Pain
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The relationship between persistent pain in spinal cord injury and medical-descriptive, demographic, psychological and familial-social data was studied. Multiple linear regression and discriminant analysis were used to predict (1) presence or absence of pain; (2) severity of pain; (3) time post-injury onset of pain; (4) whether or not pain interfered with activities of daily living. The best combinations of predictor variables accounted for only 15 and 19% of the dependent measures pain vs. no-pain and onset of pain, respectively. ⋯ Higher levels of subjective pain were associated with greater age, higher verbal intelligence, higher levels of anxiety and a more negative psycho-social situation. Persons who reported pain interfering with activities of daily living were more likely to be older, of higher intelligence, more depressed, clinically rated as experiencing greater levels of distress and immersed in a more negative psycho-social environment. The importance of psycho-social variables in the understanding of persistent spinal cord injury pain and the need for prospective studies along these lines are demonstrated.
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Comparative Study
A psychophysical analysis of experimential factors that selectively influence the affective dimension of pain.
A psychophysical analysis was made of experiential factors that influence the affective but not the sensory-discriminative dimension of pain. Seven subjects made cross-modality matching responses to several dimensions of their experience. Before each stimulus, they matched line lengths to their experienced desire to avoid pain (significance) and to their perceived likelihood of avoiding it (expectation). ⋯ In the other session, they simply focused on the pleasantness or unpleasantness of each sensation as it was experienced (affect-process responses). All subjects' affect-result responses were more positive (or less unpleasant) than affect-process responses. All of these results underscore the critical influence of expectations and the manner in which one evaluates sensations on affective responses to noxious stimulation.
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Comparative Study
The behavioral management of chronic pain: long-term follow-up with comparison groups.
To assess the long-term efficacy of an operant inpatient treatment program for severely disabled chronic pain patients, 26 treated patients were compared with 20 rejected for treatment by a clinic team and 12 who refused treatment. At follow-up ranging from 1 to 8 years, 77% of treated participants were leading normal lives without medication for pain compared to one patient in the other two groups. At time of evaluation, unsuccessfully treated patients used more medications and were higher on MMPI measures of paranoia and lower on ego-strength than successfully treated patients. Spouses of unsuccessfully treated patients had higher MMPI scores on hypochondriasis and hysteria than spouses of successfully treated patients.
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Our experience in treating 10 patients with intractable pain with paraplegia employing percutaneous epidural or dorsal column stimulation is presented. Initial and long-term results in this group are contrasted with those of 9 patients with intractable post-amputation or post-traumatic neuroma pain. The successful results of neurostimulation treatment of peripheral nerve pain contasts with the disappointing results in the treatment of paraplegic pain.
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A survey of the literature is presented in two areas of biofeedback treatment for headache--muscle contraction and migraine--and a variety of miscellaneous pain syndromes. The studies done to date are characterized largely by lack of proper no-treatment or placebo control groups, by confounding biofeedback with a variety of other strategies, or by sample sizes too small to afford any reasonable conclusions about efficacy. There is some evidence that biofeedback works better for muscle contraction headache than false feedback, but it also appears that biofeedback is no more effective than relaxation training. ⋯ The potential influence of extraneous factors linked to the therapeutic situation is pervasive in these studies, but examination of their specific roles in symptom reduction is largely missing. Some variables are listed which need to be examined and which may contribute to the alleviation of pain with much less expenditure of clinical resources than that demanded by biofeedback. Perhaps the main contribution of biofeedback has been to highlight such extraneous variables in the pain treatment setting.