Neuropathic pain and psychological morbidity in patients with treated leprosy: a cross-sectional prevalence study in Mumbai

Background

Neuropathic pain has been little studied in leprosy. We assessed the prevalence and clinical characteristics of neuropathic pain and the validity of the Douleur Neuropathique 4 questionnaire as a screening tool for neuropathic pain in patients with treated leprosy. The association of neuropathic pain with psychological morbidity was also evaluated.

Methodology/Principal Findings

Adult patients who had completed multi-drug therapy for leprosy were recruited from several Bombay Leprosy Project clinics. Clinical neurological examination, assessment of leprosy affected skin and nerves and pain evaluation were performed for all patients. Patients completed the Douleur Neuropathique 4 and the 12-item General Health Questionnaire to identify neuropathic pain and psychological morbidity.

Conclusions/Significance

One hundred and one patients were recruited, and 22 (21.8%) had neuropathic pain. The main sensory symptoms were numbness (86.4%), tingling (68.2%), hypoesthesia to touch (81.2%) and pinprick (72.7%). Neuropathic pain was associated with nerve enlargement and tenderness, painful skin lesions and with psychological morbidity. The Douleur Neuropathique 4 had a sensitivity of 100% and specificity of 92% in diagnosing neuropathic pain. The Douleur Neuropathique 4 is a simple tool for the screening of neuropathic pain in leprosy patients. Psychological morbidity was detected in 15% of the patients and 41% of the patients with neuropathic pain had psychological morbidity.     

Younger and older chronic somatoform pain patients in psycho-diagnostics,physician-patient relationship and treatment outcome

Introduction

Patients with chronic pain are found with highly variable clinical presentation and differing physical complaints. They are seen as a heterogenic group. Based on clinical observations, elderly patients seem to differ from younger patients with chronic pain. We examined whether there were systematic differences between young and old pain patients.

Methods

As part of a routine evaluation of university hospital care, a newly developed psychosomatic treatment model for chronic somatoform pain disorders was examined. The basis for treatment efficacy was a target-oriented, specific somatic and psychological intervention that included a stable physician-patient relationship. Particular attention was paid to differences in treatment outcome with regard to changes in both physical and psychopathological symptom levels. We hypothesised that younger pain patients had higher psychological burden and benefitted more from our treatment than older pain patients.

Results

Overall, 179 inpatients (57.5% women) with chronic pain were examined (age between 16 and 79 years). The group as a whole yielded high scores on the somatisation dimension (SCL-90) and showed a considerable amount of psychopathological symptoms, such as depressive mood and anxiety (HADS) and a great emotional instability (FPI-R). Age differences were only found with regards to patients’ degree of aggression (SCl-90): younger patients showed higher aggressive tendencies than older ones (p< 0.05). The treatment offered helped patients in both age groups especially with regard to reduction of depressive mood (HADS, p< 0.01) and anxiety levels (HADS, p< 0.01). Regression analysis showed different age groups and gender as significant predictors of anxiety reduction under therapy (R²=.108; model: p< 0.01).

Discussion and conclusion

Results show that younger chronic pain patients suffer more from a considerable amount of psychological distress than older ones, but our treatment approach was equally effective in both groups. However, age and gender differences, as well as the patient’s baseline level of anxiety influenced the outcome. These factors need to be studied in future research.

     

Gynecomastia--pathogenesis, diagnosis and treatment

The aim of this review is to present the up-to-date information concerning the prevalence, pathogenesis, diagnosis and treatment of gynecomastia. Gynecomastia is a benign, unilateral or bilateral enlargement of the male breast due to the imbalance between the androgens and estrogens at the breast tissue level. This clinical condition is particularly common in boys during puberty and in aging men. The breast enlargement, especially with accompanying pain can cause serious psychological problem. At the present time there are no generally accepted procedures for the evaluation and treatment of patients with gynecomastia. In the article such recommendations were proposed. There are many studies conducted to find the safe and efficient medical therapy that could ameliorate the quality of life of the patients with gynecomastia. The information on the available treatment options were also presented.     

慢性疼痛治疗的研究进展

慢性疼痛是临床常见的病症,给患者和社会都带来极大的负担。其发病机制受生理、心理和社会等多种因素的影响较为复杂,因此,慢性疼痛的治疗一直是临床上的一大难题。单一的治疗手段往往不能取得令人满意的效果,目前常采用多手段联合的方式来治疗慢性疼痛,常见的包括药物治疗、心理治疗、介入治疗以及自我管理等。针对不同类型的慢性疼痛甚至同一类型的不同病人其治疗方案也不尽相同,近年来兴起的跨学科康复计划为慢性疼痛的治疗指明了方向。本文就慢性疼痛治疗的研究进展进行了综述,以期为临床实践提供更多参考和理论依据。     

Pregabalin,the lidocaine plaster and duloxetine in patients with refractory neuropathic pain: a systematic review

Background  

Patients frequently fail to receive adequate pain relief from, or are intolerant of, first-line therapies prescribed for neuropathic pain (NeP). This refractory chronic pain causes psychological distress and impacts patient quality of life. Published literature for treatment in refractory patients is sparse and often published as conference abstracts only. The aim of this study was to identify published data for three pharmacological treatments: pregabalin, lidocaine plaster, and duloxetine, which are typically used at 2^nd line or later in UK patients with neuropathic pain.     

Mindfulness,Acceptance and Catastrophizing in Chronic Pain

Objectives

Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT) suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain.

Methods

A cross-sectional survey was conducted, including 87 chronic pain patients from an academic outpatient pain center.

Results

The results show that general psychological acceptance (measured with the AAQ-II) is a strong predictor of pain-related catastrophizing, independent of gender, age and pain intensity. Mindfulness (measured with the MAAS) did not predict levels of pain-related catastrophizing.

Discussion

Acceptance of psychological experiences outside of pain itself is related to catastrophizing. Thus, acceptance seems to play a role in the pain experience and should be part of the treatment of chronic pain. The focus of the ACT treatment of chronic pain does not necessarily have to be on acceptance of pain per se, but may be aimed at acceptance of unwanted experiences in general. Mindfulness in the sense of “acting with awareness” is however not related to catastrophizing. Based on our research findings in comparisons with those of other authors, we recommend a broader conceptualization of mindfulness and the use of a multifaceted questionnaire for mindfulness instead of the unidimensional MAAS.     

Current data on the exploration and the evaluation of clinical pain]

Pain is a complex, multidimensional and multifactorial neuropsychological phenomenon with sensory-discriminative, affective, cognitive and behavioral components. Issues on pain assessment are related to the objective evaluation of a subjective phenomenon. Different levels of evaluation are to be considered. Some methods like visual analogue scale, numerical scale and verbal permit a global pain estimation. The aim of other methods like the McGill Pain Questionnaire is a quantitative and qualitative evaluation of the sensory and affective pain components. The measure of objective behavioral changes is an interesting approach, but at the present time there is no valid, simple and commonly used method. There is also a need for methods permitting a better exploration of a pain, and in particular a selective evaluation of organic and functional factors. The limits of psychological factors evaluation are reported.     

腕踝针联合耳穴压豆治疗肝癌癌痛的疗效及对心理状态和血清疼痛介质的影响

摘要 目的：观察腕踝针联合耳穴压豆治疗原发性肝癌（PHC）癌痛的疗效及对心理状态和血清疼痛介质的影响。方法：选取湖南中医药大学第一附属医院2020年3月~2022年12月期间收治的PHC癌痛患者117例,按随机数字表法分为对照组和联合组,例数分别为58例和59例。两组患者均接受常规疼痛处理,对照组患者接受耳穴压豆治疗,联合组在对照组的基础上接受腕踝针治疗。对比两组疼痛缓解率、临床指标、心理状态和疼痛介质水平。结果：联合组的疼痛缓解率高于对照组（P<0.05）。联合组的数字疼痛法（NRS）评分低于对照组,止痛起效时间、每次疼痛持续时间短于对照组,爆发痛次少于对照组（P<0.05）。治疗后,两组焦虑自评量表（SAS）、抑郁自评量表（SDS）评分下降,且联合组低于对照组（P<0.05）。治疗后,两组5-羟色胺（5-HT）、P物质（SP）、前列腺素E₂（PGE₂）下降,且联合组低于对照组（P<0.05）。结论：腕踝针联合耳穴压豆治疗PHC癌痛,可有效减轻疼痛症状,降低血清疼痛介质水平,同时还可有效调节患者的心理状态,应用价值较好。     

美容整形受术者心理研究进展

本文综述了美容整形受术者心理分析及异常心理类型。以及产生异常心理的影响因素。同时也阐述了美容整形受术者心理状态的量化评估和心理防治等方面的研究进展。     

The relationships between burn pain, anxiety and depression

This study examined the interrelationships between anxiety, depression and pain in burn injured patients. Seventy patients with severe burns were interviewed within two weeks of their burn trauma. The short form of McGill Pain Questionnaire and a visual analog scale were employed to measure the pain experienced at rest. Anxiety and depression levels were assessed with the Beck Depression Inventory and Beck Anxiety Inventory. The results showed that significant number of patients had suffered from depressive and anxious symptomatology. Higher levels of anxiety and depression were associated with higher pain scores. Percent of total body surface burned was associated with increased pain scores, anxiety and depression. The authors emphasises the need for accurate multidisciplinary assessment and treatment of pain and psychological disorders in burn injured patients which needs to be highly individualized and frequently adjusted according to the patients specific needs.     

综合医院住院患者对自身常见心理问题的评价及其影响因素

本研究主要针对综合医院非精神科住院患者对自身常见心理问题的评价及其影响因素进行调查分析。本研究选取1 329名非精神科住院患者作为调查对象,使其在规定指导语下完成患者健康抑郁症状群量表(depression scale of the patient health questionnaire, PHQ-9)、躯体症状群量表(somatic symptom scale of thepatient health questionnaire, PHQ-15)、广泛性焦虑量表(generalized anxiety disorder 7-item scale, GAD-7)、健康焦虑量表(whiteley-7 scale, WI-7)等自评量表,并回答封闭式问题"您认为自己目前存在心理或者情绪问题吗?"。根据上述两种对自身心理问题评价方式的结果是否一致将患者分为心理问题评价一致组和心理问题评价不一致组。调查得到如下结果:心理问题评价一致组人数占研究总人数的48.3%。通过单因素方差分析和二元Logistic回归分析结果得出,该综合医院非精神科男性住院患者及少数民族患者较女性患者及汉族患者更难意识到自身心理问题(B=-0.227, p=0.044; B=0.643, p=0.022)。本研究说明,加强普及大众心理健康教育,尤其是对非精神科住院患者(特别是男性和少数民族患者)的心理健康教育,使之能正确评价自身心理问题并寻求治疗,是非常有必要的。而非精神科医生则需要更多关注到男性患者和少数民族患者,早期识别并正确处理其心理问题,促进疾病恢复,提高患者满意度。     

Behavioral and Psychological Care in Weight Loss Surgery: Best Practice Update

The objective of this study is to update evidence‐based best practice guidelines for psychological evaluation and treatment of weight loss surgery (WLS) patients. We performed a systematic search of English‐language literature on WLS and mental health, quality of life, and behavior modification published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence‐based models. Our literature search identified 17 articles of interest; 13 of the most relevant were reviewed in detail. From these, we developed evidence‐based best practice recommendations on the psychological assessment and treatment of WLS patients. Regular updates of evidence‐based recommendations for best practices in psychological care are required to address the impact of mental health on short‐ and long‐term outcomes after WLS. Key factors in patient safety include comprehensive preoperative evaluation, use of appropriate and reliable evaluation instruments, and the development of short‐ and long‐term treatment plans.     

Psychological assessment of factors affecting pain

Use of traditional stimulus-response models of pain leads to differentiation between organic and psychogenic pain, which is often not helpful, if not dangerous, in treating chronic pain. Pain does not simply reflect bodily damage but also complex psychological malfunctioning. Viewing chronic pain as an obsessional state may often help in treating the entire patient and prevent the physician from being obsessed with the patient''s obsession. Psychological assessment of pain should focus on the role of psychological processes in the multifactorial causation of the illness causing the pain, notably their role in illness-proneness in general. Also, iatrogenic psychological distress, associatively precipitated psychological conflict and illness-perpetuating psychological processes should be looked for. A serious obstacle to progress with pain problems is not lack of hard data but conceptual confusion. Before medicine can meaningfully assess psychological factors in pain problems it must first learn to perceive psychological disturbances in medical and surgical patients.     

局部放置三七粉对下颌阻生齿拔出术患者的临床疗效

目的：探讨局部放置三七粉对下颌阻生齿拔出术患者的临床疗效。方法：选取我院收治的180例下颌阻生齿拔出术患者,根 据术后治疗方式不同,将患者分为对照组和实验组。对照组患者采用常规治疗方式,实验组患者在此基础上采用局部放置三七粉 治疗。观察并比较两组患者的临床疗效、疼痛情况以及术后并发症的发生情况等。结果：两组患者的并发症相比较,实验组并发症 发生的人数均明显低于对照组（P＜0.05）。两组患者的疼痛、焦虑、抑郁情况比较,实验组明显低于对照组,差异有统计学意义（P＜ 0.05）。结论：局部放置三七粉能够减轻下颌阻生齿拔出后患者的并发症,减轻疼痛,改善患者的心理状态,提高其疗效,值得临床 推广使用。     

哈尔滨医科大学附属第二临床医学院风湿免疫科

目的:本研究旨在探讨实施护理干预对类风湿性关节炎患者疼痛的影响。方法:选取我院2010年1月--2011年6月风湿免疫科收治的300例类风湿性关节炎患者为研究对象,将300例患者随机分为两组,对照组与干预组,每组150例患者。对照组实施常规护理措施;干预组在常规护理的基础上,侧重对患者的心理护理及康复指导等。分别于入院时及入院15d对两组患者使用11点疼痛数字等级量表(PI-NRS)对患者的疼痛程度进行评估。结果:患者入院15d后,对两组使用11点疼痛数字等级量表(PI-NRS)对患者的疼痛程度进行评估。统计结果显示,对照组与干预组间存在差异,P<0.05,有统计学意义,即干预组好于对照组。结论:实施护理干预对类风湿性关节炎患者的疼痛治疗有积极明显的作用,有效的心理护理及康复指导可以促进患者的康复。     

Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: a randomised controlled trial

Introduction  

No randomised, controlled trials have been conducted to date on the efficacy of psychological and pharmacological treatments of pain catastrophising (PC) in patients with fibromyalgia. Our aim in this study was to assess the effectiveness of cognitive-behaviour therapy (CBT) and the recommended pharmacological treatment (RPT) compared with treatment as usual (TAU) at the primary care level for the treatment of PC in fibromyalgia patients.     

Effect of chronic idiopathic low back pain on the kinetic gait characteristics in different foot masks

Identification of kinetic variables in different masks of foot is important for the evaluation and treatment of chronic low back pain. The aim of this study was to investigate the effect of chronic idiopathic low back pain on kinetic variables of gait in different foot masks. 11 idiopathic chronic low back pain patients and 13 healthy matched controls participated in this study. Using Emed foot-scanner system, the ground reaction force and impulse were measured during barefoot normal walking. Then, the average footprints were divided into 10 masks using the Automask program and the data were extracted using Multimask Evaluation programs. The low back pain disability was measured by Quebec questionnaire. Our results revealed that the ground reaction force and impulse in medial and lateral midfoot and hallux masks of patients were significantly lower than controls. Furthermore, these patients demonstrated greater ground reaction force and impulse in 3–5th metatarsals mask than control group. There was a significant interaction between the low back pain and the foot masks factors. In conclusion, the ground reaction forces and impulses in different areas of foot are affected by low back pain. Therefore, the kinetic gait analysis should be considered as an appropriate tool in evaluation and prescribing proper treatment program in low back pain patients.