General self-efficacy and social support in men and women with pain - irregular sex patterns of cross-sectional and longitudinal associations in a general population sample

Causal Relationship Between Psychosocial Factors and Neck Pain: A Two-Sample Mendelian Randomization Study

Purpose

Neck pain (NP) is a multifactorial disorder that leads to severe disability. This study aimed to investigate whether potential risk factors have a causal effect on NP at the genetic level using a two-sample Mendelian randomization (MR) analysis.

Methods

Summary-level data for potential risk factors, including distress, anxiety disorder, depression, mood, sleep disorder, loneliness, education, alcohol consumption, smoking, time spent using the computer, and physical activity, as well as NP, were obtained from multiple large-scale Genome-Wide Association Studies (GWAS). Instrumental variables (IVs) were extracted from these datasets. We employed inverse variance weighting (IVW), weighted median, and MR-Egger regression methods to assess causal effects. Heterogeneity was evaluated using MR-Egger regression and IVW, while horizontal pleiotropy was assessed using MR-PRESSO analysis and MR-Egger regression.

Results

The IVW results showed that major depressive disorder (OR = 1.51, 95% CI: 1.15, 1.98, p = 3.40×10-3) and experiencing mood swings (OR = 2.73, 95% CI: 1.57, 4.75, p = 3.86×10-4) were positively associated with NP and years of schooling (OR = 0.504, 95% CI: 0.410, 0.619, p = 6.55×10-11) was negatively associated with NP. Additionally, loneliness (OR = 16.0, 95% CI: 1.29-198, p = 0.0307) showed a suggestive association with NP. As for the other factors we did not find a clear causal relationship (All p-values > 0.05).

Conclusion

This two-sample MR study provides genetic evidence supporting a causal relationship between major depressive disorder, mood swings, and years of schooling with NP, while loneliness showed a potential association. These findings highlight the critical role of psychosocial factors, such as depression, mood swings, and education level, in the prevention and management of NP. Our results may offer new insights for clinicians to develop targeted intervention strategies aimed at reducing the incidence of NP.

Sex Differences in the Association between Social Support and Major Depression: A Mediation Analysis with Interoception Mediator

Background

Social support is recognized as a critical factor in both the prevention and management of Major depression Disorder (MDD), and can influence interoceptive processes. The mechanism of sex differences in the association between social support and MDD has not been clarified. This study was to elucidate the mechanism of sex differences in the association between social support and MDD by a mediation analysis with interoception mediator.

Methods

Participants included 390 depressed patients (male/female: 150/240). Social Support Rating Scale (SSRS) was used to assess the degree of social support; Multidimensional Assessment of Interoceptive Awareness (MAIA-2C) was used to evaluate the interoception; Patient Health Questionnaire-9 (PHQ-9) was used to assess depression status. The pairwise correlated variables were put into the mediation model for the mediation analysis.

Results

The depression status in female depressed patients was more severity than that in male depressed patients, while the social support in female depressed patients was less than that in male depressed patients. In male depressed patients, the Noticing of MAIA-2C plays a partial mediating role in social support and depression status, however, in female depressed patients, the Self-Regulation and Trusting of MAIA-2C plays a partial mediating role in social support and depression status.

Conclusions

The female depressed patients receive significantly less social support than male counterparts, contributing to more severe symptoms, with the quality and adequacy of social support being crucial due to its mediation by interoception, highlighting a biological mechanism behind MDD. Differences in how interoception mediating role between genders suggest a physiological reason for the heightened severity of depressive symptoms in females.

Sex-related differences in self-efficacy in patients with heart failure: a pooled cross-sectional study of the German Competence Network Heart Failure

AIMS

To assess the level of self-efficacy in patients with heart failure (HF), identify differences between important subgroups including sex, and identify the determinants of high self-efficacy.

METHODS AND RESULTS

This was a pooled cross-sectional analysis of 2030 patients from 4 prospective studies conducted within the German Competence Network Heart Failure. We used the self-efficacy subscale and the overall summary score (OSS) of the Kansas City Cardiomyopathy Questionnaire (KCCQ-23) to assess self-efficacy and health-related quality of life. The cut-off of 75 score points was used for the dichotomization into high (≥75) vs. low (<75) self-efficacy. Depressive symptoms were measured by the Patient Health Questionnaire (PHQ-9). A total of 1615 patients with HF provided complete self-efficacy scores: mean age 66.6 ± 12.3 years and 431 (27%) women. The mean self-efficacy score was 67.5 ± 24.9, with 907 patients (56.2%) showing high self-efficacy and 708 patients (43.8%) showing low self-efficacy. Men had higher self-efficacy scores than women (68.7 ± 24.5 vs. 64.2 ± 26.0; P = 0.001). Multivariable logistic regression identified the KCCQ-OSS [odds ratio (OR) per five-point increase 1.08, 95% confidence interval (CI) 1.04-1.12], female sex (OR 0.72, 95% CI 0.56-0.94), depressive symptoms (OR per three-point increase in PHQ-9 0.90, 95% CI 0.83-0.98), and acute HF (OR 0.46, 95% CI 0.34-0.62) as important predictors of high self-efficacy.

CONCLUSION

In patients with HF, women seemed to exhibit lower self-efficacy than men. Health-related quality of life and psychological well-being were dominant determinants of self-efficacy. Future studies should investigate the role of self-efficacy as a therapeutic target for tailored and sex-specific nursing interventions.

Differential effects of everyday-life social support on chronic pain

BACKGROUND

Social support is a multidimensional construct encompassing emotional support as well as pain-focused care and attention, also known as solicitous support. One the one hand, social support is widely believed to positively influence pain symptoms, their intensity, and the ability to cope and influence pain. On the other hand, social support can be negative if it conflicts with the patient's needs or even causes discomfort. How different types of social support influence pain is not very well understood especially because most of the present research originates from laboratory studies, raising uncertainties about its generalizability to the everyday life of individuals with chronic pain.

METHODS

Here, we tested the effects of emotional, solicitous, and negative social support on pain intensity cross-sectionally in everyday life. We collected data from 20 patients with acute complex regional pain syndrome using a smartphone-based Ecological Momentary Assessment with up to 30 survey prompts over a period of five consecutive days.

RESULTS

Our results showed that solicitous social support decreased pain, in particular in male patients. Emotional support was beneficial on pain in women but not in men.

CONCLUSIONS

Taken together, these findings highlight the differential effects of social support in every-day life on chronic pain.

Pain medication tapering for patients with Persistent Spinal Pain Syndrome Type II, treated with Spinal Cord Stimulation: A RCT-study protocol of the PIANISSIMO study

BACKGROUND

Spinal Cord Stimulation (SCS) may provide pain relief in patients with therapy-refractory Persistent Spinal Pain Syndrome Type II (PSPS-T2). Despite the evidence that SCS can reduce disability and reduce pain medication usage, only 25% of the patients is able to completely omit pain medication usage after 12 months of SCS. To tackle the high burden of patients who consume a lot of pain medication, tapering programs could be initiated before starting a trajectory with SCS. The current objective is to examine whether a pain medication tapering program before SCS alters disability in PSPS-T2 patients compared to no tapering program.

METHODS AND DESIGN

A three-arm, parallel-group multicenter randomized controlled trial will be conducted including 195 patients who will be randomized (1:1:1) to either (a) a standardized pain medication tapering program, (b) a personalized pain medication tapering program, or (c) no tapering program before SCS implantation, all with a follow-up period until 12 months after implantation. The primary outcome is disability. The secondary outcomes are pain intensity, health-related quality of life, participation, domains affected by substance use, anxiety and depression, medication usage, psychological constructs, sleep, symptoms of central sensitization, and healthcare expenditure.

DISCUSSION

Within the PIANISSIMO project we propose a way to reduce the risks of adverse events, medication-induced hyperalgesia, tolerance, and dependence by providing pain medication tapering before SCS. Due to the lack of a commonly accepted in-hospital tapering approach, two different tapering programs will be evaluated in this study. If pain medication tapering programs are deemed to be more effective than no tapering on disability, this would add to the evidence towards an improved patient-centered care model in this patient group and set a clear path to advocate for pain medication tapering before SCS as the new standard treatment guideline for these patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05861609. Registered on May 17, 2023.

Validation of the Chinese version of the Oslo-3 Social Support Scale among nursing students: a study based on Classical Test Theory and Item Response Theory models

BACKGROUND

Nursing students are encountering a range of health issues. Assessing social support is a key component in most questionnaire surveys related to health status, aiming to investigate the relationships and mechanisms between health status and social support to enhance overall health. Therefore, it is essential to seek out appropriate instruments to evaluate social support for nursing students. The Oslo-3 Social Support Scale (OSSS-3) is a reliable and concise instrument for evaluating social support. To date, there have been no studies validating the OSSS-3 based on Item Response Theory (IRT) models. Also, an officially validated Chinese version has not been found. The current research intended to verify the Chinese version of the OSSS-3.

METHODS

The OSSS-3 was translated into Chinese and culturally adapted. Subsequently, the OSSS-3 was validated by employing the Classical Test Theory (CTT) and IRT models.

RESULTS

The split-half reliability was 0.622. The Cronbach's α coefficient was 0.687. The correlations between each item and total scores varied from 0.723 to 0.835. The retest coefficient was 0.907. The content validity index was 0.933. A single common factor was extracted and accounted for 61.559% of the variance. The item loading values on the single factor were between 0.743 and 0.814. The communalities were between 0.552 and 0.663. There was no variance between males and females (P = 0.055). The difference in scores between the top (30%) and bottom (30%) groups attained significance. IRT models results revealed that the discrimination parameters ranged from 1.39 to 2.33 and difficulty parameters increased monotonically.

CONCLUSION

The OSSS-3 demonstrates satisfying psychometric properties and is a proper instrument for measuring social support in Chinese nursing students.

Exploring downstream effects of gender roles in healthcare decision-making and relationships within systems: A cross-sectional analysis of openness to treatment in pediatric headache

OBJECTIVE

Socio-culturally defined identity factors present significant and often understudied influences on the experience, management, and treatment of chronic pain. For instance, there exist societal narratives about how males and females are expected to experience and express pain. Such gender roles may impact youth and caregiver openness to individual multidisciplinary treatments for pediatric headache.

METHODS

In this cross-sectional study, participants (N = 1087 youth/caregiver dyads, Mage = 14.5 years, 71% female, 97% cisgender, 77% White) completed a series of questionnaires, including Openness to Headache Treatment (OHT), upon presenting for initial multidisciplinary evaluation of chronic headache. Pearson correlations, independent samples t-tests and hierarchical regressions were used to analyze potential gender differences in youth and caregiver openness, as well as its relationships with pain-related and psychological factors.

RESULTS

Overall, female youth and their caregivers were more open to headache treatment, broadly and for individual interventions, when compared to male counterparts. Caregiver distress related to their child's headaches (i.e., fear and avoidance) was significantly correlated with openness in female youth and their caregivers, but not males.

CONCLUSION

Gendered patterns in healthcare decision-making in youth and caregivers provide insight on individual, societal, and systemic gender bias.

The influence of cultural and religious factors on cross-national variations in the prevalence of chronic back and neck pain: an analysis of data from the global burden of disease 2019 study

Introduction

Low back pain and neck pain are among the most commonly reported forms of chronic pain worldwide, and are associated with significant distress, disability and impairment in quality of life. Though these categories of pain can be analyzed and treated from a biomedical perspective, there is evidence that they are both related to psychological variables such as depression and anxiety. The experience of pain can be significantly influenced by cultural values. For example, cultural beliefs and attitudes can influence the meaning attached to the experience of pain, the responses of others to a sufferer's pain, and the likelihood of seeking medical care for particular symptoms. Likewise, religious beliefs and practices can influence the both experience of pain and the responses to it. These factors have also been associated with variations in the severity of depression and anxiety.

Methods

In the current study, data on the estimated national prevalence of both low back pain and neck pain, obtained from the 2019 Global Burden of Disease Study (GBD 2019), is analyzed in relation to cross-national variations in cultural values, as measured using Hofstede's model (n =115 countries) and in religious belief and practice, based on the most recent Pew Research Center survey (n = 105 countries). To address possible confounding factors, these analyses were adjusted for variables known to be associated with chronic low back or neck pain, namely smoking, alcohol use, obesity, anxiety, depression and insufficient physical activity.

Results

It was found that the cultural dimensions of Power Distance and Collectivism were inversely correlated with the prevalence of chronic low back pain, and Uncertainty Avoidance was inversely correlated with the prevalence of chronic neck pain, even after adjustment for potential confounders. Measures of religious affiliation and practice were negatively correlated with the prevalence of both conditions, but these associations were not significant after adjusting for cultural values and confounders.

Discussion

These results highlight the existence of meaningful cross-cultural variations in the occurrence of common forms of chronic musculoskeletal pain. Psychological and social factors that could account for these variations are reviewed, along with their implications for the holistic management of patients with these disorders.