Object

Title: Strategies for coping of chronic pain in the course of peripheral artery disease – participation of cytokiens and substance P

Abstract:

Introduction: Peripheral artery disease (PAD) affects about 3-10% of the global population, and in Western European countries 6-18% of residents over 55 years old [1-5] are ill. Atherosclerosis is influenced by many risk factors associated with abnormal lifestyles, which are the main cause of vascular endothelial dysfunction. In the course of PAD, chronic pain (CP) develops, which affects the treatment process and patients' quality of life. Research to date and available literature indicate a significant role of the inflammatory response in the etiopathogenesis of atherosclerosis and CP, including pro-and anti-inflammatory cytokines and substance P (SP) [6-10]. The feeling of pain and stress accompanying the disease determine the patient's individual coping strategies for CP. The activity of inflammatory markers present in the course of inflammatory disease determines how to manage pain/stress [11, 12]. Aim of the study: The main goal of the study is to determine the role of inflammatory and SP markers in the severity of CP and ischemia in patients with PAD in the light of strategies for coping with pain. Material and methods: Cross-sectional observational study with a control group. A group of patients experiencing CP in the course of PAD (study group), compared to a group of people with atherosclerosis, of other arteries including peripheral arteries, not experiencing pai ; n (control group). The study was conducted at the Clinical Department of Vascular Surgery at the University Hospital in Krakow. The study involved 92 people diagnosed with atherosclerosis of other arteries, including peripheral arteries, not experiencing pain (control group), and 95 people experiencing chronic pain in the course of PAD (study group). The following research methods were used in the study: 1) an estimation method in which standardized research tools were used: Coping Strategies Questionnaire – CSQ and Numerical Pain Scale; 2) diagnostic survey method, survey technique, which uses the author's questionnaire collecting socio-demographic data, information on risk factors (diabetes, hypertension, smoking including pack years of smoking), circumstances of occurrence of pain (version of the questionnaire for the study group); 3) analysis of medical documentation: result of computed tomograph of vessels – CT, results of laboratory tests determined during hospitalization (fibrinogen, C-reactive protein – CRP, antithrombin III, serum albumin); 4) diagnostic tests: Ankle-Brachial index – ABI; 5) serological tests: results of tests determined by Enzyme-Linked Immunosorbent Assay – ELISA method: Interleukin 10 – IL-10, Tumor Necrosis Factor Alpha – TNF-α, SP. When analyzing the test results, the level of statistical significance was assumed to be α =0.05. Results: CP-experi ; enced patients had significantly higher fibrinogen (p<0,001), CRP (p <0,001), SP (p<0,001) and IL-10 (p<0,001), as well as significantly lower serum albumin (p <0,023) compared to the control group. Elevated fibrinogen levels were significantly higher in people living in medium-sized cities compared to those living in the countryside and in small towns (p =0,018). Increased fibrinogen levels weakly affected the elevated ABI index in the study group (p=0,002) and moderately strongly decreased the ABI index in the control group (p<0,001) - the highest levels of fibrinogen occurred in the whole sample with the index value in the range of 0.3-0 8. The higher the fibrinogen level in the study group, the lower the level of pain intensity (p<0,001) and the lower SP concentration (p<0,001). Increasing fibrinogen levels correlate with lower catastrophic results (p<0,001) and prayers (p<0,001) in the study group and reevaluation of pain sensations (p=0,003) and ignoring sensations (p=0,003) in the control group. The longer the duration of discomfort, the higher the fibrinogen level in the study group (p<0,001). The CRP level in the study group was significantly higher in women (p=0,009). The increased CRP level significantly correlates with the reduced ABI index in the study group (p<0,001) and in the control group (p=0,002) and strongly with the increased SP concentration only in the s ; tudy group (p<0,001). The higher the CRP level, the significantly higher the results of catastrophizing (p<0,001) and lower in the field of distraction (p=0,005), re-evaluation of pain sensations (p<0,001), ignoring sensations (p<0,001), pain control (p< 0,001), ability to reduce pain (p<0,001) in the study group. People who suffered longer pain had a significantly lower CRP level (p<0,001), and the higher the CRP level, the higher the level of pain intensity (p<0,001). Higher albumin levels correlated with a higher ABI index in the study group (p<0,001), lower pain intensity (p=0,001) and the time of pain sensation (p<0,001). The higher the albumin level, the higher the results of the strategy of overvaluation (p=0,021), declarations of coping (p = 0,041), pain control (p <0,001) and ability to reduce pain (p = 0,007) in the examined group and lower catastrophizing in the examined group (p=0,024 and control group (p=0,002). The higher the albumin level, the lower the SP level in the control group (p <0,001). In the comparative group, albumin decreased with age (p=0,007). Antithrombin III did not significantly affect any of the pain management strategies studied and other variables. The increased level of IL-10 significantly affected the reduced distraction score (p<0,001) in the study and control group and the increased score of coping strategies (p=0,037) in the study group. ; The higher the Interleukin 10 level, the higher the SP level (p=0,048) in the study group. SP concentration in the study group was significantly higher in women (p=0,049). The higher the SP concentration, the lower the ABI index (p<0,001) and the higher pain intensity (p<0,001) in the study group. Patients experiencing longer pain had significantly lower SP concentration (p <0,001) in the study group. Higher SP levels in the study group correlated with higher catastrophic strategy results (p<0,001), praying/hoping (p<0,001) and lower distraction results (p<0,001), reevaluation of pain sensations (p<0,001), and declarations of coping (p=0,022), increased behavioral activity (p=0,002), pain control (p=0,003) and the ability to reduce pain (p=0,004). People with concomitant diabetes had a higher result of praying / hoping compared to people without diabetes in the study group. However, in the control group, people without diabetes had significantly higher results in terms of positive pain management strategies compared to people with concomitant diabetes. People without concomitant hypertension had a significantly higher result of reevaluating pain sensations in the study group and declaring coping in the control group. Smokers had a significantly higher catastrophic strategy score compared to non-smokers in the study group. People with a higher ABI in the study and control group ; had higher scores for re-evaluating pain sensations, ignoring sensations, declaring coping and increased behavioral activity, and lower catastrophic strategy results. Conclusions: The occurrence of changes in the concentration/level of inflammatory mediators - proinflammatory cytokine, positive acute phase proteins - is related to the ABI index, the time of pain sensation and the intensity of chronic pain experienced in relation to individual patient coping strategies in the examined and control group. (A) Patients in the study group experiencing pain have a significantly higher level of fibrinogen and CRP compared to patients not experiencing it in the control group. The occurrence of an increase in CRP level significantly correlates negatively with the ABI index and positively with the intensity of pain, and as a result affects the taking of negative and neutral strategies for dealing with pain in the study group. (B) Keeping the fibrinogen level above the upper limit of normal limits the ABI index and participates in the gradual narrowing of the vessel lumen also in patients with atherosclerosis of other arteries. The highest levels of this positive acute phase protein occur throughout the sample at an index value of 0.3-0.8. High levels of fibrinogen positively correlate with the time of feeling pain and weakly, or moderately with a reduced catastrophic and praying / hopi ; ng result as well as a decrease in pain intensity. (C) CRP has a greater impact on taking pain management strategies as compared to fibrinogen. (D) The intake of statins and acetylsalicylic acid by all subjects as well as elevated levels of anti-inflammatory cytokine IL-10 may significantly reduce the level of pro-inflammatory cytokine TNF-α in patients with atherosclerosis. It can act as a local inflammatory mediator affecting significant SP production in the course of the disease. The occurrence of changes in the concentration/level of inflammatory mediators - anti-inflammatory cytokine, negative acute phase protein - is related to the ABI index, the time of pain sensation and the intensity of chronic pain experienced in relation to individual strategies of coping with pain in the examined and control group. There is a relationship between the occurrence of changes in SP concentration and the level of inflammatory mediators - positive acute phase proteins, anti-inflammatory cytokine, negative acute phase protein. (A) Patients in the study group experiencing pain have a significantly higher concentration of IL-10 and a lower level of serum albumin in comparison to those not experiencing it in the control group. A higher level of this proinflammatory cytokine correlates negatively with taking distraction strategies regardless of pain, and positively with declaring coping and pr ; aying / hoping in the study group. (B) Higher serum albumin levels positively correlate with the ABI index and positive pain management strategies and negatively with the intensity of pain in the examined group. People who experience pain for a longer period of time, have significantly higher levels of this negative acute phase protein. (C) Antithrombin III levels did not differ significantly between the study groups and did not affect any of the analyzed factors. The occurrence of an increase in the level of fibrinogen causes a decrease in the concentration of SP in the control and test groups. The increase in the level of CRP as well as the anti-inflammatory cytokine IL-10 significantly correlate with this substance in the study group. The lower the serum albumin level, the higher the concentration of SP in the control group, and antithrombin III has no effect upon it. The occurrence of an increase in SP concentration has an impact on increasing the intensity of pain in the examined group and on lowering the ABI index regardless of their perception. SP significantly increases the taking of negative and neutral strategies for dealing with pain regardless of the pain. There is a relationship between changes in SP concentration and the level of inflammatory mediators, and specific socio-demographic factors. Women have a significantly higher CRP level and SP concentration in th ; e group experiencing pain. Serum albumin decreases with age, and people living in medium-sized cities have significantly higher levels of fibrinogen compared to those living in the countryside and in small towns in the study group. Other factors did not significantly affect the differences in concentrations/levels of the substance. There is a relationship between the occurrence of risk indicators/factors and the perception of chronic pain in relation to each of the patient's coping strategies. The occurrence of diabetes, hypertension, reduced ABI and smoking determine the negative and neutral strategies for dealing with pain. These people should be given special care taking into account their lack of ability to deal with pain.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree grantor:

Wydział Nauk o Zdrowiu

Promoter:

Bonior, Joanna ; Gach, Tomasz

Date issued:

2020

Identifier:

oai:dl.cm-uj.krakow.pl:4742

Call number:

ZB-135437

Language:

pol

Access rights:

nieograniczony

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Last modified:

Jun 21, 2022

In our library since:

Jun 21, 2022

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