The effects of medical evidence and pain intensity on medical student judgments of chronic pain patients

This study examined symptom judgments made by medical students of hypothetical chronic low back pain patients. Eight vignettes were varied as to the pain intensity reported by the hypothetical patient (low vs. moderate vs. high vs. very high) and the availability of medical evidence supportive of the pain report (present vs. absent). Ninety-five subjects read vignettes and made judgments of patient emotional distress, pain intensity, and pain-related disability. Subjects significantly discounted pain level when intensity was high but slightly augmented pain level when intensity was low. Judgments of pain and disability were higher for patients for whom medical evidence was present compared to those for whom it was absent. The results support and extend previous research on the effects of situational and patient variables on observer pain judgments. Future research should examine the influence of these biasing variables on the assessment and treatment of chronic pain patients.     

Memory for pain and affect in chronic pain patients

Radioligand binding studies were performed to determine the effect of various cations on the characteristics of [3H]glibenclamide binding to its high-affinity receptor in rat cerebral cortex membranes. Mg2+ was shown specifically to reduce radioligand binding to membranes pretreated with 5 mM EDTA. CaCl2 enhanced [3H]glibenclamide binding whilst MnCl2, KCl and NaCl were without significant effect. 2 mM MgCl2 induced a statistically significant rightward shift in the dissociation constant for glibenclamide obtained from both saturation and competition studies. These results suggest that Mg2+ may participate in the regulation of the sulphonylurea receptor in the rat cerebral cortex.     

Management of chronic pain among elderly patients

OBJECTIVE: To identify the Staphylococcus aureus capsular serotypes that are not typable, using capsular serotypes 5 and 8, which are currently used to type S aureus isolated from cows with mastitis. SAMPLE POPULATION: Milk samples (n = 273) from cows with mastitis in 178 dairy herds in California, Wisconsin, Michigan, Texas, and New York that were collected by state diagnostic laboratories and S aureus-positive milk samples collected by Veterinary Health Services in the United Kingdom (15), France (22), The Netherlands (36), and Germany (21). PROCEDURE: Capsular serotyping of coded isolates was performed by use of direct cell agglutination and immunoprecipitation of cell extracts with antisera specific for capsular types 5 and 8 and a newly developed S aureus serotyping antiserum 336. RESULTS: In the United States, S aureus capsular types 5 and 8 accounted for 18 and 23% of the isolates, respectively, and type 336 accounted for 59%. Percentage of capsular serotypes in European samples were as follows: type 5 = 34%, type 8 = 34%, type 336 = 30%, and nontypable = 2%. CONCLUSIONS: Serotypes 5 and 8 accounted for only 41% of S aureus isolates from US milk samples, but accounted for 70% of isolates from European milk samples. Addition of the newly developed serotyping antiserum 336 to the typing scheme accounted for 100% of US samples and 98% of European samples and will enable development of a more comprehensive S aureus vaccine.     

Interpersonal stress and pain behaviors in patients with chronic pain.

Evaluated the role of interpersonal stress in eliciting pain behavior. 34 male patients with chronic back pain and their wives participated in a randomized between-groups study examining the effects of 2 interactional conditions (i.e., maritally focused stress interview and neutral talking control task) on subsequent persistence in a physically demanding task and with self-reports of pain. Results show that a greater proportion of patients in the stress interview group terminated the physical activity task prematurely, compared with controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectancy variables predicting tolerance and avoidance of pain in chronic pain patients

Contemporary views on etiology and treatment for solitary bone cyst are presented. Coehn theory of metaphyseal blood flow disturbances as the cause of solitary cyst formation has been emphasized. Minimally invasive treatment modalities have been honored as steroid or autogenous marrow injections into the cyst. Campannaci classification, the most versatile one, embracing various types of cyst remodeling after treatment has been introduced in Polish literature for the first time.     

Observer judgments of acute pain: Facial action determinants.

Identified facial reactions to a series of painful and nonpainful electric shocks and examined the impact of these as discrete facial cues for observer judgments of acute pain. 30 17–28 yr old female volunteers were videotaped and reported their discomfort in response to electric shocks after earlier exposure to 1 of 3 social influence conditions: a tolerant model, an intolerant model, or neutral peer presence. Videotapes were coded for facial activity using the facial action coding system developed by P. Ekman and W. V. Friesan (1978), and peer judges rated them for painful discomfort. Ss exposed to a tolerant model reported no more discomfort than did Ss exposed to an intolerant model, despite receiving more intense levels of shock, but were judged by observers to be in more pain. Analyses of facial activity yielded consistent findings: Tolerant-model Ss, though reporting discomfort equivalent to that reported in other groups, displayed more pain-related facial activity (brow lowering, narrowing of the eye aperture from below, raising the upper lip, and blinking). There was a substantial direct relation between observer judgments of distress and discrete, pain-related facial actions (mean multiple R?=?.74 for the various shock levels rated). Data indicate that nonverbal expression yields information about the response to noxious stimulation that is nonredundant with self-report. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing the reliability and validity of pain intensity measurement in chronic pain patients

This study examined the effects of increasing the number of assessments on the reliability and validity of measures of average pain intensity. Two hundred chronic pain patients completed 2 weeks of hourly pain ratings. A series of regression analyses were performed, and test-retest stability, internal consistency and validity coefficients were computed to address 4 questions. (1) Are chronic pain patients' reports of pain similar from one day to another? (2) What is the reliability and validity of a single rating of pain intensity when used as an indicant of average pain? (3) How many assessments (data points) are required to obtain estimates of average pain intensity with adequate to excellent psychometric properties? (4) How important is it to sample pain from different days? The results were consistent with predictions based on patients' self-reports of their pain and on psychometric theory. First, the majority of patients did not report similar levels of pain from one day to another, and average pain scores calculated from ratings obtained from a single day were less stable than those calculated from ratings obtained from multiple days. Also, and as expected, the results indicate that a single rating of pain intensity is not adequately reliable or valid as a measure of average pain. However, a composite pain intensity score calculated from an average of 12 ratings across 4 days demonstrated adequate reliability and excellent validity as a measure of the average pain in this sample of chronic pain patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Active and passive coping strategies in chronic pain patients

This study assessed the validity of active and passive coping dimensions in chronic pain patients (n = 76) using the Coping Strategies Questionnaire and the Vanderbilt Pain Management Inventory. The validity of active and passive coping dimensions was supported; passive coping was strongly related to general psychological distress and depression, and active coping was associated with activity level and was inversely related to psychological distress. In addition, the Coping Strategies Questionnaire was found to be a more psychometrically sound measure of active and passive coping than the Vanderbilt Pain Management Inventory.     

Self-reported sleep and mood disturbance in chronic pain patients

BACKGROUND: Gastrostomies provide reliable long-term enteral access in patients with traumatic brain injuries. The impact of technique of gastrostomy on total hospital cost is not known. METHODS: A retrospective analysis of patients who sustained head trauma and required gastrostomies for long-term enteral access between 1 July 1990 and 1 July 1996 was performed. RESULTS: The patients who received percutaneous endoscopic gastrostomies (PEG) were similar to patients who received Stamm gastrostomies (OPEN) with respect to age, injury severity score, mechanism of injury, associated injuries, complication rates, and deaths. Total hospital costs ($ x 10(3)) were lower for patients who had PEGs placed in the intensive care unit (78.2 +/- 37.4) or endoscopy suite (71.9 +/- 37.7) compared with PEGs placed in the operating room (122.4 +/- 75.7) or OPEN gastrostomies (119.8 +/- 65.1). CONCLUSIONS: In head-injured patients, PEGs are a reliable method of obtaining long-term enteral access with a complication rate equivalent to Stamm gastrostomies. If performed in either the intensive care unit or the endoscopy suite, PEGs are associated with significantly reduced total hospital costs.     

Treating chronic pain

Quantifiable and measurable methods accurately assess pain severity and successfully guide physicians in determining which medications and modalities are appropriate and necessary for the treatment of chronic pain. A variety of pain assessment scales and the World Health Organization's three-step analgesic ladder can be the starting point for successful pain management.     

Relation between catastrophizing and depression in chronic pain patients.

The relation between catastrophizing, depression, and pain was examined in 125 chronic pain patients. The Coping Strategies Questionnaire (CSQ) developed by A. K. Rosenstiel and F. J. Keefe (see record 1984-18170-001) assessed patients' use of cognitive and behavioral strategies to cope with chronic pain. A significant association between catastrophizing and depression was found. In order to address questions of measurement redundancy, 6 clinical psychologists rated the degree to which items on the CSQ reflected depressive symptomatology. All items contained in the Catastrophizing subscale were rated by all psychologists as being reflective of symptoms of depression and were removed from the CSQ. When this subscale was excluded, none of the remaining CSQ subscales were significantly related to depression. The discussion addresses the interpretive difficulties that arise from hypothesizing mediating relations between variables that are conceptually and operationally confounded. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prayer as a coping strategy for chronic pain patients.

Prayer as a coping mechanism was examined in a group of 105 persons (average age 45 yrs) experiencing chronic pain for an average of 4.3 yrs. Previous research suggested that prayer may actually be associated with increased disability among individuals who develop a permanent, painful condition of 6 mo duration or longer. Assessment instruments included the Medical Coping Modes Questionnaire and 2 subscales of the West Haven-Yale Multidimensional Pain Inventory; prayer was measured by the Diverting Attention/Praying-Hoping Subscale of the Coping Strategies Questionnaire. Consistent with previous research, individuals who endorsed a greater use of prayer to cope with their pain also reported a greater degree of disability. Follow-up statistical analyses suggested that prayer was associated with avoidance suggestive of a passive coping response. Additional research is needed to clarify the relationship of prayer to avoidance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective analysis of acceptance of pain and values-based action in patients with chronic pain.

Objective: Acceptance of pain and values-based action appear important in the emotional, physical, and social functioning of individuals with chronic pain. The purpose of the current study was to prospectively investigate these combined processes. Method: 115 patients attending an assessment and treatment course for chronic pain in the U.K. completed a standard set of measures on two occasions separated by an average of 18.5 weeks. Results: Correlation analyses showed that acceptance of pain and values-based action measured at Time 1 were significantly correlated with pain, pain-related distress, pain-related anxiety and avoidance, depression, depression-related interference with functioning, and physical and psychosocial disability measured at Time 2. Multiple regression analyses, in which pain and relevant patient background variables were controlled, showed that the combined acceptance and values measures accounted for between 6.5% and 27.0% of variance in six key measures of patient functioning later in time. Conclusion: These results support the importance of acceptance and values-related processes in relation to chronic pain. These results also encourage continued applications of a functional contextual model of psychopathology, the model underlying Acceptance and Commitment Therapy and related approaches such as Contextual Cognitive-Behavioral Therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Polymedication and medication compliance in patients with chronic non-malignant pain

Most reports of polymedication among patients with chronic non-malignant pain have relied only on the patient's statements which have been proven to be unreliable regarding actual drug consumption. This study investigates the incidence of polymedication and medication compliance in these patients by applying objective methods. One-hundred-nine consecutive patients predominantly with facial, neuropathic or back pain were interviewed about present medication at first admission to the pain clinic. Reports were verified by toxicological urine screening, mainly with thin-layer chromatography (TLC) and gas chromatography-mass spectrometry (GC-MS) coupling. Follow-up investigations of 61 patients were conducted within 1 and 24 months after beginning therapy. Polymedication--here defined as daily intake of 3 or more preparations--was found in 41 patients (38%) in the initial investigation. In only 74 patients (68%) did the results of urine screening correspond with their reports: 23 patients (21%) concealed the consumption of drugs, and 2 patients (2%) did not take their medications. Ten cases were not interpretable. Fifty-four percent of the drugs concealed were psychotropic substances, mostly benzodiazepines, and 42% were analgesic combinations, partly with psychotropic additives. Drug intake was concealed significantly more often with polypharmacy which was occurring more frequently in patients with headache or facial pain, longer duration of pain, young age, psychiatric diagnosis and history of substance abuse. Patients with initial non-compliance were more likely to conceal drug consumption in follow-up investigations as well (P = 0.05). Therefore, screening for medication compliance in patients with chronic non-malignant pain is recommended, especially in those with the abovementioned risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of stress-related psychophysiological reactions in chronic back pain patients.

Compared the relationship of paraspinal EMG reactivity to personally relevant and general stress among 17 chronic back pain (CBP) patients, 17 non-back-pain patients, and 17 healthy controls. The 3 experimental groups were matched according to sex, age, marital status, education, and employment level. 78% of the Ss were male; 72% were married. The Ss ranged in age from 23 to 73 yrs. Ss participated in a psychophysiological assessment that included 4 trials (discussions of personal stress and pain, mental arithmetic, and reciting the alphabet). Paraspinal and frontalis EMG, heart rate, and skin resistance were recorded continuously. Psychological variables (e.g., depression and perceived control) were also assessed. Results indicate that CBP Ss displayed elevations and delayed return to baseline only in their paravertebral musculature and only when discussing personally relevant stress. Neither of the other groups displayed similar response patterns. Abnormal muscular reactivity was best predicted by depression and manner of coping with pain rather than by organic variables. These results suggest that the assessment of stress-related responses may be important in the evaluation and treatment of CBP. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician and patient factors influencing the treatment of low back pain

From January 1989 to December 1995, 5 diabetic patients with end-stage renal disease (1 woman, 4 men) underwent kidney-alone transplantation. The mean age of the recipients at the time of transplantation was 37.4 years (range, 32 to 43). Craft function and glucose tolerance was evaluated for 5 to 72 months after surgery. Postoperative complications were seen in 2 patients; nonspecific subcutaneous infections and an asymptomatic partial allograft infarction. All renal allografts were functioning 1 year after transplantation, with a mean serum creatinine level of 1.10 mg/dL (range, 0.8 to 1.8 mg/dL), and a mean urinary protein level of 17.8 mg/dL (range, 5 to 27 mg/dL). The postoperative daily dose of insulin was higher than the preoperative dose, while the level of glycated hemoglobin (HbA1C) increased after surgery and peaked 6 months after transplantation; 1 year after transplantation it had reverted to the preoperative level. As long as the diabetic complications of the renal allograft recipients are not severe, the short-term survival and the renal function of diabetic patients with end-stage renal disease improves after kidney-alone transplantation, which is still the standard method of treatment in Japan.     

Decreased pain threshold and tolerance in patients with chronic tension headache

Nociceptive processing was studied in 40 patients with chronic tension-type headache and in 40 healthy controls. We found that pericranial tenderness recorded by manual palpation was considerably higher in patients than in controls (p < or = 0.0002). Pressure pain detection and tolerance thresholds recorded in the finger, by means of a pressure algometer, were significantly lower in patients than in controls (p < or = 0.0009), and a non-significant similar trend was observed in the temple (p < or = 0.12). Detection and tolerance thresholds were decreased to a similar degree in patients compared with controls, and pain thresholds recorded in the finger and in the temple were highly correlated (r = 0.84, p < 0.0001). The electrical pain threshold at the labial commissure, by means of an electrical stimulator, was significantly decreased in patients compared with controls (p = 0.03). All of the examined pain thresholds were significantly correlated to the pericranial tenderness recorded by palpation (r = -0.35 to -0.53, p < or = 0.03). We conclude that the present finding of a general hypersensitivity to pain stimuli in chronic tension-type headache indicates that central factors play an important role in the pathogenesis of this disorder.     

Cognitive-somatic anxiety response patterning in chronic pain patients and nonpatients.

100 chronic pain patients (mean age 42.3 yrs), 100 undergraduates (mean age 20.2 yrs), 35 patients with low-back pain (mean age 44.5 yrs), and 30 health professionals (mean age 34.7 yrs) completed a cognitive-somatic anxiety questionnaire to examine group differences in Ss' manner of self-reporting anxiety. Patients, relative to nonpatients, acknowledged fewer total signs of anxiety and endorsed significantly more somatic than cognitive indicators of anxiety. Group differences suggest that global scale measures of a multidimensional symptom construct may obscure different group patterns of item endorsement. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)