Subject(s)
Health Maintenance Organizations , Labor Unions , Physicians/organization & administration , American Medical Association , Collective Bargaining , Health Maintenance Organizations/economics , Health Maintenance Organizations/organization & administration , Strikes, Employee , United States , WorkforceABSTRACT
The McGill-Melzack Pain Questionnaire (MMPQ), comprised primarily of adjectives descriptive of pain, was administered to 100 patients seeking treatment for headache. Diagnostic classification of patients into migraine or muscle contraction headache groups was conducted by a screening neurologist using information other than pain description. Reliability determinations were made following independent diagnosis by two other neurologists using a headache pain history and symptom form (HPHSF) devoid of pain adjectives. Comparison of 30 subjects HPHSF's revealed that the screening neurologist's diagnosis and that of two other neurologists, (tau = .87, rho < .01) and (tau = .48, rho < .05), indicate high agreement between three physicians in headache diagnosis devoid of pain description. Results show that migraine headache patients report significantly more affective words (t 99 = 3.89, rho < .001) than do muscle contraction headache sufferers; however, no significant differences existed between the groups' use of sensory or evaluative works. Migraine sufferers, while not reporting their headache as more severe "generally," did report more intense pain when recalling headache at its "worst" (t99 = 2.69, rho < .01) and at its "least" (t99 = 1.74, rho < .05) compared to the muscle contraction headache 'group. Discriminant analyses were conducted on one-half of the sample to determine diagnostic group membership on the basis of pain description alone. Findings revealed that group membership could be predicted at a 90% rate (chi2 145 = 33.06, rho < .001). A cross validation on the second half of the sample confirmed these findings (chi2 1.48 = 13.08, rho < .05) suggesting that the MMPQ is of value in headache diagnosis. Differences between electromyographic studies and headache pain report are discussed as well as suggestions concerning modification of the MMPQ for headache assessment.
Subject(s)
Headache/diagnosis , Pain Measurement/methods , Adolescent , Adult , Female , Humans , Male , Middle Aged , Severity of Illness Index , Tension-Type Headache/diagnosisABSTRACT
The best known biochemical pathway in the brain is probably the nigrostriatal system. Even so, its relationship to Parkinsonism is incompletely understood. Its relationship to Huntington's chorea and the dyskinetic responses is even less well understood. The significance of this system in other related disorders such as Heterogeneous system degeneration, progressive supranuclear palsy, and striatonigral degeneration is still more speculative. In an effort to elucidate underlying neuropharmacology, trials with levodopa, amantadine, haloperidol, and lithium have been undertaken. This increasing concentration in biochemical mediators reflects changing patterns in neurology where new emphasis on biochemical pathways is replacing in current interest the emphasis previously placed on more traditional neuro-anatomical pathways such as the classical ascending sensory and descending motor tracts.
