PubMed Health⌕ Search

Biomedical subjects

H L Rosomoff

Publications and source records attributed to H L Rosomoff.

At least 19 recordsLinked to original sources
PubMed1995

Types of pain treatment facilities and referral selection criteria. A review.

Family physicians often come in contact with patients who suffer from chronic pain. These patients present a treatment challenge and may require referral to a pain treatment facility. The purpose of this review is to define and clarify the current concept of a pain treatment facility and delineate the different types of treatment facilities available. Possible selection criteria for referral to such facilities are suggested, with the rationale for the selection of these criteria. The role of the family physician in the treatment by a by a special facility of a patient with chronic pain is discussed. By definition, pain treatment facilities differ. The family physician should be aware of these differences and selection criteria for referral to such facilities.

Humans↗
PubMed1995

The time is now.

Explore the source record for details and available documents.

Health Care Reform↗
PubMed1995

What's up, doc?

Explore the source record for details and available documents.

Health Care Costs↗
PubMed1995

Secondary gain concept: a review of the scientific evidence.

UNLABELLED: The "secondary gain" concept originated in the psychoanalytic literature, where it was never vigorously examined. The purpose of this review is to determine if there are scientific studies that have explored the validity of this concept. DESIGN: A computer and manual literature review yielded 166 references in which primary, secondary, and tertiary gain were mentioned. Twenty-four (14.5%) of these reports were "secondary gain" studies. Fourteen "reinforcement" studies were also found. These 38 studies were grouped according to topics and reviewed in detail. SETTING: Any medical treatment setting including pain treatment was utilized in the review procedure, i.e., no exclusion criteria. PATIENTS: Any patient type, including those suffering from chronic pain, were utilized in the review procedure, i.e., no exclusion criteria. RESULTS: A significant but limited number of studies have investigated the "secondary gain" concept, and the results of some of these studies are in conflict. Results of some studies, however, are remarkably consistent in supporting the importance of "secondary gain" to behavior. Some studies have methodological flaws, usually relating to how the presence of secondary gain was established. CONCLUSIONS: Overall the results of the reviewed studies support the potential importance of the "secondary gain" concept to understanding illness behavior and underscore a need for future research in this area.

Humans↗
PubMed1994

Prediction of pain center treatment outcome for geriatric chronic pain patients.

OBJECTIVE: Geriatric chronic pain patients (age 65 and over) form an increasing percentage of the pain center treatment population. It is therefore important to be able to predict pain center treatment success or failure for these patients; this is the first study to address this concern. DESIGN: Chronic pain patients rated themselves at pain center admission and discharge on 43 rating scales for the areas of pain, functional status, behavioral variables, and other pain center modification categories. The 43 scores at admission were used as potential predictors, while the 43 change scores (from admission to discharge) were the outcome measures to be predicted. Additional possible predictors were 16 other variables that are considered prognostic of treatment outcome, including age, number of surgeries, and prior occupational level. The statistical analysis consisted of a five-step procedure: (a) mathematical techniques were used to remove redundant outcome measures; (b) each of the remaining outcome variables was correlated with the full set of predictor variables; (c) regression techniques were used to predict the outcome variables; (d) these outcome variables were combined into independent factors using factor analysis; and (e) regression techniques were used to predict the factors. RESULTS: The variable-reduction technique was successful in removing 26 of the 43 outcome variables. Factor analysis of change scores of the remaining variables resulted in four factors, which were identified as change in activity, change in pain and behavior, change in constant pain, and change in attitude to pain center goals. The analysis showed that the best predictor of a variable's change score was the initial level of that variable. Regression analysis, using all variables as predictors except initial level, found a number of statistically significant predictors. However, no predictor variable, alone or in combination, was able to account for > 30% of the variance of any outcome measure. CONCLUSION: These results indicate that we cannot as yet predict geriatric pain center treatment outcome. Potential reasons for these results are discussed.

Aged↗
PubMed1992

Drug abuse, dependence, and addiction in chronic pain patients.

It 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 drug misuse diagnosis, which drug misuse diagnosis used (abuse, dependence, or addiction), and percentage of patients within each diagnostic category of drug misuse. The result of the review indicated that only seven studies utilized acceptable diagnostic criteria and/or definitions for the drug misuse diagnoses and gave percentages of drug misuse. Within these seven studies, the prevalence percentages for the diagnoses for drug abuse, drug dependence, and drug addiction were in the range of 3.2-18.9%. It is concluded that these diagnoses occur in a significant percentage of chronic pain patients. However, there is little evidence in these studies that addictive behaviors are common within the chronic pain population.

Behavior, Addictive↗
PubMed1992

Detoxification of nonopiate drugs in the chronic pain setting and clonidine opiate detoxification.

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.

Analgesics↗
PubMed1992

Stretching in the rehabilitation of low-back pain patients.

The major objective of this investigation was to study the effectiveness of the physical conditioning program used at the University of Miami Comprehensive Pain and Rehabilitation Center in restoring certain elements of the functional abilities of individuals suffering from chronic low-back pain and to evaluate the effectiveness of using a systematically applied, aggressive stretching maneuver as an add-on therapy in the treatment of chronic low-back pain patients. The effect(s) of the proposed stretching maneuver was evaluated. Twenty-eight chronic low-back pain patients were randomly assigned to one of two groups. The control group underwent a multimodal rehabilitation program, and the experimental group underwent the same rehabilitation program in addition to the systematic stretching maneuver under investigation. The results obtained showed that patients undergoing the multimodal rehabilitation program with and without the proposed systematic stretching maneuver showed a significant improvement in their functional abilities as seen from the significant increase in the static strength of the back extensors, with corresponding significant increase in back muscle myoelectric signals. Also, a significant decrease in their pain level was reported after 2 weeks of continuous treatment. The use of the systematic stretching maneuver enhanced the functional gains of chronic low-back pain patients compared to the control group.

Back Pain↗
PubMed1992

Chronic cervical pain: radiculopathy or brachialgia. Noninterventional treatment.

Chronic cervical pain is not always attributable to radiculopathy. Pain may derive from peripheral myofascial syndromes and/or central inflammatory root irritation from degradation of discal proteoglycans. This concept is presented with its application in 30 patients with follow-up observations up to 30 months. Twelve of twenty-five achieving a pain level of 0 (out of a possible 10), ten of twenty-five had a pain level of 2, and three of twenty-five had a pain level of 4. Five cases were considered to be failures because of patient noncompliance. Treatment was multidisciplinary: aggressive physical medicine, behavioral medicine, vocational, and recreational rehabilitation with the goal of a return to socioeconomic productivity or previous lifestyle, secondary to which pain relief or control follows. Emphasis was placed on the restoration of musculoskeletal physiology to normal with behavioral modification, good body mechanics and the application of engineering/ergonomic principles at work or recreation.

Behavior Therapy↗
PubMed1991

More Munchausen with chronic pain.

Munchausen's syndrome is a popular name for a factitious disorder with physical symptoms. We have identified four Munchausen patients within a sample of 2,860 chronic pain patients for a frequency of 0.14%. These patients are described and an attempt is made to develop a profile of the Munchausen patient presenting with chronic pain.

Adult↗
PubMed1991

Comprehensive multidisciplinary pain center approach to the treatment of low back pain.

The primary objective of our program is full function. Other objectives include relief or decrease in pain with the abolition of pain medication, elimination of assistive devices, low or zero disability rating, job satisfaction with return to work and leisure activities without limitations, independence from the health care system, prevention of reinjury, and optimum wellness. The intense, multidisciplinary program described involves a full-time multidisciplinary staff, complete patient involvement, weight control, physical restoration and conditioning, home program maintenance, pacing, body mechanics, energy-saving techniques, reinjury prevention education, pain control and elimination, drug detoxification, behavioral modification, biofeedback, relaxation, imagery, individual and group therapy, family therapy, assertiveness training, stress management, coping skills, vocational counseling, job planning/development/simulation, achievement of maximal function, immediate return to work at discharge, and follow-up care. It is possible to return 86% of these patients to full function and work; they may have some residual pain, which should eventually remit. The 14% who fail are hardcore patients with major behavioral problems, although, to be fair, there are still unanswered questions to resolve. These people have problems that cannot be eliminated within the limit of time with which we have to work with the patient. Lastly, these patients can be disturbed and dangerous, as evidenced by the headline of "A Former Patient Shoots, Kills, New York Neurosurgeon, Self, Wife."

Back Pain↗
PubMed1990

Biofeedback in back muscle strengthening.

This study was undertaken to investigate the use of electromyography (EMG) biofeedback as an add-on therapy to standard exercise in the restoration of the functional abilities of the trunk extensor muscles in patients suffering from chronic low-back pain (CLBP). A controlled experimental investigation was conducted to study the effectiveness of using the proposed treatment modality in the management of the low-back pain problem. The results obtained indicate that the proposed methodology was an effective tool to achieve a significant improvement in the strength of lumbar paraspinal muscles of chronic low-back pain patients.

Adult↗
PubMed1989

Homicide-suicide and chronic pain.

Homicide-Suicide (H-S) is a form of dual death where the murder is closely followed by the suicide of the perpetrator. H-S is extremely rare and has not previously been described within the chronic pain patient population. Such a case is presented. Psychiatric examination data from the victims of H-S revealed a number of complex, psychiatric, social, vocational, and litigation problems. Demographically the case displays some characteristics associated with suicide pacts.

Chronic Disease↗
PubMed1988

The utility of electromyographic biofeedback in the treatment of conversion paralysis.

Conversion paralysis has a poor prognosis when there is evidence of nonresponse to previous treatment, long duration, and secondary atrophy of the "paralyzed" muscles. The authors present four such cases in which conversion paralysis was treated successfully by means of electromyographic (EMG) biofeedback. Each of the four patients also suffered from a chronic pain condition. Results from statistical analyses indicated that the four patients demonstrated significant improvement in the functional capacity of the "paralyzed" muscles as measured by isometric maximum voluntary contraction and EMG activity. The improvements occurred without explicit psychotherapy and suggest that behavioral modification techniques alone may be helpful in such cases.

Adult↗
PubMed1988

Functional electric stimulation in the reversal of conversion disorder paralysis.

Numerous reports have documented the usefulness of functional electric stimulation (FES) in restoring and/or improving the function of organically diseased or paralyzed muscles. There are few reports related to the use of FES in the treatment of conversion disorder paralysis of the hysterical type. This paper presents a case of hysterically paralyzed muscles where the patient received daily treatment with FES for two weeks. Electric current was applied to a weak quadriceps and to paralyzed tibialis anterior muscles. This electrotherapeutic modality was effective in improving the function of the quadriceps and in reversing the paralysis of the tibialis anterior muscles. The improvement in the muscles' functional abilities was documented through the use of quantitative measures of muscle strength as well as computerized analysis of EMG signals. The results showed that the administration of FES resulted in a dramatic increase in motor units recruitment, increased muscle strength, and improved voluntary muscle control.

Adult↗
PubMed1987

Acceptable maximum effort (AME). A psychophysical measure of strength in back pain patients.

A new quantitative method for measuring functional abilities of chronic low-back pain patients is introduced. The method is based upon a psychophysical model referred to as acceptable maximum effort (AME). AME is the highest level of voluntary effort that a person can achieve without inducing unacceptable pain. In the current study, the AME method was applied to strength measurement. By use of a static strength measurement procedure, arm, leg, shoulder, back, and composite strengths were assessed upon admission to and discharge from a 4-week, nonsurgical comprehensive pain treatment program. The reliability of the AME method for each strength measure was assessed. In addition, the method was used to evaluate pre- to post-treatment changes in strength. Results indicate the AME method to be highly reliable and useful in determining treatment outcome. Reliability coefficients for all strength measures were above .90. The results are discussed in terms of their implications for standardized functional ability measurement in the area of chronic pain.

Back Pain↗