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

The somatoform disorders present dilemmas on acute inpatient medical/surgical services because they may closely mimic authentic physical illness and result in misapplied medical treatment. However, there have been few diagnostic studies of this important group in the medical/surgical inpatient setting. Inpatient psychiatric consultations at Mount Sinai Medical Center during 1980-1987 were recorded using a 384-item computerized data base protocol. DSM-III somatoform disorders were identified in 33 of 1801 initial consultations (1.8%) and in 35 of 1363 at time of termination (2.6%); demographic and diagnostic characteristics of somatoforms and others were compared. The question of a psychogenic component to the illness and problem with pain management were the most common stated reasons for consultation. Somatoform patients were more likely than others to be female (p less than 0.05), Hispanic (p less than 0.05), and to have Axis II comorbidity (p less than 0.001). Axis III comorbidity was present in 94%. Thirty-one percent of patients diagnosed as somatoform on final follow-up assessment had not been diagnosable as somatoform on initial assessment. The findings emphasize the necessity of ongoing assessment in improving diagnostic certainty, as well as the prevalence and importance of medical comorbidity among patients with somatoform disorders in this setting.
Gen Hosp Psychiatry 1989 Jul
PMID:Somatoform disorders in the general hospital inpatient setting. 274 35

Objective indices (heart rate, perspiration quantity, finger plethysmograph curves, and facial expression) and subjective indices (sensory and emotional subject reports) were recorded for 25 young Chinese adults (16 men, 9 women) during and after the simultaneous application of a strong pain stimulus and either foot classical (alloneural points Tsusanli and Yanglingchuan) or hand classical (alloneural points Hegu and Neiguan) acupuncture. Both forms of acupuncture were equally effective, showing that stimulation of the same nerve is not essential for pain relief. Acupuncture assuaged the emotional, but not the sensory, response to the painful stimulation.
J Gen Psychol 1989 Jul
PMID:Acupuncture and emotion: the influence of acupuncture anesthesia on the sensory and emotional components of pain. 279 83

The authors matched gynecologic patients with the abdominal pelvic pain syndrome (N = 41) with other gynecologic patients. They administered to both groups self-rating scales of anxiety, depression, anger-hostility, and somatization of the Hopkins Symptom Checklist and of the Symptom Questionnaire, a questionnaire about disruptions in early home life, and a questionnaire of recent stressful events. Patients with pain rated themselves on the average significantly more anxious, depressed, and hostile, and had more somatic symptoms than other patients; 56% of the patients with pain rated themselves within the normal ranges on all scales. There were no significant differences between the two groups in reports of disruptions of early home life and recent losses. The findings are consistent with the view that patients with the abdominal pelvic pain syndrome are psychologically a heterogeneous group; in many patients, depression and anxiety may be consequences of persistent pain.
Gen Hosp Psychiatry 1989 Jan
PMID:Anxiety and depression in patients with the abdominal pelvic pain syndrome. 291 19

In a nationwide study of the treatment of acute low back pain with and without radiation in general practice in the Netherlands the subjective well-being of patients was evaluated by means of a short questionnaire sent to patients four weeks after the initial contact with their general practitioner.After this period pain had disappeared in 28% of the patients, was diminished in 47%, was unchanged in 2% and was aggravated in 4%. There was no difference in the pain score of patients with and without follow-up encounters with their general practitioner. In all instances patients with low back pain without radiation fared significantly better than those with radiation. Radiation of pain was not constant - during the four-week follow-up period it developed in 19% of the patients originally without radiation and it disappeared in 44% of the patients originally suffering radiation.
J R Coll Gen Pract 1986 Jun
PMID:Acute low back pain: patients' perceptions of pain four weeks after initial diagnosis and treatment in general practice. 294 9

Survival duration and health quality are fundamentally important aspects of health. A utility model for survival duration and health quality is a model of the subjective value of these attributes. We investigate the hypothesis that the utility (subjective value) of survival duration and health quality is determined by a multiplicative model. According to this model, there are separate subjective scales for the utility of survival duration and health quality. If F(Y) equals the utility of surviving Y years, and G(Q) equals the utility of living in health state Q, then the multiplicative model proposes that F(Y)G(Q) equals the utility of surviving Y years in health state Q. This model provides a simple explanation for several intuitively compelling relationships. First, the distinction between better-than-death and worse-than-death health states corresponds to the assignment of positive or negative utilities to different health states. Second, a zero duration of survival removes any reason to prefer one health state over any other, just as multiplying the utility of health quality by zero eliminates differences between the utilities of different health states. Third, the subjective difference between Y years in pain and Y years free from pain increases as Y increases as if the difference in utility between pain and no pain were being multiplied by the utility of surviving Y years. A critical prediction of the multiplicative model is the hypothesis that preferences between gambles for health outcomes satisfy a property called utility independence. Individual analyses revealed that most subjects satisfy utility independence, thereby supporting the multiplicative utility model. Some subjects appear to violate a fundamental assumption of utility theory: They appear to violate the assumption that a single utility scale represents both the ordinal preference relations between certain outcomes and the subjective averaging that underlies the utility of gambles. The violation is inferred from an inconsistency between preferences for multiattribute outcomes when they are viewed as certain outcomes and when they are viewed as the outcomes of gambles.
J Exp Psychol Gen 1988 Mar
PMID:A multiplicative model of the utility of survival duration and health quality. 296 29

Back pain is very common. Rarely, it may be the first manifestation of cancer. Although many advocate selective use of laboratory and x-ray tests for back pain patients, the early detection of cancer may be an important reason to obtain such tests. To develop a diagnostic approach that would identify malignancies while remaining parsimonious, the authors evaluated 1,975 walk-in patients with a chief complaint of back pain. Thirteen patients (0.66%) proved to have underlying cancer. Findings significantly associated with underlying cancer (p less than 0.05) were: age greater than or equal to 50 years, previous history of cancer, duration of pain greater than 1 month, failure to improve with conservative therapy, elevated erythrocyte sedimentation rate (ESR), and anemia. Combining historical features and ESR results led to an algorithm that would have limited x-ray utilization to just 22% of subjects while recommending an x-ray for every cancer patient. It would further suggest which patients with negative x-ray findings require further work-up.
J Gen Intern Med
PMID:Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. 296 93

Since 1968 the inflammatory stage of diverticular disease (acute and chronic diverticulitis) has been treated with tetracosactrin in one practice. This paper reviews 100 episodes treated in this way and compares these with 50 episodes treated with rest in bed and dietary measures. Abatement of pyrexia, swelling and tenderness, as well as relief of the symptoms of pain and malaise, were usually found to occur within 24 hours of the administration of tetracosactrin zinc (1 mg) intramuscularly. No complications directly attributable to this therapy have been observed, while the duration of the clinical illness has been reduced by more than half. In neither group were antibiotics found to influence the outcome.
J R Coll Gen Pract 1985 Nov
PMID:Diverticular disease treated with corticotrophin. 300 2

Trends in the reported rates of suicide by self-poisoning in the elderly from 1974 to 1984 are presented. When all drugs were considered together there was evidence of a slow but progressive decline in age specific rates of suicide in both sexes over the period studied. When individual drugs were considered, however, the overall fall was attributable almost exclusively to a fall in suicides using barbiturates, which reflected the decrease in barbiturate prescribing over this time. Suicides using other drugs, particularly benzodiazepines and analgesics for mild to moderate pain, increased, particularly among elderly women, with coproxamol showing the biggest increase over the period studied. In many cases deaths were the result of multiple drug ingestion. Implications for the management of the elderly at risk are discussed in the context of the difficulties in identifying depressive illness in the elderly and the general rise in the elderly population.
J R Coll Gen Pract 1988 Feb
PMID:Trends in the reported rates of suicide by self-poisoning in the elderly. 320 69

This paper reviews the use of acupuncture to treat several disorders where pain is not the primary symptom. Studies on asthma have shown a small but consistent short-term therapeutic effect of acupuncture. One study of long-term effects found no improvement in asthma after acupuncture while the other reported a modest effect on symptom relief but with a greater impact on medication reduction. Further studies of the long-term effects of acupuncture on asthma would seem desirable even though the currently available findings are equivocal. Sufficient work has now been carried out on sensorineural deafness to conclude that acupuncture has no worthwhile effects on this condition. Only two studies have been carried out on tinnitus; they indicate that the effects of short courses of acupuncture are at best slight. There are some encouraging findings for acupuncture treatment of hypertension, although the study was seriously flawed by the lack of a no treatment control group. With regard to giving up smoking it seems that acupuncture may assist during the withdrawal period and that it compares favourably with other forms of treatment; whether there is any specific effect of the acupuncture is not yet clear. As with other attempts to stop people smoking, however, there is a high relapse rate. The trials of acupuncture on psychiatric disorders have suffered from the lack of detailed assessment and control groups; no conclusions can be drawn without further studies. The studies on weight loss similarly do not permit any firm conclusions about the usefulness of acupuncture.
J R Coll Gen Pract 1987 Feb
PMID:Acupuncture for some common disorders: a review of evaluative research. 331 97

Psychotropic drug use in the patient with cancer is reviewed from the perspective of the practicing oncologist and the consulting psychiatrist. Guidelines are offered for use of psychotropic agents for specific symptoms, such as nausea and vomiting, pain control, treatment of depression, delirium, anxiety, and psychosis. The importance of careful assessment and treatment of the causes of psychiatric symptoms is stressed. Recommendations for use of specific psychotropic agents are reviewed, including dosage range and route of administration as well as possible drug interactions and other factors affecting the use of these agents in patients. Anecdotal uses of these agents are also considered.
Gen Hosp Psychiatry 1987 Sep
PMID:Psychotropic medications in patients with cancer. 331 44


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