Central Sensitization in Neurological, Psychiatric, and Pain Disorders: A Multicenter Case-Controlled Study

Background. The role of central sensitization in refractory pain-related diseases has not yet been clarified. Methods. We performed a multicenter case-controlled study including 551 patients with various neurological, psychological, and pain disorders and 5,188 healthy controls to investigate the impact of central sensitization in these patients. Symptoms related to central sensitization syndrome (CSS) were assessed by the Central Sensitization Inventory (CSI) parts A and B. Patients were categorized into 5 groups based on CSI-A scores from subclinical to extreme. The Brief Pain Inventory (BPI), addressing pain severity and pain interference with daily activities, and the Patient Health Questionnaire (PHQ)-9, assessing depressive symptoms, were also administered. Results. CSI-A scores and CSI-B disease numbers were significantly greater in patients than in controls ( p < 0.001 ). Medium effect sizes (r = 0.37) for CSI-A scores and large effect sizes (r = 0.64) for CSI-B disease numbers were found between patients and control groups. Compared with the CSI-A subclinical group, the CSI-A mild, moderate, severe, and extreme groups had significantly higher BPI pain interference and severity scores, PHQ-9 scores, and CSS-related disease numbers based on ANCOVA. Greater CSI-B numbers resulted in higher CSI-A scores ( p < 0.001 ) and a higher odds ratio ( p for trend <0.001). CSS-related symptoms were associated with pain severity, pain interference with daily activities, and depressive symptoms in various pain-related diseases. Conclusions. Our findings suggest that CSS may participate in these conditions as common pathophysiology.

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The Effect of Obesity on Pain Severity and Pain Interference

10.1101/2020.03.02.20027425 ◽

2020 ◽

Author(s):

Jade Basem ◽

Robert S. White ◽

Stephanie A. Chen ◽

Elizabeth Mauer ◽

Michele L. Steinkamp ◽

...

Keyword(s):

Chronic Pain ◽

Pain Severity ◽

Pain Interference ◽

Pain Clinic ◽

Opioid Prescription ◽

The Past ◽

Total Pain ◽

Severity Scores ◽

The Impact ◽

Interference Score

ABSTRACTBackground and objectivesObesity is one of the most prevalent comorbidities associated with chronic pain, the experience of which can severely interfere with activities of daily living and increase the utilization of clinical resources. Obesity is also a risk factor for increased pain severity (pain intensity) and pain interference (pain related disability). We hypothesize that a higher level of obesity, as measured by body mass index (BMI), would be associated with increased levels of pain severity and interference in a population of chronic pain clinic patients.MethodsParticipant data was pulled from a multi-site chronic pain outpatient database from 7/8/2011 to 10/17/2016. The Brief Pain Inventory (BPI), opioid prescriptions, and basic demographic information were queried and we categorized participants into three different ordinal categories based on recorded BMI levels (underweight, normal and overweight, obese). Bivariate analyses were performed to compare pain outcomes by BMI and by other demographic/clinical patient characteristics. Multivariable linear regressions were constructed to model each of four pain severity scores in addition to total pain interference score. All models examined BMI as the primary predictor, controlling for age, receipt of a pain procedure within 45 days prior to the pain clinic encounter, opioid prescription within 45 days prior to the encounter, and diagnosis. The total pain interference model additionally included pain severity (as measured by worst pain in the past 24 hours) as a covariate.Results2509 patients were included in the study. The median BMI was 27 and the median age was 59 years. 77% of patients were diagnosed with musculoskeletal pain conditions. Bivariate tests revealed significant differences between BMI groups for all pain severity scores and for total pain interference score. On multivariable modelling controlling for age, pain procedure within 45 days prior to pain clinic encounter, opioid prescription with 45 days prior, and diagnosis, obese patients had significantly higher pain severity (as measured by worst, least, average, and current pain in the past 24 hours) as well as higher pain interference (as measured by the overall pain interference score) than normal weight and overweight patients.ConclusionIn our study of pain clinic patients, obesity was found to be associated with increased pain severity and pain interference. We believe that this relationship is multifactorial and bidirectional. Pain phyisicans should consider the impact of obesity when addressing pain management for patients.

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The buffering role of positive affect on the association between pain intensity and pain related outcomes

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2016.09.008 ◽

2017 ◽

Vol 14 (1) ◽

pp. 91-97 ◽

Cited By ~ 8

Author(s):

Ivan S.K. Thong ◽

Gabriel Tan ◽

Mark P. Jensen

Keyword(s):

Chronic Pain ◽

Depressive Symptoms ◽

Negative Affect ◽

Positive Affect ◽

Pain Intensity ◽

Sleep Problems ◽

Cross Sectional Study ◽

Pain Interference ◽

Cross Sectional ◽

The Impact

AbstractObjectivesChronic pain is a significant problem worldwide and is associated with significant elevations in negative affect, depressive symptoms, sleep problems, and physical dysfunction. Positive affect could potentially buffer the impact of pain on patient functioning. If it does, then positive affect could be directly targeted in treatment to benefit individuals with chronic pain. The purpose of this study was to test for such moderating effects.MethodsThis was a cross-sectional study, we administered measures of pain intensity, depressive symptoms, sleep problems, pain interference, and positive and negative affect to 100 individuals with chronic back or knee pain in a single face-to-face assessment session.ResultsThe associations between pain intensity and negative affect, and between pain intensity and depressive symptoms were moderated by positive affect. This moderation effect was explained by the fact that participants with low positive affect evidenced strong associations between pain intensity and both depression and negative affect; participants with high positive affect, on the other hand, evidenced weak and non-significant associations between pain intensity and both depression and negative affect. Positive affect did not moderate the associations between pain intensity and either sleep problems or pain interference.ConclusionThe findings are consistent with the possibility that positive affect may buffer the impact of pain intensity on negative affect and depressive symptoms. Longitudinal and experimental research is needed to determine the potential benefits of treatments that increase positive affect on negative affect and depressive symptoms in chronic pain populations.ImplicationsThe study findings suggest the possibility that “positive psychology” interventions which increase positive affect could benefit individuals with chronic pain by reducing the impact of pain on negative outcomes. Research to test this possibility is warranted.

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Bright light, negative air ions and auditory stimuli produce rapid mood changes in a student population: a placebo-controlled study

Psychological Medicine ◽

10.1017/s0033291706008002 ◽

2006 ◽

Vol 36 (9) ◽

pp. 1253-1263 ◽

Cited By ~ 26

Author(s):

NAMNI GOEL ◽

GLENDA R. ETWAROO

Keyword(s):

Depressive Symptoms ◽

Auditory Stimulus ◽

Bright Light ◽

Negative Ions ◽

High Density ◽

Medium Effect ◽

Controlled Study ◽

Auditory Stimuli ◽

Low Density ◽

Mood Changes

Background. Bright light and high-density negative air ion exposure are efficacious for winter and non-seasonal depression compared with a low-density negative ion placebo. Similarly, auditory stimuli improve mood in clinical populations. This study compared the short-term effects of bright light, an auditory stimulus, and high- and low-density negative ions on mood and alertness in mildly depressed and non-depressed adults.Method. One hundred and eighteen subjects, 69 women and 49 men (mean age±S.D., 19·4±1·7 years), participated once across the year. Subjects were randomly assigned to one of four conditions: bright light (10000 lux; n=29), auditory stimuli (60 dB; n=30), or high-density (4·5×1014 ions/s flow rate; n=29) or low-density (1·7×1011 ions/s; n=30; placebo control) negative ions. Exposure was for 30 min on three consecutive evenings between 1900 and 2100 hours. Mood and alertness assessments, using standardized scales, occurred before, and 15 and 30 min during exposure. The Beck Depression Inventory classified subjects as depressed ([ges ]10; n=35) or non-depressed (<10; n=83).Results. The three active stimuli, but not the low-density placebo, reduced depression, total mood disturbance (a global affect measure) and/or anger within 15–30 min. Neither testing season nor degree of depressive symptoms affected response to stimuli.Conclusions. The auditory stimulus, bright light and high-density ions all produced rapid mood changes – with small to medium effect sizes – in depressed and non-depressed subjects, compared with the low-density placebo, despite equivalent pre-study expectations. Thus, these stimuli improve mood acutely in a student sample, including a subset with depressive symptoms.

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A-53 The Relationship between Age and TMT-A Performance in Patients with Heart Failure

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab062.71 ◽

2021 ◽

Vol 36 (6) ◽

pp. 1095-1095

Author(s):

Nicholas S Lackey ◽

Natasha Nemanim ◽

Alexander O Hauson ◽

Eric J Connors ◽

Anna Pollard ◽

...

Keyword(s):

Heart Failure ◽

Effect Size ◽

Significant Proportion ◽

Effect Sizes ◽

Medium Effect ◽

Future Research ◽

Medium Effect Size ◽

Meta Regression ◽

The Impact ◽

The Relationship

Abstract Objective A previous meta-analysis utilized the Trail Making Test A (TMT-A) to measure the impact of heart failure (HF) on attention. A near medium effect size with moderate heterogeneity was observed, the HF group performed worse than healthy controls (HC). This study explores if the age of the HF group moderates differences in the performance of individuals with HF versus HC on TMT-A. Data Selection Two researchers searched eight databases, extracted data, and calculated effect sizes as part of a larger study. Inclusion criteria were: (a) adults with HF (New York Heart Association severity II or higher), (b) comparison to a HC group, (c) standardized neuropsychological/cognitive testing, and (d) adequate data to calculate effect sizes. Exclusion criteria were: (a) participants had other types of major organ failure, (b) the article was not in English, or (c) there was a risk of sample overlap with another included study. A total of six articles were included in this sub-study (Total HF n = 602 and HC n = 342). The unrestricted maximum likelihood computational model was used for the meta-regression. Data Synthesis Studies included in the meta-regression evidenced a statistically significant medium effect size estimate with moderate heterogeneity (k = 6, g = 0.636, p < 0.001, I2 = 56.85%). The meta-regression was statistically significant (slope = −0.0515, p = 0.0016, Qmodel = 9.86, df = 1, p = 0.0016). Conclusions Individuals with HF performed worse on the TMT-A than HC. Age accounted for a significant proportion of the observed heterogeneity in the meta-regression. Future research should examine the relationship of age on cognition in individuals with HF.

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A-54 The Relationship between Age and MMSE Performance Amongst Individuals with Heart Failure

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab062.72 ◽

2021 ◽

Vol 36 (6) ◽

pp. 1096-1096

Author(s):

Natasha Nemanim ◽

Nicholas Lackey ◽

Eric J Connors ◽

Alexander O Hauson ◽

Anna Pollard ◽

...

Keyword(s):

Heart Failure ◽

Meta Analysis ◽

Included Study ◽

Effect Sizes ◽

Medium Effect ◽

Future Research ◽

Global Cognition ◽

Meta Regression ◽

K 12 ◽

The Impact

Abstract Objective A previous meta-analysis assessing the impact of heart failure (HF) on cognition found the HF group performed more poorly than the healthy control (HC) on global cognition measures. The study observed a medium effect and moderate heterogeneity when using the Mini-Mental Status Examination (MMSE) to measure HF’s impact on global cognition. The current meta-regression explores whether the mean age of the HF group moderates performance on the MMSE when comparing HF patients to HC. Data Selection Two researchers independently searched eight databases, extracted data, and calculated effect sizes as part of a larger study. Inclusion criteria were: (a) adults with a diagnosis of HF, (b) comparison of HF patients to HC, and (c) adequate data to calculate effect sizes. Articles were excluded if patients had other types of organ failure, the article was not available in English, or there was a risk of sample overlap with another included study. Twelve articles (HF n = 1166 and HC n = 1948) were included. The unrestricted maximum likelihood computational model was used for the meta-regression. Data Synthesis Studies included in the meta-regression evidenced a statistically significant medium effect size estimate with moderate heterogeneity (k = 12, g = 0.671, p < 0.001, I2 = 80.91%). The meta-regression was statistically significant (slope = −0.023, p = 0.0022, Qmodel = 5.26, df = 1, p = 0.022). Conclusions Individuals with HF performed more poorly on the MMSE than HC. Larger effect sizes on the MMSE were observed in studies with participants who were younger compared to studies with participants who were older. Future research should continue to delineate the impact of age on global cognition in individuals with HF.

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P01-345-Prevalence and impact of cannabis use disorders in adolescents with early onset first episode psychosis

European Psychiatry ◽

10.1016/s0924-9338(11)72056-9 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 347-347

Author(s):

B. Schimmelmann ◽

S. Cotton ◽

P. Conus ◽

S. Kupferschmid ◽

P. McGorry ◽

...

Keyword(s):

Early Onset ◽

First Episode Psychosis ◽

Cannabis Use ◽

Effect Sizes ◽

Medium Effect ◽

First Episode ◽

List Type ◽

Episode Psychosis ◽

Cannabis Use Disorders ◽

The Impact

ObjectivePrevious studies on the impact of cannabis use disorders (CU) on outcome in psychosis were mostly based on non-representative samples, have often not controlled for confounders and rarely focused on adolescents. Thus, the aims of the present study were to assess;(i) prevalence of CU;(ii) pre-treatment and baseline differences between CU and those without CU (NCU); and(iii) the impact of baseline and course of CU on 18-month outcomes in a representative cohort of adolescents with early onset first episode psychosis (EOP).MethodThe sample comprised 99 adolescents (age 14 to 18) with EOP (onset age 14 to 17), admitted to the Early Psychosis Prevention and Intervention Centre in Australia. Data were collected from medical files using a standardized questionnaire.ResultsPrevalence of lifetime CU was 65.7%, baseline CU 53.5%, and persistent CU 26.3%. Baseline CU compared to NCU was associated with higher illness-severity, lower functioning, less insight, lower premorbid functioning and longer duration of untreated psychosis. Compared to both NCU and those who decreased or stopped CU during treatment, only persistent CU was linked to worse outcomes and more service disengagement. Effect sizes were medium controlling for relevant confounders. Medication non-adherence did not explain the link between persistent CU and worse outcome.ConclusionsThe prevalence of CU in adolescents with EOP is high, while only persistent CU use was associated with worse outcome with medium effect sizes. Specific needs of adolescent patients with respect to cannabis interventions within integrated care settings should be addressed in future studies.

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Polypharmacy, Opioid Use, and Fibromyalgia

Biological Research For Nursing ◽

10.1177/1099800416657636 ◽

2016 ◽

Vol 19 (1) ◽

pp. 97-105 ◽

Cited By ~ 7

Author(s):

Victoria Menzies ◽

Leroy R. Thacker ◽

Sallie D. Mayer ◽

Anna M. Young ◽

Shelby Evans ◽

...

Keyword(s):

Symptom Management ◽

Patient Population ◽

Adverse Drug Events ◽

Predictor Variable ◽

Chronic Widespread Pain ◽

Pain Severity ◽

Pain Interference ◽

Widespread Pain ◽

Opioid Use ◽

The Impact

The major therapeutic approach for treating fibromyalgia (FM), a chronic widespread pain syndrome, is pharmacotherapy-centered symptom management. Complexity of treatment often leads to multiple medication prescriptions. While there is no current alternative to the probable need for polypharmacy in this patient population, there remains concern related to potential side effects and adverse drug events. In this secondary analysis of data on medications taken collected from two parent studies, all medications were broken down into the following categories: opioid, nonopioid, antidepressant, anticonvulsant, muscle relaxant, and benzodiazepine. The impact on pain severity and pain interference of these medication categories as well as perceived stress, fatigue, and depression scores was assessed. Baseline pain severity ( p = .0106) and pain interference ( p = .0002) were significantly correlated with opioid use as compared to nonopioid use. A multivariate regression with backward elimination resulted in a model for pain severity with one significant predictor variable, fatigue ( p < .0001); pain interference had three significant predictor variables: opioid use ( p = .04), fatigue ( p < .0001), and depression ( p = .04). While future studies should further address the utility of opioids and examine the role of polypharmacy as part of symptom management strategies for individuals with FM, study findings suggest that, for those who suffer chronic widespread pain as the predominant symptom experience, a challenge equally as perplexing for nurses and nursing research alike as managing the pain lies in addressing the fatigue and depression in this patient population.

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Compensatory Interventions for Cognitive Impairments in Psychosis: A Systematic Review and Meta-Analysis

Schizophrenia Bulletin ◽

10.1093/schbul/sbz134 ◽

2020 ◽

Vol 46 (4) ◽

pp. 869-883 ◽

Cited By ~ 1

Author(s):

Kelly Allott ◽

Kristi van-der-EL ◽

Shayden Bryce ◽

Emma M Parrish ◽

Susan R McGurk ◽

...

Keyword(s):

Systematic Review ◽

Psychiatric Symptoms ◽

Meta Analysis ◽

Risk Of Bias ◽

Effect Sizes ◽

Medium Effect ◽

Post Intervention ◽

Psychosocial Disability ◽

The Impact

Abstract Objective Cognitive compensatory interventions aim to alleviate psychosocial disability by targeting functioning directly using aids and strategies, thereby minimizing the impact of cognitive impairment. The aim was to conduct a systematic review and meta-analysis of cognitive compensatory interventions for psychosis by examining the effects on functioning and symptoms, and exploring whether intervention factors, study design, and age influenced effect sizes. Methods Electronic databases (Ovid Medline, PsychINFO) were searched up to October 2018. Records obtained through electronic and manual searches were screened independently by two reviewers according to selection criteria. Data were extracted to calculate estimated effects (Hedge’s g) of treatment on functioning and symptoms at post-intervention and follow-up. Study quality was assessed using Cochrane Collaboration’s risk of bias tool. Results Twenty-six studies, from 25 independent randomized controlled trials (RCTs) were included in the meta-analysis (1654 participants, mean age = 38.9 years, 64% male). Meta-analysis revealed a medium effect of compensatory interventions on functioning compared to control conditions (Hedge’s g = 0.46, 95% CI = 0.33, 0.60, P < .001), with evidence of relative durability at follow-up (Hedge’s g = 0.36, 95% CI = 0.19, 0.54, P < .001). Analysis also revealed small significant effects of cognitive compensatory treatment on negative, positive, and general psychiatric symptoms, but not depressive symptoms. Estimated effects did not significantly vary according to treatment factors (ie, compensatory approach, dosage), delivery method (ie, individual/group), age, or risk of bias. Longer treatment length was associated with larger effect sizes for functioning outcomes. No evidence of publication bias was identified. Conclusion Cognitive compensatory interventions are associated with robust, durable improvements in functioning in people with psychotic illnesses.

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The influence of maternal singing on well-being, postpartum depression and bonding – a randomised, controlled trial

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03933-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Verena Wulff ◽

Philip Hepp ◽

Oliver T. Wolf ◽

Tanja Fehm ◽

Nora K. Schaal

Keyword(s):

Depressive Symptoms ◽

Postpartum Depression ◽

Interaction Effect ◽

Intervention Group ◽

Well Being ◽

Controlled Study ◽

New Mothers ◽

Positive Effects ◽

Randomised Controlled ◽

The Impact

Abstract Background Postpartum depression is fairly common in new mothers and moreover associated with impaired bonding and poor maternal well-being. The aim of the present study was to investigate the impact of a mother-infant singing intervention within the first three months after birth on maternal well-being, depressive symptoms and bonding. Methods 120 women who were recruited at the maternity ward at the University Clinic in Düsseldorf took part in this prospective, randomised-controlled study. Beside the baseline measurement 1–3 days after childbirth, depressive symptoms, maternal well-being and mother-infant bonding were evaluated with questionnaires before (two weeks after birth) and after (twelve weeks after birth) the intervention took place. The experimental group (n = 59) participated in several singing intervention sessions while the control group (n = 61) did not. In the intervention group, salivary cortisol as well as attachment and mood were assessed immediately before and after the singing sessions. Results The participants of the intervention group showed a significant reduction of cortisol (p = .023) and an improvement of attachment and mood from start to end of the intervention session (all p ≤ .008). However, no prolonged effects were revealed beyond the intervention sessions as the two groups did not differ regarding the alterations of the primary outcomes postpartum depression (interaction effect p = .187) and postpartum bonding (interaction effect p = .188) in the 10-week period from two up to twelve weeks after childbirth (all p > .05). Additional analyses of singing habits at home in both groups, revealed that only in the singing group more frequent singing was associated with less anxiety and more well-being of the mother. Conclusion Singing towards the infant seems to have positive immediate effects on the well-being of new mothers (on subjective variables as well as physiological measurements). However, the intervention did not lead to more long lasting positive effects although several limitations should be considered. Trial registration DRKS00015178 (registered at the German Clinical Trial Registry), date of registration: 09.11.2018.

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CHRONIC PAIN, FEAR OF FALLING, AND RESTRICTED ACTIVITY DAYS IN AN OLDER POPULATION

Innovation in Aging ◽

10.1093/geroni/igz038.066 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S18-S18

Author(s):

Suzanne Leveille

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Fall Risk ◽

Fear Of Falling ◽

Pain Severity ◽

Pain Interference ◽

Multisite Pain ◽

Restricted Activity ◽

Pain Characteristics ◽

The Impact

Abstract Both chronic pain and fear of falling can lead to activity restriction and increased fall risk among vulnerable elders. Little is known about pain characteristics that may be associated with fear of falling, contributing to restricted activity. We studied 765 adults aged ≥65y (mean=78.9y) in the MOBILIZE Boston Study, to evaluate the cross-sectional relationship between pain characteristics and fear of falling measured using the Falls Efficacy Scale (FES). In addition, we examined the impact of pain and fear of falling on restricted activity. We measured 3 domains of global pain: pain distribution (none, single site or multisite pain), and Brief Pain Inventory subscales of pain severity and pain interference. Restricted activity days (RADs) refer to the count of self-reported days of reduced activity due to illness or injury in the previous 12 months. We performed multivariable logistic regressions predicting fear of falling (FES<90/100) adjusted for sociodemographics, fall history and fall risk factors. Participants with multisite pain or moderate-to-high pain interference ratings were more likely to have fear of falling (adj.OR 1.97, 95%CI 1.05-3.67; adj.OR 4.02, 95%CI 2.0-8.06, respectively). Pain severity was not associated with FES. Older adults with multisite pain and fear of falling reported significantly more RADs than those with multisite pain without fear of falling (79±135 and 26±74 RADs, respectively; test for pain x FES interaction, p=0.01). Older adults with chronic pain have greater fear of falling which may contribute to restricted activity. Efforts are needed to increase activity and falls efficacy among older adults with chronic pain.

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