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Biomedical subjects

S F Dworkin

Publications and source records attributed to S F Dworkin.

At least 37 records · Page 2Linked to original sources
PubMed1994

Somatization, distress and chronic pain.

The two defining features of somatization are numerous self-reported physical symptoms and excessive health care seeking. This may be due to a lowered perceptual threshold for perceiving and reporting bodily symptoms, amplification or misinterpretation of those symptoms, or underlying psychiatric disturbance. Recurrent pain is the most common somatic symptom reported. True somatization disorder is very rare (< 1%) and requires a DSM-III-R diagnosis of at least 13 different physical symptoms which cannot be explained by, or are in gross excess of physical findings, and have caused the patients to seek health care or alter their lifestyles. However, researchers have argued that a spectrum of severity for somatization exists, and this is supported by epidemiological research. Available data also indicate that behavioural interventions may show long-term cost-effectiveness in the management of chronic pain. Chronic pain dysfunction appears to place a disproportionate burden on overall health care expenditure for chronic pain patients.

Chronic Disease↗
PubMed1994

Temporomandibular disorders and chronic pain: disease or illness?

Temporomandibular disorders (TMD) are examined from a biopsychosocial or illness perspective. Data are reviewed in accordance with the concept that TMD is a chronic pain condition that shares many features with other common chronic pain conditions. TMD is placed within the same biopsychosocial model currently used to study and manage all common chronic pain conditions. The concept of chronic pain dysfunction, which has emerged as a critical consideration for chronic pain research and management, is also reviewed. Most chronic pain patients seem to bear their condition adequately and thus maintain adaptive levels of psychosocial function. By contrast, a psychosocially dysfunctional segment of the chronic pain population appears unable to cope as well and demonstrate higher rates of depression, somatization, and health care use, even though persons in this segment are not different from their functional peers on the basis of observable organic pathology. Finally, data are reviewed from longitudinal, epidemiologic, and experimental intervention studies that substantiate these two perspectives.

Adaptation, Psychological↗
PubMed1994

Perspectives on the interaction of biological, psychological and social factors in TMD.

Temporomandibular disorders remain a poorly understood but related collection of clinical syndromes involving pain and function limitations. This article discusses TMD from the perspective of a chronic pain illness, which shares some features found in common chronic pain conditions, such as tension headache and benign back pain. From these perspectives, TMD may be viewed as a self-limiting chronic pain illness not associated with progressive physical deterioration.

Adaptation, Psychological↗
PubMed1993

Temporomandibular disorders: a survey of dentists' knowledge and beliefs.

General dentists and specialists likely to treat TMD were surveyed to gain information on their understanding of TMD causes, diagnosis and treatment. While the role of psychophysiologic factors in the etiology of TMD has been widely acknowledged in the practicing community, there is still a high level of controversy about the pathophysiologic aspects of TMD and appropriate diagnoses and treatment.

Attitude of Health Personnel↗
PubMed1991

An epidemiologic evaluation of two diagnostic classification schemes for temporomandibular disorders.

Few diagnostic classification schemes for temporomandibular disorders (TMD) have been applied systematically to examine the prevalence of various subtypes of TMD in clinic or community populations. In this study, computer algorithms were developed for classifying subjects according to the scheme of Eversole and Machado (1985) and a classification scheme recently developed in our own research at the University of Washington. The diagnostic algorithms were applied to clinical examination data for (1) persons without TMD pain (community controls) and (2) persons reporting TMD pain in the prior 6 months (community subjects with pain), identified in a random sample survey of a health maintenance organization (HMO) population, as well as (3) clinic patients seeking treatment for TMD through the same HMO. Prevalence rates for myofascial pain dysfunction in clinic patients were much higher under the University of Washington approach, whereas rates of internal derangement (type I) and degenerative joint disease were similar under the two schemes. These similar prevalence rates were not, however, accompanied by high concordance between the two schemes. These results highlight the complexities of differential diagnosis of TMD in field research, and suggest that further evaluation of alternative diagnostic schemes is warranted.

Adolescent↗
PubMed1991

Illness behavior and dysfunction: review of concepts and application to chronic pain.

The purpose of this presentation is to review the elements that comprise the concept of illness behavior including elaboration of a more formal theoretical and operational model for illness behavior and then discuss the application of the illness behavior model to chronic pain, especially chronic orofacial pain. The model of illness behavior presented emphasizes four critical areas of conceptual interest, namely, (1) monitoring of somatic signals; (2) cognitive processes whereby bodily symptoms are interpreted; (3) attaching meaning to symptoms in the context of emotional state and concurrent environmental events; and (4) the ethnocultural influences that pervade meaning and shape coping responses. Our model of illness behavior was generalized from a closely related model developed to guide research when the specific illness behavior of interest was dysfunctional chronic pain behavior. We also include a time dimension in our chronic pain model. Dysfunctional chronic pain is understood to be the most important undesirable consequence associated with suffering a persistent pain condition. Dysfunctional chronic pain is a subset of illness behaviors inconsistent with medically documented findings, while the complaints of pain are prominent. Changes occur in emotional status, most typically reported as mood and behavioral changes associated with depression, such as demoralization, helplessness, and social isolation. Excesses in medical care, hospitalizations for surgery, and abuse of medications are further characteristics of dysfunctional chronic pain.

Behavior↗
PubMed1990

Multiple pains and psychiatric disturbance. An epidemiologic investigation.

We assessed multiple pain conditions and their association with affective disturbance, somatization, and psychological distress based on questionnaire data from a probability sample of 1016 enrollees of a large health maintenance organization. Respondents were asked about the presence of five pain conditions and were classified empirically in terms of dysfunctional chronic pain status based on pain severity, pain persistence, and pain-related disability days. Logistic regression analyses revealed a highly significant association between number of pain conditions reported and elevated levels of somatization as measured by the Symptom Checklist 90-Revised. Individuals with two or more pain conditions were at elevated risk of an algorithm diagnosis of major depression, while persons with a single pain condition did not differ from persons with no current pain conditions. Number of pain conditions reported was a better predictor of major depression than were important measures of pain experience, including pain severity and pain persistence.

Adolescent↗
PubMed1990

Assessing clinical signs of temporomandibular disorders: reliability of clinical examiners.

Data on interrater reliability in assessing a number of clinical signs commonly evaluated in the diagnosis and treatment of temporomandibular disorders (TMD) is presented in this article. Four experienced dental hygienists who were field examiners for a large epidemiologic study of TMD and three experienced clinical TMD specialists (dentists) who are coinvestigators in the same study followed carefully detailed specifications and criteria for examination of TMD patients and pain-free controls. Excellent reliability was found for vertical range of motion measures and for summary indices measuring the overall presence of a clinical sign that could arise from several sources (for example, summary indices of muscle palpation pain). However, many clinical signs important in the differential diagnosis of subtypes of TMD were not measured with high reliability. In particular, assessment of pain in response to muscle palpation and identification of specific temporomandibular joint sounds seemed to be possible only with modest, sometimes marginal, reliability. These modest reliabilities could arise from examiner error because the clinical signs are themselves unreliable, changing spontaneously over time and making it difficult to find the same sign on successive examinations. The finding that, without calibration, experienced clinicians showed low reliability with other clinicians suggests the importance of establishing reliable clinical standards for the examination and diagnostic classification of TMD.

Adult↗
PubMed1990

Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls.

An epidemiologic study of clinical signs and symptoms of temporomandibular disorders (TMD) was conducted with a probability sample of adults enrolled in a major health maintenance organization (HMO). This report presents data from a first wave field examination and interview conducted by trained, calibrated dental hygienist field examiners. Significant gender differences for vertical jaw opening measures were observed but no significant age differences were found for the distribution of clinically relevant findings. Clinic cases showed smaller amounts of vertical range of jaw motion but did not differ from community cases or controls on extent of lateral, protrusive, or retrusive mandibular movements; on classification of occlusion; or on dentally related variables. Clinic cases had more pain during all jaw excursions as well as during muscle and joint palpation. Joint clicking sounds were also observed more frequently in clinic cases.

Adolescent↗
PubMed1988

Short-term effect of two therapeutic methods on myofascial pain and dysfunction of the masticatory system.

In conclusion, a short-term intervention with IS therapy was found to result in a substantial decrease in facial pain for most of the subjects treated. Generally, groups were not found to be significantly different in respect to palpation pain change from session 1 to session 2. Neither therapy significantly altered the range of mouth opening. EMG findings were variable but suggest that RI therapy may alter muscle myoelectric activity. From these findings, ice and stretch of the masticatory and neck musculature would appear to be a good short-term adjunctive therapy to control pain with little apparent risk of negative effects.

Adult↗
PubMed1988

Reliability of visual analog and verbal descriptor scales for "objective" measurement of temporomandibular disorder pain.

Eight dentists viewed standardized videotapes showing palpations of the temporomandibular joint and muscles of mastication and recorded their judgments concerning the amount of pain the patient was experiencing. Judgments were recorded using a four-point verbal descriptor scale (VDS) ("none", "mild", "moderate", "severe" pain) or a 100-mm visual analog scale (VAS) anchored with the terms "no pain" and "worst pain possible". Test/re-test reliability over a one-week period and interjudge reliabilities were calculated for each scale; reliabilities of the two scales were directly compared based on the statistical equivalence of weighted kappa and the Intraclass Correlation Coefficient. Neither scale showed satisfactory reliability. Median test/re-test reliabilities were k = 0.590 for the VDS and r = 0.822 for the VAS. Interjudge reliabilities averaged k = 0.394 for the VDS and r = 0.735 for the VAS. Direct comparison of reliabilities for the two scales showed no clear advantage for either scale. The marginal reliabilities of these scales, when used by dentists to quantify the patient's pain, suggest that neither scale should be regarded as an "objective" pain measure.

Decision Making↗
PubMed1987

Orofacial pain of psychogenic origin: current concepts and classification.

A description and attempt to classify the newly revised DSM-III and IASP classification schemes and those persistent orofacial pain syndromes that are commonly considered to be significantly associated with psychological or psychosocial factors, either as primary causes or as factors contributing to the maintenance of the chronic pain state are presented. The classification schemes include the DSM-III-R of the American Psychiatric Association and the new IASP taxonomy system, are the two systems currently available for classifying chronic orofacial pain states that are often considered to represent psychogenic pain conditions.

Burning Mouth Syndrome↗
PubMed1986

Psychological preparation influences nitrous oxide analgesia: replication of laboratory findings in a clinical setting.

In an earlier laboratory study, administration of 33% nitrous oxide yielded lower, not higher, pain thresholds when combined with appropriately altered expectations of enhanced creativity and sensitivity. The present study was undertaken in an attempt to replicate this finding in a group of clinical dental patients. It was expected that anxiety would play a significant role in our findings. The present study experimentally confirms that controlled psychological preparation of the clinical subject prior to administration of conventional dental dosages of nitrous oxide can significantly modify the perception of tooth pulp pain, neutralizing and even reversing its analgesic efficacy without increasing anxiety.

Adolescent↗
PubMed1986

Cultural perceptions of pain and pain coping among patients and dentists.

A combination of qualitative and quantitative methods were developed to describe pain and pain coping perceptions of 25 Chinese, 25 Anglo-Americans and 35 Scandinavians (54 patients and 21 dentists). Results revealed universal dimensions of pain such as time, intensity, location, quality, cause and curability. More culture-specific dimensions included the Chinese concept suantong, a multivariate concept of bone, muscle, joint, tooth and gingival pain. "Real" and "imagined" pains were mostly described by Western subjects, especially dentists; "imagined pain" being the conversion of fear or anxiety into perceived pain. These data indicate that the methods were sensitive to culture as a variable and indicate that ethnicity may play a stronger role in the perceptions of pain description than does professional socialization, but that professional socialization processes may have more influence on the perception of pain coping modes for this sample population.

Adaptation, Psychological↗