| ObjectivesTo analyze the clinical characteristics of generalized anxiety disorder(GAD)with pain symptoms,and to evaluate the effectiveness and safety of duloxetine in the treatment of these patients,which as to help cliniciansto improve recognition of GAD with pain symptoms,and to facilitate optimal treatment.Methods(1)We recruited 260 patients who met the diagnostic criteria for GAD ofInternational Classification of Diseases(ICD-10),among which 138 patients with pain(Pain Group,the VAS score?30mm),and 122 patients without pain(Non-pain Group,the VAS score< 30mm).Use self-made general questionnaire,Hamilton Anxiety Scale(HAMA),Visual Analog Scale(VAS),Patients Health Questionnaire-15(PHQ-15),Pittsburgh Sleep Quality Index(PSQI),Eysenck Personality Questionnaire(EPQ),Life Events Scale(LES),APGAR family function questionnaire and the Short-Form-36 Health Survey(SF-36)to assess the patient's clinical characteristics.Use t test,Logistic regression and multiple linear regression to analysis the difference between groups.(2)Eighty GAD patients with pain symptoms were randomly treated with either duloxetine(Study Group)or escitalopram(Control Group)for 8 weeks.Scores of HAMA,VAS and PHQ-15 were measured at baseline,second,fourth and eighth weekends.Scores of SF-36 were measured at baseline and eighth weenkend.The collecting dates were analyzed by t test,repeated measurement analysis of variance and logistic regression.Analyzed the correlation between VAS reduction rate and HAMA reduction rate.Results(1)Education level,marital status,long-term residence,personality traits,family functions,and all the clinical symptoms were statistically significant between the pain group and the non-pain group(anxiety,depression,physical discomfort were more severe in the pain group,and sleep quality and health condition were worse in the pain group).Binary Logistic regression analysis showed that the level of education,EPQ introversion/neurosis/psychosis and SF-36 physiological function/body pain were the influencing factors of GAD with pain.Correlation analysis showed that negativelife events and EPQ-N scores were correlated with VAS scores in the pain group.(2)After treatment,the total scores of HAMA,VAS and PHQ-15 of the two groups were significantly lower than that of the baseline(P<0.01).The VAS scores of duloxetine group was significantly lower than that of escitalopram group at all corresponding time points after treatment(P<0.05).The total scores of HAMA and PHQ-15 of duloxetine group was significantly lower than that of escitalopram group at the second weekend after treatment(P<0.05),and there was no statistically significant difference between the total score of HAMA and the total scores of PHQ-15 at other time points(P>0.05).The SF-36 scale score increased significantly after treatment compared with that before treatment(P < 0.05).Correlation analysis found that the HAMA deduction rate was positively correlated with the VAS deduction rate at the corresponding time points.Sequential Logistic regression analysis showed that anxiety efficacy was affected by education level,negativelife events,EPQ neuroticism and baseline VAS scores,while treatment methods(duloxetine and escitalopram),age,EPQ neuroticism and baseline PSQI scores affected pain effectiveness.ConclusionsCompared with the GAD patients without pain,the GAD patients with pain usually have lower educational level,poor family function,high level of neuroticism,poor sleep quality,and more serious symptoms of anxiety,depression and physical discomfort.Education level,personality traits,health status,and somatic symptoms had an effect on whether or not pain was associated.Duloextine treatment can effectively and safely relieve patients' anxiety and pain symptoms and improve their quality of life.Moreover,the relief of anxiety symptoms is closely related to the improvement of pain symptoms,which suggestthat the assessment and treatment of pain symptoms is helpful for the treatment of GAD. |
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