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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pain is both a sensory and an emotional experience. In a multidisciplinary pain management clinic for a geriatric population, pain and mood have been assessed prior to the initiation of management in 49 of 100 referred patients. Patients have been assessed clinically, for psychological disability using the profile of mood states (POMS) and a visual analogue scale for mood, for pain using the McGill pain questionnaire (short form), word descriptor scale and visual analogue scale and for activities of daily living (ADL) using the Disability and Impairment Interview Schedule and the Rapid Disability Rating Scale -2. All testing has followed initial screening to exclude dementia. For the group assessed by psychometric measures, median age was 75 years (range 56 to 91); 41 were female. Major pathologies were degenerative musculoskeletal disease (15), post-herpetic neuralgia (9), and psychiatric conditions (7). Intra-test item correlations were found to be significant for the McGill questionnaire and the POMS. Inter-test correlations were observed for pain measures (McGill present pain intensity with VAS pain, r = 0.67; with word descriptor, 0.64; p less than 0.001), for ADL measures (r = 0.53, p less than 0.001) and for measures of mood (VAS mood with POMS (depression), r = 0.45; p less than 0.001; with POMS (anxiety), r = 0.35; p less than 0.01. There was no significant correlation between measures of mood and pain on the McGill scale. The data to this time support the view that standard psychometric tools can be used reliably to evaluate pain, mood and activity in this population. Furthermore, it appears that mood and pain may be measured separately.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Can psychometric tools be used to analyse pain in a geriatric population? 264 22

The aim of this study is to compare the assessment of pain in 200 elderly persons participating in five senior day care programs, as rated by family caregivers, day care staff members, and the participants themselves. Staff members and participants provided information in a face-to-face interview. Family members provided information about the participants and their demographic characteristics via a mailed questionnaire. Agreement rates among informants ranged between 63% and 69%, showing moderate agreement rates. Health status (as reflected in number of medications taken and the presence of a diagnosis of musculoskeletal disease) and depression were associated with ratings of pain by all the informants. The assessment of pain in the elderly population is very difficult and there is a need for reliable and valid pain assessments to be used by different raters. The relationship between pain, depression and other variables should be further explored.
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PMID:Pain in participants of adult day care centers: assessment by different raters. 943 37

To determine the extent of under-reporting of musculoskeletal disease among very elderly nursing home patients, 50 Veterans Affairs Nursing Home patients were evaluated by means of retrospective medical chart review. The primary caregivers' charted musculoskeletal examinations were scored objectively; then the patients completed an arthritis questionnaire, a short-form Geriatric Depression Scale assessment, and the Katz Activities of Daily Living Scale assessment. Finally, each patient underwent an objectively scored musculoskeletal examination by a rheumatologist. The results indicated that musculoskeletal disease in the very elderly nursing home patient is more prevalent than self-report or examination by the primary caregiver suggested. Brief but directed arthritis symptom questioning followed by a specialized examination were necessary to diagnose treatable musculoskeletal disease in this population.
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PMID:Musculoskeletal disease in very elderly nursing home patients: does under-reporting exist? 1015 48

Fibromyalgia is a chronic, painful musculoskeletal disorder characterized by widespread pain, pressure hyperalgesia, morning stiffness and by an increased incidence of depressive symptoms. The etiology, however, has remained elusive. The aim of the present study was to examine the inflammatory response system (IRS) in fibromyalgia. Serum interleukin-6 (IL-6), soluble IL-6 receptor (sIL-6R), sgp130, sIL-1R antagonist (IL-1RA) and sCD8 were determined in 33 healthy volunteers and in 21 fibromyalgia patients, classified according to the American College of Rheumatology criteria. Severity of illness was measured with several pain scales, dolorimetry and the Hamilton Depression Rating Scale (HDRS). Serum sgp130 was significantly higher and serum sCD8 significantly lower in fibromyalgia patients than in healthy volunteers. Serum sIL-6R and sIL-1RA were significantly higher in fibromyalgia patients with an increased HDRS score (> or = 16) than in normal volunteers and fibromyalgia patients with a HDRS score < 16. In fibromyalgia patients, an important part of the variance in sCD8 (50.3%) and IL-1RA (19.3%) could be explained by the HDRS score; 74.3% of the variance in sIL-6R was explained by the combined effects of pain symptoms and the HDRS score; and 25.9% of the variance in serum sgp130 was explained by stiffness. The results support the contention that pain and stiffness in fibromyalgia may be accompanied by a suppression of some aspects of the IRS and that the presence of clinically significant depressive symptoms in fibromyalgia is associated with some signs of IRS activation.
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PMID:The immune-inflammatory pathophysiology of fibromyalgia: increased serum soluble gp130, the common signal transducer protein of various neurotrophic cytokines. 1034 65

This study investigates the demand-control-support (DCS) model by (a) using a more focused measure of job control, (b) testing for interactive and nonlinear relationships, and (c) further extending the model to the prediction of an objective outcome measure (i.e., company-administrated sickness absence). Hypotheses were tested in a heterogeneous sample of 1,739 employees from a 3-year prospective cohort study called SMASH (Study on Musculoskeletal Disorders, Absenteeism, Stress, and Health). Baseline results showed that a linear additive model was superior for job satisfaction, psychosomatic health complaints, and sickness absence, whereas a curvilinear model was superior for emotional exhaustion and depression. It is concluded that, first, there was no evidence of interactive effects. Second, it seems sensible to pay more attention to curvilinear relationships in future research. Finally, the DCS model was not supported using a more objective outcome measure.
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PMID:Linear and nonlinear relations between psychosocial job characteristics, subjective outcomes, and sickness absence: baseline results from SMASH. Study on Musculoskeletal Disorders, Absenteeism, Stress, and Health. 1078 89

The consequences of natural disasters on the social and health status of older people have not been deeply considered. The aim of this study was to evaluate the socioenvironmental and psychophysical conditions of an elderly population after a devastating earthquake. A randomly selected group of 332 older people (> or =64 years) was selected among 1548 eligible subjects living in the city of Nocera Umbra four months after an earthquake of 5.6 magnitude on the Richter scale. Three geriatricians evaluated the study subjects by means of a structured interview, and standardized scales, which considered physical and mental status, mood and anxiety, and self-perception of well-being, as well as the characteristics of family composition and social interactions. Of the study subjects, 11.1% lived alone, and 33.4% with the spouse only. Most were self-sufficient in the basic activities of daily life. Musculoskeletal diseases and hypertension were the most frequently observed pathologies in this geriatric population. In addition, 47.9% of the subjects lived in temporary houses; this group more frequently suffered from hypertension, and had a higher score of comorbidity as measured by Cumulative Illness Rating Scale (CIRS) compared to people who remained at home. People living in the pre-fabricated huts also showed a higher score on the Geriatric Depression Scale and the Hamilton scale for anxiety, and complained more often of their health status, evaluated as self-perception of well-being, when compared to the home dwellers. Although all the studied subjects suffered from the discomforts caused by the earthquake, the precariousness of living in temporary houses, whose structural characteristics do not take the needs of elderly subjects into account, could justify the higher distress experienced by persons housed in the huts. These observations suggest that, after natural disasters, emergency programs should be more adapted to elderly people, whose needs and expectations are often different from those of young adults.
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PMID:Impact of the earthquake of September 26, 1997 in Umbria, Italy on the socioenvironmental and psychophysical conditions of an elderly population. 1107 47

Musculoskeletal disease is extraordinarily prevalent among geriatric patients, with an incidence that is increasing with the growth of this segment of the population. It is a major cause of disability, dependency, dysmobility, pain, and depression. Rheumatologic evaluation of the geriatric patient provides challenges to the clinician in the proper interpretation of pain, the effect of comorbidities and multiple medications, and the need to consider an interdisciplinary approach that includes the recognition of cognitive deficits, functional evaluations, and treatment of muscle atrophy. Osteoarthritis accounts for 60% to 70% of joint disease in older persons, with pathologic and radiographic findings that are a "background" against which to consider pain and limitation of motion. Therapeutic strategies that incorporate reconditioning, the reduction of load-bearing, and adequate pain control may positively impact quality of life and reduce the potential for falls.
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PMID:Osteoarthritis. A review of musculoskeletal aging and treatment issues in geriatric patients. 1533 14

We performed this study to examine the prevalence and correlates of fatigue and depression, and their relevance to health-related quality of life in disease-free breast cancer survivors. A total of 1,933 breast cancer survivors recruited from five large hospitals in Korea completed a mailed survey, which included the Brief Fatigue Inventory, Beck Depression Inventory, European Organization for Research and Treatment of Cancer QLQ-C30, and QLQ-BR23. With a framework that included sociodemographic, clinical, and symptom characteristics, multivariate logistic regression models were used to identify factors associated with fatigue and depression. Among breast cancer survivors, 66.1% reported moderate to severe fatigue and 24.9% reported moderate to severe depression. Risk factors common to both fatigue and depression were lower income, dyspnea, insomnia, appetite loss, constipation, and arm symptoms. Risk factors for fatigue only included younger age, employment, presence of gastrointestinal disease, and pain. Having a musculoskeletal disease was identified as a risk factor for depression only. Both fatigue and depression were influenced by sociodemographic factors, comorbidity and symptom characteristics rather than cancer or treatment-related factors. Both fatigue and depression were negatively associated with survivors' health-related quality of life. However, the patterns of differences in health-related quality of life according to severity of fatigue or depression were similar. This concurrent examination of risk factors for fatigue and depression may be helpful in the development of clinical management strategies in disease-free breast cancer survivors.
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PMID:Fatigue and depression in disease-free breast cancer survivors: prevalence, correlates, and association with quality of life. 1835 87

Rheumatoid arthritis is a chronic inflammatory musculoskeletal disease with a prevalence rate of 1-3% in Western countries. In addition to limited physical function, rheumatoid arthritis patients also suffer from psychologic comorbidities. Depression in rheumatoid arthritis patients has been linked to disease outcomes such as increased healthcare service utilization and poor adherence to medication. This review focuses on the impact of depression on rheumatoid arthritis patient's quality of life and how quality of life can be improved through the management of depression. Both generic and disease-specific instruments have been used to assess health-related quality of life in rheumatoid arthritis research. Commonly used instruments include the generic Short Form-36, the Nottingham Health Profile, the disease-specific Arthritis Impact Measurement Scale and the Rheumatoid Arthritis Quality of Life. Studies have shown that depression in rheumatoid arthritis patients may exert an important impact on multiple domains of health-related quality of life. Currently, depression in rheumatoid arthritis has been managed by both psychoeducation and antidepressant treatment. They are generally effective in improving clinical outcomes. However, future studies are needed to clarify whether they can improve patient reported quality of life. As depression is a prevalent comorbidity in rheumatoid arthritis, clinicians should pay more attention to the rheumatoid arthritis patient's psychologic wellbeing. Screening for depression and other psychologic distress should be recognized as an important process in the routine clinical care of patients with rheumatoid arthritis.
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PMID:Depression and health-related quality of life in patients with rheumatoid arthritis. 1980 90

The present review summarizes the evidence on epidemiology, etiology, and treatment of comorbid mental disorders in patients with musculoskeletal diseases. Epidemiological studies highlight a significantly increased risk of comorbid mental disorders in patients with musculoskeletal diseases compared to patients without musculoskeletal diseases and physically healthy persons. With regard to the question of the causal link between these comorbidities, specific musculoskeletal disease-mental disorder combinations show specific pathogenetic pathways. Using the example of arthritis-depression comorbidity, a causality model is presented. This model describes depression as following arthritis and, in turn, aggravating the course of arthritis. Treatment studies emphasize the effectiveness of both psychotherapeutic and psychopharmacological interventions for the treatment of patients with musculoskeletal diseases and comorbid mental disorders. In particular, collaborative care interventions are promising approaches to improve the routine care of comorbid patients.
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PMID:[Psychological comorbidity in patients with musculoskeletal diseases]. 2124 29


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