Psychological assessment and treatment of patients with neuropathic pain.

Studies on the psychological assessment and treatment of neuropathic pain conditions, including postherpetic neuralgia (PHN), diabetic neuropathy, complex regional pain syndrome, post spinal cord injury, post amputation, and AIDS-related neuropathy, are reviewed. Although limited information is currently available, the findings are consistent with the larger literature on chronic pain and indicate that the assessment of neuropathic pain needs to include measurement of multiple dimensions of quality of life. Mood, physical and social functioning, and pain-coping strategies such as catastrophizing and social support are all important domains. Clinical trials of psychological interventions have not been reported in the scientific literature. Case series of successful treatment of neuropathic pain are reported, primarily in the area of biofeedback. As with other chronically painful conditions, it is likely that cognitive-behavioral interventions will improve the quality of life in neuropathic pain conditions.

Psychological aspects of neuropathic pain.

Studies on the psychosocial impact of neuropathic pain conditions, including postherpetic neuralgia, diabetic neuropathy, complex regional pain syndrome, post spinal cord injury, postamputation, and AIDS-related neuropathy, are reviewed. Although limited, data are consistent with the larger literature on chronic pain and indicate that neuropathic pain reduces quality of life, including mood and physical and social functioning. Depression and pain coping strategies such as catastrophizing and social support predict pain severity, and a single diary study demonstrates a prospective relation between depressed mood and increased pain. Clinical trials of psychological interventions have not been reported, although some case series of successful treatment of neuropathic pain are reported, primarily in the area of biofeedback. Given the evidence indicating the broad impact of neuropathic pain on many areas of function, it is surprising that so few studies have investigated the impact of psychological interventions in these populations.

Predicting level of restrained eating behavior in adult women.

OBJECTIVE: This study attempted to predict participants' level of restrained eating using the following psychological variables: body dissatisfaction, negative affect, self-esteem, and perceived problem-solving ability. METHODS: Because previous research relating to restrained eating has primarily focused on women between the ages of 18 and 25, women age 30 to 60 served as participants. In addition, this study attempted to investigate the unique and combined variance each psychological variable contributes to restrained eating. RESULTS: The results suggest that both body dissatisfaction and negative affect are significant predictors of level of restraint. DISCUSSION: Moreover, this study suggests that the concept of restrained eating is relevant to women over age 25.

Perceived effective problem solvers' attributions concerning success and failure of a simulated real-life problem.

The present study examined the effect of perceived problem-solving ability (self-identified effective and ineffective) operationalized by Heppner and Petersen's Problem Solving Inventory (PSI) and random feedback (success vs. failure) on participants' attributions. A total of 30 female and 30 male teacher trainees who had scored in the top and bottom distribution of the PSI dealt with three unexpected classroom disruptions during a lecture presentation. After their presentation, they received randomized feedback concerning their performance during disruptions. Following feedback, they completed Baumgardner's Attribution Questionnaire (AQ). Results indicated a significant PSI x Feedback interaction for ability and effort but not for task difficulty and luck. Perceived efficacious problem solvers' internal attributions depended on whether they received success or failure feedback. Similar to the self-enhancing tendency reported in the literature, this group attributed success versus failure more to ability and effort. The perceived ineffective problem solvers' attributions did not differ based on the feedback they received. Results are discussed in terms of prior research and theory.

Commercial wrist extensor orthoses: a descriptive study of use and preference in patients with rheumatoid arthritis.

OBJECTIVE: To describe patients' functional uses of 3 commercial wrist orthoses, to describe patients' preference patterns for the orthoses, and to clarify orthotic attributes that are viewed positively and negatively. METHODS: Using a cross-over design, 42 patients with definite rheumatoid arthritis used each of 3 commercial orthoses for one week. There was a one-week wash-out between each week of use. At the end of the study, private semi-structured interviews were conducted with each participant. Data from close-ended questions were tabulated. Open-ended data were analyzed using qualitative methods. RESULTS: Patients reported that the 3 commercial wrist orthoses reduced wrist pain similarly, but that comfort and a sense of security during functional tasks were only found if the orthoses were comfortable and well-fitting. Most subjects preferred the padded, short forearm orthosis, though a small number found it uncomfortably warm, and many complained that it was difficult to use when wearing long-sleeved garments. Common complaints about the two elastic orthoses included chafing at the thumb webspace and chafing at the proximal closures. Longer forearm length was often perceived as providing unnecessarily high levels of wrist support. CONCLUSIONS: No single orthosis suited all subjects. Satisfaction with an orthosis appears to be based not only on its therapeutic effect, but also the comfort and ease of its use. To maximize patient satisfaction and improve the likelihood of appropriate fit and comfort, several styles of commercial orthoses should be available. The current trend toward restricted clinic stocks appears contrary to both therapeutic goals and patient satisfaction.

Stress-induced cortisol response and fat distribution in women.

Recent studies have shown an association between uncontrollable stress and abdominal fat distribution. It has been suggested that changes in cortisol secretion might represent one possible mechanism for this relationship. This study investigated whether body fat distribution, determined by waist-to-hip ratio (WHR), is related to salivary cortisol levels in response to laboratory stressors. Subjects were 41 overweight women with a Low or a High WHR. Multiple measures of cortisol and mood were obtained during a session of stressful tasks (eg., timed arithmetic) and during a time-matched, control rest session. Also, background life stress and psychological trait variables were assessed. Compared to Low WHR subjects, High WHR subjects secreted significantly more cortisol during the stressful session after 60 minutes of stress, and considering the total area under the curve of secretion. This difference was not seen on the rest day. In terms of background and psychological measures, High WHR subjects were characterized by poorer coping skills and differences in mood reactivity. Specifically, although all subjects became more angry in response to the stressful session, High WHR subjects showed smaller increases in anger. This could indicate that they are more likely to evidence a helpless reaction to uncontrollable stress. These findings support the hypothesis that cortisol secretion might represent a mechanism for the observed association between stress and abdominal fat distribution. Furthermore, differences in coping and appraisal may suggest that a particular psychological pattern might influence the reactivity of the adrenal-cortical system to stress, and subsequent fat distribution.

Chromosome abnormality in Kallmann syndrome.

We report on an individual with Kallman syndrome (KS) and a balanced de novo translocation (7;12)(q22,q24). None of 6 full sibs, 3 half-sibs, or parents have KS or this chromosome translocation. This is the only known report of KS with a chromosome abnormality. This may represent a spurious association or genetic heterogeneity vis-a-vis the reported linkage of KS to the steroid sulphatase gene on the X chromosome. The pathophysiology and genetics of KS are discussed.

Further evidence by gene dosage for the regional assignment of erythrocyte acid phosphatase (ACP1) and malate dehydrogenase (MDH1) loci on chromosome 2p.

Quantitative studies of erythrocyte acid phosphatase (ACP1) and soluble malate dehydrogenase (MDH1), both assigned to distal chromosome 2p, were performed by colorimetric methods on the red cells of four patients in an attempt to demonstrate a gene dosage effect. The patients inherited the unbalanced form of a familial reciprocal translocation, t(2;10)(p24;q26), and had partial duplication 2p. Parents of all patients and siblings of some were included in the study. All patients had increased levels of ACP1 corresponding to the presence of three structural genes. Levels of MDH1 were not increased. Evidence shows that the ACP1 gene is in the region 2p24 leads to 2pter and that MDH is not.

Familial reciprocal translocation, t(2;10)(p24;q26), resulting in duplication 2p and delection 10q.

We describe a familial reciprocal translocation between the distal part of the short arm of chromosome 2 and the long arm of chromosome 10. Five individuals in two generations had multiple congenital anomalies. Their karyotypes were 46,XX or XY, -10, + der(10), t(2;10)(p24;q26). Seven persons were balanced translocation carriers whose karyotypes were 46,XX or XY,t(2;10)(p24;q26). Common manifestations included mental retardation, strabismus, narrow high-arched palate, wide alveolar ridges, other facial abnormalities, genital abnormalities and mutism. The phenotype of the unbalanced individuals is compared to that of previously published cases of the syndrome of partial duplication 2p and to reported patients with partial deletion of 10q.

Trisomy 18 syndrome with an unusual karyotype: possible double isochromosome.

Chromosome analysis of an infant with characteristic features of trisomy 18 is presented. The chromosome complement contained a modal count of 47 but there was only one No. 18. In addition, there were two metacentric chromosomes of different sizes. The two metacentric chromosomes were identified by G- and C-banding to be possible isochromosomes of the long and short arms of a No. 18 chromosome.

Partial trisomy 7p associated with familial 7p;22q translocation.

A newly described partial trisomy of the short arm of chromosome number 7 is reported in a familial translocation between 7 and 22. The unbalanced translocation was found in one family member, the propositus, and the balanced form in 5 other members. The possibility of this translocation being a rare telomeric attachment previously undescribed in humans is discussed. Prominent clinical features include general mental and motor retardation, microbrachycephaly, and cardiac and oral abnormalities.