Patients with chronic pain: evaluating depression and their quality of life in a single center study in Greece.

BACKGROUND: Chronic pain constitutes one of the most common reasons for seeking health care services and may even lead to disability. Chronic pain has been associated with depression and deterioration of the quality of life. The aim of our study is to outline the burden of chronic pain in the context of a primary health care (PHC) setting in Greece and to investigate its association with depression and quality of life. METHODS: A cross-sectional study was conducted from September 2016 to November 2016. The subjects of the study comprised 200 individuals who visited the regional medical center of Ag. Theodoroi, Greece. The collected data were from a representative sample of 200 adults and included demographic data, social and medical history, presence and characteristics of chronic pain and questions from three questionnaires for the assessment of pain (BPI- short form), the investigation of depression (PHQ-9) and the evaluation of the quality of life (EuroQ-5D) validated in Greek language. Multiple regression analysis was used in order to find associated factors with quality of life, depression and chronic pain. RESULTS: A percentage of 56.8% of the participants, the majority of whom (62%) were women, reported chronic pain. Among individuals with pain, lower back area was the most common location. Based on the given questionnaire, depression was detected in 22. 5% of the participants who claimed chronic pain. Regression analyses revealed that women and respondents with chronic mental disorders like depression and anxiety had significantly higher scores on the pain scale and suffered pain which had a greater impact on their daily activities. According to regression analysis decreased quality of life was expressed by women, as well as participants with a chronic mental disorder. A significant reverse correlation emerged between the quality of life, depression and pain scales. CONCLUSION: Chronic pain, as it has been studied within this PHC setting, is a common health care problem. Individuals who had experienced chronic pain and depression had a lower health-related quality of life.

The Relationship between Burden and Depression in Spouses of Chronic Kidney Disease Patients.

The purpose of the present study was to investigate the burden and depression in spouses of patients with chronic kidney disease (CKD). The interrelation between burden and depression in family caregivers has been pointed out by previous researches in several chronic diseases and researchers agree that they clearly go together and one cannot talk about one without considering the other. More particularly, in the present study, the caregiver burden, the depression, anxiety, and also health-related quality of life and demographic factors of spouses of patients with CKD were examined, using self-report questionnaires. Participants were 50 spouses of patients with CKD, 29 of whom were dialysis dependent and 21 were not dialysis dependent. Group differences were examined for participants. Results confirm the interrelation between caregiver burden and depression in spouses. The increased perceived burden related to higher levels of depression. Low levels of caregiver burden, depression, anxiety, and satisfactory quality of life were found in spouses, with no differences between them relevant to whether the patients were dialysis dependent or not. All the above parameters interrelated. Implications for the findings and future research directions are discussed.

The effect of myofascial release and microwave diathermy combined with acupuncture versus acupuncture therapy in tension-type headache patients: A pragmatic randomized controlled trial.

BACKGROUND AND PURPOSE: Nonpharmacological therapies for tension-type headache (TTH) and cervicogenic cephalalgia are often a treatment choice, despite the weak to moderate evidence. The aim of this study was to compare the effectiveness of an acupuncture/stretching protocol versus acupuncture/stretching plus physiotherapy techniques, in patients with TTH cephalalgia. METHODS: A single-blind, prospective, multicentre, randomized controlled trial was designed considering the pragmatic situation of administering such protocols and treating the 44 headache patients participating in this study. The patients were randomly assigned in 2 treatment groups (control group, n = 20, acupuncture/stretching; experimental group, n = 24, acupuncture/stretching plus physiotherapy) and completed 10 treatment sessions within 4 weeks with measurements taking place before treatment, after the fifth treatment and after the 10th treatment. The mechanical pressure pain threshold (PPT) was considered as the main outcome measure, using a mechanical algometer to measure 7 bilateral somatic points. Acupuncture in both groups included 17-20 acupuncture points, whereas stretching was initially taught and subsequently self-administered (self-stretches), following a standardized set of movements of the cervical spine. Physiotherapy consisted of microwave diathermy and myofascial release with hands-on techniques. RESULTS/FINDINGS: An improvement was noted in both groups/treatments regarding the main outcome measure PPT, all the way from the first to fifth and the 10th treatment, at all measuring sites and at all measurements in both groups (p < .001). When comparing the 2 groups, differences were noted after the 10th treatment (p < .05). DISCUSSION: In conclusion, patients with TTH headache were benefited from acupuncture and stretching but further PPT improvements were evidenced when physiotherapy hands-on techniques were added. In clinical terms, the combination of physiotherapy in the form of myofascial release and microwave diathermy with acupuncture and stretching in order to improve the analgesic effect (PPT) is strongly recommended.

The Use of Aromatherapy for Postoperative Pain Management: A Systematic Review of Randomized Controlled Trials.

PURPOSE: Aromatherapy (AT) is a complementary therapy recently used in the perianesthetic period. However, the scientific data on its effectiveness are limited. The aim of this systematic review is to present and analyze the results of all randomized controlled trials (RCTs) that studied the effectiveness of AT as a complementary treatment for postoperative pain. DESIGN: PubMed and Cochrane Library databases were searched from 1965 to December 2015. Nine randomized controlled trials that met the inclusion criteria were eventually included. METHODS: The studies included a total of 644 patients, who underwent various types of surgeries. The modified Jadad scale with eight items was used for the methodological evaluation of the RCTs. FINDINGS: Five RCTs support AT, which can alleviate postoperative pain, whereas four found no statistically significant differences between groups. CONCLUSIONS: Although AT is presented as an inexpensive complementary treatment with a low rate of adverse effects that improves patient satisfaction, it cannot be determined that there is sufficient evidence to conclude its effectiveness as a nonpharmacologic approach to the reduction of postoperative pain intensity.

Anxiety and Depression in Staff of Mental Units: The Role of Burnout.

One of the most investigated areas is the study of job stress and anxiety and its effects on the professionals' mental health status. The purpose of this study was to research the levels of anxiety and depression in staff that works in mental units and if burnout is related with these mental health parameters. The sample consisted of 217 mental health care professionals from mental health care units of all over Greece. The Greek version of the Symptoms Rating Scale for Depression and Anxiety (SRSDA) questionnaire was used to evaluate the levels of anxiety and depression and the Greek version of Maslach's Burnout Inventory (MBI) were used. Descriptive statistics were initially generated for sample characteristics. General linear models with MBI dimensions as independent variables and the anxiety and depression subscales of SRSDA as dependent variables were used to determine the relation between burnout and mental health parameters. Statistics were processed with SPSS v. 19.0. Statistical significance was set at p = 0.05. The average age of the sample was 39.00 ± 8.19 years. Regarding gender the percentage of men was 24.88% (N = 54) and of women 75.11% (N = 163). The means for the subscales of SRSDA were 4.91 ± 4.87 for Anxiety, 6.21 ± 5.92 for Depression Beck-21 and 2.83 ± 3.41 for Depression Beck-13. The results of general linear models are shown that Emotional Exhaustion and Depersonalization are statistically correlated with Anxiety and Depression Subscales of SRSDA. Burnout plays an important role in anxiety and depression levels of the staff that works in mental health units all over Greece.

A Survey of Patients' Preoperative Need for Information About Postoperative Pain-Effect of Previous Surgery Experience.

PURPOSE: The aim of this study was to determine the kind of information patients need preoperatively about postoperative pain (POP) and whether this is affected by previous surgery experience. DESIGN: A descriptive study design using preoperative questionnaires. METHODS: Questionnaires with fixed questions related to POP and its management were distributed preoperatively to consenting, consecutive surgical patients. Patients were divided into two groups: patients with previous surgery experience (group A) and patients without previous surgery experience (group B). FINDING: Of the patients who participated in the study, 94.2% wanted information about POP and 77.8% of them believe that they will feel calmer if they get the information they need. The patients' biggest concern relates to pain management issues after discharge. Next, in order of preference is information about the analgesics that they need to take. The patients want to be informed primarily with a personal interview (59.4%). Previous surgery experience has no effect on patients' needs for information. CONCLUSIONS: Most of the patients want to be informed about the management of the POP after being discharged. It is remarkable that patients who had previous surgery experience need the same information with those who had no previous surgery.

An umbrella review of the literature on the effectiveness of psychological interventions for pain reduction.

BACKGROUND: Psychological interventions are widely implemented for pain management and treatment, but their reported effectiveness shows considerable variation and there is elevated likelihood for bias. METHODS: We summarized the strength of evidence and extent of potential biases in the published literature of psychological interventions for pain treatment using a range of criteria, including the statistical significance of the random effects summary estimate and of the largest study of each meta-analysis, number of participants, 95% prediction intervals, between-study heterogeneity, small-study effects and excess significance bias. RESULTS: Thirty-eight publications were identified, investigating 150 associations between several psychological interventions and 29 different types of pain. Of the 141 associations based on only randomized controlled trials, none presented strong or highly suggestive evidence by satisfying all the aforementioned criteria. The effect of psychological interventions on reducing cancer pain severity, pain in patients with arthritis, osteoarthritis, rheumatoid arthritis, breast cancer, fibromyalgia, irritable bowel syndrome, self-reported needle-related pain in children/adolescents or with chronic musculoskeletal pain, chronic non-headache pain and chronic pain in general were supported by suggestive evidence. CONCLUSIONS: The present findings reveal the lack of strong supporting empirical evidence for the effectiveness of psychological treatments for pain management and highlight the need to further evaluate the established approach of psychological interventions to ameliorate pain.

Anterior cutaneous nerve entrapment syndrome: management challenges.

Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly underdiagnosed and undertreated chronic state of pain. This syndrome is characterized by the entrapment of the cutaneous branches of the lower thoracoabdominal intercostal nerves at the lateral border of the rectus abdominis muscle, which causes severe, often refractory, chronic pain. This narrative review aims to identify the possible therapeutic strategies for the management of the syndrome. Seventeen studies about ACNES therapy were reviewed; of them, 15 were case-control studies, case series, or case reports, and two were randomized controlled trials. The presently available management strategies for ACNES include trigger point injections (diagnostic and therapeutic), ultrasound-guided blocks, chemical neurolysis, and surgical neurectomy, in combination with systemic medication, as well as some emerging techniques, such as radiofrequency ablation and neuromodulation. An increased awareness of the syndrome and the use of specific diagnostic criteria for its recognition are required to facilitate an early and successful management. This review compiles the proposed management strategies for ACNES.

To transfer or not to transfer? Evidence from validity and reliability tests for international transfers of non-market adaptation benefits in river basins.

The attempt to design cost-effective adaptation policies incorporating non-market values to inhibit climate change impacts on water resources may increase the interest in applying the Benefit Transfer method. Benefit Transfer is a practical way to consider non-market values using functions and estimates acquired through primary valuation methods from other sites. Among the primary methods, Choice Experiments appear to particularly accommodate Benefit Transfer. Nevertheless, validity and reliability of international value transfers obtained from Choice Experiments have not been adequately examined. To this end, two identical Choice Experiments were conducted in Greece and Italy in the context of river services adaptation, testing validity and reliability of Benefit Transfer. The application of validity and reliability tests for different types of transfers is supportive for the use of Benefit Transfer, at least for the value transfer types. In particular the reliability of value transfer was higher when income adjustments were taken into account. Overall, Benefit Transfer can be attentively considered to evaluate cost-effective adaptation policies across countries experiencing similar climate change trends. The latter gains more importance given that an international Benefit Transfer setting as regards the non-market benefits of adaptation to climate change for river services is absent in the relevant literature.

Spinal cord stimulation in refractory angina. A systematic review of randomized controlled trials.

OBJECTIVE: Spinal cord stimulation (SCS) is an invasive method used for treating patients with refractory angina. Although SCS is recommended by the European Society of Cardiology and American Heart Association (class lib, level of evidence B and C, respectively), the method is used very rarely and data on its effectiveness is limited. The aim of this work was to perform a systematic review of all randomized controlled trials (RCTs) that investigated the effectiveness of SCS as a treatment for refractory angina. METHODS: Medline and Cochrane library databases were searched from their inception to April 2014 for RCTs that investigated the efficacy and safety of SCS in patients with refractory angina. RESULTS: Nine RCTs were included in the systematic review. The included RCTs were categorized into two groups: RCTs comparing SCS either with optimal medical treatment or inactive mode or low stimulation SCS; and those comparing SCS with alternative therapeutic interventions. Follow-up was short-term (1-6 months) in most studies, showing no major complications. Two studies reported a neutral effect regarding mortality. Regarding efficacy, most RCTs were in favour of SCS mainly in the short term. The most recent, multi-centre RCT reported no significant difference compared to the control group. CONCLUSIONS: RCTs investigating the efficacy of SCS were small and they demonstrated a small effect in angina improvement. Due to great differences in their design the interpretation of the results is complex. Before this method is recommended as a routine therapy for refractory angina, a larger, well-designed, multicentre RCT is needed.

Handling preference heterogeneity for river services' adaptation to climate change.

Climate projection models for the Southern Mediterranean basin indicate a strong drought trend. This pattern is anticipated to affect a range of services derived from river ecosystems and consecutively deteriorate the sectoral outputs and household welfare. This paper aims to evaluate local residents' adaptation preferences for the Piave River basin in Italy. A Discrete Choice Experiment accounting for adaptation scenarios of the Piave River services was conducted and the collected data were econometrically analyzed using Random Parameters Logit, Latent Class and Covariance Heterogeneity models. In terms of policy-relevant outcomes, the analysis indicates that respondents are willing to pay for adaptation plans. This attitude is reflected on the compensating surplus to sustain the current state of the Piave, which corresponds to a monthly contribution of 80€ per household. From an econometric point of view, the results show that it is not sufficient to take solely into account general heterogeneity, provided that distinct treatment of the heterogeneity produces rather different welfare estimates. This implies that analysts should examine a set of criteria when deciding on how to better approach heterogeneity for each empirical data set. Overall, non-market values of environmental services should be considered when formulating cost-effective adaptation measures for river systems undergoing climate change effects and appropriate heterogeneity approximation could render these values unbiased and accurate.

THE IMPACT OF SOCIOECONOMIC FACTORS ON QUALITY OF LIFE OF PATIENTS WITH CHRONIC KIDNEY DISEASE IN GREECE.

BACKGROUND: Quality of Life (QoL) is often poor in people undergoing dialysis and this sometimes contributes to the high rate of morbidity and mortality. The aim of our study is to assess the QoL of patients on haemodialysis in Greece and discuss the socio-demographic factors that affect QoL in this period of financial crisis. DESIGN/PATIENTS: Patients with CKD not on dialysis, plus those undergoing Haemodialysis (HD) and Peritoneal Dialysis (PD) were invited to complete the SF-36 questionnaire electronically, supervised by a trained nurse. Patients were asked about their marital status, education level and monthly household income. Additionally, patients were requested to comment on their subjective financial difficulties. RESULTS: A total of 172 patients were enrolled in the study, 39 of them were undergoing PD, 90 on HD and 43 had CKD. Among those with CKD, on HD and PD, 9.3%, 17.8% and 23.1%, respectively, had 'some/a lot' difficulties in copying with financial problems. The physical component summary score was significant lower in HD, while the summary score of the mental component showed no differences between the groups. In multiple linear regression analysis, age and dialysis had significantly negative correlations with physical functioning scores. Those who were divorced or widowed tended to perform worse in physical scores compared with those who were married. Mental scores were affected only by coping with financial difficulties. CONCLUSIONS: In general terms, people with CKD patients present with a poor QoL. Apart from the burden of the renal disease per se, social and economic factors (divorce, financial difficulties) seem to aggravate their status, especially in this period of financial crisis.

The impact of radiotherapy on symptoms, anxiety and QoL in patients with cancer.

AIM: To evaluate prospectively disease- and treatment-related symptoms, anxiety and quality of life (QoL), in patients with different types of cancer undergoing external-beam radiotherapy (RT) and examine the relationship among them, at baseline and at the end of the treatment. PATIENTS AND METHODS: This study included 90 patients with cancer. Patients' QoL was evaluated using the Linear Analog Scale Assessment (LASAs) questionnaire, anxiety was measured with the Spielberger state and trait inventory (STAI), while symptoms were assessed using the MD Anderson Symptom Inventory (MDASI). The assessments were carried-out at baseline and at the end of RT. RESULTS: At baseline, the QoL scores were reduced (7.5±6.5) and MDASI elevated (2.35±1.7). Patients' QoL was correlated with symptoms (r=-0.684, p=0.0005). A correlation was found between STAI-trait with MDASI scores (r=0.214, p=0.046). At the second assessment, there were significant correlations between MDASI and QoL (r=-0.68, p=0.0005). The STAI-trait had a moderate correlation with MDASI score (r=0.43, p=0.0005) and with QoL (r=-0.253, p=0.0017). CONCLUSION: The present study showed a significant impact of symptoms and high levels of anxiety following RT, which correlated with a compromised QoL. The worsening in patients' perception of their QoL did not seem to lead to a significant reduction in daily activities or treatment tolerance.

Depression and anxiety levels increase chronic musculoskeletal pain in patients with Alzheimer's disease.

BACKGROUND/OBJECTIVES: During the next decades a rapid increase is expected in the number of patients with dementia suffering from pain who often take less medication compared to normal elderly, due to several diagnostic barriers. Comorbid mood disorders result in great difficulties in pain assessment and further treatment. DESIGN: Twenty five patients with Alzheimer's disease, comorbid mood disorders, and chronic musculoskeletal pain (experimental group) and thirty one patients with Alzheimer's disease and chronic musculoskeletal pain without comorbid mood disorders (control group) were examined. The assessment tools used were Geriatric Pain Measure, Patient Health Questionnaire, Pain Assessment in Advanced Dementia, Mini Mental State Examination and Pain Anxiety Symptom Scale. Statistical analysis was performed by SPSS v17.0, using the Pearson correlation and the multiple linear regression analysis. RESULTS: The correlation between mood disorders and levels of pain intensity in the experimental group was found to be statistically higher than that in the control group (p<.001). Among all quantitative variables, highly significant correlation (p<.001) was observed between stress and depression symptomatology (r =.550, p<.001) in the experimental group. Normal regression analysis was used to assess possible differences between demographic data and PASS scores. Scores in fearful thinking and physiological responses scales of PASS were higher in female than male (p=.014), whereas scores in the cognitive anxiety scale of PASS have shown a highly significant positive correlation with years of education (p<.001). DISCUSSION: It seems that depression and anxiety are associated with chronic musculoskeletal pain intensity in dementia, thus need to be taken into consideration by health professionals for patient's management.

Environmental and stressful factors affecting the occurrence of kidney stones and the kidney colic.

The first renal disease described from Hippocrates is nephrolithiasis with renal colic, which is the pain of stone passage and is also a common renal problem with easily recognizable characteristics. There has been much written about dietary factors, which have unequivocally been proved to play an important role in the formation of kidney stones. In this regard, it is of interest that the contribution of factors such as stressful events, life style, or occupation in the formation of kidney stones has not been well studied. This review examines the clinical evidence of the stressful events and other environmental factors affecting the occurrence of kidney stones.

Rheumatoid arthritis in patients with hemoglobinopathies.

Rheumatoid arthritis (RA) in patients suffering from hemoglobinopathies is an important clinical problem, but the correlation between these diseases is still imperfectly known. The aim of this study was to analyze the clinical, serological and radiological characteristics of RA occurring in patients with hemoglobinopathies (thalassemia major, thalassemia intermedia and sickle-cell disease). In a single institution, in an adult cohort of 90 patients with hemoglobinopathies, we investigated retrospectively medical records of the patients. We evaluated the clinical findings, the autoantibodies and the radiological progression of patients who were diagnosed with RA according the American College of Rheumatology (ACR) criteria for RA. There were found 4 patients, with thalassemia major, who fulfilling the ACR criteria for RA. The clinical picture of the patients revealed a mild form of arthritis of the knees, shoulders, wrist and hands, while one patient had episcleritis. All patients had radiological damage compatible with RA (Larsen's score, 28.75 ± 29). All had positive rheumatoid factor, while anti-cyclic citrullinated peptide antibodies were positive in 1 patient. Three patients received steroid treatment and one immunosuppressive agent (methotrexate). True RA with low frequency of extra-articular manifestations is described. The diagnosis of RA must be suspected in patients with hemoglobinopathies picture and chronic arthritis of small joints.

Higher levels of psychiatric symptomatology reported by health professionals working in medical settings in Greece.

BACKGROUND: Psychological distress in healthcare workers may vary across different specialties. The purpose of this study was to investigate the differences in the rate of anxiety and depression between medical and mental healthcare workers. METHODS: The sample was randomly selected and consisted of 229 workers from the medical health sector and 212 from the mental health sector, aged 39.8 ± 7.9 years old. Health workers from University and General Hospitals from all over Greece participated in the study. The Greek version of the Symptoms Rating Scale For Depression and Anxiety (SRSDA) was used. Statistics were processed with SPSS v. 17.0. RESULTS: The medical health professionals showed statistically significantly higher scores in all the subscales in comparison with the mental health sector workers, independently of years serving in the department. The rates of a possible psychiatric disorder (score over cutoff points) were significantly elevated on the Beck-21, melancholy and asthenia subscales. CONCLUSIONS: Medical healthcare workers appear to suffer from psychological distress more than their colleagues in the mental sector.

Defensive coping and health-related quality of life in chronic kidney disease: a cross-sectional study.

BACKGROUND: Coping with the stresses of chronic disease is considered as a key factor in the perceived impairment of health related quality of life (HRQL). Little is known though about these associations in chronic kidney disease (CKD). The present study aimed to investigate the relationship of defensive coping and HRQL among patients in different CKD stages, after adjusting for psychological distress, sociodemographic and disease-related variables. METHODS: The sample consisted of 98 CKD patients, attending a university nephrology department. Seventy-nine (79) pre-dialysis patients of disease stages 3 to 4 and 19 dialysis patients were included. HRQL was assessed by the 36-item Short-Form health survey (SF-36), defensive coping by the Rationality/Emotional Defensiveness (R/ED) scale of the Lifestyle Defense Mechanism Inventory (LDMI) and psychological distress by the depression and anxiety scales of the revised Hopkins Symptom CheckList (SCL-90-R). Regression analyses were carried out to examine the association between SF-36 dimensions and defensive coping style. RESULTS: Patients on dialysis had worse scores on SF-36 scales measuring physical aspects of HRQL. In the fully adjusted analysis, a higher defensive coping score was significantly associated with a lower score on the mental component summary (MCS) scale of the SF-36 (worse mental health). In contrast, a higher defensive score showed a small positive association with the physical component summary (PCS) scale of the SF-36 (better health), but this was marginally significant. CONCLUSIONS: The results provided evidence that emotional defensiveness as a coping style tends to differentially affect the mental and the physical component of HRQL in CKD. Clinicians should be aware of the effects of long-term denial and could examine the possibility of screening for defensive coping and depression in recently diagnosed CKD patients with the aim to improve both physical and mental health.

Tetracaine 0.5% eyedrops with or without lidocaine 2% gel in topical anesthesia for cataract surgery.

BACKGROUND AND OBJECTIVE: To evaluate the level of pain during phacoemulsification and foldable intraocular lens implantation under instillation of tetracaine 0.5% eyedrops versus a combination of lidocaine 2% gel and instillation of tetracaine eyedrops. METHODS: This prospective, randomized, controlled study included 51 patients undergoing phacoemulsification under topical anesthesia. They were randomized into two groups based on the topical anesthetic method they were to receive. Preoperatively all patients were asked to answer a questionnaire. One hour postoperatively, they were asked to grade their intraoperative and postoperative pain on a visual analog scale from 0 to 10. RESULTS: There were no statistically significant differences between the two methods of anesthesia. Gender and the presence of relatives or friends were independent factors playing a significant role in pain sensitivity. CONCLUSIONS: The combination of lidocaine 2% gel and tetracaine eyedrops does not have a better analgesic result than a single instillation of tetracaine 0.5% eyedrops.

Understanding nurses' psychosomatic complications that relate to the practice of nursing.

The literature acknowledges that nursing practice can create physical and emotional stresses for its practitioners. This study aimed to acquire an in-depth understanding of being a nurse in the Greek National Health System. Interpretive phenomenology was used and Van Manen's method of analysis was implemented. Conversational interviews were conducted with a purposive sample of nine nurses employed at the University Hospital of Ioannina in Greece. The findings produced three essential themes: a dissonance between the images and reality of nursing, emotional burnout, and psychosomatic entanglement. The dissonance between the idealization of nursing and the reality of nursing, along with the emotional crisis created by daily practice, constituted the two fundamental factors for developing psychosomatic complications. These impacted negatively on the participants' personal and professional well-being. Psychosomatic complications can be prevented by clearly delineating roles, enabling collaboration between education and practice, developing mentorship programs, and using reflection in practice.