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

The recent literature on pain states shows: pain thresholds are relatively constant for an individual, but pain tolerance is influenced by psychological state; the expression of pain is a function partly of ethnic membership and degree of extroversion; pain complaints are determined as well by cultural and extroversive factors, and also degree of neuroticism. Studies of pain patients reveals that those with acute pain tend to show normal personality profiles, but the degree of pain experienced is related to the degree of anxiety present. Most chronic pain patients, like those with psychogenic pain, show somatic preoccupations and reactive depression. The treatment and/or rehabilitation of pain patients has developed in three areas. In cases of peripheral neuropathy and some spinal cord lesions, electrical stimulation with "neural pacemakers" can often "close the gate" to pain signals and provide significant reduction or abolition of pain. Psychotropic medications, particularly the tricyclic antidepressants, sometimes in combination with phenothiazines and antihistamines, are effective in many instances of central pain, and help increase the pain tolerance and decrease the need for narcotics in other pain states. Operant conditioning, including the use of biofeedback, extinguishes pain behavior and increases pain-incompatible behaviors, with good long-term results.
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PMID:Psychophysiology of pain. 0 84

Low back pain may arise from degenerative changes in the posterior joints of the lumbar spine. These joints are innervated by a branch of the posterior primary ramus, which follows an anatomically constant course. Pain impulses from these joints can be interrupted by coagulating this nerve with a radiofrequency wave, the probe having been placed in the area of the nerve percutaneously. Percutaneous lumbar rhizolysis was carried out under local anesthesia on an outpatient basis in 82 patients, most of whom had multiple level rhizolysis. Rhizolysis was successful in 67% of patients with mechanical low back pain without evidence of disc herniation and nerve-root compression or psychogenic pain, who had not previously undergone an operation for relief of the pain.
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PMID:Percutaneous radiofrequency lumbar rhizolysis (rhizotomy). 13 70

Low-back pain may arise from degenerative changes in the posterior joints of the lumbar spine. These joints are innervated by a branch of the posterior primary ramus, which follows an antomically constant course. Pain impulses from these joints can be interrupted by coagulating the nerve with a radiofrequency wave, the probe having been placed in the area of the nerve percutaneously. Percutaneous lumbar rhizolysis was carried out under local anesthesia on an outpatient basis in 82 patients, most of whom had multiple level rhizolysis, Rhizolysis was successful in 67% of patients with mechanical low-back pain without evidence of disc herniation and nerve-root compression or psychogenic pain, who had not previously undergone an operation for relief of the pain.
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PMID:Percutaneous radiofrequency lumbar rhizolysis (rhizotomy). 14 50

The question of real vs. psychogenic pain is considered, and the importance of psychiatric counseling discussed. Hospital staff should also be advised by trained psychiatric personnel how to deal with countertransference. Flexible, eclective, and intensive therapy can certainly help the pain-prone patient.
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PMID:The use and abuse of psychiatry in dealing with pain patients. 49 28

A series of 37 patients with chronic pain was investigated with regard to neurologic and psychiatric variables. Twenty of the patients were classified as having mainly organic (= somatogenic) pain syndromes while 17 patients were rather suffering from psychogenic pain syndromes. Samples of lumbar cerebrospinal fluid (CSF) were obtained from the patients and analyzed for the presence of opiate receptor-active material, here called endorphins. Patients classified as having mainly organic pain syndromes were found to have significantly lower endorphin levels than patients with predominantly psychogenic pain syndromes. In the total group of patients as well as in the two subgroups, there was a significant correlation between CSF endorphin levels and the depth of depressive symptomatology as reported by the patients. On the other hand, there was no correlation between CSF endorphin levels and extent of anxiety or motor retardation. It is concluded that CSF endorphins reflect central processes involved in chronic pain syndromes.
Pain 1978 Aug
PMID:Endorphins in chronic pain. I. Differences in CSF endorphin levels between organic and psychogenic pain syndromes. 69 70

This study investigates the capacity of the MMPI to discriminate among groups of patients with different types of pain. When multivariate analysis of variance is used, the standard set of MMPI scales discriminates between acute pain and chronic pain but not between chronic pain of two different etiologies (surgical-iatrogenic vs. unknown). The three scales that discriminate acute from chronic pain patients are those in the "neurotic triad," Hs, D, and Hy. The possibility that the unknown pain etiology group could be broken down into psychogenic pain and undetected somatogenic pathology subgroups was explored using cluster analysis. This procedure did not yield any group of patients who could be identified as having chronic pain of psychogenic origin. These results suggest that the MMPI is not a reliable tool for the differential diagnosis of chronic pain. It appears, however, that patterns of findings are partly contingent on population characteristics. Researchers should be cautious about generalizing to populations other than those from which samples are drawn.
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PMID:The MMPI and chronic pain: the diagnosis of psychogenic pain. 75 72

This article describes characteristics of groups of patients with a high probability of having pain complaints on an emotional basis. An approach to patients with psychogenic pain, including management suggestions, is emphasized, with particular reference to the use of extensive history for their identification and the importance of minimizing unnecessary medical and surgical procedures.
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PMID:Patients with psychogenic pain. 83 61

The concept that all pain must have an organic cause if not the pain is not real, is still very common in medical practice. For chronic pain this leads to big costs by repeated technical examinations and often even to iatrogenic injury to the patient as a result of diagnostic or therapeutic interventions. Psychogenic pain patients are particularly afflicted by this process of chronification. The results of a study investigating 151 chronic patients show, that psychogenic pain patients (PP, n = 75) are significantly different from those whose pain was caused by organic factors (OP, n = 35) regarding their development in childhood and adolescence (in the sense of a marked emotional deprivation). Including additional parameters raised by a structured interview (SBAS) and the trait-score of the STAI an identification of PS is possible with high sensitivity and specificity (about 95 percent). By the aid of the maturity of defence mechanisms three taxonomic subgroups in PP can be differentiated (type A, B, C). Between these types there are significant differences regarding illness behaviour (e.g. medication abuse, "doctor shopping") and responsiveness to a psychological pain interpretation. The results confirm the necessity of a differentiation of chronic pain patients as to the etiology and pathogenesis and furnish even the physician without psychosomatic education with diagnostic criteria relatively simple to raise. By these criteria a prevention of chronification in a lot of pain patients is possible. Derived from the results a pathogenic model for psychogenic pain is developed.
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PMID:[The benign chronic pain syndrome. Diagnostic subgroups, screening parameters, biographical disposition]. 149 38

In a retrospective study on 151 chronic pain patients the relevance of childhood factors as described by G. L. Engel ("pain-proneness") are empirically investigated. All patients are studied by a structured interview developed for pain patients. Two groups were clinically differentiated and compared regarding childhood development: A psychogenic pain group (PP) without any somatic pathology (IASP-classification axis 5: 09; n = 75) and a group of chronic pain patients with somatic pathology (OP; n = 35). A "psychosomatic group" (IASP-axis 5: 07, e.g. migraine; n = 41) was excluded from further investigation. There are significant differences between PP and OP regarding the emotional quality of the relationship to both parents, physical abuse by the parents, a higher strain of both parents by the job (often a family enterprise), frequent aggressive conflicts between parents and their separation or divorce. Often a favorite toy or animal replaced the missing object. Pain or complaints with same localisation of significant others are significantly more frequent. No significant differences between the two pain groups are found as to loss of parent by death and the number of hospitalisation during childhood.
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PMID:[Parent-child relations as a predisposition for psychogenic pain syndrome in adulthood. A controlled, retrospective study in relation to G. L. Engel's "pain-proneness"]. 192 68

A significant proportion of patients seen in the Emergency Department will present with somatic complaints for which there is no apparent physiologic cause. Such patients may be divided into two broad categories: (1) those with symptoms and signs consciously synthesized by the patient, either for obvious secondary gain (malingering) or as a result of more subtle and complex motivations (factitious disorders); and (2) those patients with symptoms that are the unconscious expression of psychological stress (somatoform disorders). The somatoform disorders include (1) somatization disorder (characterized by a chronic history of numerous and widely divergent somatic complaints), (2) psychogenic pain disorder (somatization expressed in terms of persistent pain), (3) hypochondriasis (a conviction that one is diseased and disabled in conjunction with a well-focused constellation of supporting symptoms), and (4) conversion disorder (a single, usually nonpainful neurologic symptom, often with identifiable coping value for the patient). The first three disorders have been aggregately termed the "common somatization syndrome." Management of the somatically focused patient includes the communication of a caring attitude to the patient in conjunction with a cautious and diligent search for treatable medical or psychiatric illness. Resocialization and development of patient links with ongoing, nurturing nonmedical as well as medical support systems is of benefit.
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PMID:The somatic patient. 200 63


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