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

General anesthesia aims to eliminate patients' awareness of excruciating pain during surgery. Nevertheless, rare occurrences of patient awareness continue because the problem is not yet completely preventable. One study puts the incidence of awareness at 0.18% for patients receiving muscle relaxants and at 0.10% for patients not given relaxant drugs. Awareness experiences frighten patients and impact their implicit and explicit memories in ways that can leave a lifetime of residual emotional and psychological problems ranging from sleep disturbances, nightmares, and daytime anxiety that may subside with time to development of post-traumatic stress disorder. Most anesthetists monitor depth of anesthesia by assessing intraoperative hemodynamic responses to surgical stimuli--an approach questioned by some authors. Several depth-of-anesthesia monitors are available, but there is no ideal monitor that is 100% reliable. This review provides an overview of literature that reports findings associated with the monitoring and occurrence of intraoperative awareness. These studies indicate assessment methods that can be trusted when we provide general anesthesia and what measures can be taken to prevent recall by patients under general anesthesia.
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PMID:Awareness under general anesthesia. 1462 75

Because the onset of a spinal cord injury may involve a brush with death and because serious injury and disability can act as a reminder of death, death anxiety was examined as a predictor of posttraumatic stress levels among individuals with disabilities. This cross-sectional study used multiple regression and multivariate multiple regression to examine whether death denial and death awareness predicted posttraumatic stress disorder (PTSD) among veterans and civilians with spinal cord injuries (N = 313). The results indicated that death anxiety (after controlling for demographic and disability-related variables) predicted a significant amount of the total levels of posttraumatic stress reactions among individuals with spinal cord injuries. Further, death awareness, pain level, and spiritual/religious coping significantly predicted the posttraumatic stress clusters of reexperiencing, avoidance, and hyperarousal. Death denial significantly predicted only hyperarousal. Because death anxiety predicts various aspects of PTSD reactions, one possible therapeutic implication is that addressing death-related topics may help to reduce PTSD reactions. Further research is needed to better ascertain the possible causality among these variables.
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PMID:Death anxiety as a predictor of posttraumatic stress levels among individuals with spinal cord injuries. 1496 75

Several of the more common causes of chronic pain include traumatic events such as motor vehicle accidents and work-related incidents. Therefore, it is not unusual for patients presenting with chronic pain to also describe significant levels of distress including post-traumatic symptomatology and, in the more severe cases, post-traumatic stress disorder (PTSD). Throughout the past few decades, the literature relating to chronic pain and PTSD has become progressively more sophisticated, resulting in well-supported theories and treatments for sufferers. However, only a handful of studies have specifically attended to the co-occurrence of these two disorders. This review presents a summary of the literature relating to the two disorders in terms of symptoms, prevalence, and comorbidity. It also briefly describes the main empirically supported psychologic theories of chronic pain and PTSD and briefly reviews the evidence regarding what factors maintain the disorders. Treatment implications and issues for future research are considered.
Curr Pain Headache Rep 2004 Apr
PMID:The prevalence of post-traumatic stress disorder in chronic pain patients. 1498 Jan 45

Research to date has focused on depression and co-existing pain in HIV with relatively little attention devoted to the study of anxiety disorders and concurrent pain. We therefore examined the relationships among panic disorder, posttraumatic stress disorder (PTSD), major depression and pain in a US national sample of persons with HIV, controlling for key sociodemographic and clinical variables, including HIV disease status. The study sample comprised 1489 HIV+ individuals (representing 219 667 persons). In multivariate analyses, panic disorder showed a strong association with pain ( beta= -15.70; 99% confidence interval [CI]=-21.33 to -10.08; P<0.001, which was significantly greater than PTSD (P=0.002) but only marginally greater than major depression (P=0.002). Longitudinal analyses of the three psychological disorders revealed that increasing pain from baseline to follow-up (an approximately 6-month period) was associated with panic disorder only (relative risk ratio=2.18, 99% CI=1.02-4.69; P<0.01), after controlling for baseline pain scores, baseline HIV disease status and change in disease stage across time. We discuss specific mechanisms by which clinical anxiety and chronic pain may be mutually maintained in HIV+ individuals. Our findings suggest that panic disorder, as well as PTSD and major depression are associated with greater pain in HIV patients.
Pain 2004 May
PMID:Panic disorder and pain in a national sample of persons living with HIV. 1508 39

In a cross-sectional study, 483 patients (age: 35.8 +/- 13.2 years) of an outpatient psychosomatic university clinic were investigated using a standardized disorder-specific set of tests. 63.1 % of the patients reported to have experienced at least one traumatic event in their life. Test-psychometrically, a posttraumatic stress disorder (PTSD) could be assumed in 10.1 %. Compared to non-traumatized patients, patients with a PTSD reported significantly more frequently somatoform symptoms; even the comparison of traumatized patients with and without PTSD demonstrated a pronounced tendency to somatize in PTSD patients. Neurologic, gastrointestinal and cardiopulmonary symptoms, as well as pain sensations and sexual dysfunctioning were predominantly reported as somatoform complaints. The results emphasize the close connection between somatization and PTSD symptoms; this should be increasingly taken into consideration in the diagnostic process within psychotraumatology.
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PMID:[Trauma, post-traumatic stress disorder and somatization]. 1569 81

A dental patient with post-traumatic stress disorder (PTSD) may present with greater dental and behavioral challenges than most dental patients. The background review of PTSD's initiating factors, diagnostic criteria, and medical management should help practitioners better understand and manage these challenges. Many of the challenges the clinician may encounter and managing recommendations are described. A case report of a PTSD patient complaining of constant bilateral tooth pain of the maxillary and mandibular bicuspids and molars is presented. Recommended techniques for identifying the tooth pain source and contributing factors are provided. The primary contributing factor for the patient's tooth pain was determined to be his severe tooth clenching activity. A maxillary acrylic appliance provided some pain reduction and a subsequent mandibular soft occlusal appliance worn opposing the maxillary appliance provided additional relief.
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PMID:Post-traumatic stress disorder: considerations for dentistry. 1511 79

My postdoctoral training under Dr. Gerard Smith began me on a lifetime of investigation on the role of stress, hormones, and disease. The first set of experiments asked what hormone, if any, best reflected the range of aroused behaviors. We found that catecholamines performed substantially better than glucocorticoids did, despite the belief that glucocorticoids were sensitive indices of stress. But we also learned that hormones themselves were nowhere near as good in monitoring stress than motor behaviors were. In a second set of experiments, we tried to understand how stress affected medical disease. We learned that stress can produce disease in a healthy organism but has its most profound effects when disease already exists. Finally, in the early 1990s, I shifted my focus on stress and disease to a broader problem in behavioral medicine, namely, medically unexplained fatigue and pain. Among the studies we have done investigating these disorders, we looked specifically at veterans of the first Gulf War--many of whom developed problems with severe fatigue. A critical question in the literature asked if unexplained fatigue was simply a physical component of concurrent posttraumatic stress disorder (PTSD). In a large epidemiological study, we found that PTSD tracked stressor intensity in a stepwise fashion, while fatiguing illness increased with stressor intensity only on the milder side of the intensity spectrum. This result indicated that the two ailments are both stress sensitive but dissimilar.
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PMID:Stress, hormones and disease. 1523 2

Intraoperative wakefulness ("awareness") is still a relevant problem. Different stages of wakefulness exist: conscious awareness with explicit recall of pain in 0.03% and with nonpainful explicit recall in 0.1-0.2% of all anesthesias; amnesic awareness or implicit recall may occur with unknown, even higher incidences. Sufficient analgesia minimizes possible painful perceptions. Opioids, benzodiazepines, and N(2)O alone or combined lead to the highest incidences of nonpainful intraoperative wakefulness. Volatile anesthetics, etomidate, barbiturates, and propofol in sufficient doses effectively block any sensory processing and therefore abolish intraoperative wakefulness. Intraoperative awareness with recall may lead to sustained impairment of the patients, in severe cases even to a post-traumatic stress disorder (PTSD). The observation of clinical signs does not reliably detect intraoperative wakefulness in all cases; monitoring of end-tidal gas concentrations, EEG, or evoked potentials may help in prevention. Active information is recommended only for patients at higher risk. Complaints about recall of intraoperative events should be taken seriously; in cases of sustained symptoms psychological help may be necessary.
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PMID:[Unwanted wakefulness during general anesthesia]. 1524 26

A man in his 50's with a prior traumatic brain injury and multiple psychiatric disorders developed acute pain and swelling in his left leg distal to the mid shin. These symptoms arose during an exacerbation of his post-traumatic stress disorder (PTSD). Among his traumatic memories, he reported having witnessed the combat injury and death of a friend who had lost his left leg distal to the mid shin. A diagnosis of conversion disorder was technically excluded because the findings met criteria for Complex Regional Pain Syndrome (CRPS) type I. Based on recent research into the neurobiology of CRPS, PTSD and conversion disorder, we propose a supraspinal mechanism which could explain how emotional stress can produce both symptoms and signs.
Pain 2004 Jul
PMID:Complex regional pain syndrome as a stress response. 1527 3

This article presents a case study of a 39-year-old European American married woman with a history of child and adolescent incest,marital rape, and physical abuse from her husband for more than 10 years. She was referred to a pain clinic for treatment of headaches and Tourette's syndrome. The client was evaluated with the Ackerman-Banks Neuropsychological Rehabilitation Battery to identify neuropsychological strengths and weaknesses. The Vulnerability to Stress Audit was used to identify life events that were positively and negatively influencing her life. The client was treated for mild traumatic brain injury, post-traumatic stress disorder,cognitive difficulties, impulsivity, confabulation, low frustration tolerance, and inability to evaluate and make decisions about socially appropriate behaviors. Treatment involved traditional psychotherapy, hypnosis, cognitive rehabilitation, biofeedback training, electromyography, finger temperature, and blood pressure.
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PMID:Applied psychophysiology, clinical biofeedback, and rehabilitation neuropsychology: a case study--mild traumatic brain injury and post-traumatic stress disorder. 1545 59


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