance & Regulatory Affairs,
Visiting Nurse Service of NY
| | | | - Sridevi Sridharan
- Center for Home Care Policy & Research, Visiting
Nurse Service of NY
| | - M. Carrington Reid
- Division of Geriatrics & Palliative Medicine, Weill
Cornell Medical Center, New York
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25
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Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs. Pain 2017; 157:1472-9. [PMID: 26963849 PMCID: PMC4912238 DOI: 10.1097/j.pain.0000000000000542] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This cross-sectional study aimed to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain. The sample included 1204 patients attending a tertiary pain management service for people with chronic disabling pain, unresponsive to medical treatment. As part of routine care, patients completed a web-based questionnaire assessing mental and physical health, functioning, and service use in the preceding 3 months. Depression was assessed using the 9-item Patient Health Questionnaire. Self-report health care utilisation was measured across 4 domains: general practitioner contacts, contacts with secondary/tertiary care doctors, accident and emergency department visits, and days hospitalised. The participation rate was 89%. Seven hundred and thirty-two patients (60.8%; 95% CI 58.0-63.6) met criteria for probable depression, and 407 (33.8%) met the threshold for severe depression. Patients with depression were more likely to be unable to work because of ill health and reported greater work absence, greater pain-related interference with functioning, lower pain acceptance, and more generalised pain. Mean total health care costs per 3-month period were £731 (95% CI £646-£817) for patients with depression, compared with £448 (95% CI £366-£530) for patients without depression. A positive association between severe depression and total health care costs persisted after controlling for key demographic, functional, and clinical covariates using multiple linear regression models. These findings reveal the extent, severity, and impact of depression in patients with chronic pain and make evident a need for action. Effective treatment of depression may improve patient health and functioning and reduce the burden of chronic pain on health care services.
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Peng WW, Guo XL, Jin QQ, Wei H, Xia XL, Zhang Y, Huang PC, Wang WC, Li SL, Wang JS, Chen J, Hu L. Biological mechanism of post-herpetic neuralgia: Evidence from multiple patho-psychophysiological measures. Eur J Pain 2016; 21:827-842. [PMID: 27977069 DOI: 10.1002/ejp.985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Post-herpetic neuralgia (PHN), which develops after the resolution of a herpes zoster eruption, is an exceptionally drug-resistant neuropathic pain. The unsatisfactory management of PHN partly results from the difficulty in dissecting out its contributing factors due to the complexity of PHN mechanism. METHODS Here, to elaborate our understanding of the PHN mechanism and to establish a basis for effective therapeutic strategies, we comprehensively investigated the contributions of multiple factors to PHN severity. RESULTS Based on the comparison of somatosensory detection thresholds (C, Aδ and Aβ fibre thresholds) between affected and unaffected sides, 16 PHN patients with significant sensory deficits and 13 PHN patients without significant sensory deficits were identified and assigned to different groups. The different extents of lesions in the nociceptive system between patients with and without sensory deficits were confirmed using laser-evoked brain responses. Moreover, patients with sensory deficits had more severe pain and psychological disorders, e.g. anxiety and depression. Importantly, chronic pain severity was significantly influenced by various psychophysiological factors (sleep disturbances, psychological disorders and hypothalamic-pituitary-adrenal axis dysfunction) for patients with sensory deficits. CONCLUSIONS Our findings demonstrated the contribution of multiple patho-psychophysiological factors to PHN severity, which could help establish a basis for the development of a rational, patient-centred therapeutic strategy. SIGNIFICANCE This study revealed the contribution of multiple patho-psychophysiological factors to PHN severity, which expanded our understanding of the underlying PHN mechanism, and helped develop a rational, patient-centred therapeutic strategy targeting towards the corresponding etiology and psychophysiological disorders for individual patient.
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Affiliation(s)
- W W Peng
- Brain Function and Psychological Science Research Center, Shenzhen University, Shenzhen, China
| | - X L Guo
- Department of Pain Medicine, Daping Hospital & Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - Q Q Jin
- Key Laboratory of Cognition and Personality (Ministry of Education) and School of Psychology, Southwest University, Chongqing, China
| | - H Wei
- Key Laboratory of Cognition and Personality (Ministry of Education) and School of Psychology, Southwest University, Chongqing, China
| | - X L Xia
- Key Laboratory of Cognition and Personality (Ministry of Education) and School of Psychology, Southwest University, Chongqing, China
| | - Y Zhang
- Key Laboratory of Cognition and Personality (Ministry of Education) and School of Psychology, Southwest University, Chongqing, China
| | - P C Huang
- Department of Pain Medicine, Daping Hospital & Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - W C Wang
- Department of Pain Medicine, Daping Hospital & Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - S L Li
- Department of Pain Medicine, Daping Hospital & Research Institute of Surgery, The Third Military Medical University, Chongqing, China
| | - J S Wang
- Department of Pain Medicine, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - J Chen
- Institute for Biomedical Sciences of Pain, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - L Hu
- Key Laboratory of Cognition and Personality (Ministry of Education) and School of Psychology, Southwest University, Chongqing, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
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Hulla R, Moomey M, Garner T, Ray C, Gatchel RJ. Biopsychosocial Characteristics, Using a New Functional Measure of Balance, of an Elderly Population with CLBP. Healthcare (Basel) 2016; 4:healthcare4030059. [PMID: 27563929 PMCID: PMC5041060 DOI: 10.3390/healthcare4030059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/03/2016] [Accepted: 08/01/2016] [Indexed: 01/04/2023] Open
Abstract
This study examined the biopsychosocial characteristics of chronic low back pain (CLBP) in an understudied but increasingly larger part of the population: the elderly (i.e., 65 years and older). A new innovative physical functioning measure (postural control, which is a proxy for the common problem of slips and falls in the elderly) was part of this biopsychosocial evaluation. Also, the National Institutes of Health (NIH)-developed Patient-Reported Outcome Measurement Information System (PROMIS) was also part of this comprehensive evaluation. Two demographically-matched groups of elderly participants were evaluated: one with CLBP (n = 24); and the other without (NCLBP, n = 24). Results revealed significant differences in most of these measures between the two groups, further confirming the importance of using a biopsychosocial approach for future studies of pain and postural control in the elderly.
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Affiliation(s)
- Ryan Hulla
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA.
| | - Michael Moomey
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX 76019, USA.
| | - Tyler Garner
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX 76019, USA.
| | - Christopher Ray
- College of Health Sciences, Texas Woman's University, Denton, TX 76204, USA.
| | - Robert J Gatchel
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, USA.
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Novak SP, Glasheen C, Roland CL. Prescription pain reliever misuse and levels of pain impairment: 3-year course in a nationally representative outpatient sample of US adults. Subst Abuse Rehabil 2016; 7:87-98. [PMID: 27418863 PMCID: PMC4935147 DOI: 10.2147/sar.s102251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The primary aim of this work was to present the prevalence data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative 3-year longitudinal survey (ages 18+ years) that captured information on patterns of self-reported pain interference and prescription pain reliever misuse. A second aim was to assess the degree to which the risk of various types of opioid misuse (onset, desistance, and incidence of dependence) was related to the longitudinal course of self-reported pain interference over the 3-year period. Methods We used a two-wave, nationally representative sample of adults (aged 18+ years) in which the baseline data were collected during 2001–2002 and a single follow-up was obtained ~3 years later (2004–2005 with 34,332 respondents with complete data on study variables for both waves). Results Our findings indicated that ~10% reported high pain interference in the past month at each wave. There was tremendous stability in levels of pain, with ~5% reporting consistent levels of high impairment over the 3-year study, a proxy for chronic pain. Levels of pain were more strongly associated with prescription pain reliever misuse concurrently rather than prospectively, and the association was largely linear, with the likelihood of misuse increasing with levels of pain. Finally, health service factors were also prominent predictors of onset, but not the outcomes, of desistance or transitions to problem use. Conclusion This study is the first to use a nationally representative sample with measures of pain and drug use history collected over an extended period. These results may help provide clinicians with an understanding that the risk of misuse is greatest when pain is active and may help guide the selection of appropriate intervention materials and monitor strategies for those at greatest risk.
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Affiliation(s)
| | | | - Carl L Roland
- Clinical Sciences and Outcomes Evidence, Pfizer Inc., Durham, NC, USA
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Lea C, Quiñones A, Whitson H, Bynum J, Thielke S. Changes in Self-Rated Health During the Transition to Retiring Living Among Medicare Managed-Care Recipients. JOURNAL OF HOUSING FOR THE ELDERLY 2016. [PMID: 29527088 DOI: 10.1080/02763893.2015.1129383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives Moving into a retirement community may be precipitated by or bring about changes in health status. We hypothesized that moving into a retirement community would be associated with a decline in self-rated health (SRH), but that health-related factors would mitigate this association. Methods We analyzed data from 58,272 participants in Cohort 3 of the Medicare Health Outcome Survey. Individuals answered questions regarding living status in 2000 and 2002. Those who moved into a retirement community were compared with those who did not. The primary outcome was change in SRH. We created adjusted and unadjusted models. Results 2,520 (4.4%) individuals moved into retirement communities between 2000 and 2002. There were no substantial differences in the mean change in SRH between those who moved and those who did not. In adjusted and unadjusted models, moving was not significantly associated with changes in SRH. In an analysis stratified by SRH, only those with the best SRH had a significant decline in SRH during the move. Discussion SRH mainly remained stable for most people regardless of moving into a retirement community. These findings argue against environmental context being a main determinant of self-perceived health status among older adults.
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Affiliation(s)
| | - Ana Quiñones
- Department of Medicine (Geriatrics) and the Aging Center, Duke University Medical Center, Durham, North Carolina
| | - Heather Whitson
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, North Carolina.,Public Health & Preventive Medicine, Oregon Health & Science University
| | - Julie Bynum
- The Dartmouth Institute for Health Policy and Clinical Practice
| | - Stephen Thielke
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington
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Efficacy of Low-Dose Oral Liquid Morphine for Elderly Patients with Chronic Non-Cancer Pain: Retrospective Chart Review. Drugs Real World Outcomes 2015; 2:369-376. [PMID: 26688789 PMCID: PMC4674530 DOI: 10.1007/s40801-015-0048-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION The use of medications among older persons can often be challenging as physiological changes may affect metabolism and cognitive abilities. Several studies show that the elderly with chronic pain are seriously undertreated or inappropriately treated, particularly with respect to opioids. OBJECTIVE To determine whether very low doses of oral liquid morphine (LM) in patients over 65 years of age with chronic non-cancer pain provides meaningful pain improvement. METHODS A retrospective chart review was conducted for ten carefully selected older patients seen at a tertiary care pain clinic in Toronto Ontario (2009-2011) with serious biomedical painful conditions and intolerance to other opioid analgesics. Data collected included demographics, LM dosing, diagnosis and average Numeric Rating Scale (NRS) pain ratings pre- and post-administration of LM. RESULTS Of the ten eligible patients, the female/male ratio was 4:1, mean age 75.5 years and mean pain duration 7.9 years. The initial dose of LM for all patients was 1-3 mg three times/day and the maintenance dose ranged from 5 to 30 mg/day. Overall, pain ratings dropped from 6.35 to 2.95 (3.4 point drop on the NRS score) with a mean follow-up of 14 months (range 10-21). CONCLUSION The case series showed that carefully selected elderly patients with biomedical pathology can benefit from very low doses of LM. Future larger and well-designed studies need to focus on the use of LM for elderly patients.
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Breland JY, Barrera TL, Snow AL, Sansgiry S, Stanley MA, Wilson N, Amspoker AB, Kunik ME. Correlates of pain intensity in community-dwelling individuals with mild to moderate dementia. Am J Alzheimers Dis Other Demen 2015; 30:320-5. [PMID: 25107934 PMCID: PMC10852910 DOI: 10.1177/1533317514545827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify correlates of participant-reported pain in community-dwelling individuals with mild to moderate dementia. METHODOLOGY Associations among participant-reported pain intensity and depressive symptoms, mental health diagnoses, pain diagnoses, pain medications, level of functional ability, and cognitive impairment were assessed in 136 community-dwelling veterans with mild to moderate dementia and pain. Univariate and multiple regressions were used to assess relationships among the independent variables and participant-reported pain. RESULTS Pain diagnoses (β = .23, t 132 = 2.65, P < .01) and pain medications (β = .21, t 132 = 2.48, P < .05) were correlated with participant-reported pain intensity in univariate regression models. Only pain diagnoses (β = .20, t 132 = 2.17, P < .05) remained a significant predictor in adjusted models. CONCLUSION Participant-reported pain in individuals with dementia appears to be a unique construct for which other psychosocial indicators cannot be substituted. Therefore, directly asking community-dwelling individuals with mild to moderate dementia about their pain is a critical component of assessment.
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Affiliation(s)
- Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Terri L Barrera
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, USA Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - A Lynn Snow
- Research & Development Service, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA Center for Mental Health & Aging and Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Shubhada Sansgiry
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, USA Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Melinda A Stanley
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, USA Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Nancy Wilson
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Amber B Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, USA Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Przekop P, Haviland MG, Oda K, Morton KR. Prevalence and correlates of pain interference in older adults: why treating the whole body and mind is necessary. J Bodyw Mov Ther 2015; 19:217-25. [PMID: 25892375 PMCID: PMC4517937 DOI: 10.1016/j.jbmt.2014.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/05/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
Our study presents pain-related interference rates in a sample of community-dwelling, older adults and determines factors associated with these restrictions. Participants were 9506 respondents to the Biopsychosocial Religion and Health Study (66.8% female and 33.2% male; average age = 62.3 years). In this sample, 48.2% reported no pain-related interference, whereas 37.7% reported moderate and 14.1% reported severe interference. As hypothesized, older age, female gender, lower education, financial strain, traumatic experiences, worse health, increased body mass index, poor sleep, and depressive symptoms all were associated with higher pain interference ratings (ordered logistic regression/three-level pain criterion; odds ratios p < 0.05). Our findings are similar to those from younger adults, and they suggest enduring effects of trauma on health and reveal the complexity of chronic pain in community-dwelling, older adults.
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Affiliation(s)
- Peter Przekop
- Betty Ford Center, 39000 Bob Hope Drive, Rancho Mirage, CA 92270, USA; Department of Pediatrics, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA; Department of Psychiatry, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA; Department of Neurology, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA.
| | - Mark G Haviland
- Department of Psychiatry, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA
| | - Keiji Oda
- Department of Epidemiology and Biostatistics, Loma Linda University, School of Public Health, Loma Linda, CA 92350, USA
| | - Kelly R Morton
- Department of Family Medicine, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA; Department of Psychology, Loma Linda University, School of Behavioral Health, Loma Linda, CA 92350, USA
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Lee JE, Kahana E, Kahana B, Barnes K. Positive affect, depressive symptoms, and arthritis pain of elderly people over time. HEALTHY AGING RESEARCH 2015; 4:16. [PMID: 29399574 PMCID: PMC5792073 DOI: 10.12715/har.2015.4.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Older adults frequently experience physical symptoms of arthritis pain. We examined the dynamic change of arthritis pain and depressive symptoms over time. We also addressed the influence of time varying arthritis pain on depressive symptoms and positive affect among community dwelling older individuals. METHODS Analyses were based on data from 4 annual follow-ups in a sample of 299 elderly residents (M=83.78) of Florida retirement communities. We estimated a hierarchical growth curve model that related the effects of time varying pain and characteristics of participants such as age, gender, cognitive functioning, emotional support and health. Growth curve modeling was used to assess changes in emotional well-being as a function of arthritis pain over time. RESULTS We found that depressive symptoms increased over 4 years whereas positive affect declined over 4 years with significant between-person differences in levels and slopes. As predicted, changes in arthritis pain co-varied with both depressive symptoms and positive affect over time. Gender, cognitive functioning, health conditions and emotional support from others were associated with between person differences in level of emotional well-being. CONCLUSIONS Our findings suggest that conceptualization of emotional well-being of older adults as a dynamic, changing construct applies both depressive symptoms and positive affect. Findings also suggest that arthritis pain as well as emotional support contribute to depressive symptoms and to positive affect among older adults with arthritis.
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Affiliation(s)
- Jeong E. Lee
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Eva Kahana
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Boaz Kahana
- Cleveland State University, Cleveland, Ohio, USA
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Dellaroza MSG, Pimenta CADM, Lebrão ML, Duarte YA. [Association of chronic pain with the use of health care services by older adults in Sao Paulo]. Rev Saude Publica 2014; 47:914-22. [PMID: 24626496 DOI: 10.1590/s0034-8910.2013047004427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 06/02/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Evaluate the association between use of health care services by older adults with chronic pain and sociodemographic and health variables. METHODS Cross-sectional study whose population sample of 1,271 older adults with chronic pain and with no cognitive deficit was obtained through home surveys in Sao Paulo, SP, Southeastern Brazil,, in 2006. The study considered pain lasting for six or more months as chronic. The criterion for health care service use was more than four doctor appointments or having been admitted to a hospital during the past year. For those in chronic pain for at least one year, the existence of an association between the use of health care services and independent variables (pain and socio-demographical characteristics and self-reported morbidities) was tested using univariate (RaoScott test of association) and multivariate analysis (Cox Multiple Regression with robust variance). Stata 11.0 was used for the statistical analysis, and the significance level adopted was p < 0.05. RESULTS The prevalence of health care service use among older people with pain was 48,0% (95%CI 35.1;52.8) and did not differ from older adults without chronic pain (50.5%, 95%CI 45.1;55.9). The multivariate analysis showed that the chance of using health care services was 33,0% lower for older adults with pain for more than two years than those with pain between one and two years (p = 0.002). The chance was 55,0% higher for those with intense pain (p = 0.003) and 45,0% higher for those with moderate pain interference in the work (p = 0.015). CONCLUSIONS Chronic pain was found to be common and was associated with negative effects on independence and mobility. More intense and recent chronic pain that affected work resulted in greater use of health care services.
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Maia Costa Cabral D, Sawaya Botelho Bracher E, Dylese Prescatan Depintor J, Eluf-Neto J. Chronic pain prevalence and associated factors in a segment of the population of São Paulo City. THE JOURNAL OF PAIN 2014; 15:1081-1091. [PMID: 25038400 DOI: 10.1016/j.jpain.2014.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/24/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED A cross-sectional epidemiologic survey was performed to determine the prevalence of chronic pain (CP) and to identify associated factors in a random sample of persons 15 years or older from a segment of the population of São Paulo City, Brazil. A total of 1,108 eligible participants were randomly selected, and face-to-face interviews were performed with 826 individuals (74.5%) between December 2011 and February 2012. Chronic Pain Grade, Hospital Anxiety and Depression Scale, and EuroQol-5D were used to verify pain characteristics and the associated signs of psychological distress. A prevalence of 42% (95% confidence interval, 38.6-45.4) was observed for CP, and the participants with CP had an average pain intensity of 5.9 (standard deviation = 1.9) and a pain-related disability of 4.1 (standard deviation = 3.2) on a 0 to 10 scale. Persistent pain was present in 68.6% of those with CP, and 32.8% of the population sample had high-intensity or high-interference pain (Chronic Pain Grade II, III, and IV). Quality of life was significantly worse among the CP individuals. The following factors were independently associated with CP: female gender, age 30 years or older, ≤ 4 years of education, symptoms consistent with anxiety, and intense physical strain. Indicators of pain severity increased with pain grades. PERSPECTIVE CP is highly prevalent in the city of São Paulo and has a considerable impact on health-related quality of life. Demographic, socioeconomic, and psychological factors are independently associated with this condition.
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Affiliation(s)
| | | | | | - José Eluf-Neto
- University of São Paulo School of Medicine, São Paulo, Brazil
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Chopra K, Arora V. An intricate relationship between pain and depression: clinical correlates, coactivation factors and therapeutic targets. Expert Opin Ther Targets 2013; 18:159-76. [PMID: 24295272 DOI: 10.1517/14728222.2014.855720] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION An apparent clinical relationship between pain and depression has long been recognized, which makes an enormous impact on the individual health care. At present, the practical implication of such overlapping symptomatology between pain and depression is not clear, but the prevalence estimates for depression are substantially inflated among patients with chronic pain and vice versa. This interaction has been labeled as the depression-pain syndrome or depression-pain dyad. AREAS COVERED This article discusses the neurobiological substrates and neuroanatomical pathways involved in pain-depression dyad along with newer therapeutic targets. EXPERT OPINION Several key themes emerged from our review of the relationship between depression and pain. First, the diagnosis of depression in pain or vice versa is particularly challenging, and the development of better diagnostic framework that involves both pain and depression is particularly required. Secondly, the entwined relationship between pain and depression supports the possibility of common coactivating factors that results in their neurophysiological overlap. A broad understanding of the role played by the central nervous system (CNS) in the processing of pain and depression may eventually lead to the introduction of triple reuptake inhibitors, agomelatine, vilazodone and ketamine with novel mechanism of action, hence appear to be of promising potential for pain with depression.
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Affiliation(s)
- Kanwaljit Chopra
- Panjab University, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Study, Pharmacology Research Laboratory , Chandigarh-160 014 , India +91 172 2534105 ; +91 172 2541142 ;
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Shega JW, Andrew M, Kotwal A, Lau DT, Herr K, Ersek M, Weiner DK, Chin MH, Dale W. Relationship between persistent pain and 5-year mortality: a population-based prospective cohort study. J Am Geriatr Soc 2013; 61:2135-2141. [PMID: 24320761 PMCID: PMC4140782 DOI: 10.1111/jgs.12554] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the association between self-reported noncancer pain and 5-year mortality. DESIGN Cohort. SETTING Community-dwelling older adults. PARTICIPANTS Canadian Study of Health and Aging 1996 wave. MEASUREMENTS Registrar of Vital Statistics-established 5-year mortality. Noncancer pain was assessed using the 5-point verbal descriptor scale, dichotomized into no or very mild versus moderate, severe, or very severe pain. Frailty was the accumulation of health deficits. Cognitive status (Modified Mini-Mental State Examination) and depressed mood (five-item mental health screening questionnaire) were also assessed. Multivariable logistic regression and Cox proportional hazards were used to analyze the relationship between pain and 5-year mortality. RESULTS Of 5,703 participants, 4,694 (82.3%) had complete data for analysis; 1,663 of these (35.4%) reported moderate, severe, or very severe pain, and 1,343 (28.6%) had died at 5-year follow-up. Four hundred ninety-six of those who died (29.8%) reported moderate, severe, or very severe pain and 847 (27.9%) no or very mild pain. Multivariate logistic analysis found that individuals with moderate, severe, or very severe pain had lower odds of 5-year mortality than those with no or very mild pain (odds ratio=0.78, 95% confidence interval (CI)=0.66-0.92; P<.001). The risk of death was lower in persons reporting moderate or greater pain than in those with no or very mild pain (HR=0.85, 95% CI=0.75-0.96; P=.01). An interaction between pain and sex explained this effect. Men with pain were not significantly more likely than men without pain to die (HR=1.00, 95% CI=0.84-1.19; P=.99), whereas women without pain (HR=0.54, 95% CI=0.47-0.63; P<0.01) and women with pain (HR=0.40; CI=0.33-0.47; P<.01) had less risk of death than men without and with pain, respectively. CONCLUSION Older women with pain were less likely to die within 5 years than older women without pain, men in pain, or men without pain.
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Affiliation(s)
- Joseph W. Shega
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Melissa Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashwin Kotwal
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
| | - Denys T. Lau
- Division of Health Care Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Keela Herr
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Mary Ersek
- School of Nursing, University of Pennsylvania, Philadelphia
| | - Debra K. Weiner
- Geriatric Research, Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennslvania
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennslvania
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennslvania
| | - Marshall H. Chin
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
| | - William Dale
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, Illinois
- Section of Hematology and Oncology, University of Chicago, Chicago, Illinois
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Goesling J, Clauw DJ, Hassett AL. Pain and depression: an integrative review of neurobiological and psychological factors. Curr Psychiatry Rep 2013; 15:421. [PMID: 24214740 DOI: 10.1007/s11920-013-0421-0] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The comorbidity of pain and depression has been well established in the literature and is associated with a greater burden to the individual and society than either condition alone. The relationship between pain and depression is quite complex and multiple factors must be considered when trying to disentangle the pain-depression link including shared neurobiology, precipitating environmental factors and cognitive influences. This article aims to provide an overview of the leading neurobiological and psychosocial theories that have advanced our understanding of the link between pain and depression. To this end we describe the shared neurobiological mechanisms in the brain thought to explain the overlap and consider psychological processes and how they inform a cognitive behavioral model. The article also provides an overview of the evidence based treatment for comorbid pain and depression.
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Affiliation(s)
- Jenna Goesling
- Department of Anesthesiology, Back & Pain Center, University of Michigan, Burlington Building 1, Suite 100, 325 E. Eisenhower Parkway, Ann Arbor, MI, 48108, USA,
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Tripp DA, Nickel JC, Shoskes D, Koljuskov A. A 2-year follow-up of quality of life, pain, and psychosocial factors in patients with chronic prostatitis/chronic pelvic pain syndrome and their spouses. World J Urol 2013; 31:733-9. [DOI: 10.1007/s00345-013-1067-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 03/22/2013] [Indexed: 12/30/2022] Open
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A Double-blind Randomized Trial of Wound and Intercostal Space Infiltration with Ropivacaine during Breast Cancer Surgery. Anesthesiology 2013; 118:318-26. [DOI: 10.1097/aln.0b013e31827d88d8] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Background:
The efficacy of local anesthetic wound infiltration for the treatment of acute and chronic postoperative pain is controversial and there are no detailed studies. The primary objective of this study was to evaluate the influence of ropivacaine wound infiltration on chronic pain after breast surgery.
Methods:
In this prospective, randomized, double-blind, parallel-group, placebo-controlled study, 236 patients scheduled for breast cancer surgery were randomized (1:1) to receive ropivacaine or placebo infiltration of the wound, the second and third intercostal spaces and the humeral insertion of major pectoralis. Acute pain, analgesic consumption, nausea and vomiting were assessed every 30 min for 2 h in the postanesthesia care unit and every 6 h for 48 h. Chronic pain was evaluated 3 months, 6 months, and 1 yr after surgery by the brief pain inventory, hospital anxiety and depression, and neuropathic pain questionnaires.
Results:
Ropivacaine wound infiltration significantly decreased immediate postoperative pain for the first 90 min, but did not decrease chronic pain at 3 months (primary endpoint), or at 6 and 12 months postoperatively. At 3 months, the incidence of chronic pain was 33% and 27% (P = 0.37) in the ropivacaine and placebo groups, respectively. During follow-up, brief pain inventory, neuropathic pain, and anxiety increased over time in both groups (P < 0.001) while depression remained stable. No complications occurred.
Conclusion:
This multicenter, prospective study shows that ropivacaine wound infiltration after breast cancer surgery decreased immediate postoperative pain but did not decrease chronic pain at 3, 6, and 12 months postoperatively.
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Abstract
OBJECTIVE Pain and depression are both common in old age, but their (long-term) temporal relationship remains unknown. This study is designed to determine whether pain predicts the onset of depression and vice versa. METHODS This is a prospective, population-based cohort study with 12-year follow-up and 3-year intervals in the Netherlands (Longitudinal Aging Study Amsterdam). At baseline, participants were aged 55 to 85 years (n = 2028). Main measurements outcomes were incident depression defined as crossing the cutoff of 16 and showing a relevant change (≥ 5 points) on the Center for Epidemiological Studies-Depression Scale among nondepressed participants and incident pain defined as a score of 2 or higher on the pain scale of the 5-item Nottingham Health Profile in pain-free participants. Multiple imputations were adopted to estimate missing values. RESULTS In nondepressed participants (n = 1769), a higher level of pain was predictive of incident depression in multiple extended Cox regression analyses (hazard rate [HR] = 1.13 [95% confidence interval {CI}: 1.05-1.22], p = .001), which all remained significant after correction for sociodemographic characteristics, life-style characteristics, functional limitations, and chronic diseases (HR = 1.09 [95% CI = 1.01-1.18], p = .035). In the pain-free participants (n = 1420), depressive symptoms at baseline predicted incident pain (HR = 1.02 [95% CI: 1.01-1.04], p = .006). This depression measure did not independently predicted the onset of pain in the fully adjusted models. CONCLUSIONS As pain precedes the onset of depression, strategies to prevent depression in chronic pain patients are warranted. In contrast, no effects of depression on the development of subsequent pain were found when adjusting for covariates.
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Wang S, Tian Y, Song L, Lim G, Tan Y, You Z, Chen L, Mao J. Exacerbated mechanical hyperalgesia in rats with genetically predisposed depressive behavior: role of melatonin and NMDA receptors. Pain 2012; 153:2448-2457. [PMID: 23046768 DOI: 10.1016/j.pain.2012.08.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/16/2012] [Accepted: 08/31/2012] [Indexed: 02/05/2023]
Abstract
A connection between pain and depression has long been recognized in the clinical setting; however, its mechanism remains unclear. This study showed that mechanical hyperalgesia induced by unilateral temporomandibular joint (TMJ) inflammation was exacerbated in Wistar-Kyoto (WKY) rats with genetically predisposed depressive behavior. Reciprocally, TMJ inflammation enhanced depressive behavior such that a lower nociceptive threshold correlated with a higher score of depressive behavior in the same WKY rats. As compared with Wistar rats, WKY rats showed a lower plasma melatonin level, downregulation of the melatonin MT1 receptor, but upregulation of the NR1 subunit of the NMDA receptor in the ipsilateral trigeminal subnucleus caudalis (Sp5C). Intracisternal administration of 6-chloromelatonin (250 μg, twice daily for 7 days) concurrently attenuated mechanical hyperalgesia and depressive behavior in WKY rats as well as downregulated the NR1 expression in the ipsilateral Sp5C. In patch-clamp recordings, melatonin dose-dependently decreased NMDA-induced currents in spinal cord dorsal horn substantia gelatinosa neurons. These results demonstrate a reciprocal relationship between TMJ inflammation-induced mechanical hyperalgesia and depressive behavior and suggest that the central melatoninergic system, through modulation of the NMDA receptor expression and activity, may play a role in the mechanisms of the comorbidity between pain and depression.
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Affiliation(s)
- Shuxing Wang
- MGH Center for Translational Pain Research, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Department of Physiology, Southern Medical University, Guangzhou, China Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, Sichuan, China Center for TMD and Orofacial Pain, Peking University School and Hospital of Stomatology, Beijing, China
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Abou-Raya S, Abou-Raya A, Helmii M. Duloxetine for the management of pain in older adults with knee osteoarthritis: randomised placebo-controlled trial. Age Ageing 2012; 41:646-52. [PMID: 22743149 DOI: 10.1093/ageing/afs072] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND pain is the leading symptom of osteoarthritis (OA) and is often chronic in nature, leading to significant morbidity and decreased quality of life. Duloxetine, a selective serotonin norepinephrine reuptake inhibitor has been demonstrated to have a centrally acting analgesic effect. OBJECTIVES the aim of the present study was to investigate the efficacy of duloxetine in reducing pain in older adults with knee OA. METHODS totally, 288 patients aged 65 years and above with primary knee OA were enrolled in this study. Patients were randomised 1:1. Totally, 144 received 60 mg/day of duloxetine HCL and 144 received placebo for 16 weeks. Outcome measures included pain reduction and improvement in physical functioning scores. Pain was assessed using the visual analogue pain scale (VAS; 0-100 mm). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used to assess function. RESULTS two-hundred and seventy four of the 288 patients completed the study. There was a statistically significant reduction in pain and a significant improvement in WOMAC scores at 16 weeks in the duloxetine group versus the placebo group. No serious side effects were reported. CONCLUSIONS the findings of the present study provide evidence for the efficacy and tolerability of duloxetine in reducing pain and subsequently improving function in older adults with knee OA. TRIAL REGISTRATION NCT01425827.
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Affiliation(s)
- Suzan Abou-Raya
- Geriatric Unit, Internal Medicine Department, University of Alexandria, Alexandria, Egypt.
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Yu H, Wang Y, Ge X, Wu X, Mao X. Depression and survival in Chinese patients with gastric cancer: a prospective study. Asian Pac J Cancer Prev 2012; 13:391-4. [PMID: 22502708 DOI: 10.7314/apjcp.2012.13.1.391] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM Depression is thought to be a predictor of poor survival among cancer patients. In our study, we aimed to investigate the association between depression and survival in patients with gastric cancer. METHODS The subjects were a total of 300 patients aged 20-75 years who had histological confirmed diagnosis of gastric cancer from January 2004 to May 2006. Three months after patients diagnosis, depression was scored using by the Depression Status Inventory (DSI) designed by Willian WK Zung. The follow-up period consisted of a total of 13,643 person-months. A Cox's regression analysis was used to assess the association between depression and survival. RESULTS The percentage of subjects with depression according to the DSI depression criteria was 31%. Tumor stage and treatment methods were significantly associated with depression of patients. Age (60 years or older), annual income, tumor stage, lymph nodes metastasis and treatment were significantly associated with increased hazard ratio (HR) for gastric cancer survival. The adjusted HR for mortality risk in gastric cancer patients with depression tended to be high (HR=3.34, 95% CI=1.23-5.49) and a significant trend was found (P<0.05). CONCLUSION The data obtained in this prospective study in Chinese support the hypothesis that depression is associated with poor survival among gastric cancer patients. Further studies with a large sample and longer term follow-up period are needed.
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Affiliation(s)
- Hui Yu
- Cardiopulmonary Function Room, Third Affiliated Hospital of Harbin Medical University, Harbin, China
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Braden JB, Young A, Sullivan MD, Walitt B, Lacroix AZ, Martin L. Predictors of change in pain and physical functioning among post-menopausal women with recurrent pain conditions in the women's health initiative observational cohort. THE JOURNAL OF PAIN 2012; 13:64-72. [PMID: 22208802 PMCID: PMC3249604 DOI: 10.1016/j.jpain.2011.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/03/2011] [Accepted: 10/05/2011] [Indexed: 12/12/2022]
Abstract
UNLABELLED Pain complaints are commonly reported symptoms among postmenopausal women and can have significant effects on health-related quality of life. We sought to identify medical and psychosocial factors that predict changes in pain and overall physical functioning over a 3-year period among postmenopausal women with recurrent pain conditions. We examined data from postmenopausal women age 50 to 79 with recurrent pain conditions (low back pain, neck pain, headache or migraines, or joint pain or stiffness) over a 3-year period using the Women's Health Initiative Observational Study Cohort (N = 67,963). Multinomial logistic regression models controlling for demographic and clinical characteristics were used to identify baseline predictors of change in the SF-36 subscales for pain and physical functioning between baseline and 3-year follow-up. Body mass index (BMI) was associated with worsening of pain (OR [95% CI] 1.54 [1.45-1.63] for BMI ≥30) and physical functioning (1.83 [1.71-1.95] for BMI ≥30). A higher reported number of nonpain symptoms, higher medical comorbidity, and a positive screen for depression (1.13 [1.05-1.22] for worsened pain) were also associated with worsening of pain and physical functioning. Baseline prescription opioid use was also associated with lack of improvement in pain (OR .42, 95% CI .36-.49) and with worsened physical functioning (1.25 [1.04-1.51]). PERSPECTIVE This study presents prospective data on change in pain and physical functioning in postmenopausal women over a 3-year period. Our results suggest depression, nonpain physical symptoms, obesity, and possibly opioid treatment are associated with worse long-term pain outcomes in this population.
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Affiliation(s)
- Jennifer Brennan Braden
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
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Abstract
BACKGROUND Chronic pain is quite common in the elderly and is often associated with comorbid depression, limitation of functioning and reduced quality of life. The aim of this study was to ascertain whether there is a differential risk of depression among persons with pain in different anatomical sites and to determine which pain conditions are independent risk factors for depression. METHODS Data are from the Ibadan Study of Ageing (ISA), a community-based longitudinal survey of persons aged 65 years and older from eight contiguous Yoruba-speaking states in Nigeria (n = 2152). Data were collected in face-to-face interviews; depression was assessed using the World Mental Health initiative version of the Composite International Diagnostic Interview (CIDI) while chronic pain was assessed by self-report (response rate = 74%). RESULTS Estimates of persistent pain (lasting more than six months), in different anatomical sites range from 1.3% to 12.8%, with the commonest being joint pains (12.8%), neck or back (spinal) pain (7.6%) and chest pain (3.0%). Significantly more pain conditions were reported by females and by respondents who were aged over 80 years. The risk for depression was higher in respondents with spinal, joint and chest pain. However, only chest pain was independently associated with depression after adjustments were made for pains at other sites and for functional disability. CONCLUSION Our data suggests that, among elderly persons, there is a differential association of depression with chronic pain that is related to the anatomical site of the pain.
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Affiliation(s)
- Bibilola D Oladeji
- Department of Psychiatry, University College Hospital, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Prevalence of musculoskeletal pain in the general Swedish population from 1968 to 2002: Age, period, and cohort patterns. Pain 2010; 151:206-214. [DOI: 10.1016/j.pain.2010.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 06/04/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
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Hawker GA, Gignac MAM, Badley E, Davis AM, French MR, Li Y, Perruccio AV, Power JD, Sale J, Lou W. A longitudinal study to explain the pain-depression link in older adults with osteoarthritis. Arthritis Care Res (Hoboken) 2010; 63:1382-90. [PMID: 20662042 DOI: 10.1002/acr.20298] [Citation(s) in RCA: 215] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 07/08/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate whether osteoarthritis (OA) pain determines depressed mood, taking into consideration fatigue and disability and controlling for other factors. METHODS In a community cohort with hip/knee OA, telephone interviews assessed OA pain and disability (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), fatigue (Multidimensional Fatigue Symptom Inventory), depressed mood (Center for Epidemiologic Studies Depression Scale), and covariates (demographics, self-rated health, comorbidity, pain coping, pain catastrophizing, and social support) at 3 time points over 2 years. Drawing on previous research, a path model was developed to test the interrelationships among the key concepts (pain, depression, fatigue, disability) over time, controlling for covariates. RESULTS The baseline mean age was 75.4 years; 78.5% of the subjects were women, 37.2% were living alone, and 15.5% had ≥3 comorbid conditions. WOMAC scores indicated moderate OA symptoms and disability. From the final model with 529 subjects, adjusting for covariates, we found that current OA pain strongly predicted future fatigue and disability (both short and long term), that fatigue and disability in turn predicted future depressed mood, that depressed mood and fatigue were interrelated such that depressed mood exacerbated fatigue and vice versa, and that fatigue and disability, but not depressed mood, led to worsening of OA pain. CONCLUSION Controlling for other factors, OA pain determined subsequent depressed mood through its effect on fatigue and disability. These effects led to worsening of pain and disability over time. These results support the need for improved pain management in OA to prevent or attenuate the downstream effects of pain on disability and mood.
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Affiliation(s)
- Gillian A Hawker
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada.
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Comparison Study on Functional Outcomes and Perceived Quality of Life Between All-Inclusive and Fee-For-Service Continuing Care Retirement Communities. J Am Med Dir Assoc 2010; 11:257-62. [DOI: 10.1016/j.jamda.2009.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 09/01/2009] [Accepted: 09/02/2009] [Indexed: 11/20/2022]
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