Pain
-
Whether self-reported lifetime civilian and war-related potential traumatic events are associated with widespread pain (WP) and if so, whether the association is attributable to posttraumatic stress disorder (PTSD) and depression has not been studied in a representative sample of the general population. In a randomly selected sample of the German general population, persons aged 60-85 years answered validated self-rating instruments: Regional Pain Scale, trauma list of the Composite International Diagnostic Interview, Posttraumatic Diagnostic Scale, and Patient Health Questionnaire 2. Participants with WP were compared with participants with no or local or regional pain (controls). ⋯ The significant association between some potential traumatic events and WP was completely abrogated after adjusting for demographic variables and PTSD. In the final model, PTSD (odds ratio 3.43, 95% confidence interval 1.88-6.26) and lifetime employment status as a worker (odds ratio 1.55, 95% confidence interval 1.04-2.31) predicted WP. Prospective studies are necessary to understand the temporal association of PTSD and WP.
-
Multicenter Study
Predictors for postpartum pelvic girdle pain in working women: the Mom@Work cohort study.
The objective of this study was to examine which factors during pregnancy and postpartum predict pelvic girdle pain (PGP) at 12 weeks postpartum among working women. A total of 548 Dutch pregnant employees were recruited in 15 companies, mainly health care, child care, and supermarkets. The definition of PGP was any pain felt in the pelvic girdle region at 12 weeks postpartum. ⋯ The pregnancy and postpartum-related predictors were: more disability at 6 weeks, having PGP at 6 weeks, higher mean pain at 6 weeks, higher somatisation during pregnancy and at 6 weeks postpartum, higher birth weight of the baby, uncomfortable postures at work and number of days of bed rest. Based on these results, it is concluded that extra attention should be given to women who experience PGP during pregnancy to prevent serious PGP during late pregnancy and postpartum. More research is needed to confirm the roles of hours of sleep, somatisation, and bed rest in relation to PGP.
-
Randomized Controlled Trial
Brain networks predicting placebo analgesia in a clinical trial for chronic back pain.
A fundamental question for placebo research is whether such responses are a predisposition, quantifiable by brain characteristics. We examine this issue in chronic back pain (CBP) patients who participated in a double-blind brain imaging (functional magnetic resonance imaging) clinical trial. We recently reported that when the 30 CBP participants were treated, for 2 weeks, with topical analgesic or no drug patches, pain and brain activity decreased independently of treatment type and thus were attributed to placebo responses. ⋯ Additionally, by means of frequency domain contrasts, we observe that at baseline, left dorsolateral prefrontal cortex high-frequency oscillations also predicted treatment outcomes and identified an additional set of functional connections distinguishing treatment outcomes. Combining medial and lateral prefrontal functional connections, we observe a statistically higher accuracy (0.9) for predicting posttreatment groups. These findings indicate that placebo response can be identified a priori at least in CBP, and that neuronal population interactions between prefrontal cognitive and pain processing regions predetermine the probability of placebo response in the clinical setting.
-
The objective of this study was to evaluate the time-series relationships between stress, sleep duration, and headache pain among patients with chronic headaches. Sleep and stress have long been recognized as potential triggers of episodic headache (<15 headache days/month), though prospective evidence is inconsistent and absent in patients diagnosed with chronic headaches (≥15 days/month). We reanalyzed data from a 28-day observational study of chronic migraine (n=33) and chronic tension-type headache (n=22) sufferers. ⋯ When patterns of stress or sleep were divergent across days, headache risk was increased only when the earlier day was characterized by high stress or poor sleep. As predicted, headache activity in the combined model was highest when high stress and low sleep occurred concurrently during the prior 2 days, denoting an additive effect. Future research is needed to expand on current findings among chronic headache patients and to develop individualized models that account for multiple simultaneous influences of headache trigger factors.