The Clinical journal of pain
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Comparative Study
A comparison of psychosocial functioning and personality in amputee and chronic pain populations.
To compare two populations with disabling conditions, amputation and chronic pain, in terms of psychosocial functioning and personality factors. We hypothesized that the degree of disability of amputees would resemble that of patients with chronic musculoskeletal pain. We also examined the prevalence of personality characteristics stereotypic of chronic pain in the two samples. ⋯ Results are discussed in terms of the dual disability of amputees with chronic pain and of the hazards of attributing common characteristics to heterogenous patient groups.
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To examine the literature for evidence that psychological factors predispose certain individuals to development of reflex sympathetic dystrophy (RSD). ⋯ The data reviewed are consistent with a theoretical model in which depression, anxiety, or life stressors may influence development of RSD through their effects on alpha-adrenergic activity. However, conclusions regarding etiological significance of these factors are not possible due to the dearth of high-quality studies. Suggestions for prospective research are described.
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Phantom breast syndrome after mastectomy has already been reported by us and other authors. The temporal course, character, and extent of these phenomena, however, have not yet been elucidated. ⋯ The present incidence of phantom-related phenomena is close to the incidence reported by others. However, persistent phantom pain after mastectomy may be more common than usually expected. Also, the persistence of pain in the scar seems to be more common than generally expected.
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To provide a basis for recommendations on the exchange of containers (syringes and cassettes) and antibacterial filters, and for choice of administration device in patients with "refractory" pain treated with long-term percutaneous intrathecal (IT) infusions of opioid (morphine or buprenorphine) and bupivacaine mixtures. ⋯ In our population, exchange of the infusion systems when they are empty (within 1 month) and of the antibacterial filters once a month does not appear to affect the concentrations of, or increase the infection risk from, the opioid-bupivacaine mixtures. The risk of bacterial contamination/colonization of the syringes from syringe drivers does not seem to be higher than that of cassettes from external portable pumps.
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Reflex sympathetic dystrophy (RSD) is an enigmatic condition. Many clinicians, however, believe that psychological factors could contribute to the onset and persistence of the syndrome. ⋯ An etiopathogenetic hypothesis based on the authors' clinical experience and the foregoing literature also encompasses elements of stress-coping theory, cognitive-behavioral views on chronic pain, and the psychobiological approach to sympathetic nervous system dysfunction. Implications of this model for future psychological research and the therapeutic treatment of RSD are discussed.