Sex differences in pain catastrophizing and its relation to the transition from acute pain to chronic pain.

BACKGROUND AND IMPORTANCE: Differences exist between sexes in pain and pain-related outcomes, such as development of chronic pain. Previous studies suggested a higher risk for pain chronification in female patients. Furthermore, pain catastrophizing is an important risk factor for chronification of pain. However, it is unclear whether sex differences in catastrophic thinking could explain the sex differences in pain chronification. OBJECTIVES: The aim of this study was to examine sex differences in pain catastrophizing. Additionally, we investigated pain catastrophizing as a potential mediator of sex differences in the transition of acute to chronic pain. DESIGN, SETTINGS AND PARTICIPANTS: Adults visiting one of the 15 participating emergency departments in the Netherlands with acute pain-related complaints. Subjects had to meet inclusion criteria and complete questionnaires about their health and pain. OUTCOMES MEASURE AND ANALYSIS: The outcomes in this prospective cohort study were pain catastrophizing (short form pain catastrophizing) and pain chronification at 90 days (Numeric Rating Scale ≥ 1). Data was analysed using univariate and multivariable logistic regression models. Finally, stratified regression analyses were conducted to assess whether differences in pain catastrophizing accounted for observed differences in pain chronification between sexes. MAIN RESULTS: In total 1,906 patients were included. Females catastrophized pain significantly more than males (p < 0.001). Multiple regression analyses suggested that pain catastrophizing is associated with pain chronification in both sexes. CONCLUSIONS: This study reported differences between sexes in catastrophic cognitions in the development of chronic pain. This is possibly of clinical importance to identify high-risk patients and ensure an early intervention to prevent the transition from acute to chronic pain.

[Back pain and radicular pain after subarachnoid haemorrhages]. / Rugpijn na een subarachnoïdale bloeding.

Subarachnoid haemorrhages (SAH) are acute life-threatening events that are frequently misdiagnosed. 4% of patients with SAH do not have the typical acute intense headaches, but present with other symptoms. Misdiagnosis leads to treatment delays and, consequently, higher morbidity and mortality. We describe two patients with atypical symptoms after SAH and delay in diagnosis. The first patient came to the emergency room with cervical, back and radicular pain that spread to both legs. An acute headache had started 11 days earlier. Physical examination showed signs of meningeal irritation. A cerebral CT scan revealed a subarachnoid haemorrhage. The second patient came to the outpatient clinic with pain in his lower back, apathy, apraxia and unsteady gait after an acute headache had started nine days before. When the patient visited our outpatient clinic, the headache had disappeared. A cerebral CT scan nevertheless revealed a subarachnoid haemorrhage. When diagnosing SAH, it is important not to miss the acute headache in the history, even though this headache may no longer be present at the time of presentation.

Management of chronic hypertension in older men: an exploration of patient goal-setting.

OBJECTIVE: Goal-setting is an approach to collaborative chronic care that involves clinicians and patients working together to set goals and to initiate and maintain specific self-care behaviors. Using patients' own perspectives, this study describes how goals for the self-management of hypertension are developed and whether or not they conform to the characteristics of effective goal-setting. METHODS: Qualitative methodology was used to explore the process of setting self-management goals for hypertensive patients. Thirty patients participated in semi-structured interviews that ascertained the detail and specificity of self-care goals, timing and quality of feedback for setting and monitoring goals and the role of family members and caregivers in setting goals. RESULTS: Patients understood the risks associated with hypertension, had intentions to control their disease, reported conducting at least one self-care task and set informal goals for themselves; however, these goals lacked the characteristics needed to initiate and maintain behavior change. CONCLUSION: Patient goal-setting is underdeveloped and poorly supported in chronic hypertension care. Future studies need to examine ways to support effective goal-setting. PRACTICE IMPLICATIONS: As part of chronic hypertension care, health care providers should incorporate time and support for dedicated goal-setting to improve the effectiveness of self-management behaviors.