Cocaine use, hypertension, and end-stage renal disease.

Cocaine use has been associated with both acute renal failure and hypertension (HTN), but only recently have data suggested it may lead to a chronic insidious form of renal failure. We designed a cross-sectional study to compare the association of cocaine use in hemodialysis patients with and without a diagnosis of HTN-related end-stage renal disease (HTN-ESRD). Two hundred one black patients from two outpatient hemodialysis units in an urban community were evaluated. There were 193 eligible patients, 106 men and 87 women, aged 49.28 +/- 14.4 years. A history of significant cocaine use before dialysis was reported by 55 of 193 subjects (28.5%). A diagnosis of HTN-ESRD was reported in 49 of 55 cocaine users (89.1%) compared with 64 of 138 nonusers (46.38%; odds ratio, 9.44; 95% confidence interval, 3.79 to 23.49; P < 0.0005). Of the 113 subjects with HTN-ESRD, 49 subjects (43.4%) had a history of cocaine abuse, either alone or in combination with other drugs. Subjects with HTN-ESRD with cocaine use were younger than those without cocaine use (40.7 +/- 9.0 versus 53.8 +/-15.3 years; P < 0.0005) and had a shorter reported duration of HTN (5.3 +/- 5.4 versus 12.7 +/- 9.8 years; P < 0.0005, adjusted for age and sex). In our urban dialysis population, a clinical diagnosis of HTN-ESRD was strongly associated with a history of cocaine use and earlier onset of ESRD. Cocaine should be considered as a cause of ESRD in patients without a clear cause of renal failure.

Self-management for medication reduction in chronic low back pain.

It has been demonstrated that pain relief is seldom produced by medication or surgical methods where there is evidence of emotional disturbance, as indicated by the MMPI. A program that attempts to engender a high level of patient responsibility in a population of chronic low back pain patients is described. Self-managed reduction of drug dependence is a major component of this program. The data indicate that the program produces a significant reduction in dependence on opiates, derivatives, synthetic opiates, hypnotics, sedatives, tranquilizers, and analgesics. Follow-up data (with attrition controlled) at six months and 12 months postdischarge do not provide any evidence for deterioration (ie, return to pretreatment levels of drug dependence). Thus, it appears that the programmatic impact is stable over at least a 12-month period postdischarge. Implications of these findings for the low back pain population, as well as other chronic pain populations, are discussed.

Interpersonal phenomenology as a function of sexual orientation, sex, sentiment, and trait categories in long-term dyadic relationships.

Homosexual and heterosexual relationships were studied with the Extended Personal Attributes Questionnaire (EPAQ) as modified by the Interpersonal Perception Method (IPM). Members of 80 dyads were assessed for perceived similarity, validation of partners' self-concept, expectations of being validated, feelings of being understood, expectations of receiving credit for insight, knowledge of being validated or invalidated, knowledge of being understood or misunderstood, and knowledge of being credited with insight. The F+ scale of the EPAQ accounted for greater congruence among IPM perspectives than any of the other EPAQ scales (M+, M-, F-). Positive EPAQ scales (F+ and M+) showed more consistency among interpersonal and intrapersonal perspectives than negative scales. Homosexual partners perceived themselves more similar to each other on the F+ scales than did heterosexual partners. Persons with female partners (lesbians and heterosexual males) had higher expectations and greater accuracy in these expectations than those with male partners. Differences within the interpersonal phenomenology of heterosexual couples found in an earlier study (Alperson & Friedman, 1983) were fully replicated. Treating the M and F scales of the EPAQ as instrumental and expressive traits rather than masculine and feminine sex roles (Spence & Helmreich, 1980) clarifies the interpretation of these results.

Low back pain comprehensive rehabilitation program: a follow-up study.

The outcome of the management of chronic low back pain in 42 men and 36 women by a comprehensive rehabilitation program consisting of biofeedback training, counseling in self-control techniques, self-regulated medication reduction, physical therapy, vocational rehabilitation services and education conducted in a therapeutic milieu was examined at 6 months and 12 months after discharge. The mean age of the subjects was 43.4 years: the mean highest school grade completed, 12.6; and the mean full scale WAIS IQ, 106.7. On admission 72 were unemployed and had been disabled and unemployed for a median time for 3 years. Almost two-thirds were involved in litigation. Thirty-three were working or accepted for employment t 6 months after discharge and 35 at 12 months (p less than 0.001). Success rates are higher when only those who stayed in the program for more than 4 weeks are considered. The employed patients rated their pain lower, used less medication and relied less on attention from physicians. They did not seem to differ in their use of relaxation skills or exercise. A similar study has been initiated of patients randomly assigned to treatment and waiting list control groups.

An innovative program for the restoration of patients with chronic back pain.

The literature on conventional medical procedures for restoring high-risk patients having chronic low back pain reveals that these procedures are ineffective and may even be iatrogenic. An alternative, noninvasive approach, which takes into consideration the critical role of cognitive and emotional factors, is practiced at Casa Colina Hospital for Rehabilitative Medicine. Details of the approach as well as comments confirming its efficacy are presented.