Articles: back-pain.
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In an attempt to unravel the relationship between chronic pain and depression, the authors studied the incidence of depression, alcoholism, and chronic pain in first degree relatives of 100 chronic pain patients with and without depression. A higher incidence of major depression was found in first degree relatives of those patients with depression than those without depression. Familial incidence of alcohol dependence was similar in both groups of patients. These findings confirm an earlier report and raise questions about the notion of considering chronic pain simply as a variant of depression and suggest the possibility that the occurrence of major depression in chronic back pain might be related to genetic vulnerability to depression in these patients.
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Comparative Study
A simultaneous comparison of fentanyl's analgesic effects on experimental and clinical pain.
Intravenous administration of 0.8 microgram/kg and 1.1 micrograms/kg fentanyl in low back pain patients reduced both sensory intensity and unpleasantness visual analogue scale (VAS) responses to experimental pain evoked by graded 5-sec nociceptive temperature stimuli (45-51 degrees C) as well as VAS-sensory and VAS-affective responses to clinical pain. Fentanyl produced similar decreases in VAS-sensory responses to experimental and clinical pain. ⋯ This interaction of type of pain (experimental versus clinical) and pain dimension (sensory versus affective) results from either a steeper sensory intensity-unpleasantness relationship for clinical pain as compared to experimental pain or additional selective influences of opiates on affective factors uniquely related to clinical pain. These results indicate that low to moderate doses of opiates reduce both sensory and affective dimensions of pain and strongly suggest that changes in pain affect occur mainly as a direct consequence of reductions in pain sensation intensity.
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Patients entering treatment for chronic benign pain often are asked to complete drawings indicating the intensity and location of their pain as part of the diagnostic process. While inferences have been made from pain drawings about the relative contributions of physiological and psychological factors to the patient's experience of pain, previous research has provided only equivocal support for this practice. A reliable method for assessing pain drawings is needed both for clinical use and to assess the validity of such interpretations. ⋯ Scorers achieved a high rate of inter-rater agreement with relatively little training. The body surface scores obtained were shown to correlate highly with the penalty point system developed by Ransford et al., suggesting that extent of pain may account for much of the variance in this system. The results are discussed in relation to the clinical and experimental uses for such a system.
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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).