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Ask Elklit - One of the best experts on this subject based on the ideXlab platform.
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the traumatised Chronic Pain Patient prevalence of posttraumatic stress disorder ptsd and Pain sensitisation in two scandinavian samples referred for Pain rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying Chronic Pain Patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a Chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in Chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in Chronic Pain Patients referred consecutively for multidisciplinary Pain rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in Chronic Pain Patients referred consecutively to multidisciplinary Pain rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All Patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 Patients were assessed, of which 304 (DK, N = 220, female n = 144; FIN, N = 84, female n = 44) were admitted and consented to participate. All Patients had to be diagnosed with a non-malign Chronic Pain condition lasting for at least 6 months (median = 6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all Chronic Pain Patients for PTSD at admission for Pain rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain rehabilitation.
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The traumatised Chronic Pain Patient—Prevalence of posttraumatic stress disorder - PTSD and Pain sensitisation in two Scandinavian samples referred for Pain rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying Chronic Pain Patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a Chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in Chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in Chronic Pain Patients referred consecutively for multidisciplinary Pain rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in Chronic Pain Patients referred consecutively to multidisciplinary Pain rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All Patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 Patients were assessed, of which 304 (DK, N =220, female n =144; FIN, N =84, female n =44) were admitted and consented to participate. All Patients had to be diagnosed with a non-malign Chronic Pain condition lasting for at least 6 months (median=6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all Chronic Pain Patients for PTSD at admission for Pain rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain rehabilitation.
Tonny Elmose Andersen - One of the best experts on this subject based on the ideXlab platform.
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the traumatised Chronic Pain Patient prevalence of posttraumatic stress disorder ptsd and Pain sensitisation in two scandinavian samples referred for Pain rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying Chronic Pain Patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a Chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in Chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in Chronic Pain Patients referred consecutively for multidisciplinary Pain rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in Chronic Pain Patients referred consecutively to multidisciplinary Pain rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All Patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 Patients were assessed, of which 304 (DK, N = 220, female n = 144; FIN, N = 84, female n = 44) were admitted and consented to participate. All Patients had to be diagnosed with a non-malign Chronic Pain condition lasting for at least 6 months (median = 6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all Chronic Pain Patients for PTSD at admission for Pain rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain rehabilitation.
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The traumatised Chronic Pain Patient—Prevalence of posttraumatic stress disorder - PTSD and Pain sensitisation in two Scandinavian samples referred for Pain rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying Chronic Pain Patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a Chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in Chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in Chronic Pain Patients referred consecutively for multidisciplinary Pain rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in Chronic Pain Patients referred consecutively to multidisciplinary Pain rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All Patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 Patients were assessed, of which 304 (DK, N =220, female n =144; FIN, N =84, female n =44) were admitted and consented to participate. All Patients had to be diagnosed with a non-malign Chronic Pain condition lasting for at least 6 months (median=6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all Chronic Pain Patients for PTSD at admission for Pain rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain rehabilitation.
Per Grunwald Andersen - One of the best experts on this subject based on the ideXlab platform.
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the traumatised Chronic Pain Patient prevalence of posttraumatic stress disorder ptsd and Pain sensitisation in two scandinavian samples referred for Pain rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying Chronic Pain Patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a Chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in Chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in Chronic Pain Patients referred consecutively for multidisciplinary Pain rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in Chronic Pain Patients referred consecutively to multidisciplinary Pain rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All Patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 Patients were assessed, of which 304 (DK, N = 220, female n = 144; FIN, N = 84, female n = 44) were admitted and consented to participate. All Patients had to be diagnosed with a non-malign Chronic Pain condition lasting for at least 6 months (median = 6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all Chronic Pain Patients for PTSD at admission for Pain rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain rehabilitation.
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The traumatised Chronic Pain Patient—Prevalence of posttraumatic stress disorder - PTSD and Pain sensitisation in two Scandinavian samples referred for Pain rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying Chronic Pain Patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a Chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in Chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in Chronic Pain Patients referred consecutively for multidisciplinary Pain rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in Chronic Pain Patients referred consecutively to multidisciplinary Pain rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All Patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 Patients were assessed, of which 304 (DK, N =220, female n =144; FIN, N =84, female n =44) were admitted and consented to participate. All Patients had to be diagnosed with a non-malign Chronic Pain condition lasting for at least 6 months (median=6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all Chronic Pain Patients for PTSD at admission for Pain rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain rehabilitation.
Merja Vakkala - One of the best experts on this subject based on the ideXlab platform.
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the traumatised Chronic Pain Patient prevalence of posttraumatic stress disorder ptsd and Pain sensitisation in two scandinavian samples referred for Pain rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying Chronic Pain Patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a Chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in Chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in Chronic Pain Patients referred consecutively for multidisciplinary Pain rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in Chronic Pain Patients referred consecutively to multidisciplinary Pain rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All Patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 Patients were assessed, of which 304 (DK, N = 220, female n = 144; FIN, N = 84, female n = 44) were admitted and consented to participate. All Patients had to be diagnosed with a non-malign Chronic Pain condition lasting for at least 6 months (median = 6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all Chronic Pain Patients for PTSD at admission for Pain rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain rehabilitation.
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The traumatised Chronic Pain Patient—Prevalence of posttraumatic stress disorder - PTSD and Pain sensitisation in two Scandinavian samples referred for Pain rehabilitation
Scandinavian Journal of Pain, 2012Co-Authors: Tonny Elmose Andersen, Per Grunwald Andersen, Merja Vakkala, Ask ElklitAbstract:Abstract Introduction Correctly identifying Chronic Pain Patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a Chronic Pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with Pain sensitisation, elevated levels of Pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in Chronic Pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in Chronic Pain Patients referred consecutively for multidisciplinary Pain rehabilitation. Aim The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in Chronic Pain Patients referred consecutively to multidisciplinary Pain rehabilitation. We wanted to investigate whether specific Pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods Data were collected from two Scandinavian multidisciplinary Pain centres (Denmark and Finland). All Patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 Patients were assessed, of which 304 (DK, N =220, female n =144; FIN, N =84, female n =44) were admitted and consented to participate. All Patients had to be diagnosed with a non-malign Chronic Pain condition lasting for at least 6 months (median=6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or Pain. Results A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular Pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion The study emphasised the importance of screening all Chronic Pain Patients for PTSD at admission for Pain rehabilitation, using up to date diagnostic tools. Implications Untreated PTSD may exacerbate or maintain the Pain condition and negatively affect outcome of Pain rehabilitation.
Hubert L. Rosomoff - One of the best experts on this subject based on the ideXlab platform.
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medicolegal rounds medicolegal issues and alleged breaches of standards of medical care in a Patient motor vehicle accident allegedly related to Chronic opioid analgesic therapy
Journal of opioid management, 2007Co-Authors: David A. Fishbain, Renee Steele Rosomoff, John E Lewis, Brandly Cole, Hubert L. RosomoffAbstract:The objective of this medicolegal case report is to present the details of the case of a Chronic Pain Patient (CPP) who was placed on Chronic opioid analgesic therapy (COAT) and was involved in a motor vehicle accident, alleged in litigation to be related to COAT. COAT standards are in a process of evolution, and this process is influenced by recent literature developments. We aim to present both the plaintiffs and defendant's expert witnesses' opinions on whether the defendant physician fell below the "standard" in allowing the CPP to drive. Both the methadone and the driving literature are utilized to explain the defendant's and plaintiffs experts' opinions and the differences between them. Based on these opinions, we have attempted to develop some recommendations on how Pain physicians should approach the problem of deciding whether Patients should be allowed to drive when on COAT. Language: en
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The problem-oriented psychiatric examination of the Chronic Pain Patient and its application to the litigation consultation
The Clinical Journal of Pain, 1994Co-Authors: David A. Fishbain, Robert Cutler, Renee Steele Rosomoff, Hubert L. RosomoffAbstract:OBJECTIVE: The purpose of this paper is (a) to delineate the behavior problems or complaints of Chronic Pain Patients (CPPs) as presented in the literature and to add those behavior problems that have not yet been identified; (b) to present a semistructured psychiatric interview format that would lead to the delineation of these problems; and (c) to present a format and structure for the proposed semistructured psychiatric interview that could be utilized for the purposes of medicolegal assessment of the CPP and the reporting of that assessment to the litigation process. SETTING: Any psychiatric/psychological examination of the CPP. METHODS: The Pain literature was reviewed for any research reports that specifically addressed or delineated the types of behavior problems found within the Chronic Pain (CP) population. These behavior problems were placed in a semistructured interview format, organized in such a way as to facilitate reporting to the litigation process if necessary. RESULTS: This semistructured psychiatric examination format is presented. Controversial problem areas in this format are discussed with appropriate references. CONCLUSIONS: CPPs are seen for the psychiatric examination with a set of behavioral problems largely determined by their medical condition, the consequences of that condition, and the social circumstances surrounding that medical condition (e.g., the litigation process). The psychiatric examination should be tailored to this special set of problems. Language: en
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functional capacity and residual functional capacity and their utility in measuring work capacity
The Clinical Journal of Pain, 1993Co-Authors: Elsayed Abdelmoty, David A. Fishbain, Renee Steele Rosomoff, Tarek M Khalil, Soha Sadek, R B Cutler, Hubert L. RosomoffAbstract:OBJECTIVE The Pain physician is often asked to establish the medical impairment of the Chronic Pain Patient (CPP) and from that determination ascertain the work capacity of the CPP. Functional capacity (FC) testing has recently been introduced as a more objective and accurate way of facilitating the determination of work capacity. However, there are conceptual problems with the measurement of FC. These will be reviewed and the relationship of FC to residual functional capacity (RFC) will be determined. Finally, a method for measuring RFC in a job-specific manner will be suggested. DATA SOURCES The literature in reference to the measurement of medical impairment, FC, and RFC was reviewed. STUDY SELECTION Studies appropriate to the objective of this review were selected for inclusion. CONCLUSIONS The FC and RFC are poorly defined. Lack of definition has interfered with design of appropriate test batteries specific to work capacity. To circumvent this problem a job-specific RFC measurement method is suggested. This method is based on the Dictionary of Occupational Titles.
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drug abuse dependence and addiction in Chronic Pain Patients
The Clinical Journal of Pain, 1992Co-Authors: David A. Fishbain, Hubert L. Rosomoff, Renee Steele RosomoffAbstract:AbstractIt is claimed that a significant percentage of Chronic Pain Patients suffer from drug/alcohol abuse/dependency/addiction. To address this question, 24 articles alluding to Chronic Pain Patient drug/alcohol dependence/addiction were reviewed according to the following criteria: method for dru
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Detoxification of nonopiate drugs in the Chronic Pain setting and clonidine opiate detoxification.
The Clinical journal of pain, 1992Co-Authors: David A. Fishbain, Hubert L. Rosomoff, Renee Steele RosomoffAbstract:Although the Pain physician is most familiar with the treatment of the opiate withdrawal syndrome, other drugs are abused by the Chronic Pain Patient. The Pain physician should then be familiar with the withdrawal syndromes associated with other drug groups. The withdrawal syndromes associated with hypnosedatives, psychotomimetics, nicotine, stimulants, ergot alkaloids, beta adrenergic blocking agents, antidepressants, muscle relaxants, and alpha-adrenergic agonists are described. Drug detoxification protocols for these drugs are reviewed. Additionally, the rationale for clonidine opiate detoxification is discussed, and current clonidine detoxification protocols are reviewed.