Pain medicine : the official journal of the American Academy of Pain Medicine
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Medical experts frequently use imaging studies to illustrate points in their court testimony. This article reviews how these studies impact the credibility of expert testimony with judges and juries. The apparent "objective" evidence provided by such imaging studies can lend strong credence to a judge's or jury's appraisal of medical expert's testimony. ⋯ Recent advances in brain imaging may profoundly impact forensic expert testimony. Functional magnetic resonance imaging and other physiologic imaging techniques currently allow visualization of the activation pattern of brain regions associated with a wide variety of cognitive and behavioral tasks, and more recently, pain. While functional imaging technology has a valuable role in brain research and clinical investigation, it is important to emphasize that the use of imaging studies in forensic matters requires a careful scientific foundation and a rigorous legal assessment.
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This study evaluated the relationship between psychological distress and disability associated with neck pain, analyzed the Neck Disability Index (NDI) for disability factors, and assessed the impact of psychological distress on those domains of disability. ⋯ Nondistressed adults reported significantly less disability due to neck pain than psychologically distressed subjects. The NDI was found to contain two factors that pertain to three domains of the disability. Five items relating to impairments in bodily function strongly correlated with depression and somatization. Presence of psychological distress has a confounding effect on NDI scores. An outcome measure containing items related only to activity limitations and participation restrictions might give a truer picture of disability associated with neck pain for patients with psychological distress.
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The objective of this study was to evaluate current practice characteristics, treatment choices, clinical experiences, and economic concerns associated with intrathecal therapy. ⋯ Intrathecal pain management practices continue to evolve as the options for treatment increase, and the body of applicable scientific literature grows; however, economic considerations can influence clinical decisions and may interfere with treatment choice and patient access to therapy.
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Recent research suggests that higher scores on measures of empathy correlate with a stronger response to observed pain, as well as higher estimates of pain intensity. Little work to date has examined the impact of empathy on evaluations of different levels of expressed pain, or how empathy may alter the accuracy of interpreting these painful facial expressions. This study examines the role of empathy in rating the intensity of facial expressions of pain, and the accuracy of these ratings relative to self-reported pain. The potential mediating role of available pain cues or the moderating role of gender on this relationship are also examined. ⋯ While observers with greater empathy may infer greater pain in senders, resulting in a smaller underestimation bias overall, they are not necessarily more accurate in estimating pain on any given stimuli. The importance of these potential differences in perceived pain for clinical assessment and interpersonal relationships are discussed.
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There is significant psychiatric literature indicating that smoking is associated with all forms of suicidality, including suicide ideation. The goal of this study was to determine if smoking is associated with suicide ideation in chronic low back pain (CLBP) patients. ⋯ CLBP smokers appear to be at greater risk for suicide ideation than nonsmoking CLBP patients. The risk of suicide ideation is even greater if the CLBP patient is a heavy smoker and has problems with alcohol.