The Usefulness of the Short Form-8 for Chronic Pain in the Orofacial Region: A Prospective Cohort Study

Background and purpose Given that chronic pain has become a major problem in recent years, affecting approximately 30% of the general population, this study used the Japanese version of the Short Form-8 (SF-8) to investigate (1) the quality of life (QOL) of patients with burning mouth syndrome (BMS) or persistent idiopathic facial pain (PIFP) (compared with a Japanese control group) and (2) whether therapeutic intervention improves the QOL and reduces pain (comparison between 0 and 12 weeks) of patients with BMS or PIFP. Materials and methods A total of 63 patients diagnosed with either BMS (n=45) or PIFP (n=18) were included in this study. The diagnostic criteria for BMS and PIFP were established based on the third edition of the International Classification of Headache Disorders. Results Our study results showed that while Physical Component Summary (PCS) in patients with BMS or PIFP improved with treatment, it did not improve to the national standard value (NSV) after 12 weeks of intervention. In contrast, the Mental Component Summary (MCS) improved to the same level as the NSV after 12 weeks of intervention. Conclusions We found that therapeutic intervention improves MCS and reduces pain; however, improving PCS requires time.

Evaluation of patients suffered from burning mouth syndrome and persistent idiopathic facial pain using Japanese version PainDETECT questionnaire and depression scales

BACKGROUND/PURPOSE

Various questionnaires have been validated as methods for screening of neuropathic pain, but none have been established for the orofacial region. Although chronic pain and depression are likely to comorbid, few studies have examined the relationship between orofacial chronic pain and depression. Therefore, we evaluated the potential of the Japanese Version of PainDETECT as an assessment tool for neuropathic pain associated with burning mouth syndrome (BMS) and persistent idiopathic facial pain (PIFP). We also evaluated the depression scale such as Beck's Depression Inventory (BDI: a subjective index) and Hamilton Depression Rating Scale (HDRS: an objective index) with BMS or PIFP.

MATERIALS AND METHODS

As a target, we administered the Japanese version of the PainDETECT questionnaire to the BMS (29 patients) and PIFP (17 patients). As a control, patients with post-extraction pain (typical nociceptive pain, (EXT) 16 patients) were also participated. We performed BDI and HDRS with BMS or PIFP.

RESULTS

Although PainDETECT final score was significantly higher in BMS [median: 10] compared with PIFP [6] and EXT [5] (p < 0.05), PainDETECT final scores for all groups were lower than the cutoff value for the possibility of neuropathic pain. HDRS was significantly higher in the BMS than the PIFP. There were no significant differences between the BMS and PIFP in BDI.

CONCLUSION

Under the limitations of current research design, the Japanese version of the PainDETECT questionnaire does not show sufficient potential as pain assessment tool for patients with BMS and PIFP. BMS is comorbid with depression objectively when compared with PIFP.

Serum Metabolic Profiles of the Tryptophan-Kynurenine Pathway in the high risk subjects of major depressive disorder

Previous reports have shown that during chronic inflammation, the tryptophan (TRP)-kynurenine (KYN) pathway plays a pivotal role in the onset of depression. The aim of this study was to investigate the characteristics of the serum TRP-KYN pathway metabolite profile in high-risk subjects of major depressive disorder (HRMDD) defined by depression scores. The concentrations of TRP-KYN pathway metabolites {TRP, KYN, 3-hydroxyanthranilic acid (3HAA), 3-hydroxykynurenine (3HK), kynurenic acid (KYNA) and anthranilic acid (AA)} were assessed in serum from HRMDD, chronic pain disorder patients and healthy controls. In serum from HRMDD, elevated levels of AA and decreased levels of TRP were observed, but the levels of other metabolites were not changed. Furthermore, the change in the AA_2nd/AA_1st ratio in subjects who progressed from a health. y state to a depressive state was correlated with an increase in the CES-D score. The level of IL-1 receptor antagonist (IL-1RA) was negatively correlated with that of AA. Interestingly, we confirmed AA as a possible biomarker for depression-related symptoms, since the metabolite profiles in the chronic pain disorder group and chronic unpredictable mild stress model mice were similar to those in the HRMDD. These results suggest that AA may be an effective marker for HRMDD.

Effect of antidepressant treatment on plasma levels of neuroinflammation-associated molecules in patients with somatic symptom disorder with predominant pain around the orofacial region

OBJECTIVE

Burning mouth syndrome (BMS) and atypical odontalgia (AO) are examples of somatic symptom disorders with predominant pain around the orofacial region. Neuroinflammation is thought to play a role in the mechanisms, but few studies have been conducted. We aimed to better understand the role of neuroinflammation in the pathophysiology and treatment of BMS/AO.

METHODS

Plasma levels of 28 neuroinflammation-related molecules were determined in 44 controls and 48 BMS/AO patients both pretreatment and 12-week post-treatment with duloxetine.

RESULTS

Baseline plasma levels of interleukin (IL)-1β (p < .0001), IL-1 receptor antagonist (p < .001), IL-6 (p < .0001), macrophage inflammatory protein-1β (p < .0001), and platelet-derived growth factor-bb (.04) were significantly higher in patients than in controls. Plasma levels of granulocyte macrophage colony stimulating factor were significantly higher in patients than in controls (p < .001) and decreased with treatment (.009). Plasma levels of eotaxin, monocyte chemoattractant protein-1, and vascular endothelial growth factor decreased significantly with treatment (p < .001, .022, and .029, respectively).

CONCLUSIONS

Inflammatory mechanisms may be involved in the pathophysiology and/or treatment response of somatic symptom disorders with predominant pain around the orofacial region.

Age of onset has limited association with body mass index at time of presentation for anorexia nervosa: comparison of peak-onset and late-onset anorexia nervosa groups

The clinical characteristics differentiating late-onset anorexia nervosa (AN) from typical pubertal onset AN remain unclear. The purpose of the present study was to examine these differences in a retrospective analysis. A total of 149 female AN patients was divided into two groups: a peak-onset AN group (n = 125) in which onset occurred between the ages of 15 and 24 years, and a late-onset AN group (n = 24) in which onset occurred at the age of > or =25 years. A logistic regression analysis was conducted with this classification as the target variable and five clinical factors as explanatory variables for the clinical characteristics at the time of initial examination. Body mass index (BMI) at the time of presentation was identified as a possible factor affecting classification as peak-onset or late-onset AN. In addition, a negative linear correlation was detected between age of onset and BMI at the time of initial examination. The results suggest that BMI at the time of the initial examination is an important clinical characteristic to differentiate peak-onset AN and late-onset AN.

[Questionary research on individual psychotherapy of borderline personality disorder (BPD)]

The authors researched individual psychotherapy of borderline personality disorder (BPD) in Japan using a questionnaire given to expert therapists. To select the expert therapists, a database search for the keywords "borderline personality disorder" and "border-line case" was carried out in the Japanese literature on psychiatry and clinical psychology. Thus, 280 expert therapists, who were authors of articles related to the psychotherapy of BPD, were selected. Qestionnaires on individual psychotherapy of BPD were sent to them, and 128 responses were obtained. About 60% of these therapists were performing structured individual psychotherapy. This was about half of the psychiatrists and almost all of the clinical psychologists. Most of the structured psychotherapy was performed once a week, with 50 minute sessions. But there also were biweekly, 30-39 minute, 40-49 minute, and 20-29 minute sessions. The basic therapeutic methodology was psychoanalytic psychotherapy, supportive psychotherapy, and eclectic therapy, with each of them constituting about one third of the total, in this order of percentage. In the case of structured individual psychotherapy, what the majority of the therapists performed is as follows. They talked about therapeutic goals. When talking about therapeutic goals, the focus was on realistic issues such as improving social adaptation, controlling impulsive behavior or reducing the symptoms. In the face of self-harm behavior, they talked about the meaning and the utility of self-harm behavior, listened to the progression of the episodes, or said it was definitely not a good thing to do. If the self-harm behaviors were repeated, they told the patients that it was necessary for them to be confined to the closed-ward, or told them that the continuation of psychotherapy might become difficult. When there was intense anger toward the therapists, they validated the rightful parts of it. Concerning the anger and depression of the therapists, they restrained their feelings and considered them later, talked about it with their colleagues and experts, or communicated to the patients their honest feelings. In the case of frequent telephone calls, they told their patients to reduce their calls as much as possible, but when the calls came, talked with them briefly. Or they allotted the times the patients could make a call. Disclosure of the private information of the therapists was not done at all, or was done sometimes according to the situation. They actively talked about the limitations of the therapists and the patient-therapist relationship. They appreciated and praised the achievements of the patients. They talked about the termination of the psychotherapy. When they happened to meet the patients outside of the therapy, they responded to the patients only when they were addressed, or they addressed the patients by themselves but just briefly. The clinical situation of the BPD individual psychotherapy in Japan was not made clear so far. Our research clarified the situation, though there was the methodological limitation of the questionnaire research.

Treatment with intravenous hyperalimentation for severely anorectic patients and its outcome

In treating patients with severe anorexia nervosa, it is important to improve their physical condition first. Patients who had lost close to 60% standard bodyweight (SBW) were candidates for inpatient treatment due to the mortality risk. With 80% SBW as the target for therapy, they were given both intravenous hyperalimentation and food by oral intake in order to improve their physical condition. In total, 51 patients were admitted. One died and four patients dropped out in the course of treatment. Forty-six patients who completed the inpatient treatment were reviewed. Although admitted with an average weight of approximately 60% SBW, they were discharged with a weight of approximately 80% SBW after approximately 60 days. An average follow up of 25.0 months was conducted, and two patients were found to have died. The mean weight, percentage resuming menstruation, and rehospitalization rate of the 44 survivors were 79% SBW, 23%, and 32%, respectively. The patients with the restricting type of anorexia had an earlier onset of the disorder and a better social outcome. Patients in whom onset occurred at a younger age had a better social outcome. After being discharged, the majority of the patients continued treatment as outpatients. Although the results were similar to those of conventional studies in terms of outcome, the shorter hospitalization was significant. Overall, in the treatment of patients with severe anorexia nervosa, it is important to begin psychotherapy while trying to improve their physical condition.

Cenesthopathy in adolescence

Psychopathological investigation was conducted on the basis of the clinical observation of 23 subjects whose cenesthopathic symptoms began before 30 years of age. This illness is called 'adolescent cenesthopathy' based on the specificity of this mental condition to the adolescent period. Adolescent cenesthopathy is compared to schizophrenia, depersonalization, sensitive delusion of reference and other symptoms. Outstanding features of adolescent cenesthopathy are shown from the perspective of its difference from schizophrenia in terms of the specific characteristics of the symptoms in this disease.