Pain flashbacks in posttraumatic stress disorder.

OBJECTIVES: Surgical patients who regain consciousness while under general anesthesia may develop symptoms of Posttraumatic Stress Disorder (PTSD). One common PTSD symptom is the experiencing of abnormal perceptions during which the patient feels as if the trauma is recurring. The objective of this report is to document the re-occurrence of pain as part of the PTSD sequelae. RESULTS: We present two patients who developed PTSD following an episode of awareness under anesthesia. In both cases, posttraumatic sequelae persisted for years and included pain symptoms that resembled, in quality and location, pain experienced during surgery. In addition to their similarity to the original pain, these pain symptoms were triggered by stimuli associated with the traumatic situation, suggesting that they were flashbacks to the episode of awareness under anesthesia. DISCUSSION: The similarity between the patients' pain symptoms and pain experienced during trauma, the triggering by traumatic cues, and the associated emotional arousal and avoidance suggest the involvement of a somatosensory memory mechanism.

Factors associated with refusal to enter a clinical trial: epidural anesthesia is a deterrent to participation.

PURPOSE: To compare patients who participate in a clinical trial for pain management involving epidural anesthesia to those who refuse and document their reasons for refusing. METHODS: Demographic and health history information was collected from 621 female patients who were screened for inclusion in a pain management trial involving epidural anesthesia. Patients who completed the clinical trial (n = 149) were compared to those who consented to provide screening information but did not enter the trial (n = 472). RESULTS: Sixty-seven percent of women who refused cited unwillingness to have an epidural as the reason for their decision. Non-Caucasians (P < 0.01), patients with no history of mood/anxiety disorders (P < 0.016) or systemic disease (P < 0.02), and patients with certain types of pain (P < 0.02) were more likely to refuse to participate in the clinical trial. A longer duration between recruitment and surgery was also found to be associated with higher participation rates (P < 0.01). A logistic regression equation significantly predicted which patients would participate or refuse (P < 0.0001), indicating that a specific set of health and demographic factors strongly influence the decision to participate in a trial. CONCLUSIONS: The decision to participate in a clinical trial is viewed as a risk/benefit analysis. Factors such as short recruitment to surgery intervals and pre-existing pain, which increase the salience of risks associated with the trial, may result in lower participation rates. Overall, epidural anesthesia is a strong deterrent to participation in a clinical trial.