Everyday pain, analgesic beliefs and analgesicbehaviours in Europe and Russia: An epidemiologicalsurvey and analysis

Беше проведено анкетно проучване в осем държави, в т.ч. Белгия, Германия, Великобритания, Италия, Полша, Русия и Испания. Оценена беше честотата на оплакване от болка при 8 506 души (52% жени), както и използването на аналгетици и нагласите спрямо тях. Предварителните анализи потвърждават високата честота на оплаквания от болка, като 70% от анкетираните посочват, че поне веднъж в месеца изпитват такава. Най-често се съобщава за главоболие и болки в гърба, a болшинството анкетирани лица - 77%, споделят, че използват аналгетични средства, когато страдат от болка. Предмет на по-нататъшните анализи бяха различията по пол, статус на заетост, държава по местоживеене и възраст. В сравнение с мъжете, жените по-често изпитват болка, употребата на аналгетици сред тях е по-голяма, както и притесненията им във връзка с тази употреба, като проявяват склонност да базират употребата върху своите познания относно лекарствените продукти. Безработните също съобщават за по-голямо използване на аналгетици и повече притеснения във връзка с това, сравнено със заетите лица. Като цяло при хората, живеещи в Русия и Полша, се отчита по-рядко болка и по-малко използване на обезболяващи средства в сравнение с останалата част на Европа. Те също така се тревожат повече във връзка с аналгетиците и по отношение на това, че използването на аналгетици от тяхна страна е слабо свързано с познания относно лекарствата. Отчитането на фактора „възраст` показва, че при по-младите епизодите на болка са по-малко, употребата на аналгетици - по-честа, a притесненията относно аналгетиците са по-слаби в сравнение с по-възрастните. Също така, по-младите са по-склонни да използват аналгетици въз основа на своите познания за продукта. Тези резултати повтарят съществуващи констатации във връзка с честотата на болката. Дават и нови сведения за различията при изпитването на болка, използването на аналгетици и нагласите към аналгетиците в Европа и Русия.

Recommendations for the management of opioid-induced constipation - how to improve usability in clinical practice

INTRODUCTION: Opioid-induced constipation remains undertreated despite effective and safe treatment options exists. Previous guidelines have only been partially effective in improving management, possibly due to their complexity, and studies suggest that a simple setup of concise and behaviorally-orientated steps improves usability. AREAS COVERED: This article introduces the concept of opioid-induced constipation and provides an overview of existing guidelines in this field. We also propose simplified recommendations for managing opioid-induced constipation, derived from a synthesis of current guidelines and the principles of optimal guideline design theory. EXPERT OPINION: Despite standard treatment with laxatives and fluid intake in patients with opioid-induced constipation, escalation of treatment is often needed where μ-opioid receptor antagonists or newer medications such as lubiprostone, linaclotide, or prucalopride are used. Previous guidelines have not been used sufficiently and thus management of the condition is often insufficient. We therefore propose simplified recommendations to management, which we believe can come into broader use. It was validated in primary care for credibility, clarity, relevance, usability, and overall benefit. We believe that this initiative can lead to better management of the substantial proportion of patients suffering from side effects of opioids

Cortisol and Subjective Stress Responses to Acute Psychosocial Stress in Fibromyalgia Patients and Control Participants

OBJECTIVE: Hypothalamic-pituitary-adrenal (HPA) axis dysfunction may play a role in fibromyalgia (FM) pathogenesis, but remains understudied in this disorder. Furthermore, early childhood adversities (ECA) are common in FM, but whether they moderate stress reactivity is unknown. Hence, we investigated cortisol and subjective responses to acute psychosocial stress in FM and controls, while adjusting for ECA. METHODS: Twenty-seven female FM patients and 24 age-matched female controls were recruited in a tertiary care center and through advertisements, respectively. The Childhood Trauma Questionnaire was used to measure ECA history. Salivary cortisol levels and subjective stress ratings were measured at multiple time points before and after the Trier Social Stress Test (TSST) was administered. RESULTS: Significant main effects of group [F(1,43)=7.04, p=0.011, lower in FM] and ECA [F(1,43)=5.18, p=0.028, higher in participants with ECA] were found for cortisol responses. When excluding controls with ECA (n=5), a significant group-by-time interaction was found [F(6,39)=2.60, p=0.032], driven by a blunted response to the stressor in FM compared with controls (p=0.037). For subjective stress responses, a significant main effect of group [F(1,45)=10.69, p=0.002, higher in FM] and a trend towards a group-by-time interaction effect [F(6,45)=2.05, p=0.078, higher in FM 30 minutes before and 30 and 75 minutes after the TSST, and impaired recovery (difference immediately after - 30 minutes after the TSST) in FM] were found. CONCLUSIONS: Blunted cortisol responsivity to the TSST was observed in FM patients compared with controls without ECA. FM patients had higher subjective stress levels compared with controls, particularly at baseline and during recovery from the TSST. In FM patients, ECA history was not associated with cortisol or subjective stress levels, or with responsivity to the TSST. Future research should investigate the mechanisms underlying HPA axis dysregulation in FM

Prevalence and impact of childhood adversities and post-traumatic stress disorder in women with fibromyalgia and chronic widespread pain.

OBJECTIVE: This study investigates the prevalence of different types of childhood adversities (CA) and posttraumatic stress disorder (PTSD) in female patients with Fibromyalgia or Chronic Widespread Pain (FM/CWP) compared to patients with Functional Dyspepsia (FD) and achalasia. In FM/CWP, we also investigated the association between CA and PTSD on the one hand and pain severity on the other. METHODS: Patient samples consisted of 154 female FM/CWP, 83 female FD and 53 female achalasia patients consecutively recruited from a tertiary care hospital. Well-validated self-report questionnaires were used to investigate CA and PTSD. RESULTS: Forty-nine per cent of FM/CWP patients reported at least 1 type of CA, compared to 39.7% of FD patients and 23.4% of achalasia patients (p < 0.01). The prevalence of CA did not differ significantly between FM/CWP and FD, but both groups had a higher prevalence of CA compared to both achalasia and healthy controls (p < 0.01). FM/CWP patients were six times more likely to report PTSD than both FD (p < 0.001) and achalasia (p < 0.001) patients. CONCLUSION: In FM/CWP, PTSD comorbidity, but not CA, was associated with self-reported pain severity and PTSD severity mediated the relationship between CA and pain severity. In summary, the prevalence of CA is higher in FM/CWP compared to achalasia, but similar to FD. However, PTSD is more prevalent in FM/CWP compared to FD and associated with higher pain intensity in FM/CWP. SIGNIFICANCE: As expected and has been shown in other functional disorders, we found elevated levels of childhood adversity in FM/CWP patients. Results of this study however suggest that the impact of childhood adversity (i.e. whether such events have led to the development of PTSD symptoms), rather than the mere presence of such adversity, is of crucial importance in FM/CWP patients. Screening for PTSD symptoms should be an essential part of the assessment process in patients suffering from FM/CWP, and both prevention and intervention efforts should take into account PTSD symptoms and their impact on pain severity and general functioning