Faculty Bibliography

Forty-eight chronic pain patients who were discharged from or left the 21-day inpatient component of a multidisciplinary pain program prior to completion were compared with a randomly selected matched group of program patients who stayed the entire 21 days. The purpose of the study was to determine if pre-admission factors are useful in predicting whether a chronic pain patient will complete an inpatient pain program. The results of pre-admission MMPI, POMS, MPQ, and information obtained from a questionnaire specially created for the program were studied. On the tests, the non-completers admitted to less psychopathology than those who did complete the program. The non-completers also had a higher number of pain-related surgeries and were more likely to be college graduates; limited social support from their families and lower MMPI premature termination scale scores were also found. Implications of these findings for the management of chronic pain patients are discussed

The relationship between combat stress, DSM-III-defined post-traumatic stress disorder (PTSD), and a variety of behavioral factors was examined in a large nonclinical population. A total of 2858 randomly selected American Legion members who had served in Southeast Asia completed a questionnaire which elicited information on military service, personal health, and a variety of mental health outcomes. The data confirm the utility of the PTSD diagnosis as a distinct clinical entity. The frequency of PTSD and the extent of symptoms developed varied with the severity of criteria used for determining the extent of traumatic exposure. The PTSD rate ranged from 1.8 to 15.0% of the total sample, depending on whether 'exposure' to combat was defined relatively narrowly or broadly. A distinct linear dose-response relationship between combat stress and a quantitative measure of PTSD intensity was observed. The frequency of PTSD diagnosis was not affected by the presence of either physical or mental health problems which predated military service. A strong, stable relationship was found between combat stress and PTSD intensity for cohorts with differing intervals since the experience of combat trauma, which persisted up to 20 years after discharge from the military. The data thus support a broader approach to defining traumatic events which recognizes individual differences in response to combat, as well as the existence of other behavioral outcomes as residual effects of combat. Implications of these findings and the importance of treating veterans with varying presentations of PTSD are discussed

Brainstem auditory evoked potential (BAEP) and visual evoked potential (VEP) studies were undertaken in 8 patients with chronic cervical pain associated with auditory and visual symptoms of more than 6 months duration. The purpose of the study was to ascertain possible central abnormalities, including posterior cervical sympathetic syndrome (Barre-Lieou syndrome), in their auditory and/or visual pathways. Patients who had been treated surgically for cervical pain were excluded from the study group. All patients had normal cervical radiographs and electromyographic findings. Six also had normal CT scans and myelograms. A criterion of the study was that abnormal results would be considered significant only if ophthalmological and/or otolaryngological work-ups failed to reveal an underlying organic abnormality. The TECA-TE 42 was used throughout the study, as well as the international Ten-Twenty System of Electrode Placement. The results showed no abnormalities in the latency, amplitude, or waveform morphology of the evoked potentials. BAEP and VEP studies do not appear to reveal central abnormalities of the auditory and visual pathways in this group of patients. However, in view of the small number of patients included in the study, no conclusions can be made with certainty and the study is continuing

This report reviews the results of the first 2 1/2 years of a comprehensive multidisciplinary inpatient-outpatient treatment program for patients with chronic pain. Functional data indicate a 33 1/3% rate of return to work or involvement in work training programs, while self-report data indicate a 50% improvement rate. Future directions for research are suggested

The management of iatrogenic drug dependence in individuals with pain can be more difficult than the treatment of the pain itself. In addition to a multidisciplinary approach to the treatment of a patient with chronic pain, there is a need for a rapid, safe, and effective method of detoxification from opiate use. Clonidine HCl, a nonopiate, has been found, in this case presentation, to be a valuable option