Recognizing the Psychiatric Burden of Anxiety and Depression in Children With Headache, Chest Pain, and Abdominal Pain

2020 ◽  
pp. 160-175
Author(s):  
Susan T. Tran ◽  
Ana B. Goya Arce ◽  
Anjana Jagpal
Keyword(s):  
Chronic Pain ◽  
Functional Disability ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Pediatric Pain ◽  
Treatment Of Depression ◽  
Pediatric Chest ◽  
Psychiatric Conditions ◽  
Headache Pain

Anxiety and depression are particularly common in pediatric chest, abdominal, and headache pain. Shared genetic factors, biological processes, and neurochemical mechanisms may underlie these comorbidities. Chronic pain in children and adolescents is associated with substantial functional disability, and impairments are especially notable when youths have comorbid anxiety or depression. Thus, early detection and treatment of comorbid psychiatric conditions in youths with chronic pain is imperative. Screening for anxiety and depression in pediatric pain is made difficult by the number of overlapping symptoms between pain and psychiatric conditions. Research on the treatment of chronic pain and comorbid depression or anxiety has advanced, but larger trials with follow-up data are needed to improve confidence in effectiveness. Implications for considering developmental and familial factors in the screening and treatment of depression and anxiety in youths with chronic pain are discussed.

scholarly journals Sleep patterns and symptoms of anxiety and depression in patients with chronic pain

2009 ◽  
Vol 67 (1) ◽  
pp. 25-28 ◽  
Author(s):  
Martha M.C. Castro ◽  
Carla Daltro
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbances ◽  
Myofascial Pain ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Sleep Patterns ◽  
Symptoms Of Depression ◽  
High Prevalence ◽  
The Mean

BACKGROUND: Sleep disturbances and symptoms of anxiety and depression have been shown to be involved in the genesis and perpetuation of chronic pain. OBJECTIVE: To evaluate sleep patterns and the prevalence of symptoms of anxiety and depression in patients with chronic pain. METHOD: Four hundred consecutive patients referred to a chronic pain outpatient clinic were investigated using patient charts, the numerical Visual Analogue Scale for the evaluation of pain, the Hospital Anxiety and Depression scale and the Mini-Sleep Questionnaire. RESULTS: The mean age of patients was 45.6±11.4 years. The most frequent medical diagnosis was myofascial pain followed by neuropathic pain. The prevalence of symptoms of anxiety was 72.8%, depression 93% and altered sleep patterns 93%. CONCLUSION: This study revealed a high prevalence of symptoms of depression and anxiety and alterations in sleep patterns in patients with chronic pain, justifying investigation into these disturbances in this group of patients.

scholarly journals Biomarkers of Allostatic Load as Correlates of Impairment in Youth with Chronic Pain: An Initial Investigation

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 709
Author(s):  
Sarah Nelson ◽  
Samantha Bento ◽  
Michelle Bosquet Enlow
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Allostatic Load ◽  
Functional Disability ◽  
Pain Treatment ◽  
Pediatric Pain ◽  
Childhood Experiences ◽  
High Exposure ◽  
Pediatric Chronic Pain ◽  
Study Results

Pediatric chronic pain is common and responsible for significant healthcare burden. However, the mechanisms underlying the development and/or maintenance of pediatric chronic pain remain poorly understood. Allostatic load (AL), or wear and tear on the nervous system following significant or prolonged stress, has been proposed to play a role in the maintenance of chronic pain, but minimal research has examined this possibility. This gap in research is particularly notable given the high exposure to adverse childhood experiences (ACEs; abuse/neglect, etc.) and psychological stress in this population. Accordingly, the current study aimed to preliminarily examine the measurement of AL in a treatment-seeking pediatric pain population. Biomarkers were collected during an already scheduled new patient pain evaluation and included salivary cortisol, dehydroepiandrosterone (DHEA), and C-reactive protein, in addition to waist–hip ratio, body-mass index, and blood pressure. A total of 61 children and adolescents with chronic pain (Mage = 14.47 years; 88.5% female and white/Caucasian) completed study procedures and were included in analyses. Preliminary results indicated that a multifactorial AL composite is feasible to assess for in a tertiary pain treatment setting and that over 50% of youth with chronic pain were classified as high risk for AL (two or more risk factors). Further, it was found that individual AL risk factors were significantly associated with functional disability and that AL may moderate the association between psychosocial and functional outcomes. Given the pilot nature of this study, results should be used to inform future investigations with larger and more diverse pediatric pain samples.

Change in Pain Severity With Open Label Venlafaxine Use in Patients With a Depressive Symptomatology: An Observational Study in Primary Care

2008 ◽  
Vol 23 (3) ◽  
pp. 178-186 ◽  
Author(s):  
Stefan Begré ◽  
Martin Traber ◽  
Martin Gerber ◽  
Roland von Känel
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Depressive Symptoms ◽  
Observational Study ◽  
Primary Care Physicians ◽  
Depressive Symptomatology ◽  
Dose Finding ◽  
Open Label ◽  
Treatment Of Depression

AbstractPurpose.Venlafaxine has shown benefit in the treatment of depression and pain. Worldwide data are extensively lacking investigating the outcome of chronic pain patients with depressive symptoms treated by venlafaxine in the primary care setting. This observational study aimed to elucidate the efficacy of venlafaxine and its prescription by Swiss primary care physicians and psychiatrists in patients with chronic pain and depressive symptomatology.Subjects and methods.We studied 505 patients with depressive symptoms suffering from chronic pain in a prospective naturalistic Swiss community based observational trial with venlafaxine in primary care. These patients have been treated with venlafaxine by 122 physicians, namely psychiatrists, general practitioners, and internists.Results.On average, patients were treated with 143 ± 75 mg (0–450 mg) venlafaxine daily for a follow-up of three months. Venlafaxine proved to be beneficial in the treatment of both depressive symptoms and chronic pain.Discussion.Although side effects were absent in most patients, physicians might have frequently omitted satisfactory response rate of depression by underdosing venlafaxine. Our results reflect the complexity in the treatment of chronic pain in patients with depressive symptoms in primary care.Conclusion.Further randomized dose-finding studies are needed to learn more about the appropriate dosage in treating depression and comorbid pain with venlafaxine.

scholarly journals Effectiveness of Text Messaging for the Management of Psychological and Somatic Distress in Depressed and Anxious Outpatients

2019 ◽  
Vol 12 (1) ◽  
pp. 12-19
Author(s):  
Roberto Truzoli ◽  
Cecilia Rovetta ◽  
Eliana Nola ◽  
Luca Matteucci ◽  
Caterina Viganò
Keyword(s):  
Group Therapy ◽  
Patient Compliance ◽  
Text Messaging ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
Cognitive Behavioral Group Therapy ◽  
Treatment Of Depression ◽  
Behavioral Group

Background:Cognitive behavioral group therapy has developed several techniques in order to make the treatment of depressive and anxiety disorders more effective. Particularly, the “homework” is a tool in order to practice therapeutic skills in ecological settings. When working with this aim, it is often necessary to support patient compliance.Researches have shown the efficacy of sending a text to the patients in order to support the patient compliance, but only a few data are available on the effectiveness of sending text in the treatment of depression and anxiety.Objective:Verify the effectiveness of sending text in the treatment of depression and anxiety in order to support patient compliance.Methods:Participants were enrolled for cognitive behavioral group therapy. Once completed the treatment, a sub-group of participants (Yes SMS group) was reached by a weekly text message for the whole 3 months time between the end of the intervention and the scheduled follow-up session.All the participants were assessed for the overall psychopathological symptoms, depression, and anxiety before and after the group intervention, and at the 3 months follow up.Results:Both groups improved from pre to post-treatment in all the assessed dimensions; the enhancement endures up to the 3 months follow up.Comparing the two groups regardless of the diagnosis, the Yes SMS group shows significant better outcomes in depression at follow-up and in anxiety both at post-treatment and at follow-up.Conclusion:The weekly SMS as prompt seems to enhance the patient’s compliance.

scholarly journals Treating anxiety and depression in older adults: randomised controlled trial comparing guided V. self-guided internet-delivered cognitive–behavioural therapy

BJPsych Open ◽  
2016 ◽  
Vol 2 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Nickolai Titov ◽  
Vincent J. Fogliati ◽  
Lauren G. Staples ◽  
Milena Gandy ◽  
Luke Johnston ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Symptoms Of Depression ◽  
Cognitive Behavioural ◽  
Randomised Controlled

BackgroundSymptoms of anxiety and depression are prevalent in older adults.AimsTo compare clinician-guided and self-guided versions of a transdiagnostic internet-delivered cognitive–behavioural therapy (iCBT) intervention for adults aged 60 years and above.MethodAdults (n=433) with symptoms of anxiety and depression were randomly allocated to: (1) clinician-guided treatment (n=153); (2) initial clinician interview followed by self-guided treatment (n=140); or (3) self-guided treatment without interview (n=140).ResultsLarge reductions (d ≥1.00) in symptoms of depression and anxiety were observed across groups, and sustained at follow-up. No differences were observed in clinical outcomes or satisfaction ratings. Age did not affect outcomes.ConclusionsCarefully developed iCBT interventions may significantly reduce symptoms of anxiety and depression in older adults when delivered in either clinician-guided or self-guided formats.

Prevalence of depression and anxiety in patients with chronic non-malignant pain–A Danish register-linkage cohort study

2017 ◽  
Vol 41 (S1) ◽  
pp. S313-S313 ◽  
Author(s):  
S. Søndergård ◽  
H.B. Vægter ◽  
A. Erlangsen ◽  
E. Stenager
Keyword(s):  
Chronic Pain ◽  
University Hospital ◽  
Pain Clinic ◽  
Interdisciplinary Treatment ◽  
Anxiety And Depression ◽  
Psychiatric Ward ◽  
Depression And Anxiety ◽  
Prevalence Rates ◽  
Prevalence Of Depression ◽  
Icd 10

IntroductionAnxiety and depression disorders are common in patients with chronic pain. Studies using clinical interviews in patients with chronic pain report prevalence rates ranging between 30–54% for depression and 17–29% for anxiety. This is the first study using contacts with a hospital psychiatric ward to investigate prevalence of depression and anxiety in patients with chronic pain.ObjectivesEstimate the prevalence of anxiety and depression in patients with chronic pain referred for interdisciplinary treatment.AimsTo increase the knowledge about mental disorders and chronic pain in secondary health care.MethodsAll chronic pain patients referred to and treated at an interdisciplinary pain clinic at Odense university hospital, Denmark from 1 Jan 2005–13 Nov 2015 were included as participants. The Danish National Patient Register was used to collect information on contacts with a hospital psychiatric ward 10-year prior to the first contact at the pain clinic due to depression (ICD-10: F32-F33) and/or anxiety (ICD-10: F40-F41).ResultsIn total, 7204 patients (64% women; mean age: 48.2) were included. Altogether, 17.8% (95% CI: 16.9–18.7) of patients had contact to a psychiatric ward. The prevalence of unipolar depression were: 6.1% (95% CI: 5.5–6.6) and anxiety: 2.1% (95% CI: 1.8–2.5), while 0.7% (95% CI: 0.5–0.9) had both depression and anxiety.ConclusionsThe prevalence rates of depression and anxiety noted in this study were lower than those reported in previous studies. A hospital-based diagnosis seems likely to be less frequent than interview-based measures, yet, might have a higher validity due to the clinician-based assessment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Patient Versus Parental Perceptions about Pain and Disability in Children and Adolescents with a Variety of Chronic Pain Conditions

2014 ◽  
Vol 19 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Thomas R Vetter ◽  
Cynthia L Bridgewater ◽  
Lee I Ascherman ◽  
Avi Madan-Swain ◽  
Gerald L McGwin
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Correlation Coefficient ◽  
Functional Disability ◽  
Pediatric Pain ◽  
Proxy Reports ◽  
Pediatric Chronic Pain ◽  
Self Reports ◽  
The Difference ◽  
Parent Proxy

BACKGROUND: Cross-informant variance is often observed in patient self-reports versus parent proxy reports of pediatric chronic pain and disability.OBJECTIVE: To assess the relationship and merit of the child versus parent perspective.METHODS: A total of 99 patients (eight to 17 years of age [mean 13.2 years]; 71% female, 81% Caucasian) and parents completed the Pediatric Pain Questionnaire and Functional Disability Inventory at their initial clinic visit. Patients’ and parents’ pain intensity and disability scores were analyzed using an intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Bland-Altman plot and Spearman’s correlation coefficient. The association between clinical/demographic variables and differences in patient/parent pain intensity and disability scores was assessed using multivariable regression.RESULTS: There was significant agreement between patients’ self-reports and parents’ proxy reports of their child’s pain intensity (ICC=0.52; P<0.001) and disability (ICC=0.57; P=0.004) at the individual level. There were no significant group differences in patient versus parent-proxy pain intensity scores (P=0.40) and disability scores (P=0.54). The difference between patient and parent-proxy pain intensity was associated with patients’ self-reported pain intensity (P<0.001). The difference between patient and parent-proxy disability was associated with patient’s self-reported pain disability (P<0.001). Bland-Altman plots revealed major inter-rater variation in the Pediatric Pain Questionnaire and Functional Disability Inventory across their score ranges. A significant relationship (r=0.38; P<0.001) was observed between patients’ self-reported pain intensity and disability.CONCLUSIONS: While equal merit should ideally be given to pediatric chronic pain patients’ self-reports and their parents’ proxy reports of pain intensity and disability, it would appear that, as needed, pediatric patients or parents can offer a clinically valid, single clinical perspective.

Exercise for the Treatment of Depression and Anxiety

2011 ◽  
Vol 41 (1) ◽  
pp. 15-28 ◽  
Author(s):  
Peter J. Carek ◽  
Sarah E. Laibstain ◽  
Stephen M. Carek
Keyword(s):  
Physical Activity ◽  
Well Being ◽  
The United States ◽  
Medical Setting ◽  
Depression And Anxiety ◽  
Efficient Treatment ◽  
Symptoms Of Depression ◽  
Treatment Of Depression ◽  
Psychiatric Conditions ◽  
Cost Efficient

Depression and anxiety are the most common psychiatric conditions seen in the general medical setting, affecting millions of individuals in the United States. The treatments for depression and anxiety are multiple and have varying degrees of effectiveness. Physical activity has been shown to be associated with decreased symptoms of depression and anxiety. Physical activity has been consistently shown to be associated with improved physical health, life satisfaction, cognitive functioning, and psychological well-being. Conversely, physical inactivity appears to be associated with the development of psychological disorders. Specific studies support the use of exercise as a treatment for depression. Exercise compares favorably to antidepressant medications as a first-line treatment for mild to moderate depression and has also been shown to improve depressive symptoms when used as an adjunct to medications. While not as extensively studied, exercise has been shown to be an effective and cost-efficient treatment alternative for a variety of anxiety disorders. While effective, exercise has not been shown to reduce anxiety to the level achieved by psychopharmaceuticals.

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