Life satisfaction in patients with chronic pain – relation to pain intensity, disability, and psychological factors

Britt-Marie StålnackeDepartment of Community Medicine and Rehabilitation, Umeå University, Umeå, SwedenAims: To investigate pain intensity, posttraumatic stress, depression, anxiety, disability, and life satisfaction in patients with injury-related chronic pain and to analyze differences in these variables regarding gender.Methods: Questionnaires addressing pain intensity (visual analogue scale [VAS]), anxiety and depression (hospital anxiety and depression [HAD] scale), posttraumatic stress (impact of event scale), disability (disability rating index, and life satisfaction [LiSat-11]) were answered by 160 patients at assessment at the Pain Rehabilitation Clinic at the Umeå University Hospital (Umeå, Sweden).Results: High level of pain intensity was scored on the VAS (mean value 64.5 ± 21.1 mm) together with high levels of anxiety, depression, and posttraumatic stress. Activity limitations in everyday life and decreased life satisfaction were reported, especially on the items physical health and psychological health. A multivariate logistic regression model showed a statistically significant association between low scores on the overall life satisfaction on LiSat-11 and high scores on HAD-depression (odds ratio = 1.141, confidence interval 1.014–1.285). Few gender differences were found.Conclusion: These findings highlight the value of a broad screening in patients with injury-related chronic pain with respect to the relationship of life satisfaction with pain intensity, anxiety, depression, posttraumatic stress, and disability. In addition, these findings support the biopsychosocial approach to assess and treat these patients optimally.Keywords: whiplash injuries, depression, quality of lif

Repeatedly Heading a Soccer Ball Does Not Increase Serum Levels of S-100B, a Biochemical Marker of Brain Tissue Damage: an Experimental Study

Objectives: The aim of the study was to analyse whether the controlled heading of soccer balls elicits increased serum concentrations of a biochemical marker of brain tissue damage S-100B.Methods: Nineteen male soccer players were randomly divided into two groups, A and B. Group A headed a soccer ball falling from 18 m five times, while group B served as controls (no heading). Blood samples were taken before and 0.5 h, 2 h and 4 h after the heading for analysis of S-100B.Results: No statistically significant (p > 0.05) increases in serum concentrations of S-100B were encountered in group A at 0.5 h (0.109 ± 0.024 μg/L), 2 h (0.098 ± 0.026 μg/L), and 4 h (0.113 ± 0.035 μg/L) when the blood samples obtained before and after the heading were compared (0.157 ± 0.134 μg/L). No statistically significant difference was found when the serum concentrations of S-100B were compared between groups A and B either before or after heading.Conclusions: Heading a soccer ball dropped from a height of 18 m five times was not found to cause an increase in serum concentrations of S-100B, indicating that the impact was not sufficient to cause biochemically discernible damage of brain tissue

Computerized assessment of pain drawing area: A pilot study

Anna Wenngren, Britt-Marie StålnackeDepartment of Community Medicine and Rehabilitation, Umeå University, SwedenAim: To investigate if pain area in patients with chronic pain could be measured by a computerized assessment on previously marked pain drawings on paper figures and to analyze the further application of the method.Methods: Seventy-two patients (54 women and 18 men) who were admitted to Umeå University Hospital during 2003 for assessment of chronic pain answered a set of questionnaires (pain intensity on the visual analog scale [VAS], disability on the Disability Rating Index [DRI], life satisfaction on the LiSat-11) and filled in pain drawings on paper figures of the human body. The pain drawings were later analyzed by using computerized assessment.Results: Women marked a greater pain area than men, but the difference was not significant (p = 0.433). No significant difference was shown for the previous seven days between men and women on the VAS (p = 0.914), DRI (p = 0.493), or LiSat-11 (p = 0.124). A statistically significant correlation was found between pain area and VAS for the previous seven days (r = 0.250; p = 0.046). Pain area was statistically significantly correlated to the DRI (r = 0.336; p = 0.014) and close to negatively correlated to the LiSat-11 (r = -0.687; p = 0.057).Conclusion: This pilot study shows that pain drawing area could be measured by a computerized assessment of pain drawings. The method points to the possibility of relating pain area with other instruments. In the present study, an association between the patients’ pain drawing area and pain intensity and between pain area and level of activity was shown.Keywords: musculoskeletal pain, screening, pain drawing, computerized assessmen

What influences chronic pain management? A best–worst scaling experiment with final year medical students and general practitioners

Background: Chronic pain education is an essential determinant for optimal chronic pain management. Given that attitudes and preferences are involved in making treatment decisions, identifying which factors are most influential to final year medical students’ and general practitioners’ (GPs) chronic pain management choices is of importance. This study investigates Swedish and Australian students’ preferences with respect to a chronic pain condition, using a best–worst scaling (BWS) experiment, which is designed to rank alternatives. Methods: BWS, a stated-preference method grounded in random utility theory, was used to explore the importance of factors influencing chronic pain management. Results: All three cohorts considered the patients’ pain description and previous treatment experience as the most important factors in making treatment decisions, whereas their demographics and voices or facial expressions while describing their pain were considered least important. Factors such as social support, patient preferences and treatment adherence were, however, disregarded by all cohorts in favour of pain assessment factors such as pain ratings, description and history. Swedish medical students and GPs show very high correlation in their choices, although the GPs consider their professional experience as more important compared to the students. Conclusion: This study suggests that the relative importance of treatment factors is cemented early and thus underline the critical importance of improving pain curricula during undergraduate medical education

Система локализации и подсчёта количества механических транспортных средств на перекрёстке

Objective: To explore patients' experiences of activity, participation and quality of life one year after a rehabilitation programme for chronic pain, and to determine the impact of the programme on their current life situation. Design: Qualitative study with emergent design. Subjects and methods: The 14 informants were patients with chronic pain who had participated in rehabilitation at a pain clinic. Individual semi-structured interviews were analysed with inductive, qualitative content analysis. Results: The core theme "Change is possible" and the themes "A life ruled by pain" (the situation before rehabilitation), "The penny's dropped" (experience during rehabilitation) and "Live a life, not only survive" (the situation at the time of the interviews) emerged from the data. These themes represent a process through which, during and after rehabilitation, the informants integrated earlier disabling symptoms into a functioning lifestyle. Conclusion: Individuals living with disabling chronic pain can create a better life by integrating their illness. A prerequisite is that healthcare professionals empower patients to develop the strength to take responsibility for their daily lives. This process is facilitated by skills to reduce pain and handle life, plus support from significant others

Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered

<p>Abstract</p> <p>Background</p> <p>Few studies have focused on the differences between persons who are recovered after whiplash injury and those who suffer from persistent disability. The primary aim of this study was therefore to examine differences in symptoms, psychological factors and life satisfaction between subjects classified as recovered and those with persistent disability five years after whiplash injury based on the Neck Disability Index (NDI).</p> <p>Methods</p> <p>A set of questionnaires was answered by 158 persons (75 men, 83 women) to assess disability (NDI), pain intensity (VAS), whiplash-related symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), post-traumatic stress (Impact of Event Scale, IES), depression (Beck's depression inventory, BDI) and life satisfaction (LiSat-11).</p> <p>The participants were divided into three groups based on the results of the NDI: recovered (34.8%), mild disability (37.3%) and moderate/severe disability (27.3%).</p> <p>Results</p> <p>The moderate/severe group reported significantly higher VAS, BDI and IES scores and lower level of physical health and psychological health compared to the mild and the recovered groups. Less significant differences were reported between the mild and the recovered groups.</p> <p>Conclusions</p> <p>The group with the highest disability score reported most health problems with pain, symptoms, depression, post-traumatic stress and decreased life satisfaction. These findings indicate that classifying these subjects into subgroups based on disability levels makes it possible to optimize the management and treatment after whiplash injury.</p

Post-traumatic stress, depression, and community integration a long time after whiplash injury

Psychological factors such as post-traumatic stress and depression may play an important role in the recovery after whiplash injuries. Difficulties in psychosocial functioning with limitations in everyday life may dominate for some time after the injury. Our study therefore investigates the relationships between pain, post-traumatic stress, depression, and community integration. A set of questionnaires was answered by 191 persons (88 men, 103 women) five years after a whiplash injury to assess pain intensity (visual analogue scale, VAS), whiplash-related symptoms, post-traumatic stress (impact of event scale, IES), depression (Beck depression inventory, BDI-II), community integration (community integration questionnaire, CIQ), life satisfaction (LiSat-11). One or more depressive symptoms were reported by 74% of persons; 22% reported scores that were classified as mild to severe depression. The presence of at least one post-traumatic symptom was reported by 70% of persons, and 38% reported mild to severe stress. Total scores of community integration for women were statistically significantly higher than for men. The total VAS score was correl-ated positively to the IES (r=0.456, P less than 0.456), the BDI (r=0.646, P less than 0.001), and negatively to the CIQ (r=-0.300, P less than 0.001). These results highlight the view that a significant proportion of people experience both pain and psycho- logical difficulties for a long time after a whiplash injury. These findings should be taken into consideration in the management of subjects with chronic whiplash symptoms and may support a multi-professional rehabilitation model that integrates physical, psychological, and psychosocial factors

Postconcussion symptoms in patients with injury-related chronic pain

Background: Postconcussion symptoms (PCSs)—such as fatigue, headache, irritability, dizziness, and impaired memory—are commonly reported in patients who have mild traumatic brain injuries (MTBIs). Evaluation of PCS after MTBI is proposed to have a diagnostic value although it is unclear whether PCS are specific to MTBI. After whiplash injuries, patients most often complain of headaches and neck pain; the other PCS are not as closely evaluated. In patients with chronic pain because of other injuries, the presence of PCS is unclear. This study aimed to describe the frequency of PCS in patients with injury-related pain and to examine the relationships between PCS, pain, and psychological factors. Methods: This study collected data using questionnaires addressing PCS (Rivermead Postconcussion Questionnaire, RPQ), pain intensity (Visual Analogue Scale), depression, anxiety (Hospital, Anxiety, and Depression Scale), and posttraumatic stress (Impact of Event Scale). Results: Fatigue (90.7%), sleep disturbance (84.9%), headache (73.5%), poor concentration (88.2%), and poor memory (67.1%) were some of the most commonly reported PCS. Significant relationships were found between PCS and posttraumatic stress, depression, and anxiety. Conclusion: To optimize treatment, it is important to assess each patient’s PCS, the mechanism of injury, and factors such as posttraumatic stress and depression