Astrid Lampe

Chronic low back pain measurement with visual analogue scales in different settings.

&NA; We asked 78 chronic low back pain patients to report on their usual pain intensity, and on the lifestyle changes caused by their pain, on a horizontally‐oriented visual analogue scale (VAS). Also, the usual and the current pain intensities were examined on a vertical VAS. Statistical analysis showed normal distribution of data in the measurement of usual pain on the horizontal VAS, but no homogeneous distribution on the vertical VAS. Therefore, in the measurement of chronic low back pain VAS should be used horizontally rather than vertically, because of higher sensitivity. The intensity of usual pain was significantly correlated with the degree of lifestyle change. No correlation was found between current and usual pain. There was no significant difference in the failure rate between the vertical and horizontal VAS. Also, there was no reduction of the failure rate by giving additional oral explanations in the use of the scale to the patient. Owing to a negative influence in distribution of rates and an increase in the failure rate, complex questions should be avoided. A short written introduction to the scale is sufficient, and oral explanations are not essential.

Chronic pain syndromes and their relation to childhood abuse and stressful life events

OBJECTIVE Childhood abuse, stressful life events, and depression have been repeatedly reported to correlate with chronic pain, but little is known about the mutual relationships among these variables. METHODS Forty-three women with chronic pelvic pain (CPP), 40 female patients with chronic low-back pain (CLBP), and a female pain-free control group (n=22) were investigated by means of a semistructured interview assessing childhood sexual and physical abuse as well as stressful life events. Additionally, the Beck Depression Inventory (BDI) was used. For multivariate analyses, structured equation modeling was applied. RESULTS Childhood physical abuse, stressful life events, and depression had a significant impact on the occurrence of chronic pain in general, whereas childhood sexual abuse was correlated with CPP only. Moreover, childhood sexual abuse was related to depression. Both childhood sexual and physical abuse showed a close relationship to an increased occurrence of stressful life events. CONCLUSION There are complex mutual interactions among childhood abuse, stressful life events, depression, and the occurrence of chronic pain. Therefore, clinicians should take into consideration these psychosocial factors while treating chronic pain patients.

Daily psychosocial stressors and cyclic response patterns in urine cortisol and neopterin in a patient with systemic lupus erythematosus

This study investigated the complex biochemical responses to personally meaningful everyday stressors in a patient with systemic lupus erythematosus (SLE). For this purpose, a 52 year-old woman with SLE collected her entire urine for 56 days on a 12-h basis for the determination of cortisol as well as neopterin, a cellular immune parameter. Additionally, using questionnaires, daily notes and interviews, extensive psychosocial and psychological time-series data were collected every 12 h. Cross-correlational analyses of the resulting time-series revealed that stressful incidents were associated with cyclic fluctuations in both urine cortisol and urine neopterin. Specifically, whenever the patient anticipated a moderately stressful incident, urine cortisol initially increased 24 h before the incident and then decreased 12 h before the incident. Moderate stressors not anticipated by the patient were associated with an initial increase 24 h following the incident and then with a decrease after a total of 36 h. Moreover, stressors having to do with the patients extramarital relationship were followed initially by a decrease in urine neopterin after 36 h and then by an increase after a total of 60 h. Our findings indicate that when investigating the relationship between psychosocial stressors and biochemical activity in SLE, appropriate consideration of the datas dynamic nature may be necessary to avoid flawed conclusions.

The impact of stressful life events on exacerbation of chronic low-back pain

The impact of stressful life events on the development and onset of chronicity of low-back pain is not yet fully understood. Sixty-four consecutive patients with chronic low-back pain treated at the orthopedic out-patient unit of the Innsbruck University Hospital were investigated with regard to stressful life events. Patients were classified into two groups: one group consisting of patients whose pain had an organic etiology (n= 16), and another group consisting of those with pain of uncertain origin (idiopathic group, n=48). A method combining a semistructured interview with a self-assessment of the severity of stress caused by life events was employed for assessing the impact of such events on chronic low-back pain. In comparison to the patient group having organic causes of pain, the idiopathic group showed significantly more patients having at least one highly stressful event preceding the last substantial aggravation of pain (p=0.028). The latter group experienced significantly more exhaustion (p=0.016) and significantly more difficulties in active coping (p=0.011) when confronted with stressful life events. Stressful life events that arouse feelings of helplessness may contribute to the development of chronic idiopathic low-back pain. Our results emphasize the importance of investigating the subjective meaning and appraisal of stressful life events, taking into consideration both individual predisposition and psychosocial resources available to the patient. Finally, it is also important that the attending physician be aware of any life event that is particularly stressful for the patient so that psychosocial help be made available at the appropriate time.

Temporal Association Between Daily Alcohol Consumption, Emotional States and Urinary Neopterin Levels in a Patient with Systemic Lupus Erythematosus

Abstract In recent years, interest has been growing regarding the role of alcohol intake on systemic lupus erythematosus (SLE) disease activity. This integrative single-case study investigated the dynamic interdependencies between alcohol consumption, various emotional states and cellular immune activity in SLE using time series analysis (i.e., ARIMA modeling, cross-correlational analysis). We determined neopterin concentrations (HPLC) in a 52-year-old woman suffering from SLE, who collected her entire urine on a twice-daily basis for a period of 56 days (total: 112 time-points). Aside from the central interest of our studies, i.e., the impact of everyday incidents on cellular immune system dynamics, the patient also provided daily information on intake of alcoholic beverages (type and quantity) and various emotional state variables (mental activity, irritation, mood). Cross-correlational analyses revealed that moderate alcohol consumption had different effects on urinary neopterin levels depending on whether time series data were analyzed before or after the occurrence of an inflammatory event (acute paranasal sinusitis) that had taken place halfway through the study period (time-points 45-54). Before sinusitis (1-44), increases in alcohol consumption were parallelized by decreases in urinary neopterin levels (lag0: r = -0.371; p< 0.05) whereas after sinusitis (55-112), increases in alcohol intake preceded increases in urinary neopterin levels with a temporal delay of 12 hours (lag1: r = +0.308; p< 0.05). The emotional states under study did not interfere with the associations between alcohol intake and neopterin levels. These findings show that even within the same patient with SLE the relationship between alcohol intake and neopterin levels might not always be stable suggesting a possible reason for inconsistent evidence from cross-correlational studies.