Optimal Scoring of the Multidimensional Pain Inventory in a Chronic Pain Sample

The Multidimensional Pain Inventory (MPI) is one of the most commonly used self-report instruments in pain settings. The MPI can be used to classify patients into three clusters or its nine scales can be treated as dimensions in efforts to understand patient heterogeneity. Previous research suggests the existence of a fourth cluster, whose members have been labeled ‘repressors,’ that emerges with the addition of a defensiveness scale to the MPI. The current paper compared the abilities of MPI cluster and dimensional models with and without a measure of defensiveness to capture variability in validating variables related to personality, psychopathology, physical functioning, and treatment outcome in a chronic pain sample. Results suggest that dimensional models consistently outperform cluster models in explaining variance in outcome variables, and that the addition of a measure of defensiveness increments the validity offered by the MPI scales. Implications for the assessment of pain patients are discussed.

Variations in Psychological Profile Among Children with Recurrent Abdominal Pain

This study was designed to determine whether distinct subgroups of children with recurrent abdominal pain (RAP) could be identified based on patterns of psychological functioning. Two hundred and eighty-three children (ages 8–17 years), and a primary caretaker, completed the Behavior Assessment System for Children (BASC) during the initial evaluation of RAP at a pediatric gastroenterology clinic. Cluster analysis of BASC scores supported a 3-cluster solution, with fair agreement observed between parents and children on cluster assignment. Approximately half of the sample identified no significant psychological problems. A small percentage (13%) evidenced intense and broad-based psychological problems, while the remainder (35–45%) indicated relative elevations in anxiety only. Cluster membership did not vary systematically by age, gender, race, or functional gastrointestinal disorder diagnosis. Distinct psychological profiles appear to exist for children with RAP. Targeting treatments to these profiles may improve the effectiveness and efficiency with which health professionals address pediatric abdominal pain. This study was supported in part by a grant from the Hall Family Foundation. Portions of this work were presented at the annual convention of the American Psychological Association in July 2004 (Honolulu, HI) and at Digestive Diseases Week in May 2004 (New Orleans, LA).     

下腰痛的影像学过度诊断及对策

下腰痛的发病率很高,就诊的患者人次居骨科就诊患者的首位。当前临床上存在下腰痛影像学的"过度检查",原因包括医方的利益驱动、医生过分依赖影像学、医生的防御性医疗以及患者方面的因素。针对下腰痛患者不同的症状和体征选择个性化的影像学检查和诊断是解决该问题的主要办法。     

The Neural Bases of Placebo Effects in Pain

Abstract— Placebo effects are beneficial effects of treatment caused not by the biological action of the treatment but by one's response to the treatment process itself. One possible mechanism of placebo treatments is that they create positive expectations, which change one's appraisal of the situation and may thereby shape sensory and emotional processing. Recent brain-imaging evidence suggests that placebo-induced expectations of analgesia increase activity in the prefrontal cortex in anticipation of pain and decrease the brain's response to painful stimulation. These findings suggest that placebo treatments can alter experience, not just alter what participants are willing to report about pain. To the extent that they involve neural systems mediating expectancy and appraisal, placebo effects in pain may share common circuitry with placebo effects in depression, Parkinson's disease, and other disorders.     

Signification and Pain: A Semiotic Reading of Fibromyalgia

Patients with persistent pain who lack adetectable underlying disease challenge thetheories supporting much of biomedicalbody-mind discourse. In this context,diagnostic labeling is as inherently vulnerableto the same pitfalls of uncertainty that besetany other interpretative endeavour. The endpoint is often no more than a name ratherthan the discovered essence of a pre-existentmedical condition. In 1990 a Committee of theAmerican College of Rheumatology (ACR)formulated the construct of Fibromyalgia in anattempt to rectify a situation of diagnosticconfusion faced by patients presenting withwidespread pain. It was proposed thatFibromyalgia existed as a ``specific entity',separable from but curiously able to co-existwith any other painful condition. Epistemological and semiotic analyses ofFibromyalgia have failed to find any sign,clinical or linguistic, which coulddifferentiate it from other diffusemusculoskeletal pain states. The construct ofFibromyalgia sought to define a discernablereality outside the play of language and topass it off as a natural phenomenon. However,because it has failed both clinically andsemiotically, the construct also fails the testof medical utility for the subject inpersistent pain.     

恐惧的代价：疼痛恐惧、心理忧虑和躯体化对疼痛感知预测作用的比较

首次在无痛群体中比较疼痛恐惧、心理忧虑和躯体化对疼痛感知的预测作用大小及调节和中介关系。以多个同类量表得分的Z分数加和作为三者的因子分,以冷压痛觉测验（CPT）疼痛指标（阈限、耐受性、强度、不愉快度）为目标变量,通过分层回归及调节和中介作用分析,发现疼痛恐惧对疼痛不愉快度的预测作用最强,心理忧虑对疼痛体验（强度、不愉快度）的预测作用被疼痛恐惧完全中介,躯体化只有在高疼痛恐惧条件下才显著负向预测疼痛不愉快度。综上,疼痛恐惧是三因素中预测CPT疼痛体验的主要因素。     

Of Power and Compassion

Abstract: While military and economic power are obviously central instruments of policy in international relations, there are a number of reasons why power alone is insufficient to succeed in fighting terrorism. Three central reasons are discussed in this essay: the limitations and the dilemma of power; the proposition that the most threatening form of terrorism, such as al‐Qaeda's, is conducted by nonstate actors, conventional deterrence against whom is less effective; and the role of motivation in conflicts where the distribution of power is asymmetrical. In addition to these objective reasons, it is argued that the foreign‐policy strategies pursued ultimately affect the actors' own values.     

癌痛规范化治疗的制约因素分析

癌痛严重影响中晚期癌症患者生活质量,通过使用第三阶梯强阿片类止痛药物,绝大部分患者疼痛能得到很好的控制。微观上,癌痛治疗的疗效与患者及医务人员的认识程度密切相关,也与医院麻醉科等其他科室的参与程度有关。宏观上,社会人文、经济、政策管理等方面的不足都制约着癌痛规范化治疗的有效实施。癌痛的规范化治疗是一项管理措施,需要进行疼痛评估、家庭支持及宗教组织的参与帮助等。我们国家在文化、经济、教育等各个方面取得长足进步时,癌痛治疗会更加规范、合理、人性化。     

不同强度的痛觉刺激对内、外倾者心率、T波幅度影响的初步研究

本文旨在探讨内、外倾者在三种不同强度痛觉刺激下心率、T波幅度的变化。通过艾森克个性问卷筛选出15名内倾者和15名外倾者,以8mA、12mA、16mA的电流引起痛觉。实验结果表明,刺激后30秒内．在12mA、16mA痛觉刺激下．内倾组心率反应值与基础值差异显著．外倾组差异不显著;在12mA刺激下．内、外倾组心率变化差异显著。从心率变化上看。两组被试对痛觉刺激均表现出适应,内倾组的适应速度比外倾组慢。在各强度痛觉刺激条件下．二组T波幅度均未随刺激量增大发生显著变化。本实验表明,心脏T波幅度对痛刺激不敏感。     

Hallucinations in the psychotic state: Psychoanalysis and the neurosciences compared

In this contribution, which takes account of important findings in neuroscientific as well as psychoanalytic research, the authors explore the meaning of the deep‐going distortions of psychic functioning occurring in hallucinatory phenomena. Neuroscientific studies have established that hallucinations distort the sense of reality owing to a complex alteration in the balance between top‐down and bottom‐up brain circuits. The present authors postulate that hallucinatory phenomena represent the outcome of a psychotic's distorted use of the mind over an extended period of time. In the hallucinatory state the psychotic part of the personality uses the mind to generate auto‐induced sensations and to achieve a particular sort of regressive pleasure. In these cases, therefore, the mind is not used as an organ of knowledge or as an instrument for fostering relationships with others. The hallucinating psychotic decathects psychic (relational) reality and withdraws into a personal, bodily, and sensory space of his own. The opposing realities are not only external and internal but also psychic and sensory. Visual hallucinations could thus be said to originate from seeing with the ‘eyes’ of the mind, and auditory hallucinations from hearing with the mind's ‘ears’. In these conditions, mental functioning is restricted, cutting out the more mature functions, which are thus no longer able to assign real meaning to the surrounding world and to the subject's psychic experience. The findings of the neurosciences facilitate understanding of how, in the psychotic hallucinatory process, the mind can modify the working of a somatic organ such as the brain.