Sodium Amytal in the Diagnosis of Chronic Pain*

1978 ◽  
Vol 23 (4) ◽  
pp. 219-228 ◽  
Author(s):  
Roy P. Shoichet

The diagnosis of chronic pain cases is now an important problem for psychiatrists and many authors have presented strong evidence for the influence of psychological factors in chronic pain conditions. The author is reporting his experience with 75 consecutive out-patient consultations. Many of the patients were foreign-born and had significant language difficulties. The main diagnostic technique described is the use of sodium amytal given intravenously over a 45 minute-period while the patient is examined physically and psychologically; his responses noted during light, midrange and deeper levels of sodium amytal sedation. Most patients fell comfortably into one of the following diagnostic groups: psychogenic regional pain, organic pain, mixed group (organic plus psychogenic regional pain), and malingering. The author suggests that sodium amytal helps to overcome language barriers, reduces the time required for proper assessment and allows the patient and the examiner to appreciate more precisely, the level of pain and the limits of physical performance as well as permitting an effective exploration of important psychodynamic issues.

2017 ◽  
Vol 55 (2) ◽  
pp. 63-68 ◽  
Author(s):  
Andrada Ciucă ◽  
Adriana Băban

Abstract The present paper is aimed at briefly presenting psychological factors involved in cancer related pain and what psychosocial interventions are efficient in reducing it. Cancer related pain is a complex experience and the most integrative and recommended approach is the biopsychosocial model. It has been proved that chronic pain is more strongly related to psychological factors than to treatment or illness related factors. Psychological factors influencing pain experience can be intuitively grouped starting with awareness of pain (i.e., attentional factor), then with evaluation of pain (i.e., cognitive factors) which is leading to feelings (i.e., emotional factors), and behaviours (i.e., coping strategies) regarding pain. Psychosocial interventions (i.e., skill based and education based interventions) have strong evidence that is effective in reducing cancer related pain.


2020 ◽  
Author(s):  
Awinita Barpujari ◽  
Michael A Erdek

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.


2021 ◽  
Vol 3 (5) ◽  
pp. e383-e392
Author(s):  
Jo Nijs ◽  
Steven Z George ◽  
Daniel J Clauw ◽  
César Fernández-de-las-Peñas ◽  
Eva Kosek ◽  
...  

2021 ◽  
pp. 003232172110059
Author(s):  
James Laurence ◽  
Harris Hyun-soo Kim

Individual attitudes towards immigration are powerfully driven by ethnic context, that is, size of foreign-born population. We advance the literature by examining how the change (growth) in foreign-born population, in addition to its size (level), is related to two distinct outcomes: natives’ views on legal and unauthorized immigration. By analysing a probability US sample, we find that an increase in the state-level immigration population is positively related to Americans’ approval of a policy aimed at containing the flow of undocumented immigrants. The proportion of immigrants in a state, however, is not a significant predictor of support for such restrictive policy. With respect to legal immigration, neither the amount of recent change in, nor the size of, the immigration population matters. Our study provides strong evidence for contextual effects: net of compositional factors, a dynamic change in foreign-born population has an independent impact on how Americans view unauthorized, but not legal, immigration.


2020 ◽  
Vol 38 (02/03) ◽  
pp. 227-234
Author(s):  
Catherine Allaire ◽  
Alicia Jean Long ◽  
Mohamed A. Bedaiwy ◽  
Paul J. Yong

AbstractEndometriosis-associated chronic pelvic pain can at times be a complex problem that is resistant to standard medical and surgical therapies. Multiple comorbidities and central sensitization may be at play and must be recognized with the help of a thorough history and physical examination. If a complex pain problem is identified, most endometriosis expert reviews and guidelines recommend multidisciplinary care. However, there are no specific recommendations about what should be the components of this approach and how that type of team care should be delivered. There is evidence showing the effectiveness of specific interventions such as pain education, physical therapy, psychological therapies, and pharmacotherapies for the treatment of chronic pain. Interdisciplinary team models have been well studied and validated in other chronic pain conditions such as low back pain. The published evidence in support of interdisciplinary teams for endometriosis-associated chronic pain is more limited but appears promising. Based on the available evidence, a model for an interdisciplinary team approach for endometriosis care is outlined.


2016 ◽  
Vol 23 (10) ◽  
pp. 1489-1499 ◽  
Author(s):  
G. Cruccu ◽  
L. Garcia-Larrea ◽  
P. Hansson ◽  
M. Keindl ◽  
J.-P. Lefaucheur ◽  
...  

2008 ◽  
Vol 33 (5) ◽  
pp. e200-e200 ◽  
Author(s):  
T GOROSZENIUK ◽  
R REDDY ◽  
S KOTHARI ◽  
R KHAN ◽  
N PRATAP ◽  
...  

2016 ◽  
Author(s):  
Roy K. Esaki

Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that has been increasingly used in the management of treatment-resistant chronic pain conditions, particularly representing neuropathic involvement or central sensitization. Complex regional pain syndrome (CRPS) is a prototypical condition often treated with ketamine infusions. Although the analgesic benefits of ketamine as an opioid-sparing adjunct in the preoperative period have been well studied, the use of ketamine to mitigate chronic pain conditions remains largely anecdotal, composed largely of case reports and uncontrolled small studies. The limited evidence and published reports support the use of ketamine infusions as one aspect of a comprehensive, multimodal approach for CRPS. Although ketamine infusions are relatively safe when titrated appropriately, with minimal respiratory depression, side effects include sympathetic activation, unpleasant psychomimetic effects, lower urinary tract symptoms, and hepatic dysfunction. 


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