Personality and psychiatric disorders in chronic pain male affected by erectile dysfunction: prospective and observational study.

The prevalence of personality disorders (PDs) and sexual dysfunction in chronic pain patients is higher than in general population. Our main objective was to analyse the influence of PD in patients with erectile dysfunction and chronic non-cancer pain and their response to andrological treatment. One-hundred one patients were included along 30 months. Pain intensity, quality of life, sexual life quality, anxiety and depression were analysed together with opioid dose. Erectile functioning was measured with the International Index of Erectile Function (IIEF) and PDs with Millon Clinical Multiaxial Inventory (MCMI-III). The mean age was 57 ± 12 years old, with moderate to severe pain, 70% were sexually active and presented moderate to severe ED. PDs were very frequent (31%, cut-off 85 and 84% cut-off 75 scores) mostly anxiety, compulsive, though disorder, somatoform and narcissistic. Self-defeating feature presence was significantly correlated (r = -0.4, 95% CI = -0.605 to -0.145, p = 0.002) with a more severe baseline ED and narcissistic, and a better response to andrological treatment (p = 0.010, d = 1.082). Patients with dysthymia features required significantly higher opioid doses vs. control (238 vs. 102 mg/day, respectively). These findings underline the importance of diagnosing PDs to rigorously treat patients with chronic pain and ED.

Randomized, Controlled, Crossover Study of Self-administered Jacobson Relaxation in Chronic, Nonspecific, Low-back Pain.

CONTEXT: Opioids decrease pain and improve functional capacity and quality of life; however, they are not always effective and are associated with harmful side effects. Few studies have shown that relaxation-based therapies, in comparison with usual care, can decrease pain. OBJECTIVE: The objective of the study was to investigate whether a controlled relaxation treatment, Jacobson progressive muscular relaxation (PMR), was effective in relieving chronic low-back pain (CLBP) and reducing pain comorbidities. The research team hypothesized that PMR-controlled relaxation could be more effective in reducing CLBP than music. DESIGN: The research team designed a randomized, controlled, crossover study. SETTING: The study took place in the pain unit, a clinic, in the Department of Health at Alicante-General Hospital (Alicante, Spain). PARTICIPANTS: Participants in this study were 58 adults with nononcological CLBP, secondary to lumbar canal stenosis, who had been treated with opioids without any changes in the 3 mo prior to the study. INTERVENTION: Participants were randomly assigned to 1 of 2 groups, each of which received 2 treatments, but in a different order (ie, either AB or BA where A was the standardized PMR, the intervention, and B was relaxing music, the control. For both groups, the 2 treatment periods were 8 wk in length, with a 1-mo washout period between them. OUTCOME MEASURES: The primary outcome measures included (1) a visual analogue scale-pain and relief intensity; (2) the 12-item short form health survey-quality of life; (3) the hospital anxiety and depression scale-anxiety and depression; and (4) the medical outcomes study sleep scale-sleep disturbances. Secondary outcome measures included a self-efficacy scale and a measure of satisfaction with treatment and compliance. RESULTS: Pain was mostly mild to moderate. Greater decreases in pain between baseline and postintervention were observed for the PMR vs the control treatment in the mild pain category, with a VAS difference of 1.8 cm and P = .018. Significant differences were also found in anxiety, depression, quality of life, and sleep between participants in the 3 pain categories. Self-rated adherence was high. CONCLUSIONS: Findings support the efficacy and acceptability of a self-guided PMR intervention for reducing CLBP with minimal time with a therapist.