Objective and subjective tremor responses to oral beta 2 agents on first exposure. A comparison of metaproterenol and terbutaline.

Objective and subjective postural tremor responses at 60 and 120 min after drug treatment were studied in 24 veterans with chronic obstructive pulmonary disease who received either 5 mg terbutaline, 20 mg metaproterenol, or a placebo in random order. Subjects were fasting, and had not taken theophylline for 15 to 24 h or any oral sympathomimetics for 2 wk. The mean tremor response to terbutaline and metaproterenol was equal at 60 min, but the 120-min response to metaproterenol was less. When the 60- and 120-min responses were averaged, tremor response to terbutaline was significantly greater than that to metaproterenol in a 5 : 4 ratio. Subjective awareness was also greater. These results are consistent with the difference in bronchodilatory potency of the two preparations. That the drug producing the greater tremor could usually be identified by the patient, even at low tremor intensities, is consistent with the hypothesis that perception of tremor is a function of relative rather than absolute increase over basal tremor unless the tremor becomes physically disabling. In general, the individual tremor response was proportional to the extent by which a patient's basal tremor exceeded the minimal basal tremor for the group as a whole. These results fit a model in which the postural tremor derives from beta-sensitive and beta-insensitive cardioballistic and skeletal muscle forces. Variability in tremor response resides principally at the peripheral skeletal beta 2-receptor and its control system.

Chronic pain and the questionable use of the Minnesota Multiphasic Personality Inventory.

Several studies have observed that patients who complain of chronic pain have significantly elevated scores on the first 3 clinical scales of the Minnesota Multiphasic Personality Inventory (MMPI). Some studies imply that this profile allows one to conclude that such patients exaggerate their symptoms, have strong feelings of inadequacy, have emotional problems which are neurotic, with implications that this is functional pain. The present study and its results challenges the use of the MMPI in attempting to distinguish psychogenic from organic pain. The MMPI was administered to 62 patients on their admission to the hospital. All 62 patients had a diagnosis of some organic findings consistent with their pain symptomatology. The average MMPI scores resulted in an elevated "Conversion-V" profile. It was also noted that as characteristics such as age of the subject, number of surgeries, and number of physicians seen increased, there was a corresponding increase in the neurotic scales. It was concluded that utmost caution should be used in interpreting individual pain patients' MMPI scores. It is especially important to avoid dismissing the pain symptomatology as functional by simply giving the patient a psychiatric diagnosis consistent with the profile. The potential of the MMPI as an aid in developing the treatment plan and as a possible predictive tool for certain treatment procedures is discussed. It is suggested that MMPI data be collected on a comparison group of patients, who have had successful relief of pain through surgical intervention.