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Low back pain: Correlation with anxiety, depression, and well-being and the effect of homeopathic medicines on the physical signs of patients
... So depression was removed from the model. This finding was compatible with the literature (16,17,(18)(19)(20). Kanwaljit et al reported that the pain was affected by emotional status on non-specific CLBP in postmenopausal women (21). ...
Purpose: The pragmatic aim of this study was to show affected factors including pain, disability level, and anxiety of kinesiophobia using structural equation modeling (SEM) in postmenopausal women with chronic low back pain (CLBP). Methods: The study was conducted with 200 women aged 45–75 years. Tampa Scale for Kinesiophobia 11, Hospital Anxiety and Depression Scale, Roland Morris Disability Questionnaire, and Visual Analog Scale were used. The SEM was also used to analyze the direction and power of complex interactions between kinesiophobia and anxiety, pain intensity, and disability level by using hypothetically designed models. The average pain intensity was 5.98 (2.39). Results: The average age of the women was 58.00±8.39 years. The average menopausal age was 45.75±5.95. The average kinesiophobia point was 25.97±8.57. Anxiety risk score was 14.74±11.27; depression risk score was 12.39±10.51. The SEM analysis outcome showed that the final model was expository kinesiophobia with pain, anxiety, and disability level (chi-square=21.37; df=28; p=0.810). Anxiety was found as a strong mediator in the relationship between kinesiophobia and pain intensity and disability. Conclusion: This study showed that SEM was appropriate method to explain relationships between kinesiophobia and pain, anxiety, and disability. The created model also showed that anxiety was a strong mediator in postmenopausal women with CLBP.
To observe the prevalence of anxiety and depression in chronic low back pain population at a tertiary care centre.
The prospective cross-sectional study was conducted using convenience sampling at the Department of Neurosurgery, at Liaquat National Hospital, Karachi, Pakistan, from January to June 2010. The prevalence of anxiety and depression in chronic low back pain patients was studied according to specified age and gender groups using Hospital Anxiety and Depression Scale.
Of the 140 patients in the study, 66 (47.14%) were females and 74 (52.85%) were males.The average age of the patients was 43.02+/-13.34 years. The average duration of symptoms was 4.29+/-3.3 years. Abnormal level of anxiety and depression were found in 77 (55%) and 68 (48.57%) patients respectively. Out of them 54 (38.5%) and 51 (36.4%) were borderline abnormal for anxiety and depression respectively, while 23 (16.4%) and 17 (12.1%) were abnormal for anxiety and depression respectively. Among the males, there were 20 (14.28%) and 23 (16.42%) patients with abnormal levels of the corresponding numbers among the females were 57 (40.71%) and 45 (32.14%). There was a significant association in anxiety (p<0.01) and depression (p<0.01) levels with respect to gender and no significant association with respect to age (p>0.05).
Individuals with chronic low back pain were at high risk to experience anxiety and depression.This risk was higher for females.
General practitioners play a pivotal part in the recognition and treatment of psychiatric disorders. Identifying somatoform disorders is important for the choice of treatment.
To quantify the prevalence of, and functional impairment associated with, somatoform disorders, and their comorbidity with anxiety/depressive disorders.
Two-stage prevalence study: a set of questionnaires was completed by 1046 consecutive patients of general practitioners (aged 25-80 years), followed by a standardised diagnostic interview (SCAN 2.1).
The prevalence of somatoform disorders was 16.1% (95% CI 12.8-19.4). When disorders with only mild impairment were included, the prevalence increased to 21.9%. Comorbidity of somatoform disorders and anxiety/depressive disorders was 3.3 times more likely than expected by chance. In patients with comorbid disorders, physical symptoms, depressive symptoms and functional limitations were additive.
Our findings underline the importance of a comprehensive diagnostic approach to psychiatric disorders in general practice.
To evaluate the details and effects of an individualized homeopathic treatment in patients with chronic low back pain in usual care.
Prospective multicenter observational study. Consecutive patients beginning homeopathic treatment in primary care practices were evaluated over 2 years by using standardized questionnaires. Diagnoses (ICD-9) and symptoms with severity, health-related quality of life (QoL), medical history, consultations, homeopathic and conventional treatments, and other health service use were recorded.
One hundred twenty-nine adults (64.3% women, mean age 43.6 +/- 12.7 y) were treated by 48 physicians. The patients mainly had chronic low back pain (average duration 9.6 +/- 9.0 y) and other chronic diseases. Nearly all the patients (91.3%) had been pretreated. The initial case-taking took 113 +/- 36, and the case analysis took 31 +/- 38 minutes. The 7.4 +/- 8.1 subsequent consultations (duration: 23.7 +/- 15.2 min) cumulated to 204.5 +/- 184.6 minutes. The patients received an average of 6.8 +/- 6.3 homeopathic prescriptions. The severity of the diagnoses and complaints showed marked and sustained improvements with large effect sizes (Cohen's d from 1.67 to 2.55) and QoL improved accordingly (SF-36 physical component scale d = 0.33; mental component scale d = 0.54). The use of conventional treatment and health services decreased markedly: the number of patients using low back pain-related drugs was half of the baseline.
Classic homeopathic treatment represents an effective treatment for low back pain and other diagnoses. It improves health-related QoL and reduces the use of other healthcare services.
The questionnaire is divided into ten sections selected from a series of experimental questionnaires designed to assess limitations of various activities of daily living. The chosen sections were those found to be most relevant to the problems suffered by people with low back pain. Each section contains six statements. A study of 25 patients with primary low back pain has already been mentioned. Their symptoms tended to resolve quickly and changes in their mean disability score can be seen over the first three weeks after referral to the spinal disorders department. The disability score was also used to demonstrate that there was no difference in the severity of symptoms in two sub-groups of patients in the same study. All new patients referred to the department complete the questionnaire when they first attend. The disability score is used as a guide to a patient's treatment programme. It cannot be used in isolation since it makes no allowance for the demands of a patient's job, his age or psychological make-up. However, it does ensure that important aspects of disability which are often forgotten are recorded in the patient's notes. Later, changes in the score may be used in monitoring the subsequent progress of the patient through treatment.
To document the prevalence of depression and examine the relationship between depression and selected pain-related variables associated with chronic back pain among elderly and nonelderly samples.
Survey with mailed questionnaire.
Patients seeking treatment at a spine diagnostic and treatment center.
Consecutive sample of elderly subjects (n = 69). Nonelderly subjects (n = 59) were randomly selected to achieve a sample size comparable to the elderly. Evaluation of depressed mood was determined by Beck Depression Inventory.
Multidimensional Pain Inventory, Pain Disability Index, Pain Duration, Work-Related Disability, Medication Use, and Pain Severity.
A high prevalence of dysphoria was found in both age groups. No significant differences were found between age and depressed mood. The only significant association between depressed mood and age occurred with pain duration, with the elderly experiencing fewer total hours per day in pain. Combining age groups, multivariate analysis of variance revealed that dysphoric chronic pain patients reported more antidepressant use, greater pain intensity, greater interference due to pain, and less life control than the nondepressed patients. Interference in activities demonstrated the strongest relationship with depressed mood in both age groups.
There is a high prevalence of dysphoria in both the elderly and nonelderly with chronic back pain. The relationships between pain-related constructs and depressed mood in chronic back pain patients are similar in the elderly and nonelderly. The impact of the pain experience on the individual's activities, functioning, and feelings of life control should be considered in theoretical and clinical explanations of the association between pain and depression.
Numerous studies have documented a strong association between chronic spinal disorders and psychopathology. However, there have been methodological shortcomings associated with much of this.
This article reviews the relevant research literature, including methodological refinements that have resulted in improved measurement of psychopathology, in order to provide the most updated conclusions concerning the links between spinal disorders and psychopathology.
A systematic review of all Medline referenced articles on this subject during the past three decades.
Previous research has shown that chronic spinal disorders are most often associated with depressive disorders, somatoform disorders, anxiety disorders, substance use disorders, and personality disorders. In addition to reviewing this research, the relationship between chronic spinal disorders and depressive disorders is examined in more detail.
Although the relationship between spinal disorders and psychopathology is complex, a diathesis-stress model is emerging as the dominant overarching theoretical model. In this model, diatheses are conceptualized as pre-existing semidormant characteristics of the individual before the onset of chronic spinal disorders, which are then activated by the stress of this chronic condition, eventually resulting in a diagnosable depressive disorder.
In the present review, a diathesis-stress model was applied specifically to the relationship between chronic spinal disorders and depressive disorders. Such a model may also be applicable to the relationship between chronic spinal disorders and other types of psychopathology, such as anxiety and substance use disorders. However, conclusive empirical support will require a prospective research design, given that these diatheses could be validly assessed only before the onset of the chronic pain condition.
To study the differences in levels of alexithymia, depression, and anxiety between a sample of adolescents diagnosed with ICD-10 persistent somatoform pain disorder (defined by the DSM-IV as a pain disorder associated with psychological factors) and healthy adolescent control subjects.
Using the Toronto Alexithymia Scale and the Hospital Anxiety and Depression Scale, we investigated the point prevalence of alexithymia, anxiety, and depression among adolescents aged 12 to 17 years, with somatoform disorder, who were hospitalized in Kaunas Medical University Hospital, Lithuania (n =120), and a healthy control group (n = 60) of adolescents aged 12 to 17 years, who were randomly selected from 6 schools in Kaunas, Lithuania.
The rate of alexithymia in adolescents with somatoform disorder was 59%, which was significantly higher than that in healthy control subjects (1%, P < 0.001). Similarly, the rate of anxiety was significantly higher in the patient group (62%), compared with control subjects (15%, P < 0.001). The rate of depression was low in both groups and did not differ significantly between groups.
Adolescents with somatoform disorder have higher levels of alexithymia and anxiety than healthy adolescent control subjects, but adolescents with somatoform disorder and adolescent control subjects do not have significantly different levels of depression.
Our objective was to review and compare, with meta-analytic methods, observational studies on the association of medically unexplained physical symptoms, anxiety, and depression with special emphasis on healthy and organically ill control groups and on different types of symptoms, measures, and illness behavior.
A search of MEDLINE and PsycLIT/PsycINFO for abstracts from 1980 to April 2001 was performed; principal investigators in the field were contacted and article reference lists were used to retrieve additional relevant articles. Two hundred forty-four studies were included on the basis of consensus ratings if they fulfilled seven of eight inclusion criteria pertaining to diagnostic accuracy and statistical appropriateness. Five hundred twenty-two studies were deferred or excluded. We focused specifically on the four functional somatic syndromes for which there were sufficient numbers for meta-analytic integration: irritable bowel syndrome (IBS), nonulcer dyspepsia (NUD), fibromyalgia (FM), and chronic fatigue syndrome (CFS). Data were extracted independently by two authors according to a prespecified coding manual with up to 70 parameters per study.
Effect sizes for the association of the four functional somatic syndromes with depression and anxiety were of moderate magnitude but were highly significant statistically when compared with healthy persons and controls with medical disorders of known organic pathology. Moreover, this association was significant whether depression was measured with or without somatic items. Chronic fatigue syndrome is characterized by higher scores of depression, fibromyalgia by lower scores of anxiety than irritable bowel syndrome. Consulting behavior and severity of somatization is related to higher levels of anxiety and depression.
Meta-analytic integration confirms that the four functional somatic syndromes (IBS, NUD, FM, CFS) are related to (but not fully dependent on) depression and anxiety. At present, there is only limited meta-analytic evidence for the same sort of association for medically unexplained physical symptoms in general. In view of the relative independence from depression and anxiety, classification and treatment of these symptoms and syndromes as "common mental disorders" does not seem fully appropriate.
PGI General Well-being Measure. Lucknow: Ankur Psychological Agency
- S K Verma
- A Verma
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