Pain-Related Cognitive Processes, Pain Interference, and Alexithymia in Patients With Primary Headaches

Objectives This study aims to investigate the effects of pain-related cognitive processes (PRCPs) and emotional state on pain-related disability (PRD) and pain interference (difficulty in performing daily routines, difficulty in engaging in social activities [the enjoyment of life], and the impact on work and/or school performance) in patients with primary headaches (PHs). Methodology PRCPs were evaluated with the Pain Anxiety Symptom Scale-20 (PASS-20), Pain Catastrophizing Scale (PCS), and Pain Belief Questionnaire (PBQ). Anxiety, depression, and alexithymia were investigated to assess the emotional state. PRD was assessed by Headache Impact Test-6 (HIT-6). Health-related quality of life (HRQoL) was evaluated under three headings: daily activities (with Short Form-36 [SF-36] Question [Q] 22), social activities (with Graded Chronic Pain Scale-Revised [GCPS-R] Q 4), as well as the working ability (with GCPS-R Q 5). Two separate models were constructed to identify the factors influencing PRD and HRQoL in PHP: M1 to reveal the factors affecting PRD and M2 to determine the independent factors affecting pain interference. In both models, correlation analysis was applied first and the significant data were then evaluated with regression analysis. Results A total of 364 participants (74 healthy controls [HCs] and 290 PHPs) completed the study. In M1, the following domains were significantly associated with PRD: cognitive anxiety (β = 0.098; 95% confidence interval [CI] = 0.001-0.405; P = 0.049); helplessness (β = 0.107; 95% CI = 0.018-0.356; P = 0.031); alexithymia (β = 0.077; 95% CI = 0.005-0.116; P = 0.033); depression (β = 0.083; 95% CI = 0.014-0.011; P = 0.025). In M2, factors associated with impairment in daily activities for PHP were as follows: duration of pain, pain intensity, alexithymia, escape-avoidance response, psychological anxiety, anxiety, and poor sleep quality (R = 0.770; R² = 0.588). The independent factors affecting social activities for PHP were pain intensity and pain-related anxiety (R = 0.90; R² = 0.81). Independent risk factors that affected the ability to work for PHP were pain intensity, cognitive anxiety, escape-avoidance response, and pain anxiety (R = 0.90; R² = 0.81). Conclusions This study highlights the importance of cognitive and emotional processes that help increase our understanding of the patient with PHs. This understanding may help to reduce disability and improve the quality of life in this population by helping to guide multidisciplinary treatment goals.

High-impact chronic pain: evaluation of risk factors and predictors

Background

The concept of high-impact chronic pain (HICP) has been proposed for patients with chronic pain who have significant limitations in work, social life, and personal care. Recognition of HICP and being able to distinguish patients with HICP from other chronic pain patients who do not have life interference allows the necessary measures to be taken in order to restore the physical and emotional functioning of the affected persons. The aim was to reveal the risk factors and predictors associated with HICP.

Methods

Patients with chronic pain without life interference (grade 1 and 2) and patients with HICP were compared. Significant data were evaluated with regression analysis to reveal the associated risk factors. Receiving operating characteristic (ROC) analysis was used to evaluate predictors and present cutoff scores.

Results

One thousand and six patients completed the study. From pain related cognitive processes, fear of pain (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.87-0.98; P = 0.007) and helplessness (OR, 1.06; 95% CI, 1.01-1.12; P = 0.018) were found to be risk factors associated with HICP. Predictors of HICP were evaluated by ROC analysis. The highest discrimination value was found for pain intensity (cut-off score > 6.5; 83.8% sensitive; 68.7% specific; area under the curve = 0.823; P < 0.001).

Conclusions

This is the first study in our geography to evaluate HICP with measurement tools that evaluate all dimensions of pain. Moreover, it is the first study in the literature to evaluate predictors and cut-off scores using ROC analysis for HICP.

Validation, reliability, and cross-cultural adaptation study of Graded Chronic Pain Scale Revised into Turkish in patients with primary low back pain

OBJECTIVE

This study aims to assess the adaptation of the Graded Chronic Pain Scale-Revised to the Turkish language and psychometric properties in patients with primary low back pain.

METHODS

The translation from the original text into the Turkish language was carried out step by step in accordance with the recommendations. Structural validity was analyzed by exploratory factor analysis (EFA). Reliability was carried out by internal consistency and test-retest analysis. Convergent validity was evaluated through scales composed in accordance with the research standards for chronic low back pain with the National Institutes of Health Task Force recommendations.

RESULTS

One hundred thirty-five patients, 58 (43%) men and 77 (57%) women, completed the study. A two-factor structure was obtained according to EFA. The first factor consisted of questions 3, 4, and 5, and the same questions constitute the Pain, Enjoyment of Life, and General Activity scale. Cronbach α coefficient r = 0.814 (good internal consistency) was calculated for internal consistency.

CONCLUSION

In this article, we presented the cross-cultural adaptation process of Graded Chronic Pain Scale-Revised to the Turkish language and evidence of its validity and reliability in a sample of patients with primary low back pain.

Prevalence of Dementia and Mild Cognitive Impairment in a Rural Area of Sivas, Turkey

Introduction The exact prevalence of dementia in Turkey is unknown. The purpose of this study was to determine the frequency of dementia in members of the population aged 60 years and older, as well as the influence of detailed sociodemographic factors on the prevalence rate in Sivas City Center, a large city in the middle of Anatolia, Turkey. Methods This was a cross-sectional, simple random sampling, door-to-door, population-based study. A total of 500 individuals aged 60 and older from the city center region of Sivas, Turkey, were involved. A sociodemographic data form, the Standardized Mini-Mental Test, the clock drawing test, the Cornell Scale for Depression in Dementia, and the Daily Life Activities and Instrumental Daily Life Activities tests were used in the screening phase. Results A total of 500 individuals ranging in age from 60 to 95 years were assessed. A total of 84 participants were diagnosed with dementia. The dementia prevalence was found to be 16.8% in Sivas city province. Dementia was associated with age (p<0.001), female sex (p<0.001), marital status (p<0.001), family income (p<0.001), and the absence of formal education (p<0.001). Conclusions This study is the first community-based study of cognitive impairment in Turkey, with a study design, procedures, and diagnostic criteria designed to determining the rate of dementia. Old age, a higher score on the Cornell Scale for Depression in Dementia, and a low educational level were independent risk factors for dementia. Further studies are required to confirm these results.

Serum 25-hydroxyvitamin D levels in restless legs syndrome patients

OBJECTIVE

Restless legs syndrome is characterised by discomfort during rest and an urge to move the limbs that is accompanied by abnormal sensations. Studies on disease pathophysiology have focused on dopaminergic dysfunction. Vitamin D may play an important role in dopamine function, but the role of vitamin D in restless legs syndrome has not been examined. We compared the serum vitamin D levels of RLS patients and matched controls and explored the correlation of plasma vitamin D levels with disease severity.

PATIENTS/METHODS

We measured serum 25-hydroxyvitamin D levels in 36 patients with restless legs syndrome and compared them to 38 healthy control subjects.

RESULTS

The mean serum 25-hydroxyvitamin D levels were 7.31±4.63 ng/mL in female patients with restless legs syndrome and 12.31±5.27 ng/mL in female control subjects (p=0.001). We found a significant inverse correlation between vitamin D levels and disease severity in females (p=0.01, r=-0.47).

CONCLUSION

The mean serum vitamin D levels were lower in female patients with restless legs syndrome. Low vitamin D levels may cause dopaminergic dysfunction in restless legs syndrome patients. Further studies are required to confirm these results.