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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

About a century ago, George Crile, a surgeon and experimental physiologist, suggested that the meaning of pain could be discovered in the context of evolution. Pain is a signal of a physical injury that would be otherwise ignored by the individual, a form of ignorance that would ultimately have mortal consequences. Crile believed that pain has a second purpose, that has important implications for how psychiatry now understands the emotions, specifically fear and anxiety. In essence, he suggested that fear is the memory of pain, and its adaptive advantage is that it enables individuals to anticipate and avoid injury. Fear-as-memory could be acquired either through individual experience (learned fear) or through species experience (instinctive fear). Among other things, this conception of pain and fear explained why surgical shock (from physical injury) and nervous shock (induced by fear or fright) appeared, at times, to provoke a similar physiologic response--a phenomenon first commented on by the British surgeon, Herbert Page. With this simple grammar, injury-pain-fear, Page and Crile laid the foundations for the modern concept of psychogenic trauma, extending the old idea of "trauma," meaning a wound or physical injury, to include psychological experiences and processes. The modern conception was completed by Freud, by connecting one more emotional state, anxiety. If fear is not simply a memory of pain but a memory that is bound to stimuli in the here-and-now, then anxiety is memory set loose. Put in other words, anxiety is the capacity to imagine pain and not merely to recollect pain. From the time of Beyond the Pleasure Principle (1919), anxiety took on a life of its own, so to speak, no longer part of the constellation of emotions and experiences identified by Page and Crile. Without an external object toward which to direct itself, fear becomes anxiety--a state of nervous anticipation of the unknown, of what is hidden in the shadows or penumbra of awareness. Anxiety is not a vector directed toward a threatening object or event in the environment but is situated in the person's own bodily experience, the workings of the mind, the Cartesian theater of self-representation. As an experience and event located entirely within the psyche, to be mastered by asserting a strong ego, reflections on anxiety became one of the self-constituting experiences of the Western concept of the person. In contemporary psychiatry, the constellation of injury, pain, fear, anxiety, memory, and imagination would seem to live on mainly in the context of traumatogenic anxiety and PTSD.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The cultural context of anxiety disorders. 854 64

Intelligence and personality dysfunctions after minor traumatic brain injury (TBI) (whiplash; slight head impact) incurred in a motor vehicle accident (MVA) were studied in adults after an average interval of 20 months. There was a mean loss of 14 points of Full Scale IQ from estimated preinjury baseline IQ determined from the standardization group (WAIS-R) without evidence for recovery. Personality dysfunctions included cerebral personality disorder, psychiatric diagnosis (30 of 33 patients), post-traumatic stress disorder, persistent altered consciousness, and psychodynamic reactions to impairment. Cognitive loss is caused by interaction of brain injury with distractions such as pain and emotional distress. Unreported head impact and altered consciousness at the time of accident contribute to the underestimation of brain trauma after minor TBI.
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PMID:IQ loss and emotional dysfunctions after mild head injury incurred in a motor vehicle accident. 868 10

Results from studies of pharmacotherapies for primary alcoholism are reviewed, including selective serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitors (e.g. fluoxetine), opiate antagonists (e.g. naltrexone) and dopamine agonists (e.g. bromocriptine). Because there is considerable comorbidity between alcohol dependence, anxiety, and affective disorders, results from studies of medications used to treat these psychiatric disorders are also reviewed, including the 5-HT agonist buspirone and the noradrenergic agent desipramine. The neurobehavioural model of alcohol dependence implies that combinations of medications may lead to more effective treatment; thus, identifying subtypes of alcoholic patients will be important in determining which therapies or combinations of therapy will be most effective in treating alcohol dependence. For example, in an ongoing study, we are attempting to subtype an alcoholic population for treatment selection by measuring endogenous opioid activity. Because endogenous opioids are involved in analgesia, we exposed male and female subjects with alcoholism [some of whom had post-traumatic stress disorder (PTSD)] to cold-induced pain and measured their response before and after administration of naloxone or placebo. The naloxone injection reduced pain response. In addition, women who have PTSD are much more sensitive to stress, which may be related to levels of brain opioid activity.
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PMID:Neurobehavioural basis for the pharmacotherapy of alcoholism: current and future directions. 873

Recent studies have reported a high prevalence of symptoms of post-traumatic stress disorder (PTSD) among individuals with chronic pain. Studies suggest that persons with pain and PTSD also display higher levels of affective disturbance. In the present study we examined self-reports of pain, affective disturbance, and disability among pain patients with and without symptoms of PTSD. Patients without PTSD symptoms were further subdivided into persons whose pain was the result of an accident or insidious in onset. Thus, three groups were examined: (1) persons with accident related pain and high PTSD symptoms (Accident/High PTSD); (2) persons with no or few symptoms of PTSD whose pain was accident related (Accident/Low PTSD); and (3) patients whose pain was not accident related and did not have PTSD symptoms (No Accident). No Accident patients were older than persons with accident related injuries, and both accident related pain groups were more likely than No Accident patients to be involved in litigation or receiving compensation. Thus, these variables were controlled for in the statistical analyses. Self-report of pain was also included as a covariate in the analyses examining group differences in affective disturbance and disability. Accident/High PTSD patients displayed higher levels of self-reported pain compared to the other two groups. The Accident/High PTSD group also had the highest levels of affective disturbance. Both accident groups tended to report greater disability compared to patients whose pain was not accident related. These findings suggest that PTSD symptoms in chronic pain patients are associated with increased pain and affective distress. Accident related pain, even without the presence of PTSD symptoms, appears to be associated with greater disability. The results indicate that the identification and treatment of PTSD symptoms in refractory pain patients may be a critical albeit subtle factor in the effective management of suffering and disability in this population.
Pain 1996 Aug
PMID:The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance and disability among patients with accident and non-accident related pain. 888 Aug 42

The successful treatment of severe left lower limb phantom pain is reported. Hypnosis and antidepressant drugs were the basis for the treatment which controlled the phantom limb pain and an associated post-traumatic stress disorder.
Pain 1996 Aug
PMID:Psychosomatic treatment of phantom limb pain with post-traumatic stress disorder: a case report. 888 Aug 63

CHILDBIRTH CAN BE A VERY PAINFUL EXPERIENCE, often associated with feelings of being out of control. It should not, therefore, be surprising that childbirth may be traumatic for some women. Most women recover quickly post partum; others appear to have a more difficult time. The author asserts that post-traumatic stress disorder (PTSD) may occur after childbirth. He calls this variant of PTSD a "traumatic birth experience." There is very little literature on this topic. The evidence available is from case series, qualitative research and studies of women seeking elective cesarean section for psychologic reasons. Elective cesarean section exemplifies the avoidance behaviour typical of PTSD. There are many ways that health care professionals, including physicians, obstetric nurses, midwives, psychologists, psychiatrists and social workers, can address this phenomenon. These include taking a careful history to determine whether a woman has experienced trauma that could place her at risk for a traumatic birth experience; providing excellent pain control during childbirth and careful postpartum care that includes understanding the woman's birth experience; and ruling out postpartum depression. Much more research is needed in this area.
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PMID:Post-traumatic stress disorder after childbirth: the phenomenon of traumatic birth. 908 90

On the day of the disaster, 641 victims were seen at St. Luke's International Hospital. Among those, five victims arrived with cardiopulmonary or respiratory arrest with marked miosis and extremely low serum cholinesterase values; two died and three recovered completely. In addition to these five critical patients, 106 patients, including four pregnant women, were hospitalized with symptoms of mild to moderate exposure. Other victims had only mild symptoms and were released after 6 hours of observation. Major signs and symptoms in victims were miosis, headache, dyspnea, nausea, ocular pain, blurred vision, vomiting, coughing, muscle weakness, and agitation. Almost all patients showed miosis and related symptoms such as headache, blurred vision, or visual darkness. Although these physical signs and symptoms disappeared within a few weeks, psychologic problems associated with posttraumatic stress disorder persisted longer. Also, secondary contamination of the house staff occurred, with some sort of physical abnormality in more than 20%.
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PMID:Sarin poisoning on Tokyo subway. 919 33

The aims of the present study were to inquire into the prevalence of fibromyalgia syndrome, to assess nonarticular tenderness, to measure fibromyalgia syndrome-related symptoms, quality of life, and functional impairment among posttraumatic stress disorder (PTSD) patients as compared with control subjects. Furthermore, the differences between the PTSD patients with and without fibromyalgia syndrome were studied. Twenty-nine PTSD patients and 37 control subjects were assessed as to the diagnosis of fibromyalgia syndrome according to the American College of Rheumatology. Tenderness was assessed manually and with a dolorimeter. Fibromyalgia syndrome-related symptoms, quality of life, physical functioning, PTSD symptomatology, and psychiatric features were assessed by valid and reliable self-report inventories. Results showed that the prevalence of fibromyalgia syndrome in the PTSD group was 21% vs. 0% in the control group. Furthermore, the PTSD group was more tender than the control group. PTSD subjects suffering from fibromyalgia syndrome were more tender, reported more pain, lower quality of life, higher functional impairment and suffered more psychological distress than the PTSD patients not having fibromyalgia syndrome. It is suggested that previous reports on diffuse pain in PTSD in fact described undiagnosed fibromyalgia syndrome. The link between psychological stress and pain syndromes is emphasized.
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PMID:Posttraumatic stress disorder, tenderness and fibromyalgia. 922 8

This study examines the relationship between extent of injury, degree and type of psychological distress and self-report of pain in burn survivors. One hundred eighty burn patients were interviewed within 2 weeks of their burn trauma. Using a visual analogue scale to assess subjective pain and pain relief, and self-report measures of post-traumatic stress symptoms and general psychological distress, we assessed the relationship between PTSD symptoms, general distress and pain. Subjective pain was unrelated to sex, ethnicity, or total body surface area burned. The most important correlate of subjective pain was general psychological distress. Intrusive PTSD symptoms had no independent power to predict the variance in pain scores. However, among women, more severe avoidant symptoms were associated with greater subjective pain.
Pain 1997 Aug
PMID:Determinants of pain expression in hospitalized burn patients. 927 9

A study was conducted to investigate chronic pain patterns in Vietnam veterans with posttraumatic stress disorder (PTSD). Combat veterans with PTSD completed standardized PTSD severity, pain, somatization, and depression measures. Of 129 consecutive out-patient combat veterans with PTSD, 80% reported chronic pain. In descending order were limb pain (83%), back pain (77%), torso pain (50%), and headache pain (32%). Compared to PTSD combat veterans without chronic pain, PTSD veterans who reported chronic pain reported significantly higher somatization as measured by the Minnesota Multiphasic Inventory 2 hypochondriasis and hysteria subscales. In the sample of 103 combat veterans with PTSD and chronic pain, MMPI 2 hypochondriasis scores and B PTSD symptoms (reexperiencing symptoms) were significantly related to pain disability, overall pain index, and current pain level MMPI 2 hypochondriasis and depression scores were also significantly related to percent body pain. These results are discussed in the context of current conceptualizations of PTSD.
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PMID:Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. 933 Feb 37


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