The Clinical journal of pain
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Although convergent lines of evidence indicate that one can expect a high rate of suicide completion for chronic pain patients, this problem has not previously been investigated. Follow-up data from our pain center revealed three chronic pain patients (two men and one woman) who completed suicide. These three cases are presented. ⋯ Calculation of the 95% confidence interval and comparison of these suicide rates to the general population of the United States using the Z statistic indicated that all chronic pain patient suicide rates were significantly greater than that of the general population. White men, white women, and white worker compensation men with chronic pain in the age range of 35-64 years are twice, three, and three times as likely, respectively, as their counterparts in the general population to die by suicide. Although no firm conclusions can be drawn because of the small suicide sample, these case reports indicate a need for further studies of chronic pain patient suicide rates at other pain centers.
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Pain related to fibromyalgia may consist of a complex interaction of nociceptive, neuropathic, dysregulatory central nervous system and psychosomatic mechanisms. Nociceptor pain is based on the excitation of nervous sensors specialized to signal potentially harmful stimuli, i.e., the nociceptors. Metabolic deficiencies in muscle and neurogenic inflammation induced by the release of substance P and other neuropeptides from the peripheral nerve endings may result in chemical sensitization of nociceptors and an ensuing hyperalgesia particularly present in tender points. ⋯ Persistent abnormal spinal reflex transmission due to, e.g., peripheral trauma or inappropriate postural habits may result in a vicious circle between muscle hypertension and pain. Similarly, a defective sympathetic control may result in disturbed microcirculation and nociceptor excitation (e.g., in sympathetic algodystrophy). Many symptoms of pain in fibromyalgia (trigger points, pain referral, pain associated with muscle spasm or neurogenic joint immobilization) can be attributed to abnormal control mechanisms in a complex cybernetic system.(ABSTRACT TRUNCATED AT 250 WORDS)
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A review of Social Security Disability Income (SSDI), listed impairments (Section 1.05) for axial pain, the application process, appeals process, and the importance and impact of the treating physician's role in Social Security disability determination is discussed. The authors summarize the major types of disability programs and the present impairment rating systems, and present recent research in the complicated area of chronic pain and illness behavior that may alter the present system. They give recommendations that may aid the treating physician to prepare the patient's application for Social Security Disability Income.