Somatic Pain Symptoms Research Articles

The effect of somatic pain and comorbid mental distress on oral health-related quality of life in orthodontic patients.

The purpose of the present study was to evaluate the prevalence of somatic pain in orthodontic patients and determine whether somatic pain contributes to worsening oral health-related quality of life (OHRQoL) through the mediating effect of psychological discomfort. Scale measurements and analyses were conducted on a cohort of 769 orthodontic outpatients, encompassing Patient Health Questionnaire-15-pain (PHQ-15-P), Hua-Xi Emotional-Distress Index (HEI), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and Oral Health Impact Profile-14 (OHIP-14). Among the respondents, 56.3% (N = 433) reported somatic pain and 20.0% (N = 154) had mental discomfort based on PHQ-15-P and HEI scores. Patients with somatic pain symptoms had significantly higher scores of HEI and OHIP-14 (P < 0.001), and higher PHQ-15-P and HEI scores emerged as statistically significant predictors of lower OHIP-14 scores (P < 0.001). HEI scores which assessed anxiety and depression partially mediated the correlation between PHQ-15-P and OHIP-14 scores, of which anxiety accounted for 52.9% of the overall mediation effect, dominating the indirect effect. Orthodontic patients reporting somatic pains were at a significantly higher risk of worsening OHRQoL during treatment, and this adverse effect is partially mediated by anxiety and depression. Our findings highlight the necessity for the assessment of general health and mental well-being during orthodontic interventions. To prevent delays in treating general disorders and the potential failure of orthodontic treatments, we encourage increased attentiveness towards patients with somatic symptoms and consideration of the adverse effects of comorbid mental distress.

Asylum seekers' self-reported health conditions in Rio de Janeiro, Brazil, from 2010 to 2017

From 2011 to 2022, 348,067 people applied for a refugee status in Brazil. The reasons that resulted in their migration, the risks during their journey, and the cultural transition upon arrival may be associated with different health problems. This study aimed to analyze the self-reported health conditions of asylum seekers in the municipality of Rio de Janeiro from 2010 to 2017. This is a cross-sectional study with secondary data. Data were collected from asylum application forms at the Brazilian National Committee for Refugees (Conare) from 2010 to 2017 and from social interviews in the Archdiocesan Caritas of Rio de Janeiro (Cáritas/RJ). The prevalence rates of health conditions, their respective 95% confidence intervals (95%CI) and odds ratio (OR) were calculated in a simple logistic regression model according to sociodemographic and migration variables. This study included 1,509 individuals. Upon arrival in Brazil, 620 (41%) reported having one or more health conditions. The chances of showing health problems were higher in people from the Congo (OR = 18.7) and the Democratic Republic of the Congo (OR = 9.5), in undocumented individuals (OR = 4.4), women (OR = 2.1), in people with elementary education (OR = 1.9), aged ≥ 45 years (OR = 1.8), and among those who live/lived maritally (OR = 1.8 and 2.5, respectively). Of those who reported a health condition, more than half claimed experiencing pain (52%). Physical pain may be related to post-traumatic stress and other mental health distress, manifesting itself by somatic pain symptoms.

Somatic pain associated with initiation of interferon-alpha (IFN-α) plus ribavirin (RBV) therapy in chronic HCV patients: A prospective study

ObjectiveThis study is aimed to investigate the association between interferon-alpha (IFN-α) plus ribavirin (RBV) treatment and emergence of somatic pain symptoms in patients with hepatitis C virus (HCV) over a 24-week treatment. MethodIn this prospective cohort study, 297 patients with HCV were evaluated at baseline and 2nd, 4th, 8th, 12th, 16th, 20th, and 24th week with structured Mini-International Neuropsychiatric Interview for Major Depressive Disorder (MDD) diagnosis and the Neurotoxicity Rating Scale (NRS) for somatic symptoms. ResultsEighty-seven out of the 297 patients (29%) developed IFN-α induced depression and had significantly higher somatic pain symptoms as early as the 2nd week and at all the assessment time points (p ​< ​.001). Most depressed patients perceived greatest somatic pain at the 8th week of treatment. Moreover, NRS somatic pain scores after initial therapy strongly correlated with NRS somatic pain scores at all other assessment time points (p ​< ​.001). ConclusionIFN-α therapy induce significant somatic pain as early as the 2nd week of treatment in HCV patients who later developed MDD. Thus, initial NRS somatic pain score after initiation of IFN-α treatment may serve as a reference for the susceptibility of the individual to IFN-α induced depression.

Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome

Sleep disturbances are common, and perhaps are even more prevalent in irritable bowel syndrome (IBS). To determine the effect of measured sleep on IBS symptoms the following day, IBS-specific quality of life (IBS-QOL) and non-GI pain symptoms. IBS patients' sleep patterns were compared to healthy individuals via wrist-mounted actigraphy over 7 days. Daily bowel pain logs (severity, distress; 10-point Likert) stool pattern (Bristol scale) and supporting symptoms (e.g. bloating, urgency; 5-point Likert) were kept. Validated measures, including the GI Symptom Rating Scale-IBS, Visceral Sensitivity Index, Pittsburgh Sleep Quality Index and the IBS-Quality of Life were collected. Mediation analysis explored the relationship between sleep, mood and bowel symptoms. Fifty subjects (38.6 ± 1.0 years old, 44 female; 24 IBS and 26 healthy controls) completed sleep monitoring. IBS patients slept more hours per day (7.7 ± 0.2 vs. 7.1 ± 0.1, P = 0.008), but felt less well-rested. IBS patients demonstrated more waking episodes during sleep (waking episodes; 12.1 vs. 9.3, P < 0.001). Waking episodes predicted worse abdominal pain (P ≤ 0.01) and GI distress (P < 0.001), but not bowel pattern or accessory IBS symptoms (P > 0.3 for each). Waking episodes negatively correlated with general- and IBS-specific QOL in IBS (r = -0.58 and -0.52, P < 0.001 for each). Disturbed sleep effects on abdominal pain were partially explained by mood as an intermediate. Sleep disturbances are more common in irritable bowel syndrome, and correlate with IBS-related pain, distress and poorer irritable bowel syndrome-related quality of life. Disturbed sleep effects extend beyond the bowel, leading to worse mood and greater somatic pain in patients with the irritable bowel syndrome.

The evolution of thinking about temporomandibular pain

Every dentist has observed the fact that pain symptoms and responses are different among the patients in his or her practice. This is especially true for patients who seek treatment for temporomandibular disorders (TMD), because some of these patients do well when appropriately treated, whereas others continue to have pain. Also, some patients in the latter group may have other somatic pain symptoms that are accompanied by psychological symptoms such as anxiety and depression. What is the most likely explanation for these differences? Dr. Visscher is a physical therapist and epidemiologist, an associate professor, and chair, Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands. Dr. Lobbezoo is a professor, chair, and vice dean, Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.

Use of the SS Scale, FIQR, and FIQ VASs for assessment of symptom severity in Egyptian fibromyalgia patients

BackgroundFibromyalgia (FM) is a complex syndrome associated with significant impairment in the quality of life and function. The ability to evaluate and measure the severity of FM is likely to provide several benefits.ObjectiveThis study aimed to assess symptom severity in Egyptian FM patients using the Symptom Severity Scale (SS Scale), Revised Fibromyalgia Impact Questionnaire (FIQR), and Fibromyalgia Impact Questionnaire Visual Analog Scales (FIQ VASs).Patients and methodsTwenty-four female patients who fulfilled the ACR-2010 criteria of FM were included in the present study. The SS Scale, FIQR, and FIQ VASs were used to assess symptom severity of FM.ResultsThe respective mean of the SS Scale, FIQR, and FIQ VASs were 7.3 ± 2.4,52.9 ± 22.1, and 39.3 ± 14.2, and they were positively correlated with measure of pain distribution [widespread pain index (WPI)] in our patients. The SS Scale, WPI, FIQR, and FIQ VASs scores were positively correlated with many regional pain distribution sites (upper arm pain and jaw pain at most) and somatic pain symptoms (central nervous system symptoms, musculoskeletal symptoms. otological and hypersensitivity symptoms). The high scores of the SS Scale, FIQR, and FIQ VASs and their positive correlations with most of the regional pain sites and distribution and somatic symptoms indicate the severity of symptoms in the studied population. The FIQ VAS was the only significant independent determinant of FM severity (P < 0.001) in backward/ stepwise multiple linear regression models.ConclusionThe SS Scale of the ACR-2010 criteria, FIQR, and FIQ VASs were excellent methods for assessment of symptom severity in our Egyptian FM patients.

Onset, prognosis and risk factors for widespread pain in schoolchildren: A prospective 4-year follow-up study

Little is known about the epidemiology of widespread pain (WSP) in children and adolescents. This study aims to estimate the new-onset and prognosis of WSP in schoolchildren and investigate factors predicting its development. A prospective study was conducted among 1756 schoolchildren (age 10–12 years) in Southern Finland. At baseline, information was collected on WSP, regional musculoskeletal pain symptoms, depressiveness, fatigue, sleep problems, physical activity and joint hypermobility. These children were contacted again 1 year and 4 years later to determine the outcome and the new-onset of WSP. A total of 1282 children (73%) of the baseline study population were found at both follow-ups. Of the children who had WSP at baseline, 31% and 30% reported persistence/recurrence of symptoms at 1- and 4-year follow-up, respectively. However, only 10% of these children reported WSP at both 1 and 4 years. Of the children who were free of WSP at baseline, 18% reported new-onset WSP at 1-year follow-up and 3% reported these symptoms at both follow-up times. The independent baseline risk factors of WSP were older age (OR 1.3 95% CI 1.0–1.8), female gender (OR 1.4, 1.1–1.9), depressiveness (OR 1.5, 1.1–2.2) and regional back pain symptoms (Neck pain: OR 1.7, 1.1–2.4; Upper back pain: OR 2.1, 1.1–4.1; Lower back pain: OR 3.0, 1.6–5.7). Both psychological factors and somatic pain symptoms predict future development of WSP in adolescents.

Diagnostische und therapeutische Bedeutung von Schmerzsymptomen der Depression

In primary care settings chronic therapy-resistant pain presents a particular and multifaceted problem with which a physician has to deal. Among many possible background causes of such a pain, depression is one of the most frequent, but rarely a priori recognised and diagnosed. In recent multinational studies, encompassing >25000 patients attending primary care units, in about 10% of patients major depressive disorder has been diagnosed a posteriori according to the stringent DSM-IV criteria. In 45-95% of these patients pain was a principal symptom of depression. It is obvious that early recognition of depression in such patients is of major importance, because of multiple medical, social and economic consequences resulting from non-treatment. Many experimental and clinical findings explain the link between depression and pain and demonstrate the fundamental role of noradrenergic and serotoninergic dysfunction in the origin of both phenomena. These findings also provide the rational basis for the effective management of depression with dominant somatic pain symptoms by antidepressants and, in particular, with those possessing both noradrenergic and serotoninergic enhancing properties. The therapeutic efficacy in painful syndromes of, for instance, tricyclic antidepressants has been well documented whereas the SSRIs, which selectively block the uptake of 5-HT, seem to be much less, if at all, effective. Recent clinical studies with the new generation of so-called dual acting antidepressants (which selectively block the NA- and 5-HT-uptake) provide encouraging results. These drugs (venlafaxine, duloxetine) are promising as an effective and well-tolerated option to the TCA treatment.

Serotonin noradrenaline reuptake inhibitors: New hope for the treatment of chronic pain

Depression and painful symptoms occur frequently together. Over 75% of depressed patients report painful symptoms such as headache, stomach pain, neck and back pain as well as non-specific generalized pain. In addition, World Health Organization data have shown that primary care patients with chronic pain have a four fold greater risk of becoming depressed than pain-free patients. Increasingly, pain is considered as an integral symptom of depression and there evidence to suggest that pain and depression may arise from a common neurobiological dysfunction. Serotonergic cell bodies, in the raphe nucleus, and noradrenergic cell bodies in the locus coeruleus send projections to various parts of the brain, where they are involved in the control of mood, movement, cognitive functioning and emotions. In addition both serotonergic and noradrenergic neurons project to the spinal cord. These descending pathways serve to inhibit input from the intestines, skeletal muscles and other sensory inputs. Usually, these inhibitory effects are modest, but in times of stress, in the interest of the survival of the individual, they can completely inhibit the input from painful stimuli. A dysfunction of the serotonergic and noradrenergic neurons can thus affect both the ascending and descending pathways resulting in the psychological symptoms of depression and somatic pain symptoms such as chronic pain, fibromyalgia, non-cardiac chest pain, or irritable bowel syndrome. In view of this, it is not surprising that tricyclic antidepressants have been a standard treatment of chronic pain for many years. In contrast and in spite of their improved tolerance, selective serotonin reuptake inhibitors do not appear to be particularly effective in the treatment of pain. Recently, a number of open and controlled trials with selective serotonin and noradrenaline reuptake inhibitors such as venlafaxine, milnacipran and duloxetine, suggest that these compounds may be more effective in relieving pain than selective inhibitors of serotonin reuptake. Wherever valid comparisons have been made the newer dual action drugs appear to be as effective as the tricyclic and considerably better tolerated. Dual action antidepressants may thus soon become the new standard treatment of chronic pain whether it is associated with depression or not. In addition, these agents may also have a role in modulating neurogenesis and other neuroplastic changes in the central nervous system, thereby leading to more complete recovery in patients suffering from the symptoms of depression or chronic pain.

The Epidemiology of Recurrent Abdominal Pain From 2 to 6 Years of Age: Results of a Large, Population-Based Study

Recurrent abdominal pain (RAP) is one of the most common complaints of childhood and is associated with several adverse outcomes in adulthood. Few large, population-based, longitudinal studies have been conducted. The purpose of this study was to investigate the prevalence and epidemiologic features of RAP through early childhood. We report findings from a large, population-based, cohort study of childhood (the Avon Longitudinal Study of Parents And Children). The prevalence and continuity of RAP from 2 to 6 years of age were explored, with associated physical and psychological symptoms among the children and their parents. In a population cohort of 13971 children, RAP was reported for 11.8% of 6-year-old children. It was less common at ages 2 years (3.8%) and 3 years (6.9%). There was a striking degree of continuity of RAP between the ages of 2 and 6 years. RAP was associated with headaches and limb pains among children and with higher rates of anxiety among both children (adjusted odds ratio: 2.12; 95% confidence interval: 1.70-2.65) and their mothers (odds ratio: 1.75; 95% confidence interval: 1.30-2.36). In a large, population-based, cohort study, RAP was found to be increasingly common up to the age of 6 years. Children with RAP at a young age have a high risk of RAP later in childhood. RAP is associated with other somatic pain symptoms among children and with symptoms of anxiety among children and their mothers. These findings highlight the high prevalence and continuity of RAP through early childhood and the importance of considering psychological symptoms for these children and their families.

Predictors of low back pain in British schoolchildren: a population-based prospective cohort study.

To determine the onset of low back pain (LBP) in schoolchildren and to investigate the role of mechanical and psychosocial factors as risk factors for its onset. A prospective population-based cohort study was conducted of 1046 schoolchildren, aged 11 to 14 years at baseline, identified as being free of LBP, from 39 secondary schools in Northwest England. New onset of LBP at 1-year follow-up was measured. Children who reported high levels of psychosocial difficulties were more likely to develop LBP than their peers (relative risk: 1.6; 95% confidence interval: 1.1-2.3). An excess risk was, in particular, associated with conduct problems (2.5; 1.7-3.7). Similarly, children who reported high numbers of somatic symptoms at baseline were at greater risk of developing LBP: abdominal pain (1.8; 1.1-3.0), headaches (1.6; 0.97-2.8), and sore throats (1.5; 0.8-2.6). In contrast, we have been unable to demonstrate a strong association between daily mechanical load (schoolbag weight) and the short-term risk of new-onset LBP (highest versus lowest quintile: 1.2; 0.7-2.1). In children who were initially free of LBP, adverse psychosocial factors and the presence of other preexisting somatic pain symptoms were predictive of future LBP, reflecting findings in adults. In contrast, there was little evidence of an increase in short-term risk associated with mechanical load across the range of weights commonly carried by children to school.

Reduction mammaplasty improves symptoms of macromastia.

The condition macromastia has not been defined and characterized precisely by the medical community. Whether the patient with hypertrophic breasts is a candidate for or can be helped by reduction mammaplasty is unclear to both the medical and the lay community. A prospective study of 39 women undergoing reduction mammaplasty surgery was initiated to answer these questions. Patients rated the severity of their somatic pain symptoms and discomfort before reduction mammaplasty and again after complete recovery. The severity of their symptoms and complaints was numerically graded and analyzed. These data were compared with similar data obtained from 40 "small-breasted" women of similar age. Headache, neck pain, back pain, shoulder pain, and bra strap groove pain were present in 60 to 92 percent of patients, and 97 percent of patients had at least three of these pain symptoms preoperatively. All the patients had reduction of their pain symptomatology postoperative, and 25 percent of the study patients had total elimination of pain symptoms by reduction mammaplasty. The postoperative incidence and severity of pain symptoms and discomfort complaints were statistically equivalent to or less than the levels in the control group.