© Borgis - New Medicine 2/2008, s. 26-28
*Aneta Dąbek1, Marek Wielochowski2, Janusz Domaniecki3
The level of anxiety among patients with primary Raynaud´s phenomenon as a starting point of therapy**
1Chair of Rehabilitation, University of Physical Education
2Chair of Psychosocial Bases of Rehabilitation at the University of Physical Education in Warsaw
Head of Chair of Rehabilitation prof. dr habilitatus of medicine Janusz Domaniecki
Summary
Introduction: Raynaud´s phenomenon belongs to the group of angiospastic vascular disorders. Anxiety, stress and cold are basic reasons for the contraction of peripheral vascular blood vessels in Raynaud´s diseases. The blood flow is reduced and the skin becomes pale.
Aim: The person who is ill feels pain and burning in this part of the body. Raynaud´s phenomenon affects about 20% of the general population. The aim of this study was to establish the level of anxiety among patients with Raynaud´s phenomenon. Common approaches to treatment include only taking the medicine calcium channel blockers. This approach cannot be considered to be the best way of healing this phenomenon because of the high rate of occurrence of anxiety among people with Raynaud´s phenomenon.
Material and methods: The sample consisted of 24 patients from the Dermatology Clinic of Warsaw Medical Academy (aged 17+-1). The control group contained 30 pupils from schools in Warsaw (aged 17+-1.5). Subjects were measured with the State-Trait Anxiety Inventory (Spielberger, 1970).
Results: The results show that patients with Raynaud´s phenomenon have a high level of state anxiety (t=4.27 for p<0.0000826) as well as of trait anxiety (t=5.49 for p<0.0000012).
Conclusion: The results suggest that holistic therapy might be considered to be a more effective way of treatment for patients with Raynaud´s phenomenon than the pharmacological approach. However, this thesis needs further exploration.
Introduction
Raynaud´s phenomenon is a paroxysmal contraction of peripheral vascular blood vessels in the hands and arms (rarely the feet, ears, tongue and mamma). The contraction lasts from 15 to 45 minutes (1). During an intensive vascular attack paleness and sensation disorder can be observed (so-called numbness of fingers). After a vascular attack redness and swelling are visible and the patient experiences intensive throbbing pain. Raynaud´s phenomenon affects about 20% of the entire population (2). Despite this, depending on sources and causes, the frequency of occurrence of Raynaud´s phenomenon varies from 4.6 to 30% (3), (1), (4), and still there are no effective methods of healing this illness. The only commonly applied method of treatment in Poland is pharmacotherapy. Pharma therapy does not often bring the expected results. This method requires significant financial support and is often very troublesome for the patient because the medicine is taken 3-4 times a day (5).
Primary Raynaud´s symptom appears mainly among young people under 20. Excessive mental excitement and cold are considered to be the main causes of primary Raynaud´s phenomenon (6). Relaxation training is aimed at lowering the psychological tension including the level of anxiety. Autogenic Schultz´s Training is especially effective for patients with primary Raynaud´s phenomenon. Through creating the impression of warmth in the body of the patient with primary Raynaud´s phenomenon, autogenic Schultz´s Training influences the blood vessels causing an increase of the blood flow.
The aim of this research is to examine and measure the level of anxiety of patients with primary Raynaud´s phenomenon. Determining the level of anxiety of patients with primary Raynaud´s phenomenon constitutes the starting point for the therapy. The high level of anxiety may indicate the need to cure the illness through applying a complex method.
Materials and methods
Patients with diagnosed primary Raynaud´s phenomenon from the Dermatology Clinic of Warsaw, Medical Academy took part in this research. The patients were diagnosed by capillaroscopy and medical interview.
The control group constituted pupils from High Gardening Schools in Warsaw. The basic information concerning both groups is presented in table 1.
Table 1. Description of the examined groups.
| Variable | Experimental group | Control group |
| Number of people | 24 | 30 |
| Age | 17 ? 1 | 17 ? 1.5 |
The assumption that the patients participating in the research should demonstrate visible changes in capillaries during the capillaroscopy examination affected the number of participants who fulfilled this condition. As is well known, there is no rule that persons with primary Raynaud´s phenomenon demonstrate even widened or enlarged vascular loops (7).
The State-Trait Anxiety Inventory of Spielberger (1970) constituted the research tool.
This questionnaire form was adapted to Polish conditions by K. Wrześniowski and.
T. Sosnowski (1987) and allows the state and the features of anxiety to be measured. It consists of 2 scales of 20 items each.
In the anxiety scale (L-s) the examined person gives his opinion about his current physical and mental state and he has a choice of four categories of answer at his disposal:
´definitely no´, ´probably no´, ´probably yes´, ´definitely yes´. In the scale of anxiety features (L-c) the answers concern the frequency of occurrence of the described states and feelings. The choice of answers is as follows: ´hardly ever´, ´sometimes´, ´often´, ´almost always´. The answers are itemised from 1 to 4. In every scale the theoretical scope of results often fluctuates from 20 to 80 points. The questionnaire form is intended to examine youth above 15 years old (8). The examined patients completed the questionnaires directly after the capillaroscopy examination. In the description of the data analysis Student´s t-test was used.
Results
Anxiety as a state (L-s). A statistically significant difference in the level of anxiety as the state of the patient with primary Raynaud´s phenomenon was found in comparison with healthy persons.
Arithmetic means of the strict results for both groups are presented in figure 1.
Fig. 1. Arithmetic means of STAI score value of anxiety as a state among patients with primary Raynaud´s phenomenon (bright) and among healthy people (dark).
Anxiety as a trait (L-c)
A statistically significant difference in the level of anxiety as a trait, meaning
constant feature or predisposition, was found between the experimental group and
the control group. Arithmetic means of the strict results are presented in figure 2.
Fig. 2. Arithmetic means of STAI score value of anxiety as a trait among patients with primary Raynaud´s phenomenon (bright) and among healthy people (dark).
Discussion
Considerably higher level of anxiety as a state and anxiety as a trait among patients with primary Raynaud´s phenomenon undoubtedly suggests the need for a holistic approach towards people suffering from primary Raynaud´s phenomenon. Bearing that in mind, pharmacological treatment becomes unsatisfactory. Determining the level of anxiety as itself among patients with primary Raynaud´s phenomenon does not constitute a problem. It seems to be essential to discover whether the high level of anxiety among patients with primary Raynaud´s phenomenon initiated the illness or appeared
secondarily as a result of cold and wet hands complex.
Solving this problem would have a beneficial influence not only on the process of treatment but would also contribute to the prevention of this illness. Polish researchers (9), who conducted the EEG electroencephalographic test on 54 patients with primary Raynaud´s phenomenon, had a problem with distinguishing the cause from the effect. In 51.9% of cases pathological records were noted. The dominating changes were changes which were located in the temporal region. Only an accurate, precise and long-term test showed that these changes had a secondary character.
Experts involved in the treatment of patients with primary Raynaud´s phenomenon agree that the source of the illness is anxiety. However, there is no scientific evidence confirming this theory. This issue is fundamental on account of the effectiveness of the treatment. It is widely known that the best treatment is treating the cause, not the symptoms.
Pharmacological treatment (pharmacotherapy) among patients with primary Raynaud´s phenomenon is a symptomatic treatment and often does not bring the expected effects, and additionally is very often accompanied with various side effects, which can be as follows: stopping liquids, heartburn and intense headaches.
Relaxation exercises, particularly the autogenic Schultz´s training, in contrast to pharmacological treatment do not have any side effects. Additionally they do not generate any costs. The foreign scientific literature devotes a lot of space to causal treatment of patients with primary Raynaud´s phenomenon. Researchers often use the phenomenon of biological feedback, so-called biofeedback. Already in 1980 researchers from Harvard University (6) used three kinds of relaxation exercises – autogenic Schultz´s training, progressive relaxation, and the kind of practice based on biofeedback – and compared the effectiveness of treating patients with primary Raynaud´s phenomenon. Admittedly, substantial differences between the effectiveness of particular relaxation exercises were not demonstrated. However, these studies have a surprisingly innovative approach towards the problem of treating patients suffering from this disease. The relaxation session conducted appropriately and professionally can reduce the level of anxiety. The research reveals (11) that only half a percent of the examined patients with primary Raynaud´s phenomenon tolerate pharmacotherapy.
In mild cases of Raynaud´s phenomenon we can use relaxation instead of pharmacotherapy. In some serious cases of Raynaud´s phenomenon, the therapy should be accompanied with other methods decreasing (lowering) the level of anxiety such as autogenic Schultz´s Training as well as sauna therapy (treatment in infrared sauna). Unfortunately complex therapy is rarely used in Poland. On the other hand the level of anxiety measured by the State-Trait Anxiety Inventory of Spielberger may constitute a control tool useful for evaluating the effectiveness of treatment of patients with primary Raynaud´s phenomenon.
Conclusions
1. The level of anxiety as a trait and as a state among patients with primary Raynaud´s phenomenon is significantly higher than among people from the control group.
2. The psychological index in the form of anxiety as a trait and anxiety as a state is an effective predictor of primary Raynaud´s phenomenon.
**Work done within the framework of the statutory research conducted at the Chair of Rehabilitation, University of Physical Education in Warsaw within DS. 110 project, Treatment of Primary Raynaud´s Syndrome, financed by the Minister of Science and Higher Education
Piśmiennictwo
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