Psychological predictors of change in the number of musculoskeletal pain sites among Norwegian employees: a prospective study.

BACKGROUND: The pathogenesis of syndromes of widespread musculoskeletal pain remains an enigma. The present study sought to determine if psychological states, job satisfaction, pain intensity, and sleep problems contributed to the spread and decline of the number of musculoskeletal pains. METHODS: A sample of 2989 Norwegian employees completed a questionnaire at baseline and follow-up 2 years later. Data were analyzed with multinomial and ordinal logistic regression analyses to determine effects on direction and degree of change of number of pain sites (NPS). RESULTS: After adjustment for sex, age, skill level, and number of pain sites at baseline, increases in the number of pain sites from baseline to follow-up were predicted by emotional exhaustion, mental distress, having little surplus, feeling down and sad, sleep disturbances, and intensity of headache. Decreases were predicted by low levels of emotional exhaustion, mental distress, sleep disturbances, restlessness, and lower intensity of headache, neck pain, shoulder pain, and back pain. Higher numbers of pain sites at baseline were associated with reduction of number of pain sites and lower likelihood of spread. Some factors that did not predict whether decrease or increase occurred were nevertheless associated with the degree of decrease (depression, anxiety, having surplus, self-efficacy) or increase (anxiety). CONCLUSIONS: Several psychological and physiological factors predicted change in the number of pain sites. There is a need for further investigations to identify possible mechanisms by which psychological and behavioral factors propagate the spread of pain.

Attitudes towards, and wishes for, euthanasia in advanced cancer patients at a palliative medicine unit.

BACKGROUND: Most studies on attitudes towards euthanasia and physician-assisted suicide (PAS) have been conducted in healthy populations. The aim of this study is to explore and describe attitudes towards, and wishes for, euthanasia/PAS in cancer patients with short life expectancy. METHOD: Semi-structured interviews with 18 cancer patients with a life expectancy of less than nine months. All patients were recruited from an inpatient palliative medicine unit. RESULTS: Patients holding a positive attitude towards euthanasia/PAS do not necessarily want euthanasia/PAS for themselves. Wishes are different from requests for euthanasia/PAS. Fear of future pain and a painful death were the main reasons given for a possible wish for euthanasia/PAS. Worries about minimal quality of life and lack of hope also contributed to such thoughts. Wishes for euthanasia/PAS were hypothetical; they were future oriented and with a prerequisite that intense pain, lack of quality of life and/or hope had to be present. Additionally, wishes were fluctuating and ambivalent. CONCLUSION: The wish to die in these patients does not seem to be constant. Rather, this wish is more appropriately seen as an ambivalent and fluctuating mental 'solution' for the future. Health care providers should be aware of this when responding to utterances regarding euthanasia/PAS.