Assessment of postoperative pain: Contributing factors to the differences between patients and doctors

This study was undertaken to compare the assessment of pain intensity by 50 patients and by their doctors according to a visual analog scale 5 h and 20 h after major abdominal surgery, and to examine the relationships between the differences in rating of patients and doctors and the factors inherent in the patients which include preoperative expectation of pain, level of anxiety, and the surgical history of the patient. The ratings given by the patients were significantly higher than those given by the doctors at both time periods. However, the correlation between the ratings given by the two was low:r=0.31 andr _s=0.27 at 5 h after the operations, andr=0.58 andr _s=0.49 at 20 h. The results of analysis using Hayashi's quantification theory Type II indicated a moderate association between the rating difference and the patient's age, surgical history, preoperative state of anxiety, and expectation of pain. It is concluded that postoperative pain management, whether in clinical practice or in research, necessitates more consideration of the several above-mentioned individual factors and a preoperative interview in which the patient's level of anxiety and the amount of information the patient has concerning the surgery and post-operative pain is clearly assessed.     

Gender differences in psychological and cortisol responses to distress: A five-year follow-up of patients with back pain

To further evaluate gender-related coping strategies, clinical and psychological characteristics of patients with low back pain were related to their serum cortisol levels on admission to hospital and at five-year follow-up after operation and/or rehabilitation. Women expressed more somatization and depression than did men on admission, but gender difference disappeared during follow-up while depressive feeling tended to decrease. Men had more cortisol in blood in the afternoon. Sex explained a significant proportion of the variance in cortisol values at admission, whereas depression, sex and operation contributed to variance at follow-up. It was concluded that gender differences in psychological coping with distress modify cortisol responses to the experience of low back pain.     

大肠癌患者术前焦虑与个性特征及应对方式的相关性研究

目的探讨大肠癌患者术前焦虑与其个性特征及应对方式的相关性,为减轻患者术前焦虑、顺利应对手术应激提供依据。方法采用焦虑自评量表(SAS)、艾森克人格问卷简式量表中国版(EPQ-RSC)和特质应对方式问卷(TCSQ)在入院当天(术前5～7d)对136例大肠癌患者进行调查。结果大肠癌患者术前焦虑得分(44.69±8.76)分,显著高于国内常模(P<0.01);大肠癌患者术前焦虑发生率为35.29%。焦虑组内外向、积极应对得分显著低于非焦虑组,神经质、消极应对得分显著高于非焦虑组(P<0.05,P<0.01)。大肠癌患者术前焦虑得分与内外向、积极应对呈负相关,与神经质、消极应对呈正相关(均P<0.01)。结论大肠癌患者术前普遍存在焦虑情绪,且与患者的个性特征及应对方式相关。护理人员需针对性格内向、情绪不稳定及较多采用消极应对方式的患者进行针对性心理护理,以减轻其焦虑情绪,顺利完成手术。     

Magnetic resonance imaging characteristics of temporomandibular joint pain during opening and biting in patients with disc displacement.

OBJECTIVE: The purpose of this study was to evaluate the magnetic resonance (MR) imaging characteristic of temporomandibular joint (TMJ) pain during opening and biting in patients with disk displacement. STUDY DESIGN: MR images of 1252 TMJs in 640 patients with disk displacement were studied retrospectively. The relationship between TMJ pain and age, sex, and MR imaging findings, such as disk displacement with or without reduction, TMJ fluid, and osteoarthrosis, was analyzed using logistic regression analysis. RESULTS: The resultant data showed a significant relationship between TMJ pain during maximum jaw opening and disk displacement without reduction (OR = 2.36). The resultant data also showed a significant relationship between TMJ pain during maximum biting and TMJ fluid (OR = 1.85). CONCLUSION: The results suggest that TMJ pain during opening and biting is related to disk displacement without reduction and TMJ fluid on MR images.     

Employee adjustment to an organizational merger: stress,coping and intergroup differences

The present study was designed to test the utility of a stress-coping model of employee adjustment to organizational change. The model was based on the view that an understanding of the determinants of employee adjustment to this type of work stress lies in gaining knowledge about the event characteristics, how the event is appraised, the coping strategies used in response to the change and the extent of the employee's coping resources (neuroticism and social support). Data were collected from 662 fleet staff (mainly pilots) employed in a newly merged airline company. Structural equation analyses provided support for the role of each of the components of the proposed model of employee adjustment— as expected, there was some evidence that both situational appraisals and coping responses mediated the effects of the event characteristics and coping resources on adjustment. Adopting an intergroup perspective, the research was also designed to compare the situational appraisals, coping responses and adjustment of the employees of the two premerger companies (a domestic and an international airline). In accord with predictions derived from social identity theory, the employees of the premerger domestic company had the most positive reactions to the merger, presumably because the merger offered them the opportunity to improve their social identity.     

The evaluation of facial, head, neck, and temporomandibular joint pain patients

The purposes of this paper are 1) to present an evaluation procedure for patients with signs and symptoms of temporomandibular joint (TMJ) pain dysfunction syndrome (PDS) and 2) to describe the findings of the evaluation procedure on 12 patients with TMJ PDS. The evaluation emphasizes the collection of subjective and objective data. Records from 12 patients with facial, head, and neck pain were reviewed. The most frequent symptoms were: headache (1 00%), neckache (83.3%), and ear pain (58.3%). The most frequent signs were: muscle tenderness (100%) and mandibular deviation on opening (66.7%). Subjects with lateral pterygoid muscle tenderness had digastric muscle tenderness as well. Subjects with medial pterygoid muscle tenderness had masseter and hyoid muscle tenderness. Masseter muscle tenderness was strongly related to sternocleidomastoid and mylohyoid muscle tenderness and neckache. J Orthop Sports Phys Ther 1982;3(4):193-199.     

Stress, psychological distress, and coping in patients on the waiting list for lung transplantation: an exploratory study

Little information is available in literature on quality of life, stress and coping during the period patients are waiting for lung transplantation. This study explored potential stressful events that patients experience during the waiting period assessed the level of anxiety and depression and explored the use of coping strategies. Cross sectional analysis were performed. Between 3 and 27 months the number of patients that participated varied between 70 and 21. Measurements took place every 3 months until 27 months after waiting list placement. Instruments were the State Trait Anxiety Inventory, the Self-rating Depression Scale (SDS)-Zung and questions concerning stress and coping. Feeling tension caused by 'having to wear a beeper', and 'being afraid that the transplantation will come too late' were identified as important stress factors. Patients on the waiting list experienced more anxiety and depression, compared to the general population. The longer patients had been on the waiting list, the more anxiety and depression they experienced. Positive coping strategies like 'trying to relax' were more frequently used than negative ones like 'taking sedatives'. Stress, anxiety, and depression occur frequently in waiting list patients.     

Cognitive-behavioral approach to the treatment of chronic pain patients

BACKGROUND AND OBJECTIVES: Chronic pain is both prevalent and costly. Despite advances in understanding the anatomy, physiology, and biochemistry of nociception and development of potent analgesic agents and advanced technology, a significant number of people continue to experience pain and related disability. The perception of and response to pain are influenced by cognitive, affective, and behavioral factors as well as physical pathology. In this article, a selective review of research supporting the important contributions of psychologic factors is provided, a cognitive-behavioral perspective to understanding pain is presented, an integrative treatment and rehabilitation approach based on this perspective is described, and some of the evidence supporting the effectiveness of this treatment approach is summarized. CONCLUSION: Chronic pain by definition persists over a long period-it is a chronic disease. Even the most sophisticated treatments are incapable of eliminating all pain for all pain sufferers. There is also tremendous variation in how patients respond to treatments provided and prescribed. Better treatment outcomes are likely to occur when the psychologic contributors and the physical factors involved are addressed. Moreover, a treatment approach based on the cognitive-behavioral perspective should help patients adapt to residual pain that remains after currently available treatments are undertaken. Thus cognitive-behavioral treatments should be viewed as important complements to more traditional pharmacological, physical, and surgical interventions.     

JOSPT perspectives for patients. Anterior knee pain: a holistic approach to treatment

Pain under the kneecap, also known as anterior knee pain or patellofemoral pain, is one of the most common reasons why active people seek healthcare. Recently, a panel of 50 experts from 9 countries gathered in Belgium to discuss the potential causes of and best treatments for this condition. A synopsis of this meeting is published in the June 2012 issue of JOSPT and provides new insights and discussion of evidence-based treatments for those who have knee pain. J Orthop Sports Phys Ther 2012;42(6):573. doi:10.2519/jospt.2012.0505.     

Changes in coping strategies, relationship to the perpetrator, and posttraumatic distress in female crime victims

This study examined the relationship between changes in coping and posttraumatic stress disorder (PTSD) symptomatology among recent female rape and physical assault victims as a function of assault type and perpetrator status. Participants were assessed within 1 month after trauma and again at 3 months after trauma. Results indicate that changes in coping strategies over time are associated with the severity of the PTSD symptoms. Assault type was not a significant factor in the association between changes in coping and PTSD, but perpetrator status was. Victims with known perpetrators, who coped more by social withdrawal, had more severe PTSD symptoms over time. The importance of examining the dynamic nature of coping in the development of PTSD is discussed.     

A prospective study of patients with sciatica. A comparison between conservatively treated patients and patients who have undergone operation, Part I: Patient characteristics and differences between groups

Based on a prospective study on 342 sciatica patients examined with rhizography, the aim was to determine which factors others than the rhizography finding and the grade and duration of symptoms were related to the selection of patients to undergo operation. Compared with surgically treated patients, conservatively treated patients who did not undergo operation and who had pathologic rhizography findings had pessimistic attitudes to possible surgery, often expressed a desire to retire, and considered their work as physically stressful. The women in this group were older and had lower pain indices than women who underwent operation. Conservatively treated patients with negative rhizography had more severe occupational handicaps, minor expectations of possible surgery, physically more strenuous jobs requiring difficult physical positions, and lower indices for pain and ADL than did the operated patients. The social and ergonomic background problems are emphasized in sciatica patients conservatively treated after rhizography.     

Ethnic and sex differences in response to clinical and induced pain in chronic spinal pain patients

There is widely held clinical opinion and some tentative research justification for stereotypic or ethnic and sex differences in response to pain. To more adequately test this notion, 60 chronic spinal pain patients (black, Mexican American, and Caucasian, with ten men and ten women per group), all having persistent spinal pain for over 1 year, were studied. They were administered the ischemic pain test, a numerical estimate of spinal pain, and two independent raters scaled the amount of pain emphasis, based upon the patient's physical condition and pain behaviors. Results showed ethnic differences on the ischemic test (a psychophysiologic scaling technique used to approximate clinical pain and pain tolerance) with Mexican Americans describing the highest levels. Women of all ethnic groups tended to be judged as emphasizing their pain more than men, based upon judgment of their pain behaviors, and upon their own numerical estimates of pain. They also indicated that they more nearly approached their pain tolerance. It was concluded that while ethnic and sex differences were found, stereotypic responses were not uniform, and tended to be related to the manner in which that pain was assessed. These results are discussed in light of cultural differences.     

慢性疼痛患者疼痛程度及应对策略的调查

目的了解慢性疼痛患者的疼痛程度及应对策略,并探讨两者之间的相关性。方法采用随机抽样方法抽取武汉市11所三级甲等医院住院的慢性疼痛患者270例,采用数字疼痛强度量表及自行设计的慢性疼痛应对策略问卷进行调查。结果患者近1周的疼痛评分为0～10(6.39±2.49);近1周无疼痛1例(0.37%),轻度疼痛44例(16.30%),中度疼痛122例(45.18%),重度疼痛68例(25.18%),剧烈疼痛35例(12.96%)。其应对策略各维度中,积极心态评分(2.99±1.10)、忽视疼痛(2.61±1.11)、分散注意力(3.21±1.06)、行动解决(2.77±0.73)、寻求帮助(2.99±0.86)、消极心态(2.57±1.01)、限定活动(4.12±1.01)。患者疼痛强度与应对策略中的忽视疼痛呈负相关(r=-0.208,P<0.01)。结论慢性疼痛患者的疼痛程度多处于中重度,其疼痛程度与应对策略相关。医护人员应重视和规范慢性疼痛的管理,采取相应措施提高患者应对策略,以减轻其疼痛程度。     

Comprehensive multidisciplinary pain center approach to the treatment of low back pain.

The primary objective of our program is full function. Other objectives include relief or decrease in pain with the abolition of pain medication, elimination of assistive devices, low or zero disability rating, job satisfaction with return to work and leisure activities without limitations, independence from the health care system, prevention of reinjury, and optimum wellness. The intense, multidisciplinary program described involves a full-time multidisciplinary staff, complete patient involvement, weight control, physical restoration and conditioning, home program maintenance, pacing, body mechanics, energy-saving techniques, reinjury prevention education, pain control and elimination, drug detoxification, behavioral modification, biofeedback, relaxation, imagery, individual and group therapy, family therapy, assertiveness training, stress management, coping skills, vocational counseling, job planning/development/simulation, achievement of maximal function, immediate return to work at discharge, and follow-up care. It is possible to return 86% of these patients to full function and work; they may have some residual pain, which should eventually remit. The 14% who fail are hardcore patients with major behavioral problems, although, to be fair, there are still unanswered questions to resolve. These people have problems that cannot be eliminated within the limit of time with which we have to work with the patient. Lastly, these patients can be disturbed and dangerous, as evidenced by the headline of "A Former Patient Shoots, Kills, New York Neurosurgeon, Self, Wife."     

Occult fractures of articular eminence and glenoid fossa presenting as temporomandibular disorder: a case report.

We report an unusual case of occult fractures of the articular eminence and glenoid fossa due to a previous traffic accident presenting as a temporomandibular disorder. A 24-year-old Japanese man was referred for trismus and pain in the right temporomandibular joint, and was suspected of having temporomandibular disorder. Although the magnetic resonance image did not show displacement of the articular disk, T2-weighted images revealed disruption of the cortical low-intensity line of the right articular eminence. On a computerized tomography (CT) scan, an isolated bone fragment of the right articular eminence was clearly seen, and fractures of the right glenoid fossa and articular eminence were noted. The patient was treated by instructing him not to open his mouth widely and to remain on a soft diet for 4 weeks. A CT examination performed 1 year after the treatment showed complete healing of the fracture in the right articular eminence and glenoid fossa.     

Short Communication: Gender differences in coping with the major external stress of the Washington,D.C. sniper

This study examined the relationship between gender and strategies for coping for individuals faced with a perceived major, life‐threatening stressor. The focus here was the sniper(s) that terrorized the greater Washington, D.C. metropolitan area for over 3 weeks in October 2002. A retrospective survey of 144 random respondents regarding their behavior and coping mechanisms during this period indicated that, overall, women's behavior was affected more than men's. Unexpectedly, most emotion‐focused coping mechanisms studied here yielded no significant gender differences. The findings are discussed in light of recent thinking in social psychology on sex‐role stereotyping and risk‐taking. Copyright © 2004 John Wiley & Sons, Ltd.