Mutual influence of intensity of pain syndrome and borderline mental disorders in patients with coxarthrosis

  • I. D. Spirina Dnipropetrovsk Medical Academy of Health Ministry of Ukraine
  • E. S. Fedenko Dnipropetrovsk Medical Academy of Health Ministry of Ukraine
  • S. V. Rokutov Dnipropetrovsk Medical Academy of Health Ministry of Ukraine
  • V. Y. Kazakov Dnipropetrovsk Medical Academy of Health Ministry of Ukraine
  • A. V. Shornikov Dnipropetrovsk Medical Academy of Health Ministry of Ukraine
Keywords: pain, nonpsychotic mental disorders, coxarthrosis, psychopathological disturbances

Abstract

The objective of this study is to evaluate the mutual influence of pain syndrome and borderline psychiatric disorders depending on its intensity and tolerability in patients with coxarthrosis who need endoprosthetics. 76 patients with coxarthrosis aged from 25 to 68 who were hospitalized in the Department of Endoprosthetics at Mechnikov Regional Clinical Hospital in Dnipro City in the period from November 2015 to September 2016 were observed. For diagnosis of psychopathological disorders, and for evaluation of the effectiveness of therapeutic interventions, the following methods were used in our research: clinical and psychopathological (technique SCL-90-R), Tаylor anxiety scale, study of the type of attitude to the disease (LOBI), Dembo-Rubinstein self-esteem scale, Leonhard-Schmieschek questionnaire for assessment of accentuation of personality traits, the Luscher 8-colour test and the Toronto alexithymia scale (TAS). Severity of pain syndrome was assessed using a visual analogue scale of pain (VAS). Forms of borderline mental disorders were diagnosed in 51 patients with coxarthrosis, such as depressive disorder (F 32) – 19 (24.8%), neurasthenia (F 48) – 12 (16.2), anxiety and phobic disorders (F 40–41) – 14 (18.1%), and personality disorders (F 60.5, F 60.6, F 60.7) – 6 (7.6%). In 25 (33.3%) patients clinically-defined forms of mental disorders were identified. Leading syndromes in these disorders were depression – 19 (24.8%) patients, anxiety and phobic – 15 (20.0%), asthenic – 10 (12.4%), hypochondriacal – 7 (9.5%) patients. According to the results of the correlation analysis, a close correlation between the severity of pain syndrome and borderline mental disorders (r = 0.779) was established for patients in the preoperative stage. The average level of pain syndrome on the VAS scale in patients with borderline mental disorders was twice as high as in patients without these disorders (63.4 vs. 32.4 points), but it does not depend on the main psychopathological syndrome. The average level of pain on the VAS scale in patients with borderline mental disorders at the preoperative stage was twice as high as in patients without these disorders (63.4 vs 32.4 points), and after surgical intervention the level decreased only by 5.9 points or 9.3%. In patients with coxarthrosis with detected borderline mental disorders (51 people) the therapy had a complex character and was conducted both at the hospital stage for one month, and in the outpatient stage as "maintenance" therapy for 3 months or more. Therapy of the neurotic state with decompensation lasted on average 6 months. Treatment included psycho-educational and therapeutic arrangements (conversations, lectures, autotraining) and psychopharmatherapy (tranquilizers, antidepressants, antipsychotics in small and medium therapeutic doses). The conducting of simultaneous corrective measures for identified borderline mental disorders in patients of the main groups contributed to a significant reduction in the severity of pain within the six-month period of observation and moved them towards the level of the patients in the control group. Borderline mental disorders that take place in patients with chronic somatic diseases, which include, in particular, coxarthrosis, significantly amplify the severity of the condition, reduce the possibility of adaptation, and thus aggravate the course and the outcome of the main disease. 

References

Ackerman, I. N., Bohensky, M. A., de Steiger, R., Brand, C. A., Eskelinen, A., Fenstad, A. M., Furnes, O., Graves, S. E., Haapakoski, J., Mäkelä, K., Mehnert, F., Nemes, S., Overgaard, S., Pedersen, A. B., & Garellick, G. (2017). Lifetime risk of primary total hip replacement surgery for osteoarthritis from 2003–2013: A multi-national analysis using national registry data: International lifetime risk of total hip replacement for osteoarthritis. Arthritis Care and Research. >> doi.org/10.1002/acr.23197

Axford, J., Butt, A., Heron, C., Hammond, J., Morgan, J., Alavi, A., Bolton, J., & Bland, M. (2010). Prevalence of anxiety and depression in osteoarthritis: Use of the hospital anxiey and depression scale as a screening tool. Clinical Rheumatology, 29(11), 1277–1283. >> doi.org/10.1007/s10067-010-1547-7

Bair, M., Wu, J., Damush, T., Sutherland, J., & Kroenke, K. (2008). Association of depression and anxiety alone and in combination with chronic musculoske¬letal pain in primary care patients. Psychosomatic Medicine, 70(8), 890–897. >> doi.org/10.1097/psy.0b013e318185c510

Beltman, M. W., Voshaar, R. C. O., & Speckens, A. E. (2010). Cognitive-behavioural therapy for depression in people with a somatic disease: Meta-analysis of randomised controlled trials. The British Journal of Psychiatry, 197(1), 11–19. >> doi.org/10.1192/bjp.bp.109.064675

Bokma, W. A., Batelaan, N. M., van Balkom, A. J. L. M., & Penninx, B. W. J. H. (2017). Impact of anxiety and/or depressive disorders and chronic somatic diseases on disability and work impairment. Journal of Psychosomatic Research, 94, 10–16. >> doi.org/10.1016/j.jpsychores.2017.01.004

Calvo-Lobo, C., Vilar Fernández, J. M., Becerro-de-Bengoa-Vallejo, R., Losa-Iglesias, M. E., Rodríguez-Sanz, D., Palomo López, P., & López López, D. (2017). Relationship of depression in participants with nonspecific acute or subacute low back pain and no-pain by age distribution. Journal of Pain Research, 10, 129–135. >> doi.org/10.2147/JPR.S122255

Chaban, O. S., & Khaustova, O. O. (2010). Terapiia khronichnoho alhichnoho syndromu u patsiientiv z nepsykhotychnymy depresyvnymy rozladamy i komorbidnoiu somatychnoiu patolohiieiu [Therapy of chronic algic syndrome in patients with non-psychotic depressive disorders and comorbid somatic pathology]. Ukrainskyi Visnyk Psykhonevrolohii, 18(1), 67–72 (in Ukrainian).

Cho, H. J., Morey, V., Kang, J. Y., Kim, K. W., & Kim, T. K. (2015). Prevalence and risk factors of spine, shoulder, hand, hip, and knee osteoarthritis in community-dwelling koreans older than age 65 years. Clinical Orthopaedics and Related Research, 473(10), 3307–3314. >> doi.org/10.1007/s11999-015-4450-3

Chong, T., Don, D. W., Kao, M.-C., Wong, D., & Mitra, R. (2013). The value of physical examination in the diagnosis of hip osteoarthritis. Journal of Back and Musculoskeletal Rehabilitation, 26(4), 397–400. >> doi.org/10.3233/BMR-130398

Danilov, A. B. & Danilov, A. B. (2010). Bol': Patogenez i lechenie [Pain: Patho¬genesis and treatment]. Rossiyskiy Zhurnal Boli, 2, 35–39 (in Russian).

Duffy, P. J., Masri, B. A., Garbuz, D. S., & Duncan, C. P. (2005). Evaluation of patients with pain following total hip replacement. The Journal of Bone and Joint Surgery. American Volume, 87(11), 2566–2575.

Gerrits, M. M., van Oppen, P., Leone, S. S., van Marwijk, H. W., van der Horst, H. E., & Penninx, B. W. (2014). Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders. BMC Psychiatry, 14(1). >> doi.org/10.1186/1471-244X-14-187

Gignac, M. A. M., Backman, C. L., Davis, A. M., Lacaille, D., Cao, X., & Badley, E. M. (2013). Social role participation and the life course in healthy adults and individuals with osteoarthritis: Are we overlooking the impact on the middle-aged? Social Science and Medicine, 81, 87–93. >> doi.org/10.1016/j.socscimed.2012.12.013

Hardcastle, S. A., Dieppe, P., Gregson, C. L., Hunter, D., Thomas, G. E. R., Arden, N. K., Spector, T. D., Hart, D. J., Laugharne, M. J., Clague, G. A., Edwards, M. H., Dennison, E. M., Cooper, C., Williams, M., Davey Smith, G., & Tobias, J. H. (2014). Prevalence of radiographic hip osteoarthritis is increased in high bone mass. Osteoarthritis and Cartilage, 22(8), 1120–1128. >> doi.org/10.1016/j.joca.2014.06.007

Hawker, G. A., Gignac, M. A. M., Badley, E., Davis, A. M., French, M. R., Li, Y., Perruccio, A. V., Power, J. D., Sale, J., & Lou, W. (2011). A longitudinal study to explain the pain-depression link in older adults with osteoarthritis. Arthritis Care and Research, 63(10), 1382–1390. >> doi.org/10.1002/acr.20298

Kc, R., Li, X., Forsyth, C. B., Voigt, R. M., Summa, K. C., Vitaterna, M. H., Tryniszewska, B., Keshavarzian, A., Turek, F. W., Meng, Q.-J., & Im, H.-J. (2015). Osteoarthritis-like pathologic changes in the knee joint induced by environmental disruption of circadian rhythms is potentiated by a high-fat diet. Scientific Reports, 5, 16896. >> doi.org/10.1038/srep16896

Kirkness, C. S., McAdam-Marx, C., Unni, S., Young, J., Ye, X., Chandran, A., Peters, C. L., & Asche, C. V. (2012). Characterization of patients undergoing total knee arthroplasty in a real-world setting and pain-related medication prescriptions for management of postoperative pain. Journal of Pain and Palliative Care Pharmacotherapy, 26(4), 326–333. >> doi.org/10.3109/15360288.2012.734898

Lawrence, R. C., Felson, D. T., Helmick, C. G., Arnold, L. M., Choi, H., Deyo, R. A., Gabriel, S., Hirsch, R., Hochberg, M. C., Hunder, G. G., Jordan, J. M., Katz, J. N., Kremers, H. M., & Wolfe, F. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis & Rheumatism, 58(1), 26–35. >> doi.org/10.1002/art.23176

Loskutov, A. E. (2010). Endoprotezirovanie tazobedrennogo sustava [Hip arthroplasty]. Lira, Dnipropetrovsk (in Russian).

Makolkin, V. I., Pak, I. V., & Men’shikova, I. V. (2007). Koksartroz: Voprosyi etiologii, epidemiologii, klinicheskih proyavleniy i novyih podhodov k leche¬niyu [Coxarthrosis: Etiology, epidemiology, clinical manifestations and new approaches to therapy]. Terapevticheskii Arkhiv, 79(1), 81–85 (in Russian).

Matcham, F., Rayner, L., Steer, S., & Hotopf, M. (2014). The prevalence of depression in rheumatoid arthritis: A systematic review and meta-analysis: Reply. Rheumatology (Oxford, England), 53(3), 578–579. >> doi.org/10.1093/rheumatology/ket439

Middleton, K. R., Ward, M. M., Haaz, S., Velummylum, S., Fike, A., Acevedo, A. T., Tataw-Ayuketah, G., Dietz, L., Mittleman, B. B., & Wallen, G. R. (2013). A pilot study of yoga as self-care for arthritis in minority communities. Health and Quality of Life Outcomes, 11, 55. >> doi.org/10.1186/1477-7525-11-55

Mújica Mota, R. E. (2013). Cost-effectiveness analysis of early versus late total hip replacement in Italy. Value in Health, 16(2), 267–279. >> doi.org/10.1016/j.jval.2012.10.020

Munce, S., & Stewart, D. (2007). Gender differences in depression and chronic pain conditions in a national epidemiologic survey. Psychosomatics, 48(5), 394–399. >> doi.org/10.1176/appi.psy.48.5.394

Nassonova, V. A., Mendel, O. I., Denisov, L. N., Vertkin, A. L., Alekseyeva, L. I., & Naumov, A. V. (2011). Osteoartroz i ozhirenie: Kliniko-patogeneticheskie vzaimosvjazi [Osteoarthrosis and obesity: Clinical and pathogenetic associations]. Profilakticheskaya Meditsina, 1, 29–37 (in Russian).

O’Connor, K., Vizcaino, M., Ibarra, J. M., Balcazar, H., Perez, E., Flores, L., & Anders, R. L. (2015). Multimorbidity in a mexican community: Secondary analysis of chronic illness and depression outcomes. International Journal of Nursing, 2(1), 35–47. >> doi.org/10.15640/ijn.v2n1a4

Ottaviani, S., Bernard, J.-L., Jean-Luc, B., Bardin, T., Thomas, B., Richette, P., & Pascal, R. (2012). Effect of music on anxiety and pain during joint lavage for knee osteoarthritis. Clinical Rheumatology, 31(3), 531–534. >> doi.org/10.1007/s10067-011-1925-9

Poulsen, E., Christensen, H. W., Overgaard, S., & Hartvigsen, J. (2012). Prevalence of hip osteoarthritis in chiropractic practice in Denmark: A descriptive cross-sectional and prospective study. Journal of Manipulative and Physiological Therapeutics, 35(4), 263–271. >> doi.org/10.1016/j.jmpt.2012.01.010

Rahman, M. M., Kopec, J. A., Goldsmith, C. H., Anis, A. H., & Cibere, J. (2016). Validation of administrative osteoarthritis diagnosis using a clinical and radiological population-based cohort. International Journal of Rheumatology, 2016, 1–7. >> doi.org/10.1155/2016/6475318

Rebrov, B. A., Blaginina, I. I., & Rebrova, O. A. (2011). K voprosu o svjazi hronicheskogo bolevogo sindroma i trevozhno-depressivnyh rasstrojstv u bol'nyh terapevticheskogo profilja [To the question of the relationship of chronic pain syndrome and anxiety depressive disorders in patients of therapeutic profile]. Bol', Sustavy, Pozvonochnik, 1(2), 83–87 (in Russian).

Riediger, W., Doering, S., & Krismer, M. (2010). Depression and somatisation influence the outcome of total hip replacement. International Orthopaedics, 34(1), 13–18. >> doi.org/10.1007/s00264-008-0688-7

Rodic, D., Meyer, A. H., & Meinlschmidt, G. (2015). The association between depressive symptoms and physical diseases in Switzerland: A cross-sectional general population study. Frontiers in Public Health, 3, 47. >> doi.org/10.3389/fpubh.2015.00047

Sale, J. E. M., Gignac, M., & Hawker, G. (2008). The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis. The Journal of Rheumatology, 35(2), 335–342.

Sharma, A., Kudesia, P., Shi, Q., & Gandhi, R. (2016). Anxiety and depression in patients with osteoarthritis: Impact and management challenges. Open Access Rheumatology: Research and Reviews, 8, 103–113. >> doi.org/10.2147/OARRR.S93516

Sharma, L., & Berenbaum, F. (Eds.). (2007). Osteoarthritis: A companion to rheumatology. Mosby, Philadelphia.

Strine, T. W., Mokdad, A. H., Balluz, L. S., Gonzalez, O., Crider, R., Berry, J. T., & Kroenke, K. (2008). Depression and anxiety in the united states: Findings from the 2006 behavioral risk factor surveillance system. Psychiatric services, 59(12), 1383–1390. >> doi.org/10.1176/appi.ps.59.12.1383

Tonelli, S. M., Rakel, B. A., Cooper, N. A., Angstom, W. L., & Sluka, K. A. (2011). Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement. Biology of Sex Differences, 2, 12. >> doi.org/10.1186/2042-6410-2-12

Tukker, A., Visscher, T., & Picavet, H. (2008). Overweight and health problems of the lower extremities: Osteoarthritis, pain and disability. Public Health Nutrition, 1. >> doi.org/10.1017/S1368980008002103

Turner, J., & Kelly, B. (2000). Emotional dimensions of chronic disease. The Western Journal of Medicine, 172(2), 124–128.

Zagorodniy, N. V. (2011). Endoprotezirovanie tazobedrennogo sustava. Os¬novyi i praktika [Hip arthroplasty. Fundamentals and practice]. Geotar-Media, Moscow (in Russian).

Published
2017-02-15
How to Cite
Spirina, I. D., Fedenko, E. S., Rokutov, S. V., Kazakov, V. Y., & Shornikov, A. V. (2017). Mutual influence of intensity of pain syndrome and borderline mental disorders in patients with coxarthrosis. Regulatory Mechanisms in Biosystems, 8(1), 84-90. https://doi.org/10.15421/021715