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

Two interrelated studies are reported. One reports the results of a questionnaire interview with a reference group of 51 general practitioners. The respondents express a considerable dissatisfaction with their previous medical training as it concerns their knowledge of the psychosomatic medical paradigm. The other study evaluates the effects of a 5-year education program concerning psychodynamic theories and an integrative psychosomatic approach to treatment. Six general practitioners participated in this educational program, which included both theoretical seminars and practical training in psychotherapy (under supervision) with patients suffering from chronic idiopathic pain syndrome. All the participants reported developing substantial skill in treating such patients and in handling other kinds of patients with multifactorial etiology of symptoms. The participants of the training program did not initially differ from the larger reference group as to the previous knowledge and practice in integrative psychosomatic medicine, and it may be concluded that many physicians would profit from such post-graduate training. The self-reports of all these experienced physicians also indicate that there is too little theory and practice of the psychesoma interaction in the basic medical education.
Gen Hosp Psychiatry 1992 Nov
PMID:Education of general practitioners in psychosomatic medicine. Effects of a training program on the daily work at Swedish primary health care centers. 147 7

This study compares autogenic training and training in multiple self-hypnosis strategies in a sample of 56 patients diagnosed as having chronic tension headache on the basis of medical evaluation by a neurologist. At posttreatment and follow-up, no differences between the two treatment regimens in the reduction of headache and psychological distress were observed. During treatment, patients reduced their headache activity and level of psychological distress significantly in contrast to the waiting-list period (p < 0.05). Follow-up measurements indicated that therapeutic improvement was maintained (p < 0.05). Short-term and long-term pain reduction was accompanied by an increase in perceived pain control (p < 0.003). Moreover, those patients who attributed the pain reduction obtained during therapy to their own efforts manifested long-term pain reduction (p < 0.003).
Gen Hosp Psychiatry 1992 Nov
PMID:Autogenic training and self-hypnosis in the control of tension headache. 147 11

A variety of analgesic regimens can be developed, based on sound pharmacological principles, in response to the empirical estimate of pain intensity. Including optimal doses of nonopioids to reduce the amount of opioid required is recommended. Furthermore, when pain is anticipated, the nonopioid regimen can be administered on a regular schedule rather than as needed. Preventing pain is better than attempting to reduce it after full intensity has been reached. Careful selection of an effective regimen can prevent breakthrough pain, along with stress and anxiety, which are factors that often require desperate attempts for relief. Options for the dentist to consider are summarized in Table 5 and may be simulated through substitution of other NSAID or opioid equivalents.
Gen Dent
PMID:Considerations for selecting effective analgesic regimens in dental practice. 149 61

This article reviews the relationship between depressive disorders and somatoform disorders, somatization, and pain. These disorders and symptoms are clinically interrelated, yet the nature of the interrelation is not well understood. This review of the literature from 1975 through mid-year 1990 addresses the epidemiology and treatment of these conditions and/or symptoms when they occur together. When robust criteria are used to determine which publications are included, only 14 are available that address depressive disorders, somatoform disorders, and somatization. Similarly, there are only 13 that address depressive disorders and pain. Taken together, these studies indicate that 1) in somatization disorder patients, there is a high prevalence of depression; 2) in patients with major depression, there are substantial levels of hypochondriacal and somatizing symptoms; 3) that depression in the face of coexisting somatization disorder can be successfully treated; 4) in chronic pain patients, there is a high prevalence of depressive disorders; 5) in patients with major depression, pain is a frequent complaint; 6) and finally, that pain improves with the treatment of depression. What is most striking from this review, however, is the very limited number of studies that address these important problems. This lack of research-based data calls for new aggressive research efforts in this area.
Gen Hosp Psychiatry 1992 Jul
PMID:The epidemiology and treatment of depression when it coexists with somatoform disorders, somatization, or pain. 150 48

Painful shoulder conditions are common primary care problems. Providers should learn the topographical landmarks about the shoulder and understand shoulder mechanics. A careful clinical evaluation will usually provide a likely diagnosis. In unclear cases with marked pain, weakness, and reduced mobility, or with a suspected rotator cuff tear or rupture, arthrography or MRI will usually establish a diagnosis. Therapy of bursitis/tendinitis consists of a steroid injection into the inflamed subacromial area or a 14-day trial of an NSAID. Therapy of bicipital tendinitis, largely empiric because definitive studies are unavailable for any specific treatment, includes judicious peritendinous steroid injections and avoiding aggravating activities. In the management of patients with suspected tendon tears or rupture, primary care practitioners can confirm the diagnosis by ordering MRI or arthrography before referring these patients to an orthopedist for definitive surgical therapy. Optimal management of adhesive capsulitis remains unclear, but an intraarticular steroid injection appears beneficial at least in temporarily diminishing pain. Pendular motion exercising is also an integral part of therapy. Deleterious effects of peribursal or intraarticular steroid infiltration appear minimal; but injections into the tendon or frequent, repetitive injections are contraindicated. Each shoulder condition has a variable course, depending on the structure(s) and extent of involvement.
J Gen Intern Med
PMID:Painful shoulder syndromes: diagnosis and management. 844 Oct 74

A survey was made of the general practitioners, hospital consultants and community nurses who had cared for a random sample of people dying in 1987. Their views and experiences of the balance of care between hospital and the community are reported. All three groups wanted more people to be looked after in their homes rather than in hospital if adequate care could be arranged at home. But they perceived inadequacies in home help and district nursing services and many wanted other community services expanded or introduced. The main shortcomings of the hospital service were seen as inadequate numbers of hospice beds, difficulty obtaining admission for people needing long term care, discharge too early and some over-treatment of people who were dying. There was some evidence from relatives that pain control was better in hospital than at home, and the district nurses also reported that pain was not controlled satisfactorily for patients dying at home as often as it could be. It is concluded that inadequacies in community services may discourage some people from taking on the care of their relatives at home.
Br J Gen Pract 1991 Jul
PMID:Balance of care for the dying between hospitals and the community: perceptions of general practitioners, hospital consultants, community nurses and relatives. 172 Sep 59

A series of 25 patients referred for psychiatric consultation with nonspecific abdominal pain (NSAP) are compared with a prospectively admitted series who were not referred. The referred patients had a longer duration of pain and also had high levels of psychiatric illness. The referred patients had more life events associated with the onset of their pain than controls. Inquiry about previous psychiatric history, childhood abuse, and a symptom model would increase the detection of NSAP patients who require psychiatric evaluation. Outcome after recommended treatment is also addressed.
Gen Hosp Psychiatry 1991 Jan
PMID:Psychogenic abdominal pain. 199 16

A chart review was conducted of depressed patients at three general hospitals without psychiatric units. A substantial proportion of the patients did not receive psychiatric consultation. These patients tended to be less seriously ill than those who were evaluated by consulting psychiatrists. Despite the fact that a majority of patients treated without consultation reported disturbances of mood, appetite, and sleep, as well as somatic pain for which no source was readily apparent, only a small proportion received antidepressants in standard dosages. Issues surrounding the indications for and attitudinal barriers to antidepressant use in primary care are discussed.
Gen Hosp Psychiatry 1991 Jan
PMID:Depressed patients who do and do not receive psychiatric consultation in general hospitals. 199 18

Spinalized rats received an intrathecal injection of either (-)-nicotine or (+)-nicotine in order to study the stereoselectivity of antinociception. Pain threshold was measured using the tail-flick test. Both stereoisomers had anti-nociceptive effects, but (-)-nicotine was up to 970 times more potent, depending on test conditions. The antinociceptive action of (-)-nicotine was antagonized by mecamylamine and yohimbine but not by naloxone and atropine. The findings show that spinal mechanisms are highly stereoselective toward nicotine, and suggest that primarily nicotinergic and alpha-adrenergic receptors are involved in its central antinociceptive effects.
J Neural Transm Gen Sect 1990
PMID:Antinociceptive effects of the stereoisomers of nicotine given intrathecally in spinal rats. 215 97

1. The evidence reviewed here indicates that pinaverium bromide (Dicetel) relaxes gastrointestinal (GI) structures primarily by inhibiting Ca2+ influx through potential-dependent channels of surface membranes of smooth muscle cells. 2. The in vivo selectivity of pinaverium bromide for the GI tract appears to be due mainly to its pharmacokinetic properties. Because of its low absorption (typical for quaternary ammonium compounds) and marked hepatobiliary excretion, most of the orally-administered dose of pinaverium bromide remains in the GI tract. 3. Orally-administered pinaverium bromide does not elicit adverse cardiovascular side-effects at doses that effectively relieve GI spasm, pain, transit disturbances and other symptoms related to motility disorders. 4. Pinaverium bromide is the only Ca2(+)-antagonist with known therapeutic efficacy in the treatment of irritable bowel syndrome and certain other functional intestinal disorders.
Gen Pharmacol 1990
PMID:Action of pinaverium bromide, a calcium-antagonist, on gastrointestinal motility disorders. 217 9


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