Pain medicine : the official journal of the American Academy of Pain Medicine
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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.
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The present study sought to derive an algorithm using factor analysis and structural equation modeling (SEM) to describe headache and orofacial pain patients using measures of behavioral and psychological functioning. This investigation further examined whether the underlying factor structure differed in 3 presumed distinct diagnostic categories: myofascial, neuropathic, and neurovascular pain. ⋯ Analysis derived a 3-factor solution. The factors were Pain Impact, Illness Conviction, and Depression. SEM revealed the critical causal pathway showing that Depression determined Illness Conviction and Pain Impact. We conclude that the main target for pain treatment is depression. No differences in factor structure were found for the 3 diagnostic categories of myofascial, neuropathic, or neurovascular pain. This suggests that psychological processes are similar in chronic headache and orofacial pain patients despite their presumed distinct underlying pathophysiological mechanisms. SME is a powerful methodology to construct causal models that has been underutilized in the pain literature.
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To assess the relative frequency of violent ideation [VI] in physical rehabilitation and community samples, and to identify associated factors. ⋯ Recent research supports the contention that there is a relationship between ideation, angry affect, aggressive behavior and delayed recovery. Thus the presence of VI in the patient should be a cause for concern, and has clear ramifications for those working in the clinical setting. Primary prevention should involve not only the identification of hostile patients at risk for VI and aggression, it should also involve identifying programs or systems where a higher incidence of VI is likely to be observed. As VI was found to be associated with a range of variables, including characterological disorders, mood and social conflict, a further evaluation of factors contributing to VI would be recommended prior to intervention.