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

An unselected sample of outpatient subjects (n = 330) with localized nonspecific low back pain (LBP) was studied. Investigation consisted of clinical assessment, physical examination, and psychiatric interview based on the DSM-III classification. A psychiatric disorder, according to the DSM-III criteria (axis I) was found in 41% of the subjects. Multiple correspondence analysis and cluster analysis were used to objectively identify clinical subtypes without preconceived theoretical models. Correspondence analyses suggested the existence of a 'psychological pain' syndrome consisting of several of the following symptoms: diffuse back pain, impossibility to assess intensity of pain on a pain scale, aggravation of pain by changing climate, by domestic activities or by psychological factors and dysesthesias in the back. Cluster analysis provided support for a four-group classification of low back pain, which may be interpreted through the relationships between psychological disturbances and the LBP clinical features. The results call for further investigation of the complex relationship between psychological disturbances and back pain. However, clinicians must be aware of the interest of a minimal psychiatric assessment in low back pain patients: psychiatric disorders frequently appear in these patients and an appropriate treatment of the psychiatric syndrome may reduce back pain.
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PMID:Classification of nonspecific low back pain. I. Psychological involvement in low back pain. A clinical, descriptive approach. 141 53

During a study of mental disorder in a primary care clinic in Nigeria, 214 patients, selected on the basis of their scores on the General Health Questionnaire, were interviewed with the Composite International Diagnostic Interview, a structured clinical interview that allows for a systematic assessment of somatization symptoms. Only 1.1% of this clinical sample fulfilled the DSM-III-R criteria for somatization disorder, but 4.7% and 10.8% met the criteria for somatoform pain disorder and undifferentiated somatoform disorder, respectively. Age, gender and the presence of a DSM-III-R diagnosis of depression or dysthymia accounted for significant variability in the number of reported somatization symptoms. On factor analysis, a factor with close similarity to DSM-III-R somatization disorder was obtained. This factor is associated with the demographic features commonly found among patients with DSM-III-R somatization disorder.
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PMID:Somatization in primary care: pattern and correlates in a clinic in Nigeria. 141 17

We report data on abdominal pain and depression from a survey of Hispanic Americans by the United States National Center for Health Statistics. The point prevalence rates of chronic abdominal pain were 4.6% in Mexican Americans and 5.8% in Cuban Americans in a total of 4175 subjects. The rate was 8.3% among 1323 Puerto Ricans. In 53% the abdominal pain came in waves. Using the Depression scale of the Center for Epidemiologic Studies (CES-D), 18.7% of Mexican and Cuban Americans with pain were found to be depressed to an extent likely to require intervention, and 40.8% of Puerto Ricans were so affected. The Diagnostic Interview Schedule (DIS) gave more conservative figures for major depression in terms of DSM-III, viz., 6.8% for Mexican and Cuban Americans with chronic pain, and 12.6% for Puerto Ricans with chronic pain. Logistic regression analyses demonstrated links between depression and female sex, the single state, low education and income, and chronic abdominal pain. The most consistent relationships for depression were with chronic pain, female sex and the single state. The results confirm the strong relationships between chronic pain, mood and female gender, and other socio-demographic variables.
Pain 1992 Apr
PMID:Chronic abdominal pain and depression. Epidemiologic findings in the United States. Hispanic Health and Nutrition Examination Survey. 159 84

In DSM-III-(R) functional syndromes are introduced, which are partly important for the earning capacity of the afflicted patients. In this paper the somatoform pain disorder is discussed exemplary. According to the DSM-III-R patients with somatoform pain disorder gets typically incapacitated for working. Problems of examination of these patients are reflected in regard of the social insurance pension for patients with traditional neurosis. The construct of the somatoform pain disorder implies not a well-differentiated concept as it existed in the neurosis. Finding out the correct diagnosis depends mainly on the patients self description. Because of this, there are problems to distinguish this disorder from malingering. The estimation of the earning capacity depends mainly on the severity of the disorder, which can be determined analogous to the neurosis. Important social medical aspects (e.g. early recognition) are pointed out.
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PMID:[Somatoform pain and work capacity]. 160 62

This study used structured diagnostic interviews and DSM-III criteria to assess lifetime prevalence and pre-morbid risk of psychiatric disorder in a sample of men with long-standing chronic back pain (CLPB) attending a primary care clinic. A control group of age and demographically matched men without history of back pain was also studied. Compared to controls, men with CLBP had significantly higher lifetime rates of major depression (32% vs. 16%), alcohol use disorder (64.9% vs. 38.8%), and a major anxiety disorder (30.9% vs. 14.3%). Almost all CLBP men ever experiencing a mood disorder reported recurrent, not single, episodes. The 6 month point prevalence of major depression, but not other disorders, was also significantly elevated for men with CLBP. In CLBP, the first episode of major depression generally (58.1%) followed pain onset. While the initial major depressive episode usually commenced within the first 2 years of established pain, late onset mood disorder was also common. By comparison in most cases (81%) onset of alcohol use disorders considerably preceded pain. When an age-matching procedure was used to gauge relative vulnerability to psychiatric illness in patients and controls, CLBP patients had significantly higher pre-pain rates of alcohol use disorder but not depression. After age of pain onset, CLBP subjects had over 9 times the risk of developing major depression, but had similar rates of developing alcoholism. We conclude that (1) alcohol use disorders rather than depression may increase risk of developing CLBP, and (2) risk of new onset and recurrent major depression remains high for men throughout their pain career. This suggests that psychological adaptation to long-standing pain may be less successful than previously thought, especially with regard to recurrent mood disorder.
Pain 1991 May
PMID:Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: a controlled study. 183 55

Any undue concern with bodily function is often labeled as hypochondriacal. Kellner's Illness Attitude Scales, self-rating instruments, distinguish between generic worry about illness, concern about pain, health habits, hypochondriacal beliefs, thanatophobia, disease phobia, and bodily preoccupations. The Illness Attitude Scales have been used in a number of studies concerned with patients suffering from DSM-III-R hypochondriasis, panic disorder, melancholia, in the medically ill, in pregnant women, during medical procedures such as mammography, and in experiments in therapeutics, such as drug trials. The results of these studies and of clinical investigations suggest that the differential diagnosis between hypochondriacal beliefs (characterized by resistance to reassurance), disease phobia, thanatophobia, and the other less specific illness attitudes, is worthy of clinical attention and may entail prognostic and therapeutic implications. Pilowsky's concept of abnormal illness behavior, unlike the DSM-III-R, provides a framework for such differentiation.
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PMID:Differential diagnosis of hypochondriacal fears and beliefs. 189 57

Nursing home and congregate apartment residents (N = 598) were classified on the basis of a DSM-IIIR symptom checklist as suffering possible major, minor, or no depression; they also completed the Geriatric Depression Scale (GDS) and the Profile of Mood States (POMS). Possible major depressives reported more intense pain and a greater number of localized pain complaints than did minor depressives; nondepressed individuals reported the least intense pain and fewest localized complaints. The effect remained strong even when functional disability and health status were controlled statistically. Both pain intensity and number of localized complaints were correlated with GDS and POMS factor scores, but strength and direction of associations varied with level of depression. Item-by-item examination of localized complaints again indicated that more depressed individuals were more likely to report pain, particularly where physicians had identified a physical problem that might account for the pain. Results are compared with previous research on pain among younger individuals. Implications for treatment of depressed elderly are discussed.
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PMID:The relation of pain to depression among institutionalized aged. 198 40

Cardiovascular manifestations of anxiety have long been known. A particularly intriguing problem even today is the differentiation between real and false "heart attacks". We compared 20 patients with functional cardiac complaints and 20 patients with myocardial infarction with respect to their "heart attacks" and psychological disorders. In spite of methodological problems our results indicate much more dramatic symptoms in the functional group. Their localization of "cardiac" pain resembled the generally accepted picture for myocardial infarction much more than that of the patients with an actual infarction. Functional patients showed more help seeking behavior and were less able to describe triggers for their attacks than patients with myocardial infarction. Functional patients largely met DSM-III-R diagnostic criteria for panic disorder and had a higher prevalence of other psychological disorders.
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PMID:[Myocardial infarct, functional heart symptoms and panic syndrome]. 201 47

The 28-item Dissociative Experiences Scale was administered to a stratified cluster sample of 1,055 respondents in the general population of Winnipeg. Dissociative experiences were common in the sample and were not related to socioeconomic status, sex, education, religion, or place of birth, although they declined with age in both sexes. A principal components analysis identified three factors accounting for 47.1 percent of the combined variance of the scores. The first factor, absorption-imaginative involvement, is composed of common, benign experiences, such as missing part of a conversation and being able to ignore pain. The other two factors, activities of dissociated states and depersonalization-derealization, composed of less common experiences such as not recognizing friends or family members and not recognizing one's reflection in a mirror, may be powerful predictors of DSM-III-R dissociative disorders.
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PMID:Dissociative experiences in the general population: a factor analysis. 203 14

The authors discuss posttraumatic stress disorder (PTSD) as a basis for personal injury litigation. Three case examples raise issues related to: (1) the controversy surrounding expansion of tort liability, (2) the courtroom use of psychiatric nomenclature as represented in the DSM (e.g., PTSD), and (3) ethical concerns regarding psychiatric expert witnesses. Psychiatrists became easy targets when problems related to personal injury "stress" cases developed. A careful analysis, however, demonstrates that the issues are complex and multifaceted. For example, tort liability expansion was primarily instituted to compel a greater provision of liability insurance, not to reward stress claims. The increasing use of psychiatry's DSM in the courtroom has occurred despite explicit precautions against forensic application. Finally, the need for psychiatric expert witnesses has increased because courts have gradually usurped some psychiatric clinical prerogatives and because there has been a trend toward greater consideration of emotional pain and suffering. Although psychiatric expert witnesses have not been beyond reproach, critics have attempted to impeach the entire psychiatric profession for the questionable actions of the minority. The authors provide a detailed analysis of current problems, offer suggestions for improvement, and provide an educational counterpoint to the "hysterical invective" that often greets psychiatric testimony.
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PMID:Posttraumatic stress disorder in tort actions: forensic minefield. 224 44


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