ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The “secondary gain” concept originated in the psychoanalytic literature, where it was never vigorously examined. The purpose of this review is to determine if there are scientific studies that have explored the validity of this concept.DesignA computer and manual literature review yielded 166 references in which primary, secondary, and tertiary gain were mentioned. Twenty-four (14.5%) of these reports were “secondary gain” studies. Fourteen “reinforcement” studies were also found. These 38 studies were grouped according to topics and reviewed in detail.SettingAny medical treatment setting including pain treatment was utilized in the review procedure, i.e., no exclusion criteria.PatientsAny patient type, including those suffering from chronic pain, were utilized in the review procedure, i.e., no exclusion criteria.ResultsA significant but limited number of studies have investigated the “secondary gain” concept, and the results of some of these studies are in conflict. Results of some studies, however, are remarkably consistent in supporting the importance of “secondary gain” to behavior. Some studies have methodological flaws, usually relating to how the presence of secondary gain was established.ConclusionsOverall the results of the reviewed studies support the potential importance of the “secondary gain” concept to understanding illness behavior and underscore a need for future research in this area.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveThe study assessed the predictive ability of the standardized Multiperspective Multidimensional Pain Assessment Protocol (MMPAP). An assessment tool that predicts return to work with chronic pain patients is needed, as increasing numbers of disability applications are adjudicated in the courts.DesignNational randomized validation sample of disability applicants. Each MMPAP consisted of physical examinations by two physiatrists and the participant's subjective assessment. Criterion standards were Multidimensional Pain Inventory and McGill Pain Questionnaire. There was phone follow-up 6 months postdecision.SettingSix clinical sites were ambulatory referral centers, both public and private.ParticipantsPopulation-based random national sample of 710 Social Security disability applicants claiming chronic pain related to their disability, stratified by national Social Security Administration (SSA) applicant demographics. Seventy-eight were lost to follow-up, and 688 initially refused.InterventionsNo interventions were continued or initiated by the research team between assessment and follow-up.Main Outcome MeasuresClaimant employment status 6 months after disability decision was primary outcome, change in pain intensity, and change in employment situation.ResultsThe MMPAP predicted with 90% accuracy employment status of SSA disability applicants with chronic pain 6 months postdecision when assessed at application by two physicians trained in Physical Medicine and Rehabilitation (physiatry). Accuracy of employment situation change was 93%, and pain intensity change was 65%. Self-report measures, physical exmination results, psychological status, functional limitations, and physician's subjectve appraisal predict future employment.ConclusionThe MMPAP accurately predicts future employment of disability applicants claiming chronic pain. The introduction of this standardized protocol will assist in standardizing disability determination for claimants with chronic pain.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveThe first goal of the study was to determine the internal reliability of the Coping Strategies Questionnaire (CSQ) in young adults. The second goal was to examine the relation of the CSQ to reported pain levels. The third goal was to investigate the relationship between the CSQ and concomitant pain problems. The fourth goal was to compare young adults and different chronic pain samples in terms of the frequency of coping strategy use and perceived effectiveness of coping strategies.DesignThe study included 252 undergraduate students who were given the CSQ, a demographic and pain level questionnaire, and a concomitant pain problem survey.ResultsThe results indicated that the CSQ was internally reliable when used to assess pain coping strategy use among young adults. Catastrophizing was found to be associated with both pain level and concomitant pain problems, with subjects reporting higher levels of catastrophizing having higher levels of pain and a higher frequency of both migraine headaches and low back pain. Finally, differences were found when comparing the perceived effectiveness in controlling and decreasing pain, and in the use of specific coping strategies in the young adult and chronic pain samples. The young adult sample reported a greater perceived efficacy in controlling and decreasing pain, compared to a sample of low back pain patients and a sample of myofacial pain patients.ConclusionsThe results indicate that the CSQ is a reliable measure for the study of pain-coping strategies used in this population, and one that relates to differences reported in the experience of pain.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo test the concept that externalized tunneled intrathecal catheters lead to a high risk of complications, such as meninigitis and epidural abscess, and therefore should not be used for durations of intrathecal pain treatment of > 1 week.DesignProspective, cohort, nonrandomized, consecutive, historical control trial.SettingTertiary care center, institutional practice, hospitalized and ambulatory care.PatientsTwo hundred adults (107 women, 93 men) with refactory cancer pain treated for 1–575 (median, 33; total, 14,485) days; 79 patients were treated at home for 2–226 (median, 36; total, 4, 711) days. All patients had died by the close of the study.InterventionsInsertion of intrathecal tunneled nylon (Portex) catheters (223 in 200 patients) with Millipore filters. The catheter hubs were securely fixed to the skin with steel sutures. Standardized care after insertion: (a) daily phone contact with the patients, their families, or the nurses in charge; (b) weekly dressing change at the tunnel outlet by the nurses; (c) refilling of the infusion containers by the nurses; (d) exchange of the infusion systems when empty (within 1 month) and of the antibacterial filter once a month by specially instructed Pain Department nurses. All contact between the connections of the syringes, cassettes, and needles with the operator's hands was carefully avoided during filling and refilling of the infusion containers and exchange of the antibacterial filters; no other aseptic precautions were taken.Main Outcome MeasuresWe recorded the rates of perfect function and complications of the systems. The rates of complications recorded in this study with externalized tunneled intrathecal catheters are discussed and compared with the rates reported in the literature with externalized (tunneled and nontunneled) epidural and intrathecal catheters, as well as with internalized (both epidural and intrathecal catheters connected to subcutaneous ports, reservoirs, and pumps.ResultsThe following rates (as a percentage of number of patients) of perfect function and complications of the systems were recorded (the ranges of rates reported in the literature are given in parentheses): perfect function of the system, 93% (31–90%); accidental injury of an unknown epidural tumor followed by an epidural hematoma, 0.5% (04%); skin breakdown at the insertion site, 2% (2–50%); postdural puncture headache, 15.5% (10%); external leakage of CSF, 3.5% (427%); CSF hygroma (“pseudomeningocele”), 1.5% (4− 6.25%); hearing loss and MBniBre-like syndrome, 0% (12%); pain on injection, 0% with continuous infusion and 4.5% with intermittent injections (3–36% with intermittent injections); catheter tip dislodgement, 1.5% (633%); catheter (system) occlusion, 1% (3–12%); accidental catheter withdrawal, 4% (3–22%); catheter (system) leakage, 1.5% (2.1–26.6%); all mechanical complications, 8.5% (1044%); local (catheter entry site) infection, 0.5% (2–33%); catheter track infection, 0% (625%); epidural abscess, 0% (0.625%); meningitis, 0.5% (1–25%); systemic infection, 0% (3%); incidence of all infections (nhreatment days), 1 /7,242 ( 1 / 168− 1 /2,446).ConclusionsIn our population and with the technique of insertion and care reported here, the use of externalized tunneled intrathecal catheters has not been associated with higher rates of complications when compared with earlier reported rates of externalized epidural catheters and internalized (both epidu- ral and intrathecal) catheters connected to subcutaneously implanted ports, reservoirs, and pumps. The opinion that the use of externalized tunneled in- trathecal catheters should be restricted only to patients who need pain treat- ment for

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveIn neuropathic pain states, dynamic mechanical allodynia is mediated by large diameter AB-fibers. We test whether ongoing peripheral C-no-ciceptor input is necessary to maintain central changes hypothetically responsible for AB-mediated allodynia.Case reportA patient with long-standing diabetes mellitus demonstrated generalized signs of painless diabetic small fiber polyneuropathy. Following mechanical trauma, the patient additionally developed a typical neuropathic pain syndrome at the arm. Despite substantial impairment of cutaneous small fiber function, he complained of severe dynamic mechanical allodynia confined to a forearm skin area.Methods and ResultsMarstock test revealed a considerably increased cold perception threshold within the allodynic area and on the contralateral side. The patient could not perceive any warm sensation on either side. Histamine iontophoresis was not followed by any itch or pain sensations within the allodynic area or contralaterally. Nociceptive C-fiber axon reflex reactions were substantially impaired within the allodynic skin or contralaterally. Standard neurophysiological testing and quantitative vibrametry showed only mild impairment of large diameter sensory and motor fiber function at the arms. Cardiovascular reflex tests showed almost no heart rate variation indicating impairment of vagal small fiber function.Conclusions(a) Cutaneous nociceptive C-fibers do not signal dynamic mechanical allodynia. This symptom may hypothetically be due to secondary changes in the central nervous system processing that might strengthen the synaptic ties between AB-fibers and central nociceptive pathways, or due to peripheral multiplication of primary afferent low threshold mechanoreceptor input. (b) Ongoing nociceptive C-fiber input is not necessary to maintain either hypothetical mechanism. (c) Hypothetical secondary central hyperexcitability might work autonomously without any nociceptive C-fiber input for a long time or even indefinitely in some neuropathic patients.

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0749-8047    

出版商:OVID    

年代:1995

数据来源: OVID