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The role of preoperative anxiety in perioperative adaptation is viewed in two different ways. Janis suggested that anxiety is a drive that evokes the cognitive work of worrying. Leventhal stresses the importance of coping behavior for adaptation, while anxiety may or may not accompany this coping process. Both theories have empirical support. The aim of this study was to determine whether both theories could show empirical support because the scientists chose different methods: Janis used interviews, Leventhal and Lazarus anxiety scales. The study analyzed the pre- and postoperative emotional reactions of surgical patients with three different methods of anxiety measurement: an anxiety scale, a fear thermometer, and a psychoanalytic interview (Gottschalk-Gleser content analysis method). The different methods were compared and related to the adaptation behavior (Table 3). The data showed a clear interaction between the selected methods and respective theories about the effects of preoperative anxiety on intra- and postoperative adaptation. The anxiety scales showed no correlation with adaptation behavior (blood pressure and heart rate during surgery; postoperative pain medication) and were not related to the anxiety scores obtained from the interview (content analysis). On the other hand, the interview anxiety measurements showed a clear relationship between separation anxiety (and also shame anxiety), physiological excitement during surgery (increase in heart rate), and postoperative medication (increased analgesics and tranquilizers). The patients who worried about the risks of surgery (Verletzungsangst, see Fig. 3) had very good perioperative adjustment, so that the quality of anxiety measured in the interview was very important for the prediction of adaptation.
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PMID:[Subjective verbal methods in preoperative measurement of anxiety]. 340 1

On the basis of 18 preoperative variables obtained consecutively in 31 patients undergoing drainage operation for pain in chronic pancreatitis, a preoperative discriminant score for satisfactory/unsatisfactory result is set up. The patient most likely to be free of pain after the operation has no preoperative use of tranquilizers, no diabetes, little dilatation of the pancreatic duct, no small pseudocysts, but daily use of opiates. This is probably not a matter of causal connection but rather an expression of common underlying pathophysiological mechanism(s), somatic or psychological. A pocket chart for the practical use in the preoperative assessment index is designed.
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PMID:Prediction of outcome of pancreaticogastrostomy for pain in chronic pancreatitis. 358 2

The problems of long term treatment with antiparkinson drugs are numerous, involving increased involuntary movements, painful dystonic cramps, decrease or loss of therapeutic benefit, wearing-off, episodes of akinesia (on-off) and long periods of "freezing". Important side effects are also mental changes with heavy dreams, hallucinations, nocturnal confusional states and paranoid psychosis. As most of these side effects are dose-related, they are postponed and lessened by small daily doses of L-dopa and decarboxylase inhibitor. Frequent small doses may decrease the wearing-off effect but may cause unpredictable episodes of on-off. The addition of or partial replacement by bromocriptine may decrease fluctuations and dyskinesias in many patients. To reduce the side effects such as nausea, orthostatic hypotension and mental disturbances, daily doses of 15-30 mg should be built up very slowly. Painful dystonias are related to the off period and respond well to baclofen. For the treatment of severe psychic disturbances tranquilizers with little or no extrapyramidal side effects, such as clomethiazole, benzodiazepine derivatives and (if necessary) thioridazine, are recommended. Bromocriptine may also be useful in occasional cases which do not, or no longer, respond to L-dopa.
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PMID:[Parkinson therapy 1985]. 372 12

A Michigan couple sued a pharmacist (Troppi is Scarf) for dispensing tranquilizers instead of oral contraceptives to the wife, who became pregnant and was delivered of her healthy but unwanted eighth child. The trial court judge dismissed the case on the grounds that the State's policy considered a healthy child a benefit. Michigan court of Appeals reversed the decision, making the pharmacist liable for damages on 4 courts: the cost of rearing the child, the pain and anxiety of pregnancy and birth, medical and hospital expenses, and the woman's lost wages owing to the pregnancy, childbirth and child-rearing. A jury will assess the amount of the damages. Discussion of the cost of rearing a child concerned the modern lack of economic value of the child's services or companionship versus the value of the joys of bringing up a child, and the defendants claimed that the child should have been aborted or adopted. The court decided that the defendant could not expect the mother to have the emotional and mental makeup to abort or have the child adopted. This case is one of the first such decisions in American courts.
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PMID:The birth of a healthy child due to negligent failure of "Pill": Benefit or loss? 509 21

In order to identify those chronic pain patients unlikely to improve from nerve blocks, preadmission questionnaires of 337 patients were studied and various pre-existing factors were analyzed against short term treatment results. Factors associated with significant reductions in treatment success (P less than 0.05) included: being injured at work, being out of work because of pain, receiving financial compensation, involvement in legal action, previous surgery for pain, long duration of pain, high pain severity ratings, frequent analgesic use and use of tranquilizers.
Pain 1981 Jun
PMID:Factors predicting short-term outcome of nerve blocks in the management of chronic pain. 616 96

A retrospective study of 200 chronic pain patients was conducted to determine whether preexisting physical or social factors influence treatment success with transcutaneous electrical nerve stimulation (TENS). Responses to 30 questions from a preadmission questionnaire were analyzed against short-term treatment success. Patients with pain of more than a year's duration, who had undergone multiple surgical operations for pain control, who used tranquilizers, or who were not working because of pain, demonstrated a generally lower rate of treatment success, although the differences were not statistically significant. Treatment success rate was significantly higher for retired patients than for those with blue-collar jobs or those who were unemployed. There was no association between treatment success rate and site, frequency, character or severity of pain, age, sex, use of narcotic analgesics, or the presence of financial compensation or litigation. The value of TENS for chronic pain remains largely empirical.
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PMID:Chronic pain therapy with transcutaneous electrical nerve stimulation: predictive value of questionnaires. 619 Apr 65

Analgesic drug abuse led to end-stage renal disease in 31% of 122 patients in a cross-sectional investigation at our center. Addiction to analgesics and tranquilizers remained a serious problem in these patients even after they were placed on chronic hemodialysis. There is strong evidence that drug addiction leading to end-stage renal disease and chronic hemodialysis correlates with a special type of personality typified by the 60-year-old depressive woman suffering from chronic headache.
Pain 1983 Sep
PMID:Analgesic dilemma in chronic hemodialysis patients. 663 15

Twenty-nine consecutively treated patients over a 5-year period with upper extremity reflex sympathetic dystrophy were admitted to Massachusetts General Hospital for prolonged continuous stellate ganglion blockade. Diagnosis was based on the presence of pain, decreased joint motion, trophic changes, and vasomotor disturbances. Selection for blockade was made on the failure to improve with outpatient physical therapy, tranquilizers, and mild analgesics. Treatment consisted of indwelling-catheter injections of bupivacaine hydrochloride every eight hours to the stellate ganglion for an average of 7 days, supplemented with vigorous physical therapy. Improvement during treatment was documented in all but two patients with regard to pain and decreased joint motion and in two-thirds with regard to trophic and vasomotor changes. Long-term follow-up demonstrated a relapse rate of 25%, but marked improvement persisted in the rest and normal status was attained in four of 26 patients at an average of 3 years later.
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PMID:The treatment of upper extremity reflex sympathetic dystrophy with prolonged continuous stellate ganglion blockade. 683 22

A case of a 36-year-old man, with a history of traumatic amputation below the elbow on the left side, resulting in intractable phantom limb pain, is described. The patient failed to respond to a variety of medications including several analgesics, tranquilizers, and a beta-blocker. Other extended series of conventional treatment modalities, which included stellate ganglion and peripheral nerve blocks and neuromal excision with the anterior transposition of the ulnar nerve, did not relieve the pain. Acupuncture was then attempted with the subjective relief of phantom limb pain and the objective result that the patient could wear a prosthesis.
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PMID:Acupuncture in phantom limb pain. 697 7

A 10 percent random sample of all active patient charts in the Family Practice Clinic at the University of California, Davis, Sacramento Medical Center was analyzed for age, sex, occupation, marital status, and number of clinic visits in the previous 12 months. Diagnoses and treatments for each visit were also recorded. Thirty-six percent of all adult female patients and 26.5 percent of all adult male patients were diagnosed as having psychosocial problems. Patients with psychosocial diagnoses made more visits for both acute and chronic illnesses and were more frequently diagnosed with illnesses in every diagnostic category than were other patients. Women, patients in blue-collar occupations, and patients who had never married or were divorced were most likely to have psychosocial diagnoses. Of the patients with psychosocial diagnoses, 18.8 percent were treated with antidepressants, 16.0 percent with pain medications, and 11.1 percent with tranquilizers.
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PMID:Diagnostic profile of a family practice clinic: patients with psychosocial diagnoses. 705 49


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