Psychological Factors in Experience of Pain During Childbirth.

Pain during delivery is unique because it is accompanied by powerful emotions. Emotions that occur in women during labor and delivery are closely tied to upbringing and culture in which they were raised and consequently with the sensation of experienced pain. According to the Melzack-Wall Theory of Pain, general mood is directly related to the intensity and quality of pain and it is therefore justifiable to presuppose that certain psychosocial factors will be linked with the intensity and quality of pain experienced during childbirth. (Melzack et al., 1981). We endeavored to show the effect of psychosocial factors that influence the intensity and quality of labor pain. Data was collected in a sample of 176 parturient women who delivered without Cesarean sections or epidural anesthesia. The intensity and quality of pain were obtained through the administration of the McGill Pain Questionnaire-Short Form. Psychosocial factors included: number of births, presence of partner, self-evaluation of knowledge of physio-anatomical aspects of birth and the completion of a pregnancy course. Labor and delivery pain is of high intensity anl the quality of pain is most frequently characterized as smarting, cramping, exhausting, and sharp. The presence of a partner and the completion of a pregnancy course is exercised by a small number of parturients. Self-evaluation of preexisting knowledge of physio-anatomical aspects of delivery is predictive of the affective component of intensity of childbirth pain. Psychosocial factors have been shown as significant for the intensity and quality of experienced childbirth pain.

Quality and intensity of low back pain in cronic PTSD patients.

The aim of this study was to analyze the association between chronic low back pain (LBP) in chronic post-traumatic stress disorder (PTSD) with quality and intensity of pain experience. A total of 406 war veterans from 1991-1995 war in Croatia participated in this study. They were divided into four groups, according to psychiatric interview, psychometric testing and the presence of LBP verified by the imaging of lumbar area, into: (i) war veterans suffering from PTSD and LBP (N = 102), (ii) war veterans suffering from PTSD only (N = 108), (iii) war veterans suffering from LBP only (N = 99) and (iv) healthy controls (N = 97). On the basis of medical records, interviews and different types of self-assessment questionnaires the inter-relationship between chronic pain and chronic PTSD was analyzed. PTSD was assessed by TSI-A (Trauma symptom Inventory, whereas pain was measured by Melzack-McGill Pain Questionnaire - short form (MPQ-SF) and Visual Analogue Scale (VAS). The patients with chronic PTSD had significantly higher total pain scores as well as affective and sensory pain components when compared to the patients without PTSD. No significant association was found between chronic LBP and symptoms of PTSD. Chronic LBP as functional painful syndrome in PTSD could be result of altered neuroanatomical and neurophysiological pain pathway and one of the markers of PTSD.

Quality of pain in herpes zoster patients.

Pain typically accompanies acute herpes zoster and persists well beyond rash healing. Different types of pain are reported by patients with herpes zoster. Current studies show that these types of pain vary with respect to their presence, location, duration, intensity and quality, hence pain needs to be analyzed more thoroughly. The aim of the study was to assess different components of pain in patients with herpes zoster. The study subjects were 46 patients diagnosed with herpes zoster and selected out of 493 patients treated at the Pain Therapy Clinic, the outpatient facility of Zagreb Clinic for Traumatology, in 2010. Measures used to assess pain and daily activities were the following: SF McGill Pain Questionnaire, Visual Analogue Scale, Self-Assessment of Life Satisfaction, Health Satisfaction and Enjoyment in Life. Analgesic treatment together with demographic and clinical characteristics of patients were also taken into account. The results have shown that the patients report about spontaneous pain mostly in terms of the following qualities of high level pain intensity: throbbing, aching, hot-burning and sharp. The results also demonstrate that herpes zoster pain significantly affects the patients' everyday living quality and their emotional health. Comprehensive assessment of pain is necessary for clinical research about the epidemiology, natural history, pathophysiologic mechanisms, treatment, and prevention of pain in herpes zoster.

Do IL-1B and IL-1RN modulate chronic low back pain in patients with post-traumatic stress disorder?

The aim of this study was to analyze the association between single nucleotide polymorphism (SNP) in IL1B (rs1143 634) and IL1RN (rs2234677) with chronic low back pain (LBP) in chronic post-traumatic stress disorder (PTSD). A total of 406 war veterans from 1991-1995 war in Croatia participated in this study. They were divided into four groups, according to psychiatric interview, psychometric testing and the presence of LBP, verified by the imaging of lumbar area, into: (i) war veterans suffering from PTSD and LBP (N = 102), (ii) war veterans suffering from PTSD only (N = 108), (iii) war veterans suffering from LBP only (N = 99) and (iv) healthy controls (N =97). Each subject provided a blood sample for IL1B and IL1RN polymorphism testing. We found no association of rs1143634 in IL1-B with LBP Permutation test showed significant association of rs1143634 in IL1-RN with LBP group and presence of wild type allele A was protective in LBP group. The same SNP (rs1143634) in IL1-B was associated with the intensity of pain. No other associations were observed between these two markers and self-reported measures evaluating PTSD and pain symptoms. These results suggest the potential role of cytokine network in the pathogenesis of chronic PTSD and LBP, although the direct causative pathway remains unclear. The alteration of cytokine network on the level of the brain, spinal medulla and the spine may be responsible for modulation of pain and the occurrence of LBP

Prevalence of the metabolic syndrome in the old institutionalized people in Zagreb, Croatia.

Metabolic syndrome (MeS) is defined by a cluster of abnormalities comprising obesity, hypertension, carbohydrate intolerance and dyslipidemia. MeS increases the risk of developing various diseases, including coronary heart disease, stroke, peripheral angiopathy and type 2 diabetes. In our study, the subjects were 561 persons, residents of 11 homes for the elderly in Zagreb, Croatia. There were 160 men (28.5%) and 401 women (71.5%), aged from 56 to 96 years (the average being 79 years). Physical examination was conducted, which included blood pressure measurement, and body height and weight. Blood samples were taken for biochemical analysis. Along with other biochemical parameters, the levels of glucose, triglycerides and cholesterol (LDL, HDL-C) were also measured. The results have shown the prevalence of MeS in the elderly instutionalised people to be in the range of 20.8%, according to WHO criteria. The most common MeS component was hypertension, and it was significantly more frequent in women than in men; also, the elevated triglyceride levels were more often found in women; the difference between men and women was also statistically significant. MeS is a serious and growing health problem not only in Croatia but worldwide as well. Further studies are needed to verify the prevalence of MeS in Croatia, as it is a major risk for CVD and many other severe diseases.