Physical therapists' nonverbal communication predicts geriatric patients' health outcomes.

Two studies explored the link between health care providers' patterns of nonverbal communication and therapeutic efficacy. In Study 1, physical therapists were videotaped during a session with a client. Brief samples of therapists' nonverbal behavior were rated by naive judges. Judges' ratings were then correlated with clients' physical, cognitive, and psychological functioning at admission, at discharge, and at 3 months following discharge. Therapists' distancing behavior was strongly correlated with short- and long-term decreases in their clients' physical and cognitive functioning. Distancing was expressed through a pattern of not smiling and looking away from the client. In contrast, facial expressiveness, as revealed through smiling, nodding, and frowning, was associated with short- and long-term improvements in functioning. In Study 2, elderly subjects perceived distancing behaviors of therapists more negatively than positive behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Orthopaedic patients' reporting of pain management

Advances in pain management have occurred in recent years through the development of patient-controlled and epidural analgesia, while the conventional regime of intramuscular analgesia has also continued to be used. This article describes a study comparing orthopaedic patients' experiences of postoperative pain using the three methods of analgesia.     

The effect of age on A delta- and C-fibre thermal pain perception

It has been suggested that ageing may have a differential effect on C fibre-mediated protopathic/tonic pain versus epicritic/phasic pain perception mediated by A delta fibres. The present study attempted to independently assess age-related changes in the function of A delta- and C-nociceptive fibres by examining CO2 laser-induced thermal pain thresholds before, during and after a compression block of the superficial radial nerve in 15 young and 15 healthy elderly adult subjects. Nerve block efficacy was monitored via measures of cold, warm and mechanical threshold, and simple reaction time. During nerve compression block, reaction time and mechanical threshold increased, cold sensation became impaired while warm sensation remained unaffected throughout the test in both groups. With respect to pain sensitivity, young adults exhibited significant increases in thermal pain threshold during A-fibre block while pain threshold remained relatively stable across the 3 test periods in the elderly group. It would appear that elderly adults rely predominantly on C-fibre input when reporting pain whereas younger adults utilise additional input from A delta fibres. Subsequent analysis revealed that during pre- and post-block periods, older adults exhibited a significant elevation in thermal pain threshold; however, when A delta-fibre function was impaired and only C-fibre information was available, both groups responded similarly. These findings support the notion of a differential age-related change in A-fibre-mediated epicritic pain perception versus C-fibre-mediated protopathic pain.     

The effect of peripheral glycerol on trigeminal neuropathic pain examined by quantitative assessment of abnormal pain and sensory perception

In nine patients with trigeminal neuropathic pain after nerve injury, we examined prospectively the effect of peripheral glycerol neurolysis on abnormal pain and sensory perception. In the painful facial skin area of these patients, we found increased temperature and tactile thresholds and the presence of abnormal temporal summation of pain. In seven patients, neuropathic pain was peripheral and disappeared after application of local anaesthesia at or proximal to the site of nerve injury. Neuropathic pain was central in two patients, and unresponsive to local anaesthesia applied proximal to the site of nerve injury. Six weeks after injection of glycerol proximal to the site of nerve injury, no or marginal pain relief was found in 8 patients with peripheral or central trigeminal neuropathic pain. On the other hand, in one of the patients with peripheral trigeminal neuropathic pain, glycerol was given at the site of nerve injury, and produced total pain relief for the whole observation period of 7 months. In this patient, pain relief was associated with normalisation of abnormal temporal summation of pain, which was not observed in the 8 patients with no or marginal pain relief. No further changes in temperature or tactile thresholds were found in any of the 9 patients after a single injection of absolute glycerol. Total pain relief in one of the patients probably is related to the ability of glycerol to inhibit ongoing ectopic impulse generation at the site of nerve injury. We suggest that glycerol-induced reduction of primary afferent hyperactivity may secondarily result in down-regulation of central neuronal hyperexcitability. The efficacy of application of glycerol at the site of nerve injury in patients with peripheral trigeminal neuropathic pain may warrant further investigation. However, this prospective study does not provide evidence that application of glycerol proximal to the site of nerve injury has a place in the treatment of trigeminal neuropathic pain.     

The effect of therapists' training on group therapeutic outcome.

The outcome of group therapy for psychotic patients was used as the dependent variable in assessing the comparative efficacy of trained and untrained therapists. The latter were undergraduate students with no training or experience in psychotherapy. For this reason, their role in psychotherapy was viewed as analogous to that of a placebo in studies assessing drug effects. Changes in psychological test performance of 295 patients before and after 5 mo. of group therapy served as the criterion of therapeutic behavior change. By comparison to an untreated control group the lay therapists achieved slightly better results than psychiatrists and psychiatric social workers doing group therapy with similar patients. Caution is urged in extending the implications of these results beyond group therapy with schizophrenic patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical medicine and its relationship to patient management

In this article, some general concerns for the use of modalities and procedures for the older person are given. Management of the geriatric patient requires knowledge, understanding, and patience; it requires a clinician and health care staff that care about older people. It requires a recognition of the dignity of age and the intrinsic worth of each individual as a human being. It requires hope and an ability to project a quality of life, regardless of the living condition. It requires kind words and a hands-on effort. It requires an appreciation of life and a high degree of ethical and moral concern.     

The patients' experiences of their chronic non-malignant pain

This paper reports the results of a study which investigated the experiences of 75 people with chronic non-malignant pain. People with chronic non-malignant pain can find that traditional medical techniques do not help their pain, and they have to learn to live with it. However, pain can affect their lives in many ways. Within this study, qualitative data were collected to illustrate what it meant to people to experience this chronic pain. It was found that pain adversely affected many dimensions of sufferers' lives, and the effects extended to family and friends. It seemed that having others believe the pain was crucial to many patients. Health care professionals can offer these patients much in helping them come to terms with the way in which pain has affected both themselves and their lives.     

Effects of cigarette smoking on perception of thermal pain.

The effects of cigarette smoking on pain perception were evaluated in 18 healthy smokers. Thermal pain stimuli were used to assess pain detection threshold and tolerance and to collect subjective ratings of the intensity and unpleasantness of painful stimuli. After overnight abstinence, pain perception was evaluated before and after 3 experimental treatments. Participants smoked normal cigarettes, smoked denicotinized cigarettes, or remained abstinent. Smoking normal cigarettes produced relative increases in pain tolerance compared with abstinence. Smoking denicotinized cigarettes produced intermediate effects on tolerance not different from the other 2 treatments. Effects were not detected for pain threshold or subjective pain ratings. Results suggest that cigarette smoking can have antinociceptive effects, which may depend both on nicotine and on other factors associated with smoking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients' social functioning

BACKGROUND: There is evidence that high expressed emotion (EE) in relatives of patients with schizophrenia is associated with higher levels of burden of care, and with worse perception of patient's social functioning. However, it is not clear whether changes in EE levels over time are associated with changes in relatives' burden of care and their perception of patients' social functioning. METHODS: Fifty patients with a diagnosis of schizophrenia and 50 relatives were included in the study soon after patients' admission to hospital. Thirty-six relatives and 31 patients were re-assessed 9 months after patients' discharge. Both assessments included patients' symptomatology and relatives' EE levels, burden of care, and perception of patients' social functioning. RESULTS: Twenty-three relatives (64%) had the same EE level in both assessments, nine (25%) had changed from high to low EE, and four (11%) from low to high EE. Improvement in burden and perception of patients' social role performance were significantly more accentuated among relatives who changed from high to low EE than among relatives who had a stable EE level. Variables that best predicted changes in EE levels were changes in burden scores and number of hours of contact between patients and relatives at follow-up. CONCLUSIONS: Change in EE is associated with change in circumstances and burden. Findings support the idea that EE is better understood in an integrative model.     

A review of captopril renal scintigraphy and its effect on patient management

Renal artery stenosis is an important and potentially curable cause of hypertension. Captopril renography is now recognized to have a high sensitivity and specificity in its diagnosis. Ultimately, however, the result is of little benefit if it does not lead to a change in patient management. To assess how patient management was changed following the result of a captopril renogram, we reviewed the notes of 95 patients who had undergone this test over a 5 year period to identify renal artery stenosis. Of these patients, significant renal artery stenosis was suggested in 16 (17%), of whom only 9 (56%) underwent a change in management (7 proceeding to angiography with or without angioplasty, 2 having alterations in medication). In the 67 patients who had a negative renogram, 16 (24%) had an alteration in management (13 angiography, 3 altered drug treatment). Finally, of the 12 patients who had a non-diagnostic renogram, 7 (60%) had a management change (3 angiography, 4 altered drug therapy). Our results suggest that, despite evidence from the literature that captopril renography is both sensitive and specific for renal artery stenosis, clinicians still rely on other factors when determining who has significant stenosis and, therefore, who should proceed to a further investigation or have a change in medication. Ultimately, this reduces the clinical value of the test at present.     

The effect of pictorial illusion on prehension and perception

The present study examined the effect of a size-contrast illusion (Ebbinghaus or Titchener Circles Illusion) on visual perception and the visual control of grasping movements. Seventeen right-handed participants picked up and, on other trials, estimated the size of "poker-chip" disks, which functioned as the target circles in a three-dimensional version of the illusion. In the estimation condition, subjects indicated how big they thought the target was by separating their thumb and forefinger to match the target's size. After initial viewing, no visual feedback from the hand or the target was available. Scaling of grip aperture was found to be strongly correlated with the physical size of the disks, while manual estimations of disk size were biased in the direction of the illusion. Evidently, grip aperture is calibrated to the true size of an object, even when perception of object size is distorted by a pictorial illusion, a result that is consistent with recent suggestions that visually guided prehension and visual perception are mediated by separate visual pathways.     

A survey of UK manual therapists' practice of and attitudes towards manipulation and its complications

BACKGROUND AND PURPOSE: Little is known about the practice of manipulation by UK physiotherapists. This study was conducted to discover current practice of, and attitudes towards, manipulation among UK manipulative therapists. METHODS: A postal questionnaire was sent to 300 UK manipulative therapists who were members of two professional associations representing differing approaches to manual therapy: the Society of Orthopaedic Medicine (SOM) and the Manipulation Association of Chartered Physiotherapists (MACP). RESULTS: A 50% response rate was achieved and 129 respondents identified themselves as 'users' of manipulation. Anxiety about possible complications was a prominent reason adduced by 'non-users' and 'partial users' for their avoidance of manipulative procedures. The thoracic spine was the region most often manipulated, followed by the lumbar spine. Nineteen per cent of users had encountered complications from manipulation, which were most common in the cervical region and were predominantly non-serious. The majority of SOM members and a minority of MACP members used generalized cervical rotary manipulations--thought by some to be potentially dangerous. Attitudes to manipulation were generally positive, although overall respondents were uncertain as to whether its benefits outweighed its risks. Members of the SOM emerged as more frequent users of manipulation and as less conservative in their attitudes to certain aspects of manipulation. CONCLUSIONS: Allowing for possible under-reporting or other response biases, spinal manipulation emerged as a relatively safe and widely practised technique among this sample.     

An investigation of the effects of music and art on pain perception.

The authors examined the effects of preferred music, visual distraction, and silence on pain perception. Visual distraction was provided by participants' choice of painting from a selection of 15 popular artworks. Eighty participants (43 females) underwent 3 trials of cold pressor pain induction with measurement of tolerance, pain intensity, perceived control, and anxiety, and a music listening patterns questionnaire. Preferred music was found to significantly increase tolerance and perceived control over the painful stimulus and to decrease anxiety compared with both the visual distraction and silence conditions. Pain intensity rating was decreased by music listening when compared with silence. During the music condition, frequent listening to the chosen piece in everyday life was found to negatively correlate with anxiety level, and extent of knowledge of the lyrics further positively correlated with tolerance of the stimulus and perceived control. That general importance of music in everyday life also correlated with perceived control reiterates the importance of relationship and familiarity with favorite music as key to its therapeutic effect. There was no relationship between structural features of the selected music and any of the significant effects. It is suggested that preference may render music with different structural aspects functionally equivalent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural effect on postoperative pain

OBJECTIVE: To investigate whether the S + G2/M fraction (proliferative index) is a prognostic determinant in breast cancers classified as Auer IV. STUDY DESIGN: Prognostic evaluation of Auer IV DNA histograms with respect to the high versus low S + G2/M fraction, obtained by image cytometry on consecutive breast cancer imprint preparations. RESULTS: When studying recurrence-free survival (n = 136), the prognostic value of S + G2/M was found to vary with time: it was negligible before the median time to relapse (1.5 years) but thereafter statistically significant, in both univariate and multivariate analysis. The same pattern was found when overall survival was used as the end point; the effect was delayed to about the median time until death (three years). Tumors with a low S + G2/M fraction were smaller and more often estrogen receptor- and progesterone receptor-positive than those with a high S + G2/M fraction. CONCLUSION: According to ICM-DNA values corresponding to the S + G2/M region, patients with breast cancers classified as Auer IV can be divided into subgroups with different tumor characteristics and prognoses.     

Trigeminal neuropathic pain: pathophysiological mechanisms examined by quantitative assessment of abnormal pain and sensory perception

OBJECTIVE: This study was undertaken to examine the pathophysiological characteristics of trigeminal neuropathic pain. METHODS: The study included 23 consecutive patients with trigeminal neuropathic pain (15 patients with pain after nerve injury and 8 patients with pain of spontaneous origin). For each patient, quantitative examination of sensory and pain perception was performed in the painful facial skin area, and results were compared with the findings for the contralateral nonpainful facial skin area. RESULTS: In the painful facial skin area of patients with neuropathic pain after nerve injury, we demonstrated increased temperature and tactile thresholds, as well as abnormal temporal summation of pain (i.e., repetitive nonpainful skin stimulation produced an abnormal progressive increase of pain intensity, with abnormal radiation of pain and aftersensation). In the painful skin area of patients with pain of spontaneous origin, temperature and tactile thresholds were not increased, but heat pain and cold pain thresholds were significantly reduced, indicating heat and cold hyperalgesia. The characteristics of temporal summation of pain were not significantly altered in the painful facial skin area in this group of patients. CONCLUSION: This clinical study provides evidence that the pathophysiological mechanisms of trigeminal neuropathic pain after nerve injury involve impaired function of both small unmyelinated fibers and large myelinated fibers. An explanation for the finding of abnormal temporal summation of pain may involve hyperexcitability of central wide-dynamic range neurons. The results suggest that other mechanisms are involved in trigeminal neuropathic pain of spontaneous origin. Reduced heat and cold pain thresholds indicate heat and cold hyperalgesia, which possibly may be explained by sensitization of peripheral C nociceptors.     

The perception of induced dental pain in young and elderly women

Pain threshold for electrical stimulation of healthy, unfilled teeth was studied in young and elderly women. Using the methodology of Sensory Decision Theory, ability to discriminate between suprathreshold shocks (d') and response bias were also assessed. No difference in threshold was observed betweeen the young and elderly groups. The elderly women were poorer at discriminating between suprathreshold shocks than the young women. These results were interpreted to reflect the integrity of highthreshold dental pulp afferents in the elderly and a central nervous system deficit on the part of the elderly for discriminating between such shocks. Significant age differences in response bias were also observed. Elderly subjects were biased against reporting shock as very faint pain compared to the young subjects and they restricted the range of their criteria across the six-point rating scale.