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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to assess the perception of muscle tension in chronic pain patients and healthy controls. Twenty chronic back pain patients, 20 patients who suffered from temporomandibular pain and dysfunction, and 20 healthy controls were instructed to produce eight different levels of muscle contraction in either the m. masseter or the m. erector spinae. Each level was produced three times; trials were presented in random order. Analyses of the accuracy and the sensitivity of discrimination of muscle tension levels revealed that the patients were less able to perceive muscle contraction levels correctly and that they underestimated their actual levels of muscle tension. Patients and controls did not differ in the extent to which they contracted muscles not involved in the task. Patients suffering from musculoskeletal disorders seem to display a genuine deficit in discrimination of muscle tension that is related to neither local physiological changes at the site of pain, lack of motivation, in-attention, nor fatigue.
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PMID:Discrimination of muscle tension in chronic pain patients and healthy controls. 138 53

Pharmacotherapy plays an important part in the overall management of patients with multiple sclerosis. Most therapies directed at altering the natural history of the underlying disease process are only partially effective or are controversial or experimental. However, many effective symptomatic therapies are available to the clinician. The action and uses of corticosteroids in multiple sclerosis are discussed, and approaches to the treatment of spasticity, paroxysmal disorders, bladder dysfunction, cerebellar ataxia, neurobehavioral manifestations, fatigue, and acute and chronic pain in patients with multiple sclerosis are examined.
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PMID:Pharmacotherapy of multiple sclerosis: current status. 151 15

Twenty consecutive patients with recurrent Tolosa-Hunt syndrome were studied. One had a parent who suffered from recurrent Tolosa-Hunt syndrome. Thirty-three percent of the patients had also recurrent periods of weeks to months of unilateral periorbital pain without ophthalmoplegia. One patient had cluster headache before the Tolosa-Hunt syndrome started. Some patients had involvement of cranial nerves outside the cavernous sinus region during Tolosa-Hunt syndrome and also between episodes. The same systemic symptoms, i.e. back pain, cold feet, arthralgia, gut problems, varices, vertigo, chronic fatigue, thrombophlebitis, memory deficiency and signs of inflammation in serum, occurred in Tolosa-Hunt syndrome as earlier found in patients with orbital venous vasculitis. Seventy-three percent of the patients had pathologic orbital phlebograms. All patients treated with steroids reacted promptly; four who developed chronic pain syndromes were treated satisfactorily with azathioprine.
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PMID:Recurrent Tolosa-Hunt syndrome. 155 57

The influence of chronic pain on daily life was studied in 58 patients (55 women and three men) with fibromyalgia. The mean age was 45 +/- 11 (SD) years. A mail questionnaire including a 2-day diary was used for data collection. Information was gathered on social background, employment status, symptoms, physical training habits, patients' experience of general health, physical condition, and difficulties in performing motor tasks. The patient reported every half hour in the activity diary the degree of pain and fatigue, whether the activities were difficult to perform, and whether the patient considered them to be enjoyable, valuable, and meaningful. Fifty-five percent of the group had gainful employment. Most were working shorter hours and with changed work tasks. Motor tasks, such as carrying, holding, and running were more difficult to perform than before the onset of the symptoms, and half of the group reported most of their activities as strenuous to perform. Thirty-nine persons (67%) reported no, or very short, pain-free periods during the 2 days. In conclusion, symptoms influenced daily life considerably, and almost all patients reported changes in habits and routines as a consequence of fibromyalgia. An assessment of the patient's total life situation gives valuable information for understanding the patients' ability to handle everyday life.
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PMID:Living with fibromyalgia. Consequences for everyday life. 163 77

A differentiation between the normal sensation of tiredness and the symptom "fatigue" is often difficult. Both are influenced by cultural, social, psychological and biological factors, which can lead--interactively--to symptom formation. Psychiatric disorders frequently associated with fatigue are all forms of depression, somatization and anxiety disorders, chronic pain states and drug abuse among many others. In at least 2/3 of patients with the fashionable chronic fatigue syndrome--formerly called neurasthenia--a psychiatric diagnosis can be made, most of them also suffer from many symptoms attributes to the autonomous nervous system. The clinical approach should be cautious avoiding diagnostic and therapeutic overaction and therapy should emerge from a diagnosis properly assessed.
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PMID:[Intense fatigue in humans. Psychosocial and cultural aspects]. 175 73

Field management, through the use of specially trained field consultants, is a mechanism by which interdisciplinary interventions can be implemented in non-institutional settings. Management of the real environmental determinants (home, work, social) of pain and disability should improve the effectiveness of behaviorally based interventions and make these treatments more accessible. Over a 6 year period, 261 patients having various chronic somatic complaints (e.g., pain, fatigue, gastrointestinal complaints) underwent interdisciplinary outpatient treatment based on medical and behavioral sciences. Comparison of patients having field management with patients receiving office-based treatment found a significantly greater reduction in disability with field management. 84% of field managed patients had a successful outcome as defined by: (a) return to regular work, or (b) reduced limitations on work, exercise, and daily living activities, depending on functional status at assessment. Only 61% of patients with office-based treatment were successful. Compliance, defined as the frequency with which treatment was mutually terminated, was significantly higher with field management. The availability of long-term disability benefits was highly predictive of a poorer outcome. However, field management remained effective for improving functional status regardless of the availability of benefits. Finally, determination of the cost of non-institutional treatment indicated that field management is a cost-effective modality. Implications of these findings for the treatment of disability in chronic pain and other chronic illness syndromes are discussed.
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PMID:Non-institutional treatment of chronic pain by field management: an outcome study with comparison group. 230 64

The overall function, pain, and mood disturbance of 54 patients with benign chronic pain were studied as to their response to epidural spinal electrical stimulation (ESES) more than 12 months after the implantation of ESES electrodes. Both responder (n = 23) and nonresponder (n = 31) pain patients demonstrated extensively worse physical and psychosocial function on the Sickness Impact Profile (SIP) and worse self-rated mood disturbance on the Mood Adjective Check List (MACL) than a control population sample. Responders to ESES were insignificantly less impaired in physical functions of daily life than nonresponders, but clearly less inhibited in the social pattern of contact. Self-rated pain sensation differed 36% between responders and nonresponders, and the pain measures of all pain patients correlated with total mood disturbance on the MACL and with its dimensions for depression and fatigue. Social characteristics, sex, diagnoses, comorbidity, and duration of pain did not discriminate. In a supplementary prospective short-term study, pain ratings had improved by 30% 3 weeks after implantations. The night sleep and general psychic balance (SIP category emotional behavior) were then also significantly improved. A shortened SIP version of 8 items optimizing responder-nonresponder differences and 12 items of mood disturbance are suggested to supplement pain ratings for overall assessment of chronic pain patients. A wider usage of ESES is recommended for pain patients who can comply to the regimen, because the surgical technique is now simple and safe.
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PMID:Physical, psychologic, and social function in chronic pain patients after epidural spinal electrical stimulation. 242 68

Peak pain symptoms and experiences were explored within a group of 243 intractable pain patients seen consecutively at a pain clinic. Using a 5-point scale, patients rated the frequency with which 99 symptom adjectives occurred when their pain was at its worst. Key cluster analysis identified 11 reliable, conceptually clear symptom clusters: Four affective symptom categories, Angry Depression, Diminished Drive, Intropunitive Depression and Anxiety, describing emotional states concomitant with peak pain; two somatic symptom categories, Ecto-Pain and Endo-Pain, describing surface and deep bodily pain, respectively; and five additional symptom categories including Cognitive Dysfunction, Sleep Disturbance, Fatigue, Withdrawal and Disequilibrium. Among the affective symptom clusters, symptoms of Angry Depression were reported to occur frequently by 32% of the patients while only 11% reported the frequent occurrence of Intropunitive Depression. For the somatic symptom clusters, 25 and 52% reported the frequent occurrence of Ecto-Pain and Endo-Pain, respectively. Pain reports measured by Ecto-Pain and Endo-Pain were nearly independent of all other symptom categories. The results suggest that the experiential context of pain differs widely among intractable pain patients. The study derived a Pain Symptom Checklist to measure each symptom cluster as one way to identify coping styles among chronic pain patients.
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PMID:Multidimensional analysis of peak pain symptoms and experiences. 262 24

Psychological effects of Neurotropin--a widely used analgesic in Japan--have been evaluated in a double blind cross-over study on volunteers belonging to the nursing staff of a hospital under sleep deprivation or not. Each subject was asked to record his feelings by self-assessment on scales registering the following states: fatigue-/rest+, mental stress-/relaxation+, cold sensation-/comfort+, dissatisfaction-/satisfaction+. Neurotropin was shown to be devoid of demonstrable psychological effects in the subjects under normal sleeping conditions. After sleep deprivation, Neurotropin globally determined significantly more psychological evolutions towards positives+ and less towards negative- mood than inactive placebo. From the self-assessed feelings, euphoria was unaffected, whereas Neurotropin significantly reduced fatigue and improved relaxation and comfort. These results are compared with the observations made on animals submitted to Specific Alternation of Rhythm in Temperature (SART) where Neurotropin relieves such symptoms as hyperalgesia. This model for experimental pain study corresponds to a depletion of brain serotonin and catecholamines. The effects of Neurotropin on exhausted volunteers could, as in the SART model, be due to an inhibition of monoaminergic depletion. The relevance of this finding to some association of chronic pain and psychogenic factors is to be considered.
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PMID:Psychological effects of Neurotropin in man under normal conditions and after sleep deprivation: a double-blind placebo study. 273 97

Depression in the elderly should be viewed as a biological disorder, with multifactorial etiology, and not as a consequence of increasing social, physical, and material losses. Diagnosis is made basically on somatic symptoms, the most important ones being chronic fatigue, chronic pain, chronic sleep disorder, chronic gastrointestinal disturbance, and dysphoria. Other illnesses that might be present instead of or in addition to depression should be sought, both before depression therapy is started and also in the face of persistent symptoms after treatment is started. Basic treatment is with antidepressant medications, with careful attention to selection of drug and dosage, and careful monitoring for adverse effects. Antidepressant therapy and any other applicable forms of therapy are not mutually exclusive, and any other means of improving the patient's overall situation should be vigorously sought.
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PMID:Geriatric depression: avoiding the pitfalls of primary care. 355 33


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