Osteoarthritis May Play a Role in Social Isolation

When older adults become socially isolated, their health and well-being can suffer. Now a new study suggests a link between being socially isolated and osteoarthritis (arthritis), a condition that causes joint pain and can limit a person’s ability to get around.

The findings are published in the Journal of the American Geriatrics Society.

Arthritis patients often have other health issues which may increase their risk of becoming socially isolated. These include anxiety and depression, being afraid to move around (because arthritis makes moving painful), physical inactivity and being unable to take care of themselves.

About 30 percent of adults over 65 have arthritis to some degree, especially in their leg joints. Despite that, until now there has been little research on the link between arthritis and social isolation.

Researchers analyzed data from the European Project on OSteoArthritis (EPOSA) study. They wanted to examine any potential links between arthritis and social isolation, and to identify the disease’s contribution to social isolation.

EPOSA is a study of 2,942 adults between the ages of 65 to 85 years old who live in six European countries: Germany, Italy, the Netherlands, Spain, Sweden, and the UK. In all, 1,967 people, around the age of 73, participated in the study. Half of the participants were women, and almost 30 percent had arthritis.

The researchers looked at whether the participants were socially isolated at the beginning of the study as well as 12 to 18 months later. The participants completed questionnaires that kept track of how often they connected socially with friends and family members and how often they volunteered or participated in social activities.

At the start of the study, almost 20 percent were socially isolated. Those who weren’t socially isolated tended to be younger, had higher incomes and more education. They were also more likely to be physically active, had less physical pain, had faster walking times and were in better all-around health.

Of the 1,585 participants who weren’t considered socially isolated at the beginning of the study, 13 percent had become socially isolated 12 to 18 months later. They reported that their health and osteoarthritis had worsened, they were in more pain, had become less physically active, had slower walking times, and had depression and problems with thinking and making decisions.

The researchers say the findings suggest that osteoarthritis can increase the risk of social isolation. In particular, having problems with thinking and making decisions, as well as having slower walking times, is associated with an increased risk of becoming socially isolated.

Since social isolation can lead to poorer health, the researchers suggest that older adults with arthritis may benefit from engaging in physical activity and social activities. Specifically, they suggest that health care providers might refer people to senior centers where activities are specially designed for people with arthritis.

Source: American Geriatrics Society

 

Anxiety, Depression Tied to Greater Opioid Use After Surgery

Pain is an unavoidable part of the healing process after surgery. Yet the current opioid crisis has made the standard prescribing practices for painkillers loaded with risk.

A new study from Michigan Medicine (U-M) could help clinicians navigate this risk by identifying which patients may be more likely to continue using opioids after their immediate recovery period.

“There is not much research on which surgical patients require more or less opioids, despite a push in the field for personalized medicine,” said first author Daniel Larach, M.D., M.T.R., M.A., a resident at U-M at the time of the study and now an assistant professor of clinical anesthesiology at the University of Southern California.

“Often with postoperative opioid prescribing, personalization falls by the wayside, with surgeons using the same amounts for every person receiving a certain procedure.”

The findings are published in the Annals of Surgery.

For the study, the research team evaluated the data of more than 1,000 people undergoing an elective hysterectomy, thoracic surgery, or a total knee or hip replacement. Before their operations, each patient provided demographic information and completed several screening questionnaires.

The patients were given scores measuring their degree of depression, anxiety, fatigue, sleep disturbance, physical function, as well as the severity of their overall and surgical site pain. The researchers also measured how many pills were prescribed to each patient.

The patients were then contacted one month following the surgery to assess how many opioid pills they had consumed.

“We found that anxiety is linked with more opioid use, which is disheartening to see but also heartening in the sense that this is something we could potentially target,” said Larach.

Other patient factors linked to increased opioid use included younger age, non-white race, no college degree, alcohol and tobacco use, and sleep disturbance.

Chad Brummett, M.D., associate professor of anesthesiology and director of anesthesia clinical research and pain research, said people may be knowingly or unknowingly medicating for other conditions.

“The only thing we’re giving them is opioids and we’re not giving them alternatives or other options,” he said. For example, patients with high anxiety around the time of surgery could be offered behavioral care or other non-opioid medications for anxiety and resulting pain.

Brummett also noted that the study found overprescription of opioids for all surgical procedures and a link between the prescription size and use.

“I think it is striking that you see once again that the more you prescribe, the more patients take, even after adjusting for all of these other risk factors,” Brummett said.

The team noted that right-sizing prescriptions through initiatives such as the Michigan Opioid Prescribing Engagement Network (OPEN), which provides recommendations for prescription amounts for various medical procedures, is a critical first step.

But, they say, this step should be followed by more research into specific patient factors that can be addressed in other ways.

“We are asking surgeons to learn about and think about pain and behavioral health in ways that we have not previously done. It will require an open mind,” said Brummett.

Source: Michigan Medicine- University of Michigan

 

Too Much Caffeine May Trigger Migraine in High-Risk People

Three or more servings of caffeinated beverages may be linked to a greater risk of migraine occurrence on that day or the following day among episodic migraine (EM) patients (those who have up to 14 headache days per month), according to a new study published in the American Journal of Medicine.

Among EM patients who rarely consumed caffeinated beverages, however, even one to two servings increased the odds of having a headache that day.

Migraine is the third most prevalent illness in the world, affecting more than one billion adults worldwide. In addition to severe headache, symptoms of migraine can include nausea, changes in mood, sensitivity to light and sound, as well as visual and auditory hallucinations.

Migraine patients report that weather patterns, sleep disturbances, hormonal changes, stress, medications and certain foods or beverages can bring on migraine attacks. However, few studies have looked at the immediate effects of these suspected triggers.

For the study, researchers from Beth Israel Deaconess Medical Center (BIDMC), Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health (HSPH) evaluated the role of caffeinated beverages as a potential trigger of migraine.

Their findings reveal that, among patients who experience episodic migraine, one to two servings of caffeinated beverages were not associated with headaches on that day, but three or more servings of caffeinated beverages may be associated with higher odds of migraine headache occurrence on that day or the following day.

“While some potential triggers such as lack of sleep may only increase migraine risk, the role of caffeine is particularly complex, because it may trigger an attack but also helps control symptoms,” said study leader Elizabeth Mostofsky, Sc.D., an investigator in BIDMC’s Cardiovascular Epidemiology Research Unit and a member of the Department of Epidemiology at HSPH.

“Caffeine’s impact depends both on dose and on frequency, but because there have been few prospective studies on the immediate risk of migraine headaches following caffeinated beverage intake, there is limited evidence to formulate dietary recommendations for people with migraines.”

For the study, 98 adults with frequent episodic migraine completed electronic diaries every morning and every evening for at least six weeks.

Every day, participants reported the total servings of caffeinated coffee, tea, soda and energy drinks they consumed. They also filled out twice daily headache reports detailing the onset, duration, intensity, and medications used for migraines since the previous diary entry.

Participants also provided detailed information about other common migraine triggers, including medication use, alcoholic beverage intake, activity levels, depressive symptoms, psychological stress, sleep patterns and menstrual cycles.

“One serving of caffeine is typically defined as eight ounces or one cup of caffeinated coffee, six ounces of tea, a 12-ounce can of soda and a 2-ounce can of an energy drink,” said Mostofsky.

“Those servings contain anywhere from 25 to 150 milligrams of caffeine, so we cannot quantify the amount of caffeine that is associated with heightened risk of migraine. However, in this self-matched analysis over only six weeks, each participant’s choice and preparation of caffeinated beverages should be fairly consistent.”

Overall, the researchers saw no link between one to two servings of caffeinated beverages and the odds of headaches on the same day, but they did see higher odds of same-day headaches on days with three or more servings of caffeinated beverages.

However, among people who rarely consumed caffeinated beverages, even one to two servings increased the odds of having a headache that day.

“Despite the high prevalence of migraine and often debilitating symptoms, effective migraine prevention remains elusive for many patients,” said principal investigator Suzanne M. Bertisch, M.D., M.P.H., of the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center, and Harvard Medical School.

“This study was a novel opportunity to examine the short-term effects of daily caffeinated beverage intake on the risk of migraine headaches. Interestingly, despite some patients with episodic migraine thinking they need to avoid caffeine, we found that drinking one to two servings/day was not associated with higher risk of headache. More work is needed to confirm these findings, but it is an important first step.”

Source: Beth Israel Deaconess Medical Center

 

 

Online Self-Management Helpful for Anxiety, Depression and Pain

Emerging research suggests that for some individuals, online symptom self-management plus clinician telecare is the best strategy for treating anxiety, depression and pain.

As a background, it is well documented that pain is the most common physical symptom for which adults seek medical attention in the United States. Moreover, anxiety and depression are the most common mental health issues for which adults visit a doctor. We also now understand that medications, especially opioids for pain, may not be the only or best therapy.

In the new study, Regenstrief Institute research scientist Kurt Kroenke, M.D., a pioneer in the treatment of patient symptoms, discovered online symptom self-management or online symptom self-management plus clinician telecare can be effective solutions for individuals with anxiety, depression and pain.

“Pain, anxiety and depression can produce a vicious cycle in which the presence of one symptom, if untreated, may negatively affect the response to treatment of the other two symptoms,” said Dr. Kroenke.

“So treating not just pain, but pain and mood symptoms simultaneously is quite important, as is doing it how, when and where the patient is most receptive.”

In the study, published in the Journal of General Internal Medicine, Dr. Kroenke and colleagues discovered that online symptom self-management works to decrease pain, anxiety and depression symptoms. They also found that online symptom self-management works even better when coupled with clinician telecare.

Prior studies have found a benefit to adding telecare to usual care in the doctor’s office. The researchers have now shown that the intermediate (and less costly) mechanism of online pain and mood self-management is effective and, for some, even more effective when coupled with live phone follow-up with a nurse.

“The magnitude of effect on pain, anxiety and depression we report is comparable to the effect of online and telecare interventions for chronic disorders like hypertension, diabetes and heart disease,” said Dr. Kroenke.

“The moderate improvement in symptoms we saw at a group level indicates that some individuals had great symptom improvement while others had little improvement.

Our results strongly suggest that web-based self-management might be enough for some patients while others may require a combination of online self-management and phone consultations with a nurse manager in order to experience symptom reduction.”

To test whether pain, anxiety and depression symptoms could be simultaneously addressed by patients in their homes or other location of their choice, Dr. Kroenke and colleagues conducted the CAMMPS (Comprehensive vs. Assisted Management of Mood and Pain Symptoms) trial.

This randomized comparative effectiveness study builds upon previous research, including the design of widely used depression and anxiety screening tools, and the conduct of several studies demonstrating the effectiveness of telecare.

For the study, a total of 294 individuals with arm, leg, back, neck or widespread pain which persisted (for 10 or more years in more than half of participants) despite medication, who also had at least moderately severe depression and anxiety, were divided into two groups.

One group received a web-based self-management program comprised of nine modules (coping with pain; pain medications; communicating with providers; depression; anxiety; sleep; anger management; cognitive strategies; and problem-solving).

The other group was given this program plus telecare by a nurse who made scheduled telephone calls as well as contacts prompted by patient responses to the online self-management program or e-mail requests.

A supplementary paper, published in the journal Telemedicine and Telecare, reports that participants in both arms of the study found it helpful and were satisfied. They also discovered higher satisfaction in the group that received both online self-management and telecare.

While those in the online self-management group indicated they wanted more human contact, participants in the group that received telecare from a nurse were divided — some wanted more contact, others desired less contact.

This finding led the paper’s authors, including first author Michael A. Bushey, M.D., of the Indiana School of Medicine and senior author Dr. Kroenke, to conclude that customizable solutions would best suit a range of patients.

Source: Regenstrief Institute

Fatigue, Poor Sleep Plague Many Women With Premature Ovarian Insufficiency

A new Brazilian study finds that women with premature ovarian insufficiency (POI) who are receiving hormone therapy have poorer sleep quality and greater fatigue than women of the same age with preserved ovarian function.

POI is the loss of ovarian function before the age of 40. The condition differs from premature menopause in that women with POI can still have irregular or occasional periods for years and might even become pregnant.

Sleep problems are a frequent complaint of women who are transitioning through menopause and postmenopause: It is estimated that 40% to 50% of menopausal and postmenopausal women struggle with sleep issues. Sleep problems include difficulty falling asleep and/or staying asleep, as well as waking up too early.

Complicating matters is the fact that women with insomnia also report more body pain, headaches, daytime dysfunction, mood disorders, fatigue, and decreased work productivity. Although some of the problems are related to other common symptoms of menopause such as hot flashes, not all sleep issues can be traced back to these root causes.

Although numerous studies have been conducted about the sleep patterns of menopausal and postmenopausal women in general, this newest study from Brazil is believed to be the first to specifically evaluate the sleep quality in women with POI.

The findings show that women with POI who are receiving hormone therapy have poorer sleep quality, largely as a result of taking longer to fall asleep. These women were also found to have a higher fatigue index and were more likely to use sleep-inducing medications compared with comparably aged women who still had full ovarian function.

“This study shows that women with POI have poor sleep quality despite the use of hormone therapy,” says Dr. Stephanie Faubion, Medical Director of The North American Menopause Society (NAMS).

“Another interesting finding from the study is that total sleep quality in women with POI was directly related to the number of children they had and overall was similar to sleep quality in women without POI.”

“This speaks to the scope of the problem when it comes to sleep disturbances and the important and often under-recognized factors that contribute to sleep complaints being more common in women than in men.”

Source: The North American Menopause Society

Severe Workplace Injuries Tied to Greater Risk of Suicide, Overdose Deaths

Sustaining a work-related injury severe enough to result in at least a week off of work almost triples the combined risk of suicide and overdose deaths among women, and increases the risk by 50 percent among men, according to a new study by a research team from Boston University School of Public Health (BUSPH).

The researchers say that offering better treatment options for pain and substance use disorders as well as treatments for post-injury depression may dramatically improve the quality of life and reduce death risk among workers with severe injuries.

According to the National Safety Council, approximately 12,600 American workers are injured on the job each day. In 2017, an estimated 104,000,000 production days were lost due to workplace injuries. The most common types of injuries that lead to missed work are overexertion, contact with objects or equipment (struck, caught or crushed in equipment or structure) and falls/slips.

To estimate the link between workplace injury and death, the research team looked at the data of 100,806 workers in New Mexico, 36,034 of whom had lost work time after sustaining an injury between 1994 and 2000.

The researchers looked at workers’ compensation data for that period, Social Security Administration earnings and mortality data through 2013, and National Death Index cause of death data through 2017.

Their findings reveal that men who had had a lost-time injury were 72 percent more likely to die from suicide and 29 percent more likely to die from drug-related causes. These men also had greater rates of death from cardiovascular diseases. Women with lost-time injuries were 92 percent more likely to die from suicide and 193 percent more likely to die from drug-related causes.

Prior research conducted by the authors showed that women and men who had needed to take at least a week off after a workplace injury were more than 20 percent more likely to die from any cause. They write that this new study highlights the roles of suicide and opioids as major causes of those deaths.

“These findings suggest that work-related injuries contribute to the rapid increase in deaths from both opioids and suicides,” said study senior author Dr. Leslie Boden, professor of environmental health at BUSPH.

“Improved pain treatment, better treatment of substance use disorders, and treatment of post-injury depression may substantially improve quality of life and reduce mortality from workplace injuries.”

The study findings are published in the American Journal of Industrial Medicine.

Source: Boston University School of Medicine