The temporality of illness: Four levels of experience

This essay argues that, while much has been gained by medicine's focus on the spatial aspects of disease in light of developments in modern pathology, too little attention has been given to the temporal experience of illness at the subjective level of the patient. In particular, it is noted that there is a radical distinction between subjective and objective time. Whereas the patient experiences his immediate illness in terms of the ongoing flux of subjective time, the physician conceptualizes the illness as a disease state according to the measurements of objective time. A greater understanding of this disparity in temporal experiencing provides insights into the lived experience of illness and can preclude difficulties in communication between physician and patient.     

Pain: Biopsychosocial Mechanisms and Management

Traditionally, pain has been viewed as a sensory event warning of tissue damage or illness. This explanation fails to account for many of the experiences of people suffering from clinically painful conditions. Over the past two decades, a new biopsychosocial perspective on pain has emerged. This perspective emphasizes that pain is a dynamic process that not only is influenced by biological, psychological, and social mechanisms of pain, but also produces biological, psychological, and social changes that can affect future responses to pain. This review presents findings from recent studies of the biological, psychological, and social mechanisms of pain and discusses the implications of these findings for pain research, assessment, prevention, and treatment, as well as for health care policy.     

The Role of Cardioprotective Avoidance Beliefs in Noncardiac Chest Pain and Associated Emergency Department Utilization

This study examined cardioprotective avoidance beliefs and general panic/agoraphobia variables among 45 Emergency Department patients with a primary complaint of noncardiac chest pain (NCCP) in the absence of coronary artery disease or other medical explanation. Cardioprotective beliefs about the dangerousness of work and physical activity were assessed with the Fear-Avoidance Beliefs Questionnaire (FABQ). Additional measures assessed complaints of cardiac distress and panic, anxiety sensitivity, panic-related beliefs, agoraphobic avoidance, and depressive symptoms. Hierarchical regression analysis indicated that cardiac distress symptoms are a function of panic symptoms and cardioprotective beliefs concerning both physical activity and work, with 62% of the total variance explained. The predictors also explained 57% of the variance in Emergency Department utilization, which was significantly related to cardiac distress symptoms, number of illnesses, and work-avoidance beliefs. Neither outcome was related to demographics, depression symptoms, general anxiety sensitivity, general panic cognitions, or agoraphobic avoidance. Results suggest that current behavioral understandings of NCCP might be advanced by further examination of cardiac-specific avoidance beliefs and behavior and the potential role these factors play in both symptom experience and medical utilization.     

Biology and a Theology of Evolution

The challenge and stimulus to theology that is constituted by the scientific version of Genesis which will prevail for the foreseeable future is expounded in relation to the significance of the succeeding stages of the life process and to the general features of biological evolution. A responsive theology of evolution is discerned as involving a renewal of insights associated with the themes of immanence, panentheism, the Wisdom and Word of God, and a sacramental universe. Such a revitalized theology allows one to conceive of humanity and Jesus the Christ in a fully evolutionary perspective without loss of an emphasis on the particularity of the Incarnation.     

Generalised Chronic Musculoskeletal Pain as a Rational Reaction to a Life Situation?

While the biomedical model is still theleading paradigm within modern medicine and healthcare, and people with generalised chronicmusculoskeletal pain are frequent users of health careservices, their diagnoses are rated as having thelowest prestige among health care personnel. Anepistemological framework for understanding relationsbetween body, emotions, mind and meaning is presented.An approach based on a phenomenological epistemologyis discussed as a supplement to actions based on thebiomedical model.Within the phenomenological frame of understanding,the body is viewed as a subject and carrier ofmeaning, and therefore chronic pain can be interpretedas a rational reaction to the totality of a person'slife situation. Search for possible hidden individualmeanings in painful muscles presupposes meeting healthpersonnel who view the person within a holistic frameof reference.     

The Family Environment in Chronic Pain Patients: Comparison to Controls and Relationship to Patient Functioning

Operant and cognitive-behavioral models of chronic pain have called attention to the importance of examining the marital and family environments of chronic pain patients. In this study, 50 chronic pain patients and their spouses and 33 control participants and their spouses completed measures of the family environment, marital satisfaction, and patient physical and psychological functioning. Patients' overt pain behaviors were coded from videotapes of patient–spouse interactions. Compared to controls, pain patients and their spouses rated their family environments as lower in cohesion and higher in control, and there was a trend for spouses to report more marital dissatisfaction. Chronic pain patient depression was associated negatively with patient-rated family cohesion and expressiveness and spouse-rated family organization and positively with patient-rated family conflict. Overt patient pain behaviors and spouse-rated patient disability were related negatively to spouse-rated family cohesion. Spouse marital satisfaction was associated negatively with patient depression and with spouse ratings of patient disability and pain behaviors.     

Multidimensional Assessment of Chronic Low Back Pain: Predicting Treatment Outcomes

This study explored responses of chronic low back pain patients to treatment for different types of patients (dysfunctional, interpersonally distressed, and minimizer/adaptive coper), as classified using the Multidimensional Pain Inventory (MPI). In addition, changes in MPI scores during treatment were examined separately for each patient type. Finally, this study explored the relationships between changes in MPI scores and physical improvement. Between-group differences in improvement were significant, with dysfunctional patients showing the most improvement on several scales. MPI scales that best predicted physical improvement differed according to patient type. Implications for treatment of low back pain patients are suggested, based upon differential reactions to treatment and different predictors of physical improvement for each patient group.     

Neurophysiological codes of words in subcortical structures of the human brain.

Investigations into the cerebral mechanisms of mental activity, using modern mathematical-technical capabilities, allows the transition from study of structural-functional organization to a new stage: the study of neural coding of these cerebral processes.Here we present the results of studying the elementary components of the neurophysiological pattern-code of words and the neurophysiological correlates of the simplest mental processes, generalization, and mental conclusion. The elementary components of the pattern-code are the group sequences of neuronal firing with comparatively stable intervals in between. The processes of mental conclusion and decision making occur when full, compressed, and complex patterns-codes appear in the brain.In discussing the data obtained, the problems of relationship between a part and the whole in activity of cerebral systems is considered, and the hypothesis of a dynamic pace-maker mechanism for cerebral organization of mental activity, is proposed.     

实验性恶心与呕吐——大脑皮层与内脏相关研究的新途径

大脑皮层与内脏关系的脑机制是揭示心身疾病和心理疾病的重要依据。本文综述了经典条件学习与期待性恶心与呕吐的关系以及实验性恶心与呕吐的研究方法。作者认为,实验性恶心与呕吐结合脑成像技术是研究大脑皮层与内脏关系神经机制的重要途径。     

Longitudinal Assessment of Pain, Coping, and Daily Functioning in Children with Sickle Cell Disease Receiving Pain Management Skills Training

Objective. To conduct intensive pain management skills training (IST) in children with sickle cell disease (SCD) and their parents and to comprehensively evaluate pain, coping, and daily functioning in children pre, immediately post, and 3 months following treatment. Methods. Three children who received IST in nonpharmacological and pharmacological pain management strategies completed a Coping Strategies Questionnaire (CSQ) at pre, post, and follow-up assessments, and daily pain and activity diaries for 18 weeks, spanning from 1 week pretreatment to 11 weeks posttreatment. Results. From pre- to posttreatment, 1 child receiving IST indicated increased report of active coping attempts and all 3 children indicated decreased report of negative thinking on the CSQ. Participants in IST used coping skills on 90% of days with pain and reported the skills to be moderately helpful on the daily diaries. For daily activities such as eating dinner, playing with friends, and hours slept, children participated similarly on days with pain and days without pain during the posttreatment period. Given the small number of participants in this study, individual cases are discussed to highlight similarities and differences in how participants responded to the treatment and during the 3-month follow-up period. Conclusions. In this pilot study, each participant showed improvement in coping and daily functioning after completing the IST program. Individual differences in response to treatment indicate the need for more targeted intervention programs that incorporate pharmacological and nonpharmacological components. The results of this study highlight both the promise and the complications of conducting comprehensive pain intervention and functional outcome studies in children with SCD.