Brain imaging confirms what your grandmother told you: overworrying makes you feel worse. Treating #anxiety can often ease the burden of #ChronicPain.
Thread: comparing tests that screen for anxiety with & without physical symptoms threadreaderapp.com/thread/1270853…
Thread: comparing tests that screen for anxiety with & without physical symptoms threadreaderapp.com/thread/1270853…
The Hospital Anxiety & Depression Scale (HADS) doesn't include specific physical symptoms. HADS assesses #anxiety by asking how often a person feels tense, restless, worried, vaguely frightened, or panicked. svri.org/sites/default/… 
By contrast, 40% of the items on the 4 Dimensional Symptoms Questionnaire ask about specific physical symptoms, every 1 of which can be indicate #migraine. semanticscholar.org/paper/The-Four…
40% of the 4 Dimensional Symptoms Qs are about physical symptoms because it assesses "somatization."
Somatic Symptom Disorder is a newly introduced mental disorder characterized by "extreme" or "abnormal" reactions to real or imagined illness or #pain.
I'm not making this up.
Somatic Symptom Disorder is a newly introduced mental disorder characterized by "extreme" or "abnormal" reactions to real or imagined illness or #pain.
I'm not making this up.
Q: Are doctors able to diagnose #anxiety without misdiagnosing a wide range of medical diseases as mental illness? Does the HADS (no physical symptoms) measure anxiety as well as the 4DSQ (40% somatization)?
A: Yes.
A: Yes.
Researchers found 4DSQ & HADS were "equally able to detect depressive and anxiety disorders." 4DSQ had some advantage in detecting panic disorder, agoraphobia, & social phobia, but 4DSQ found little overlap bwn somatization & these disorders. link.springer.com/article/10.118…
See Table 4: Differences in 4DSQ scores between patients with a psychosocial and a somatic diagnosis in the validation study of the Four-Dimensional Symptom Questionnaire (4DSQ). bmcpsychiatry.biomedcentral.com/articles/10.11…
@headsUPmigraine also calls on doctors to stop using the Daily Pain Catastrophizing Scale. It assesses rumination (focused attention on real/anticipated pain), magnification (worry "something serious" might happen), & helplessness. ncbi.nlm.nih.gov/pmc/articles/P…
The Pain Catastrophizing survey is likely to overdiagnose people with #ChronicPain as "catastrophizers" because it fails to distinguish between accurate descriptions of living with continual pain and obvious indicators of anxiety.
"Pain catastrophizing" is well entrenched with nearly 17,000 references in research papers since 2015.
People presented with the test should know that doctors may use their score to decide whether or not to rx #opioids.
People presented with the test should know that doctors may use their score to decide whether or not to rx #opioids.
@headsUPmigraine agrees with psychologists who contend that "pathologizing" #pain "pollutes the therapeutic relationship by introducing ... implicit, if not explicit, blame. It is demoralizing to the patient who feels at fault, disbelieved, and alone." journals.sagepub.com/doi/pdf/10.117…
#ChronicPain at least doubles the risk of #suicide even without underlying anxiety or depression. With millions forced off or denied effective, FDA-approved #opioid meds, pain-associated suicide has become a public health crisis. jwatch.org/na47486/2018/0…
In 2019, @US_FDA added new warnings to all rx #opioids, cautioning doctors that sudden discontinuation or rapid taper can cause "uncontrolled pain, psychological distress, and #suicide." fda.gov/drugs/drug-saf…
.@headsUPmigraine's lobbying since 2016 has been fueled by our outrage at the needless suffering of millions & the rising body count of people denied effective care.
Assessing people in #pain for #anxiety & #depression has never been more important.
Assessing people in #pain for #anxiety & #depression has never been more important.
We propose doctors supplement the no-physical-symptom #anxiety screener (HADS) with a simplified pain-related worry survey: 1 question each for anxiety, helplessness, & depression.
Psychologist @BethDarnall who designed the widely used & influential "Pain Catastrophizing Scale" has a survey pinned to her twitter page, inviting comments from people with #ChronicPain.
We applaud her for this outreach.
We applaud her for this outreach.
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