Pain-Related Cognitive Processes, Pain Interference, and Alexithymia in Patients With Primary Headaches.

Objectives This study aims to investigate the effects of pain-related cognitive processes (PRCPs) and emotional state on pain-related disability (PRD) and pain interference (difficulty in performing daily routines, difficulty in engaging in social activities [the enjoyment of life], and the impact on work and/or school performance) in patients with primary headaches (PHs). Methodology PRCPs were evaluated with the Pain Anxiety Symptom Scale-20 (PASS-20), Pain Catastrophizing Scale (PCS), and Pain Belief Questionnaire (PBQ). Anxiety, depression, and alexithymia were investigated to assess the emotional state. PRD was assessed by Headache Impact Test-6 (HIT-6). Health-related quality of life (HRQoL) was evaluated under three headings: daily activities (with Short Form-36 [SF-36] Question [Q] 22), social activities (with Graded Chronic Pain Scale-Revised [GCPS-R] Q 4), as well as the working ability (with GCPS-R Q 5). Two separate models were constructed to identify the factors influencing PRD and HRQoL in PHP: M1 to reveal the factors affecting PRD and M2 to determine the independent factors affecting pain interference. In both models, correlation analysis was applied first and the significant data were then evaluated with regression analysis. Results A total of 364 participants (74 healthy controls [HCs] and 290 PHPs) completed the study. In M1, the following domains were significantly associated with PRD: cognitive anxiety (ß = 0.098; 95% confidence interval [CI] = 0.001-0.405; P = 0.049); helplessness (ß = 0.107; 95% CI = 0.018-0.356; P = 0.031); alexithymia (ß = 0.077; 95% CI = 0.005-0.116; P = 0.033); depression (ß = 0.083; 95% CI = 0.014-0.011; P = 0.025). In M2, factors associated with impairment in daily activities for PHP were as follows: duration of pain, pain intensity, alexithymia, escape-avoidance response, psychological anxiety, anxiety, and poor sleep quality (R = 0.770; R2 = 0.588). The independent factors affecting social activities for PHP were pain intensity and pain-related anxiety (R = 0.90; R2 = 0.81). Independent risk factors that affected the ability to work for PHP were pain intensity, cognitive anxiety, escape-avoidance response, and pain anxiety (R = 0.90; R2 = 0.81). Conclusions This study highlights the importance of cognitive and emotional processes that help increase our understanding of the patient with PHs. This understanding may help to reduce disability and improve the quality of life in this population by helping to guide multidisciplinary treatment goals.

Sleep quality and depression in patients with ankylosing spondylitis and their associations with clinical parameters: A cross-sectional, case-control study.

OBJECTIVES: This study aimed to explore sleep quality in patients with ankylosing spondylitis (AS) and to reveal the clinical parameters that predict sleep quality and depression in AS. METHODS: This study included 100 AS patients and 100 age/sex-matched healthy individuals. The AS activity was assessed by Bath AS Disease Activity Index (BASDAI), AS Disease Activity Score (ASDAS-ESR, ASDAS-CRP), and Visual Analog Scale (VAS). The functional status was assessed by the Bath AS Functional Index (BASFI). AS Quality of Life Questionnaire was administered for the assessment of the disease-related quality of life. Pittsburgh Sleep Quality Index for sleep assessment and Beck Depression Inventory for psychological assessment were administered to all participants. RESULTS: Sleep problems and depressive symptoms were significantly higher in AS patients compared to healthy individuals. All of the AS clinical parameters were significantly higher in AS patients with poor sleep quality than in AS patients with good sleep quality. In the correlation analysis, it was determined that poor sleep quality, depressive symptoms and low quality of life were strongly correlated with each other and AS clinical parameters. The most effective predictor for sleep problems was higher BASDAI scores, followed by higher BASFI, VAS, ASDAS-ESH scores, and younger age. Higher BASFI and VAS scores were predictors for depressive symptoms. CONCLUSION: The findings indicate that poor sleep, depressive symptoms and low quality of life may negatively affect the AS clinic, and therefore sleep quality and depression should not be ignored in the examinations of AS patients.

High-impact chronic pain: evaluation of risk factors and predictors.

Background: The concept of high-impact chronic pain (HICP) has been proposed for patients with chronic pain who have significant limitations in work, social life, and personal care. Recognition of HICP and being able to distinguish patients with HICP from other chronic pain patients who do not have life interference allows the necessary measures to be taken in order to restore the physical and emotional functioning of the affected persons. The aim was to reveal the risk factors and predictors associated with HICP. Methods: Patients with chronic pain without life interference (grade 1 and 2) and patients with HICP were compared. Significant data were evaluated with regression analysis to reveal the associated risk factors. Receiving operating characteristic (ROC) analysis was used to evaluate predictors and present cutoff scores. Results: One thousand and six patients completed the study. From pain related cognitive processes, fear of pain (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.87-0.98; P = 0.007) and helplessness (OR, 1.06; 95% CI, 1.01-1.12; P = 0.018) were found to be risk factors associated with HICP. Predictors of HICP were evaluated by ROC analysis. The highest discrimination value was found for pain intensity (cut-off score > 6.5; 83.8% sensitive; 68.7% specific; area under the curve = 0.823; P < 0.001). Conclusions: This is the first study in our geography to evaluate HICP with measurement tools that evaluate all dimensions of pain. Moreover, it is the first study in the literature to evaluate predictors and cut-off scores using ROC analysis for HICP.

Preliminary validation of the Turkish version of the pain catastrophizing scale for children and parents (PCS-C and PCS-P) in primary childhood headache.

OBJECTIVES: The aims of this study were to translate the pain catastrophizing scale for children and parents (PCS-C and PCS-P) into Turkish (TurPCS-C and TurPCS-P) and evaluate the psychometric properties in children with primary headache. METHODS: Exploratory factor analysis was used to test the construct validity. Reliability was measured using item-total score correlation, internal consistency (Cronbach α coefficient), Cronbach α if the item was deleted, and test-retest correlation. Concurrent validity and convergent validity of the scales were correlated with other scales (Revised Children's Anxiety and Depression Scale [RCADS], RCADS Parent RCADS-P, Quality of Life Scale for Children [PedsQL], and PedsQL-Parents [PedsQL-P]) and some related features (pain intensity, mobile phone usage time, and headache duration). RESULTS: Of the 80 children participating in the study, 55 (68.8%) were girls and 25 (31.2%) were boys. It was determined that the original three-factor structure was not supported for TurPCS-C and TurPCS-P. Cronbach α value was 0.871 for TurPCS-C consisting of 12 items, and Cronbach α value was 0.890 for TurPCS-P consisting of 12 items. As the PedsQL score increased, there was a negative correlation (p<0.05, r=-0.575) in all three areas of TurPCS-C, and there was a positive correlation (p<0.05) among the scores from the RCADS scale and TurPCS-C. Similarly, there was a negative correlation with PedsQL-P and TurPCS-P and positive correlation with RCADS-P and TurPCS-P (p<0.05 for each). CONCLUSION: TurPCS-C and TurPCS-P are an evaluation instrument with sufficient validity and reliability, and it can be reliably used to examine pediatric patients with primary headache.

Validation, reliability, and cross-cultural adaptation study of Graded Chronic Pain Scale Revised into Turkish in patients with primary low back pain.

OBJECTIVE: This study aims to assess the adaptation of the Graded Chronic Pain Scale-Revised to the Turkish language and psychometric properties in patients with primary low back pain. METHODS: The translation from the original text into the Turkish language was carried out step by step in accordance with the recommendations. Structural validity was analyzed by exploratory factor analysis (EFA). Reliability was carried out by internal consistency and test-retest analysis. Convergent validity was evaluated through scales composed in accordance with the research standards for chronic low back pain with the National Institutes of Health Task Force recommendations. RESULTS: One hundred thirty-five patients, 58 (43%) men and 77 (57%) women, completed the study. A two-factor structure was obtained according to EFA. The first factor consisted of questions 3, 4, and 5, and the same questions constitute the Pain, Enjoyment of Life, and General Activity scale. Cronbach α coefficient r = 0.814 (good internal consistency) was calculated for internal consistency. CONCLUSION: In this article, we presented the cross-cultural adaptation process of Graded Chronic Pain Scale-Revised to the Turkish language and evidence of its validity and reliability in a sample of patients with primary low back pain.

Prevalence of Dementia and Mild Cognitive Impairment in a Rural Area of Sivas, Turkey.

Introduction The exact prevalence of dementia in Turkey is unknown. The purpose of this study was to determine the frequency of dementia in members of the population aged 60 years and older, as well as the influence of detailed sociodemographic factors on the prevalence rate in Sivas City Center, a large city in the middle of Anatolia, Turkey. Methods This was a cross-sectional, simple random sampling, door-to-door, population-based study. A total of 500 individuals aged 60 and older from the city center region of Sivas, Turkey, were involved. A sociodemographic data form, the Standardized Mini-Mental Test, the clock drawing test, the Cornell Scale for Depression in Dementia, and the Daily Life Activities and Instrumental Daily Life Activities tests were used in the screening phase. Results A total of 500 individuals ranging in age from 60 to 95 years were assessed. A total of 84 participants were diagnosed with dementia. The dementia prevalence was found to be 16.8% in Sivas city province. Dementia was associated with age (p<0.001), female sex (p<0.001), marital status (p<0.001), family income (p<0.001), and the absence of formal education (p<0.001). Conclusions This study is the first community-based study of cognitive impairment in Turkey, with a study design, procedures, and diagnostic criteria designed to determining the rate of dementia. Old age, a higher score on the Cornell Scale for Depression in Dementia, and a low educational level were independent risk factors for dementia. Further studies are required to confirm these results.

Prevalence of migraine and co-morbid psychiatric disorders among students of Cumhuriyet University.

BACKGROUND: The aim of this study was to investigate the prevalence of migraine and associated psychiatric disorders among university students at Cumhuriyet University of Sivas in Turkey. METHODS: A total of 1601 university students participated in this study and answered the questionnaires. The study was conducted in three stages: the self-questionnaire, the neurological evaluation, and the psychiatric evaluation. In the first stage, the subjects completed a questionnaire to assess migraine symptoms. In the second stage, the subjects who reported having migraines underwent a detailed neurological evaluation conducted by a neurologist to confirm the diagnosis. In the final stage, the subjects with migraines completed a psychiatric examination using the structured clinical interview for DSM IV-R Axis I. RESULTS: The self-reported migraine prevalence rate was 13.7%, and the actual prevalence rate of migraine among the university students was calculated to be 10.6% (n=169). When the results obtained with the SCID-I were examined, a current SCID-I psychiatric diagnosis was found in 39 (23.1%) of the 169 subjects with migraines. A total of 73 (43.2%) students with migraines had a lifetime SCID-I psychiatric diagnosis. CONCLUSIONS: The results of this study indicate that migraines were highly prevalent among university students in Turkey with comorbid psychiatric disorders. Treatment strategies must be developed to manage these comorbidities.

Serum 25-hydroxyvitamin D levels in restless legs syndrome patients.

OBJECTIVE: Restless legs syndrome is characterised by discomfort during rest and an urge to move the limbs that is accompanied by abnormal sensations. Studies on disease pathophysiology have focused on dopaminergic dysfunction. Vitamin D may play an important role in dopamine function, but the role of vitamin D in restless legs syndrome has not been examined. We compared the serum vitamin D levels of RLS patients and matched controls and explored the correlation of plasma vitamin D levels with disease severity. PATIENTS/METHODS: We measured serum 25-hydroxyvitamin D levels in 36 patients with restless legs syndrome and compared them to 38 healthy control subjects. RESULTS: The mean serum 25-hydroxyvitamin D levels were 7.31±4.63 ng/mL in female patients with restless legs syndrome and 12.31±5.27 ng/mL in female control subjects (p=0.001). We found a significant inverse correlation between vitamin D levels and disease severity in females (p=0.01, r=-0.47). CONCLUSION: The mean serum vitamin D levels were lower in female patients with restless legs syndrome. Low vitamin D levels may cause dopaminergic dysfunction in restless legs syndrome patients. Further studies are required to confirm these results.

Migraine prevalence, alexithymia, and post-traumatic stress disorder among medical students in Turkey.

The aim of this study was to investigate the prevalence of migraine, alexithymia, and post-traumatic stress disorder among medical students at Cumhuriyet University of Sivas in Turkey. A total of 250 medical students participated in this study and answered the questionnaires. The study was conducted in three stages: the self-questionnaire, the neurological evaluation, and the psychiatric evaluation. In the first stage, the subjects completed a questionnaire to assess migraine symptoms and completed the three-item Identification of Migraine Questionnaire, the Toronto Alexithymia Scale, and the Post-Traumatic Stress Disorder Checklist-Civilian Version Scale. The subjects who reported having a migraine underwent a detailed neurological evaluation conducted by a neurologist to confirm the diagnosis. In the final stage, the subjects with a migraine completed a psychiatric examination using the structured clinical interview for DSM-IV-R Axis I. The actual prevalence of migraine among these medical students was 12.6 %. The students with a migraine were diagnosed with alexithymia and post-traumatic stress disorder more frequently than those without migraine. The Migraine Disability Assessment Scale scores correlated with the post-traumatic stress disorder scores. The results of this study indicate that migraine was highly prevalent among medical students in Turkey and was associated with the alexithymic personality trait and comorbid psychiatric disorders including post-traumatic stress disorder. Treatment strategies must be developed to manage these comorbidities.

The role of event-related potentials in subclinical cognitive dysfunction in essential tremor.

Several studies have reported that patients with essential tremor (ET) may also have mild cognitive impairment. Event-related potentials (ERPs) involve cognitive processes in the brain. No detailed investigation has been conducted into auditory ERPs (AERPs) to detect the subclinical cognitive dysfunction in patients with ET. Therefore, this study aimed to clarify the usefulness of AERPs in ET-related cognitive impairment. The AERPs were obtained by using an oddball paradigm in 27 patients with ET and 27 age-matched control subjects. The mean latency and amplitude of the ERPs were compared between the two groups. The correlation between disease duration and the mean values of all components of the potentials was assessed. The association between tremor severity and potentials was also evaluated. The patients with ET showed significant prolongation of all components of the ERP latencies at each electrode site. The N200 and P300 amplitudes were reduced in the ET group. Interestingly, the significant prolongation of N100 and N200 latencies correlated with disease duration, and N200 latencies appeared significantly longer in patients with severe tremor. Significant differences were found between the components of the AERPs and tremor severity and disease duration. This finding implies that ERPs may be useful in evaluating the cognitive functions in ET and that those AERP abnormalities may appear before clinical presentation.

Audio-vestibular evaluation in patients with essential tremor.

The aim of this study was to investigate audio-vestibular function in patients with essential tremor. Twenty-three patients with essential tremor (46 ears) and 21 health control subjects (42 ears) were included in the present study. Patients and comparison subjects were matched for age and gender. All patient and control subjects underwent pure tone audiometric test, tympanogram, transient-evoked otoacoustic emissions and auditory brainstem response. Vestibular system was evaluated by bitermal caloric test. Comparison of variables between the groups was performed. Investigation of the relationship between parameters about ET disease and hearing levels were also studied. Pure tone thresholds significantly differed between patients and controls in 250 and 500 Hz frequencies (p < 0.05). There was no statistically significant difference in 1,000, 2,000, 4,000, and 6,000 Hz frequencies in essential tremor patients in comparison to the control subjects. A correlation between tremor severity and audiometric scores in low frequencies was not found. In addition, statistical analysis did not demonstrate a correlation between audiometric scores and tremor duration. The otoacoustic emission responses were found significantly different in patient and control group. The latencies of waves I, V and I-V inter-peak latencies on the ABR were not different between the groups. Our findings indicated that, abnormalities are due to cochlea rather than the retro cochlear pathology which is responsible for hearing loss associated with essential tremor.