Pain
-
The need to document cost-benefit of comprehensive work rehabilitation services represents a critical requirement for its long-term viability as a treatment option for injured workers. One approach to improving cost-benefit is to identify patients who experience difficulty completing a rigorous goal-oriented treatment approach. This study examined a set of psychological, pain, perceived work environment, and patient expectation measures in order to determine whether such factors were associated with failure to complete rehabilitation. ⋯ In addition, this group was significantly younger and had been out of work longer. The groups did not differ on gender, marital status, ICD-9 diagnoses or perceived work environment. These findings indicate that patients displaying the pattern of low return to work expectations, heightened perceived disability, pain and somatic focus experience compliance problems in an intensive work rehabilitation program.(ABSTRACT TRUNCATED AT 250 WORDS)
-
We investigated the relationship between somatic and psychological symptoms and pain reported during a clinical examination for 220 patients with chronic temporomandibular disorder (TMD) pain. The clinical examination involved palpation of the muscles of the face and neck, as well as intraoral sites and non-TMD-related placebo sites. A distinction was drawn between somatization--the tendency to report numerous somatic symptoms--and psychological distress manifested by report of numerous affective and cognitive symptoms. ⋯ Heightened somatization and high-intensity pain were strong predictors of widely dispersed muscle palpation pain during the clinical examination. High-somatization patients were 3 times more likely than low-somatization subjects to report having a painful placebo site. Pain dispersion was more closely linked to report of number of somatic symptoms than to report of affective and cognitive symptoms of psychological distress.
-
It is being increasingly recognized that the solution to the problem of inadequate postoperative pain relief lies not so much in development of new techniques but in development of a formal organization for better use of existing techniques. Acute Pain Services (APS) are being increasingly established to provide good quality postoperative analgesia. In the United States such 24-h services usually consist of anesthesiologists, residents, specially trained nurses and pharmacists. ⋯ Regular recording of each patient's pain intensity by VAS every 3 h and recording of treatment efficacy on a bedside vital-sign chart are the cornerstones of this model. A VAS greater than 3 is promptly treated. Surgeon and ward nurse participation are crucial in this organization.(ABSTRACT TRUNCATED AT 250 WORDS)