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At least 19 recordsLinked to original sources
PubMed1989

Effects of extraversion and neuroticism on experimental pain, clinical pain, and illness behavior.

The effects of 2 personality traits, extraversion and neuroticism, on experimental and clinical pain were characterized in a group of myofascial pain dysfunction (MPD) patients. Extraverts did not differ from introverts in visual analogue scale (VAS) sensory or VAS affective ratings of graded 5-sec nociceptive temperature stimuli (43-51 degrees C) nor in VAS sensory-VAS affective relationships related to their clinical pain. However, high extravert patients scored lower on affective inhibition (Pilowsky Illness Behavior Questionnaire; IBQ) compared to low extravert patients. This result is consistent with previous suggestions that extraverts inhibit overt expressions of suffering less than do introverts. High neurotic patients did not differ from low neurotic patients in their VAS sensory ratings of either experimental or clinical pain. Their VAS affective ratings of both types of pain were marginally higher as compared to low neurotic patients. As hypothesized, high neurotic score patients gave higher VAS ratings of emotions related to suffering and scored higher on items related to affective disturbance on the IBQ as compared to low neurotic score patients. Overall, the results indicate that the personality traits of neither extraversion nor neuroticism affect sensory mechanisms of nociceptive processing but appear to exert their influence by means of cognitive processes related to the ways in which people constitute the meanings and implications of pain.

Behavior↗
PubMed1991

Pain clinics and pain clinic treatments.

Chronic pain is multi-factorial, and consequently a multidisciplinary approach is essential for its proper management. Pain Clinics may treat acute pain, chronic pain and cancer pain, and need to differentiate between these different conditions. Careful diagnosis and assessment is essential, including history, examination, questionnaires and relevant investigations. A variety of treatments exist to manage chronic pain, some of which have already been discussed in this issue. Treatments may be summarized as drugs, surgical (including nerve blocks), stimulation techniques, psychological techniques and general or physical measures. If a Pain Relief Unit has the ability to provide all of these types of treatment, then it can manage any type of pain, with the ability to relieve pain and improve quality of life greatly in a significant number of sufferers.

Chronic Disease↗
PubMed1993

Psychosomatic clinic or pain clinic. Which is more viable?

Outpatient consultation-liaison (C-L) psychiatry has been beset with problems concerning funding and patient acceptance. Though the consultation, liaison, and referral clinic models for outpatient C-L psychiatry each offer advantages, they have not conquered these fundamental problems. This paper introduces the multidisciplinary pain clinic as an alternative means of addressing somatic symptoms and psychiatric disorders in an ambulatory medical population. The multidisciplinary pain clinic offers advantages in terms of reimbursement, patient acceptance, and opportunities for interdisciplinary research. The pain clinic model has disadvantages that include administration by departments other than psychiatry, traditional location in a tertiary care hospital, and limitations to who can be treated. However, it offers a place where both the physiological and psychological aspects of somatic symptoms may be addressed. The pain clinic nurtures the priorities and goals of primary care for a patient population whose complexities may outstrip the resources of a single primary care physician.

Chronic Disease↗
PubMed1994

[Clinical experience of pain clinic in Kaohsiung Government Employees' Clinic Center].

UNLABELLED: This research was to analyze 1814 cases visited from January 1992 to December 1993 with respect to the characteristics and therapeutic effect of pain treatment in the pain clinic of Kaohsiung Government Employees' Clinic Center. The results were as follows: 1. Age level of patients ranged from 17 to 90 years old. The biggest group was of the old age group (956 cases, 52.7%). 2. Diagnostically, joint pain was the largest complain (602 cases, 33.2%). It was followed by spondylosis/spondylolithesis (324 cases, 17.9%) and myofascial pain syndrome (228 cases, 12.6%). There were 180 cases (9.9%) with two or more combined chronic pain syndrome. 3. Relationship between age and chronic pain: Old people were mostly suffered with osteoarthritis, spondylosis/spondylolithesis and post-herpetic neuralgia. Middle age people mainly had frozen shoulder, gouty arthritis and myofascial pain syndrome. Tendinitis and tension headache often occurred in young people. 4. Pre-treatment pain intensity: Most patients has Visual Analogue Scale of 7 to 8 (1622 cases, 89.4%). 5. THERAPEUTIC METHODS: Medication was mainly given to most of the patients. Some patients received nerve block (582 cases, 32.1%) and/or rehabilitation (389 cases, 21.4%). 6. Therapeutic effect was expressed by pain relief. Most patients felt moderate (708 cases, 39.0%) and almost complete pain relief (559 cases, 30.8%). CONCLUSION: Chronic pain could occurred in any age group. The kinds of chronic pain syndrome were prone to different age groups. Chronic pain patients could get good therapeutic effect if they cooperated with the doctor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Effects of age on temporal summation and habituation of thermal pain: clinical relevance in healthy older and younger adults.

Although the effects of aging on the experience of clinical pain seem relatively clear, investigations of age-related changes in pain perception using laboratory-based pain assessment procedures have yielded contradictory findings. One potential source of variability in this literature is the type of experimental noxious stimulus that is used. Although thermal pain thresholds are the most commonly reported measure of pain sensitivity, use of suprathreshold stimuli in pain assessment procedures may yield additional, more clinically relevant information concerning the effects of aging on the experience of pain. The present study examined the effects of age on temporal summation of both the intensity and unpleasantness of thermal pain at multiple stimulus temperatures. Specifically, responses to repetitive thermal stimuli delivered to the volar forearm at 47 degrees C, 50 degrees C, and 53 degrees C were assessed in 34 younger (mean age, 22.4 years) and 34 older (mean age, 62.2 years) healthy volunteers. Results suggested that for the 47 degrees C and 50 degrees C stimulus trains, older adults exhibited higher ratings of the intensity and unpleasantness of thermal pain and enhanced temporal summation of thermal pain relative to younger adults. Moreover, thermal pain sensitivity was inversely related to perceptions of general health and to reports of recent clinical pain among younger, but not older, subjects. Collectively these findings may indicate small, although potentially significant, age-related alterations in the plasticity of the central nervous system or endogenous pain-modulatory capacities.

Journal Article↗
PubMed2004

Laboratory pain perception and clinical pain in post-menopausal women and age-matched men with osteoarthritis: relationship to pain coping and hormonal status.

The present study examined relationships between pain coping, hormone replacement therapy, and laboratory and clinical pain reports in post-menopausal women and age-matched men with osteoarthritis. Assessment of nociceptive flexion reflex threshold was followed by an assessment of electrocutaneous pain threshold and tolerance. Participants rated their arthritis pain using the Arthritis Impact Measurement Scales. To assess pain coping, participants completed measures of emotion-focused coping, problem-focused coping, and pain catastrophizing. Results indicated that women were more likely than men to report using emotion-focused pain strategies, and that emotion-focused coping was associated with more arthritic pain and lower electrocutaneous pain tolerance. Correlations between coping measures and pain reports revealed that catastrophizing was associated with greater arthritis pain and lower pain threshold and tolerance levels. However, catastrophizing was not related to nociceptive flexion reflex threshold, suggesting that the observed relationship between catastrophizing and subjective pain does not rely on elevated nociceptive input. A comparison of men (n=58), post-menopausal women receiving hormone replacement therapy (n=32), and post-menopausal women not receiving hormone replacement therapy (n=42) revealed no significant group differences in arthritis pain, electrocutaneous pain threshold or tolerance, or nociceptive flexion reflex threshold. Thus, older adults with osteoarthritis do not exhibit the pattern of sex differences in response to experimental pain procedures observed in prior studies, possibly due to the development of disease-related changes in pain coping strategies. Accordingly, individual differences in clinical and experimental pain may be better predicted by pain coping than by sex or hormonal differences.

Adaptation, Psychological↗
PubMed1994

Why use a pain clinic? Management of neurogenic pain before and after referral.

Pain arising from damage or malfunction of the nervous system (for example postherpetic neuralgia, peripheral nerve injuries and the neuropathies) is often severe and resistant to standard analgesics. These patients are commonly seen in pain clinics where they receive a variety of treatments including psychotropic drugs (such as antidepressants and anticonvulsants), nerve blocks and stimulation. There is concern that the management of these difficult patients may be less than optimal where they are not seen by pain specialists. We examined a cohort of 703 patients with long-established nerve-damage pain seen in ten outpatient pain clinics. We compared their use of treatments prior to referral with the management given in the pain clinic. The majority of patients (79%) had had their pain for over 1 year before being seen in the pain clinic, yet many had not tried simple and effective treatments prior to referral. Less than a quarter had received an adequate trial of antidepressants; only one in seven had been appropriately treated with anticonvulsants; and only one in 10 had tried a nerve stimulator. All these treatments were frequently provided in the pain clinic. Referral of patients with nerve-damage pain to a pain clinic may greatly increase their access to therapies of proven value.

Anticonvulsants↗
PubMed2003

Attendance at a pain clinic with severe chronic pain after open and laparoscopic inguinal hernia repairs.

BACKGROUND: The aim was to compare the frequency of severe chronic pain that required attendance at a pain clinic after open and laparoscopic inguinal hernia repairs. METHODS: This was a retrospective analysis of 7999 patients who underwent inguinal hernia repair between January 1994 and December 2001. The definition of severe chronic pain was pain related to inguinal hernia surgery that was bad enough for the patient to seek further medical help and be referred to the specialist pain clinic after exclusion of surgically correctable pathology such as hernia recurrence. RESULTS: During the study there were 7153 open repairs and 846 laparoscopic repairs. Sixty-nine patients (1.0 per cent) were referred to the pain clinic a median of 16.9 (range 5.1-69.4) months after open hernia repair. Three patients (0.4 per cent) were referred a median of 16.5 (range 7.3-21.5) months after laparoscopic hernia repair (P = 0.045). CONCLUSION: Laparoscopic inguinal hernia repair was associated with a significantly lower frequency of attendance at the pain clinic with severe chronic pain.

Chronic Disease↗
PubMed2004

Body pain area and pain-related negative affect predict clinical pain intensity in patients with fibromyalgia.

UNLABELLED: Patients with fibromyalgia (FM) report widespread chronic musculoskeletal pain. Palpation of 9 paired tender points (TPs) is commonly used for the diagnosis of FM according to criteria specified by the American College of Rheumatology. Although TP palpation can be used to assess deep tissue hypersensitivity, it has failed as a reliable indicator of clinical pain intensity in FM. The sum of local areas of pain (SLAP) obtained from a body pain diagram represents a relevant measure of the spatial extent of clinical pain, a feature most likely important for FM pain. Because spatial summation of pain can be an important determinant of clinical pain intensity, we hypothesized that this measure would predict clinical pain intensity in FM patients. Because pain is strongly associated with negative emotions, we evaluated the relationship of pain-related negative affect (PRNA) with clinical pain intensity in FM. The independent contributions of SLAP, PRNA, and TP count to the variance of clinical pain intensity were assessed in 280 FM patients. Clinical pain intensity of 280 FM patients was measured by using a visual analogue scale. FM patients shaded all painful body areas on body pain diagrams. Dolorimetry was used for TP evaluations. PRNA was assessed with the Medical College of Virginia Pain Questionnaire. Hierarchical linear regression was used to test the association of SLAP, TPs, and PRNA with clinical pain intensity. FM patients' mean visual analogue scale rating (0 to 100) of usual clinical pain was 50.1. Mean SLAP, TP count, and PRNA were 11.4, 16.0, and 44.3, respectively. Hierarchical linear regression analysis identified SLAP, TP count, and PRNA as independent predictors of clinical pain that accounted for 45% of the variance in clinical pain intensity ratings in FM patients. Consistent with the literature, TP count predicted only a small part (4%) of this variance. Our statistical model of body pain areas and negative affect predicts a large portion of the variance of pain intensity in FM. This result suggests that the extent of pain areas and negative emotions are uniquely associated with clinical pain intensity in FM. PERSPECTIVE: The number of painful body areas obtained by body pain diagrams is a better predictor of clinical pain intensity than TPs in FM patients. The combination of painful body areas, TP counts, and PRNA predicts 45% of the clinical pain intensity of FM patients. This finding might be useful for clinical evaluations of FM patients.

Adult↗
PubMed1981

Coordinated out-patient management of chronic pain at the University of Virginia Pain Clinic.

The Pain Clinic at the University of Virginia Medical Center is a comprehensive facility providing a coordinated team approach to the management of chronic pain syndromes. The Clinic is primarily an out-patient facility, although in-patient therapy in clinic-assigned beds is available for special problems. Approximately 1,500 new patients are seen annually in the Clinic's own facilities, resulting in approximately 3,500 patient visits. All diagnostic facilities are readily available, and all somatic modulation and psychotherapeutic techniques are utilized for pain management. Referrals are accepted only from physicians and then only after all medical records, the Clinic's Patient Assignment Inventory Narrative (a screening brochure), and special studies are reviewed. The initial evaluation includes, as well, history taking, physical examination, psychological testing and interview, special studies, specialty consultations, and family interview. A therapeutic plan is then developed and discussed with the patient and family members. The Clinic's philosophy is to encourage the patient to assume responsibility for all aspects of the treatment program including drug detoxification, activity and exercise programs, and functional performance.

Chronic Disease↗
PubMed1998

Outcome from a rapid-assessment chest pain clinic.

Chest pain accounts for much of the rising numbers of emergency admissions, but in-patient assessment is not necessarily the best way of dealing with these patients. We ran a 'rapid-assessment chest pain clinic' to provide an alternative route of assessment, and audited its outcome. General practitioners referred patients with recent-onset chest pain, increasing chest pain, chest pain at rest, or other chest pain of concern, on the understanding that they would be seen within 24 h. During 8 1/2 months, 334 patients were referred and 317 patients were seen, most of whom had exercise electrocardiography. A median of 6 months later, 278 patients were personally contacted to determine outcome. Of these, 18% had been admitted immediately with acute coronary syndromes, and 49% had been diagnosed as non-coronary chest pain (none of whom subsequently infarcted or died). Continuing symptoms were infrequent, and satisfaction was high, although 13% of patients had been revascularized. A significant number of patients required immediate admission and/or ultimate revascularization, but many more did not. The majority of these patients had non-coronary chest pain, and this diagnosis was substantiated by their excellent outcome and (in some cases) by further investigation.

Adult↗
PubMed2003

Ratings of experimental pain and pain-related negative affect predict clinical pain in patients with fibromyalgia syndrome.

Patients with fibromyalgia syndrome (FMS) report chronic pain related to abnormal sensitivity of muscles that is reflected by so-called tender points (TP). TP represent areas of abnormal mechanical pain thresholds that have only shown a minor correlation with clinical pain of FMS patients and seem to be better suited for predicting distress. Pain-related negative affect (PRNA), abnormal temporal summation of second pain (termed wind-up or WU), and abnormal WU decay are frequently present in FMS patients. WU and WU decay can provide measures of central sensitization, which may contribute to clinical FMS pain. We therefore investigated the role of WU, WU decay, TP count, and PRNA as predictors of clinical pain in FMS subjects.Fifty-five FMS subjects rated their clinical pain at entry into the study using a visual analogue scale (VAS). After a TP evaluation, all subjects received two trials of thermal WU and WU decay testing. Hierarchical regression analysis demonstrated that the combination of PRNA ratings, TP count, and WU decay ratings predicted 49.7% of the variance of clinical pain in FMS. This model demonstrates independent relationships of biological and psychological factors to clinical pain and underscores the important role of abnormal peripheral and central pain mechanisms for FMS. Therefore, the combination of PRNA, TP count, and WU decay may provide an excellent measure for future clinical studies of FMS patients.

Adult↗