The Clinical journal of pain
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Previous findings in patients with nonmalignant pain indicate a relationship between pain coping strategies and psychological factors. Although coping strategies have been explored in patients with cancer pain, relationships with such factors have not been reported. We wished to examine relationships between selected pain and psychological variables and the use of pain coping strategies. ⋯ Pain intensity and state anxiety demonstrated similar relationships. Pain quality as measured with the MPQ demonstrated moderately strong correlation with diverting attention, praying and hoping, catastrophizing, and increased activity. Interventions aimed at reinforcing or expanding a patient's pain coping repertoire should be developed with consideration given to the patient's anxiety level, pain intensity, pain quality, and pain expression preference.
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Relationships between locus of control beliefs (HLC), psychological distress (GHQ-12), and coping strategies were studied in 415 subjects with low back pain (LBP) (2 of 3 were men, with a mean age of 45 years). Those with more external beliefs and symptoms of psychological distress reported more severe LBP. ⋯ Irrespective of the degree of LBP, use of more active behavioral coping strategies were more frequent in subjects who had strong beliefs in internal control over back pain. In addition, catastrophizing thoughts were more frequent in subjects who had symptoms of psychological distress.
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Individuals with chronic pain frequently experience a complex and convoluted journey through the health care system that is often unrewarding for all involved. Excessive pain behavior may lead to unnecessary diagnostic testing or invasive procedures and result in iatrogenic complications and prolonged disability. ⋯ Often there is no direct correlation between objective impairment and an individual's request for disability status. As job satisfaction and financial security diminish during our economic recession, the impact of the disability epidemic becomes more profound.
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Clinical Trial Controlled Clinical Trial
Placebo-controlled trial of dexamethasone for chronic biliary pain after cholecystectomy.
Activation of the sympathetic nervous system appears to be relevant in some patients with unexplained pain after cholecystectomy, particularly those who show increases in plasma transaminase activity after challenge with morphine (morphine responders). In this study, the hypothesis that dexamethasone would improve chronic biliary pain, perhaps by suppressing activation of the sympathetic nervous system, was tested in a double-blind, placebo-controlled, cross-over trial in 20 patients, 10 morphine responders and 10 nonresponders. ⋯ During treatment with dexamethasone, 1 mg each night for 4 weeks, neither morphine responders nor nonresponders showed a significant improvement in pain or nausea or a significant reduction in sympathoadrenomedullary activity as assessed by urinary excretion of catecholamines. At the dose administered, dexamethasone was unhelpful for chronic pain after cholecystectomy and did not result in suppression of the sympathetic nervous system as assessed by urinary excretion of NE.
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The treatment of chronic pain is costly and frustrating for the patient, health care provider, and health care system. This is due, in part, to the complexity of pain symptoms which are influenced by behavior patterns, socioeconomic factors, belief systems, and family dynamics as well as by physiological and mechanical components. Assessment of treatment outcomes is often limited to the patient's subjective, multidimensional, self-reports. ⋯ In this study, a 36% reduction in clinic visits in the first year postintervention was found among the 109 patients who participated in an outpatient behavioral medicine program. Decreased clinic use continued in the first 50 patients followed 2 years postintervention. Decreased use projected to an estimated net savings of $12,000 for the first year of the study posttreatment and $23,000 for the second year.