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Emrich M, Gnall KE, Garnsey CL, George JR, Park CL, Mazure CM, Hoff RA. Associations of Posttraumatic Stress Disorder Symptom Clusters and Pain Interference in Post-9/11 Veterans: Exploring Sleep Impairment and Physical Activity as Underlying Mechanisms. Int J Behav Med 2024:10.1007/s12529-024-10268-4. [PMID: 38438749 DOI: 10.1007/s12529-024-10268-4] [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] [Accepted: 02/04/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) symptoms and pain are highly prevalent and comorbid, particularly in veterans, but mechanisms explaining their linkage remain unclear. The aims of this study were to determine: (1) whether sleep impairment and physical activity (PA) mediate relations between PTSD symptoms and pain interference (assessed both longitudinally and as residual change) and (2) the unique roles of each PTSD symptom cluster in those relationships. METHODS The present study is a secondary analysis of a longitudinal observational investigation of 673 post-9/11 veterans (45.8% women). Surveys were administered at baseline and 3-month and 6-month follow-ups. RESULTS PTSD symptoms were significantly associated with pain interference longitudinally and worsening pain interference over time. Sleep impairment, but not PA, significantly mediated the relationship between PTSD symptoms and subsequent pain interference. Hyperarousal symptoms were found to be the primary driver of the relationship between PTSD symptoms and pain interference and re-experiencing symptoms were associated with change in pain interference via sleep impairment. Men and women did not differ on any of the study variables with the exception of PA. CONCLUSION Findings underscore the importance of targeting sleep as a key modifiable health factor linking PTSD symptoms to pain interference in post-9/11 veterans.
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Affiliation(s)
- Mariel Emrich
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA.
| | - Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Camille L Garnsey
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Jamilah R George
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT, USA
| | - Rani A Hoff
- Northeast Program Evaluation Center (NEPEC), VA Connecticut Healthcare System, West Haven, CT, USA
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2
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Wu CH, Chou WH, Long YH, Yang HH, Lin T, Yang CC, Sun WZ, Chen CC, Lin CP. Development of the Chronic Pain Cognition Scale: A Culture-Sensitive Pain Measurement in Chinese. J Pain Res 2023; 16:3075-3084. [PMID: 37701561 PMCID: PMC10493149 DOI: 10.2147/jpr.s422197] [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: 06/09/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose People with pain problems are highly vulnerable to cultural disparities, and it is imperative to reduce these inequalities. This cross-sectional study aimed to develop a culturally sensitive Chronic Pain Cognition Scale (CPCS) for Chinese-/Chinese dialect-speaking populations and investigate its psychometric properties. Patients and Methods Adult patients with chronic low back pain or chronic neck pain who visited pain clinics at a medical center in northern Taiwan were enrolled. Participants completed the demographic, intensity of pain, and two other related sensations, "Sng ()" and "Ma ()", often reported in Chinese-speaking populations, CPCS, Chronic Pain Acceptance Questionnaire-8, and Pain Self-Efficacy Questionnaire. Results 200 patients were included. Patients' mean age was 64.84 ± 14.33, 126 (63.0%) were female, and 83 (41.5%) had 13+ years of education. The average duration of pain was 77.25 ± 97.46 months, the intensity of pain was 6.04 ± 2.50, Ma was 3.43 ± 3.24, and Sng was 4.54 ± 3.14. The CPCS comprised four factors: pain impact (how pain impact one's life), losing face (how one being disrespected due to pain), helplessness, and avoidance, with good structural validity and adequate reliability (Cronbach α, 0.60-0.81) and satisfactory criterion-related validity. Moreover, losing face, an essential concept in Chinese relationalism, was significantly related to pain, Sng, and Ma (r = 0.19, 0.15 and 0.16), but not to pain acceptance or self-efficacy, indicating a culturally specific element in pain measurement. Conclusion The CPCS has good psychometric properties and is suitable for evaluating chronic pain in the clinical setting, and might be generalizable to other Chinese-/Chinese dialect-speaking populations.
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Affiliation(s)
- Chih-Hsun Wu
- Department of Psychology, National Chengchi University, Taipei, Taiwan
- Clinical Psychology Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Han Chou
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsun Long
- Clinical Psychology Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Hao-Han Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Tung Lin
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Chi-Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
- Holistic Mental Health Center, Taipei City Hospital, Taipei, Taiwan
| | - Wei-Zen Sun
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Cheng Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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3
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Mordeno IG, Gallemit IMJS, Ferolino MAL, Sinday JV. DSM-5-Based ASD Models: Assessing the Latent Structural Relations with Functionality in War-Exposed Individuals. Psychiatr Q 2021; 92:347-362. [PMID: 32748123 DOI: 10.1007/s11126-020-09804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is a dearth of studies investigating the latent structure of Acute Stress Disorder (ASD) following the changes in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). To date, there is no consensus on the best representation of ASD. This study addressed this gap by examining four latent ASD models in a sample of war-exposed individuals (N = 424). Investigation on the relationship of the best-fitting model to functionality in the latent level was also conducted. The five-factor model, composed of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal factors, yielded the best-fitting model. Latent associations between the factors of the model and functionality suggest that symptoms of functionality do not significantly affect the factor structure of ASD. These findings have implications for understanding the underlying mechanism of ASD and can inform the development of more nuanced trauma-related interventions, particularly addressing ASD symptoms and functionality separately.
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Affiliation(s)
- Imelu G Mordeno
- Department of Professional Education, Mindanao State University - Iligan Institute of Technology, Andres Bonifacio Ave., Tibanga, 9200, Iligan City, Philippines.
| | - I Marie Joy S Gallemit
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Michelle Anne L Ferolino
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
| | - Jonahliza V Sinday
- School of Graduate Studies, College of Education, Mindanao State University - Iligan Institute of Technology, Iligan City, Philippines
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4
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Van Tu P, Ngoc TU, Nguyen PL, Thuong NH, Van Tuan N, Van Hung N, Nga VT, Van Quan T, Lam LT, Chu DT. The impact of sexual harassment on obesity in female adolescents: An update and perspective to control. Diabetes Metab Syndr 2020; 14:1931-1939. [PMID: 33038851 DOI: 10.1016/j.dsx.2020.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Sexual victimization, happened during childhood and beyond, is known to be a substantial contributing factor for obesity development later in life. This work aims to bring about updated information on the relationship between sexual harassment and obesity. METHODS Based on an intensive scientific literature review in Google Scholar, Pubmed databases, the total of 106 studies (N = 141,199) were assessed including 52 studies on the connection between negative lifetime impacts and obesity, 11 studies on post-traumatic stress disorder (PTSD) symptoms with proposed biological mechanisms related to obesity, 15 studies on the relationship between major depressive disorder (MDD) symptoms and obesity, 11 studies on the body dismorphic disorder (BDD) and 17 studies on the binge eating disorder (BED) were also examined to evaluate the association of obesity and traumatic life experiences. RESULTS Although 40-70% of all cases related to obesity have been considered to be hereditary, many experts argue that deviations in the environment contribute to excessive food intake and depressed physical activity in numerous Western countries. Several studies have identified that childhood sexual abuse (CSA) may be nearly as common as obesity. However, just a few researchers have taken notice of the possible connection between these two. CONCLUSIONS By mentioning some possible obesity-related psychological disorders in response to CSA, we present updated information on the relationship between sexual harassment and obesity.
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Affiliation(s)
- Pham Van Tu
- Faculty of Social Work, Hanoi National University of Education, Hanoi, Viet Nam
| | - Tran Uyen Ngoc
- Department of Animal Sciences, Wageningen University & Research, Wageningen, Netherlands
| | | | - Nguyen Hiep Thuong
- Faculty of Social Work, Hanoi National University of Education, Hanoi, Viet Nam
| | | | - Nguyen Van Hung
- National Center for Special Education, the Vietnam National Institute of Educational Sciences, Hanoi, Viet Nam
| | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, Danang, Viet Nam
| | | | - Le Thi Lam
- University of Science and Education - the University of Da Nang, Viet Nam
| | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Viet Nam.
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5
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Devlin A, Casey S, Williams S, Giummarra MJ. Association of fear-avoidance and self-efficacy on pain disability in individuals with co-morbid post-traumatic stress and chronic pain. J Health Psychol 2020; 27:188-198. [DOI: 10.1177/1359105320947819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated relationships between post-traumatic stress symptoms (PTSS) and pain disability. Fifty people with chronic pain (probable PTSD, n = 22) completed measures assessing pain interference, PTSS, fear avoidance, and pain self-efficacy. We hypothesized that people with probable PTSD would have higher fear avoidance and lower pain self-efficacy; and that PTSS would be indirectly associated with pain disability via fear avoidance and self-efficacy. People with probable PTSD had higher fear avoidance, but there were no differences in self-efficacy, pain severity or disability. There was an indirect association between PTSS and pain disability via fear avoidance, but not via self-efficacy.
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Affiliation(s)
- Anna Devlin
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
- Psychology Department, Epworth HealthCare, Melbourne, Australia
| | - Sara Casey
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Scott Williams
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Melita J Giummarra
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Melbourne, Australia
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6
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Do post-traumatic pain and post-traumatic stress symptomatology mutually maintain each other? A systematic review of cross-lagged studies. Pain 2019; 159:2159-2169. [PMID: 29994992 DOI: 10.1097/j.pain.0000000000001331] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
After traumatic exposure, individuals are at risk of developing symptoms of both pain and post-traumatic stress disorder (PTSD). Theory and research suggest a complex and potentially mutually maintaining relationship between these symptomatologies. However, findings are inconsistent and the applied methods are not always well suited for testing mutual maintenance. Cross-lagged designs can provide valuable insights into such temporal associations, but there is a need for a systematic review to assist clinicians and researchers in understanding the nature of the relationship. Thus, the aim of this systematic review was to identify, critically appraise, and synthesize results from cross-lagged studies on pain and PTSD symptomatology to assess the evidence for longitudinal reciprocity and potential mediators. Systematic searches resulted in 7 eligible studies that were deemed of acceptable quality with moderate risk of bias using the cohort study checklist from Scottish Intercollegiate Guidelines Network. Furthermore, synthesis of significant pathways in the cross-lagged models showed inconsistent evidence of both bidirectional and unidirectional interaction patterns between pain and PTSD symptomatology across time, hence not uniformly supporting the theoretical framework of mutual maintenance. In addition, the synthesis suggested that hyperarousal and intrusion symptoms may be of particular importance in these cross-lagged relationships, while there was inconclusive evidence of catastrophizing as a mediator. In conclusion, the findings suggest an entangled, but not necessarily mutually maintaining relationship between pain and PTSD symptomatology. However, major variations in findings and methodologies complicated synthesis, prompting careful interpretation and heightening the likelihood that future high-quality studies will change these conclusions.
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7
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Herbert MS, Malaktaris AL, Dochat C, Thomas ML, Wetherell JL, Afari N. Acceptance and Commitment Therapy for Chronic Pain: Does Post-traumatic Stress Disorder Influence Treatment Outcomes? PAIN MEDICINE 2019; 20:1728-1736. [DOI: 10.1093/pm/pny272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractObjectiveThe aim of this study was to determine whether post-traumatic stress disorder (PTSD) moderates treatment outcomes in Acceptance and Commitment Therapy for chronic pain.DesignLongitudinal.SettingVeterans Affairs San Diego Healthcare System.SubjectsA total of 126 veterans with chronic pain participating in an Acceptance and Commitment Therapy intervention for chronic pain. A structured clinical interview was used at baseline to designate PTSD-positive (N = 43) and -negative groups (N = 83).MethodsLinear mixed-effects models to determine whether PTSD moderated change in pain interference, pain severity, pain acceptance, depressive symptoms, or pain-related anxiety at post-treatment and six-month follow-up.ResultsParticipants with co-occurring PTSD reported greater pain interference, pain severity, depressive symptoms, and pain-related anxiety at baseline. PTSD status did not moderate treatment effects post-treatment. Rather, there were significant improvements on all study measures across groups (P < 0.001). PTSD status moderated change in depressive symptoms at six-month follow-up (P < 0.05). Specifically, participants with chronic pain alone demonstrated improvement in depressive symptoms compared with pretreatment levels, whereas participants with PTSD regressed to pretreatment levels.ConclusionsPTSD status did not significantly affect treatment outcomes, with the exception of depressive symptoms at six-month follow-up. Overall, Acceptance and Commitment Therapy for chronic pain appears helpful for improving outcomes among veterans with co-occurring PTSD; however, veterans with co-occurring PTSD may experience fewer long-term gains compared with those with chronic pain alone.
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Affiliation(s)
- Matthew S Herbert
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, California
| | - Anne L Malaktaris
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, California
| | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Michael L Thomas
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California
- Department of Psychiatry, University of California, San Diego, California
| | - Julie Loebach Wetherell
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, California
| | - Niloofar Afari
- Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California
- VA San Diego Healthcare System, San Diego, California
- Department of Psychiatry, University of California, San Diego, California
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8
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Gaffey AE, Burns JW, Aranda F, Purim-Shem-Tov YA, Burgess HJ, Beckham JC, Bruehl S, Hobfoll SE. Social support, social undermining, and acute clinical pain in women: Mediational pathways of negative cognitive appraisal and emotion. J Health Psychol 2018; 25:2328-2339. [PMID: 30146929 DOI: 10.1177/1359105318796189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Women may be disproportionately vulnerable to acute pain, potentially due to their social landscape. We examined whether positive and negative social processes (social support and social undermining) are associated with acute pain and if the processes are linked to pain via negative cognitive appraisal and emotion (pain catastrophizing, hyperarousal, anger). Psychosocial variables were assessed in inner-city women (N = 375) presenting to an Emergency Department with acute pain. The latent cognitive-emotion variable fully mediated social undermining and support effects on pain, with undermining showing greater impact. Pain may be alleviated by limiting negative social interactions, mitigating risks of alternative pharmacological interventions.
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Affiliation(s)
- Allison E Gaffey
- Yale School of Medicine, USA.,Rush University Medical Center, USA
| | | | | | | | | | - Jean C Beckham
- Duke University School of Medicine, USA.,Durham VA Health Care System, USA
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9
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Ravn SL, Vaegter HB, Cardel T, Andersen TE. The role of posttraumatic stress symptoms on chronic pain outcomes in chronic pain patients referred to rehabilitation. J Pain Res 2018; 11:527-536. [PMID: 29563832 PMCID: PMC5848846 DOI: 10.2147/jpr.s155241] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Posttraumatic stress symptoms (PTSS) are highly prevalent in chronic pain patients and may affect pain symptomatology negatively, but there is still a great need to explore exactly how this occurs. Therefore, this study investigated differences in pain intensity, pain-related disability, and psychological distress between chronic pain patients not exposed to a trauma, patients exposed to a trauma with no PTSS, and patients exposed to a trauma with PTSS. Moreover, the moderating effects of PTSS on the associations between pain intensity and pain-related disability and psychological distress were investigated. Methods In this cross-sectional cohort study, data were consecutively collected over the course of a year in patients with chronic non-malignant pain referred for multidisciplinary pain rehabilitation at a Danish university hospital pain center using questionnaires assessing pain, pain-related disability, PTSS, anxiety, and depression. Results The final sample consisted of 682 chronic pain patients, who were divided into three subgroups (no trauma, 40.6%; trauma/no PTSS, 40.5%; trauma/PTSS, 18.9%). Chronic pain patients with PTSS reported significantly higher levels of pain intensity, pain-related disability, depression, and anxiety compared to chronic pain patients without a trauma and chronic pain patients without PTSS. Moreover, PTSS significantly moderated the associations between pain intensity and pain-related psychosocial disability, depression, and anxiety. Conclusion These results highlight the importance of assessing PTSS in chronic pain patients and suggest that PTSS have a specific influence on the association between pain intensity and more psychosocial aspects of the pain condition.
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Affiliation(s)
- Sophie Lykkegaard Ravn
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,The Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
| | - Henrik Bjarke Vaegter
- Pain Research Group, Pain Center South, Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Cardel
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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10
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Ravn S, Sterling M, Lahav Y, Andersen T. Reciprocal associations of pain and post-traumatic stress symptoms after whiplash injury: A longitudinal, cross-lagged study. Eur J Pain 2018; 22:926-934. [DOI: 10.1002/ejp.1178] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/10/2022]
Affiliation(s)
- S.L. Ravn
- Department of Psychology; University of Southern Denmark; Odense M Denmark
- Specialized Hospital for Polio and Accident Victims; Rødovre Denmark
| | - M. Sterling
- Recover Injury Research Centre; NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries; The University of Queensland; Brisbane Qld Australia
| | - Y. Lahav
- Department of Psychology; University of Southern Denmark; Odense M Denmark
- I-Core Research Center for Mass Trauma; Tel Aviv Israel
| | - T.E. Andersen
- Department of Psychology; University of Southern Denmark; Odense M Denmark
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11
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Langford DJ, Theodore BR, Balsiger D, Tran C, Doorenbos AZ, Tauben DJ, Sullivan MD. Number and Type of Post-Traumatic Stress Disorder Symptom Domains Are Associated With Patient-Reported Outcomes in Patients With Chronic Pain. THE JOURNAL OF PAIN 2018; 19:506-514. [PMID: 29307748 DOI: 10.1016/j.jpain.2017.12.262] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 12/05/2017] [Accepted: 12/13/2017] [Indexed: 11/30/2022]
Abstract
Post-traumatic stress disorder (PTSD) commonly accompanies complex chronic pain, yet PTSD is often overlooked in chronic pain management. Using the 4-item Primary Care (PC)-PTSD screening tool, we evaluated the relationship between the number and type of PC-PTSD symptoms endorsed and a set of patient-reported outcomes, including: pain intensity and interference, function, mood, quality of life, and substance abuse risk in a consecutive sample of patients with chronic pain (n = 4,402). Patients completed PainTracker, a Web-based patient-reported outcome tool that provides a multidimensional evaluation of chronic pain, as part of their intake evaluation at a specialty pain clinic in a community setting. Twenty-seven percent of the sample met PC-PTSD screening criteria for PTSD by endorsing 3 of the 4 symptom domains. Significant ordinal trends were observed between increasing number of PTSD symptoms and all outcomes evaluated. The occurrence of even 1 PTSD symptom was associated with overall poorer outcomes, suggesting that subsyndromal PTSD is clinically significant in the context of chronic pain. Among the 4 PTSD domains assessed, "numbness/detachment" was most strongly associated with negative pain outcomes in relative weight analysis. Results from this cross-sectional study suggest that a range of pain-related outcomes may be significantly related to comorbid PTSD. PERSPECTIVE We present evidence that PTSD symptoms are significantly related to a broad set of pain-related patient-reported outcomes. These findings highlight the need to evaluate for PTSD symptoms in patients with chronic pain, especially feelings of numbness or detachment from others, to improve understanding and management of chronic pain.
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Affiliation(s)
- Dale J Langford
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington.
| | - Brian R Theodore
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Danica Balsiger
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Christine Tran
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Ardith Z Doorenbos
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - David J Tauben
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Mark D Sullivan
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
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12
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Co-occurrence of posttraumatic stress symptoms, pain, and disability 12 months after traumatic injury. Pain Rep 2017; 2:e622. [PMID: 29392235 PMCID: PMC5777683 DOI: 10.1097/pr9.0000000000000622] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/29/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. This study showed that PTSD is associated with worse pain and disability at 12 months after traumatic injury. The associations between PTSD criterion symptoms and pain outcomes highlight the likely occurrence of shared mechanisms, particularly between the experience of severe pain, hyperarousal, avoidance, and cognitive appraisals of stress or pain. New efforts are required to develop and validate interventions that can effectively treat comorbid pain and PTSD to prevent their long-term impacts on psychological wellbeing and socioeconomic position. Introduction: Chronic pain is common after traumatic injury and frequently co-occurs with posttraumatic stress disorder (PTSD) and PTSD symptoms (PTSS). Objectives: This study sought to understand the association between probable PTSD, PTSS, and pain. Methods: Four hundred thirty-three participants were recruited from the Victorian Orthopaedic Trauma Outcomes Registry and Victorian State Trauma Registry and completed outcome measures. Participants were predominantly male (n = 324, 74.8%) and aged 17-75 years at the time of their injury (M = 44.83 years, SD = 14.16). Participants completed the Posttraumatic Stress Disorder Checklist, Brief Pain Inventory, Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, Tampa Scale of Kinesiophobia, EQ-5D-3L and Roland-Morris Disability Questionnaire 12 months after hospitalization for traumatic injury. Data were linked with injury and hospital admission data from the trauma registries. Results: Those who reported having current problems with pain were 3 times more likely to have probable PTSD than those without pain. Canonical correlation showed that pain outcomes (pain severity, interference, catastrophizing, kinesiophobia, self-efficacy, and disability) were associated with all PTSSs, but especially symptoms of cognition and affect, hyperarousal, and avoidance. Posttraumatic stress disorder symptoms, on the contrary, were predominantly associated with high catastrophizing and low self-efficacy. When controlling for demographics, pain and injury severity, depression, and self-efficacy explained the greatest proportion of the total relationship between PTSS and pain-related disability. Conclusion: Persons with both PTSS and chronic pain after injury may need tailored interventions to overcome fear-related beliefs and to increase their perception that they can engage in everyday activities, despite their pain.
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13
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Kroska EB. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain. Scand J Pain 2016; 13:43-58. [DOI: 10.1016/j.sjpain.2016.06.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 01/14/2023]
Abstract
Abstract
Background
The fear-avoidance model of chronic pain has established avoidance as a predictor of negative outcomes in chronic pain patients. Avoidance, or deliberate attempts to suppress or prevent unwanted experiences (e.g., pain), has been studied extensively, with multiple reviews implicating this behavior as a predictor of disability, physical disuse, and depression. Despite hundreds of studies examining the associations between different components of this model (i.e., catastrophizing, fear, avoidance, depression), the association between fear-avoidance and pain intensity has remained unclear. The present study seeks to clarify this association across samples.
Method
The present analyses synthesize the literature (articles from PsycInfo, PubMed, and ProQuest) to determine if fear-avoidance and pain intensity are consistently correlated across studies, samples, and measures. Eligible studies measured pain intensity and fear-avoidance cross-sectionally in chronic pain patients. The search resulted in 118 studies eligible for inclusion. A random-effects model was used to estimate the weighted mean effect size. Comprehensive Meta-Analysis software was used for all analyses. Moderation analyses elucidate the variables that affect the strength of this association. Meta-regression and meta-ANOVA analyses were conducted to examine moderating variables. Moderator variables include demographic characteristics, pain characteristics, study characteristics, and national cultural characteristics (using Hofstede’s cultural dimensions). Publication bias was examined using the funnel plot and the p-curve.
Results
Results indicate a small-to-moderate positive association between fear-avoidance and pain intensity. The results were stable across characteristics of the sample, including mean age, gender distribution, marital status, and duration of pain. Moderation analyses indicate that the measures utilized and cultural differences affect the strength of this association. Weaker effect sizes were observed for studies that utilized measures of experiential avoidance when compared to studies that utilized pain-specific fear-avoidance measures. Studies that utilized multiple measures of fear-avoidance had stronger effect sizes than studies that utilized a single measure of fear-avoidance. Three of Hofstede’s cultural dimensions moderated the association, including Power Distance Index, Individualism versus Collectivism, and Indulgence versus Restraint.
Conclusions
The present meta-analysis synthesizes the results from studies examining the association between fear-avoidance and pain intensity among individuals with chronic pain. The positive association indicates that those with increased fear-avoidance have higher pain intensity, and those with higher pain intensity have increased fear-avoidance. Findings indicate that cultural differences and measurement instruments are important to consider in understanding the variables that affect this association. The significant cultural variations may indicate that it is important to consider the function of avoidance behavior in different cultures in an effort to better understand each patient’s cultural beliefs, as well as how these beliefs are related to pain and associated coping strategies.
Implications
The results from the current meta-analysis can be used to inform interventions for patients with chronic pain. In particular, those with more intense pain or increased fear-avoidance should be targeted for prevention and intervention work. Within the intervention itself, avoidance should be undermined and established as an ineffective strategy to manage pain in an effort to prevent disability, depression, and physical deconditioning.
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Affiliation(s)
- Emily B. Kroska
- University of Iowa , E11 Seashore Hall , Iowa City , IA 52242 , USA
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14
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Holley AL, Wilson AC, Noel M, Palermo TM. Post-traumatic stress symptoms in children and adolescents with chronic pain: A topical review of the literature and a proposed framework for future research. Eur J Pain 2016; 20:1371-83. [PMID: 27275585 DOI: 10.1002/ejp.879] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE The co-occurrence of chronic pain and post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) has gained increasing research attention. Studies on associations among pain and PTSS or PTSD in youth have largely been conducted in the context of acute injury or trauma. Less is known about the risk for co-occurrence with paediatric chronic pain. In this review, we (1) propose a conceptual framework to outline factors salient during childhood that may be associated with symptom severity, co-occurrence and mutual maintenance, (2) present relevant literature on PTSS in youth with acute and chronic pain and identify research gaps and (3) provide recommendations to guide paediatric research examining shared symptomatology. DATABASES AND DATA TREATMENT Electronic databases (PubMed and Google Scholar) were used to identify relevant articles using the search terms 'child, adolescent, paediatric, chronic pain, acute pain, post-traumatic stress symptoms and post-traumatic stress disorder'. Studies were retrieved and reviewed based on relevance to the topic. RESULTS Our findings revealed that existing biobehavioural and ecological models of paediatric chronic pain lack attention to traumatic events or the potential development of PTSS. Paediatric studies are also limited by lack of a conceptual framework for understanding the prevalence, risk and trajectories of PTSS in youth with chronic pain. CONCLUSIONS Our new developmentally informed framework highlights individual symptoms and shared contextual factors that are important when examining potential associations among paediatric chronic pain and PTSS. Future studies should consider bidirectional and mutually maintaining associations, which will be aided by prospective, longitudinal designs. WHAT DOES THIS REVIEW ADD?: This review presents relevant literature on pain and PTSS in youth and proposes a conceptual framework to examine factors salient during childhood that may be associated with symptom severity, comorbidity and mutual maintenance of chronic pain and PTSS in paediatric populations. We highlight dynamic factors that may change across children's development and provide recommendations to guide paediatric research examining potential associations among PTSS and chronic pain.
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Affiliation(s)
- A L Holley
- Division of Psychology, Oregon Health & Science University, Portland, USA.
| | - A C Wilson
- Division of Psychology, Oregon Health & Science University, Portland, USA
| | - M Noel
- Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, AB, Canada
| | - T M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington and Seattle Children's Research Institute, USA
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15
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Examining the Latent Structure of Acute Stress Disorder Symptoms in Filipino-Victims of a Flashflood Disaster. Community Ment Health J 2015; 51:613-20. [PMID: 25575912 DOI: 10.1007/s10597-015-9826-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
Although Acute Stress Disorder (ASD) was introduced in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition for a number of years already, only few studies have examined ASD in its latent level. Utilizing 998 respondents who experienced a deadly flashflood, the results revealed that of the 7 models, Dysphoric arousal model fitted best whereas the new DSM-5 single factor model received the lowest fit. The findings of the study are pertinent in the current changes of ASD in DSM-5 and would elucidate further ASD's latent structure that best represent Asian sample, particularly Filipinos.
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16
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Choi YM, Kim KH. Etifoxine for pain patients with anxiety. Korean J Pain 2015; 28:4-10. [PMID: 25589941 PMCID: PMC4293506 DOI: 10.3344/kjp.2015.28.1.4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 02/05/2023] Open
Abstract
Etifoxine (etafenoxine, Stresam®) is a non-benzodiazepine anxiolytic with an anticonvulsant effect. It was developed in the 1960s for anxiety disorders and is currently being studied for its ability to promote peripheral nerve healing and to treat chemotherapy-induced pain. In addition to being mediated by GABAAα2 receptors like benzodiazepines, etifoxine appears to produce anxiolytic effects directly by binding to β2 or β3 subunits of the GABAA receptor complex. It also modulates GABAA receptors indirectly via stimulation of neurosteroid production after etifoxine binds to the 18 kDa translocator protein (TSPO) of the outer mitochondrial membrane in the central and peripheral nervous systems, previously known as the peripheral benzodiazepine receptor (PBR). Therefore, the effects of etifoxine are not completely reversed by the benzodiazepine antagonist flumazenil. Etifoxine is used for various emotional and bodily reactions followed by anxiety. It is contraindicated in situations such as shock, severely impaired liver or kidney function, and severe respiratory failure. The average dosage is 150 mg per day for no more than 12 weeks. The most common adverse effect is drowsiness at the initial stage. It does not usually cause any withdrawal syndromes. In conclusion, etifoxine shows less adverse effects of anterograde amnesia, sedation, impaired psychomotor performance, and withdrawal syndromes than those of benzodiazepines. It potentiates GABAA receptor-function by a direct allosteric effect and by an indirect mechanism involving the activation of TSPO. It seems promising that non-benzodiazepine anxiolytics including etifoxine will replenish shortcomings of benzodiazepines and selective serotonin reuptake inhibitors according to animated studies related to TSPO.
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Affiliation(s)
- Yun Mi Choi
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Kyung Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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17
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López-Martínez AE, Ramírez-Maestre C, Esteve R. An examination of the structural link between post-traumatic stress symptoms and chronic pain in the framework of fear-avoidance models. Eur J Pain 2014; 18:1129-38. [PMID: 24677331 DOI: 10.1002/j.1532-2149.2014.00459.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The tendency to respond with fear and avoidance can be seen as a shared vulnerability contributing to the development of post-traumatic stress disorder (PTSD) and chronic pain. Although several studies have examined which specific symptoms of PTSD (re-experiencing, avoidance, emotional numbing and hyperarousal) are associated with chronic pain, none has considered this association within the framework of fear-avoidance models. METHODS Seven hundred fourteen patients with chronic musculoskeletal pain were assessed. Of these, 149 patients were selected for the study based upon the following inclusion criteria: exposure to a traumatic event before the onset of pain (with scores equal to or higher than 8 points on the fear and hopelessness scales of the Stressful Life Event Screening Questionnaire Revised) and scores equal to or higher than 30 on the Davidson Trauma Scale. RESULTS Structural equation modelling was used to test the association between PTSD symptoms and pain outcomes (pain intensity and disability) using the mediating variables considered in the fear-avoidance models. The results show that emotional numbing and hyperarousal symptoms, but neither re-experiencing nor avoidance, affected pain outcome via anxiety sensitivity (AS), catastrophizing and fear of pain. PTSD symptoms increased the levels of AS, which predisposes to catastrophizing and, in turn, had an effect on the tendency of pain patients to respond with more fear and avoidance. CONCLUSIONS This study provides empirical support for the potential role of PTSD symptoms in fear-avoidance models of chronic pain and suggests that AS is a relevant variable in the relationship between both disorders.
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Affiliation(s)
- A E López-Martínez
- Faculty of Psychology, Department of Personality, Assessment and Psychological Treatment, University of Málaga, Spain
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18
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Ulirsch J, Ballina L, Soward A, Rossi C, Hauda W, Holbrook D, Wheeler R, Foley K, Batts J, Collette R, Goodman E, McLean S. Pain and somatic symptoms are sequelae of sexual assault: Results of a prospective longitudinal study. Eur J Pain 2013; 18:559-66. [DOI: 10.1002/j.1532-2149.2013.00395.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 01/27/2023]
Affiliation(s)
- J.C. Ulirsch
- TRYUMPH Research Program; University of North Carolina; Chapel Hill USA
| | - L.E. Ballina
- TRYUMPH Research Program; University of North Carolina; Chapel Hill USA
| | - A.C. Soward
- TRYUMPH Research Program; University of North Carolina; Chapel Hill USA
| | - C. Rossi
- Forensic Nursing Program; Medicine; Cone Health System; Greensboro USA
| | - W. Hauda
- Pediatric Emergency Medicine; Inova Fairfax Hospital; Falls Church; USA
| | - D. Holbrook
- Forensic Nursing Program; Mercy Medical Center; Baltimore USA
| | - R. Wheeler
- Department of Emergency Medicine; University of North Carolina; Chapel Hill USA
| | - K.A. Foley
- Department of Emergency Medicine; Sentara Norfolk Hospital; USA
| | - J. Batts
- Department of Emergency Medicine; Carolinas Medical Center; Charlotte USA
| | - R. Collette
- SANE Program; Mission Health System; Asheville USA
| | - E. Goodman
- SANE Program; Wake Forest Baptist Medical Center; Winston-Salem USA
| | - S.A. McLean
- TRYUMPH Research Program; University of North Carolina; Chapel Hill USA
- Department of Emergency Medicine; University of North Carolina; Chapel Hill USA
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19
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Ghobadifar MA, Zarei S, Heidarnezhad AH. Relieving Pain with Acupuncture after Inguinal Surgeries. Korean J Pain 2013; 26:312-3. [PMID: 23862010 PMCID: PMC3710950 DOI: 10.3344/kjp.2013.26.3.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/18/2013] [Indexed: 11/05/2022] Open
Affiliation(s)
- Mohamed Amin Ghobadifar
- Department of Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Safar Zarei
- Department of Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
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20
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Zarei S, Bigizadeh S, Pourahmadi M, Ghobadifar MA. Chronic Pain and Its Determinants: A Population-based Study in Southern Iran. Korean J Pain 2012; 25:245-53. [PMID: 23091685 PMCID: PMC3468801 DOI: 10.3344/kjp.2012.25.4.245] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/22/2012] [Accepted: 08/08/2012] [Indexed: 01/07/2023] Open
Abstract
Background Prevalence of chronic pain and its association with demographic characteristics have been reported by different studies from different geographical regions in the world. However, data from many Middle East countries including Iran (especially southern Iran) are scare. The aim of the present study was to demonstrate the prevalence of chronic pain and its association with demographic, psychological and socioeconomic factors in an Iranian population. Methods In this population-based survey, the target population was comprised of subjects aged 20 to 85 years residing in Jahrom, southern Iran during 2009-2011. All eligible subjects were invited to participate in the study. Before a detailed questionnaire was given; face to face interviews were done for each individual. Results There were 719 men and 874 women with an average age of 40.5 years at the onset of the study. Among the study population, 38.9% (620/1,593) complained of chronic pain, of whom 40.8% (253/620) were men and 59.2% (367/620) were women. Foot and joint pain were observed in 31.9%. Hip and spine pain, migraine and tension headaches, heart pain, and abdomen pain were observed in 21.5%, 15.5%, 9.5%, and 8.0% of chronic pain cases, respectively. There was a significant association among the covariables age, sex, overweight, educational level, income, and type of employment with chronic pain as the dependent variable (P < 0.0001). Conclusions Our findings show the prevalence of chronic pain and its association with demographic, psychological and socioeconomic factors. Individuals with low incomes and less education became accustomed to pain due to a lack of knowledge.
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Affiliation(s)
- Safar Zarei
- Department of Physiology, Medicine School, Jahrom University of Medical Sciences, Jahrom, Iran
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