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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Drug addiction among physicians appears to be an occupational hazard, with chronic pain, depression, and the easy availability of drugs major factors leading to addiction. In this study of 46 cases of physician addicts handled by the Virginia State Board of Medicine, meperidine hydrochloride (Demerol) was the most frequent addictive agent. The Virginia disciplinary and therapeutic plan for addicted physicians was effective in successfully rehabilitating and returning to medical practice 72% of the 46 physician addicts reported to the board from 1949 to 1974.
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PMID:Drug addiction among physicians. The Virginia experience. 98 93

Peripheral nerve stimulating devices were implanted for pain control in 33 patients with a variety of disabling chronic pain conditions, which had persisted despite usual medical and surgical therapy. The implants were placed on major nerves innervating the area of the patient's pain. Records were obtained of each patient's stated relief from pain produced by nerve stimulation, along with assessments of narcotic withdrawal, ability to return to work, sleep pattern, and relief from depression. Based on these five criteria 17 patients were judged to be treatment failures, while eight patients had excellent results, and seven had intermediate results. Twelve of the failures were in patients with either low back pain with sciatica, or pain from metastatic disease. The most dramatic successes occurred in patients with peripheral nerve trauma. The incidence of complications has been low, and two patients have used the stimulator for 5 years without adverse effects. Techniques of peripheral stimulator implantation, possible mechanisms of action, and conclusions regarding peripheral nerve stimulation in the treatment of chronic pain are discussed.
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PMID:Peripheral nerve stimulation in the treatment of intractable pain. 108 48

Electroconvuslive therapy alleviated the symptoms of four out of six patients suffering from chronic pain and from depression as measured by the Hamiliton Depression Rating Scale. All of the patients had been unsuccessfully treated with tricyclic antidepressant medication. The author suggests that ECT may be the treatment of choice for some patients with this combination of symptoms.
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PMID:Electroconvulsive therapy for chronic pain associated with depression. 112 7

The purposes of the present study of chronic pain patients were to (a) assess whether cognitive and behavioral coping style is related to personality factors, (b) assess how coping styles differ across personality types, and (c) assess how outpatient interdisciplinary intervention affects the coping styles of various personality types. Four MMPI clusters (Depression/Pathological, V-type, Marginal Depression, and Marginal V-type) were derived using a hierarchical clustering procedure. Seventy subjects also completed the Coping Strategies Questionnaire before and after a 3-week outpatient pain management program. Pretreatment analyses indicated the Depression/Pathological and Marginal Depression groups used diverting attention less than either V-type group. The V-type group reported using praying/hoping significantly more than either of the marginal groups. At posttreatment the Depression/Pathological group used catastrophizing significantly more than either of the marginal groups. Results of pre-post analyses indicated that the Depression/Pathological group increased their use of diverting attention, reinterpreting pain sensations, and ignoring pain sensations, while decreasing catastrophizing. The V-type group increased their use of reinterpreting pain sensations, while decreasing praying/hoping and catastrophizing. Neither of the Marginal subtypes showed significant pre-post changes in coping strategies. These results suggest that different personality types use different pain coping strategies prior to multidisciplinary treatment. Groups showing more severe psychological distress, perhaps related to an underlying personality disorder, displayed greater changes in coping strategies with treatment, but remained more dysfunctional after treatment. These findings suggest that the alteration of coping strategies may be an important treatment effect needing more individualization to maximize treatment response.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Relationship of MMPI cluster type, pain coping strategy, and treatment outcome. 138 94

The prevalence of major depression in patients with chronic low back pain (CLBP) is approximately three to four times greater than that reported in the general population. In spite of these high prevalence rates, there have been few systematic attempts to investigate the efficacy of treatment for major depression in patients with CLBP. While several studies have examined the efficacy of antidepressant medication and psychological treatment in patients with chronic pain, most of these studies have focused on treating chronic pain rather than depression. The few studies that have specifically addressed the treatment of depression in CLBP indicate that tricyclic antidepressants and cognitive-behavioral approaches may be effective means of treating depressed chronic pain patients. Clinical issues related to diagnostic confounds, rehabilitation outcome, and conceptualizations of the relation between pain and depression are discussed. It is argued that, in patients with clinical levels of depression, treatment modalities specifically targeting depressive symptomatology deserve serious consideration as an integral component of pain management programs.
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PMID:The treatment of depression in chronic low back pain: review and recommendations. 845 72

We investigated the role of fear of pain in headache sufferers using the Fear of Pain Questionnaire (FPQ). Seventy-six headache sufferers and 58 controls completed the FPQ and measures of depression, anxiety, and anger. Headache sufferers also completed measures of stress-related physical symptoms and coping with pain. We found that the FPQ has excellent internal consistency as well as good concurrent and construct validity indicated by the high correlations between the FPQ subscales and both anxiety and depression but low correlations with anger. There were marked differences between headache sufferers and controls on the FPQ; headache sufferers showed much greater fear of severe and medical pain and lower fear of minor pain. Fear of pain was generally not related to headache characteristics such as frequency, severity, or duration. On the other hand, it was related to headache impact such as disruption of pleasurable activities. These results are consistent with models of chronic pain disorders which emphasize the role of fear of pain over the nociceptive intensity of the pain stimulus.
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PMID:Fear of pain in recurrent headache sufferers. 139 48

Because of the increased incidence of chronic disease and other health problems associated with aging, chronic pain is a common companion for the elderly. Pain is of great clinical importance, often associated with disability, loss of independence, and reduced quality of life. A fact that is of interest to psychiatric nurses is that many elderly with complaints of chronic pain also exhibit signs and symptoms of depressive disorders. Treating chronic pain conditions is complex and difficult, and health-care professionals are increasingly recognizing that psychological factors are often involved in the development and continuation of chronic pain problems. Depression is one of these influential variables. Increased understanding of the role of depression in the etiology and maintenance of chronic pain can improve assessment and intervention for the elderly with chronic pain complaints.
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PMID:Chronic pain and depression. 140 16

This research develops and evaluates a simple method of grading the severity of chronic pain for use in general population surveys and studies of primary care pain patients. Measures of pain intensity, disability, persistence and recency of onset were tested for their ability to grade chronic pain severity in a longitudinal study of primary care back pain (n = 1213), headache (n = 779) and temporomandibular disorder pain (n = 397) patients. A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale. Pain intensity measures appeared to scale the lower range of global severity while disability measures appeared to scale the upper range of global severity. Recency of onset and days in pain in the prior 6 months did not scale with pain intensity or disability. Using simple scoring rules, pain severity was graded into 4 hierarchical classes: Grade I, low disability--low intensity; Grade II, low disability--high intensity; Grade III, high disability--moderately limiting; and Grade IV, high disability--severely limiting. For each pain site, Chronic Pain Grade measured at baseline showed a highly statistically significant and monotonically increasing relationship with unemployment rate, pain-related functional limitations, depression, fair to poor self-rated health, frequent use of opioid analgesics, and frequent pain-related doctor visits both at baseline and at 1-year follow-up. Days in Pain was related to these variables, but not as strongly as Chronic Pain Grade. Recent onset cases (first onset within the prior 3 months) did not show differences in psychological and behavioral dysfunction when compared to persons with less recent onset. Using longitudinal data from a population-based study (n = 803), Chronic Pain Grade at baseline predicted the presence of pain in the prior 2 weeks. Chronic Pain Grade and pain-related functional limitations at 3-year follow-up. Grading chronic pain as a function of pain intensity and pain-related disability may be useful when a brief ordinal measure of global pain severity is required. Pain persistence, measured by days in pain in a fixed time period, provides useful additional information.
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PMID:Grading the severity of chronic pain. 140 9

Twenty-six adult outpatients suffering from chronic back pain were observed in a clinical study. Treatment was multifaceted. A psychiatrist with a subspecialty in pain management served as the coordinator of all treatments used. Treatment included biofeedback, physical therapy, behavioral-management program and pain measurement scales, psychotherapy with pain counseling, and medication. Patients were seen weekly for 4 months and observed for 1 year thereafter. Results of the study bore out the necessity of a coordinated multifaceted approach to treatment of chronic pain. Strong emotional overlay was seen in all patients. Stress, depression, and secondary gain are symptoms that were addressed along with the physical symptomatology. Patients improved significantly. The psychiatric component serving as the anchor for treatment was viewed as a key to success. The emotional component present in chronic pain must not be overlooked, because it plays a vital role in successful treatment.
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PMID:Chronic back pain: view from a psychiatrist's office. 142 38

This article presents a literature review on the effects of abuse on health care utilization and health status of women in the US. The abuse of women is defined as any physical abuse of a woman by an intimate male partner. Several studies have estimated that abuse of women remains prevalent in the US and often results in serious physical and mental injuries. Victims are more likely to have poor health, chronic pain problems, depression, suicide attempts, addiction, and pregnancy problems. This review indicates that abused women use a disproportionate amount of health care services including emergency rooms visits, primary care, and community mental health center visits. Despite its high prevalence and the disproportionate use of health care services it causes, woman abuse is rarely recognized by health care providers. Even when health care professionals detect woman abuse, they often provide inappropriate or harmful treatment. Thus, health providers need to educate themselves about women abuse, know community and legal sources to which to refer abused women, and develop protocols for identifying and caring for such women.
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PMID:The effects of woman abuse on health care utilization and health status: a literature review. 142 44


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