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Biomedical subjects

D A Fishbain

Publications and source records attributed to D A Fishbain.

At least 55 records · Page 3Linked to original sources
PubMed1995

Secondary gain concept: a review of the scientific evidence.

UNLABELLED: 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. DESIGN: A 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. SETTING: Any medical treatment setting including pain treatment was utilized in the review procedure, i.e., no exclusion criteria. PATIENTS: Any patient type, including those suffering from chronic pain, were utilized in the review procedure, i.e., no exclusion criteria. RESULTS: A 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. CONCLUSIONS: Overall 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.

Humans↗
PubMed1994

Measuring residual functional capacity in chronic low back pain patients based on the Dictionary of Occupational Titles.

STUDY DESIGN: This study designed and tested a functional battery based on the Dictionary of Occupational Titles (DOT). OBJECTIVES: Such a battery can be used to measure residual functional capacity (RFC) in chronic pain patients (CPP) and results can be matched against the demand minimum functional capacities (DMFC) of DOT jobs. SUMMARY OF BACKGROUND DATA: Physicians have difficulty translating medical impairment into functional limitation and thereby establishing the RFC of CPPs. METHODS: The DOT, a USA government publication, provides information about physical demands of every USA job according to 36 factors and subfactors. The authors defined and developed a functional battery based on these factors/subfactors. This battery was tested on 67 consecutive CPPs to determine the percentage of CPPs able to pass specific job factors and the full battery and return to some DOT job, and evaluated the effects of pain on battery performance. The data were factor analyzed. RESULTS: The battery determined if CPPs could perform DOT job factors and had the necessary RFC to be placed in a DOT job. The vast majority of CPPs could not pass the full battery and the presence of pain and original job classification predicted whether a CPP could perform a job factor. Factor analyses grouped the factors into four independent categories supporting the design of the battery. CONCLUSION: The battery can assess whether CPPs are able to return to work.

Adult↗
PubMed1994

Does nonsurgical pain center treatment of chronic pain return patients to work? A review and meta-analysis of the literature.

Evidence in the literature relating to return to work as an outcome variable for nonsurgical treatment for chronic pain was examined. Study selection criteria were as follows: a detailed definition of patient work status, delineation of work status pre-treatment and at follow-up, and documentation of the proportion of patients employed at follow-up. Of 171 studies reviewed, 37 fulfilled these selection criteria. Because the data were objective in nature, they were abstracted by the senior author only. For the coded variables of time to follow-up, proportion of patients working pre-treatment and at follow-up and number of patients, descriptive statistics and correlations were calculated. Change in employment status at follow-up was significant (P < .005) for all groups examined. In addition, comparisons for work outcome between treated patients versus patients rejected due to lack of insurance, and between treated patients versus patients who dropped out of treatment were both significant (P < .001). The mean difference in employment at follow-up for treated patients versus those not treated was approximately 50%. The proportion of patients working increased from 20% to 54% post chronic pain nonsurgical treatment. Correlation analyses did not find a significant trend in percent employed with time to follow-up. These results indicate that (1) chronic pain nonsurgical treatment does return patients to work; (2) increased rates of return to work are due to treatment, and (3) benefits of treatment are not temporary.

Chronic Disease↗
PubMed1994

Outcomes in treatment of pain in geriatric and younger age groups.

Chronic pain treatment outcome studies have generated conflicting information on whether geriatric (age 65+) patients (1) benefit from pain center treatment, and (2) benefit as much as do other age groups. We asked chronic pain patients to rate themselves at pain center admission and discharge on 43 scales assessing area of pain, functional status, behavioral variables, and other areas (pain center modification goals). Patients were placed into one of three age groups: "geriatric" (n = 153); "middle aged" 45 to 64 years (n = 126); and "younger" 21 to 44 years (n = 191). First, tests of geriatric improvement were performed. Next, the three groups were compared on baseline variables and on overall admission, discharge, and change scores. Change scores of the three groups were compared using analysis of covariance, followed by pairwise post hoc tests. Overall, the geriatric group improved on 42 of the 43 scales (p < .001). Geriatric improvement was significant on 37 scales, with most scales being significant at p < .001. Geriatric patients were significantly different from the other two groups on most baseline variables. Their admission scores were better than the other two groups. Geriatric improvement was not significantly different from the other two groups on 37 of the scales. Geriatric change was significantly better on two scales and significantly worse on 4 scales. Geriatric chronic pain patients are (1) distinctly different from younger chronic pain patients, (2) show significant and meaningful improvement with pain center treatment, and (3) demonstrate as great an improvement as the other age groups in the majority of measures.

Activities of Daily Living↗
PubMed1994

Functional electrical stimulation treatment of postradiculopathy associated muscle weakness.

Eighteen chronic pain patients (CPPs) with postradiculopathy-associated muscle weakness were entered into a nonrandomized functional electrical stimulation (FES) clinical treatment study to determine if FES can improve postradiculopathy associated muscle weakness. Because of the clinical nature of the unit, the CPPs could not be denied treatments other than FES. To control for these other treatments, the CPPs were used as their own controls with two control conditions, ie, where possible, the contralateral probable normal muscle was used as a control (control 1) and; in a subgroup of CPPs (n = 6), FES treatment was initially withheld to the probable weak muscle (control 2). Strength was measured as isometric maximum voluntary contraction (IMVC) and was used as the outcome treatment variable. IMVC was measured in both the probable weak and contralateral probable normal muscles at entrance into the Pain Center, at beginning of FES treatment, at completion of FES treatment, and for the control 2 condition at the end of the non-FES treatment period. Statistical analyses of the IMVC strength results using the two control conditions indicated (1) both the FES-treated and untreated muscles increased significantly in IMVC strength, (2) improvement in IMVC strength for FES-treated muscles was significantly greater than for probable normal FES-untreated muscles and, (3) improvement in IMVC strength in FES-treated muscles was significantly greater during the FES-treatment period than during the non-FES treatment period. FES treatment of postradiculopathy-associated muscle weakness in CPPs seems to increase the strength of the probable weak muscle above the increase in strength provided by other concurrent treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Prediction of pain center treatment outcome for geriatric chronic pain patients.

OBJECTIVE: Geriatric chronic pain patients (age 65 and over) form an increasing percentage of the pain center treatment population. It is therefore important to be able to predict pain center treatment success or failure for these patients; this is the first study to address this concern. DESIGN: Chronic pain patients rated themselves at pain center admission and discharge on 43 rating scales for the areas of pain, functional status, behavioral variables, and other pain center modification categories. The 43 scores at admission were used as potential predictors, while the 43 change scores (from admission to discharge) were the outcome measures to be predicted. Additional possible predictors were 16 other variables that are considered prognostic of treatment outcome, including age, number of surgeries, and prior occupational level. The statistical analysis consisted of a five-step procedure: (a) mathematical techniques were used to remove redundant outcome measures; (b) each of the remaining outcome variables was correlated with the full set of predictor variables; (c) regression techniques were used to predict the outcome variables; (d) these outcome variables were combined into independent factors using factor analysis; and (e) regression techniques were used to predict the factors. RESULTS: The variable-reduction technique was successful in removing 26 of the 43 outcome variables. Factor analysis of change scores of the remaining variables resulted in four factors, which were identified as change in activity, change in pain and behavior, change in constant pain, and change in attitude to pain center goals. The analysis showed that the best predictor of a variable's change score was the initial level of that variable. Regression analysis, using all variables as predictors except initial level, found a number of statistically significant predictors. However, no predictor variable, alone or in combination, was able to account for > 30% of the variance of any outcome measure. CONCLUSION: These results indicate that we cannot as yet predict geriatric pain center treatment outcome. Potential reasons for these results are discussed.

Aged↗
PubMed1994

The problem-oriented psychiatric examination of the chronic pain patient and its application to the litigation consultation.

OBJECTIVE: The purpose of this paper is (a) to delineate the behavior problems or complaints of chronic pain patients (CPPs) as presented in the literature and to add those behavior problems that have not yet been identified; (b) to present a semistructured psychiatric interview format that would lead to the delineation of these problems; and (c) to present a format and structure for the proposed semistructured psychiatric interview that could be utilized for the purposes of medicolegal assessment of the CPP and the reporting of that assessment to the litigation process. SETTING: Any psychiatric/psychological examination of the CPP. METHODS: The pain literature was reviewed for any research reports that specifically addressed or delineated the types of behavior problems found within the chronic pain (CP) population. These behavior problems were placed in a semistructured interview format, organized in such a way as to facilitate reporting to the litigation process if necessary. RESULTS: This semistructured psychiatric examination format is presented. Controversial problem areas in this format are discussed with appropriate references. CONCLUSIONS: CPPs are seen for the psychiatric examination with a set of behavioral problems largely determined by their medical condition, the consequences of that condition, and the social circumstances surrounding that medical condition (e.g., the litigation process). The psychiatric examination should be tailored to this special set of problems.

Accidents↗
PubMed1993

The prediction of return to the workplace after Multidisciplinary Pain Center treatment.

The prediction of return to the workplace after Multidisciplinary Pain Center (MPC) treatment has become a major research area. To delineate the variables that predict this outcome, the authors reviewed 164 multidisciplinary variables studies. Of these, 79 addressed work as an outcome variable. Twenty-six studies attempted to identify patient variables predicting return to the workplace. These latter studies were critically inspected for eight methodological criteria: pain location, follow-up time interval, response percentage and follow-up method, return to work subcategorization, vocational movement, univariate vs. multivariate statistics, multi-colinearity and variance, and statistical treatment of dropouts. In addition, other disability studies besides those in the chronic pain area were reviewed for return to the workplace predictor variables. Of these 26 studies, only a few appeared to satisfy the criteria examined. In addition, many studies were in conflict with one another on whether a variable was predictive. The review of the nonchronic pain/disability prediction literature yielded a large number of potential predictors that related to the work area. It is unclear which variables or set of variables predict return to the workplace after MPC treatment. Chronic pain studies may be neglecting the work area as an important source of return to the workplace predictor variables.

Combined Modality Therapy↗
PubMed1993

Functional capacity and residual functional capacity and their utility in measuring work capacity.

OBJECTIVE: The pain physician is often asked to establish the medical impairment of the chronic pain patient (CPP) and from that determination ascertain the work capacity of the CPP. Functional capacity (FC) testing has recently been introduced as a more objective and accurate way of facilitating the determination of work capacity. However, there are conceptual problems with the measurement of FC. These will be reviewed and the relationship of FC to residual functional capacity (RFC) will be determined. Finally, a method for measuring RFC in a job-specific manner will be suggested. DATA SOURCES: The literature in reference to the measurement of medical impairment, FC, and RFC was reviewed. STUDY SELECTION: Studies appropriate to the objective of this review were selected for inclusion. CONCLUSIONS: The FC and RFC are poorly defined. Lack of definition has interfered with design of appropriate test batteries specific to work capacity. To circumvent this problem a job-specific RFC measurement method is suggested. This method is based on the Dictionary of Occupational Titles.

Animals↗
PubMed1993

Opiate detoxification protocols. A clinical manual.

The purpose of any opiate detoxification protocol is to minimize or eliminate the signs and symptoms associated with opiate withdrawal, thereby decreasing the chances of relapse to opiate dependence. In the last few years, because of the development of new medications such as clonidine, for the treatment of opiate withdrawal, a number of new protocols have been developed. Four different types of protocols are reviewed and outlined: methadone substitution/detoxification, codeine or other opiate substitution/detoxification, opiate of choice detoxification, and buprenorphine substitution/detoxification. In addition, six protocols utilizing clonidine are presented, including a protocol utilizing opiate antagonist precipitated withdrawal. Finally, two protocols that utilize naltrexone are outlined, and adjunct medications potentially useful in opiate detoxification are reviewed. Some suggestions for the treatment of drug-seeking behavior during detoxification and the advantages and disadvantages of the various protocols are summarized.

Administration, Cutaneous↗
PubMed1992

Drug abuse, dependence, and addiction in chronic pain patients.

It is claimed that a significant percentage of chronic pain patients suffer from drug/alcohol abuse/dependency/addiction. To address this question, 24 articles alluding to chronic pain patient drug/alcohol dependence/addiction were reviewed according to the following criteria: method for drug misuse diagnosis, which drug misuse diagnosis used (abuse, dependence, or addiction), and percentage of patients within each diagnostic category of drug misuse. The result of the review indicated that only seven studies utilized acceptable diagnostic criteria and/or definitions for the drug misuse diagnoses and gave percentages of drug misuse. Within these seven studies, the prevalence percentages for the diagnoses for drug abuse, drug dependence, and drug addiction were in the range of 3.2-18.9%. It is concluded that these diagnoses occur in a significant percentage of chronic pain patients. However, there is little evidence in these studies that addictive behaviors are common within the chronic pain population.

Behavior, Addictive↗
PubMed1992

Detoxification of nonopiate drugs in the chronic pain setting and clonidine opiate detoxification.

Although the pain physician is most familiar with the treatment of the opiate withdrawal syndrome, other drugs are abused by the chronic pain patient. The pain physician should then be familiar with the withdrawal syndromes associated with other drug groups. The withdrawal syndromes associated with hypnosedatives, psychotomimetics, nicotine, stimulants, ergot alkaloids, beta adrenergic blocking agents, antidepressants, muscle relaxants, and alpha-adrenergic agonists are described. Drug detoxification protocols for these drugs are reviewed. Additionally, the rationale for clonidine opiate detoxification is discussed, and current clonidine detoxification protocols are reviewed.

Analgesics↗
PubMed1992

Monosymptomatic hypochondriacal psychosis: belief of contracting rabies.

The authors describe a forty-one-year-old female with possible monosymptomatic hypochondriacal psychosis (MHP): a delusional belief that she had contracted rabies. This is the first report of this type of delusion in MHP. The patient failed to respond to multiple somatic therapies and finally made a serious suicide attempt. The authors discuss the reasons for the failed treatment and suggest a sequential protocol for treatment of MHP based on the current literature.

Adult↗