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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the United States various forms of managed care have been introduced to control the use of expensive medical services. One of the most prominent involves utilization review of hospital admissions. While reviewing the appropriateness of inpatient treatment is appealing in principle, its application is made difficult by clinical uncertainty. Managed care plans develop and implement review criteria often without the guidance of clear clinical norms of treatment. Under these conditions, we suggest that utilization review organizations (UROs) can be expected to develop "styles" of review that respond to clinical uncertainty, influenced by their experience, professional orientation, and financial incentives. Two review styles are explored in this paper: standardization, where the URO reduces the variance in clinical practices by eliminating those practices that deviate from professional norms and stringency, whereby the URO shifts the distribution of clinical practice as it tries to change the professional norms of practice. Data from a 1992-1993 national survey of utilization review organizations are used to test whether UROs have review styles that systematically respond to organizational attributes, economic pressures, and clinical uncertainty associated with three medical conditions: cardiac catheterization, low back pain, and adolescent depression. UROs were found to adopt more stringent review strategies for conditions with weaker norms of appropriate treatment. Financial incentives and organizational experience are positively related to greater stringency. Standardization responds to professional orientation and organizational experience. Variation in the review styles of UROs has implications for the resulting distribution of clinical practices as well as the equity of access to medical care.
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PMID:Risk, motives, and styles of utilization review: a cross-condition comparison. 972 11

Diurnal rhythm of serum melatonin concentrations was estimated in 12 men with low back pain syndrome before and after exposure to a very low-frequency magnetic field (2.9 mT, 40 Hz, square wave, bipolar). Patients were exposed to the magnetic field for 3 weeks (20 min per day, 5 days per week) either in the morning (at 10:00 hr) or in the late afternoon (at 18:00 hr). Significant depression in nocturnal melatonin rise was observed regardless of the time of exposure. This phenomenon was characteristic for all the subjects, although the percent of inhibition of melatonin secretion varied among the studied individuals.
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PMID:Chronic exposure to 2.9 mT, 40 Hz magnetic field reduces melatonin concentrations in humans. 988 93

Depressive disorders in employees and their dependents pose a major occupational health challenge, with implications for productivity, competitiveness, disability program utilization and medical care costs. The following article shows just how big an impact depression has had on the benefit programs of a major Midwestern employer--generating over half of all mental healthcare diagnoses and claims and even more days of disability and 12-month recidivism than chronic physical complaints such as heart disease, diabetes, high blood pressure and low back pain.
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PMID:The cost of depression in the workplace. 1017 3

In our Neuropsychiatric dispensary in Galicia, all 3,000 consultations from June 1997 to May 1998 were summed up. We serve a population of 125,000 living in a semi-rural district dependent on a strong industrialised city with car, ship and fishing industry. Of all consulting people, 50% of the 1,000 new ones were unemployed, and 25% of the 2,000 who came for check-ups. In the group under 25 years of age not having had their first job, main findings were anxiety, stress migraine, schizoid outbreaks and self-referring delusion. In the group of young people with unstable jobs, we often found depression, phobias, anorexia/bulimia, low back pain and functional digestive disorders. Age groups 35-50 showed depression patterns, hypochondriac symptoms, low back pain and delusion outbreaks. Those over 50 years old often came from reorganised companies, and showed hypochondriac or psychosomatic sickness, or they applied for retirement or sickness benefits.
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PMID:Unemployment and mental health in Galicia, Spain. 1019 66

Living with daily pain during a long period of time is a considerable strain which affects many aspects of life. The aim of this study was to explore the experiences and coping strategies of patients with chronic low back pain. A strategic sample of 22 patients with chronic low back pain were interviewed according to a semistructured qualitative method: 14 women and eight men, with a mean age of 46 and a mean duration of illness of 15 years. 18 had been treated with low back surgery. All patients had pain every day. 19 were never without pain. They reported disturbed sleep, irritable mood and depression; 15 had thought of suicide. They felt constantly worn out. The pain influenced their everyday life and their total situation. The lives of patients with intermittent daily pain were less affected. The patients were asked what advice they would give to others in a similar situation. Their main point was not to give up, to focus less on the pain and the limitations and more on everything that could bring dedication and joy to everyday life.
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PMID:[The pain takes hold of life. A qualitative study of how patients with chronic back pain experience and cope with their life situation]. 1038 6

To understand the relative efficacy of noradrenergic and serotonergic antidepressants as analgesics in chronic back pain without depression, we conducted a randomized, double-blind, placebo-control head-to-head comparison of maprotiline (a norepinephrine reuptake blocker) and paroxetine (a serotonin reuptake blocker) in 103 patients with chronic low back pain. Of these 74 completed the trial; of the 29 who did not complete, 19 were withdrawn because of adverse effects. The intervention consisted of an 8-week course of maprotiline (up to 150 mg daily) or paroxetine (up to 30 mg daily) or an active placebo, diphenhydramine hydrochloride (up to 37.5 mg daily). Patients were excluded for current major depression. Reduction in pain intensity (Descriptor Differential Scale scores) was significantly greater for study completers randomized to maprotiline compared to placebo (P=0.023), and to paroxetine (P=0.013), with a reduction of pain by 45% compared to 27% on placebo and 26% on paroxetine. These results suggest that at standard dosages noradrenergic agents may provide more effective analgesia in back pain than do selective serotonergic reuptake inhibitors.
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PMID:Effects of noradrenergic and serotonergic antidepressants on chronic low back pain intensity. 1120 64

Multimodal pain management programmes have been used for chronic pain conditions such as low back pain or headache for many years with good results. However their effectiveness for treating fibromyalgia has only recently been established and with respect to long-term outcome the evidence is still not convincing. Recent findings, about abnormalities in pain control and neuroendocrine systems, help to understand the symptomatology of fibromyalgia and give theoretical support for these treatment concepts. They might also explain why secondary phenomena like depression, anxiety, deconditioning and disability can make it harder to treat the condition at a chronic stage. The ingredients of such multimodal programmes are described and evidence for their effectiveness is presented.
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PMID:Pain management strategies and team approach. 1056 81

The epidemic-like rise in chronic low back pain in western industrial nations is less an expression of a medical than a psychosocial phenomenon. Differentiation between acute, chronic or chronifying pain is of crucial importance for therapeutic procedures. Pain syndromes in the muscular-skeletal system tend to become chronic to a far larger extent than expected. More than 80 % of low back pain represents a functional pain syndrome and does not show any pathoanatomical correlate. Pain existing independently seems to be predestined by a somatic and psychosocial deconditioning syndrome. Those at risk of chronifying pain or those whose pain is already chronic should be given an interdisciplinary, multimodal therapeutic program. A pilot study was carried out in our clinic: multidisciplinary treatment was given to our patients (of which over 90 % belonged to stages II and III on the Gerbershagen scale) and the result was significant improvement in the measurements of pain intensity, sensoric and affective pain perception, their list of complaints, the common scale of depression and the pain disability index. Taking previously published studies into consideration, it is safe to say that a multidisciplinary, multimodal program of therapy even after stay in hospital results in considerable relief of pain and improvement in the ability to cope with the pain for patients with chronified pain syndromes in the muscular-skeletal system which are resistant to treatment on an outpatient basis.
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PMID:[The multimodal interdisciplinary therapeutic program in chronic back pain. A new treatment strategy]. 1060 31

A new cluster arousal analysis system was developed to quantify microdisturbances in the sleep architecture. The system was evaluated in 10 healthy volunteers and the sleep of 23 outpatients with chronic low back pain was investigated before and after a special rehabilitative training. The comparison of sleep parameters before and after the treatment showed a significant reduction of the cluster disturbed sleep (CDS), whereas sleep efficiency and the number of stage shifts remained unchanged. The reduction of the CDS correlated with a reduction of depression scale. This cluster arousal analysis appears to be a sensitive tool for evaluating alterations in the sleep microstructure.
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PMID:Cluster arousal analysis in chronic pain-disturbed sleep. 1060 84

Every physician encounters patients with physical symptoms that remain unexplained, despite appropriate investigations. Medical curricula and textbooks fail to provide guidance about the management of such problems. Particularly specialists tend to feel helpless; this often leads to more referrals and unnecessary operations. Three patients, referred to a neurologist for a second opinion, had chronic, unexplained, crippling pains: a woman aged 53 with low back pain radiating to the right leg for 27 years, a man aged 31 with neck pain for 3 years and a woman aged 31 with pain in the left arm for 1.5 years. They had no recognisable features of depression. Their illness behaviour reversed after the neurologist reassured the patients and advised them to embark upon a strict programme of gradually increasing activities. In two of the patients, the scheme was supervised by the general practitioner. A follow-up interview (after a median interval of 3 years) of 27 similar patients referred for a second opinion showed some success with this approach in about half of them. In retrospect no predictive factors at baseline could be identified other than age and duration of symptoms. An indispensable first step in patients with unexplained, chronic pain is unqualified recognition of the symptoms, reassurance, and an explanation that avoids the mind-body division.
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PMID:[Chronic, unexplained pain: from complaint to action]. 1077 88


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