NCCN成人临床癌痛指南中心理问题、精神症状和精神用药的解读

疼痛的体验是主观的,疼痛与痛苦相伴而行。NCCN成人癌痛指南对癌痛的评估和治疗中涉及大量的心理问题与干预、精神症状评估和精神药物应用,本文力求对这方面进行解读,以揭示癌痛治疗中对人的尊重和对“总疼痛”的理解。     

庄子与史铁生的自由精神之比较

“乘物以游心”的庄子在乱世以自由逍遥的精神追求探究人生意义,执着的行魂史铁生处盛世思接远古,以个体的自由精神彰显生命本色。前者的自由精神是在时代之匣里对必然人生命运的结果性追求,后者的自由精神是于个体的偶然命运之殇里传递过程的美好。二者穿越时空对自由精神的多向度诉求使得人类的普世价值历久弥新。     

Type D Personality and Chronic Pain: Construct and Concurrent Validity of the DS14

A body of research has demonstrated that the Type D personality is a risk factor among cardiac patients. Previous studies validating the Type D Scale (DS14) across other clinical groups have not included chronic pain patients in their samples. The purpose of this study was to investigate the construct and concurrent validity of the DS14 using the MMPI-2. The DS14 and its two component subscales demonstrated strong internal consistency among chronic pain patients. The two subscales of the DS14 were found to be related to similar clinical scales on the MMPI-2, and significant differences were found in the MMPI-2 profiles of individuals with and without the Type D personality. Considerations for clinical practice and research are discussed.     

Information processing in chronic pain disorder: A preliminary analysis

Researchers have alternately suggested selective attention, impaired stimulus filtering, and affective language deficiency models as accounting for multiple somatic complaints in persons with chronic pain disorder. The purpose of the present study was to establish the comparative usefulness of these three models for explaining somatic focus in a chronic pain population. Nine chronic pain patients evidencing high somatic focus (somatizing chronic pain patients), 10 chronic pain patients evidencing low somatic focus (nonsomatizing chronic pain patients), and 10 healthy control subjects were administered a computerized version of the emotional Stroop test as a test of these models. A total of 105 pain-, depression-, and neutral-content words were used as Stroop test stimuli. Stroop test color-naming response latencies were submitted to a two-way Group × Word Type mixed-model ANOVA, with Word Type as the repeated measure. Results reveal that neither the selective attention model nor the affective language deficiency model adequately explain Stroop test performance in somatizing chronic pain patients. Findings provide tentative support for the impaired stimulus filtering model, with somatizing chronic pain patients evidencing similar Stroop test response delays across all words. These results suggest that chronic pain sufferers misinterpret bodily sensations. Findings are discussed in terms of a bilevel approach for treatment of somatizing chronic pain patients that would include assisting the patient in accurate appraisal and interpretation of physical symptoms.     

Emotional distress and the perceived interference of menstruation

The relation of perceived interference of menstruation on expected behaviors to emotional distress was examined. It was predicted that the perceived interference of menstruation would be more predictive of emotional distress associated with menstruation than either menstrual or premenstrual pain. Participants completed measures of menstrual pain and visual analogue scales of emotional distress (anger, frustration, depression, anxiety, fear). Measures of perceived ability to tolerate the pain, the perceived interference of the pain, and attitudes toward menstruation were also collected. Results indicated that perceived interference was the strongest predictor of emotional distress secondary to menstrual pain. Ratings of menstrual and premenstrual pain were also significant predictors of emotional distress. Results supported the major hypothesis of the study and provide evidence that the appraisal of interference imposed by a particular condition or Stressor may be an important factor in stress and coping processes.     

Book Reviews

Books reviewed:
Raymond D. Boisvert, John Dewey: Rethinking Our Time
Larry A. Hickman, ed., Reading Dewey: Interpretations for a Postmodern Generation
Jennifer Welchman, Dewey's Ethical Thought
Richard Shusterman, Practicing Philosophy: Pragmatism and the Philosophical Life
Richard E. Hart and Douglas R. Anderson, eds., Philosophy in Experience: American Philosophy in Transition
Richard Kearney, Poetics of Modernity: Toward a Hermeneutic Imagination     

Sexual-Assault History and Long-Term Physical Health Problems: Evidence From Clinical and Population Epidemiology

Having a history of sexual assault is associated with both poor general health and limitations in physical functioning, as well as with specific health problems such as chronic pelvic pain, premenstrual disturbance, other gynecologic symptoms, fibromyalgia, headache, other pain syndromes, and gastrointestinal disorders. In studies evaluating the possible role of depression in these associations, depression among sexually assaulted persons did not account for their poorer health. Although there are unanswered questions in the literature on the associations between sexual assault and health, existing findings are consistent with standard criteria for inferring causal relationships from observational data. For example, many assault-health associations are supported by multiple, independent studies, and many demonstrate dose-response relationships (i.e., more incidents of sexual assault, or more severe assaults, are associated with more adverse health outcomes).     

Understanding Chest Pain: What Every Psychologist Should Know

Chest pain is one of the most frequent presenting complaints in Emergency Rooms and other medical settings. A considerable number of these patients do not have significant coronary artery disease. This led to plausible alternative explanations for these presenting symptoms and these patients tend to have unremarkable cardiac outcomes. Nevertheless, many studies have also documented that symptoms and related disability persist in the face of reassurances about benign cardiac status. Given the implied threat of chest pain (e.g., myocardial infarction) and the presence of chest pain symptoms in other noncardiac conditions (including anxiety and panic), it is not surprising that many of these patients present with considerable emotional distress. Consequently, chest pain symptoms represent diagnostic and treatment dilemmas for physicians and psychologists alike. The extent to which cardiac and noncardiac factors contribute to all forms of chest pain remains unknown. The function of this review is to provide mental health professionals with a primer on relevant clinical issues in chronic chest pain. We examine several common medical and psychiatric causes of chronic chest pain and selectively review (1) the relevant medical and psychiatric diagnostic and treatment considerations for chest pain and (2) the hypothetical biobehavioral mechanisms relevant to psychological intervention, (3) while expanding on existing conceptual models for understanding chest pain, and (4) offering some suggestions for future research.     

Assessing self-report of pain: A comparison of two recording procedures

Intensive vs. reduced demand self-monitored pain levels were compared in nine pain patients. Each patient self-monitored pain intensity on a 6-point scale every 2 hr. Overall, daily mean and maximum pain levels were calculated for each patient (1) across all intervals (intensive self-monitoring) and (2) four times per day, at meal times and bedtime (reduced-demand self-monitoring). Differences were found to be negligible. The reduced-demand procedure produced data that were closely representative of pain fluctuations indicated in the more intensive bihourly ratings. Results are discussed in terms of the representativeness and standardization in pain self-monitoring as well as possible enhancement of recording compliance through the use of the less demanding four times per day procedure.Portions of these data were presented at the meeting of the Association for Behavior Analysis, Dearborn, June 1979.     

Distraction for Pediatric Immunization Pain: A Critical Review

The paper provides a critical review of distraction for pediatric immunizations in order to determine clinical practicality and efficacy of this commonly employed intervention. The MEDLINE and PsycINFO databases were searched to identify papers that included an evaluation of a distraction intervention as a method of pediatric immunization pain management. Fifteen papers were included in this review. Effect sizes were calculated to estimate the clinical significance of findings. In order to examine possible differences in effect sizes related to distraction characteristics, chi square analyses were conducted. Results indicate that distraction is clinically effective in the reduction of pain during pediatric immunizations. Support is found for behavioral and cognitive explanations of distraction mechanisms. Further, various distraction stimulus characteristics were found to be associated with the clinical significance of findings. This article is based on the preliminary examination paper of the first author under the direction of the second, at West Virginia University.