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

This study examined the issue of rational decision-making involved in the 'patient need' standard of informed consent. A majority of elective cholecystectomy patients (90% of 144) correctly identified their risk of death on a multiple choice questionnaire after preoperative counselling, but before surgery. However, many of those patients who answered correctly (54%) reported that they were not informed about the risk of death when questioned again after discharge. An attempt to discriminate patients who reported being informed from those who did not using measures of preoperative pain, emotional distress and medication was not successful. Faced with an inability to obtain informed consent from some patients, coupled with legal liability for failing to do so, surgeons are advised to obtain consent in writing, to provide comprehensive, multi-media counselling, and to be particularly conscientious with confused patients and those with complications.
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PMID:Patients may not recall disclosure of risk of death: implications for informed consent. 239 3

A survey of general practitioners in north west London was undertaken by questionnaire to elicit information about problems that they had had in looking after patients at home who were terminally ill and about their perceived needs for both training and support services. The response rate was 73% (196 of 268 doctors). Thirty two per cent of respondents frequently or always had problems in controlling pain in such patients, and 45% frequently or always had difficulties in coping with the emotional distress of patients or relatives, or both. Between 20 and 30% of respondents often had problems with inadequate support services, poor communication with support services and hospital specialists, and difficulty in admitting patients who were terminally ill. Roughly half of the respondents thought that more training in managing pain and other symptoms that are associated with terminal illness would be of great help, and a similar response was noted for bereavement counselling. About 40% of respondents indicated that training in communicating with dying patients would be a great help in improving care and three quarters that more home nursing support was necessary.
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PMID:Terminal care at home: perspective from general practice. 242 20

Experience of pain is manifested by a subject's behaviour, i.e. by verbalization, movements, facial expressions etc. Experience of pain is a latent construct, and the question of whether the pain is "real" becomes secondary when the behavioural aspect is emphasised: "When the patient communicates pain, then there is a pain problem". The task of the clinician and the researcher is to find out what is behind a person's response to pain. The pain behaviour is determined by many factors. These include psychological suffering due to emotional distress; learning processes regulating pain behaviour; anticipated pain and fear of pain as a cause of passivity and avoidance behaviour in chronic low back pain patients; the influence of cognitive factors, particularly the relationship between negative expectations, cognitive distortion and activity; and finally, the role of psychological distress in chronic pain. These factors are discussed in this paper. Some empirical studies are briefly reviewed to illustrate the topic. Implication of these conceptualizations for treatment of and outcome research in chronic low back pain will be briefly discussed.
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PMID:Determinants of pain behaviour in patients with chronic low back pain. 253 28

The relationship of electromyographic (EMG) and temporal artery vasomotor activity to MMPI subgroups was examined in 60 chronic headache sufferers. Analysis of the right frontalis data revealed a significant interaction between MMPI subgroup and position (reclining, sitting, standing) with a trend toward the same interaction with the left frontalis. However, this effect was only found when the contemporary MMPI norms were utilized in the formation of the subgroups. No effects were found for the bilateral trapezius EMG or bilateral temporal artery sites. Analysis of the self report data revealed a significant main effect for the Total Pain Score of the Pain Mannequin but not for a current headache intensity rating. Again, the former effect was seen most clearly when the contemporary MMPI norms were used. In general, these data support a Psychological Distress Hypothesis in that patients with significant elevations (greater than 70) demonstrated greater frontalis EMG activity and higher Pain Mannequin scores. Additionally, the data demonstrate the importance of utilizing the contemporary MMPI norms in the formation of subgroups.
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PMID:The relationship of electromyographic and vasomotor activity to MMPI subgroups in chronic headache patients: the use of the original and contemporary MMPI norms. 258 98

Somatization disorder (SD) is a syndromatic classification that allows a physician to identify more easily patients with a lifelong history of chronic subjective physical complaints that are unverified by objective examinations either at the time of initial presentation or during the subsequent five years. The somaticizing process is believed to be an expression of emotional distress. The most common complaints of SD patients include recurrent pain (site and quality vary), conversion (pseudoneurologic) symptoms, nervousness or depression (or both), sexual and marital discord, and, often, menstrual difficulties. Such patients will generally have a history of repeated hospitalization or surgery. These symptoms are not perceived as mild or unimportant but lead to physician consultation, prescription drug use, and modification of life-style. Such patients are prone to "doctor-shopping" and self-medication and are at risk for many iatrogenic illnesses. Because they generally are resistant to psychologic explanations for their condition, management aimed at protecting them from the consequences of their behavior is important. A heightened threshold for instituting aggressive diagnostic and treatment procedures is necessary.
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PMID:Somatization disorder. 266 8

Pain patients' retrospective reports of pain are important to physicians and other health professionals in helping to decide on future treatment plans. Unfortunately patients' memory of pain can be inaccurate and subject to overestimation. This study examined variables which influenced accuracy of remembering pain in 93 chronic pain patients. The patients were initially evaluated by a physician and completed a comprehensive pain questionnaire and an SCL-90. All patients were asked to monitor their pain intensity every hour for 1 week. At the end of this period each patient was asked to estimate their average pain intensity ratings for 4 times during the day for the previous week. These estimations were compared with the actual mean pain ratings. Results showed that most patients tended to overestimate their pain intensity levels. Cervical and low back pain patients were found to be more accurate than headache and abdominal pain patients in remembering their pain. Patients who reported more emotional distress, who had conflicts at home, who were less active and who relied on medication tended to be the most inaccurate in remembering their pain.
Pain 1989 Jun
PMID:The influence of physical and psychosocial factors on accuracy of memory for pain in chronic pain patients. 275 10

In 539 patients 5 years after myocardial infarction (MI), quality of life and factors influencing life quality were studied. All patients originally participated in an early intervention trial with metoprolol. A cardiac follow-up questionnaire and the Nottingham Health Profile were answered by 82%. In the former, information about subjective symptoms, smoking, work and current medication was obtained; the latter described health-related quality of life in terms of energy, sleep, emotions, mobility, pain and social isolation. The rate of and the reasons for rehospitalization were registered in the patients' records. The MI patients reported a comparatively high quality of life. Compared with 'normal' population, a decrease was noted in energy, sleep and mobility, and in sex life, hobby-activity and holiday activity. A nonparametric multivariate analysis disclosed that dyspnoea, angina pectoris and anxiety were closely associated with decreased quality of life. In conclusion, 5 years after MI most patients seemed well-adjusted. Impaired quality of life was reported by patients suffering from angina pectoris, dyspnoea and emotional distress. No relationship was found between health-related quality of life and the beta blocker, metoprolol, which was the most frequently used drug.
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PMID:Quality of life five years after myocardial infarction. 275 9

One hundred thirty-six (136) patients referred for manometry were studied to see if a multidimensional psychometric inventory could differentiate those with esophageal contraction abnormalities from subjects with other manometric diagnoses. Contraction abnormalities are manometric findings commonly used to support the diagnosis of esophageal spasm syndrome. Recent psychological symptoms were determined using the Hopkins Symptom Checklist (SCL-90R). Three groups of symptomatic patients were compared: those with contraction abnormalities (n = 86), those with aperistalsis (n = 14), and those with normal peristaltic patterns (n = 36). Subjects with contraction abnormalities appeared mildly and diffusely more psychologically symptomatic than those with aperistalsis, but these findings were not apparent with statistical control of between-group differences in recent pain. Contraction abnormality patients could not be differentiated from those with no manometric abnormality. These findings indicate that short-term emotional distress does not effectively differentiate patients with esophageal symptoms and contraction abnormalities from symptomatic patients with other manometric diagnoses.
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PMID:Value of recent psychological symptoms in identifying patients with esophageal contraction abnormalities. 279 3

A modified version of the McCorkle & Young Symptom Distress Scale, based on a linear analogue self-assessment scoring system, was used to assess symptom distress in a heterogeneous sample of 53 cancer patients. The scale was simultaneously completed by the nurses caring for those patients, who were asked to rate the patient according to how they perceived he was feeling with regard to each particular symptom. The scores were compared for congruency. This preliminary study suggests that, although nurses appear able to estimate the degree of distress due to changes in mobility and appearance or the presence of diarrhoea, constipation and tiredness, they are less effective in perceiving the degree of distress due to the less 'visible' symptoms such as pain, nausea, anorexia, sleeping disturbances, concentration and mood. Perhaps surprisingly, the trend was for nurses to overestimate the degree of distress when this was compared with the patients' self-assessment.
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PMID:Patients' and nurses' perceptions of symptom distress in cancer. 280 38

We examined the relationship between pain and cognitive activity during the latent (less than or equal to 3 cm), mid-active (5-7 cm), and transition (greater than or equal to 8 cm) phases of labor and the concomitant efficiency of the latent, active, and descent phases in 115 nulliparous women. Patients provided subjective pain ratings and described their thoughts during each of the three phases. Higher levels of pain during the latent phase of labor were predictive of longer latent (r = 0.58) and active (r = 0.50) phases of labor. Distress-related thoughts during latent labor were predictive of longer latent (r = 0.31, P less than .01), active (r = 0.67), and second-stage (r = 0.61) labor. We found no relationships between pain and cognitive activity measured during active labor and efficiency of active labor or second stage of labor. Pain and cognitive activity assessed during the latent phase were also prognostic of obstetric outcome. Thirteen of 19 women (68.4%) who reported "horrible" or "excruciating" pain required instrumental delivery, compared with eight of 27 women (29.6%) in the "discomforting" pain group. Subjects in the "distress-related" cognitive group had 2.6 times the incidence of instrumental delivery, five times the incidence of abnormal fetal heart rate patterns, and four times the requirement for pediatric assistance for the neonate than subjects in the "coping" group. We conclude that latent labor is a critical phase in the psychobiology of labor and that pain and cognitive activity during this phase are important contributors to labor efficiency and obstetric outcome.
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PMID:The clinical significance of pain and cognitive activity in latent labor. 290 41


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