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A 50-year old woman with right post-thoracotomy pain was referred to us for assistance with pain control. She required pentazocine 60-150 mg per day before our treatment. First, we treated her with intercostal nerve block or oral morphine sulfate. But the result was not satisfactory after five months. Then we tried intrapleural bupivacaine. An epidural catheter was inserted into the pleural space from eight intercostal space at the anterior axillary line and 10 ml of 0.5% bupivacaine was instilled. The treatment was effective for about 4-5 hours. We continued this method for 42 days with 10 ml of 0.25% or 0.5% bupivacaine once or twice a day. She felt so good from the intrapleural analgesia and could be discharged. There was no hypotension, respiratory depression, urinary retention except burning thoracic sensation. We think it is possible to use this intrapleural bupivacaine to treat a certain kind of unilateral chronic pain.
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PMID:[A case report of long-term post-thoracotomy pain management with intrapleural bupivacaine]. 207 4

Orofacial pain is usually evaluated and treated from a biomedical perspective. There is no question that the large majority of individuals having acute orofacial pain benefit from timely and appropriate medical intervention. When orofacial pain persists, however, the likelihood that this pain can influence and be influenced by behavioral factors increases. While some individuals are able to adapt and cope with chronic orofacial pain, others develop significant behavioral problems. These problems may include an overly sedentary lifestyle, dependence on habit-forming narcotic medications, or severe depression or anxiety. The hallmark of the behavioral perspective on chronic pain is the insistence that a careful assessment and treatment of such behavioral problems is just as important as appropriate biomedical intervention.(1)
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PMID:Behavioral assessment of chronic orofacial pain. 208 2

Studies undertaken over the past ten years have demonstrated that stress and depression can induce immune alterations, including decreased numbers of immunocompetent cells and impaired lymphocyte and natural killer cell activity. Factors such as age and severity of symptomatology influence these effects. The substantial stress and depression associated with chronic pain syndromes and the evidence for opioid involvement in immunomodulation suggest that immune system changes may occur in some patients with chronic facial pain.
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PMID:Psychoneuroimmunology: potential relevance to chronic orofacial pain. 208 5

The purpose of this paper is to determine whether patients with chronic temporomandibular disorder (TMD) pain manifest behavioral, experimental, and psychological characteristics similar to patients with other chronic pain illnesses. The Chronic Pain Battery (CPB), a multidimensional assessment tool for chronic pain patients, was used to compare several important variables between 78 TM disorder (TMD) patients and 98 non-TMD chronic pain patients. The study found that chronic TMD patients had lower "usual" pain intensity and suffering levels, fewer vegetative symptoms associated with depression, higher pain tolerance, less impairment of activity, more hope about treatment outcome, lower health care system utilization, but higher reported stress levels than non-TMD chronic pain patients. The two groups manifested no significant differences in use of narcotics, sedatives, and sleeping pills; levels of depression, anxiety, somatization, hostility, or psychoticism; illness behavior reinforcement in their social surroundings; or ratings of problems with work, family, self-esteem, or suicidal impulses. These findings suggest that chronic TMD pain patients (with a symptom duration of over six months) are behaviorally and psychologically similar to non-TMD chronic pain patients, but that they differ in their perceptions of their disorder, rendering them less handicapped by their problems. Psychological, social, and behavioral treatment methods useful for treating chronic pain syndrome may thus also be applied along with dental therapy for optimal treatment of TMD associated with chronic pain.
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PMID:Chronic TM disorder and non-TM disorder pain: a comparison of behavioral and psychological characteristics. 209 86

This study examined profiles of self-reported depressive symptoms in chronic pain patients (n = 51), family practice outpatients (n = 52), and controls (n = 53) who were receiving neither psychological nor medical treatment and were pain free. Subjects in the three groups were matched for age and sex. The short form of the Multiscore Depression Inventory (SMDI) was used. Chronic pain and family practice groups had similar SMDI profiles, with significant elevations on Low Energy, Pessimism, Sad Mood, and Low Self-Esteem subscales compared with controls. Although both groups of medical patients were depressed compared with control subjects, their SMDI profiles were different from those previously reported for psychiatric inpatients with a diagnosis of depression.
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PMID:Self-reported depression profiles in chronic pain and family practice patients. 213 26

Three groups of elderly subjects (chronic pain patients, patients with major depression, and healthy individuals) were administered measures of self-esteem, ego defense mechanisms, and coping style to examine how these personality components are affected by illness. Ego defense mechanisms and self-esteem for all three groups were not found to be different and were positive except for depressed patients, who used greater levels of projection and demonstrated lower levels of self-esteem. Each subject group utilized equally problem-focused and emotion-focused coping styles. These findings from a preliminary study are consistent with previous research demonstrating stability of personality throughout the life span, and suggest that the psychological functioning of older individuals with chronic pain syndromes or depression remains positive and resilient.
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PMID:Positive ego and coping functions in chronic pain and depressed patients. 214 Jun 83

Several investigators have noted the moderating role of the spouse in determining the severity and disability associated with the experience of chronic pain. In this study, pain-contingent responses from spouses, but not global marital satisfaction, accounted for a significant proportion of the variance in reported pain severity. Global marital satisfaction predicted depressive symptom severity. The interaction between global marital satisfaction and the reported frequency of punishing responses to pain behavior added significantly to the prediction of depressive symptoms. Similarly, the interaction between marital satisfaction and degree of spouse solicitousness significantly predicted pain severity. These results are consistent with evolving literatures on the important relationship between marital distress, aversive communication and depression on the one hand, and the potentially deleterious role of the solicitous spouse in the maintenance of chronic pain on the other.
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PMID:The role of marital interaction in chronic pain and depressive symptom severity. 214 61

The relation between catastrophizing, depression, and pain was examined in 125 chronic pain patients. The Coping Strategies Questionnaire (CSQ; Rosenstiel & Keefe, 1983) 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.
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PMID:Relation between catastrophizing and depression in chronic pain patients. 153 68

In order to study the effects of compensation and litigation, 201 chronic pain patients were selected from a sample of 444: 99 were working, 15 were working and litigating, 53 were receiving Worker's Compensation, and 34 were receiving Worker's Compensation and litigating. Employment (working vs. Worker's Compensation) and litigation status (litigating vs. not litigating) were analyzed in a 2 x 2 factorial design with measures of pain, disability, psychological distress, and selected demographics as dependent variables. Compared to Worker's Compensation patients, working patients reported significantly less disability (down-time, days spent in bed, interference of pain in daily activities) and pain of a longer duration. Compared to litigating patients, non-litigating patients reported less pain (on the McGill Pain Questionnaire) and less disability (stopping activity, interference of pain in daily activities). On two measures of psychological distress (depression, anxiety), there were significant interactions: Worker's Compensation patients who were litigating reported less distress than non-litigants, while working patients who were litigating reported more distress than non-litigants. The results indicate clear differences in self-reports of disability associated with both employment and litigation status. They also suggest that litigation may function as a coping response for patients who are distressed by the adversarial nature of the Worker's Compensation system. Limitations of the study as well as suggestions for further research also are discussed.
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PMID:Litigation and employment status: effects on patients with chronic pain. 214 75

87 subjects with varying intensities of constant low back pain answered a pain questionnaire which included Graphic Rating Scales and took part in a battery of psychological tests (Eysenck Personality Inventory, the Meta-Contrast Technique, the Separation Test, and the Rod-and-Frame Test). This was done to corroborate the relationship found between subjects with different intensities of pain and their experiences of psychological problems. Comparisons are made between subjects with acute and chronic pain and between past pain experiences and the present level of pain. No statistical significant differences on psychological measures were found between subjects with varying intensities of pain, but differences were found for previous pain experiences. All subjects had significant rates of depression and regression. A difference between acute and chronic pain subjects was noted in that significantly more women had chronic pain than did men.
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PMID:Interaction between constant levels of low back pain and other psychological parameters. 215 Jul 3


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