Relations Between Depression, Alcohol and Gender in the Metropolitan Region of São Paulo, Brazil.

Relations between Depression, Alcohol and Gender in the Metropolitan Region of São Paulo, Brazil.

Filed under: Depression Treatment

Cien Saude Colet. 2012 Sep; 17(9): 2425-34
Prado Jde A, Kerr-Corrêa F, Lima MC, Silva GG, Santos JL

As part of the GENACIS project, this paper sought to assess the prevalence of depression in an urban sample in the city of São Paulo, Brazil, as well as the association between depression and alcohol abuse according to gender. To achieve this, an epidemiological survey was conducted using a stratified probability sample, including 2,083 adults. CIDI SF was used to identify depression. The Rao Scott test and multivariate logistic regression were used for statistical analysis. The response rate was 74.9%. Females (58.3%) under 40 years of age (52%) were predominant. The prevalence of depression was 28.3% for women and 12.7% for men. Most men declared being drinkers (61.1%) in the last year. Depression was associated with an alcohol drinking pattern, mostly binge drinking, in addition to the occurrence of problems derived from alcohol use. Most women declared being abstainers (69.5%). Depression was associated with cohabiting with spouses with alcohol-related problems. Results reveal that the association between depression and alcohol consumption is distinct between genders.
HubMed – depression

Pain in patients with chronic fatigue syndrome: time for specific pain treatment?

Filed under: Depression Treatment

Pain Physician. 2012 Sep; 15(5): E677-86
Nijs J, Crombez G, Meeus M, Knoop H, Damme SV, Cauwenbergh V, Bleijenberg G

Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers.To examine whether pain is a unique feature of CFS, or does it share the same underlying mechanisms as other CFS symptoms? Second, it is examined whether effective treatments for pain from CFS are currently available.Narrative review covering the scientific literature up through December 2011.Several universities.From the available literature, it is concluded that musculoskeletal factors are unlikely to account for pain from CFS. Pain seems to be one out of many symptoms related to central sensitization from CFS. This idea is supported by the findings of generalized hyperalgesia (including widespread increased responsiveness to painful stimuli) and dysfunctional endogenous analgesia in response to noxious thermal stimuli. Pain catastrophizing and depression partly account for pain from CFS. Pain increases during exercise is probably due to the lack of endogenous analgesia and activation of several genes in response to exercise in CFS. There is currently no evidence in support for the efficacy of complementary medicine in the treatment of pain from CFS. Intensive education about the biology of pain from CFS (within the framework of central sensitization) has positive short-term effects for patients with CFS, and fatigue-targeting cognitive behavioral therapy appears to be effective for pain from CFS as well.The role of the deficient hypothalamus-pituitary-adrenal axis in relation to pain from CFS, as well as the interactions with immune (dys)functioning require further study.Recent research has increased our understanding of pain from CFS, including its treatment. It is advocated to optimize current CFS treatment protocols by targeting the underlying mechanism for those patients having severe pain.
HubMed – depression

Multivariate prognostic modeling of persistent pain following lumbar discectomy.

Filed under: Depression Treatment

Pain Physician. 2012 Sep; 15(5): 421-34
Hegarty D, Shorten G

Persistent postsurgical pain (PPSP) affects between 10% and 50% of surgical patients, the development of which is a complex and poorly understood process. To date, most studies on PPSP have focused on specific surgical procedures where individuals do not suffer from chronic pain before the surgical intervention. Individuals who have a chronic nerve injury are likely to have established peripheral and central sensitization which may increase the risk of developing PPSP. Concurrent analyses of the possible factors contributing to the development of PPSP following lumbar discectomy have not been examined.The aim of this study is to identify risk and protective factors that predict the course of recovery following lumbar discectomy and to develop an easily applicable preoperative multivariate prognostic model for the occurrence of PPSP in this patient cohort.A prospective study of elective lumbar discectomy with a 3 month follow-up.University setting in IrelandAll ASA I-II patients, (n = 53, 18-65 years old), undergoing elective lumbar discectomy at a single institute were included and followed for a 3 month period postsurgery. Preoperative potential predictors were collected: age, gender, pain intensity (McGill score, visual analog scale [VAS], Present Pain Intensity), degree of dysfunction (Roland-Morris Function score), psychological status (pain catastrophizing, anxiety, and depression scores), health-related quality of life (SF-36), quantitative sensory testing (QST), inflammatory biomarkers, and a genetic pain profile. The proposed primary outcome was significant pain reduction (VAS > 70%) 3 months following surgery compared to the preoperative pain intensity.A final prediction model was obtained using a multivariate logistic regression in combination with bootstrapping techniques for internal validation. Twenty (37.7%) patients developed PPSP. Independent predictor factors included age (odds ratio [OR] = 1.0 per year), present pain intensity (OR = 0.6), and degree of dysfunction (OR = 1.2). The concordance index C (.658) supports a good monotonic association (where perfect prediction is 1) and the Akaike’s information criteria indicated a good fit of the model. Inclusion of additional measured parameters (QST, biomarker, or genotyping) did not improve the model.Before this internally validated model can be integrated into clinical practice, and used for patient counselling and quality assurance purposes, external validation studies are necessary.We demonstrated that the occurrence of PPSP can be predicted using a small set of variables easily obtained at the preoperative visit. This a prediction rule that could further optimize perioperative pain treatment and reduce attendant complications by allowing the preoperative classification of surgical patients according to their risk of developing PPSP.
HubMed – depression

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