Pain
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Review Historical Article
The role of psychological factors in chronic pain. I. A half century of study.
This review examines a half century of thought about the role of psychological factors in chronic pain. Changing views are discussed, and representative examples of pain research based on psychoanalytic, behavioural, cognitive, and psychophysiological theories are presented and evaluated. ⋯ Studies reviewed show that an earlier concept, based on simple formulations of psychological causation, has been replaced by more comprehensive explanations comprising both physical and psychological influences. Further methodological and conceptual problems are discussed in the second paper of this 2-part review.
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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)
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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.
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Percutaneous radiofrequency lumbar facet denervation has been in use as a treatment for intractable, mechanical low back pain for over 2 decades. A number of case series have been reported with high rates of success in selected patients; however, there has been limited objective outcome assessment, long-term follow-up, and analysis of prognostic factors. We have reviewed our experience with diagnostic lumbar facet blocks and percutaneous radiofrequency denervation at a mean follow-up interval of 3.2 years. ⋯ There was no difference, however, between the long-term results of bilateral denervation for bilateral or axial pain and those of unilateral denervation for unilateral pain. There was no significant difference in the rate of response between the 56 patients who had undergone prior lumbosacral spine surgery and the 26 who had not. There were no complications from the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Although a number of self-report indices that measure intensity and psychosocial components of the pain experience are available, these measures do not assess the range of cognitive, behavioral, and physiological reactions frequently associated with pain. This paper describes the initial determination of the psychometric properties of the Biobehavioral Pain Profile (BPP) developed to measure these reactions. The BPP is a 41-item self-report scale tested in a sample of 617 subjects with chronic recurrent pain, chronic non-malignant pain or chronic malignant pain. ⋯ Test-retest reliability for the scales ranged from 0.57 to 0.73. Low correlations among the BPP and general indices of fear, depression, anxiety, body consciousness and social desirability are reported. The BPP appears to provide a unique composite assessment of self-report of behavioral, physiological, and cognitive reactions to pain experienced by individuals with a wide range of pain problems.