Zvia Rudich

Longitudinal associations between depression, anxiety, pain, and pain-related disability in chronic pain patients.

Objective The current study sets out to examine the longitudinal relationship between pain, pain-related disability, and symptoms of depression and anxiety. The latter symptoms are highly prevalent in chronic pain and seriously impede functioning and quality of life. Nevertheless, the direction of the relationship involving these variables among individuals with chronic pain is still unclear. Methods Four-hundred twenty-eight individuals with chronic pain (238 women, mean age 54.84 years, mean pain duration 85.21 months) treated at two pain clinics completed questionnaires regarding their pain (Short-Form McGill Pain Questionnaire), depression (Center for Epidemiological Studies–Depression Scale), state anxiety (State-Trait Anxiety Inventory), and pain-related disability (Pain Disability Index) at four time points, with an average of 5 months between measurements. Cross-lagged, structural equation modeling analyses were performed, enabling the examination of longitudinal associations between the variables. Results Significant symptoms of both depression and anxiety were reported by more than half of the sample on all waves. A latent depression/anxiety variable longitudinally predicted pain (&bgr; = .27, p < .001) and pain-related disability (&bgr; = .38, p < .001). However, neither pain (&bgr; = .10, p = .126) nor pain-related disability (&bgr; = −.01, p = .790) predicted depression/anxiety. Conclusions Among adult patients with chronic pain treated at specialty pain clinics, high levels of depression and anxiety may worsen pain and pain-related disability.

Distinguishing affective and somatic dimensions of pain and depression: a confirmatory factor analytic study†‡

In this study, we examined the overlap between pain and depression in a sample of 342 chronic pain patients treated at a specialty pain clinic. Confirmatory factor analysis was conducted to test the differentiation of pain and depression measured as latent factors derived from the subscales of the Short Form McGill Pain Questionnaire and the Center for Epidemiological Studies Depression Scale. The affective pain subscale did not load on latent depression and the somatic depression subscale loaded weakly on latent pain. Although pain and depression are linked, we found that affective pain is distinct from depression, and that somatic depression is distinct from pain. This finding justifies further examination of the casual relationship between pain and depression.

LF 16-0687 Ms, a new bradykinin B2 receptor antagonist, decreases ex vivo brain tissue prostaglandin E2 synthesis after closed head trauma in rats

OBJECTIVE Bradykinin (B) contributes to secondary brain injury. This injury is mediated in part by prostaglandin (PG). Antagonism of B(2) receptors improves neurological status after brain injury, but the effect of B(2) antagonism on brain tissue PG is unknown. This study examined the effect of LF 16-0687 Ms, a new B(2) receptor antagonist, on brain tissue PGE(2) after closed head trauma (CHT). METHODS Rats were anesthetized and received sham+saline, sham+LF 16-0687 Ms, CHT+saline, or CHT+LF 16-0687 Ms. Brain tissue samples were obtained at 24 h for determination of PGE(2) (after 2 h of ex vivo incubation) and water content. Neurological severity score (NSS) was assessed at 1 and 24 h. RESULTS In the group receiving CHT+LF 16-0687 Ms, brain tissue PGE(2) (77.7+/-65.9 pg/mg tissue, mean+/-SD) was less than in the group receiving CHT+saline (368.1+/-186.2 pg/mg tissue) and not different than sham+saline (78.7+/-30.7 pg/mg tissue). LF 16-0687 Ms also improved NSS and decreased brain water content by 51%. CONCLUSION We conclude that the beneficial effect of LF 16-0687 Ms on outcome after CHT is accompanied by blockade of PGE(2) increase in injured brain tissue.

Pain Specialists' Evaluation of Patient's Prognosis During the First Visit Predicts Subsequent Depression and the Affective Dimension of Pain

OBJECTIVE To examine the predictive value of physicians prognosis after patients first visit to a pain specialty clinic. DESIGN This is a prospective-longitudinal study in which patients completed questionnaires regarding their pain and psychological constructs before their first visit to a pain specialist and again after an average of 5 months. Physicians rated patients prognosis immediately after the first visit. SETTING This study was conducted at the outpatient specialty pain clinic at Soroka University Medical Center. PATIENTS Forty-five chronic pain patients suffering from a range of nonmalignant pain conditions. OUTCOME MEASURES Sensory and affective pain measured by the Short-Form McGill Pain Questionnaire and depressive symptoms measured by the Center for Epidemiological Studies-Depression Scale. RESULTS Multiple regression analysis revealed that physicians rating of patient prognosis at Time 1 uniquely predicted subsequent depressive symptoms and affective pain but not sensory pain at Time 2 even after controlling for Time 1 levels of these variables. CONCLUSION Physicians pessimistic evaluation of patients prognosis after the first visit was longitudinally associated with an increase in depression and in the affective dimension of pain over time, but not with changes in the sensory component of pain. Referring to physician pessimism as a marker for pre-depressed patient may lead to early preventive interventions.

Does War Hurt? Effects of Media Exposure After Missile Attacks on Chronic Pain

This study focused on the effects of exposure to terrorist missile attacks on the physical and mental well being of chronic pain patients. In this prospective and longitudinal design, 55 chronic pain patients treated at a specialty pain clinic completed self-report questionnaires regarding their pain, depression and anxiety pre- and post a three week missile attack on the southern region of Israel. In addition, levels of direct and indirect exposure to the attacks were measured. Results of regression analyses showed that exposure to the attacks through the media predicted an increase in pain intensity and in the sensory component of pain during the pre-post war period, but did not predict depression, anxiety or the affective component of pain. These findings contribute to the understanding of the effects of terrorism on physical and emotional distress and identify chronic pain patients as a vulnerable population requiring special attention during terrorism-related stress.

Role of Pain-Based Catastrophizing in Pain, Disability, Distress, and Suicidal Ideation

Background: In chronic pain, patients’ coping affects their adaptation. In two studies, we examined the role of pain catastrophizing, a maladaptive coping strategy, in pain, distress, and disability. In Study 2 we compared catastrophizing to pain acceptance and to other coping strategies. Methods: Study 1. Chronic pain patients (N = 428) were assessed four times as to their pain, disability, catastrophizing, and distress (depression and anxiety). Study 2. Patients (N = 165) were assessed as to coping and pain acceptance, pain, related distress, depression, hope, suicidal ideations, perceived burdensomeness, and thwarted belongingness. Results: Study 1. A Structural Equation Modeling (SEM) analysis revealed that Time 1 Pain-based catastrophizing prospectively predicted pain (β =.36, p < .001). Distress prospectively predicted pain related disability (β = .34, p <.001). Study 2. Pain-based catastrophizing predicted sensory pain (β = .22, p = .018), depression (β = .43, p < .001), and suicidal ideation (O.R. = 1.88), which were also predicted by depression and perceived burdensomeness. Distraction predicted sensory pain (β = .21, p = .017, respectively). Activity engagement predicted low levels of depression (β = -.29, p < .001, respectively), and willingness to accept pain predicted low pain-related distress (β = -.16, p = .05). Conclusions: Pain catastro-phizing and pain acceptance constitute risk and resilience factors. Both should be assessed and targeted in pain management.

Depressive personality vulnerability in chronic physical pain: Centrality of sociotropy

OBJECTIVE Chronic physical pain is one of modern medicines principal challenges. Recently, there has been a keen research interest in the role of depressive personality vulnerability (DPV) in the course of chronic pain. This is the first attempt to examine the role of three leading DPV dimensions-sociotropy, autonomy, and self-criticism-in chronic pain. METHOD Chronic pain patients (N = 428) were assessed four times as to their pain, disability, anxious depression, and pain-based catastrophizing. At Time 1, sociotropy, autonomy, and self-criticism were also assessed. The effects of sociotropy, autonomy, and self-criticism on pain, disability, anxious depression, and pain-based catastrophizing were examined using structural equation modeling analyses. RESULTS All DPV dimensions uniquely predicted Time 1, but not Time 2, anxious depression. Sociotropy predicted Time 1 pain and catastrophizing over and above anxious depression, as well as an increase in catastrophizing over time. Autonomy predicted a decrease in catastrophizing and disability, and Time 1 anxious depression predicted an increase in self-criticism. CONCLUSIONS Sociotropy appears to be a unique dimension of DPV in chronic pain.

66 DISTINGUISHING AFFECTIVE AND SOMATIC DIMENSIONS OF PAIN AND DEPRESSION: A CONFIRMATORY FACTOR ANALYTIC STUDY

from the opioids. It is highly likely that the potentiation in synaptic strength translates into enhanced pain behaviour: 1. Induction protocols leading to LTP also cause hyperalgesia in behaving animals and in human subjects. 2. Postsynaptic lamina I neurons that express LTP are indispensable for full expression of hyperalgesia and 3. Signalling pathways and pharmacological profiles of LTP at C-fibre synapses and hyperalgesia largely overlap. Thus, plasticity at the first synapse in pain pathways is a promising target for the prevention and treatment of hyperalgesia of various origins.