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Rivel M, Achiron A, Stern Y, Zeilig G, Defrin R. Emotional burden among MS patients: associations between specific chronic pain diagnoses and psychological features. J Neurol 2024; 271:688-698. [PMID: 37875677 DOI: 10.1007/s00415-023-12048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
Central neuropathic pain (CNP) and musculoskeletal pain (MSP) are often comorbid with multiple sclerosis (MS), yet data on the emotional burden entailed by this comorbidity are very limited. We studied whether MS patients with CNP exhibited greater emotional burden and pain severity than those with MSP and whether this emotional burden was attributed to the MS, the chronic pain, or both. Participants were 125 MS patients (55 with CNP; 30 with MSP; 40 MS pain-free) and 30 healthy controls (HCs). Participants completed questionnaires assessing pain interference, pain catastrophizing, depression, anxiety, stress, hypervigilance, and chronic pain. Group comparisons and a two-step cluster analysis were performed, and the association between cluster membership and clinical group membership was evaluated. Chronic pain was stronger and more widespread in the CNP group than in the MSP group. Both pain groups had higher pain interference, pain catastrophizing, and stress compared to MS pain-free and HC groups. All MS groups had greater depression levels compared to HCs, and the CNP group had the highest anxiety level. The "high psychological distress" cluster comprised mainly participants with CNP (57%), and the "minimal psychological distress" cluster comprised mainly the MS pain-free and HC groups. In conclusion, CNP seems to induce greater emotional burden and pain severity than does MSP. Whereas depression may be attributed to MS, and anxiety to CNP, enhanced pain interference, catastrophizing, and stress may be attributed to the comorbidity of MS and chronic pain. Identifying these traits among MS patients and targeting them in management programs may contribute to more effective, individually based care.
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Affiliation(s)
- Michal Rivel
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anat Achiron
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Stern
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Gabi Zeilig
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurological Rehabilitation, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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Henningsen MJ, Larsen JG, Karlsson WK, Christensen RH, Al-Khazali HM, Amin FM, Ashina H. Epidemiology and clinical features of paroxysmal hemicrania: A systematic review and meta-analysis. Headache 2024; 64:5-15. [PMID: 38205903 DOI: 10.1111/head.14658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To assess the prevalence or relative frequency of paroxysmal hemicrania and its clinical features in the adult general population and among adult patients evaluated for headache in tertiary care. BACKGROUND Paroxysmal hemicrania is a rare trigeminal autonomic cephalalgia with characteristic attacks of headache, associated cranial autonomic symptoms and signs, and an absolute response to indomethacin. Its epidemiological burden remains unknown in both the adult general population and among adult patients evaluated for headache in a tertiary care setting. Moreover, the frequencies of the clinical features associated with paroxysmal hemicrania have not been well established. METHODS A literature search of PubMed and Embase was conducted from January 1, 1988, to January 20, 2023. Eligible for inclusion were observational studies reporting the point prevalence or relative frequency of paroxysmal hemicrania or its clinical features in the adult general population or among adult patients evaluated for headache in tertiary care. Two independent investigators (M.J.H. and J.G.L.) performed the title, abstract, and full-text article screening. Each included study's risk of bias was critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Estimates of prevalence or relative frequency were calculated using a random-effects meta-analysis. The between-study heterogeneity was assessed using the I2 statistic and further explored with meta-regression. This study was pre-registered on PROSPERO (identifier: CRD42023391127). RESULTS A total of 17 clinic-based studies and one population-based study met the eligibility criteria. Importantly, an overall high risk of bias was observed across the eligible studies. The relative frequency of paroxysmal hemicrania was estimated to be 0.3% (95% CI, 0.2%-0.5%) among adult patients evaluated for headache in tertiary care with considerable heterogeneity (I2 = 76.4%). No cases with paroxysmal hemicrania were identified among 1,838 participants in a population-based sample. Moreover, the most prevalent cranial autonomic symptoms were lacrimation (77.3% [95% Cl, 62.7%-87.3%]), conjunctival injection (75.0% [95% Cl, 60.3%-85.6%]), and nasal congestion (47.7% [95% Cl, 33.6%-62.3%]). CONCLUSIONS Our findings suggest that paroxysmal hemicrania is a rare disorder among adults evaluated for headache in tertiary care, while its prevalence in the general population remains unknown. Further studies focusing on the clinical features of paroxysmal hemicrania are warranted.
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Affiliation(s)
- Mikkel J Henningsen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johanne G Larsen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - William K Karlsson
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rune H Christensen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Haidar M Al-Khazali
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Håkan Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Thimma Ravindranath P, Smith JG, Niloofar RN, Ebelthite C, Renton T. Sleep disturbances are associated with pain intensity and pain-related functional interference in patients experiencing orofacial pain. J Oral Rehabil 2023; 50:980-990. [PMID: 37243957 DOI: 10.1111/joor.13521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/08/2023] [Accepted: 05/23/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Sleep and pain have a reciprocal relationship, interacting with psychosocial aspects including depression, anxiety, somatization and significant stressful events. OBJECTIVE The aim of this study was to assess patients with oro-facial pain (OFP) and related sleep disturbances and determine the strongest psychosocial correlates. METHODS A cross-sectional study of anonymized data of consecutive patients with OFP {January 2019 and February 2020} were analysed. Diagnostic and Axis-II data were integrated to assess the relationship between sleep disturbances, measured using Chronic Pain Sleep Inventory, and demographic factors, clinical comorbidities, recent stressful events, pain severity and pain- and psychological-related function. RESULTS Five out of six patients with OFP were presented with pain-related sleep disturbances. Sleep problems were enhanced in patients with primary oro-facial headache compared with other OFP conditions. However, once the level of pain intensity and interference was accounted for, primary headache, was not a significant correlate of pain-related sleep disturbances. Multivariate analysis revealed (average) pain severity and pain interference were both significantly associated with sleep problems. There were also significant independent associations of sleep problems with somatization levels and reported experience of recent stressful events. CONCLUSION Identifying sleep problems as a part of OFP management may be beneficial and could result in better management outcomes.
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Affiliation(s)
| | - Jared G Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Rasooli Nia Niloofar
- Faculty of Dentistry, Oral and Craniofacial Science, King's College London, London, UK
| | - Candice Ebelthite
- IMPARTS, Mind and Body Programme, King's Health Partners, London, UK
| | - Tara Renton
- Faculty of Dentistry, Oral and Craniofacial Science, King's College London, London, UK
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Owen N, Dew L, Logan S, Denegri S, Chappell LC. Research policy for people with multiple long-term conditions and their carers. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221104407. [PMID: 35721799 PMCID: PMC9201348 DOI: 10.1177/26335565221104407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People with multiple long-term conditions (MLTC) are a growing population, not only in
the United Kingdom but internationally. Health and care systems need to adapt to rise to
this challenge. Policymakers need to better understand how medical education and training,
and service configuration and delivery should change to meet the needs of people with MLTC
and their carers. A series of workshops with people with MLTC and carers across the
life-course identified areas of unmet need including the impact of stigma; poorly
coordinated care designed around single conditions; inadequate communication and
consultations that focus on clinical outcomes rather than patient-oriented goals and
imperfectly integrate mental and physical wellbeing. Research which embeds the patient
voice at its centre, from inception to implementation, can provide the evidence to drive
the change to patient-centred, coordinated care. This should not only improve the lives of
people living with MLTC and their carers but also create a health and care system which is
more effective and efficient. The challenge of MLTC needs to be bought to the fore and it
will require joint effort by policymakers, practitioners, systems leaders, educators, the
third sector and those living with MLTC to design a health and care system from the
perspective of patients and carers, and provide practitioners with the skills and tools
needed to provide the highest quality care.
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Affiliation(s)
- Natalie Owen
- Science, Research & Evidence Directorate, Department of Health and Social Care, London, UK
| | - Leanne Dew
- Science, Research & Evidence Directorate, Department of Health and Social Care, London, UK
| | - Stuart Logan
- NIHR PenARC, University of Exeter Medical School, Exeter, UK
| | | | - Lucy C Chappell
- Science, Research & Evidence Directorate, Department of Health and Social Care, London, UK
- School of Life Course Sciences, King’s College London, London, UK
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