Meaning of chronic pain in situations of risk and routine situations to patients with depression

Introduction: The individual response to pain in a specific situation has an influence on the meaning of chronic pain experiences.Aim: The aim of the present study was to analyze the influence of both situations of risk and routine on the meaning of chronic pain to patients with depression.Materials and Methods: The study included two groups of 16 patients with chronic pain and depression. Group 1 perceived the pain situation as a risk and Group 2—as a routine. The groups were assessed with: 1) quantitative methods: HAM-D-17, Spielberger’s questionnaire for state and trait anxiety degree and VAS; and 2) qualitative method—content analysis of the answers to the question “What does the pain mean to you?”.Results:The two samples had close mean ages, respectively 57.81 ± 13.63 (Group 1) and 54.88 ± 10.68 (Group 2). The share of women (87.5%) was predominant over that of men (12.5%). No significant differences were found in the mean values of the quantitative indicators between the groups. The content analysis revealed specific experiences of pain as a punishment, discomfort, and anxiety for Group 1, and as a part of life for Group 2.Conclusion:Тhe way of perceiving the pain situation influences the meaning of chronic pain experiences in patients with depression. The combined assessment of the situation and specific pain experiences reveals information about the psychosocial functioning. It could be used as a method for picking out patients in need of psychotherapeutic and educational interventions aimed at accepting chronic pain as a part of life

Pain as a threat—psychological and phenomenological aspects

Introduction: Pain is a multidimensional experience of injury or threat of future damage, with sensory, cognitive, motivational and emotional aspects. The essence of the pain experience depends on the meaning that the individual gives to pain in a particular situation.Aim: The aim of the article is to analyze and structure the concept of pain as a threat, covering its psychological and phenomenological aspectsMaterials and Methods: A review and critical analysis of relevant literature have been conducted.Results: It has been established that a predisposing factor for maintaining acute pain and turning it into a chronic one is the expectation (threat) of future harm. The emotional components of the threat of pain (fear and anxiety), as well as the cognitive ones (overvigilance and catastrophizing), have been studied. The assessments of the situation during pain and of the pain-coping resources are the main cognitive mediators that determine the outcome. The perception of pain as a threat provokes fear, anxiety, experiences of insecurity, helplessness, and maladaptive behaviors. Pain-avoiding behavior is in the basis of the stress-diathesis in the manifestation of chronic pain and it predicts future disability.Conclusion: Pain is a threat to the physical and the psychosocial functioning. The assessment of the emotional, cognitive and situational aspects related to pain should be a part of the multidisciplinary approaches to pain management. Manipulating these factors is key to reducing the risk of pain becoming chronic. The application of effective behavioral and cognitive techniques, aimed at increasing the resources for coping with and controlling pain enables patients to continue to function normally in spite of the pain

Common physiological aspects and interconnections between stress and pain

Introduction: Stress and pain are phenomena with similar conceptual explanations and they both play an essential role in our survival as individuals. They are a challenge to the organism's adaptive capacities and homeostasis processes. The physiological aspects of the two phenomena reveal common neurobiological origins and multiple interconnections.Aim: The purpose of the article is to conceptualize and structure evidence relating to the common physiological aspects of pain and stress phenomena and to analyze their interconnections.Materials and Methods: A review and critical analysis of relevant literature.Results: The relationship between stress and pain has been studied. Stress participates in the manifestation of acute pain and maintains the processes of its chronicity. It has been hypothesized that the different stress models in the pathogenesis of pain are due to the influence of factors associated with the psychological aspects of stress.Conclusion: Most authors support the idea that physiological responses to stress and pain are relatively nonspecific. They are influenced by many factors related to current physical condition, past experiences of stressful situations and pain, emotional (fear, anxiety, depression) and cognitive factors involved in generating complex programs, aimed at restoring homeostasis. The stress model of pain is a manifestation of the interconnections and the potential interactions between the two phenomena. Data analysis provokes questions and offers prospects for more comprehensive studies related to exploration of the causal relationship between the two phenomena

ISOTRETINOIN INDUCED PSYCHOTIC SYMPTOMS

Isotretinoin is an effective treatment for severe and resistant forms of acne. It has proven potential for inducing dose-dependent psychiatric side effects, especially in some vulnerable groups of patients. Objective: The aim of the present article is to report a case of a 22-year-old woman with a family history of schizophrenia who was diagnosed with acne. After unsuccessful antibiotic treatment of acne, a panic disorder accompanied by depressive symptoms manifested. Isotretinoin 20 mg/day was used as а second step of the dermatological treatment for a period of four months, along with psychotropic treatment for panic disorder – sertraline 50 mg/day and flupentixol 1,5 mg/day. When the dose of Isotretinoin was increased to 40 mg/day, paranoid delusions occurred. The manifestation of psychotic symptoms required discontinuation of all medications and initiation of antipsychotic therapy with quetiapine. The psychotic symptoms completely disappeared when the dose of quetiapine was increased to 300 mg/day. Conclusion: The presented case emphasizes the need for increased vigilance about the manifestation of psychiatric symptoms, especially in patients with a family history, current or past medical history of mental disorder. In such cases, consultation with a psychiatrist before starting treatment with Isotretinoin is recommended in order to better clarify the benefits and the risks of the treatment. The endogenous origin of the psychosis was discussed in the differential diagnostic plan, which requires long-term monitoring of the mental state

INFLUENCE OF DEPRESSION AND ANXIETY ON PAIN INTENSITY IN PATIENTS WITH CHRONIC PAIN AND DEPRESSION

Depression in chronic pain often manifests with symptoms of anxiety. Purpose: The aim of the study is to investigate the influence of depression, state and trait anxiety on pain intensity in patients with chronic pain and depression. Materials and Methods: Sixty-one patients with chronic pain and depression were studied. The study was phased. Тhe second stage was carried out three months after the first. All participants received antidepressant treatment. The severity of depression was assessed with HAM-D-17, the level of state and trait anxiety – with Spielberger's STAI and pain intensity – with VAS. The trait anxiety was studied during the first stage. Regression analysis was used to perform the purpose of the study. Results: The mean age of the sample was 55.6066±10.90608. Women comprised 91.8% of the sample, and men – 8.2%. A reduction in the mean values of the indicators in the second stage was reported. A regression analysis during the first stage showed that 60% of the variations in pain intensity were explained by the influence of the three variables (R=,616; R2=,379). Depression had the greatest impact and degree of influence on pain (t=3,372; p=,001), compared to state anxiety (t=,513; p=,015). The influence of trait anxiety was negligible (t=-,484; p=,630). The results of the analysis of the second stage were similar (R=,644, R2=,415). The influence of depression was significant (p=,011; t=2,626), compared to that of state anxiety (t=2,012; p=,049). Conclusions: Depression is the main variable influencing pain intensity. The search for symptoms of depression and their treatment is crucial for the management of chronic pain

Correlations between pain intensity, severity of depression, state and trait anxiety in patients with chronic pain and depression

Introduction: Patients with chronic pain and depression are a specific group in which mental (depression and anxiety) and physical (pain) symptoms manifest together.Aim: The aim of the present study is to investigate the correlations between the severity of depression, the anxiety (trait and state), and the intensity of pain in patients with chronic pain and depression.Materials and Methods: The study included 61 patients with chronic pain and depression. It was conducted in two stages with a three-month period between them. All participants received antidepressant treatment. The severity of depression was assessed with HAM-D-17, the level of state and trait anxiety—with Spielberger’s STAI, and pain intensity—with VAS. A correlation analysis between the main indicators was carried out in both stages of the study.Results: The mean age of the sample was 55.61 ± 10.91. Women comprised 91.8% of the sample and men—8.2%. A reduction of the mean values of the indicators in the second stage was reported, with the most pronounced being in the severity of depression from 16.15 ± 5.87 to 13.36 ± 6.96. The number of patients with high trait (80.33%) and high state anxiety (64%—first stage, 62.5%—second stage) was predominant. The correlation analysis at both stages of the study proved significant correlations between all indicators (p < 0.01).Conclusion: The patients with chronic pain and depression are a specific group that requires a complex clinical assessment of the associated indicators depression, anxiety, and pain intensity for their effective management

Specifics and Dynamics of the Pain Symptoms and Experiences in Patients with Depression // Специфика и динамика на болковите симптоми и преживявания при пациенти с депресия

Depression is a leading factor involved in the maintenance of chronic pain. The aim of this dissertation is to clarify the causal relationships between affective and sensory pain variables and their impact on the specifics and dynamics of pain experiences in patients with chronic pain and depression. Quantitative and qualitative methods for assessment the phenomenon of pain, were combined. Significant correlations between the studied variables: pain intensity, severity of depression, state and trait anxiety, were proved. The severity of depression was a major factor influencing pain variations. State anxiety had a lesser influence on the pain intensity. The influence of trait anxiety was negligible. The combined influence of the three variables explain to a large extent the variations in pain intensity in patients with chronic pain and depression. The scales used to assess the variables (HAM- D -17, STAI and VAS) were represented as a battery for examining patients with chronic pain and depression. Content analysis identified specific experiences of pain in patients with depression: punishment, despair, low self-esteem, guilt and suicidal ideation and cessation of social contacts. The improving of depression symptoms reduces the specifics of the experiences. The combination of qualitative and quantitative methods allowed for an in-depth study of pain experiences in patients with depression in the direction of their deconstruction to a lower hierarchical level for analysis.Депресията е водещ фактор, участващ в поддържането на хроничната болка. Настоящата дисертация цели да се изяснят каузалните взаимовръзки между афективните и сетивни променливи на болката и тяхното влияние върху спецификата и динамиката на преживяванията на болка при пациенти с депресия и хронична болка. Съчетани са количествени и качествени методи за оценка на феномена болка. Установяват се значими корелации между изследваните променливи: интензивност на болката, тежест на депресия, ситуативна и личностна тревожност. Тежестта на депресията е основен фактор, влияещ върху вариациите на болката. Ситуативната тревожност има по-слабо влияние, а личностната тревожност е с незначително върху интензивността на болката. Комбинираното влияние на трите променливи обяснява в голяма степен вариациите в болката при пациенти с хронична болка и депресия. Използваните скали за оценка на променливите HAM-D – 17, STAI и VAS, проявяват характер на тестова батерия за изследване на пациенти с хронична болка и депресия. Посредством контентен-анализ се изведоха специфичните преживявания на болка при пациенти с депресия: за наказание, отчаяние, понижена самооценка, вина и суицидни идеи и спиране на социалните контакти. Подобрението на депресията редуцира специфичното в преживяванията. Съчетанието на качествени и количествени методи даде възможност за задълбочено изследване на преживяванията на болка при пациенти с депресия в посока на тяхното декомпозиране до по-ниско йерархично ниво за анализ

ASSESSMENT OF THE SITUATION DURING PAIN BY PATIENTS WITH CHRONIC PAIN

The way a person perceives and interprets the situation during pain provokes a variety of emotional and behavioral responses. Aim: The aim of the study was to analyze the assessment of the situation during pain by patients with chronic pain. Materials and methods: A sample of 120 patients with chronic pain was studied. Sixty-one of them had clinically manifested symptoms of depression, and fifty-nine had no depression. The patients were evaluated using the following scales: HAM-D-17, Spielberger questionnaire – STAI – form Y1 and form Y2 and VAS. A model of four situations was applied to assess the situation during pain: unique, risky, routine and situation of uncertainty. Results: The mean age of the sample was 51.90±11.94. Women predominate (81.7%) over men (18.3%). The group with depression had moderate severity of depression and pain intensity and high state and trait anxiety. A majority of them (48.4%) assessed the situation during pain as a risk and/or an uncertainty. The group without depression had moderate state and trait anxiety and mild pain intensity. More than half of them (62.7%) assessed the situation as routine. Conclusion: Depression and anxiety affect the perceived situation during pain. Assessing and understanding the specific links between them is essential for forming adaptive ways of coping with chronic pain