Correlates of Fear of Falling in Older Adults Who Have Experienced a Fall

Nearly one half of older adults who have experienced a fall report a fear of falling. The present study examined several variables in relation to fear of falling. Thirty community-dwelling older adults, over 60 years of age, who experienced a fall in the previous 12 months participated. Subjects were divided into two groups (low-fear and high-fear) and compared on scores on a Fear of Falling questionnaire, the Falls Efficacy Scale, the Philadelphia Geriatric Center Pain Intensity Scale, the Ways of Coping Checklist-Revised, the Geriatric Depression Scale-15, and the State–Trait Anxiety Inventory for Children. At least a little fear of falling was reported by 25 (83.3%) of the individuals who had fallen. Highly fearful fallers were significantly more likely to endorse higher levels of pain and general anxiety than fallers reporting low levels of fear of falling. Future directions for research were noted.     

Characteristics of Children Presenting to a Behavioral Treatment Program for Pediatric Headache

This study examined headache characteristics and psychological variables associated with pediatric headache in a specialty treatment clinic. Children were referred by pediatric neurologists to a hospital-based pediatric behavioral medicine clinic for behavioral treatment in conjunction with medical management of the pain. Headache typology of the children indicated that 1/3 of the sample reported at least daily headaches, and a large percentage of patients described experiencing headaches that lasted for more than a day (26%). Child and parent report of pain revealed a fairly high level of correspondence for headache activity. Regarding other psychological characteristics, children in this study endorsed higher than expected levels of somatization even after adjusting for headache symptoms. Compared with children's report, parents' report showed only slightly higher levels of secondary gain experienced by children because of pain. Gender differences were not found. The implications of these findings for improving our understanding of pediatric headache are discussed.     

老年癌症患者疼痛管理

面对日益加剧的人口老龄化趋势,国际肿瘤界逐渐意识到老年肿瘤治疗问题的严重性。老年肿瘤患者在被确诊时多已处于晚期,基础疾病多,各脏器功能下降,姑息治疗对老年肿瘤患者显得非常重要,尤其是疼痛治疗。目前,因为对老年人疼痛的认识不足、评估不够、过分担心药物副作用,使得老年癌痛控制现状不容乐观。本文综述了老年癌痛的特点、评估方法及治疗原则,强调对于老年癌症患者治疗的目标不是重返工作或者延长生命,而是尽最大可能地提高生活质量,让老年癌症患者远离癌痛,真正享受到无痛人生。     

老年下背痛诊断的思考

下背痛是一组临床十分常见的症候群,老年下背痛随着增龄因素,发病率逐渐提高,而老年下背痛的诊断治疗有其自己的特点。本文叙述了老年下背痛的发病机制、特点、诊断及误诊分析,探讨在临床工作中对待老年下背痛患者要以辩证的哲学思想分析和解决问题,避免误诊。     

“三阶梯”止痛原则临床实践20年

WHO癌痛“三阶梯”止痛原则发布20年来,经过医患双方上亿人次的临床实践,取得了巨大成功。人类对癌性疼痛乃至良性疼痛的认识,从来没有如此深刻;有关止痛的实践也从来没有如此广泛。作者回顾了“三阶梯”原则的产生背景和历史功绩,指出了“三阶梯”原则在实践中丰富和发展的必要性。作者建议,今后我国癌症止痛应“临床勇于实践,用药讲究技巧,工作重点下移”。     

加强小儿围术期疼痛管理——医学伦理的必然要求

近年小儿围术期疼痛管理日益引起人们的重视。小儿围术期疼痛管理包括围术期疼痛的监测和评估,疼痛治疗的原则和策略等方面的内容。鉴于儿童是一个相对独立的利益群体,即使新生儿在围术期也有完善的疼痛治疗的需求,重视小儿围术期的疼痛诉求,体现了对小儿的人文关怀和基本权力的维护,是医学伦理的必然要求。     

应用层次分析法建立最优心理结构的探讨

层次分析法是一种新的将定量分析与定性分析相结合的系统分析与决策方法。通过分析当前在心理系统中应用层次分析法存在的问题,首次提出了应用层次分析法来为心理系统建立最优心理结构的设想。应用这种方法要求所研究的心理系统必须有操作性定义,并能形成判定“最优心理结构”的统一标准,因此这种方法特别适用于心理量表。文章通过一个例子具体介绍了如何应用层次分析法的基本思想和计算方法来给心理量表中的各个维度赋予理想化的权值及其进一步应用与验证的方法。     

Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety

Many patients with chronic pain also exhibit elevated levels of health anxiety. This study examined the effect of health anxiety on the use of safety-seeking behaviors (SSBs) in pain-provoking situations. Participants were 20 chronic back pain patients with high health anxiety (Group H), 20 with low health anxiety (Group L) and 20 pain-free controls (Group C). Two physical tasks were video recorded, and compared both for overt pain behavior (identified by blind observers following a standardized procedure) and for the occurrence of SSB (identified by showing the participants video playback and asking them to specify motivation for all actions/behaviors displayed during the tasks). While there were no differences in the display of overt pain behaviors, Group H deployed a greater number of SSBs than Groups L and C. This finding held true for both tasks and remained significant when concurrent pain and mood ratings were statistically controlled for. SSB was correlated with catastrophizing thoughts but not pain intensity; pain intensity was correlated with overt pain behavior but not catastrophizing. Taken together, these findings suggest that SSB is distinct from overt pain behavior and may be a defining characteristic of chronic pain patients reporting high levels of health anxiety.     

Predicting short-term outcome in well-being following suicidal behaviour: the conjoint effects of social perfectionism and positive future thinking

This study investigated an integrative, psychological model of suicidality involving the relationship between perfectionism and future thinking to predict short-term outcome in well-being following a suicidal episode. Two hundred and sixty-seven adults hospitalized following a self-harm episode completed a range of clinical and psychological measures in hospital and were followed up approximately two months after discharge. Hierarchical regression analyses confirmed that, among the suicidal self-harmers who had a history of repetitive self-harm (n=65), outcome among low social perfectionists changed as a function of positive future thinking such that outcome was better for those high on positive thoughts compared with those low on positive future thoughts. There was no such positive change in outcome among the high social perfectionists. There were also no significant interactive effects evident among the non-repetitive self-harmers (n=61). These findings extend recent research to suggest that socially prescribed perfectionism and positive future thinking (but not negative future thinking) are implicated in outcome following repetitive suicidality. Implications for theory and clinical practice are discussed.     

The relationship between greater mindfulness and less subjective experience of chronic pain: Mediating functions of pain management self‐efficacy and emotional intelligence

Previous research shows a connection between greater mindfulness and less subjective experience of pain. The present study examined whether pain management self‐efficacy and emotional intelligence mediate this relationship in individuals experiencing chronic pain. Two hundred participants experiencing chronic pain completed measures of mindfulness, experience of pain, pain management self‐efficacy, and emotional intelligence. Greater mindfulness was associated with less subjective experience of pain, greater pain management self‐efficacy, and more emotional intelligence. More pain management self‐efficacy and higher emotional intelligence were associated with less subjective experience of pain. Emotional intelligence and pain management self‐efficacy significantly mediated the relationship between mindfulness and pain. The connection between greater mindfulness and less subjective experience of pain may be due to mindfulness providing a foundation for emotional functioning and behavioural regulation that result in reductions in the experience of pain.