• Psychological Factors in Chronic Pain: Assessment and Treatment Issues
• Measuring Outcomes: The Key to Quality Management
• A Practical Approach to Pain Management in Patients with Cancer and AIDS
• Injection Techniques in the Management of Local Pain
• Pelvic Pain

Psychological Factors in Chronic Pain: Assessment and Treatment Issues

Robert N. Jamison

This article presents an overview of psychological factors which influence chronic pain. Emphasis is placed on assessment technique and psychological treatment approaches for patients with chronic pain. In the first section, the usefulness of psychometric measures are discussed and areas considered critical in the psychological assessment of chronic pain are reviewed, including (1) pain intensity, (2) functional capacity, (3) mood and personality, (4) pain beliefs and coping, (5) medication usage, (6) adverse effects, (7) behavioral analysis, and (8) health care utilization. Personality factors affecting pain syndromes, DSM-IV diagnoses and health care utilization issues are also discussed. In the second section, an overview of psychological and behavioral interventions for chronic non-malignant pain are presented within the context of a multi-disciplinary pain management program. A rationale for a group-based program along with the roles of a team, program goals, patient selection criterion, components of the program, and information on program evaluation is reviewed.

Measuring Outcomes: The Key to Quality Management

Richard L. Stieg

 

Managed care continues to encroach upon virtually all health care delivery systems. Cost controls within these systems have been governed in the past by selection/deselection procedures and utilization management that are primarily based upon claims cost data. The recent movement toward integration of health care quality measures with financial data offers some hope that quality will not be unduly compromised in the efforts to control health care costs. In this new milieu there are increasing opportunities for health care professionals to participate in the development and refinement of managed care products. A model for a worker=s compensation managed care system being developed in Colorado is offered as an example of the movement toward more meaningful partnering between health care payers and providers.

A Practical Approach to Pain Management in Patients with Cancer and AIDS

Jennifer E. Merrell, Carol A. Warfield

This review describes practical management techniques for pain associated with cancer and AIDS. Multi-disciplinary and multi-modality approaches are discussed.

Injection Techniques in the Management of Local Pain

Andrew A. Fischer

 

This is a review of local anesthetic (LA) injections and infiltrations particularly combined with > needling= for management of local musculoskeletal pain. New techniques are described including preinjection blocks (PIBs) which consist of blocking the sensory input from an area prior to giving an injection. PIBs prevent pain which would be caused by needle penetration of sensitive tissue. Needling and infiltration (N and I) with 1% lidocaine has been performed after PIB in 179 tender spots (Tss), trigger points (TrPs), and muscle spasms by the author, in 123 patients with the goal to relieve pain and promote healing. The immediate effect after the procedure as well as long-term results from 1 week to 7 months have been evaluated independently by a physiatrist experienced with injections (Dr. Tae Mo Chang). N and I extending over the entire taut band of abnormal muscle fibers, caused effective relief of pain and functional improvement in tender spots (Tss), trigger points (TrPs) and in muscle spasm caused by a variety of conditions including: acute and chronic sports and work injuries, motor vehicle accidents, muscle and ligament sprains (supraspinous, sacroiliac), overuse and repetitive stress syndromes, tennis elbow; local injuries or radicular irritation; and local inflammations such as bursitis, tendinitis, and osteoarthritis; and traumatic dystrophy, a type of reflex sympathetic dystrophy. Needling and infiltration of trigger areas and tender spots is effective treatment in several conditions. Pre-injection blocks allow the performance of the N and I of tender areas without pain.

Keywords: Trigger points; Injections; Preventive analgesia; Pain relief

 

 

 

 

1996;7(2):119-133

Pelvic Pain

John S. McDonald

 

This paper focuses on the special aspects of pelvic pain that make it a difficult area in which to work. This will be done by use of specific examples of certain chronic pelvic pain conditions. This will be followed by a general discussion of current diagnosis and treatment methods for common pain syndromes. Most of these patients are women who suffer from pelvic pain. Case presentations will be used to illustrate the application of the materials presented. In the final analysis, diagnosis and management of chronic pelvic pain is best treated by an individual who is experienced, knowledgeable, and cognizant of the intricate relationship between pain, organopathology and neuropathology.