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Adolescent↗
Biomedical subjects
Donald Bakal
Publications and source records attributed to Donald Bakal.
Relationships between pain, cognitive activity and epidural analgesia during labor.
This study examined the dynamic interplay between subjective pain, pain behavior and cognitive activity during the latent (less than or equal to 3 cm), mid-active (5-7 cm) and transition (greater than or equal to 8 cm) phases of labor in 115 nulliparous women. Subjects received no analgesia during the latent phase and either no analgesia or epidural analgesia during the active and/or transition phase. Data were analyzed according to phase and analgesic condition. For subjects with no epidural analgesia, both the Present Pain Intensity (PPI) and the Present Behavioral Intensity (PBI) scores were correlated within and between phases. In contrast, Coping/Distress scores were weakly correlated between the latent and active labor phases and were unrelated between the active and transition phases. PPI and Coping/Distress scores were highly correlated within the latent phase but were independent within the active and transition phases of labor. PBI and Coping/Distress scores were moderately correlated within the latent and active phases and were unrelated during the transition phase. Epidural techniques reduced subjective pain and pain behavior significantly but had no apparent effect on the coping or distress-related cognitive activity characteristic of active labor. We concluded that coping and distress-related cognitive activity in labor may follow a phase-specific pattern which is relatively independent of pain or pain relief after labor has become active.
Adult↗
Subjective distress accompanying headache attacks: evidence for a cognitive shift.
This study examined the nature of the cognitions experienced by chronic headache sufferers during headache episodes and assessed whether these cognitions were differentially related to illness behavior and to symptom properties of headache attacks. The data were examined both in terms of headache severity and in terms of the muscle contraction-migraine dichotomy. Forty-four headache patients monitored, with an open-ended assessment format, the thoughts and feelings experienced prior to and during episodes of head pain. The majority of patient responses could reliably be placed into 1 of 2 categories: (a) stress-related cognitions and (b) disorder-related cognitions. The percentage of headache-related thoughts and feelings correlated significantly with several indices of headache severity, including intensity of pain, quality of pain, length of headache attacks, and presence of early morning onset. Further significance to these findings was added by demonstrating that the patients who predominantly reported disorder-related cognitions also displayed a tendency to deny life problems not related to pain. The data were taken as support for the hypothesis that chronic headache disorders of increased severity are accompanied by a cognitive shift whereby the patient's primary concern moves from situational and interpersonal stress to distress associated with the disorder itself.
Adult↗
Illness behavior and chronic headache.
Illness behavior was examined in chronic headache sufferers within the context of the psychobiological or severity model of headache. A Procrustes factor analytic procedure demonstrated the appropriateness of using the existing IBQ factor structure with chronic headache patients. The dimensions of illness behavior were not found to be related to headache diagnosis (muscle contraction, migraine, combined) nor to topographical properties of head pain which are used to infer diagnosis (forehead, bilateral, sides, unilateral). Headache patients who experienced the greatest amount of headache activity during a 21-day self-observation period were found to view their disorder in somatic as opposed to psychological terms. A comparison of patients with continuous pain and patients with episodic pain provided additional support for the somatic-psychological distinction. Patients with continuous head pain viewed their disorder in somatic terms and also scored higher on the dimension of denial than did patients with episodic pain. Taken together these data demonstrated the utility of examining psychological components of the chronic headache syndrome from a severity perspective.
Adult↗