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Biomedical subjects

R M Gallagher

Publications and source records attributed to R M Gallagher.

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

The reliability of depression diagnosis in chronic low back pain. A pilot study.

The variability in estimated rates of major depressive disorder (MDD) in chronic pain samples may be accounted for by sample and methodological differences. Most studies rely on a single measure of depression and lack independent or repeated measures. This study investigated the prevalence of psychiatric disorders in a convenience sample of 18 patients disabled by low back pain (LBP) referred to, evaluated, and treated in a comprehensive pain rehabilitation program specifically designed to restore work readiness and return to work. Subjects had one or more spinal conditions, had work-related back pain for more than 6 months (x = 23.8), were Caucasian, predominantly young (x = 37.5) and male (55%), and were disabled on workers' compensation and approved for rehabilitation. The performance of three diagnostic procedures, the Pain Medicine Evaluation, an independent Structured Clinical Interview for DSM-III-R (SCID), and Longitudinal Clinical Diagnosis were compared with the "gold standard" of the Final Diagnosis which incorporated information from the other three. Also, the performance of a questionnaire, The Pain & Mood Structural Interview (PMSI), designed to assess the causal relationship of pain and mood and specifically the confounding effects of physical factors, was examined. Thirteen of 18 patients (72%) were diagnosed with MDD at Final Diagnosis. MDD diagnosis was made on 4 of 18 patients (22%) on the initial Pain Medicine Evaluation and on 9 of 18 patients (50%) on the SCID, with only 1 ruled out by the confounding questionnaire, for a SCID current prevalence of 44%. Both the SCID and Pain Medicine Evaluation accurately diagnosed the MDD cases they identified; 9 of 13 MDD cases (69%) were precipitated by a physical factor other than their pain. Three episodes of MDD were ruled out by confounding. These findings are discussed in relation to their implications for assessing pain patients for psychiatric comorbidity.

Adult↗
PubMed1994

Dihydroergotamine nasal spray for the acute treatment of migraine.

We conducted a multicenter, double-blind, parallel-group study to compare the efficacy and safety of dihydroergotamine (DHE) nasal spray and placebo over 4 hours in the treatment of migraine. Of the 112 patients enrolled, 100 were included in the "intent-to-treat" efficacy analysis. The patients self-administered either 2.0 mg DHE (0.5 mg per nostril, repeated after 15 minutes) or placebo at the onset of two separate headaches and rated hourly the drugs' effects on pain severity, pain relief, nausea, and vomiting. The physicians assessed the overall effectiveness of the drugs in relieving headache pain, nausea, and vomiting. Both the patients' and physicians' ratings indicated that DHE was significantly superior to placebo in improving headache and nausea; according to the patients' ratings, these between-group differences were already significant at the first (hour 1) evaluation. There were no significant differential treatment effects with respect to relief of vomiting. Most adverse events were mild or moderate, confined to the nasopharyngeal area, and probably related to the route of administration. We conclude that DHE nasal spray is a safe and effective treatment for the pain and nausea of migraine attacks.

Administration, Intranasal↗
PubMed1991

Is major depression comorbid with temporomandibular pain and dysfunction syndrome? A pilot study.

There is a lack of information about the precise strength of the relationship between chronic pain and depression. In a prior study, women with temporomandibular pain and dysfunction syndrome (TMPDS) had much higher scores than did controls on a measure of nonspecific psychological distress. The question arose as to whether rates of clinical depression are also unusually high in TMPDS patients. Their former treating clinician rates cases for likely lifetime presence or absence of depression. A subset of those rated as likely depressed then had their diagnoses verified independently through a structured clinical interview by a psychiatrist and clinical psychologist. Results revealed a minimum lifetime prevalence rate for major depression of 41%. A rate of this magnitude in TMPDS cases is clearly much higher than would be found for women of similar background in the general population.

Adult↗
PubMed1990

The behavioral medicine service. An administrative model for biopsychosocial medical care, teaching, and research.

The biopsychosocial model has been promoted for its advantages in many important health problems. However, the lack of administrative practice models specifically designed to develop and promote the model hinder the development of systematic clinical applications. This article describes a successful clinical teaching and research practice, The Behavioral Medicine Service, that was conceptualized and developed based on the biopsychosocial model. Systematic planning enabled the service to take advantage of clinical, research, and teaching opportunities and to reduce the constraints imposed on development from within psychiatry and the institution. Advantages of the organizational model include multidisciplinary treatment teams, a systematic method of biopsychosocial assessment and management planning, and continuity of care between several settings: the medical-surgical wards of a general hospital; a behavioral medicine inpatient unit; and outpatient subspecialty clinics for chronic pain, chronic medical illness, anxiety and stress-related disorders, and drug and alcohol abuse. The Human Behavioral Pharmacology Laboratory forms the research arm of the service. Referrals of a diversity of medical and psychiatric problems create a unique learning opportunity for residents. Billing for multimodal team treatment, training residents, establishing clinical research, and managing a plethora of referrals were developmental challenges addressed by the service.

Behavioral Medicine↗
PubMed1990

AIDS: who will care at home?

This study examined a program to educate providers of home health care about AIDS. A U.S. Public Health Service-funded program PROJECT Tec-HI, was designed to train family members, friends, and homemaker/home health aides to care for AIDS patients. Students had classroom and clinical learning opportunities. Pre- and posttesting of five AIDS-related items embedded in a scale of general health care knowledge suggested differential learning of AIDS content. Students with experience caring for AIDS patients completed the curriculum significantly more often. The greater the level of students' knowledge on pretest the more likely they were to complete PROJECT Tec-HI. Results suggested that even persons willing to learn about AIDS are not immune to fears that preclude their ability to learn about the disease. This study suggests that AIDS educators must help students deal with their levels of fear in order to prepare quality care givers for AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Outpatient treatment of chronic pain groups for couples.

The purpose of this study was to assess the impact of outpatient group treatment for chronic pain patients and their spouses on psychological symptomatology, marital adjustment, and locus of control. There was a significant improvement in mean scores on four of the seven measures pre- and post-treatment. This data suggests that group treatment can significantly reduce chronic pain related problems especially anxiety, depression, and interpersonal sensitivity for the patient as well as for the spouse. It also supports other findings for the effectiveness of brief group therapy programs for chronic pain patients. Although this study has several limitations the results warrant further investigation using control groups and a larger sample size.

Adult↗
PubMed1989

Menstrual migraine and intermittent ergonovine therapy.

The treatment of patients suffering with menstrual migraine is sometimes a difficult and frustrating problem for the physician. As many menstrual migraine headaches are refractory to abortive therapy, prophylactic therapy is often needed. Ergonovine maleate, an ergot derivative with vasoconstrictive properties, has been used with some success in migraine headache patients. Forty patients who were treated with intermittent prophylactic ergonovine were studied over six months. The patients ranged in age from 22 to 40 years, and all suffered with menstrual migraine headaches which were refractory to abortive therapy. Each patient took ergonovine maleate 0.2 mg three to four times daily during menses and recorded headache occurrence and severity. After three months, 24 patients (60%) reported significantly less severe attacks, six patients (15%) reported less frequent headaches and 14 patients (35%) reported no improvement. After six months there was a decrease in effectiveness with 20 patients (50%) reporting significantly less severe headaches and two patients (5%) reporting less frequent headaches. This limited study suggests that ergonovine maleate may be of value in the treatment of difficult menstrual migraine patients.

Adult↗
PubMed1989

Safety and effectiveness of cranial electrotherapy in the treatment of tension headache.

One hundred patients were enrolled in a multicenter double-blind study to evaluate the safety and effectiveness of the Pain Suppressor Unit, a cranial electrotherapy stimulator for the symptomatic treatment of tension headaches. Treatment consisted of extremely low level, high frequency current applied transcranially. Pain scores before and after 20 minute treatments of individual headaches as well as patient and physician global evaluations were the primary efficacy variables. Following use of the active unit, patients reported an average reduction in pain intensity of approximately 35%. Placebo patients reported a reduction of approximately 18%. The difference was statistically significant (p = 0.01). The active unit was rated as moderately or highly effective in 40% by physicians, and in 36% by patients. Both physicians and patients scored the placebo unit moderately or highly effective for only 16%. The difference in ordered outcomes was statistically significant (p = 0.004). Approximately 10% of patients in each group reported at least one minor adverse experience. Cranial electrotherapy stimulation is distinct from TENS, and is safe and often effective in ameliorating the pain intensity of tension headaches. It should be considered as an alternative to the chronic usage of analgesics.

Adult↗
PubMed1989

Determinants of vocational disability in patients with low back pain.

Eighty-seven unemployed subjects with low back pain were recruited from an orthopedic back pain clinic and were given a battery of physical and psychologic tests. Subjects were contacted six months later to determine their current compensation status and whether they had returned to work. Age, length of time out of work, how much they had lifted in their previous job, the number of weeks they had been compensated, current activity levels, leg pain, and various psychologic factors significantly differentiated those who worked from those who did not. Physical examination findings and testing of the ability to lift were not significantly related to return to work. It is suggested that demographic, job-related, and psychologic factors should be emphasized, rather than only physical capacity, in the evaluation of vocational potential and the assessment of disability in patients with low back pain.

Adult↗
PubMed1988

Nonnarcotic analgesic abuse. A common biopsychosocial problem.

Abuse of nonnarcotic analgesics is a common but often unsuspected problem that can lead to serious physical illness. This paper reviews the epidemiology, medical consequences, associated psychiatric problems, relationship to psychoactive drug abuse, and treatment of nonnarcotic analgesic abuse, and presents an illustrative case.

Acetaminophen↗
PubMed1988

Fiorinal with codeine in the treatment of tension headache--the contribution of components to the combination drug.

The contribution of the Fiorinal and codeine phosphate components to the effectiveness of the Fiorinal with Codeine combination in the treatment of tension headache symptoms was evaluated in a randomized, placebo-controlled, multicenter double-blind study. Patients admitted to the trial took two capsules of Fiorinal with Codeine, Fiorinal alone, codeine alone, or placebo during each of two tension headache attacks. Immediately before and at intervals up to four hours after drug ingestion, patients rated pain severity, pain relief, the tense and uptight feeling, and muscle stiffness. The response to treatment was evaluated in 154 patients. Despite a high placebo response, a factor known to obscure the contribution of components, Fiorinal and codeine were each found to contribute significantly to the therapeutic effect of the Fiorinal with Codeine combination. Statistical or borderline superiority of the combination drug over Fiorinal alone was seen most frequently at the early evaluations, a finding that reflected the rapid onset of action of codeine. Statistically significant differences between Fiorinal with Codeine and codeine alone seen principally at the later assessments reflected the long duration of action of the Fiorinal component. The frequency of adverse reactions did not differ significantly among the four study groups.

Adolescent↗
PubMed1983

Psychiatry--family practice liaison: a collaborative approach to clinical training.

In view of the growing need for effective liaison between psychiatry and family practice programs, some of the models for educational and clinical liaison are discussed, and a clinical training program is described in which psychiatry and family practice educators work collaboratively in the training of both family practice and psychiatry residents and medical students. The program is offered as a model for providing comprehensive clinical training to residents and students and comprehensive clinical care to patients.

Education, Medical, Undergraduate↗