Psychosomatic medicine
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Chronic low back pain (CLBP) patients often are described as "somatizers", who report multiple somatic complaints beyond back pain itself, but the nature and clinical significance of this observation is poorly understood. To clarify the characteristics, correlates and severity of somatization in CLBP, we rigorously assessed somatization symptoms in a sample of patients not selected for psychiatric or pain clinic referral. Male CLBP patients (N = 97), attending a primary care orthopaedic clinic, and matched healthy controls (N = 49), were assessed using the Diagnostic Interview Schedule III-A (DIS), Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HRSD), McGill Pain Questionnaire (MPQ), Sickness Impact Profile (SIP), and the Pain and Impairment Relationship Scale (PAIRS). ⋯ Lower mood and increased impairment, but not pain intensity, were related to greater number of somatic complaints. Symptoms of somatization are prevalent, but not universal, in CLBP and the pattern of these symptoms is reminiscent of the "spectrum of severity" reported in other medical populations. Recognizing this spectrum of somatization may lead to better patient-treatment matching and improved clinical outcomes.
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Psychosomatic medicine · Sep 1986
The influence of happiness, anger, and anxiety on the blood pressure of borderline hypertensives.
Differences in blood pressure associated with reported happiness, anger, and anxiety are examined among 90 borderline hypertensives during 24-hr blood pressure monitoring. There were 1152 individual ambulatory blood pressure readings for which subjects classified their emotional state as happy (n = 628), angry (n = 67), or anxious (n = 457) on scales from one (low) to ten (high). Pressures were transformed to z-scores using the subject's 24-hr mean and standard deviation to assess relative elevation during reported emotional arousal. ⋯ Examination of arousal intensity showed that scores on the happiness scale were inversely related to systolic pressure (p less than 0.01) whereas the degree of anxiety was positively associated with diastolic pressure (p less than 0.02). Emotional effects were also related to the degree of individual daily pressure variation such that the greater the variability, the larger the blood pressure change associated with the emotions. The results suggest that happiness, anger, and anxiety increase blood pressure to differing degrees and that emotional effects may be greater in individuals with more labile blood pressure.
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Psychosomatic medicine · May 1986
Sleep and posttraumatic rheumatic pain modulation disorder (fibrositis syndrome).
The clinical features and sleep physiology of 11 female patients with "fibrositis syndrome" or rheumatic pain modulation disorder (RPMD) were compared with 11 female postaccident pain (PAP) patients who complained of widespread musculoskeletal pain, fatigue, and nonrestorative sleep following a nonphysically injurious motor vehicle or work-related accident. Both groups had similar musculoskeletal pain, fatigue, sleepiness and an alpha (7.5-11 Hz) EEG non-rapid eye movement (NREM) sleep anomaly. A psychophysiologic arousal mechanism during NREM sleep induced by the emotional stress of the accident may mediate the subsequent nonrestorative sleep, musculoskeletal pain, and fatigue symptoms in the posttraumatic pain disorder.
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Psychosomatic medicine · Sep 1985
Thermal sensory decision theory indices and pain threshold in chronic pain patients and healthy volunteers.
Fifty-five low back pain patients and 47 healthy volunteers judged the intensity of calibrated thermal stimuli. The method of constant stimuli yielded a pain threshold, and sensory decision theory (SDT) methods provided two independent indices of perceptual performance: discriminability, P(A), the ability to differentiate among various stimulus intensities; and report criterion, B, the tendency to use a particular response. Compared to healthy volunteers, chronic pain patients were far poorer discriminators [lower P(A)]. ⋯ The poor discriminability in patients could be due to attenuation of afferent neural input. The higher criterion suggests that the thermal stimuli were perceived as being innocuous relative to their clinical pain. Comparison of SDT indices with the threshold measures revealed that the pain threshold was highly correlated to the subject's criterion for reporting pain, B, and unrelated to discriminability, P(A).
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Psychosomatic medicine · Mar 1979
Adjustment in diabetic adolescent girls: II. Adjustment, self-esteem, and depression in diabetic adolescent girls.
The Rosenberg Self-Esteem Scale, Beck Depression Inventory, and Sullivan Diabetic Adjustment Scale were administered to 105 adolescent girls with diabetes. Results indicate that levels of self-esteem and depression highly correlate with the level of adjustment as assessed on the Diabetic Adjustment Scale (DAS). That is, the adjustment of adolescent diabetic girls in peer and family relationships, dependence-independence conflicts, and attitudes toward diabetes is significantly related to self-esteem; and the level of depression is significantly related to all these adjustment factors as well as body image. ⋯ The importance of diabetes as a scapegoat for normal adolescent concerns is discussed. It was also hypothesized that depression in adolescents may be expressed through concerns about diabetes. The importance of exploring relationships with peers and fathers is emphasized.