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Biomedical subjects

E Tunks

Publications and source records attributed to E Tunks.

12 recordsLinked to original sources
PubMed1999

Regional soft tissue pains: alias myofascial pain?

This chapter deals with four main questions: what is the evidence that 'myofascial pain' syndromes exist?; what is the evidence that the myofascial pain concept is clinically useful?; what is the evidence that managing patients in terms of the myofascial pain diagnosis confers benefits?; and what is the evidence-based management of myofascial pain? The purpose of a diagnosis is to provide boundaries around subgroups of illness in a population since each subgroup presumably has a different mechanism, natural history, prognosis, course and response to treatment. The current literature is divided in its conceptual approach to the problem of regional musculoskeletal pain. Some authors regard myofascial pain as being distinct from regional musculoskeletal pain while others regard these as synonymous. A postulated theory of the pathophysiology of myofascial pain is discussed. This contrasts with a view that regional myofascial pain represents a non-specific localized pain arising from multiple regional, systemic and psychosocial factors. In order to consider myofascial pain as a distinct diagnosis, it would be necessary to resolve reliability issues in the identification of its critical diagnostic features. Beyond reliability issues, there are also problems of sensitivity and specificity--i.e. of the patient population that it identifies--which must be resolved if controlled trials are to be conducted. The clinical usefulness of the myofascial pain diagnosis is considered with regard to what is believed about the course of healing, the determinants of disability, the course of regional versus widespread musculoskeletal pain, the relationship of musculoskeletal injury to pain, and the evidence-based management of musculoskeletal pain. An epidemiological perspective is proposed with regard to regional musculoskeletal pain. This allows for the identification of operationally defined strata of regional musculoskeletal pain and permits studies in course, prognosis and treatment, even though some conceptual issues such as the 'myofascial pain diagnosis' remain to be clarified.

Fibromyalgia↗
PubMed1999

Regional soft tissue pains: alias myofascial pain?

This chapter deals with four main questions: what is the evidence that 'myofascial pain' syndromes exist?; what is the evidence that the myofascial pain concept is clinically useful?; what is the evidence that managing patients in terms of the myofascial pain diagnosis confers benefits?; and what is the evidence-based management of myofascial pain? The purpose of a diagnosis is to provide boundaries around subgroups of illness in a population since each subgroup presumably has a different mechanism, natural history, prognosis, course and response to treatment. The current literature is divided in its conceptual approach to the problem of regional musculoskeletal pain. Some authors regard myofascial pain as being distinct from regional musculoskeletal pain while others regard these as synonymous. A postulated theory of the pathophysiology of myofascial pain is discussed. This contrasts with a view that regional myofascial pain represents a non-specific localized pain arising from multiple regional, systemic and psychosocial factors. In order to consider myofascial pain as a distinct diagnosis, it would be necessary to resolve reliability issues in the identification of its critical diagnostic features. Beyond reliability issues, there are also problems of sensitivity and specificity--i.e. of the patient population that it identifies--which must be resolved if controlled trials are to be conducted. The clinical usefulness of the myofascial pain diagnosis is considered with regard to what is believed about the course of healing, the determinants of disability, the course of regional versus widespread musculoskeletal pain, the relationship of musculoskeletal injury to pain, and the evidence-based management of musculoskeletal pain. An epidemiological perspective is proposed with regard to regional musculoskeletal pain. This allows for the identification of operationally defined strata of regional musculoskeletal pain and permits studies in course, prognosis and treatment, even though some conceptual issues such as the 'myofascial pain diagnosis' remain to be clarified.

Journal Article↗
PubMed1996

Pain clinics.

This article addresses issues related to multimodal pain programs and unimodal treatments, particularly those that deal with persistent musculoskeletal pain. Factors including prevalence, morbidity, and prognosis are examined. The research evidence for physical therapy modalities, psychological treatments, and vocational and pharmacologic interventions is critically appraised. A clinical decision algorithm for persistent pain management until referral to a multimodal chronic pain program is presented.

Acute Disease↗
PubMed1996

Gender differences in psychosocial adjustment to chronic pain and expenditures for health care services used.

Gender differences in reports of chronic pain, in coping responses to the consequences of painful conditions, and in the use of health care services have recently received considerable attention. This report examines the gender effects of referral practices to a chronic pain specialty clinic and the nature of the relationship between health care needs and use of health care services. This historical cohort analytic survey of 571 patients referred to the pain clinic assessed them by gender for selected referral variables through a chart review, and randomly sampled (n = 222) these patients' current adjustment and health service use through mailed questionnaires or telephone interview. The questionnaire consisted of psychosocial scales (PAIS-SR; Social Support); cognitions, including the Meaning of Illness Questionnaire (MIQ); and a health service utilization inventory designed to assess direct, out-of-pocket, indirect, and cash transfer expenditures. Selected referral demographic characteristics were similar between the gender groups at referral with the exception of three factors: distance from clinic, referring physician, and having a disability pension. At follow-up, the adjustment groups were similar to their gender counterparts on all sociodemographic and clinical variables including a high prevalence of poor psychosocial adjustment. Women's adjustment was accounted for by cognitive variables, whereas men's adjustment was by social variables. There were differential expenditures for health service use by gender with similar health care needs. Women used specific health care services more than men, which was explained in part by psychological need and meaning. Men's use of services, on the other hand, was explained in part by meaning alone. The importance of gender, differences in the role that social support and meaning variables play in predicting psychosocial adjustment to chronic pain is elaborated in this study. The interaction effects between health care need and gender to explain variations in use of health care services indicates that users of services varied in ways that suggest a bias or barrier of their own or of service providers to access services.

Adaptation, Psychological↗
PubMed1995

The reliability of examination for tenderness in patients with myofascial pain, chronic fibromyalgia and controls.

OBJECTIVE: To establish the reliability with which tenderness could be evaluated in patients with chronic myalgias, using dolorimetry and palpation. METHODS: Three blinded examiners using pressure dolorimetry and digital palpation compared 19 paired tender points and 8 paired control points in 4 matched groups of 6 patients with fibromyalgia (FM), myofascial pain, pain controls, and healthy controls. RESULTS: Good interrater and test-retest reliability were found for dolorimetry scores. There were significant differences in tenderness ratings by dolorimetry between the diagnostic groups, with the patients with FM and myofascial pain having the greatest tenderness, the normals having the least tenderness, and the pain controls having tenderness levels midway between the patients with FM or myofascial pain and the normals. In all patients, control points had higher pain thresholds than tender points. One-third of patients with localized pain complaints demonstrated a significant relationship between region of clinical pain complaint and measured tenderness thresholds by dolorimetry. In ratings of tenderness by digital palpation, there was very good intrarater reliability over 26 of 27 paired points, and good interrater reliability at 75% of the points. One-half of patients with localized pain complaints demonstrated a significant relationship between region of clinical pain complaint and number of tender points by palpation. CONCLUSION: Both dolorimetry and palpation are sufficiently reliable to discriminate control patients from patients with myofascial pain and FM, but may not discriminate patients with myofascial pain from those with FM. Neither method appears to correlate well with the location of the clinical pain complaint, regardless of diagnosis.

Adult↗
PubMed1992

A profile of users of specialty pain clinic services: predictors of use and cost estimates.

During the past decade, the multidisciplinary pain clinic has become a popular alternative to the traditional treatment of persistent pain. There is, however, little information describing this population of health care users nor the impact this new demand has on utilization of health care services. The objectives of this study were three fold: to develop a profile of the characteristics of patients referred to a specialty pain clinic including their psychosocial adjustment to their condition; to identify predictors of the use of the specialty services; and to estimate the cost of health service utilization. This historical cohort analytic survey of 571 patients referred to the clinic assessed them for exposure to selected referral variables through a chart review and sampled (n = 222) these patients' current adjustment and health service use through mailed questionnaire. There were four types of use of specialty clinic services. These included: non-users (n = 210); consultation only (n = 180); and the remaining 32% of the referrals were divided between "users-non complete" (n = 98) and "users-complete" (n = 83). "User" groups were similar in characteristics to each other at referral and follow-up on all the major variables with the exception of two factors: non-users lived further from the clinic than users and users were rated as psychologically more vulnerable than non-users. The best predictors for attending the clinic were the presence of referral information from the referring physician and the geographic location of the patient's referring physician. The prevalence of poor psychosocial adjustment was 55.7%, high by comparison with other specialty clinics. Seventy percent of the variance in psychosocial adjustment to chronic pain was explained by social and cognitive variables. In addition, users of specialty pain clinic services generated proportionately less costs in the use of other health services when they were compared to non-users. The importance of social support and meaning of illness variables in predicting psychosocial adjustment to chronic pain is corroborated in this study as is the relevance of the pain clinic cognitive behavioural approach for these problems. In addition, compared to other chronic pain sufferers with similar characteristics, it appears that the use of the pain clinic contains the use of other services and thus has an important economic impact.

Adaptation, Psychological↗
PubMed1991

The role of litigation in predicting disability outcomes in chronic pain patients.

This study examined the extent to which being involved in civil and industrial litigation predicted outcome in an population of chronic pain patients. Data were collected in a structured telephone interview for a litigant group of 80 patients and a nonlitigant group of 47 patients. There were no significant differences in the amount of medication used, the number of hours spent resting per day, or the number of individuals who were able to return to work. Litigants showed significantly higher levels of depression. Multiple regression analyses indicated that litigation was not the primary predictor of downtime or medication use. Litigation was found to be the primary predictor of Zung depression scores. Discriminant function analyses indicated that litigation was not the most important variable in distinguishing between those working and not working. Results lend support to previous studies that suggest that the suspicion and disbelief with which litigating patients are often treated is unfounded.

Adult↗
PubMed1986

Epidemiologic comparison of persistent pain sufferers in a specialty pain clinic and in the community.

Most research into the causes and management of chronic pain has come from specialized chronic pain clinics, where patients have been selected through referral. Because it is assumed that persistent pain problems result in important socioeconomic and medical problems, it seemed important to determine whether the problems reported by patients in specialty pain clinics are characteristic of those reported by persistent pain sufferers in general. An epidemiologic study compared two groups of individuals with self-reported persistent pain complaints. One group was drawn randomly from a typical family medical group practice and the other was drawn from a specialized multidisciplinary pain clinic. The two groups were similar in most demographic variables, the length of the pain history, and the most commonly reported sites of pain. However, patients from the pain clinic were more likely to have had work-related accidents, to report greater health-care utilization, and to complain of more constant pain and greater levels of disability. Patients from the pain clinic reported greater impairment on the indices constructed to measure psychologic, social, and performance consequences of the pain experience. What most distinguished patients from the pain clinic was not medical factors alone, but reported impairment in function, and psychosocial difficulties. The implications are that patients referred to specialized pain clinics may not be representative of individuals in general who suffer persistent pain; the former likely require an interdisciplinary approach that includes attention to psychosocial and disability issues, not just medical or surgical treatments for pain.

Accidents, Occupational↗
PubMed1978

Computed tomography after psychosurgery.

The computed tomography scans of patients who had frontal leukotomy show bilateral cysts in the frontal lobes that have attenuation values similar to cerebrospinal fluid, and are not contrast enhanced.

Adult↗
PubMedDate not supplied

Environments and addiction: a proposed taxonomy.

When reviewing the broad area that relates environments to addiction one is faced with an enormous volume of research with differing environmental and psychosocial factors, contrasting populations, a variety of addictive substances, and a range of addiction processes. For all these factors, there are important outcome variables. To survey this disparate literature, it is helpful to use a multiaxial model as a framework or taxonomy. In this way it is possible to see the effects that environments, broadly conceived, exert on addictive behaviors. A variety of environments is considered: interpersonal, organizational, cultural and physical, as one axis or dimension. The influence of this dimension on a second dimension relating to type of addiction is also examined. Finally, a dimension pertaining to the "life history" of addictions, from acquisition through maintenance, cessation, and relapse is considered in relation to the first two dimensions. While a variety of environmental factors affect addictive behaviors, current research indicates the need to take individual differences, cognitive mediation, and the interaction of the person with the environment into account. Significant areas that need further exploration are the failure of addictions to occur in some environments, and the development of secondary prevention approaches. Implications for intervention and directions for future research are suggested.

Cross-Cultural Comparison↗