Attitudes and emotions towards pain and sensitivity to painful stimuli among people routinely engaging in masochistic behaviour.

BACKGROUND: People engaged in masochistic behaviour (MB) seek to experience pain and the pleasure it evokes in sadomasochistic (S&M) sessions. The sensitivity and attitude to pain in these individuals has hardly been tested. We evaluated pain perception among these individuals and tested whether their experiences and attitudes towards pain are context-related. METHODS: Thirty-four healthy subjects participated; 17 routinely engaged in MB and 17 controls. Pressure pain threshold (PPT) was measured in two body regions. A structured questionnaire on S&M activities and context-related pain experiences and emotions was completed, as well as the pain catastrophizing (CAT) and fear of pain (FOP) questionnaires. RESULTS: PPT was significantly higher among MB individuals and positively correlated with the frequency of S&M sessions. MB individuals also had lower levels of CAT, and FOP correlated negatively with the frequency of MB and the number of body regions involved. Pleasure evoked during S&M sessions correlated positively with pain intensity and number of body regions involved. Pain in everyday life correlated negatively with MB activities. However, the emotional attitude to everyday pain was ambivalent: MB individuals perceived pain intensity and unpleasantness similar to the controls, but simultaneously gained pleasure from the pain. CONCLUSIONS: MB individuals exhibited pain hyposensitivity, presumably resulting from frequent engagement in MB. Alternatively, these subjects may have a predisposition which enables this engagement. Attitudes towards pain in MB individuals are complex. They appear to be context-related with pain experienced as pleasurable and rewarding during S&M sessions, and negative but still pleasurable in everyday life.

The long-term impact of tissue injury on pain processing and modulation: a study on ex-prisoners of war who underwent torture.

BACKGROUND: Tissue injury may, in some instances, induce chronic pain lasting for decades. Torture survivors suffer from high rates of chronic pain and hypersensitivity in the previously injured regions. Whether torture survivors display generalized alterations in pain perception and modulation, and whether such alterations underlie their chronic pain is unknown. We aimed at exploring the long-term alterations in pain perception and modulation in torture survivors. METHODS: In order to address these questions, a systematic quantitative somatosensory evaluation was performed in individuals (n = 60) who suffer from chronic pain, and who, decades previously, were tortured, resulting in substantial tissue damage. These individuals were compared with age- and sex-matched individuals (n = 44) of similar background. Testing included the measurement of pain threshold and pain tolerance, perceived suprathreshold stimuli, conditioned pain modulation (CPM) and temporal summation of pain (TSP) in intact body regions. RESULTS: Chronic pain was found highly prevalent (86.6%) among torture survivors, who exhibited higher suprathreshold pain ratings (p < 0.05), poorer CPM (p < 0.0001) and stronger TSP (p < 0.0001) than controls. Significant differences in CPM and TSP were also found between torture survivors and controls with chronic pain. Chronic pain intensity among torture survivors correlated negatively with the magnitude of CPM (r = -0.47, p < 0.01). CONCLUSIONS: Torture appears to induce generalized dysfunctional pain modulation that may underlie the intense chronic pain experienced by torture survivors decades after torture. The results may be generalized to instances where chronic pain exists for decades after severe injury in non-tortured populations and emphasize the importance of preventive care.

Trajectories of stress reactions and somatization symptoms among war veterans: a 20-year longitudinal study.

BACKGROUND: There is considerable evidence that immediate and long-term stress reactions are associated with increased somatic symptomatology. However, because of the scarcity of long-term longitudinal studies, the trend of mutual change of these factors has not been assessed. This study examined the chronological inter-relationships between post-traumatic stress reactions and somatization symptoms among combatants over a 20-year period. METHOD: Two groups of veterans were assessed 1, 2, 3 and 20 years after their participation in the 1982 Lebanon War: a clinical group of veterans who had been diagnosed with combat stress reaction (CSR) on the battlefield (n=363), and a matched control group of veterans (n=301). RESULTS: The CSR veterans reported higher initial levels of intrusion and avoidance and a steeper decline in those symptoms over time in comparison to the control group. The former also reported higher initial levels of somatization symptoms than the latter. In addition, over the years, stress reactions were positively associated with somatization symptoms. For both study groups, in the first years after the war, stress reaction symptoms predicted somatization symptoms. However, with time, the trend was reversed and somatization symptoms predicted stress reactions. CONCLUSIONS: The findings suggest that CSR is a marker for future stress reactions and somatization symptoms, and indicate a long-term role for these symptoms in veterans' psychological distress.

Demented patients' participation in a clinical trial: factors affecting the caregivers' decision.

Clinical trials for Alzheimer's disease take place in medical centers all over the world. Patients and caregivers have to decide whether or not to agree to participate in clinical trials. This study aimed to investigate the motivation that determines the caregivers' choice. Nineteen caregivers of demented patients who consented to participate in a clinical trial in our Memory Clinic and 10 caregivers who refused to participate were interviewed. The data were gathered by a self-report questionnaire covering various aspects of the caregivers' decision-making process. Among the reasons for agreeing to participate in the clinical trial were the respondents' belief that it would improve or help to maintain the patients' condition. Most of the respondents of both groups indicated that information regarding side effects and success probability was adequately provided in advance. The primary reason for refusal was the potential side effects of the drug. The implications of the findings are discussed.

Posttraumatic residues of captivity: a follow-up of Israeli ex-prisoners of war.

BACKGROUND: This article examines the long-term impact of wartime captivity. METHOD: One hundred sixty-four prisoners of war (POWs) and 189 matched combatants of the 1973 Yom Kippur War filled out a series of questionnaires that assessed posttraumatic stress disorder (PTSD), general psychiatric symptomatology, and social functioning according to DSM-III-R criteria. RESULTS: Almost 2 decades after the war, ex-POWs exhibited higher rates and greater intensity of posttraumatic stress reactions, more general psychiatric symptomatology, and more severe problems in functioning at home, at work, and in the military than did the control group (Israeli veterans who were not POWs). They were also more likely to obtain official disability recognition and to seek psychological help. Their recovery was slower and professional help less effective. In addition, the veterans with PTSD in both groups had high rates of comorbid general psychiatric symptomatology. CONCLUSION: These findings point to the depth, range, and persistence of the stress residuals of wartime captivity.

Young women with PD: a group work experience.

Parkinson's Disease (PD) prior to the age of 40 affects between 5-10% of the PD population. The psychosocial changes that patients with early PD encounter, may be more devastating and disabling than the actual motor disability. The paper describes a unique experience in groupwork with young female PD patients treated in the Movement Disorders Unit of the Tel Aviv Sourasky Medical Center. The paper focuses on the special issues which characterized this group's experience: stigma, body and sexual image, and personality traits.

An Israeli model of a hospital emergency information center.

The Emergency Information Center model developed by the social work department of Tel Aviv Sourasky Medical Center is activated in cases of mass casualties following disasters. It aims to provide reliable information to help the public cope with confusion and uncertainty, and to enable the medical staff to concentrate on treating the casualties. The Information Center is comprised of several interrelated units within the hospital, and maintains contact with a range of community organizations. The article describes the structure and activities of the various units, and discusses a number of aspects relevant to personnel organization in crisis intervention.

Mass casualties: an organizational model of a hospital information center in Tel Aviv.

The article describes an organizational model of an information center, developed by the social work department of Tel Aviv Sourasky Medical Center. The information center is designed to provide information when mass casualties are brought to the hospital following terrorist attacks or other catastrophes. The information center is comprised of a number of interrelated units within the hospital and is in contact with a range of organizations in the community. The structure and activities of the various units is described. The article also discusses a number of aspects relevant to personnel organization in crisis intervention.

PTSD among Israeli former prisoners of war and soldiers with combat stress reaction: a longitudinal study.

OBJECTIVE: The aim of this study was to assess the long-term impact of war captivity and combat stress reaction on rates of posttraumatic stress disorder (PTSD) in Israeli veterans of the 1973 Yom Kippur war. METHOD: One hundred sixty-four former prisoners of war (POWs), 112 veterans who had had combat stress reaction, and 184 combat veteran comparison subjects filled out the PTSD Inventory, a self-report scale based on the DSM-III-R criteria for PTSD. The inventory diagnoses past and present PTSD, assesses its intensity, and provides a symptom profile. RESULTS: Thirty-seven percent of the veterans who had had combat stress reaction, 23% of the former POWs, and 14% of the comparison subjects had had diagnosable PTSD at some time in the past. The current rates were 13%, 13%, and 3%, respectively. The results showed different recovery rates over time: almost two-thirds of the veterans with combat stress reaction who had had PTSD in the past recovered, while less than one-half of the POW group showed this improvement. CONCLUSIONS: These findings indicate that small but significant proportions of the POWs and veterans with combat stress reaction were still suffering from PTSD almost two decades after the war. The different recovery rates in the two groups may reflect the differences in duration and severity of stressors, the impact of immediate intervention on long-term adjustment, or both.

Assessment of PTSD: validation of the revised PTSD Inventory.

The PTSD Inventory, a self-report diagnostic questionnaire based on DSM-III criteria, was revised to meet the more recent DSM-III-R criteria. This study examined the validity of the revised inventory relative to a structured clinical interview (SCID) and the Impact of Events Scale (IES). Results showed a high degree of concordance between the instruments, supporting the use of the more standardized, easy to administer and economical PTSD Inventory.