The epidemiology of chronic pain in Libya: a cross-sectional telephone survey.

BACKGROUND: Chronic pain is a public health problem although there is a paucity of prevalence data from countries in the Middle East and North Africa. The aim of this study was to estimate the prevalence of chronic pain and neuropathic pain in a sample of the general adult population in Libya. METHODS: A cross-sectional telephone survey was conducted before the onset of the Libyan Civil War (February 2011) on a sample of self-declared Libyans who had a landline telephone and were at least 18 years of age. Random sampling of household telephone number dialling was undertaken in three major cities and interviews conducted using an Arabic version of the Structured Telephone Interviews Questionnaire on Chronic Pain previously used to collect data in Europe. In addition, an Arabic version of S-LANSS was used. 1212 individuals were interviewed (response rate = 95.1 %, mean age = 37.8 ± 13.9 years, female = 54.6 %). RESULTS: The prevalence of chronic pain ≥ 3 months was 19.6 % (95 % CI 14.6 % to 24.6 %) with a mean ± SD duration of pain of 6 · 5 ± 5 · 7 years and a higher prevalence for women. The prevalence of neuropathic pain in the respondents reporting chronic pain was 19 · 7 % (95 % CI 14 · 6-24 · 7), equivalent to 3 · 9 % (95 % CI 2 · 8 to 5 · 0 %) of the general adult population. Only, 71 (29 · 8 %) of respondents reported that their pain was being adequately controlled. CONCLUSIONS: The prevalence of chronic pain in the general adult population of Libya was approximately 20 % and comparable with Europe and North America. This suggests that chronic pain is a public health problem in Libya. Risk factors are being a woman, advanced age and unemployment. There is a need for improved health policies in Libya to ensure that patients with chronic pain receive effective management

Contemporary review of risk-stratified management in acute uncomplicated and complicated diverticulitis

BACKGROUND: Acute colonic diverticulitis is a common clinical condition. Severity of the disease is based on clinical, laboratory, and radiological investigations and dictates the need for medical or surgical intervention. Recent clinical trials have improved the understanding of the natural history of the disease resulting in new approaches to and better evidence for the management of acute diverticulitis. METHODS: We searched the Cochrane Library (years 2004-2015), MEDLINE (years 2004-2015), and EMBASE (years 2004-2015) databases. We used the search terms "diverticulitis, colonic" or "acute diverticulitis" or "divertic*" in combination with the terms "management," "antibiotics," "non-operative," or "surgery." Registers for clinical trials (such as the WHO registry and the https://clinicaltrials.gov/) were searched for ongoing, recruiting, or closed trials not yet published. RESULTS: Antibiotic treatment can be avoided in simple, non-complicated diverticulitis and outpatient management is safe. The management of complicated disease, ranging from a localized abscess to perforation with diffuse peritonitis, has changed towards either percutaneous or minimally invasive approaches in selected cases. The role of laparoscopic lavage without resection in perforated non-fecal diverticulitis is still debated; however, recent evidence from two randomised controlled trials has found a higher re-intervention in this group of patients. CONCLUSIONS: A shift in management has occurred towards conservative management in acute uncomplicated disease. Those with uncomplicated acute diverticulitis may be treated without antibiotics. For complicated diverticulitis with purulent peritonitis, the use of peritoneal lavage appears to be non-superior to resection

Recognition of patients with medically unexplained physical symptoms by family physicians: results of a focus group study

BACKGROUND: Patients with medically unexplained physical symptoms (MUPS) form a heterogeneous group and frequently attend their family physician (FP). Little is known about how FPs recognize MUPS in their patients. We conducted a focus group study to explore how FPs recognize MUPS and whether they recognize specific subgroups of patients with MUPS. Targeting such subgroups might improve treatment outcomes. METHODS: Six focus groups were conducted with in total 29 Dutch FPs. Two researchers independently analysed the data applying the principles of constant comparative analysis in order to detect characteristics to recognize MUPS and to synthesize subgroups. RESULTS: FPs take into account various characteristics when recognizing MUPS in their patients. More objective characteristics were multiple MUPS, frequent and long consultations and many referrals. Subjective characteristics were negative feelings towards patients and the feeling that the FP cannot make sense of the patient's story. Experience of the FP, affinity with MUPS, consultation skills, knowledge of the patient's context and the doctor-patient relationship seemed to influence how and to what extent these characteristics play a role. Based on the perceptions of the FPs we were able to distinguish five subgroups of patients according to FPs: 1) the anxious MUPS patient, 2) the unhappy MUPS patient, 3) the passive MUPS patient, 4) the distressed MUPS patient, and 5) the puzzled MUPS patient. These subgroups were not mutually exclusive, but were based on how explicit and predominant certain characteristics were perceived by FPs. CONCLUSIONS: FPs believe that they can properly identify MUPS in their patients during consultations and five distinct subgroups of patients could be distinguished. If these subgroups can be confirmed in further research, personalized treatment strategies can be developed and tested for their effectiveness

Fragebogen zu Bewältigungsressourcen bei Rückenschmerzen: Evaluierung an einer Stichprobe chronischer Kreuzschmerzpatienten

BACKGROUND The coping resources questionnaire for back pain (FBR) uses 12 items to measure the perceived helpfulness of different coping resources (CRs, social emotional support, practical help, knowledge, movement and relaxation, leisure and pleasure, spirituality and cognitive strategies). The aim of the study was to evaluate the instrument in a clinical patient sample assessed in a primary care setting. SAMPLE AND METHODS The study was a secondary evaluation of empirical data from a large cohort study in general practices. The 58 participating primary care practices recruited patients who reported chronic back pain in the consultation. Besides the FBR and a pain sketch, the patients completed scales measuring depression, anxiety, resilience, sociodemographic factors and pain characteristics. To allow computing of retested parameters the FBR was sent to some of the original participants again after 6 months (90% response rate). We calculated consistency and retest reliability coefficients as well as correlations between the FBR subscales and depression, anxiety and resilience scores to account for validity. By means of a cluster analysis groups with different resource profiles were formed. Results. RESULTS For the study 609 complete FBR baseline data sets could be used for statistical analysis. The internal consistency scores ranged fromα=0.58 to α=0.78 and retest reliability scores were between rTT=0.41 and rTT=0.63. Correlation with depression, fear and resilience ranged from r=-0.38 to r=0.42. The cluster analysis resulted in four groups with relatively homogenous intragroup profiles (high CRs, low spirituality, medium CRs, low CRs). The four groups differed significantly in fear and depression (the more inefficient the resources the higher the difference) as well as in resilience (the more inefficient the lower the difference). The group with low CRs also reported permanent pain with no relief. The groups did not otherwise differ. CONCLUSIONS The FBR is an economic instrument that is suitable for practical use e.g. in primary care practices to identify strengths and deficits in the CRs of chronic pain patients that can then be specified in face to face consultation. However, due to the rather low reliability, the use of subscales for profile differentiation and follow-up measurement in individual diagnoses is limited.Hintergrund Bei dem Fragebogen zu Bewältigungsressourcen bei Rückenschmerzen (FBR) handelt es sich um ein Verfahren, das mit 12 Items erfasst, wie hilfreich verschiedene Bewältigungsressourcen (BR) erlebt werden (soziale emotionale Unterstützung, praktische Hilfe, Wissen, Bewegung und Entspannung, Hobby und Genuss, Spiritualität, kognitive Strategien). Ziel der Studie war es, die Skala an einer klinischen Stichprobe im hausärztlichen Setting zu evaluieren. Stichprobe und Methoden Es handelt sich um eine Sekundäranalyse im Rahmen einer großen Kohortenstudie. In 58 Allgemeinarztpraxen wurden Patienten mit chronischen Kreuzschmerzen rekrutiert. Die Patienten bearbeiteten neben dem FBR eine Schmerzzeichnung, Skalen zu Depression, Angst, Resilienz sowie soziodemographische und schmerzbezogene Fragen. Einem Teil der Patienten wurde der FBR nach 6 Monaten nochmals zugeschickt (90 % Responserate). Es wurden Konsistenzwerte und Retestreliabilitäten berechnet. Korrelationen zwischen den FBR-Skalen und den Depressions-, Angst- und Resilienzratings wurden zur Validitätsbestimmung ermittelt. Mittels einer Clusteranalyse wurden Gruppen mit unterschiedlichen Ressourcenprofilen gebildet und verglichen. Ergebnisse Insgesamt lagen 609 vollständige FBR-Datensätze zur Auswertung vor. Die internen Konsistenzwerte lagen zwischenα = 0,58 und α = 0,78. Die Retestreliabilitäten nahmen Werte von rTT = 0,41 bis rTT = 0,63 an. Die Korrelationen mit Depression, Angst und Resilienz bewegten sich im Bereich zwischen r = − 0,38 und r = 0,42. Anhand der Clusteranalyse wurden vier Gruppen gebildet (hohe BR, niedrige Spiritualität, mittlere BR und niedrige BR). Die Gruppen unterschieden sich signifikant in Angst und Depression (je ineffizienter die Ressourcen desto höher) sowie Resilienz (je ineffizienter die Ressourcen desto niedriger). Die Gruppe mit niedrigen BR berichtete außerdem häufiger über Dauerschmerzen ohne Pause. In den anderen Parametern unterschieden sich die Gruppen nicht. Schlussfolgerungen Der FBR ist ein ökonomisches Verfahren, das für die praktische Anwendung z. B. in der Hausarztpraxis gut geeignet ist, um Stärken und Defizite in den BR von chronischen Rückenschmerzpatienten zu identifizieren und im Gespräch zu vertiefen. Aufgrund der niedrigen Reliabilitäten sind die Subskalen zur Verlaufskontrolle oder Profilinterpretation nur bedingt zu empfehlen

Differences between patients with chronic widespread pain and local chronic low back pain in primary care - a comparative cross-sectional analysis.

BACKGROUND: Chronic pain is a common reason for consultation in general practice. Current research distinguishes between chronic localized pain (CLP) and chronic widespread pain (CWP). The aim of this study was to identify differences between CWP and chronic low back pain (CLBP), a common type of CLP, in primary care settings. METHODS: Fifty-eight German general practitioners (GPs) consecutively recruited all eligible patients who consulted for chronic low back pain during a 5-month period. All patients received a questionnaire on sociodemographic data, pain characteristics, comorbidities, psychosomatic symptoms, and previous therapies. RESULTS: GPs recruited 647 eligible patients where of a quarter (n = 163, 25.2%) met the CWP criteria according to the American College of Rheumatology. CWP patients had significantly more comorbidities and psychosomatic symptoms, showed longer pain duration, and suffered predominantly from permanent pain instead of distinguishable pain attacks. CWP patients were more often females, are less working and reported a current pension application or a state-approved grade of disability more frequently. We found no other differences in demographic parameters such as age, nationality, marital status, number of persons in household, education, health insurance status, or in health care utilization data. CONCLUSIONS: This project is the largest study performed to date which analyzes differences between CLBP and CWP in primary care settings. Our results showed that CWP is a frequent and particularly severe pain syndrome. TRIAL REGISTRATION: German Clinical Trial Register, DRKS00003123. &nbsp