Pain medicine : the official journal of the American Academy of Pain Medicine
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This paper reviews the current literature focusing on pain in HIV/AIDS, including prevalence, pathophysiology, substance abuse, treatment issues, and psychosocial contributions. In light of the high prevalence of pain among individuals with HIV/AIDS, attention is paid to the negative psychosocial impacts of pain in this population and to psychosocial barriers to optimal HIV/AIDS-related pain treatment. ⋯ Subsequently, a biopsychosocial model of chronic pain assessment and treatment is applied. A multidimensional framework is presented for appropriate assessment and treatment of HIV/AIDS patients with pain, and specific recommendations and guidelines are offered for assessment and multimodal treatment of HIV/AIDS-related pain informed by the model.
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The potential for malingering must always be considered among patients presenting with pain. When malingering is identified, care may be discontinued. This case report describes a patient who feigned sickle cell crisis, a painful condition, in the presence of other identifiable and potentially painful medical illnesses.
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This study was designed to determine whether affective inhibition and somatosensory amplification are elevated in patients with a history of myofascial face pain (MFP). These processes may underlie a tendency to express distress in somatic rather than affective terms, leading to somatized or masked depression. ⋯ Affective inhibition and somatosensory amplification are likely to be elevated in patients with MFP. Although not accounted for by psychiatric symptomatology, the possibility that these response styles are reactive to coping with chronic face pain cannot be ruled out.
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To examine the consistency of internist judgments about low back pain; to examine the influence of different clinical factors on those judgments. ⋯ While there is little agreement among internists regarding judgments of low back pain, individual physicians hold consistently to their opinions. These findings suggest that management of low back pain may be idiosyncratic, potentially compromising patient care.
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To examine the longitudinal use of methadone in a pain clinic. ⋯ Chronic pain patients may be safely and effectively treated with methadone. Those not responding or tolerating methadone may be benefited by treatment with other opioids.