Alexithymia in adolescents with and without chronic pain

Psychological Treatments for Alexithymia: A Systematic Review

Alexithymia, a psychological condition characterized by emotional suppression, is positively correlated with depression and anxiety and can develop into various mental disorders. Although alexithymia affects 10% of the symptomatic population and 25% of psychiatric patients, there has been a paucity of intervention studies. Even though several effective psychological treatments, including cognitive behavioral therapy (CBT), have been tested in recent years, there is a lack of comprehensive reviews on their efficacy. The objectives of this systematic review were to explore and synthesize findings from recent randomized controlled trials (RCTs) about psychological treatments, with the following inclusion criteria: (1) published from 2010 to 2024; (2) full text being available in English; (3) peer-reviewed journals; and (4) baselines and outcomes measured by TAS-20 and raw data were provided. We excluded non-psychological studies and studies involving mindfulness and DBT. We searched electronic databases (PubMed, PsycInfo, and Google Scholar) and found 18 RCTs and 21 arms for alexithymia, with a combined total of 1251 participants. Fourteen arms (67%) investigated the effect of CBT on alexithymia, including acceptance and commitment therapy (seven arms), behavioral activation therapy (two arms), schema therapy, and compassion-focused therapy. The results indicated that most psychological interventions significantly decreased TAS-20, illustrating a showcase of treatments from each trial with different effect sizes (within-intervention group, ranging from 0.41 to 13.25). However, due to the heterogeneity between the studies, this review study may not be conclusive enough to make each intervention standardized. Further high-quality RCTs with larger sample sizes and more consistent methodologies are needed, and corrective findings from such studies should be applied to produce more robust evidence-based psychological interventions for treating alexithymia.

Anxiety and Depression in Youth With Chronic Pain: A Systematic Review and Meta-Analysis

Importance

For youth with chronic pain, anxiety and depression are reported as consequences of experiencing pain and maintaining factors of ongoing pain and disability. However, prevalence estimates of anxiety and depression remain unclear.

Objective

To report the prevalence of clinical anxiety and depression for youth with chronic pain and compare symptoms of anxiety and depression between youth with and without chronic pain.

Data Sources

MEDLINE, PsycINFO, CENTRAL, and Embase from inception to April 30, 2023.

Study Selection

Included studies that reported prevalence data or symptom scores for anxiety and/or depression in individuals younger than 25 years (mean, ≤18 years) with chronic pain and were published in English.

Data Extraction and Synthesis

From 9648 nonduplicate records, 801 full-text articles were screened. Screening and data extraction occurred in duplicate. Prevalence was determined using event rate calculations. Between-group symptom differences were calculated using Hedges g. Analyses were conducted using the random-effects model. Reporting bias and Grading of Recommendation, Assessment, Development, and Evaluation assessments were conducted.

Main Outcomes and Measures

Prevalence of anxiety and depression (based on diagnosis and clinical cutoff scores) and differences in anxiety and depression symptoms. Moderators of prevalence and symptom differences were analyzed when data allowed.

Results

A total of 79 studies were included with a total sample of 22 956 youth (n = 12 614 with chronic pain). Most youth were female (mean, 74%), with an age range of 4 to 24 (mean [SD], 13.7 [2.10]) years. The prevalence estimate of anxiety diagnoses was 34.6% (95% CI, 24.0%-47.0%) and the portion that exceeded clinical cutoff scores was 23.9% (95% CI, 18.3%-30.6%). The prevalence of depression diagnoses was 12.2% (95% CI, 7.8%-18.7%) and the portion that exceeded clinical cutoff scores was 23.5% (95% CI, 18.7%-29.2%). Youth with chronic pain had greater symptoms of anxiety (g = 0.61; 95% CI, 0.46-0.77) and depression (g = 0.74; 95% CI, 0.63-0.85) compared with controls. Sex, age, pain location, and recruitment sample may moderate anxiety and depression. Considerable heterogeneity was reported for all outcomes. Studies had a low reporting bias, and outcomes were moderate to high quality.

Conclusions and Relevance

The findings of this meta-analysis suggest that 1 in 3 youth with chronic pain meet criteria for anxiety disorder, and 1 in 8 meet criteria for a depressive disorder. This represents a major clinical comorbidity. Moving forward, screening, prevention, and treatment of mental health should be important health care priorities for youth with chronic pain.

Gender Diversity Among Youth Attending an Intensive Interdisciplinary Pain Treatment Program

Transgender and gender diverse (TGD) youth with chronic pain may be at unique risk for psychological distress and associated functional impairment, yet research on the intersection of chronic pain and gender identity is lacking. In a retrospective chart review of 491 participants admitted to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States over an approximately 4-year period, 6.11% were TGD. TGD participants who completed the IIPT program reported significant and large improvements in anxiety, depression, pain catastrophizing, and functional ability. At baseline, TGD participants presented as more emotionally distressed and functionally impaired compared to age-matched, cisgender peers. When accounting for baseline scores, TGD participants who completed the IIPT program reported similar scores to cisgender peers at discharge, yet TGD youth were significantly less likely than cisgender peers to complete the IIPT program. Future directions and implications for clinical practice are discussed.

Using exploratory graph analysis (EGA) in validating the structure of the Perth alexithymia questionnaire in Iranians with chronic pain

Background

Chronic pain's influence on emotional well-being can be significant. It may evoke feelings of despair, frustration, nervousness, and melancholy in individuals, which often manifest as reactions to enduring pain and disruptions in their daily lives. In this study, we seek to perform Bootstrap Exploratory Graph Analysis (EGA) on the Persian Version of the Perth Alexithymia Questionnaire (PAQ) in a cohort of people with chronic pain.

Methods

The research concentrated on the population of individuals encountering chronic pain within Tehran province from 2022 to 2023. Ultimately, the analysis comprised information from 234 male participants (with a mean age of 30.59, SD = 6.84) and 307 female participants (with a mean age of 30.16, SD = 6.65). After data collection, statistical analysis was conducted using the EGAnet2.0.4 package in R.4.3.2 software.

Results

The outcome of bootstrapped EGA unveiled a two-dimensional configuration of the PAQ comprising Factor 1 denoted as negative difficulty in describing and identifying feelings (N-DDIF) and Factor 2 characterized as general-externally orientated thinking (GEOT), representing robust structural integrity and item consistency (all items have stabilities > 0.70).

Conclusion

These findings endorse the validity of the PAQ, as evidenced by its confirmation in a broader sample using a novel methodology consistent with existing literature on two-factor decentering models.

[Emotional competence of patients with chronic pain : A self- and third-party assessment]

RESEARCH QUESTION

The aim of the study is to assess the status quo of emotional competence in people with chronic pain. How do patients experience themselves regarding to their ability to perceive, express, and regulate emotions? And does this assessment coincide with the assessment of emotional competence (EC) by mental health professionals?

METHODS

The study took place in the context of interdisciplinary multimodal pain therapy at an outpatient clinic in N = 184 adult German-speaking individuals with non-cancer-related chronic pain. EC was assessed at the end of therapy using the self- and third-party assessment scales of the Emotional Competence Questionnaire. The external assessment was performed by the mental health team. Standard scores were created using the norm sample provided by questionnaires. These were analyzed descriptively and inferentially.

RESULTS

Self-perceived EC was average (Mself_total = 99.31; SD = 7.78). The mental health professionals predominantly rated the emotional competence of the patients significantly lower (Mexternal_total = 94,70; SD = 7,81; F(1.179) = 35,73; p < 0.001; η2 = 0.17). Emotional expressivity, as a component of EC, was externally rated as below average (Mexpressivity_external = 89.14, SD = 10.33).

DISCUSSION

Patients with chronic pain rate themselves as unimpaired in terms of their daily emotional awareness, expression, and regulation abilities. At the same time, mental health professionals rate these same individuals as significantly less emotionally competent. The question remains open as to what extent the divergent assessments can be explained by assessment bias.

Chronic Pain in Autistic Youth: Clinical Prevalence and Reflections on Tailoring Evidence-Based Interventions from an Interdisciplinary Treatment Team

Though there is growing awareness of the overrepresentation of autistic patients in chronic pain clinics, potential adaptations for the assessment and treatment of chronic pain in this population have not yet been established. To address this gap, a retrospective review of electronic medical records and discussions by an interdisciplinary pain treatment team were summarized to inform potential biopsychosocial factors affecting the presentation, assessment, and treatment of chronic pain in autistic youth. Our sample included a record review of 95 patients receiving treatment in an interdisciplinary outpatient pediatric pain clinic. Results indicated that 9% (n = 9) of the patients presented to the clinic with a prior diagnosis of autism, but an additional 21% (n = 20) were identified as likely meeting criteria for autism based on the clinical assessment of the developmental history, behaviors observed during the clinical encounter(s), and expert clinical judgment, suggesting that the prevalence rate of autism may be closer to 30% in our outpatient pediatric pain clinic. Over half (52%) of the autistic youth presented to the clinic with widespread pain, 60% identified as female, and 6% identified as gender expansive or transgender. Qualitative insights revealed that most of the autistic patients had co-occurring sensory-processing challenges and difficulty in describing their pain, emotions, and somatic experiences and exhibited cognitive inflexibility and social challenges. We summarize our team's clinical reflections on how autism-relevant biopsychosocial vulnerability factors may contribute to the experience of pain in autistic youth and propose treatment targets and adaptations for the assessment and treatment of pain in this population. Finally, we recommend the need for interventions focused on sensorimotor integration, especially for autistic youth, and describe how pain clinics may be particularly helpful for identifying and supporting autistic females, for whom the potential role of autism in pain experiences had not been considered until receiving treatment in our clinic.

Type 1 Diabetes Mellitus, Psychopathology, Uncertainty and Alexithymia: A Clinical and Differential Exploratory Study

Type 1 diabetes mellitus (T1DM) represents a complex pathology affecting a large number of people. Research suggests that psychological factors influence coping with T1DM. This study aimed to investigate the presence and role of psychopathology, alexithymia and uncertainty in people affected by T1DM. The sample consisted of 137 patients (88 females, 49 males) affected by T1DM aged from 11 to 19 years old (Mean: 13.87; SD: 2.40). The diagnostic protocol consisted of a sociodemographic questionnaire, Self-administration Psychiatric Scales for Children and Adolescents (SAFA), Toronto Alexithymia Scale-20 (TAS-20) and Intolerance to Uncertainty Scale-12 (IUS-12). Descriptive, differential, correlational and regression analyses were performed in order to examine the relationships between these variables. The results suggested the sample had high levels of psychopathological indexes, alexithymia and intolerance of uncertainty. Also, there were significant differences between TAS-20 and IUS-12 distributions with respect to psychopathology. Correlations and multivariate linear regressions indicated age, gender and education significantly predicted alexithymia and intolerance of uncertainty. This data suggest the presence of elevated psychopathology, alexithymia and uncertainty in people with diabetes.

Efficacy and safety of duloxetine in chronic musculoskeletal pain: a systematic review and meta-analysis

BACKGROUND

Chronic musculoskeletal pain (CMP) is a complex condition that is mainly treated with analgesic drugs. However, antidepressant intervention is also an important factor in the treatment of CMP. Duloxetine is an effective treatment option for patients with CMP as its antidepressant effect. The purpose of this article is to evaluate the efficacy and safety of duloxetine in treating CMP.

DATABASES AND DATA TREATMENT

We searched PubMed, Web of Science, Embase, Cochrane Library from inception to May, 2022. Randomized controlled trials (RCTs) evaluating the efficacy and safety of duloxetine versus placebo in patients with CMP were included. We identified 13 articles and studied a population of 4201 participants in 4 countries.

RESULTS

This meta-analysis showed that the duloxetine has statistically significant compared with the placebo control, benefits on 24-hour average pain, living quality, physical function, and global impressions and there was no difference in the incidence of serious adverse event. In general, duloxetine can improve mood and pain level at the same time.

CONCLUSIONS

This review shows a significant contribution of duloxetine to CMP symptom relief. This meta-analysis improved that duloxetine can significantly reduce the pain level of patients, improve depressive symptoms and global impression, and has no obvious serious adverse reactions. However, additional studies are required to confirm the relationship between psychological diseases and chronic pain and explore their internal links.

Primary Dysmenorrhea Associated with Psychological Distress in Medical Sciences Students in The North of Iran: A Cross-Sectional Study

Primary dysmenorrhea is the usual medical status in medical students that are defined as pain
during the menstrual period. This study was done to evaluate the psychological problems associated with dysmenorrhea.
Materials and Methods: Three hundred forty students aged 18 to 20 years participated in this cross‑sectional
study (194 with dysmenorrhea and 150 without dysmenorrhea). In this cross‑sectional study, data were collected
through the sociodemographic checklist, the verbal multidimensional scoring system (VMS), and the revised
version of the Symptom Checklist-90 (SCL-90-R) questionnaire using the convenience sampling method. This
questionnaire includes 9 Subscale and a GSI index. We considered psychological distress to be equivalent to
the Global Severity İndex (GSI), which is obtained by dividing 90 questions by 90. The significance level of the
tests was considered 0.05.
Results: The GSI of the SCL-90 score in the 194 students with dysmenorrhea and 150 students without dysmenorrhea
was 1.02 ± 0.42 and 0.34 ± 0.15 respectively (P<0.001). In the group with dysmenorrhea, the severity
of dysmenorrhea was significantly associated with a family history of dysmenorrhea and mother's education
(P=0.012 and P=0.037, respectively). The strongest predictors of GSI>1 were a family history of dysmenorrhea
and mother's education [odds ratio (OR)=2.33, 95% confidence interval (CI), 1.43-4.15 and OR=0.45, 95% CI,
0.24-0.87, respectively].
Conclusion: According to the result, dysmenorrhea is associated with psychological distress. Psychological interventions
and counseling in addition to drug treatment are suggested for treatment of primary dysmenorrhea.
Therefore, it is necessary to formulate strategies and health policies to recover psychological issues of menstrual
health.

Weak Hand Grip Strength Is Associated with Alexithymia in Outpatients in a Mexican Population

Hand grip strength has been considered as a possible marker for metabolic and psychiatric disease. To date, however, no research has focused on the association between alexithymia and hand grip strength. The objective of the present study was to investigate the correct association between hand grip strength and alexithymia. A cross-sectional study was carried out in Comalcalco, Tabasco, México. A total of 246 individuals were included. Hand grip strength was evaluated in the dominant hand using a Takei^® portable digital dynamometer. Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20). Two linear regression models adjusted by confounders were used to determine the association between alexithymia and hand grip strength. The rate for positive alexithymia was 39.0% (n = 94). Individuals with alexithymia showed a weaker hand grip strength than the comparison group (t = 2.4, 244 df, p = 0.01). Individuals with alexithymia had significantly reduced levels of hand grip strength (β = −0.39 ± 0.14; p = 0.006); after additional adjustment for clinical variables, decreased hand grip strength remained (β = 8.00 ± 1.86; p ≤ 0.001). Our results suggest that a decrease in hand grip strength could be associated with alexithymia. This measurement could be useful as a predictive marker for the identification of alexithymia in Mexican individuals who attend outpatient clinics.

Evaluation of alexithymia in individuals with chronic pain in a Mexican population: Alexithymia in a Mexican population

INTRODUCTION

Alexithymia is the difficulty in identifying and describing feelings. Several studies have suggested that chronic pain can be linked to alexithymia. The aims of this study were to determine the presence of alexithymia in a sample of Mexican individuals who attended public health services, to assess if alexithymia is higher in medically ill individuals with pain than in those without pain, and to determine which alexithymia dimensions are more affected by the presence of pain.

METHODS

Demographic and clinical features were evaluated in 250 Mexican outpatients of the General Hospital of Comalcalco, Tabasco. Pain was evaluated using the Visual Analogue Scale for Pain Assessment (VAS-P) and alexithymia was evaluated using the Toronto Alexithymia Scale (TAS-20).

RESULTS

38.8% of the sample was identified with probable/definite alexithymia and up to 61.2% of individuals were currently experiencing pain. Individuals with pain exhibited higher scores in the TAS-20 dimensions: difficulty describing feelings (p = 0.02), difficulty identifying feelings (p < 0.001) and higher total TAS-20 score (p < 0.001). Also, Probable/definite alexithymia was more frequently reported in individuals with pain (49% vs. 21.6%, p < 0.001).

CONCLUSIONS

Our results show that a large proportion of individuals who attend public health services in a Mexican population present pain. We also identified that pain could be associated with alexithymia, in particular with a difficulty in describing and identifying feelings. An early identification and treatment of alexithymia could help in reducing the clinical burden of chronic pain in Mexican outpatients.

Personality and Cognitive-Emotional Variables in Spanish Children and Adolescents With and Without Cleft Lip and/or Palate

OBJECTIVES

To analyze personality (Big Five Model) and cognitive-emotional variables in children and adolescents with a cleft lip/palate (s) in comparison to an equivalent peer sample without an orofacial cleft.

DESIGN

Cross-sectional study with data collected using self-reported questionnaires over 2 years.

SETTING

Data were collected during visits to health center dental clinics.

PATIENTS

Children and adolescents (aged 8-18 years) with nonsyndromic CL/P (n = 60) and without a cleft (n = 60).

METHOD

Patients completed questionnaires with assistance as needed from a member of the research team.

MAIN OUTCOME MEASURES

Children's Perceived Self-Efficacy, Cognitive Emotion Regulation Questionnaire (child version), Big Five Questionnaire for Children, and Alexithymia Questionnaire for Children.

RESULTS

When accounting for age, children with CL/P had normative self-efficacy and cognitive-emotional regulation strategies, with the protective factor of significantly lower rumination than peers. Children with CL/P were significantly lower on the Big Five personality areas of conscientiousness, openness to experience, extraversion, and agreeableness along with significantly higher neuroticism. They were similarly significantly higher than peers for alexithymia.

CONCLUSION

Children with CL/P showed strengths in self-efficacy typical of peers and less use of some maladaptive coping strategies; however, they also had higher levels of alexithymia and risk factors associated with the Big Five Model of personality. Strategies may be clinically useful that maximize areas of strength to support children with CL/P in expressing their emotions to reduce alexithymia, coping with of negative affect, and building assertiveness.