The Clinical journal of pain
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Forty-six pain clinic patients (British) were compared with 143 nonclinical subjects (Canadian) on a variety of demographic and illness variables. A subset of 43 nonclinical subjects was further compared with the 46 pain clinic patients for depression and illness behaviour. Both groups were well matched for age, sex, and marital status. ⋯ Nearly 75% of subjects in both groups were aware of the diagnosis for their pain condition. On Beck Depression Inventory both groups scored in the nondepressed range. On the Illness Behaviour Questionnaire the pain clinic group scored significantly higher on disease conviction, somatization, and denial than did the nonclinical sample.
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A review of Social Security Disability Income (SSDI), listed impairments (Section 1.05) for axial pain, the application process, appeals process, and the importance and impact of the treating physician's role in Social Security disability determination is discussed. The authors summarize the major types of disability programs and the present impairment rating systems, and present recent research in the complicated area of chronic pain and illness behavior that may alter the present system. They give recommendations that may aid the treating physician to prepare the patient's application for Social Security Disability Income.
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Despite advances in the understanding of pain mechanisms and innovative strategies to assess pain patients, there continues to be a substantial proportion of patients who do not appear to benefit from treatment interventions available. One possible explanation for these results is the tendency to treat chronic pain patients as a homogeneous group with generic treatments--adherence to "patient and treatment uniformity myths." Following from the traditional medical model, several attempts have been made to identify specific subgroups of patients exclusively on the basis of physical factors. ⋯ Alternative strategies to classify subgroups of pain patients based on combinations of physical, psychosocial, and behavioral measures (i.e., multiaxial strategies) are presented. The efforts to classify homogeneous subgroups of chronic pain patients are reviewed, and the potential utility of customizing therapeutic interventions to patient characteristics is discussed.
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We studied 31 patients with acute herpes zoster (AHZ) less than 28 days' duration. Clinical characteristics (pain, allodynia, course of disease) and somatosensory perception thresholds (thermal discrimination, hot pain, and vibration) of the affected dermatome and the contralateral homologous area were assessed. Touch-evoked allodynia was found in 17 (55%) and dysesthesia in a further 5 (16%). ⋯ Thermal threshold abnormalities were significantly associated with the prevalence of postherpetic neuralgia (PHN) at 3 months. The effect of nerve blockade was less favorable on allodynia than spontaneous pain. The results of possible pathophysiological mechanisms are discussed.
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Those in professions treating pain must prepare to justify the cost-effectiveness of the treatments they supply. Attempts have been made to define cost-effectiveness. Is it the lowest possible cost? The return of the patient to work and other daily activities? Pain clinics must develop good working relationships with business providers; establish credibility; plan, communicate, evaluate results scientifically; and educate the public.