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Zhang Z, Lao J, Liu M, Zheng S, Zhao M, Zhang M. Symptom cluster among cancer survivors from a nationally representative survey: a network analysis. Support Care Cancer 2024; 32:333. [PMID: 38713314 DOI: 10.1007/s00520-024-08531-1] [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: 11/18/2023] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE To identify the symptom cluster among cancer survivors and examine their subgroup differences via network analysis based on nationally representative data. METHODS This cross-sectional study included 2966 survivors participating in the 2020 National Health Interview Survey (NHIS). Participants self-reported the presence of 14 symptoms capturing four clusters (physical, somatic, sleep, and psychologic problems). Network analysis models were used to reveal the relationships between symptoms and those interactions. Network comparison tests were applied to compare subgroups. RESULTS The core symptoms of the symptom cluster were fatigue (Bet = 33, Clo = 0.0067, Str = 0.9397), pain (Bet = 11, Clo = 0.0060, Str = 0.9226), wake up well rested (Bet = 25, Clo = 0.0057, Str = 0.8491), and anxiety (Bet = 5, Clo = 0.0043, Str = 0.9697) among cancer survivors. The core symptoms, network structure, and global strength were invariant between time since diagnoses (< 2 years vs. ≥ 2 years) or between numbers of cancers (1 vs. ≥ 2), yet varied between the comorbidity group and non-comorbidity group (≥ 1 vs. 0). CONCLUSIONS Fatigue would be a potential target for alleviating other symptoms through a negative feedback loop of other related symptoms of cancer survivors. In particular, cancer survivors with other chronic diseases should be the focus of attention and strengthen targeted intervention.
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Affiliation(s)
- Zhen Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Jiahui Lao
- The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Mingming Liu
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Shenglong Zheng
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Ming Zhao
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Min Zhang
- Department of Nursing, Qilu Hospital, Shandong University, Jinan, China.
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Anarte-Lazo E, Liew BXW, Devecchi V, Bernal-Utrera C, Rodriguez-Blanco C, Falla D. Network analyses reveal the interaction between physical features, fear of movement and neck pain and disability in people with acute and chronic whiplash-associated disorders. Eur J Pain 2024; 28:322-334. [PMID: 37725095 DOI: 10.1002/ejp.2184] [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: 02/21/2023] [Revised: 07/20/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND AND OBJECTIVE A network analysis can be used to quantitatively assess and graphically describe multiple interactions. This study applied network analyses to determine the interaction between physical and pain-related factors and fear of movement in people with whiplash-associated disorders (WAD) during periods of acute and chronic pain. METHODS Physical measurements, including pressure pain-thresholds (PPT) over neural structures, cervical range of motion, neck flexor and extensor endurance and the cranio-cervical flexion test (CCFT), in addition to subjective reports including the Tampa Scale of Kinesiophobia (TSK-11), Neck Disability Index (NDI) and neck pain and headache intensity, were assessed at baseline in 47 participants with acute WAD. TSK-11, NDI and pain intensity were assessed for the same participants 6 months later (n = 45). Two network analyses were conducted to estimate the associations between features at baseline and at 6 months and their centrality indices. RESULTS Both network analyses revealed that the greatest weight indices were found for NDI and CCFT at baseline and for neck pain and headache intensity and NDI and TSK-11 at both time points. Associations were also found betweeen cervical muscle endurance and neck pain intensity in the acute phase. Cervical muscle endurance assesssed during the acute phase was also associated with NDI after 6 months - whereas PPT measured at baseline was associsated with headache intensity after 6 months. CONCLUSION The strongest associations were found for headache and neck pain intensity and neck disability and fear of movement, both during acute pain and when mesured 6 months later. The extent of neck endurance and measures of PPT at baseline may be associated with neck disability and headache, respectively, 6 months after a whiplash injury. SIGNIFICANCE Through two network analyses, we evaluated the interaction between pain-related factors, fear of movement, neck disability and physical factors in people who had experienced a whiplash injury. We demonstrated that physical factors may be involved in the maintenance and development of chronic pain after a whiplash injury. Nevertheless, the strongest associations were found for headache and neck pain intensity and neck disability and fear of movement, both during acute and chronic phases.
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Affiliation(s)
- Ernesto Anarte-Lazo
- Doctoral Program in Health Sciences, University of Seville, Seville, Spain
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK
| | - Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Carlos Bernal-Utrera
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Cleofas Rodriguez-Blanco
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Cao W, Wang L, Hou TH, Shi YZ, Zheng QH, Zheng H, Zou ZH, Qin D, Yang Q, Chen SJ, Wang HY, Xiao XJ, Li Y. Disease-Related Factors Associated with Acupuncture Response in Patients with Chronic Tension-Type Headache: A Secondary Analysis of A Randomized Controlled Trial. Chin J Integr Med 2024:10.1007/s11655-023-3615-2. [PMID: 38206534 DOI: 10.1007/s11655-023-3615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To explore the demographic and disease-related factors associated with acupuncture response in patients with chronic tension-type headache (CTTH). METHODS Using data from a randomized clinical trial (218 cases) consisting of 4 weeks of baseline assessment, 8 weeks of treatment, and 24 weeks of follow-up, participants were regrouped into responders (at least a 50% reduction in monthly headache days at week 16 compared with baseline) and non-responders. Twenty-three demographic and disease-related factors associated with acupuncture response in 183 participants were analyzed by multivariable logistic regression. RESULTS One hundred and nineteen (65.0%) participants were classified as responders. Four factors were significantly independently associated with acupuncture response, including treatment assignment, headache intensity at baseline, and 2 domains [general health (GH) and social functioning (SF)] from the 36-Item Short Form Health Survey quality of life questionnaire. Treatment assignment was associated with non-response: participants receiving true acupuncture were 3-time more likely to achieve a CTTH response than those receiving superficial acupuncture [odds ratio (OR) 0.322, 95% confidence interval (CI) 0.162 to 0.625, P=0.001]. Compared with patients with mild-intensity headache, patients with moderate-intensity headache were twice as likely to respond to acupuncture (OR 2.001, 95% CI 1.020 to 4.011, P=0.046). The likelihood of non-response increased by 4.5% with each unit increase in the GH grade (OR 0.955, 95% CI 0.917 to 0.993, P=0.024) while decreased by 3.8% with each unit increase in the SF grade (OR 1.038, 95% CI 1.009 to 1.069, P=0.011). CONCLUSIONS Greater headache intensity, lower GH score, and higher SF score were associated with better acupuncture responses in CTTH patients. These 3 factors require independent validation as predictors of acupuncture effectiveness in CTTH.
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Affiliation(s)
- Wei Cao
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Lu Wang
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Ting-Hui Hou
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Yun-Zhou Shi
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Qian-Hua Zheng
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Hui Zheng
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Zi-Hao Zou
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Di Qin
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Qian Yang
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Si-Jue Chen
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Hai-Yan Wang
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Xian-Jun Xiao
- Acupuncture and Moxibustion School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
| | - Ying Li
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China.
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Zhou K, Huang X, Chen M, Li Z, Qin J, Ji Y, Yu X, Yan F. Pre-hospital symptom clusters and symptom network analysis in decompensated cirrhotic patients: A cross-sectional study. J Adv Nurs 2024. [PMID: 38197541 DOI: 10.1111/jan.16044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/25/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024]
Abstract
AIMS To generate pre-hospital symptom networks, explore core, bridge and sentinel symptoms, identify pre-hospital symptom clusters and analyse relationship between influencing factors and symptom clusters in decompensated cirrhosis patients. DESIGN A cross-sectional study design using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. METHODS Demographical, physiological, psychological and sociological characteristics and the pre-hospital symptoms of 292 decompensated cirrhotic patients were collected from October 2021 to March 2023 in China. Frequencies, percentages, means, standard deviations, independent samples t-tests, one-way analysis of variance, exploratory factor analysis, multiple stepwise regression analysis and network analysis were used for data analysis. RESULTS 'I don't look like myself' and itching were core and bridge symptoms, while bloating and lack of energy were sentinel symptoms in decompensated cirrhotic patients. Monthly family income, anxiety, depression, social support and disease duration influenced the neuropsychological symptom cluster, with worrying as the strongest predictor symptom. Influential factors for cirrhosis-specific symptom cluster included Child-Pugh class, monthly family income, disease duration, anxiety and depression, with itching being the strongest predictor symptom. Monthly family income, disease duration and depression were influential factors for gastrointestinal symptom cluster, with loss of appetite as the strongest predictor symptom. CONCLUSIONS Neuropsychological, cirrhosis-specific and gastrointestinal symptom clusters were formed in decompensated cirrhotic patients. Through network analysis, direct connections between symptoms, symptom clusters and their influencing factors were revealed, thereby offering clinicians a foundation for effectively managing patients' pre-hospital symptoms. IMPACT Decompensated cirrhosis patients commonly have multiple symptoms, while the management of pre-hospital symptoms is often suboptimal. This study identified neuropsychological, cirrhosis-specific, gastrointestinal symptom clusters and recognized core, bridge and sentinel symptoms in these patients. It also revealed the most prominent symptoms within each cluster. This provides insight into the hierarchy of symptoms, improving symptom management in decompensated cirrhosis. PATIENT AND PUBLIC INVOLVEMENT There was no patient or public involvement.
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Affiliation(s)
- Kebing Zhou
- School of Nursing, Jinan University, Guangzhou, China
| | | | - Meiling Chen
- Department of Gastroenterology, Sixth Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiying Li
- School of Nursing, Jinan University, Guangzhou, China
| | - Jieying Qin
- School of Nursing, Jinan University, Guangzhou, China
| | - Yelin Ji
- School of Nursing, Jinan University, Guangzhou, China
| | - Xuefen Yu
- Comprehensive Ward, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fengxia Yan
- School of Nursing, Jinan University, Guangzhou, China
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Beyera Bayuma T, Abebe BG. Analyzing actors' interaction behavior in land transactions in informal settlement settings: A case study of Burayu city, Ethiopia. Heliyon 2023; 9:e19515. [PMID: 37809735 PMCID: PMC10558734 DOI: 10.1016/j.heliyon.2023.e19515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023] Open
Abstract
Informality plays an imperative role in offering housing for households in developing countries when the formal market cannot provide enough to keep up with residents' demands. The actors' interaction, with one another, plays an imperative role in land transactions in informal settlement areas. As informal actors operate outside the formal land transactions their activities and methods of operation are rarely understood. Therefore, based on social network theory, this paper aims to identify and examine informal actors, their functions, interactions, and power relationships in informal settlement areas. To this end, this study employed key informant interviews, focus group discussions, structured questionnaires, and a review of published literature, as well as official documents. In the study area, most residents acquired land through informal mechanisms. Major actors include farmers, local land administrators, speculators, land brokers, residents, government officials, and religious leaders. The study also uncovers that the role of each actor varies from information provision to price fixing. Their roles and interactions are governed by dynamic networks and occasionally overlap functions. Among the network actors, land brokers are considered the most influential and powerful because they possess a high degree of centrality, closeness, betweenness, and eigenvector. They hold a pivotal position in the network and act as a liaison between the network's actors. Therefore, the roles of land brokers, who often actively influence the land transaction process, should be considered in urban land governance and incorporated in policy formulation and implementation.
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Affiliation(s)
- Tefera Beyera Bayuma
- Ethiopian Institute of Architecture, Building Construction and City Development, Department of Urban and Regional Planning, Addis Ababa University, Ethiopia
| | - Birhanu Girma Abebe
- Ethiopian Institute of Architecture, Building Construction and City Development, Department of Urban and Regional Planning, Addis Ababa University, Ethiopia
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Gerdle B, Dragioti E, Rivano Fischer M, Ringqvist Å. Pain intensity and psychological distress show different associations with interference and lack of life control: A clinical registry-based cohort study of >40,000 chronic pain patients from SQRP. FRONTIERS IN PAIN RESEARCH 2023; 4:1093002. [PMID: 36937562 PMCID: PMC10017552 DOI: 10.3389/fpain.2023.1093002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Background Both chronic pain and depressive and/or anxiety symptoms are associated with negative impacts on daily living, including interference and lack of life control. However, little is known about how pain and psychological distress affect these impacts. Aim The first aim was to assess how pain intensity, psychological distress, and social support interact with interference and lack of life control. A second aim was to investigate whether the strength of these relationships is moderated by the presence or absence of depression and/or anxiety. Subjects and methods Patient-Reported Outcome Measures (PROMs), which are available in the Swedish Quality Registry for Pain Rehabilitation (SQRP), were retrieved for patients with chronic pain (N = 40,184). A theoretical model with the constructs/latent variables pain intensity, psychological distress, interference, lack of life control, and social support was proposed and analyzed using Partial Least Squares Structural Equation Modelling (PLS-SEM). Indicators for these constructs were identified from the PROMs of the SQRP. Two models of the total cohort, which differed with respect to the causal relationship between pain intensity and psychological distress, were investigated. The moderating effects of anxiety and/or depression were also analyzed. Results Relatively low correlation and explanatory power (R 2 = 0.16) were found for the pain intensity-psychological distress relationship. Pain intensity had a stronger effect on interference than on lack of life control. The reverse was found for psychological distress - i.e., psychological distress seemed to have a higher negative influence on function than on interference. The underlying assumption of the causal relationship between pain intensity and psychological distress determined how strong pain intensity and psychological distress influenced interference and lack of life control. Social support showed very similar absolute significant correlations with interference and lack of life control. Interference and lack of life control showed relatively weak associations. The psychological distress level was a moderating factor for several of the paths investigated. Discussion and conclusion A clinical treatment consequence of the low correlation between pain intensity and psychological distress may be that clinically treating one may not reduce the effect of the other. The relative importance of pain intensity and psychological distress on interference and lack of life control depends on the underlying assumption concerning the pain intensity-psychological distress relationship. Interference and lack of life control showed relatively weak associations, underscoring the need to clinically assess them separately. Social support influenced both impact constructs investigated. The cohort display heterogeneity and thus presence of definite signs of anxiety and/or depression or not was a moderating factor for several of the associations (paths) investigated. The results are important both for the assessments and the design of treatments for patients with chronic pain.
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Affiliation(s)
- Björn Gerdle
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Correspondence: Björn Gerdle
| | - Elena Dragioti
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcelo Rivano Fischer
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Åsa Ringqvist
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
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Fernández-de-las-Peñas C, Florencio LL, Varol U, Pareja JA, Ordás-Bandera C, Valera-Calero JA. Network Analysis Reveals That Headache-Related, Psychological and Psycho-Physical Outcomes Represent Different Aspects in Women with Migraine. Diagnostics (Basel) 2022; 12:2318. [PMID: 36292007 PMCID: PMC9600561 DOI: 10.3390/diagnostics12102318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 10/29/2023] Open
Abstract
Evidence supports that migraine is a complex pain condition with different underlying mechanisms. We aimed to quantify potential associations between demographic, migraine-related, and psychophysical and psychophysical variables in women with migraine. Demographic (age, height, and weight), migraine-related (intensity, frequency, and duration), related-disability (Migraine Disability Assessment Scale, Headache Disability Inventory), psychological (Hospital Anxiety and Depression Scale), and psycho-physical (pressure pain thresholds -PPTs-) variables were collected from a sample of 74 women suffering from migraine. We calculated adjusted correlations between the variables by using a network analysis. Additionally, we also calculated centrality indices to identify the connectivity among the variables within the network and the relevance of each variable in the network. Multiple positive correlations (ρ) between PPTs were observed ranging from 0.1654 (C5-C6 and tibialis anterior) to 0.40 (hand and temporalis muscle). The strongest associations within the network were those between migraine attack frequency and diagnosis of chronic migraine (ρ = 0.634) and between the HDI-E and HDI-P (ρ = 0.545). The node with the highest strength and betweenness centrality was PPT at the second metacarpal, whereas the node with the highest harmonic centrality was PPT at the tibialis anterior muscle. This is the first study applying a network analysis to understand the underlying mechanisms in migraine. The identified network revealed that a model where each subgroup of migraine-related, psychological, and psycho-physical variables showed no interaction between each variable. Current findings could have clinical implications for developing multimodal treatments targeting the identified mechanisms.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Umut Varol
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Camilo Jose Cela University, 28692 Villafranca del Castillo, Spain
| | - Juan A. Pareja
- Department of Neurology, Hospital Quirón Pozuelo, 28223 Madrid, Spain
| | | | - Juan A. Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Camilo Jose Cela University, 28692 Villafranca del Castillo, Spain
- Department of Physiotherapy, Faculty of Health, Camilo José Cela University, 28692 Villafranca del Castillo, Spain
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Ríos-León M, Valera-Calero JA, Ortega-Santiago R, Varol U, Fernández-de-las-Peñas C, Plaza-Manzano G. Analyzing the Interaction between Clinical, Neurophysiological and Psychological Outcomes Underlying Chronic Plantar Heel Pain: A Network Analysis Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10301. [PMID: 36011936 PMCID: PMC9408584 DOI: 10.3390/ijerph191610301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
Plantar heel pain (PHP) is one of the most common foot pain conditions in adults. Several biological and psychological factors could be involved in chronic PHP in a complex matrix. However, reciprocal interactions between these factors are unknown. The aim of the present study was to use network analysis to quantify potential multivariate relationships between pain-related, function, clinical, mechanosensitivity, psychological, and health-related variables in individuals with PHP. Demographic (age, gender), pain-related (pain intensity), function, clinical (myofascial trigger points [TrPs]), mechanosensitivity (pressure pain thresholds), psychological (Beck Depression Inventory), and health-related variables (EQ-5D-5L) were collected in 81 PHP patients. Network connectivity analysis was conducted to quantify the adjusted correlations between the modeled variables and to assess their centrality indices. The connectivity network showed local associations between pain-related variables, foot function, and mechanosensitivity. Additionally, associations between quality of life, depression, and pain-related variables were found, while TrPs was associated with quality of life and mechanosensitivity. The node with the highest strength centrality was the worst pain intensity, while mechanosensitivity and worst pain intensity showed the highest closeness and betweenness centrality. This is the first study to apply network modeling to understand the connections between pain-related, function, clinical, mechanosensitivity, psychological, and health-related variables in PHP. The role of pain severity and mechanosensitivity is highlighted and supported by the network. Thus, this study reveals potential factors that could be the target in the management of PHP, promoting a comprehensive and effective therapeutic approach.
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Affiliation(s)
- Marta Ríos-León
- Hospital Nacional de Parapléjicos, SESCAM, 45004 Toledo, Spain
| | - Juan Antonio Valera-Calero
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Umut Varol
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Valera-Calero JA, Arendt-Nielsen L, Cigarán-Méndez M, Fernández-de-las-Peñas C, Varol U. Network Analysis for Better Understanding the Complex Psycho-Biological Mechanisms behind Fibromyalgia Syndrome. Diagnostics (Basel) 2022; 12:diagnostics12081845. [PMID: 36010196 PMCID: PMC9406816 DOI: 10.3390/diagnostics12081845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess potential associations between sensory, cognitive, health-related, and physical variables in women with fibromyalgia syndrome (FMS) using a network analysis for better understanding the complexity of psycho-biological mechanisms. Demographic, clinical, pressure pain threshold (PPT), health-related, physical, and psychological/cognitive variables were collected in 126 women with FMS. A network analysis was conducted to quantify the adjusted correlations between the modeled variables and to assess the centrality indices (i.e., the degree of connection with other symptoms in the network and the importance in the system modeled as a network. This model showed several local associations between the variables. Multiple positive correlations between PPTs were observed, being the strongest weight between PPTs over the knee and tibialis anterior (ρ: 0.28). Catastrophism was associated with higher hypervigilance (ρ: 0.23) and lower health-related EuroQol-5D (ρ: −0.24). The most central variables were PPT over the tibialis anterior (the highest strength centrality), hand grip (the highest harmonic centrality) and Time Up and Go (the highest betweenness centrality). This study, applying network analysis to understand the complex mechanisms of women with FMS, supports a model where sensory-related, psychological/cognitive, health-related, and physical variables are connected. Implications of the current findings, e.g., developing treatments targeting these mechanisms, are discussed.
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Affiliation(s)
- Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, 28692 Villanueva de la Cañada, Spain; (J.A.V.-C.); (U.V.)
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, 28692 Villanueva de la Cañada, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Sanse-Motorisk Interaktion (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark;
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcon, Spain
- Correspondence:
| | - Umut Varol
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, 28692 Villanueva de la Cañada, Spain; (J.A.V.-C.); (U.V.)
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Understanding Sensitization, Cognitive and Neuropathic Associated Mechanisms behind Post-COVID Pain: A Network Analysis. Diagnostics (Basel) 2022; 12:diagnostics12071538. [PMID: 35885444 PMCID: PMC9316513 DOI: 10.3390/diagnostics12071538] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 12/23/2022] Open
Abstract
This study aimed to describe a network including demographic, sensory-related, psychological/cognitive and other variables in individuals with post-COVID pain after hospitalization. Demographic (i.e., age, height, weight, months with symptoms), sensory-related (Central Sensitization Inventory -CSI-, Self-Report Leeds Assessment of Neuropathic Symptoms -S-LANSS-, PainDETECT), psychological/cognitive (Hospital Anxiety and Depression Scale -HADS-A/HADS-D-, Pain Catastrophizing Scale -PCS-, Tampa Scale for Kinesiophobia -TSK-11-) and other (sleep quality and health-related quality of life -EQ/5D/5L) variables were collected in 146 COVID-19 survivors with post-COVID pain. A network analysis was conducted to quantify the adjusted correlations between the modelled variables, and to assess their centrality indices (i.e., the connectivity with other symptoms in the network and the importance in the system modelled as network). The network revealed associations between sensory-related and psychological/cognitive variables. PainDETECT was associated with S-LANSS (ρ: 0.388) and CSI (ρ: 0.207). Further, CSI was associated with HADS-A (ρ: 0.269), TSK-11 (ρ: 0.165) and female gender (ρ: 0.413). As expected, HADS-A was associated with HADS-D (ρ: 0.598) and TSK-11 with PCS (ρ: 0.405). The only negative association was between sleep quality and EQ-5D-5L (ρ: −0.162). Gender was the node showing the highest strength, closeness, and betweenness centralities. In addition, CSI was the node with the second highest closeness and betweenness centralities, whereas HADS-D was the node with the second highest strength centrality. This is the first study applying a network analysis for phenotyping post-COVID pain. Our findings support a model where sensitization-associated symptoms, neuropathic phenotype, and psychological aspects are connected, reflecting post-COVID pain as a nociplastic pain condition. In addition, post-COVID pain is gender dependent since female sex plays a relevant role. Clinical implications of current findings, e.g., developing treatments targeting these mechanisms, are discussed.
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