Nervousness and pain sensitivity: II. Changed relation in ex-addicts as a predictor for early relapse.

We recently demonstrated a coupling between nervousness and pain sensitivity in healthy volunteers, and we defined a mean ratio of nervousness/log pain threshold of 1.95 +/- 1.47 for healthy humans. Because in another study former opiate addicts were found to exhibit a persistent opioid independent analgesia, we wondered whether nervousness is also changed in these patients, or if the balance between nervousness and pain sensitivity is altered. Forty unmedicated former opiate addicts during long-term rehabilitation and 40 age-matched control subjects were included in the study. The subjects rated their nervousness prior to a cold pressor test on a Visual Analog Scale. It turned out that the average nervousness rating was higher than in the control subjects and that a distinct subgroup of pain sensitive ex-addicts exhibited a higher ratio of nervousness vs. pain threshold. In this group the risk for relapse was three to four times higher than in the other ex-addicts.

Decreased nociceptive sensitivity: a biological risk marker for opiate dependence?

In recent studies using a cold pressor test we could show that former opiate addicts are persistently less pain-sensitive than healthy controls, indicating a neurophysiologic dysfunction in these patients. In the present study we addressed the issue of whether this dysfunction was caused by the drug abuse or already existed prior to the heroin addiction, and whether it is restricted to pain sensitivity or affects somatosensory or nociceptive sensitivity in general. After validating the method we obtained retrospective ratings for the pain, cold and warmth sensitivity for the time before addiction, during addiction and during detoxification. Ex-addicts perceive themselves less pain- and cold-sensitive than healthy controls, and no difference was detectable between the pre-addiction and the rehabilitation ratings, although nociceptive sensitivity is highly increased during detoxification. Warmth sensitivity was not different to healthy controls and was not affected by drug withdrawal. Our findings suggest that a decreased nociceptive sensitivity may already precede opiate addiction pointing to physiological dysfunctions in heroin pre-addicts.

[Drug dependence and self-injury within the scope of health occupations]. / Sucht und Selbstgefährdung im Rahmen der Gesundheitsberufe.

Members of the health profession live within a special field of tensions between permanent contact with disease and dying; the own biography sometimes influences choice of profession, and moreover may contribute irritating factors for the further life in profession; functioning within the professional and the familial situation at the same time; pressure of public opinion. Some examples of profession-specific conflictouse constellations are presented here. They just want to be examples by no means systematic or comprehensive. However they want to help members of the health professions to come out of their isolation, want to give them more courage for self reflection and for adequate psychohygienic means.