Psychogenic Pain Research Articles

Efficacy of sequential primary motor and prefrontal cortices intermittent Theta burst stimulation in persistent somatoform PAIN disorder (TAP-PAIN): A randomized sham-controlled pilot trial

Aim: There is a need to elucidate intermittent Theta burst stimulation (iTBS) as a novel treatment in persistent somatoform pain disorder (PSPD). Methods: Twenty patients were randomly allocated to active iTBS (n = 11) and sham iTBS (n = 9) and received 10 iTBS sessions, 2 sessions per day, sequentially to primary motor and dorsolateral prefrontal cortices for 5 days in a week. Each iTBS session comprised of 2 sec. per train of 10 bursts (3 pulses per burst at 50 Hz; total 30 pulses) and were given with a gap of 5 Hz, total of 20 trains, and 600 pulses. Visual Analogue Scale, Brief Pain Inventory and Global Pain Scale (GPS), Montgomery and Asberg Depression Rating Scale, Hamilton Anxiety Rating Scale - Anxiety, World Health Organization Quality-of-Life Scale-brief, and Pittsburgh Sleep Quality Index were applied at baseline, after last session, and at 2 weeks after last TBS session. Intention to treat analysis was conducted. Results: Both groups were comparable for baseline psychopathology scores including clinical variables like age (t = 0.865; P = 0.398), duration of illness (t = 1.600; P = 0.127), and motor threshold (t = 0.304; P = 0.765). On repeated measures ANOVA, a significant within-group time effect for VAS, BPI-Severity, BPI-Interference, BDI – II, MADRS, HAM-A, and WHOQOL- BREF was found for active and sham TBS groups, respectively. GPS scores had significant within-group (active) * time interaction (F = 11.651; P = .001; ηp2 = 0.538) and between-group * time interaction (F = 3.407; P = 0.044; ηp2 = 0.159). However, between-group * time effect interaction was lost after covariance (F = 1.726; P = 0.196; ηp2 = 0.110). Conclusion: No major adverse effects were reported. Our pilot trial concludes that safe therapeutic efficacy of iTBS in PSPD is inconclusive. Lower total number of sessions along with small sample size may limit the study findings.

A case of NMDAR Encephalitis with muscular pain as the main presentation

BackgroundPersistent somatoform pain disorder (PSPD) is often the initial diagnosis in patients seeking treatment in psychiatric departments, making it challenging to consider organic nervous system diseases. However, autoimmune encephalitis can present with atypical initial symptoms, leading to misdiagnosis or missed diagnosis. Lumbar puncture, with antibody support, plays a crucial role in diagnosing autoimmune encephalitis.Case presentationThis report describes a 40-year-old male adult patient who was initially diagnosed with persistent somatoform pain disorder in 2022. The patient reported a reduction in pain while resting on his back. There were no fever or relevant medical history. Despite 8 months of symptomatic treatment, the symptoms did not improve. Moreover, the patient developed confusion, gibberish speech, non-cooperation during questioning, and increased frequency and amplitude of upper limb convulsions. Lumbar puncture revealed elevated protein levels and protein-cell dissociation. The autoimmune encephalitis antibody NMDAR (+) was detected, leading to a diagnosis of autoimmune encephalitis (NMDAR).ConclusionAutoimmune encephalitis (NMDAR), starting with persistent somatoform pain (PSPD), often presents with atypical symptoms and can be easily misdiagnosed. Therefore, it is important to consider the possibility of organic nervous system disease in time, and to test serum or cerebrospinal fluid antibodies to rule out organic nervous system disease after symptomatic treatment of mental disorders is ineffective. This approach facilitates the early diagnosis of autoimmune encephalitis and other underlying organic neurological disorders.

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department.

Pediatric chest pain is a common chief complaint in the emergency department. Not surprisingly, children with chest pain are usually brought to the emergency department by their parents out of fear of heart disease. However, chest pain in the pediatric population is generally a benign disease. In this review, we have identified musculoskeletal pain as the most prevalent etiology of chest pain in the pediatric population, accounting for 38.7-86.3% of cases, followed by pulmonary (1.8-12.8%), gastrointestinal (0.3-9.3%), psychogenic (5.1-83.6%), and cardiac chest pain (0.3-8.0%). Various diagnostic procedures are commonly used in the emergency department for cardiac chest pain, including electrocardiogram (ECG), chest radiography, cardiac troponin examination, and echocardiography. However, these examinations demonstrate limited sensitivity in identifying cardiac etiologies, with sensitivities ranging from 0 to 17.8% for ECG and 11.0 to 17.2% for chest radiography. To avoid the overuse of these diagnostic tools, a well-designed standardized algorithm for pediatric chest pain could decrease unnecessary examination without missing severe diseases.

The Diagnostic Value of Carnett's Test with Chronic Abdominal Pain: A Narrative Review.

Chronic abdominal wall pain is a poorly recognized cause of chronic abdominal pain, and patients frequently go misdiagnosed despite a battery of medical tests. The Carnett's test is a diagnostic tool used to distinguish between abdominal wall pain and visceral pain. This review synthesizes the current literature on the Carnett's test, merges the viewpoints of diverse writers, and evaluates and reports on the Carnett's test's applicability. Several clinical investigations have established the usefulness of the Carnett's test in the diagnosis of chronic abdominal wall pain. Furthermore, the Carnett's test is quite useful in determining the depth of the mass and detecting psychogenic abdominal pain. However, its diagnostic use for acute abdominal pain is limited. The Carnett's test is a simple and safe point-of-care diagnostic technique, with several studies supporting its usefulness. Early detection of abdominal wall pain is critical for chronic abdominal wall pain therapy. Carnett's test is very useful in patients with chronic, unexplained local abdominal discomfort who are compliant and do not have a clear rationale for surgery.

Effectiveness of Kinesio-Taping and Conventional Therapy for Non-Specific Chronic Low Back Pain

Chronic non-specific low back pain, which is treated in orthopedic rehabilitation settings, is a frequent musculoskeletal issue. Lumbar spondylosis, Psychogenic Low Back Pain, Spinal Stenosis and poor posture are all causing pain for the patient. Kinesio-Taping helps to reduce or eliminate discomfort. Objective: To see how effective kinesio-tapping and traditional therapy are for non-specific chronic low back pain. Methods: This was a quasi-experimental study design in which 30 patients were recruited using a convenient sampling sample, with 15 individuals in each group (Group A, Kinesio-Tapping with Conventional Therapy includes stretching, strengthening and hot pack) Group B which consists solely of standard conventional therapy. An independent T-Test for inter-group comparison and a paired sample T-Test for within-group analysis were used to assess the Oswestry Low Back Pain Disability and Numeric Pain Rating Scale. Results: There was a significant change between the baseline and post-treatment NRPS values. Mean difference of 10.42 and 3.14 were reported between the pretreatment and post treatment values of NPRS in KT taping Group which was significant (p-value < 0.05). Mean difference of 14.18 and 3.68 were reported between the pretreatment and post treatment values of NPRS in Conventional PT Program Group which was significant (p-value < 0.05). Conclusions: Kinesio-Taping in conjunction with Conventional Therapy is more effective than Conventional Therapy alone in treating Chronic Non-specific Low Back Pain.

On the question of the features of pain syndrome in oncopediatric practice

Background. Nociceptive and neuropathic pains are characteristic of oncological diseases and can be complicated by a psychogenic component, the conditions for the formation of which in juvenile cancer patients are poorly studied.Aim. A clinical analysis of a psychogenic pain symptom complex acting in isolation or as a component of a pain disorder with somatic prerequisites.Materials and methods. Using the clinical and psychopathological method, 60 patients aged 10–17 years undergoing treatment in an oncological hospital were studied.Results and conclusion. Psychogenic pain is a component of polymorphic psychogenic education (nosogenic reaction), it develops in children with a special characterological warehouse when they get into a situation of hospital stress.

Serum 3-Hydroxybutyrate is Expected to Serve as One of the Supportive Diagnostic Markers of Persistent Idiopathic Dentoalveolar Pain (PDAP).

Persistent idiopathic dentoalveolar pain (PDAP), previously referred to as atypical odontalgia, is a chronic dental pain that occurs without signs of pathology. PDAP is considered a diagnosis of exclusion, and its definition is currently under refinement and remains ambiguous. The metabolite known as 3-hydroxybutyrate (3HB) has garnered significant interest as a potential indicator for both depression and chronic psychogenic pain. We investigated the characteristics of patients with PDAP and hypothesized that serum 3HB could support the diagnosis of PDAP. Forty-one patients with PDAP and 167 patients with odontogenic toothache were investigated regarding depression and anxiety scales in addition to the general dental evaluation. Blood tests including high-sensitivity CRP, HbA1c, and 3HB were performed for all patients. Associations between PDAP and patients' varying characteristics were investigated using hierarchical multivariate logistic regression analyses. There were more females, current smokers, patients with orofacial pain (such as temporomandibular joint pain, glossalgia, and headache), and people with elevated 3HB levels among patients with PDAP than among control participants. Multivariate logistic regression analyses predicting patients with PDAP identified the female sex (odds ratio [OR]: 4.16), current smoking (OR: 14.9), glossalgia (OR: 19.8) a high CES-D score (≥16) (OR: 5.98), and elevated serum 3HB (≥80 μmol/L) (OR: 18.4) factors significantly associated with PDAP. Our results demonstrated that serum 3HB levels could be elevated in patients with PDAP compared to other types of odontogenic pain, although 3HB was not specific to PDAP. Based on our findings, five factors - female sex, current smoking, depressive tendencies, chronic orofacial pains, and high serum 3HB levels - could be useful for diagnosing PDAP.

Psychogenic Pain in the Mind of Gymnasts Caught Between Glory and Frustration

This study analyzes the lack of psychological support and follow-up for gymnasts motivated to compete in the Congolese championship. On the one hand, it calls into question the extent of social difficulties in light of current psychological suffering. On the other hand, it questions the fact that the athletes are dependent on their parents, who have no stable employment or have lost it with the onset of the COVID-19 epidemic. Despite this disastrous social situation, the sports system itself offers no guarantees in the face of athletes' growing uncertainty. The analysis of this phenomenon on gymnasts revealed worrying psychological profiles in the Congolese sporting population, with mental pathologies emerging and developing insidiously. To enable a proper assessment of athletes' mental strengths and weaknesses, our understanding shows that Target models of mental preparation would be more effective if psychopathologies were diagnosed first. We point to managerial irresponsibility in failing to take the psychosocial aspect seriously at a time when competitors are under pressure to achieve glory at all costs. Through observation of complaints against frustrations and, taking into account our conception of the structural model of the psyche, we found that athletes express themselves through a sad expression, both facial and verbal, to signal the emotional value of their agony. However, the desire to overcome this despair is marked by a costly defense that translates into a commitment to superstitious practices.

Infrared Thermography: Clinical Value for Diagnosing Persistent Somatoform Pain Disorders?

BACKGROUND: Patients with persistent somatoform pain disorder (PSPD) are not uncommon. Still, the disease diagnosis relies primarily on structured interviews, with no objective indicators yet available to aid in the diagnosis. This has led to low diagnostic rates and overconsumption of health care resources for the disorder. Although there is a large body of research to improve the diagnosis of the condition, there are currently no objective indicators available for diagnosis. OBJECTIVES: The aim of this study is to investigate the clinical value of infrared thermography (IRT) for diagnosing PSPD. STUDY DESIGN: This is a retrospective study. SETTING: A single academic hospital, outpatient setting. METHODS: The clinical data of patients diagnosed with PSPD in the Pain Department of the First Affiliated Hospital of the Army Medical University from September 2020 to September 2022 were analyzed. The differences in IR thermograms between PSPD patients and healthy controls were analyzed, as well as the relationship between the Hamilton Depression Rating Scale, Hamilton Anxiety Scale, Pittsburgh Sleep Quality Index (PSQI) score, Patient Health Questionnaire-15, and Symptom Check List-90 and the differences in IR thermograms of PSPD patients. RESULTS: The mean squared error, structural similarity measure, different hash, contrast, entropy, inverse variance, and correlation values of the IR thermogram helped to determine PSPD with statistically significant differences (P < 0.05). Inverse variance values were weakly negatively correlated with PSQI scores of PSPD patients (r -0.4721, P < 0.05). LIMITATIONS: This study was limited by its sample size and retrospective observational design. CONCLUSIONS: IRT analysis is a useful objective method in diagnosis of PSPD, which also provides a new line of thought for studying the pathogenesis of PSPD. KEY WORDS: Persistent somatoform pain disorder, PSPD, thermal imaging, infrared thermography, IRT, image texture characteristics, psychometric variables, image analysis

Mirror Therapy in Patients with Somatoform Pain Disorders-A Pilot Study.

Patients with chronic pain report reduced quality of life and high symptom burden while often responding insufficiently to treatment options. Mirror therapy has been proven to be effective in treating phantom limb pain and other conditions such as CRPS. This study was designed to investigate the efficacy of mirror therapy in patients with somatoform pain disorders on symptom severity and associated physiological parameters. Fifteen patients with persistent somatoform pain disorder (F45.40) or chronic pain disorder with somatic and psychological factors (F45.41) participated and received four weeks of tablet-based mirror therapy. Symptom severity was measured with established questionnaires, and their thermal detection, pain thresholds, and heart rate variability (HRV) were also assessed. After mirror therapy, pain intensity was reduced (z = -2.878, p = 0.004), and pain thresholds for cold stimuli were also diminished, i.e., the subjects became more sensitive to cold stimuli (z = -2.040, p = 0.041). In addition, a reduction of absolute power in the low-frequency band of HRV (t(13) = 2.536, p = 0.025) was detected. These findings indicate that this intervention may reduce pain intensity and modulate associated physiological parameters. As these results are limited by several factors, e.g., a small sample size and no control group, they should be validated in further studies investigating this novel intervention in these patients.

SigN-PQ Neuropathic Pain Questionnaire Development and Validation in English and Filipino Languages

Objectives. This study aimed to develop and validate a simple questionnaire for chronic neuropathic pain that can be administered as a screening tool by general practitioners and internists in order to help them identify patients with probable neuropathic pain.
 Methods. Following a development phase and a pilot study, the revised version of the screening tool which included eleven descriptors associated with neuropathic pain both in English and Filipino languages was validated on 120 consecutive patients with any type of pain except psychogenic pain, recruited in the out-patient clinics of six hospitals. The questionnaire was validated by assessing the sensitivity, specificity, positive and negative predictive value of each item and the overall questionnaire. The internal consistency of the questionnaire items was assessed using the Kuder-Richardson formula 20.
 Results. Overall, the internal consistency of the SigN-PQ using the Kuder-Richardson formula 20 was 0.7837; the sensitivity was 91.89% with specificity of 80.22%, PV (+) was 65.38% and PV(-) was 96.0%. For the English version, the descriptors with the highest scores were burning (Sensitivity: 100%, Specificity: 93%) and electricity-like (Sensitivity: 100%, Specificity: 93%). For the Filipino version, mainit (burning) has the highest sensitivity of 88% with specificity of 82.6%, followed by gumagapang (tingling) with sensitivity of 86.96% and specificity of 85.42%. The sensation of saksak (stabbing) and hiwa (lancinating) have the lowest sensitivity, 60% and 54% respectively, although their specificity scores are high. Since this study is a validation of a screening tool for neuropathic pain, the investigators decided to choose descriptors with higher sensitivity. Thus, in the final version of the SignN-PQ, the descriptors saksak and hiwa were removed.
 Conclusion. The SigN-PQ Neuropathic Pain Questionnaire has a high overall sensitivity of 91.89% and specificity of 80.22%. The pain descriptors in the questionnaire are consistent with the descriptors cited in the literature. It is a valid screening instrument for neuropathic pain that can be easily incorporated in the daily practice of general practitioners and internists.

Abdominal pain

Abdominal pain is a symptom that determines the accuracy and timeliness of diagnosis, treatment, and prognosis. The article describes the causes of acute and chronic abdominal pain, particularly the pain in the abdominal wall, and the challenges in recognizing them. The pathogenetic features of visceral, parietal, referred, and psychogenic pain and the principles of symptomatic therapy are addressed. It is emphasized that complex invasive examinations of the abdominal organs are especially relevant for elderly patients who often have conditions that require computed tomography, including contrast-enhanced scans. Without losing the importance of modern examination methods used in clinical practice, the author states that a detailed medical history and a thorough physical examination can significantly narrow the work-up. Endoscopic and other instrumental invasive examinations should be strictly justified and applied with a cost-effective rational approach.

Somatoform disorders and expressed emotions in the family: Results from a cross-sectional observational study to evaluate a novel relationship

Background: Expressed emotions (EEs) in the family affect the presentation and course of psychiatric disorders. Somatoform disorders with their psychosocial origins may be caused or perpetuated by family dynamics like EEs. Aims: The study aimed to assess the prevalence, type, and levels of EEs in the families of patients with somatoform disorders. Methods: One hundred and six adult patients with somatoform disorders (F45; ICD-10) and their family member were recruited for the study. Patients with any comorbid medical or psychiatric disorder and substance use disorders (except tobacco dependence) or subjects living alone were excluded from the study. The study participants were assessed for somatoform disorders and EEs using a sociodemographic proforma, Mini-International Neuropsychiatric Interview structured interview, Patient Health Questionnaire-15 (PHQ-15), Family Emotional Involvement and Criticism Scale, and perceived criticism measure (PCM). Final analysis was done using statistical tests including Chi-square test, Fisher’s exact test, Student’s t-test, Pearson’s correlation coefficient, and univariate and multiple regression analysis. P ≤ 0.05 was considered to denote statistical significance. Results: The most common somatoform disorder in the sample was somatization disorder (33%) followed by persistent somatoform pain disorder (18.87%) and undifferentiated somatoform disorder (15.09%). Age (P = 0.007), married status (c2 = 6.752, P = 0.034), and a diagnosis of hypochondriacal disorder and somatization disorder (c2 = 14.613, P = 0.023) were significantly associated with perceived criticism (P < 0.05), while emotional overinvolvement (EOI) was high in subjects with somatoform autonomic dysfunction disorder (21.75) (P < 0.05). Significant positive correlation was seen between PCM and PHQ15 (severity measure) scores (r = 0.209; P = 0.032). Conclusions: Moderate level of EEs were found in the families of patients with somatoform disorders with the association being significant for criticism in hypochondriacal and somatization disorders and for EOI in somatoform autonomic dysfunction disorders. The hypothesis needs further study with follow-up and stronger statistical models to establish causation.

АНАЛИЗ ФАРМАЦЕВТИЧЕСКОГО РЫНКА ЛЕКАРСТВЕНННЫХ ПРЕПАРАТОВ ДЛЯ ЛЕЧЕНИЯ САХАРНОГО ДИАБЕТА В РЕСПУБЛИКЕ СЕВЕРНАЯ ОСЕТИЯ – АЛАНИЯ

Relevance: pain syndrome is a common phenomenon in oncopediatrics, and pain control and proper treatment tactics remain relevant to date. Objective: to generalize the experience of approaches to the therapy of psychogenic pain syndrome in children and adolescents with oncological and oncohematological diseases at the stage of antitumor treatment. Methods: traditional clinical and psychopathological, clinical and catamnestic methods and scale methods were used for psychiatry. Research material: children and adolescents who were treated at the Research Institute of the Russian Scientific Research Center and the Oncological and Oncohematological departments of the Morozovskaya DGKB DZM in 2020-2022. Results: 32 patients were selected from all those examined with suspected psychogenic pain, whose pain syndrome corresponded to the concept of "psychogenic algic syndrome". It was noted that female patients prevailed among patients with psychogenic pain.The patients were characterized by an exaggerated description and perception of pain sensations, the intensity of pain was associated with an emotional background, current events. Typical for patients were personality accentuations, as well as such psychopathological manifestations as anxiety, reduced mood background, fears, hypochondriac fixation. The proposed treatment tactics included medical (medicinal) and non-medical methods (psychotherapy, work with parents and caring adults). Conclusions:integrative models of therapy (a combination of medicinal and non-medicinal methods) for psychogenic pain syndrome show their high effectiveness.

ЛЕЧЕНИЕ ПСИХОГЕННОГО БОЛЕВОГО СИНДРОМА У ДЕТЕЙ И ПОДРОСТКОВ В ПРОЦЕССЕ ПРОТИВООПУХОЛЕВОЙ ТЕРАПИИ

Relevance: pain syndrome is a common phenomenon in oncopediatrics, and pain control and proper treatment tactics remain relevant to date. Objective: to generalize the experience of approaches to the therapy of psychogenic pain syndrome in children and adolescents with oncological and oncohematological diseases at the stage of antitumor treatment. Methods: traditional clinical and psychopathological, clinical and catamnestic methods and scale methods were used for psychiatry. Research material: children and adolescents who were treated at the Research Institute of the Russian Scientific Research Center and the Oncological and Oncohematological departments of the Morozovskaya DGKB DZM in 2020-2022. Results: 32 patients were selected from all those examined with suspected psychogenic pain, whose pain syndrome corresponded to the concept of "psychogenic algic syndrome". It was noted that female patients prevailed among patients with psychogenic pain.The patients were characterized by an exaggerated description and perception of pain sensations, the intensity of pain was associated with an emotional background, current events. Typical for patients were personality accentuations, as well as such psychopathological manifestations as anxiety, reduced mood background, fears, hypochondriac fixation. The proposed treatment tactics included medical (medicinal) and non-medical methods (psychotherapy, work with parents and caring adults). Conclusions:integrative models of therapy (a combination of medicinal and non-medicinal methods) for psychogenic pain syndrome show their high effectiveness.

Comparative effectiveness of group-analysis therapy and psychoeducation in patients with different somatoform disorders

IntroductionPsychological interventions including group analysis (Leichsenring et al., 2015, Beutel et al., 2008) are effective with patients having somatoform disorders.ObjectivesTo reveal differences in dynamics of pathological bodily sensations, quality of life, illness representation in patients with somatoform disorders undergoing group analysis and psychoeducation program.Methods100 patients with somatoform disorders (undifferentiated somatoform disorder – 42, somatization disorder – 10, somatoform autonomic disfunction – 36, persistent somatoform pain disorder and other SD – 12) were randomly assigned randomized to psychoeducation intervention and to the group analysis psychotherapy. Before and after treatment they filled Screening for somatoforms symptoms (Rief, Hiller, 2003), Illness Perception Questionnaire - Revised (Moss-Morris et al., 2002), Cognitions About Body And Health Questionnaire (Rief et al., 1998), Scale for the Assessment of Illness Behaviour (Rief et al., 2003), Quality of Life Enjoyment and Satisfaction Questionnairie-18 (Ritsner et al., 2005).ResultsIn both conditions decrease in complaints was the most in patients with undifferentiated somatoform disorder and the least in somatoform autonomic disfunction (F=6.19, p&lt;.01, η²=.17). In patients with somatization disorder there was the most increase in quality of life in leisure time, beliefs about intolerance to bodily sensations, rechecking the diagnosis (F=3.32-4.87, p&lt;.05, η²=.10-.14). Decrease in beliefs about bodily weakness, illness consequences was the most prominent in patients with somatization disorder undergoing group therapy (F=2.90-4.46, p&lt;.05, η²=.09-.13).ConclusionsPatients with undifferentiated somatoform disorder demonstrate most clinical improvement in interventions while patients with somatization disorder – the most psychological improvement. Research is supported by the Russian Foundation for Basic Research, project No. 20-013-00799.DisclosureResearch is supported by the Russian Foundation for Basic Research, project No. 20-013-00799.

Chest pain in a pediatric emergency department: clinical assessment and management reality in a third-level Portuguese hospital.

Background:Chest pain in children and adolescents is a common complaint in the emergency department (ED), being mostly benign. A thorough patient history and physical examination should be enough in most cases for its proper management. Regarding non-cardiac chest pain, anxiety plays an important role.Methods:Retrospective analysis of all admissions in a pediatric ED of a Portuguese third-level hospital with a chief complaint of chest pain between January and December 2018. Chi-square test was used to compare different etiologies, considering a significance level of 5%.Results:A total of 798 visits were included: 53.6% girls, 80.8% adolescents (mean age: 13years old). According to the Pediatric Canadian Triage and Acuity Scale, 77.7% was prioritized as level IV: less urgent; 65.3% reported associated symptoms including dyspnea (31.8%), cough (18.2%), and palpitations (16.1%). In physical examination, 45.5% had alterations: 62.8% with chest wall tenderness. Further investigation was done in 84% of patients: 62.4% electrocardiograms (altered in 14.7%), 52.6% chest radiographies (altered in 17.1%) and 8.9% cardiac biomarkers (altered in 12.7%). The 3 main causes of chest pain were musculoskeletal (33%), idiopathic (24.4%) and psychogenic (21.6%), with 1.1% of cardiac etiology. Less than 3% needed hospital admission and 18.9% were oriented to an outpatient consultation. 7.1% readmissions reported. When compared to other causes as a group, psychogenic chest pain presented a statistically significant association with female sex, adolescence, psychiatric antecedents, previous stressful event, and normal physical examination. Of these, <30% were oriented to a pedopsychiatry/psychology consultation.Conclusions:Opposing to the low priority level in triage, benign diagnosis found, and low hospital admissions, there was a high percentage of complementary diagnostic tests performed with few altered results. In psychogenic chest pain there was a low postdischarge referral. The authors highlight the importance of clinical algorithms to reduce unnecessary tests performed and readmissions and improve orientation and follow-up, particularly in psychogenic etiology.

Relationship between Alcohol Intake and Chronic Pain with Depressive Symptoms: A Cross-Sectional Analysis of the Shika Study.

Although alcohol intake is associated with chronic pain (CP) and analgesia, epidemiological studies have not yet examined the factors affecting the relationship between alcohol intake and CP in detail. Therefore, the present cross-sectional study investigated the relationship between alcohol intake and CP in community-dwelling middle-aged and elderly individuals with/without depressive symptoms. Participants comprised 2223 inhabitants of Shika town in Ishikawa prefecture, located on the Noto Peninsula facing the Sea of Japan, and included 1007 males and 1216 females. CP, depressive symptoms, and alcohol intake were assessed using a CP questionnaire, the Geriatric Depression Scale-15 and the brief-type self-administered diet history questionnaire, respectively. In males without depressive symptoms, mean alcohol intake was significantly higher at 5.70% energy (27.92 g/day) in the CP group than that of 3.75% energy (20.00 g/day) in the non-CP group. The prevalence of low back/knee pain was also significantly higher in males with than in those without depressive symptoms. The present results suggest that long-term alcohol intake is related to CP by reducing the pain threshold and enhancing nociceptive pain as a possible mechanism. However, even a low alcohol intake was associated with psychogenic pain in participants with depressive symptoms. Further studies to investigate the involvement of depressive symptoms and alcohol intake in CP and its prevention are needed.

Relationship between fatty acid intake and chronic neck/shoulder/upper limb pain without elevated CRP in a Japanese population: a cross-sectional analysis of the Shika study.

Abstract Although chronic pain (CP) is classified as inflammatory or non-inflammatory, the involvement of fatty acid intake in this process has not yet been examined in detail. Therefore, the present study investigated whether the relationship between CP and fatty acid intake differs between high and low C-reactive protein (CRP) levels in middle-aged and elderly individuals in the Shika study. One-thousand and seven males and 1216 females with mean ages of 68⋅78 and 69⋅65 years, respectively, participated in the present study. CRP was quantified by blood sampling from participants who responded to a CP questionnaire. The brief-type self-administered diet history questionnaire (BDHQ) was used to assess fatty acid intake. Interactions were observed between CP and CRP on monounsaturated fatty acids (MUFA) and eicosadienoic acid in a two-way analysis of covariance adjusted for sex, age, lack of exercise, lack of sleep, current smoking and drinking status, and BMI. MUFA (OR 1⋅359) and eicosadienoic acid (OR 1⋅072) were identified as significant independent variables for CP in a multiple logistic regression analysis, but only in the low CRP group. Only a high intake of MUFA and eicosadienoic acid was associated with chronic neck/shoulder/upper limb pain without elevated CRP. In psychogenic and neuropathic pain without elevated CRP, an increased intake of MUFA and eicosadienoic acid, a family member of n-6 fatty acids, appears to affect CP. Further longitudinal studies are needed to elucidate this relationship.

SUBJECTIVEWELL-BEING AS AN INDICATOR OF MENTAL HEALTH OF PERSONALITY

The article deals with the phenomenon of mental health of the person, approaches to the study of this concept, its main functional characteristics and components. It is highlighted the notion of subjective well-being within psychological research, its essence and its place in the structure of mental health. The influence of individual personality characteristics on the experience of subjective well-being is determined. Approaches to the understanding of psychological well-being and its interrelation with the mental health of the individual are investigated. The article deals with theoretical analysis and generalization of basic researches of the structure of subjective well-being as one of the indicators of mental health of the individual. Mental health is considered as a condition that involves a comprehensive general development and harmonious work of all mental functions; a state of mental well-being, which manifests itself in the absence of the psychogenic pain and is a guarantee of adequate regulation of activity and behavior. The level of subjective well-being confirms the position of a person regarding the possibilities and extent of realization its potential, and is a prerequisite for the realization of goals, dynamic lifestyle, maximally productive and positive interaction with people. To sum up, subjective wellbeing / ill-being of a person can be regarded as an indicator of her mental health, while mental health is an objective, real manifestation of subjective well-being.