1
|
Fairweather D, Bruno KA, Darakjian AA, Bruce BK, Gehin JM, Kotha A, Jain A, Peng Z, Hodge DO, Rozen TD, Munipalli B, Rivera FA, Malavet PA, Knight DRT. High overlap in patients diagnosed with hypermobile Ehlers-Danlos syndrome or hypermobile spectrum disorders with fibromyalgia and 40 self-reported symptoms and comorbidities. Front Med (Lausanne) 2023; 10:1096180. [PMID: 37181352 PMCID: PMC10166812 DOI: 10.3389/fmed.2023.1096180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Background Joint pain is a common symptom in patients with hypermobile Ehlers-Danlos Syndrome (hEDS), hypermobility spectrum disorders (HSD) and fibromyalgia. The goal of this study was to determine whether symptoms and comorbidities overlap in patients diagnosed with hEDS/HSD and/or fibromyalgia. Methods We retrospectively examined self-reported data from an EDS Clinic intake questionnaire in patients diagnosed with hEDS/HSD, fibromyalgia, or both vs. controls with an emphasis on joint issues. Results From 733 patients seen at the EDS Clinic, 56.5% (n = 414) were diagnosed with hEDS/HSD and fibromyalgia (Fibro), 23.8% (n = 167) hEDS/HSD, 13.3% (n = 98) fibromyalgia, or 7.4% (n = 54) none of these diagnoses. More patients were diagnosed with HSD (76.6%) than hEDS (23.4%). Patients were primarily White (95%) and female (90%) with a median age in their 30s (controls 36.7 [18.0, 70.0], fibromyalgia 39.7 [18.0, 75.0], hEDS/HSD 35.0 [18.0, 71.0], hEDS/HSD&Fibro 31.0 [18.0, 63.0]). There was high overlap in all 40 symptoms/comorbidities that we examined in patients diagnosed with fibromyalgia only or hEDS/HSD&Fibro, regardless of whether they had hEDS or HSD. Patients that only had hEDS/HSD without fibromyalgia had far fewer symptoms/comorbidities than patients with hEDS/HSD&Fibro. The top self-reported issues in patients that only had fibromyalgia were joint pain, hand pain when writing or typing, brain fog, joint pain keeping from daily activities, allergy/atopy and headache. Five issues that significantly and uniquely characterized patients diagnosed with hEDS/HSD&Fibro were subluxations (dislocations in hEDS patients), joint issues like sprains, the need to stop sports due to injuries, poor wound healing, and migraine. Conclusion The majority of patients seen at the EDS Clinic had a diagnosis of hEDS/HSD plus fibromyalgia that was associated with more severe disease. Our findings indicate that fibromyalgia should be routinely assessed in patients with hEDS/HSD and vis-a-versa to improve patient care.
Collapse
Affiliation(s)
- DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States
| | - Ashley A. Darakjian
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Barbara K. Bruce
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States
| | - Jessica M. Gehin
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Archana Kotha
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Angita Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Zhongwei Peng
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States
| | - David O. Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States
| | - Todd D. Rozen
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Bala Munipalli
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Fernando A. Rivera
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Pedro A. Malavet
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Dacre R. T. Knight
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| |
Collapse
|
2
|
Best KM, Mojena MM, Barr GA, Schmidt HD, Cohen AS. Endogenous Opioid Dynorphin Is a Potential Link between Traumatic Brain Injury, Chronic Pain, and Substance Use Disorder. J Neurotrauma 2022; 39:1-19. [PMID: 34751584 PMCID: PMC8978570 DOI: 10.1089/neu.2021.0063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Traumatic brain injury (TBI) is a serious public health problem associated with numerous physical and neuropsychiatric comorbidities. Chronic pain is prevalent and interferes with post-injury functioning and quality of life, whereas substance use disorder (SUD) is the third most common neuropsychiatric diagnosis after TBI. Neither of these conditions has a clear mechanistic explanation based on the known pathophysiology of TBI. Dynorphin is an endogenous opioid neuropeptide that is significantly dysregulated after TBI. Both dynorphin and its primary receptor, the ĸ-opioid receptor (KOR), are implicated in the neuropathology of chronic pain and SUD. Here, we review the known roles of dynorphin and KORs in chronic pain and SUDs. We synthesize this information with our current understanding of TBI and highlight potential mechanistic parallels between and across conditions that suggest a role for dynorphin in long-term sequelae after TBI. In pain studies, dynorphin/KOR activation has either antinociceptive or pro-nociceptive effects, and there are similarities between the signaling pathways influenced by dynorphin and those underlying development of chronic pain. Moreover, the dynorphin/KOR system is considered a key regulator of the negative affective state that characterizes drug withdrawal and protracted abstinence in SUD, and molecular and neurochemical changes observed during the development of SUD are mirrored by the pathophysiology of TBI. We conclude by proposing hypotheses and directions for future research aimed at elucidating the potential role of dynorphin/KOR in chronic pain and/or SUD after TBI.
Collapse
Affiliation(s)
- Kaitlin M. Best
- Department of Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marissa M. Mojena
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gordon A. Barr
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Heath D. Schmidt
- Department of Biobehavioral Health Sciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Akiva S. Cohen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Address correspondence to: Akiva S. Cohen, PhD, Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, 3615 Civic Center Boulevard, Room 816-I, Philadelphia, PA 19104, USA
| |
Collapse
|
3
|
Brazenor GA, Malham GM, Teddy PJ. Can Central Sensitization after injury persist as an autonomous pain generator? - A comprehensive search for evidence. PAIN MEDICINE 2021; 23:1283-1298. [PMID: 34718773 DOI: 10.1093/pm/pnab319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/11/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To conduct a comprehensive search for evidence whether Central Sensitization following an injury can act as a persistent autonomous pain generator after the inducing injury has healed. METHODS We searched Medline on PubMed and the Cochrane Library, screening 3,572 abstracts, from which 937 full text articles were obtained, with 186 of these discarded as irrelevant to the question being posed. The remaining 751 articles were studied for evidence. RESULTS Fourteen publications were judged to provide weak evidence for the hypothesis of central sensitization as a persisting autonomous pain generator, but none addressed the question directly. No strong evidence for the affirmative answer was found.Sixty-two publications were judged to provide weak evidence for a negative answer, and nine judged to provide strong evidence.Unexpectedly, serious weaknesses were discovered in the literature underpinning the validity of the clinical diagnosis of Central Sensitization in man:(i) Inappropriate extrapolation, in many publications, of laboratory animal data to humans.(ii) Failure to demonstrate the absence of peripheral pain generators which might be perpetuating Central Sensitization.(iii) Many factors now shown to confound what is being measured by quantitative sensory testing, conditioned pain modulation, and Central Sensitization Inventory. CONCLUSIONS We found no evidence proving that central sensitization can persist as an autonomous pain generator after the initiating injury has healed.Our review has also shown that the evidential basis for the diagnosis of CS in individual patients is seriously in question.
Collapse
Affiliation(s)
| | | | - Peter J Teddy
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| |
Collapse
|
4
|
Teplova AE, Bakker HAHM, Perry SIB, van Etten-Jamaludin FS, Plat MCJ, Bekkers MBM. The Impact of Deployment and Combat Exposure on Physical Health Among Military Personnel: A Systematic Review of Incidence, Prevalence, and Risks. Mil Med 2021; 187:e1074-e1085. [PMID: 34296281 DOI: 10.1093/milmed/usab302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The impact of deployment and combat on mental health of military personnel is well described. Less evidence is available to demonstrate and summarize the incidence, prevalence, and risks of these exposures on physical health. This study aims to (1) systematically review the available literature to determine the incidence and prevalence of physical health conditions among military personnel during and after deployment and (2) investigate the risks of deployment and combat exposure on physical health. METHODS A systematic review using the PubMed and EMBASE databases was performed. The literature search was limited to articles written in English, published from 2000 through 2019. The quality of studies was assessed with the Joanna Briggs Institute Appraisal Checklist. The results were grouped per system or condition of physical health and presented by forest plots without a combined effect size estimate. RESULTS Thirty-two studies were found eligible for this review. We identified a wide variety of incidence and prevalence rates of numerous physical health conditions and a high heterogeneity across the included studies. Acute respiratory symptoms, diarrhea, musculoskeletal injuries, pain, and tinnitus were found to be the most incident or prevalent conditions. Except for hearing loss, no associations with deployment and physical health problems were observed. An increased risk for asthma, headache, hearing loss, and pain was reported in relation to the combat exposure. CONCLUSION Given the characteristics of included studies and extracted data, the magnitude of the found differences in incidence and prevalence rates is most likely to be due to methodological heterogeneity. The specific exposures (e.g., infrastructure, environmental conditions, and activities during deployment) are suggested to be the determinants of (post) deployment physical health problems and need to be addressed to decrease the impact of deployment. Findings from this systematic review highlight which conditions should be addressed in response to service members' health and wellness needs in the (post)deployment phase and may be used by clinicians, researchers, and policy-makers. However, knowledge gaps regarding the potential risk factors during deployment and combat still exist. Studies using consistent methods to define and measure the physical health conditions and specific exposures are needed.
Collapse
Affiliation(s)
- Alina E Teplova
- Department of Physical, Medicine and Rehabilitation, Basalt Rehabilitation, Medical Centre Haaglanden: Medisch Centrum Haaglanden, The Hague 2512 VA, The Netherlands
| | | | - Sander I B Perry
- Department of Data Science and Epidemiology, University of Amsterdam, University Medical Center Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Faridi S van Etten-Jamaludin
- Research Support, Medical Library AMC, University of Amsterdam, University Medical Center Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Marie-Christine J Plat
- Expertcentre Force Health Protection, Military Healthcare Organisation, Ministry of Defence, Doorn 3941 PW, The Netherlands
| | - Margaretha B M Bekkers
- Expertcentre Force Health Protection, Military Healthcare Organisation, Ministry of Defence, Doorn 3941 PW, The Netherlands
| |
Collapse
|
5
|
López-López A, Matías-Pompa B, Fernández-Carnero J, Gil-Martínez A, Alonso-Fernández M, Alonso Pérez JL, González Gutierrez JL. Blunted Pain Modulation Response to Induced Stress in Women with Fibromyalgia with and without Posttraumatic Stress Disorder Comorbidity: New Evidence of Hypo-Reactivity to Stress in Fibromyalgia? Behav Med 2021; 47:311-323. [PMID: 32356678 DOI: 10.1080/08964289.2020.1758611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is evidence regarding the presence of alterations in both the stress response and the endogenous pain modulation systems of people with fibromyalgia (FM). However, research on pain modulation under induced stress on FM patients is scarce and contradictory. The present study analyzes stress-induced changes in pain and intolerance thresholds among FM patients, examining the possible existence of differences linked to PTSD comorbidity and gaining insights into the role of cardiovascular reactivity. Eighteen women diagnosed with FM and comorbid PTSD (FM + PTSD), 18 women diagnosed with FM and no PTSD (FM-PTSD), and 38 healthy women (HC) were exposed to the Social Stress Test task. Pressure pain thresholds and intolerance thresholds were measured before and during stress induction, and after a recovery period, while systolic blood pressure and heart rate were simultaneously recorded. Overall, while pain thresholds decreased during stress and recovery for HC, no significant changes were observed for women with FM. The intolerance threshold decreased for HC during stress, but was maintained at basal level during recovery. FM-PTSD women exhibited a delayed response, with a drop at recovery. For FM + PTSD, tolerance levels remained unchanged. In addition, cardiovascular reactivity did not seem to explain these results. This performance of the pain modulation system seems to follow the same pattern of hypoactive responsiveness under stressors that has previously been observed in FM patients on the autonomic and neuroendocrine axes. Such a hypoactive pattern may involve a non-adaptive response that may contribute to the development and maintenance of chronic pain.
Collapse
Affiliation(s)
- A López-López
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
| | - B Matías-Pompa
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
| | - J Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, King Juan Carlos University, Madrid, Spain
| | - A Gil-Martínez
- Department of Physical Therapy, Center of Higher Education Studies La Salle, Autonomous University of Madrid, Madrid, Spain
| | - M Alonso-Fernández
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
| | - J L Alonso Pérez
- Department of Physical Therapy, European University of Madrid, Madrid, Spain
| | - J L González Gutierrez
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, King Juan Carlos University, Madrid, Spain
| |
Collapse
|
6
|
Benedict TM, Keenan PG, Nitz AJ, Moeller-Bertram T. Post-Traumatic Stress Disorder Symptoms Contribute to Worse Pain and Health Outcomes in Veterans With PTSD Compared to Those Without: A Systematic Review With Meta-Analysis. Mil Med 2021; 185:e1481-e1491. [PMID: 32248229 DOI: 10.1093/milmed/usaa052] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) and chronic pain are frequently co-morbid conditions in the U.S. veteran population. Although several theories about the cause of increased pain prevalence in individuals with PTSD have been presented, no synthesis of primary data informing the impact of co-morbid PTSD and pain has been completed. The purpose of this study was to systematically review the literature and quantify disability, function, and pain-related beliefs and outcomes in veterans with PTSD compared to veterans without PTSD. MATERIALS AND METHODS A systematic search of three electronic databases was conducted. Inclusion criteria required pain-related comparison of veterans with PTSD to those without PTSD. Primary outcome measures and standardized mean differences (SMDs) were assessed for pain, function, disability, pain beliefs, and healthcare utilization using a random effects model. RESULTS 20 original research studies met inclusion criteria and were assessed for quality and outcomes of interest. The majority of studies were cross-sectional. Veterans with PTSD and pain demonstrated higher pain (SMD = 0.58, 95% CI 0.28-0.89), disability (SMD = 0.52, 95%CI 0.33-0.71), depression (SMD = 1.40, 95%CI 1.2-1.6), catastrophizing beliefs (SMD = 0.95, 95% CI 0.69-1.2), sleep disturbance (SMD = 0.80, 95% CI 0.57-1.02), and healthcare utilization; they had lower function (SMD = 0.41, 95% CI 0.25-0.56) and pain self-efficacy (SMD = 0.77, 95% CI 0.55-0.99) compared to veterans without PTSD. CONCLUSION In veterans with chronic pain, PTSD symptomology has a large effect for many negative health-related outcomes. This review supports the need for clinicians to screen and understand the effects of PTSD symptoms on patients with pain. Clinicians should recognize that veterans with PTSD and pain likely have elevated pain catastrophizing beliefs and decreased self-efficacy that should be targeted for intervention.
Collapse
Affiliation(s)
- Timothy M Benedict
- Department of Rehabilitation Sciences, University of Kentucky, 900 S. Limestone Ave Lexington, Lexington, KY 40536-0200
| | - Patrick G Keenan
- Office of the Chief, Specialist Corps, 3630 Stanley Road, Fort Sam Houston, San Antonio, TX 78234
| | - Arthur J Nitz
- Department of Rehabilitation Sciences, University of Kentucky, 900 S. Limestone Ave Lexington, Lexington, KY 40536-0200
| | - Tobias Moeller-Bertram
- Department of Medicine at UC Riverside, Desert Clinic Pain Institute, 36101 Bob Hope Drive, Rancho Mirage, CA 92270
| |
Collapse
|
7
|
Aytur SA, Ray KL, Meier SK, Campbell J, Gendron B, Waller N, Robin DA. Neural Mechanisms of Acceptance and Commitment Therapy for Chronic Pain: A Network-Based fMRI Approach. Front Hum Neurosci 2021; 15:587018. [PMID: 33613207 PMCID: PMC7892587 DOI: 10.3389/fnhum.2021.587018] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/12/2021] [Indexed: 01/29/2023] Open
Abstract
Over 100 million Americans suffer from chronic pain (CP), which causes more disability than any other medical condition in the United States at a cost of $560-$635 billion per year (Institute of Medicine, 2011). Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy (CBT) can be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy (ACT) has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions (Gutierrez et al., 2004). However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women (n = 9) with chronic musculoskeletal pain. Functional magnetic resonance imaging (fMRI) data were collected pre- and post-ACT, and changes in functional connectivity (FC) were measured using Network-Based Statistics (NBS). Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire (AAQ-II), the Chronic Pain Acceptance Questionnaire (CPAQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the NIH Toolbox Neuro-QoLTM (Quality of Life in Neurological Disorders) scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection (default mode, DMN), emotion (salience, SN), and cognitive control (frontal parietal, FPN). These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies.
Collapse
Affiliation(s)
- Semra A. Aytur
- Department of Health Management and Policy, University of New Hampshire, Durham, NH, United States
| | - Kimberly L. Ray
- Department of Psychology, University of Texas at Austin, Austin, TX, United States
| | - Sarah K. Meier
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Jenna Campbell
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Barry Gendron
- Wentworth Health Partners Seacoast Physiatry, Somersworth, NH, United States
| | - Noah Waller
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Donald A. Robin
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| |
Collapse
|
8
|
Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, Fitzcharles MA, Paiva ES, Staud R, Sarzi-Puttini P, Buskila D, Macfarlane GJ. AAPT Diagnostic Criteria for Fibromyalgia. THE JOURNAL OF PAIN 2019; 20:611-628. [DOI: 10.1016/j.jpain.2018.10.008] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023]
|
9
|
Hassett AL, Fisher JA, Vie LL, Kelley WL, Clauw DJ, Seligman MEP. Association Between Predeployment Optimism and Onset of Postdeployment Pain in US Army Soldiers. JAMA Netw Open 2019; 2:e188076. [PMID: 30735237 PMCID: PMC6484606 DOI: 10.1001/jamanetworkopen.2018.8076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Pain after deployment is a major health care concern. While risk factors have been previously studied, few studies have explored protective factors. OBJECTIVE To examine the prospective association between predeployment optimism and the onset of new pain after deployment in US Army soldiers. DESIGN, SETTING, AND PARTICIPANTS This prospective longitudinal cohort study examined US Army soldiers (active duty, Reserve, and National Guard) who deployed to Afghanistan or Iraq between February 12, 2010, and August 29, 2014, and completed the necessary psychological and health assessments before and after deployment. Analyses were performed in the Person-Event Data Environment between July 2016 and November 2018. This study relied exclusively on existing, secondary Army data. Of the 413 763 Army soldiers who met the specified deployment criteria, 385 925 soldiers were missing 1 or more of the required assessment forms. Of the remaining 27 838 soldiers who were examined for eligibility, 7104 soldiers were excluded because of preexisting back pain, joint pain, or frequent headaches. These exclusions resulted in a final analytic sample of 20 734 eligible soldiers. MAIN OUTCOMES AND MEASURES This study examined new reports of pain after deployment, including new back pain, joint pain, and frequent headaches. RESULTS Among 20 734 US Army soldiers (87.8% male; mean [SD] age, 29.06 [8.42] years), 37.3% reported pain in at least 1 new area of the body after deployment: 25.3% reported new back pain, 23.1% reported new joint pain, and 12.1% reported new frequent headaches. As a continuous measure, each 1-U increase in optimism was associated with 11% lower odds of reporting any new pain after deployment, even while adjusting for demographic, military, and combat factors (odds ratio, 0.89; 95% CI, 0.86-0.93). Tertile analyses revealed that compared with soldiers with high optimism (lowest odds of new pain) soldiers with low optimism had 35% greater odds of reporting new pain in any of the 3 sites evaluated (odds ratio, 1.35; 95% CI, 1.21-1.50). In addition, a larger increase in risk of new pain was observed when comparing the moderate-optimism and low-optimism groups rather than the high-optimism and moderate-optimism groups. CONCLUSIONS AND RELEVANCE Higher levels of optimism were associated with lower odds of reporting new pain after deployment, over and above other common determinants of pain, including demographic and military characteristics and combat experiences. Soldiers with low levels of optimism before deployment could benefit from programs geared toward enhancing optimism.
Collapse
Affiliation(s)
- Afton L. Hassett
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor
| | - Joseph A. Fisher
- Positive Psychology Center, University of Pennsylvania, Philadelphia
- Research Facilitation Laboratory/Army Analytics Group, Monterey, California
| | - Loryana L. Vie
- Positive Psychology Center, University of Pennsylvania, Philadelphia
- Research Facilitation Laboratory/Army Analytics Group, Monterey, California
| | - Whitney L. Kelley
- Positive Psychology Center, University of Pennsylvania, Philadelphia
- Research Facilitation Laboratory/Army Analytics Group, Monterey, California
| | - Daniel J. Clauw
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor
| | | |
Collapse
|
10
|
Yavne Y, Amital D, Watad A, Tiosano S, Amital H. A systematic review of precipitating physical and psychological traumatic events in the development of fibromyalgia. Semin Arthritis Rheum 2018; 48:121-133. [DOI: 10.1016/j.semarthrit.2017.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/11/2017] [Accepted: 12/09/2017] [Indexed: 01/09/2023]
|
11
|
Affiliation(s)
- Steven E. Harte
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Richard E. Harris
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Daniel J. Clauw
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| |
Collapse
|
12
|
Magtanong GG, Spence AR, Czuzoj-Shulman N, Abenhaim HA. Maternal and neonatal outcomes among pregnant women with fibromyalgia: a population-based study of 12 million births. J Matern Fetal Neonatal Med 2017; 32:404-410. [PMID: 28954564 DOI: 10.1080/14767058.2017.1381684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE Fibromyalgia (FM) is a rheumatologic disorder marked by chronic, widespread pain and associated comorbid conditions. The purpose of our study was to evaluate the effect of FM on maternal and neonatal outcomes. METHODS Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1999 to 2013, we conducted a population-based retrospective cohort study consisting of women who delivered during that period. Logistic regression was used to compare maternal and neonatal outcomes among pregnancies in women with and without FM. RESULTS Of 12 584 918 births during the 15-year study period, 7758 (0.06%) were to women with FM with rates increasing over the study period. Women with FM were more commonly older in age, overweight or obese, and users of alcohol, tobacco, and illicit drugs. They were more likely to experience anxiety, depression, and bipolar disorder. Women with FM were at greater risk of gestational diabetes, preterm premature rupture of membranes, and placental abruption. Women with FM more commonly had cesarean deliveries (odds ratios (OR): 1.11, 95% CI: 1.05-1.16) and births complicated by venous thromboembolism (OR: 2.34, 95% CI: 1.91-2.86). Infants of women with FM were more likely to be premature (OR: 1.35, 95% CI: 1.25-1.46) and have intrauterine growth restriction (OR: 1.48, 95% CI: 1.30-1.68). CONCLUSIONS The prevalence of FM in pregnancy is rising in the US. FM is a high-risk pregnancy condition associated with adverse maternal and newborn outcomes.
Collapse
Affiliation(s)
- Glenda Gatan Magtanong
- a Department of Obstetrics and Gynecology , Jewish General Hospital, McGill University , Montreal , QC , Canada
| | - Andrea R Spence
- b Centre for Clinical Epidemiology and Community Studies , Jewish General Hospital , Montreal , QC , Canada
| | - Nicholas Czuzoj-Shulman
- b Centre for Clinical Epidemiology and Community Studies , Jewish General Hospital , Montreal , QC , Canada
| | - Haim Arie Abenhaim
- a Department of Obstetrics and Gynecology , Jewish General Hospital, McGill University , Montreal , QC , Canada.,b Centre for Clinical Epidemiology and Community Studies , Jewish General Hospital , Montreal , QC , Canada
| |
Collapse
|
13
|
Ramos JA. The Great Deceiver: A Case of Central Sensitization Presenting as Carcinoid Syndrome. A & A CASE REPORTS 2016; 6:364-365. [PMID: 27144900 DOI: 10.1213/xaa.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Central sensitization defines a state of amplified sensory input within the nervous system across many organ systems; it overlaps syndromes as fibromyalgia, chronic fatigue, irritable bowel, and interstitial cystitis. Commonly, individuals will experience multiple syndromes during the course of their lifetime. A 62-year-old patient presented for evaluation of multiple medically unexplained symptoms postsurgically including chronic left chest wall and flank pain with concomitant diarrhea, abdominal pain, and facial flushing. After extensive multidisciplinary evaluations, he was diagnosed as having central sensitization in which the initial presentation mimicked carcinoid syndrome. He was subsequently treated with extensive multidisciplinary pain rehabilitation, and it did well.
Collapse
Affiliation(s)
- Juan A Ramos
- From the Department of Anesthesiology, Division of Pain Medicine, University of Florida Health, Gainesville, Florida
| |
Collapse
|
14
|
Cook AJ, Meyer EC, Evans LD, Vowles KE, Klocek JW, Kimbrel NA, Gulliver SB, Morissette SB. Chronic pain acceptance incrementally predicts disability in polytrauma-exposed veterans at baseline and 1-year follow-up. Behav Res Ther 2015; 73:25-32. [PMID: 26233854 PMCID: PMC5032639 DOI: 10.1016/j.brat.2015.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 06/12/2015] [Accepted: 07/13/2015] [Indexed: 11/28/2022]
Abstract
War veterans are at increased risk for chronic pain and co-occurring neurobehavioral problems, including posttraumatic stress disorder (PTSD), depression, alcohol-related problems, and mild traumatic brain injury (mTBI). Each condition is associated with disability, particularly when co-occurring. Pain acceptance is a strong predictor of lower levels of disability in chronic pain. This study examined whether acceptance of pain predicted current and future disability beyond the effects of these co-occurring conditions in war veterans. Eighty trauma-exposed veterans with chronic pain completed a PTSD diagnostic interview, clinician-administered mTBI screening, and self-report measures of disability, pain acceptance, depression, and alcohol use. Hierarchical regression models showed pain acceptance to be incrementally associated with disability after accounting for symptoms of PTSD, depression, alcohol-related problems, and mTBI (total adjusted R(2) = .57, p < .001, ΔR(2) = .03, p = .02). At 1-year follow-up, the total variance in disability accounted for by the model decreased (total adjusted R(2) = .29, p < .001), whereas the unique contribution of pain acceptance increased (ΔR(2) = .07, p = .008). Pain acceptance remained significantly associated with 1-year disability when pain severity was included in the model. Future research should evaluate treatments that address chronic pain acceptance and co-occurring conditions to promote functional recovery in the context of polytrauma in war veterans.
Collapse
Affiliation(s)
- Andrew J Cook
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA; Texas A&M Health Science Center, College of Medicine, Temple, TX, USA
| | - Eric C Meyer
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA; Texas A&M Health Science Center, College of Medicine, Temple, TX, USA.
| | - Lianna D Evans
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA
| | - Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - John W Klocek
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Nathan A Kimbrel
- Durham VA Medical Center, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Suzy Bird Gulliver
- Texas A&M Health Science Center, College of Medicine, Temple, TX, USA; Warriors Research Institute, Baylor Scott & White Healthcare System, Waco, TX, USA
| | - Sandra B Morissette
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA; Central Texas Veterans Health Care System, Temple, TX, USA; Texas A&M Health Science Center, College of Medicine, Temple, TX, USA
| |
Collapse
|
15
|
Abstract
Fibromyalgia is the currently preferred term for widespread musculoskeletal pain, typically accompanied by other symptoms such as fatigue, memory problems, and sleep and mood disturbances, for which no alternative cause can be identified. Earlier there was some doubt about whether there was an "organic basis" for these related conditions, but today there is irrefutable evidence from brain imaging and other techniques that this condition has strong biological underpinnings, even though psychological, social, and behavioral factors clearly play prominent roles in some patients. The pathophysiological hallmark is a sensitized or hyperactive central nervous system that leads to an increased volume control or gain on pain and sensory processing. This condition can occur in isolation, but more often it co-occurs with other conditions now being shown to have a similar underlying pathophysiology (eg, irritable bowel syndrome, interstitial cystitis, and tension headache) or as a comorbidity in individuals with diseases characterized by ongoing peripheral damage or inflammation (eg, autoimmune disorders and osteoarthritis). In the latter instance, the term centralized pain connotes the fact that in addition to the pain that might be caused by peripheral factors, there is superimposed pain augmentation occurring in the central nervous system. It is important to recognize this phenomenon (regardless of what term is used to describe it) because individuals with centralized pain do not respond nearly as well to treatments that work well for peripheral pain (surgery and opioids) and preferentially respond to centrally acting analgesics and nonpharmacological therapies.
Collapse
|
16
|
Bigler ED. Effort, symptom validity testing, performance validity testing and traumatic brain injury. Brain Inj 2014; 28:1623-38. [PMID: 25215453 PMCID: PMC4673569 DOI: 10.3109/02699052.2014.947627] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 05/09/2014] [Accepted: 07/20/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND To understand the neurocognitive effects of brain injury, valid neuropsychological test findings are paramount. REVIEW This review examines the research on what has been referred to a symptom validity testing (SVT). Above a designated cut-score signifies a 'passing' SVT performance which is likely the best indicator of valid neuropsychological test findings. Likewise, substantially below cut-point performance that nears chance or is at chance signifies invalid test performance. Significantly below chance is the sine qua non neuropsychological indicator for malingering. However, the interpretative problems with SVT performance below the cut-point yet far above chance are substantial, as pointed out in this review. This intermediate, border-zone performance on SVT measures is where substantial interpretative challenges exist. Case studies are used to highlight the many areas where additional research is needed. Historical perspectives are reviewed along with the neurobiology of effort. Reasons why performance validity testing (PVT) may be better than the SVT term are reviewed. CONCLUSIONS Advances in neuroimaging techniques may be key in better understanding the meaning of border zone SVT failure. The review demonstrates the problems with rigidity in interpretation with established cut-scores. A better understanding of how certain types of neurological, neuropsychiatric and/or even test conditions may affect SVT performance is needed.
Collapse
Affiliation(s)
- Erin D. Bigler
- Department of Psychology
- Neuroscience Center
- Magnetic Resonance Imaging Research Facility, Brigham Young University
Provo, UTUSA
- Department of Psychiatry
- The Brain Institute of Utah, University of Utah
Salt Lake City, UTUSA
| |
Collapse
|
17
|
Hansson P. Translational aspects of central sensitization induced by primary afferent activity: what it is and what it is not. Pain 2014; 155:1932-1934. [PMID: 25067835 DOI: 10.1016/j.pain.2014.07.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Per Hansson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| |
Collapse
|