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Biomedical subjects

D C Turk

Publications and source records attributed to D C Turk.

At least 19 recordsLinked to original sources
PubMed2005

An expanded view of psychological aspects in head pain: the biopsychosocial model.

Traditionally, headache has been viewed from a limited perspective, both medically and psychologically. The authors propose that a more expanded view of headache that considers each perspective as important, as embodied in the biopsychosocial model, will greatly enhance understanding and be more useful in treatment planning. This model views pain as emanating from a complex interaction of biological, psychological and social variables. This paper describes the key behavioural, affective and cognitive influences and provides pertinent supporting examples from the literature.

Affect↗
PubMed2003

Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics.

STUDY DESIGN: Postal survey. OBJECTIVES: Because of the high prevalence and inadequate control of pain following spinal cord injury (SCI), it is important to have information about the factors associated with the use of specific pain therapies. We conducted this study to evaluate the ability of pain characteristics and psychosocial factors to predict the use of treatments. SETTING: The Miami Project to Cure Paralysis (Miami, FL, USA). METHODS: People with SCI (n=120) were mailed a packet containing a questionnaire with questions regarding demographic factors, pain characteristics, and pain treatments along with a copy of the Multidimensional Pain Inventory. RESULTS: A total of 59% of the respondents had been prescribed treatment or self-initiated efforts to treat pain over the previous 18-month period. The most common treatments used by this sample were massage (26.6%), opioids (22.5%) and nonsteroidal anti-inflammatory drugs (NSAIDs) (20%). The most effective treatments overall were 'physical therapies' with 50% receiving these treatments indicating that their pain was 'considerably reduced' or that they were 'pain free.' Opioids and anticonvulsants were perceived to be the most effective pharmacological agents prescribed (33.3 and 23.8% reporting their pain was considerably better or eliminated, respectively). People using prescription medication reported significantly greater pain severity, more widespread pain, more descriptive adjectives, more evoked pain, greater difficulty in dealing with pain, and more interference and decreased activity levels due to pain, compared to people not using prescription medication. A combination of greater difficulty in dealing with pain, intense pain, presence of evoked pain, and higher level of perceived support from significant others was predictive of taking prescription medication. CONCLUSION: People taking prescription medication reported significantly more intense pain with neuropathic characteristics that significantly affected daily life and routine activities. A substantial percentage of individuals with pain related to SCI did not obtain significant pain relief from prescription medications. None of the factors assessed predicted the use of nonprescription treatments. The results of this study confirm the inadequacy of available modalities to manage chronic pain related to SCI.

Activities of Daily Living↗
PubMed2001

Reliability of the lumbar flexion, lumbar extension, and passive straight leg raise test in normal populations embedded within a complete physical examination.

STUDY DESIGN: The study measured the reliability of the passive straight leg raise (SLR) test and lumbar range of motion (LROM) tests measured as continuous variables embedded within a comprehensive physical examination. OBJECTIVES: To determine the reliability of the SLR and LROM test scores when they are measured with a Cybex electronic inclinometer (Lumex, Inc., New York, NY) within a physical examination. SUMMARY OF BACKGROUND DATA: Good published empirical reliability exists for the Cybex and for SLR and LROM tests when the measurements are taken in isolation from other physical examination procedures. Reliability of the Cybex for continuous SLR and LROM measurement within a physical examination has not been assessed, however. METHODS: Forty-five participants were seen by one of two physician/physiotherapist teams. Participants were examined by both team members. The first examiner conducted the first tests and retested 1 week later (intrarater reliability). The second examined the participants the day after their first appointment (inter-rater reliability). RESULTS: Only two scores showed substantial reliability (defined as r > or = 0.60). These scores were left (r = 0.81) and right (r = 0.79) SLR intrarater reliability. All other scores fell below the specified cutoff. CONCLUSIONS: SLR and LROM scores used clinically are collected during comprehensive physical examinations. Most scores gathered under these conditions were not reliable. These findings have implications for the use of clinically derived SLR and LROM scores.

Adult↗
PubMed2001

Nonpharmacologic approaches to the management of myofascial temporomandibular disorders.

The temporomandibular disorders (TMDs) are a heterogeneous group of painful musculoskeletal conditions that include masticatory muscle pain. TMD is a common condition but its etiology is, as yet, poorly understood. Although TMD can be quite disabling, most patients presenting with symptoms improve regardless of treatment type. This article focuses on nonpharmacologic treatments for TMD; recent articles on etiology, assessment, and treatment for this muscle pain condition are reviewed. Psychological approaches include biofeedback, minimal therapist contact interventions, relaxation, and cognitive-behavioral therapy. We suggest that treatments based on the biopsychosocial model of illness should be used concurrently with treatments focusing only on the biomedical aspects of TMD. Psychological treatments need not be viewed as a treatment of last resort, but rather should be delivered concurrent with biomedical treatments. We present data from recent clinical trials showing that treatment-matching approaches tailoring psychological and educational treatments to psychosocial profiles, delivered concurrent with usual dental care, results in greater and more sustained improvement than usual dental care alone. As such, treatment for TMD should be viewed in much the same way as treatment for most other chronic pain conditions, that is, from a multidisciplinary perspective.

Behavior Therapy↗
PubMed2000

Predictors of chronic disability in injured workers: a systematic literature synthesis.

BACKGROUND: Loss of productive life among injured workers potentially could be prevented by clearer knowledge of disability risk factors. Despite the number of studies that have examined predictors of disability, there have been no systematic literature reviews integrating multiple risk factor domains. Such a synthesis could help to define important gaps in knowledge, inform future study designs most likely to successfully address these gaps, and highlight the importance of secondary (disability) prevention to public health policy. A systematic synthesis of the literature on risk factors for chronic or recurrent disability in injured workers was performed to meet this need. METHODS: Articles were identified through a MEDLINE search, personal file searches, and requests to experts. Information concerning study methods and results was abstracted from 20 articles that met the inclusion criteria (population-based or prospective cohort studies). RESULTS: The most frequently identified predictors of prolonged disability were older age and greater baseline pain and functional disability. Lumbar symptoms, smaller company size, and construction work were significant predictors in several, but not all, studies. Risk factors did not appear to differ for back versus mixed injuries. CONCLUSIONS: Several risk factors for prolonged disability were identified. Research is needed to develop and test multivariate models of worker, workplace, health care, and administrative risk factors for prolonged and recurrent disability in order to refine and target interventions.

Accidents, Occupational↗
PubMed2000

Pain in patients with fibromyalgia syndrome.

Chronic diffuse pain and hyperalgesia are two cardinal features of pain in fibromyalgia syndrome (FMS). Advancement in understanding the pathophysiology and treatment efficacy often depends on pain that is defined and measured. Pain is a subjective phenomenon that we can measure only by indirect methods. In this article, we provide methodological guidelines for pain assessment and review recent developments in understanding pain mechanisms and evaluating treatments in FMS. Finally, we demonstrate the heterogeneity of the FMS population and suggest the need for matching treatments to patient characteristics in order to improve clinical outcomes.

Antidepressive Agents↗
PubMed2000

Prevalence and impact of posttraumatic stress disorder-like symptoms on patients with fibromyalgia syndrome.

OBJECTIVE: Traumatic events can result in a set of symptoms including nightmares, recurrent and intrusive recollections, avoidance of thoughts or activities associated with the traumatic event, and symptoms of increased arousal such as insomnia and hypervigilance. These posttraumatic stress disorder (PTSD)-like symptoms are frequently observed in persons with chronic pain syndromes. Little is known about how these two phenomena interact with one another. The present study evaluated PTSD-like symptoms in patients with fibromyalgia syndrome (FMS) and examined the relation between PTSD-like symptoms and problems associated with FMS. DESIGN: Ninety-three consecutive patients underwent a comprehensive FMS evaluation and completed self-report questionnaires measuring PTSD-like symptoms, disability, and psychosocial responses to their pain condition. Subjects were divided in two groups based on level of self-reported PTSD-like symptoms. RESULTS: Approximately 56% of the sample reported clinically significant levels of PTSD-like symptoms (PTSD+). The PTSD+ patients reported significantly greater levels of pain (p < 0.01), emotional distress (p < 0.01), life interference (p < 0.01), and disability (p < 0.01) than did the patients without clinically significant levels of PTSD-like symptoms (PTSD-). Over 85% of the PTSD+ patients compared with 50% of the PTSD- patients demonstrated significant disability. Based on response to the Multidimensional Pain Inventory, a significantly smaller percentage of PTSD+ patients were classified as adaptive copers (15%) compared with the PTSD- group (48.2%). CONCLUSIONS: Results suggest that PTSD-like symptoms are prevalent in FMS patients and may influence adaptation to this chronic illness. Clinicians should assess the presence of these symptoms, as the failure to attend to them in treatment may impede successful outcomes.

Chronic Disease↗
PubMed2000

Evaluation of the relationship between depression and fibromyalgia syndrome: why aren't all patients depressed?

OBJECTIVE: To examine the relationship between fibromyalgia syndrome (FM) and depression by determining the set of factors that differentiate FM patients with and without depressive disorders. METHODS: A sample of 69 patients with FM underwent a standardized tender point examination and a semistructured psychological interview and completed a set of self-report inventories. RESULTS: Of the sample, 39 met criteria for depressive disorder and 30 did not. Depressed patients with FM were significantly more likely to live alone, report elevated functional limitations, and display maladaptive thoughts than nondepressed patients. Nondepressed patients were significantly more likely to have received prior physical therapy than depressed patients. Pain severity, numbers of positive tender points, and pain intensity of tender points and control points did not differentiate the depressed and nondepressed patients. Discriminant analysis revealed that living status, the perception of functional limitations, maladaptive thoughts, and physical therapy treatment together identified diagnoses of depressive disorders for 78% of the patients. CONCLUSION: Concurrent depressive disorders are prevalent in FM and may be independent of the cardinal features of FM, namely, pain severity and hypersensitivity to pressure pain, but are related to the cognitive appraisals of the effects of symptoms on daily life and functional activities.

Depression↗
PubMed1999

Assessment of patients' reporting of pain: an integrated perspective.

A common assumption about pain is that it always results from the presence of underlying organic pathology. In the absence of objective pathology, an individual's report of pain may be ascribed to psychological causes. There is a wide variation in patient's experience of pain and organic factors alone cannot explain individual differences in patients' reports. Assessment of patients who report pain requires attention to psychosocial, behavioural, and organic factors. We describe a comprehensive approach to the assessment of psychological and behavioural variables that affect patients' reports of pain. We counter the duality of the somatogenic versus psychogenic perspective and suggest a more integrated assessment that encompasses not only the severity of pain and related physical pathology but also the person who is reporting the presence of pain.

Adaptation, Psychological↗
PubMed1999

Anger in chronic pain: investigations of anger targets and intensity.

The study was designed to assess the frequency and intensity of patients' anger directed toward various potential targets and how intensity of anger toward different targets was related to the chronic pain experience. Ninety-six chronic pain patients who were referred for a comprehensive evaluation completed questionnaires to assess their levels of anger, pain, distress, and disability. Approximately 70% of the participants reported to have angry feelings. Most commonly, patients reported to be angry with themselves (74%) and health care professionals (62%). The relevance of anger to chronic pain experience seemed to vary across targets. Anger toward oneself was significantly associated with pain and depression, whereas only overall anger was significantly related to perceived disability. The results suggest that anger should be conceptualized as a multifactorial construct. In addition to presence, intensity, and expression of anger, targets of anger may be important to better understand psychological adaptation to chronic pain.

Adult↗
PubMed1999

The role of psychological factors in chronic pain.

The traditional view conceptualizes pain as being directly associated with the extent of physical pathology. The observations that there are a number of patients who report pain in the absence of physical pathology, the converse, asymptomatic individuals who evidence objective physical pathology, the inconsistency in response of patients with identical diagnoses, and the low association between impairments and disability suggest that factors other than physical pathology contribute to the reports of pain. The role of behavioral, cognitive, and affective factors have each been shown to have direct effects on the report of pain, adaptation, and response to treatment, as well as indirect effects by influencing sympathetic nervous system and neurochemical factors associated with nociception. The direct and indirect effects of behavioral (operant), cognitive, and affective factors in chronic pain are described.

Animals↗
PubMed1999

Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups.

The presence of postural, myofascial, and mechanical abnormalities in patients with migraine, tension-type headache, or both headache diagnoses was compared to a headache-free control sample. Twenty-four control subjects were obtained from a convenience sampling and each was matched by age and sex to three patients with headache (one with migraine [with or without aura], one with tension-type headache, and one with diagnoses of both migraine and tension-type headache [combined diagnosis]) who had been previously assessed by a physical therapist at a headache clinic. Physical therapy assessment findings were compared among the four groups. There was a significant difference in the presence of postural abnormalities between the controls and the patients, with posture abnormalities more likely to be present in those with headache. The patients were also significantly more likely to have active trigger points and trigger points in the neck than were the control subjects. There were no significant group differences identified in the mechanical measures, nor were there any significant differences among the three headache categories. Determination of the clinical significance of these musculoskeletal abnormalities in patients with headache will require the development and testing of further standardized assessments as well as physical therapy treatment programs.

Adult↗