Journal of psychosomatic research
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Psychophysiological recordings (electrodermal activity, heart rate, respiration rate and frontalis and back muscle tension) were taken in chronic low back pain (CLBP) patients and control subjects during baseline conditions and during the presentation of six acute pressure pain stimuli. No baseline differences in back muscle tension between CLBP patients and controls were found, but CLBP patients did have higher baseline electrodermal activity. During pain stimulation, CLBP patients showed larger skin conductance reactions than controls. ⋯ Contrary to expectation, no differences were found between CLBP patients and controls in physiological habituation after repeating the pain stimulus. Comparison of subjective pain ratings and psychophysiological variables showed that for control subjects arousal and subjective pain were related. For CLBP patients there was no such clear relationship.
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Randomized Controlled Trial Clinical Trial
Cognitive-behavioral therapy in patients with ankylosing spondylitis in a German self-help organization.
A cognitive-behavioral treatment program for pain control was administered to 22 subjects with a diagnosis of ankylosing spondylitis (AS) in a self-help setting of the German Rheumatism League. A sample of 17 AS subjects from the same setting served as waiting-list controls. The program consisted of training in progressive muscle relaxation, cognitive restructuring, attention related techniques and pleasant activity scheduling, and was aimed at an improvement of self-control strategies. ⋯ Reductions of pain intensity, anxiety, and psychophysiological symptoms were maintained at 12 month follow-up. Although pain reduction was statistically significant, it did not exceed 14% in the pain diary. The more important aspect of the treatment appears to be emotional stabilization and increased feelings of well-being.
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Several investigators have noted the moderating role of the spouse in determining the severity and disability associated with the experience of chronic pain. In this study, pain-contingent responses from spouses, but not global marital satisfaction, accounted for a significant proportion of the variance in reported pain severity. ⋯ Similarly, the interaction between marital satisfaction and degree of spouse solicitousness significantly predicted pain severity. These results are consistent with evolving literatures on the important relationship between marital distress, aversive communication and depression on the one hand, and the potentially deleterious role of the solicitous spouse in the maintenance of chronic pain on the other.
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Comparative Study
Effects of time-limited vs unlimited compensation on pain behavior and treatment outcome in low back pain patients.
A common theme in the pain literature is that worker's compensation reinforces pain behavior and adversely influences treatment outcome of chronic pain patients. This study compared 110 chronic low back pain males divided into three groups: 44 receiving no compensation, 27 receiving time-limited worker's compensation, and 39 receiving unlimited social security disability benefits. All patients participated in a multimodal treatment program (e.g. nerve blocks, transcutaneous electrical nerve stimulation, relaxation training, biofeedback). ⋯ In general, however, more worker's compensation and non-compensation patients who were initially not working had returned to work at the time of follow-up compared with the disability patients. These results suggest that time-limited compensation may not affect treatment outcome or interfere with return-to-work chances while unlimited compensation may adversely influence the probability that patients will return to work. These findings support the notion that worker's compensation patients receiving time-limited financial benefits do not necessarily represent a 'problem' subgroup of chronic pain patients.
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The assumption of a specific migraine-related psychophysiological response stereotype under conditions of stress, recovery and relaxation was examined in 37 migraineurs (non-headache state) and 44 normal controls. Two stressors were presented, industrial noise and a 'social discomfort' situation, each was followed by a recovery period. Relaxation was induced by verbal instructions accompanied by soft music. ⋯ The hypothesis of a specific vasomotor stress response stereotype in migraineurs could not be corroborated. The observed differences in relaxation and recovery were hypothesized. But the overall results are not easily explained on the grounds of a coherent model (e.g. elevated sympathetic arousal level).