The Clinical journal of pain
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Homicide-Suicide (H-S) is a form of dual death where the murder is closely followed by the suicide of the perpetrator. H-S is extremely rare and has not previously been described within the chronic pain patient population. ⋯ Psychiatric examination data from the victims of H-S revealed a number of complex, psychiatric, social, vocational, and litigation problems. Demographically the case displays some characteristics associated with suicide pacts.
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The long-term analgesic effects and the complications of epidural narcotic analgesia (ENA) were investigated in 40 cancer patients in whom systemic narcotic therapy failed to relieve pain or caused unacceptable side effects. In 32 patients, an externally fixated polyamide epidural catheter was used ("external group"), and in 8 patients, a polyurethane epidural catheter was tunneled and connected to a subcutaneous access port ("internal group"). The average duration of catheter treatment was 80.9 days (range 9-533 days). ⋯ In two patients of the internal group, neurological complications occurred, but these disappeared spontaneously after removal of the system. They were presumably due to epidural fibrosis with compression of the spinal cord. Further technical improvements are necessary for the easier use and higher safety of the catheter technique.
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Diagnostic epidural blocks were performed on 27 chronic pain patients sequentially using saline, fentanyl, and lidocaine solution. The patients were divided into one of four groups based on their response to the epidural solutions: placebo response group--pain relief with placebo solutions; fentanyl response group--pain relief with epidural fentanyl; lidocaine response group (LRG)--pain relief with lidocaine but not fentanyl; and no response group--no pain relief with any of the solutions used. The four groups were compared on the basis of age, sex, site of pain, duration of pain, narcotic use, pain assessment index, and workmen's compensation claims. ⋯ On the basis of the information gathered, it was theorized that, despite their response to epidural lidocaine, LRG patients may actually be a group of operant pain patients. Their failure to receive analgesia from epidural fentanyl may be a learned response such that they associate any sensory input from the affected area as painful. If follow-up studies support these findings, then the diagnostic opioid technique may be a more sensitive tool in diagnosing chronic pain.
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The purpose of this study was to assess the impact of outpatient group treatment for chronic pain patients and their spouses on psychological symptomatology, marital adjustment, and locus of control. There was a significant improvement in mean scores on four of the seven measures pre- and post-treatment. ⋯ It also supports other findings for the effectiveness of brief group therapy programs for chronic pain patients. Although this study has several limitations the results warrant further investigation using control groups and a larger sample size.