Chronic nonmalignant pain and violent behavior

Bruns, Daniel; Disorbio, John Mark; Hanks, R. J.

doi:10.1007/s11916-003-0022-4

Cited by 15 publications

(12 citation statements)

References 53 publications

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“…In literature, the relationship between chronic pain and aggressiveness was indirectly assessed by studying the connection with anger,10,28 in fact, aggression is a behavioral reaction developing from feelings of anger. Fishbain et al13 analyzed the prevalence of different forms of anger in community non-patients, community patients, patients with acute pain, and CPPs.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic pain has also been correlated with symptoms of impulsivity, anger, and aggression10–14 that could in turn be related to different factors, such as the increase of muscle reactivity in the painful area, increased adipose tissue, endogenous opioid system dysfunction, as well as the genetic polymorphisms affecting the opioid, serotonergic, and adrenergic systems 15,16…”

Section: Introductionmentioning

confidence: 99%

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Aggression, impulsivity, and suicide risk in benign chronic pain patients – a cross-sectional study

Margari¹,

Lorusso²,

Matera³

et al. 2014

NDT

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ObjectivesThe objective of this study was to investigate the role that psychopathological dimensions as overt aggression and impulsivity play in determining suicide risk in benign chronic pain patients (CPPs). Furthermore we investigated the possible protective/risk factors which promote these negative feelings, analyzing the relationship between CPPs and their caregivers.MethodsWe enrolled a total of 208 patients, divided into CPPs and controls affected by internistic diseases. Assessment included collection of sociodemographic and health care data, pain characteristics, administration of visual analog scale (VAS), Modified Overt Aggression Scale (MOAS), Barratt Impulsiveness Scale Version 11 (BIS), Hamilton Depression Rating Scale (HDRS), and a caregiver self-administered questionnaire. All variables were statistically analyzed.ResultsA significant difference of VAS, MOAS-total/verbal/auto-aggression, HDRS-total/suicide mean scores between the groups were found. BIS mean score was higher in CPPs misusing analgesics. In CPPs a correlation between MOAS-total/verbal/auto-aggression with BIS mean score, MOAS with HDRS-suicide mean score and BIS with HDRS-suicide mean scores were found. The MOAS and BIS mean scores were significantly higher when caregivers were not supportive.ConclusionIn CPPs, aggression and impulsivity could increase the risk of suicide. Moreover, impulsivity, overt aggression and pain could be interrelated by a common biological core. Our study supports the importance of a multidisciplinary approach in the CPPs management and the necessity to supervise caregivers, which may become risk/protective factors for the development of feelings interfering with the treatment and rehabilitation of CPPs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Aggression, impulsivity, and suicide risk in benign chronic pain patients – a cross-sectional study

Margari¹,

Lorusso²,

Matera³

et al. 2014

NDT

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“…Evaluating the safety of a patient with depression is critical. Chronic neuropathic pain can be fatal because of its associations with suicide and with violence [6,44]. A careful assessment of suicidal risk has a direct bearing on whether the individual would be best treated in an inpatient or outpatient setting.…”

Section: Clinical Evaluation Of Sleep and Mood In The Context Of Chromentioning

confidence: 99%

Comorbidities in Chronic Neuropathic Pain

2004

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Neuropathic pain arises from a lesion or dysfunction within the nervous system; the specific mechanisms that elicit neuropathic pain symptoms are the subject of ongoing research. It is generally acknowledged that neuropathic pain is extremely difficult to treat, and a major factor impacting outcomes is the presence of comorbidities such as poor sleep, depressed mood, and anxiety. Patients who suffer from chronic pain experience difficulties in initiating and maintaining sleep. Sleep deprivation has been associated with a decreased pain threshold, muscle aches, and stiffness in normal volunteers. The interrelationship of these factors is complex: Many chronic pain patients are depressed and anxious; sleep deprivation can lead to anxiety; and depression can be both the cause and the result of sleep disturbances. Thus, physicians must evaluate all aspects of pain, sleep, and mood in chronic pain patients. Several instruments have been developed to aid physicians in gathering qualitative and quantitative information from chronic pain patients. This triad of chronic pain, sleep disturbances, and depression/anxiety must be fully addressed if the patient is to be restored to optimal functionality. A multidisciplinary team approach allows for treatment of the whole patient. Nonpharmacologic interventions include relaxation therapy, sleep restriction therapy, and cognitive therapy. Strategies for pharmacologic interventions should attempt to maximize outcomes by employing, where possible, agents that address both the pain and the comorbidities. In this way, functionality may be restored and the patient's quality of life improved.

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“…Studies on the mediating processes between factors and aggression [2] and the effects of chronic pain both in humans and animals are still scarce. It has been shown that patients with chronic non-malignant pain are prone to exhibit aggressive or violent behaviour [11]. Statistics kept by the federal government indicate that 22,400 non-fatal workplace assaults were reported in the United States in 1992.…”

Section: Introductionmentioning

confidence: 99%

Partners with Bad Temper: Reject or Cure? A Study of Chronic Pain and Aggression in Horses

2010

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BackgroundExperiencing acute pain can affect the social behaviour of both humans and animals and can increase the risk that they exhibit aggressive or violent behaviour. However, studies have focused mainly on the impact of acute rather than chronic painful experiences. As recent results suggest that chronic pain or chronic discomfort could increase aggressiveness in humans and other mammals, we tested here the hypothesis that, in horses, aggression towards humans (a common source of accidents for professionals) could be linked to regularly reported vertebral problems of riding horses.Methodology/Principal FindingsVertebral examination and standardized behavioural tests were made independently on the same horses. Here we showed that most horses severely affected by vertebral problems were prone to react aggressively towards humans (33/43 horses, chi-square test, df = 1, χ2 = 12.30, p<0.001), which was not the case for unaffected or slightly affected horses (9/16 horses, chi-square test, df = 1, χ2 = 0.25, p>0.05). The more affected they were, the fewer positive reactions they exhibited (rs = −0.31, p = 0.02).Conclusions/SignificanceThis is to our knowledge the first experimental evidence of such a link between chronic discomfort/potential pain (inferred from the presence of vertebral problems) and aggression, suggesting that chronic painful experiences may act in ways similar to those of acute experiences. Chronic discomfort or pain may often be overlooked when facing “bad tempered” individuals, whether humans or animals. This experimental study confirms the importance of including chronic discomfort or pain as a major factor in interpersonal relations and models of aggression.

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Chronic nonmalignant pain and violent behavior

Cited by 15 publications

References 53 publications

Aggression, impulsivity, and suicide risk in benign chronic pain patients – a cross-sectional study

Aggression, impulsivity, and suicide risk in benign chronic pain patients – a cross-sectional study

Comorbidities in Chronic Neuropathic Pain

Partners with Bad Temper: Reject or Cure? A Study of Chronic Pain and Aggression in Horses

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Chronic nonmalignant pain and violent behavior

Cited by 15 publications

References 53 publications

Aggression, impulsivity, and suicide risk in benign chronic pain patients &ndash; a cross-sectional study

Aggression, impulsivity, and suicide risk in benign chronic pain patients &ndash; a cross-sectional study

Comorbidities in Chronic Neuropathic Pain

Partners with Bad Temper: Reject or Cure? A Study of Chronic Pain and Aggression in Horses

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Aggression, impulsivity, and suicide risk in benign chronic pain patients – a cross-sectional study

Aggression, impulsivity, and suicide risk in benign chronic pain patients – a cross-sectional study