Pain Treatment Centers Research Articles

How to read The Body in Pain.

How To Read The Body in Pain** David B. Morris He has seen but half the Universe who never has been shown the House of Pain. — Ralph Waldo Emerson1 A quiet revolution beginning about 1960 promises to transform centuries of medical thinking about pain. From the time of the Hippocratic writings, pain has held die clear and secure status of a symptom. In effect, Western medicine has attributed a distinctive legibility to pain, as if pain were a more or less readable inscription diat die skilled physician might interpret for its revelations about processes hidden deep within the flesh: a message composed, sent, and delivered by illness. The physician dius serves, among other offices, as a professional reader of pain, and pain — despite its reputation for noisy inarticulateness — holds the physician in the peculiar intimacy characteristic of reading. They share a common but equivocal language ranging from open, unmistakable declarations of fact to delicate hints and subtle ambiguities. The medical revolution now under way does not seek to overthrow the ancient status of pain as a symptom. Radier, it introduces a radical change in perspective, which acknowledges that pain is sometimes completely illegible. This more or less unreadable pain no longer resembles a message that passes in between the physician and the illness. The message is die illness. "We treat pain as a diagnosis, not a symptom," explains anesthesiologist Michael Kilbride, founder of die Muskegon (Michigan) General Hospital's Pain Management Center, opened four years ago.2 This typical transformation of pain from symptom to diagnosis or syndrome — from * Elaine Scarry, The Body in Pain: The Making and Unmaking of the World (New York: Oxford University Press, 1985). All quotations are from this edition and are cited parenthetically in the text. Copyright β 1985 by Oxford University Press, Inc. Reprinted by permission of Oxford University Press, Inc. t This work was supported by a grant from the Division of Research Programs of the National Endowment for the Humanities. Literature and Medicine 6 (1987) 139-155 © 1987 by The Johns Hopkins University Press 140 READING THE BODY IN PAIN the sign of illness to illness itself — is the conceptual change underlying a major realignment in the contemporary practice of medicine that might be called the emergence of the pain clinic. By recent count, there are close to one thousand private and public pain treatment centers in the United States. The two separate programs first established in 1960 by Dr. John J. Bonica (Seattle) and by Dr. Benjamin L. Crue, Jr. (Pasadena) have fostered within medicine a new growth industry. Faced with this sudden proliferation , patients do not always recognize that at different pain clinics the philosophies, goals, and methods of treatment may differ greatly, even as Drs. Crue and Bonica disagree about fundamental issues in the understanding of pain.3 Medical opinion about the value of pain clinics is far from unanimous. Still, the institutional signs of change are unmistakable. Two weighty medical journals now share the one-word title Pain.* There are national organizations, international conferences, and an entirely new medical specialty (algology) all devoted to the study of pain. Pain (with its accompanying issues, physical and metaphysical) now threatens to obsess the modern world much in the way pleasure (in its relations to virtue, reason, and the good life) preoccupied the ancients. From a literary point of view, what appears most striking about recent developments in medicine is that pain has acquired an unprecedented textuality. Its complications and elusive silences, which defeat simplistic or reductive readings, give pain something of the texture we recognize in complex novels or poems, where the physician who seeks to treat Macbeth or Lear must unravel a knot that ties body to mind, medicine to politics, nature to culture. For some researchers and clinicians, pain is better understood not in its traditional role as a sensation but rather as a perception, implying that it cannot be fully grasped apart from the vagaries of human consciousness. Non-conscious pain seems a contradiction in terms, and even the most unambiguously organic injury (if it hurts long and hard enough) eventually provides a site for the mind to brood upon. The "gatecontrol " model of pain developed by Ronald...

Survey of Pain in the United States: The Nuprin Pain Report

In August and September 1985, a nationwide telephone survey was made of 1,254 persons aged 18 and older, representing a cross-section of the adult population in the continental United States. This survey provided quantitative data on the prevalence and severity of different kinds of pain, the demographic characteristics of those with pain, the impact of pain on work and other activities, the relationship between pain and measures of stress and health locus of control, the use of medical and other professionals in pain treatment, and the effectiveness of various treatments for pain relief. This is the first nationwide survey of an unselected sample of the U.S. census and provides extensive data documenting the need for additional research on pain and its control and for improved education of the public and health professions.

Validity and Therapeutic Efficacy of Individual Patient Goal Attainment Procedures in a Chronic Pain Treatment Center

A sample of 180 patients treated at The Boulder Pain Control Center was randomly chosen to participate in Goal Attainment Scaling (GAS). Of these participants, a total of 76 returned for a 6-month follow-up assessment. Data from these patients were used for two studies: (a) a study of the construct validity of the GAS as a treatment outcome measure, and (b) an assessment of treatment efficacy using the GAS. For the first study, Rao's canonical factor analysis was used to judge the construct validity of the GAS scores. There is moderate statistical evidence to show that GAS can add to our understanding of the structure of pain treatment outcome measures. For the second study, a simple comparison of the treatment group (n = 76) with a control group (n = 129) on several functional, verbal, and sociocultural outcome measures showed that GAS participation accounted for 24.7% of the variance in improvement after treatment.

The Millon Behavioral Health Inventory: concurrent and predictive validity in a pain treatment center.

The Millon Behavioral Health Inventory (MBHI) is one of only a few diagnostic instruments designed specifically for psychological evaluations of medical patients. However, despite being available for clinical use for several years, there are virtually no published research evaluations of this inventory. The present study evaluated the MBHI in light of Minnesota Multiphasic Personality Inventory (MMPI) and Beck Depression Inventory (BDI) scores and treatment outcomes of 52 chronic pain patients. MBHI scales were highly correlated with admission and denial of psychopathology, as well as emotional distress, but had little relationship to Hs and Hy of the MMPI. The Pain Treatment Responsivity scale (PP), Allergic Inclination scale (MM), and MMPI D scale predicted the outcome of pain treatment at comparable levels. The specificity of the MBHI scales seems questionable in that 10 of 19 intercorrelations between PP and other MBHI scales were between 0.70 and 0.86. A stepwise regression procedure did not select PP among MBHI variables used to predict treatment outcomes. Results were interpreted as supporting cautious clinical use with pain patients until further research has been carried out.

The use of structured group therapy sessions in the treatment of chronic pain patients

Although group therapy is used in a number of multidisdplinary pain treatment centres, few published accounts of procedures are available. The present report describes the use of a moderately directive group therapy method, integrating psychodynamic, cognitive, and behavioural models of therapy. Content of sessions was structured to address problems specific to chronic pain patients. The therapist provided interpretations and confronted patients when appropriate. Problems encountered are described, and two examples are presented. Ideas for improved approaches to group therapy are discussed, with special emphasis on a method integrating physical and psychological therapy.

Effect of Epidural Steroids in the Cervical and Lumbar Region on Surgical Intervention for Diskogenic Spondylosis

Pain Treatment Centers, *Lake Forest Hospital, Lake Forest, and †Illinois Masonic Medical Center, University of Illinois, Chicago, Illinois, U.S.A.

Role of the Physical Therapist at Pain Treatment Centers

A nationwide survey of pain treatment centers was conducted for the purpose of investigating the role of the physical therapist at the centers. The majority of centers employing a physical therapist treated both inpatients and outpatients. Cervical and low back pain were the most common types of pain. The treatments most commonly used were an individualized exercise program, relaxation training, transcutaneous electrical nerve stimulation, and instruction in body mechanics. The majority of therapists attended staff meetings once a week, were responsible for teaching classes related to physical therapy, and were involved in some type of patient follow-up. Almost half of the therapists were engaged in pain research and clinical education.

Managing the problem pain patient: Compliance or social control?

This paper explores the usefulness of a social control perspective for the analysis of the everyday medical management of problem pain patients. The popular, social-psychologically based, patient-compliance model is founded on certain assumptions which limit applicability to pain patient-practitioner interaction. A social control model is proposed to account for the moral and social construction of the problem pain patient. Data are presented from studies of pain management seminars and the patient screening process in a comprehensive pain treatment center to illustrate how this moral and social construction is accomplished.

Drug withdrawal and the use of placebos in sixty-three chronic pain treatment centers

1Chronic Pain Management Program at Spalding Rehabilitation Hospital, Denver, USA 2Clinical Data Network, Broomfield, Colorado, USA

Relief of Dental Pain by Ice Massage of the Hand

Department of Psychology, McGill University and Pain Treatment Center, Montreal General Hospital, Montreal, Canada

Critical evaluation of 110 geriatric patients in a pain treatment center (PTC)

Critical evaluation of 110 geriatric patients in a pain treatment center (PTC)

A comparison of cognitive impairment due to benzodiazepines and to narcotics.

In an attempt to determine the source of cognitive impairment in 106 consecutively admitted patients at the Johns Hopkins Chronic Pain Treatment Center, EEG, the Wechsler Adult Intelligence Scale, Memory Quotient, and Bender Gestalt tests were administered. Patients receiving benzodiazepines alone demonstrated alterations in cognitive functioning and EEG evidence of a sedative effect. Patients receiving narcotics alone and a group of patients not receiving medication did not show signs of cognitive impairment. The effects of benzodiazepines on sleep and perception of chronic pain, in combination with the cortical changes that they produce, imply that these drugs should not be used in most patients with chronic pain.