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

Animal data indicate that serotonin (5-HT) is a major neurotransmitter involved in the control of numerous central nervous system functions including mood, aggression, pain, anxiety, sleep, memory, eating behavior, addictive behavior, temperature control, endocrine regulation, and motor behavior. Moreover, there is evidence that abnormalities of 5-HT functions are related to the pathophysiology of diverse neurological conditions including Parkinson's disease, tardive dyskinesia, akathisia, dystonia, Huntington's disease, familial tremor, restless legs syndrome, myoclonus, Gilles de la Tourette's syndrome, multiple sclerosis, sleep disorders, and dementia. The psychiatric disorders of schizophrenia, mania, depression, aggressive and self-injurious behavior, obsessive compulsive disorder, seasonal affective disorder, substance abuse, hypersexuality, anxiety disorders, bulimia, childhood hyperactivity, and behavioral disorders in geriatric patients have been linked to impaired central 5-HT functions. Tryptophan, the natural amino acid precursor in 5-HT biosynthesis, increases 5-HT synthesis in the brain and, therefore, may stimulate 5-HT release and function. Since it is a natural constituent of the diet, tryptophan should have low toxicity and produce few side effects. Based on these advantages, dietary tryptophan supplementation has been used in the management of neuropsychiatric disorders with variable success. This review summarizes current clinical use of tryptophan supplementation in neuropsychiatric disorders.
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PMID:L-tryptophan in neuropsychiatric disorders: a review. 130 30

The past year has witnessed a dramatic increase in the number of studies that have focused on psychosocial and behavioral components of spinal cord injury (SCI) rehabilitation. The current article reviews and synthesizes this research highlighting the most important contributions to the areas of psychological adjustment, employment, suicide and mortality, aging, substance abuse, cognitive impairment, and pain management.
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PMID:Spinal cord injury and its rehabilitation. 139 39

This article reviews important psychosocial factors that effect reintegration of the burned patient into society. Issues of pain, brain injury, the psychological reaction, posttraumatic stress, the impact on the family, and alcohol and substance abuse are discussed, and possible solutions to these problems are offered.
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PMID:Reintegrating the healed burned adult into society: psychological problems and solutions. 163 67

The phenomenon of adolescent depression combines depressive symptoms with adolescent developmental variables and contextual factors, such as family patterns, ethnic background, socioeconomic status, gender, biologic factors, and individual experience with personal loss. These developmental and contextual factors lead to specific adolescent manifestations of depression, such as academic problems, sexual activity, substance abuse, conduct disorders, pain, eating disorders, and the potential for suicide. Assessment of the depressed adolescent includes specific questions concerning these possible manifestations and problem behaviors. Thorough assessment always includes questioning about the possibility and lethality of suicidal ideation. Modes of treatment include counseling, various forms of individual and group psychotherapy, environmental manipulation, and use of psychopharmacologic agents. Follow-up care is essential for the prevention or early treatment of future depressive episodes. The ultimate goal of care of the depressed adolescent is to prevent suicide and to minimize disruption of the adolescent developmental process.
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PMID:Depression in adolescents. Context, manifestations, and clinical management. 189 92

This review draws on data obtained in the cancer pain, nonmalignant pain, and addict populations to examine critically the major issues raised by the use of chronic opioid therapy in nonmalignant pain. The available evidence suggests that there is probably a selected subpopulation of patients with chronic nonmalignant pain who may obtain sustained partial analgesia without the development of toxicity or the psychologic and behavioral characteristics of addiction. Future discussions of this approach must adequately define the terminology of addiction and strive to distinguish medical considerations from the societal and regulatory influences that may affect prescribing behavior. Those who treat patients with chronic pain must actively participate in these discussions lest decisions with enormous impact on patient care be made solely by those whose primary responsibility is the elimination of substance abuse.
J Pain Symptom Manage 1990 Feb
PMID:Chronic opioid therapy in nonmalignant pain. 196 92

Recent reports suggest that opioid maintenance may be appropriate for treatment-resistant patients with chronic nonmalignant pain syndromes. However, a history of substance abuse is thought to be a contraindication for such treatment. We present a pilot study of a methadone maintenance-type treatment for patients with both chronic pain and substance abuse, evaluating the ability to attract and hold patients, the methodology for assessing change, and the potential problems and pitfalls. Weekly random urinalysis, weekly psychotherapy, and quarterly self-report tests of pain, mood, and function were used to evaluate change. Three out of 4 patients remained in treatment for 19-21 months, stopped needle use, and/or markedly decreased substance abuse, and appear to have improved functionally. Surprisingly, all 3 patients had significant psychopathology requiring treatment with psychotropic medication. This treatment may warrant further research.
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PMID:Chronic pain and substance abuse: a pilot study of opioid maintenance. 198 Dec 44

Chronic pain is a problem of great public health importance that is frequently seen in the primary care setting. Pain chronicity shows a strong association with psychosocial factors. Assessment of these factors should be composed of two parts: (1) psychological factors and (2) psychiatric illness. Psychological factors include all those pain-associated alterations in the patient's environment that reinforce illness behavior. Psychiatric illness includes those syndromes that retard recovery from illness or injury, such as depression, anxiety, substance abuse, and dementia. Psychiatric and psychological interventions can be successfully introduced in the context of a comprehensive rehabilitation effort. Usually these interventions can be accomplished by the family physician in concert with a consultant psychiatrist or psychologist. In severely disabled or resistant patients, referral to a multidisciplinary pain clinic will be necessary.
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PMID:Chronic pain in primary care. Identification and management of psychosocial factors. 199 47

Depressed patients and suicidal patients are common Emergency Department patrons with the potential for serious morbidity or death. Dysphoric mood, vegetative symptoms, and negative perceptions of oneself, the environment, and the future are characteristic of depression. Often, the patient is unaware of the depression and presents with a variety of somatic complaints, chronic fatigue, or pain syndromes. In these instances, the physician must consider the diagnosis of depression and ask the patient about any history of depressive symptoms. In all depressed patients, a careful history and physical examination are needed to identify any drugs or concurrent medical illnesses which might cause or exacerbate the depression. If depression is suspected or if the patient presents after a suicide attempt, then a thorough evaluation of suicide potential is mandatory. Several risk factors for completed suicide exist. Male sex, age under 19 or over 45, few social supports, and a history of previous suicide attempts are all factors associated with increased suicide rates. Concurrent chronic or severe medical illnesses and certain psychiatric illnesses, notably depression, schizophrenia, and substance abuse, also increase an individual's risk for suicide. The method of suicide attempt and the chance for rescue must also be considered when determining risk as well as the presence of an organized plan. Acute psychosis in the suicidal patient is an ominous finding and these patients should be admitted to the hospital. The physician must adopt an empathetic and nonjudgmental attitude when caring for potentially suicidal patients. Disposition can be determined after careful evaluation of risk factors, circumstances surrounding the attempt, and the patient's current feelings. Consultation with a psychiatrist or another mental health professional is desirable for any potentially suicidal patient. Many such patients can be safely treated as outpatients with proper referral; certain high-risk individuals will need to be admitted to the hospital. The decision to either hospitalize or discharge can be difficult and the emergency physician should admit the patient if doubt exists.
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PMID:Depression and suicide assessment. 200 61

A case of retropharyngeal emphysema associated with drug abuse is presented. Although chest symptoms of pneumomediastinum have been widely reported with substance abuse, pain localized to the neck is rarely described. In the present case, localized dysphagia was the only complaint, and no free air could be demonstrated within the thorax. For uncomplicated cervical emphysema or pneumomediastinum due to substance abuse, extensive workup may be unnecessary, and conservative therapy, including administration of 100% oxygen and observation is recommended if resolution is prompt.
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PMID:A simple sore throat? Retropharyngeal emphysema secondary to free-basing cocaine. 209 67

Recent literature indicates a relationship between history of sexual abuse and subsequent psychological and social dysfunction. Less thoroughly examined are the possible abuse-related physical effects. This article examines the prevalence of sexual abuse among 135 chronic pain patients. History of abuse for all patients was determined during initial interview. Twenty-eight percent reported child sexual abuse, with history of victimization more significant for women (39%) than men (7%). The abused and nonabused groups of women differed on such variables as marital status, occupation, history of rape and substance abuse, and age of hospitalization. The relationship between sexual abuse and chronic somatic reactions was discussed.
Clin J Pain 1990 Jun
PMID:Childhood sexual abuse among chronic pain patients. 213 3


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