A controlled study of amitriptyline in the treatment of chronic pain.

This paper reports a study in which a double-blind controlled cross-over study of amitriptyline vs. placebo was carried out in a group of patients referred to a multidisciplinary pain clinic for the management of chronic intractable pain for which no substantial organic cause could be demonstrated. Of 52 patients entering the 12-week trial, 20 withdrew before completion. No differences were found in terms of global improvement on either agent. Subjective reports indicated a greater reduction in pain at 2 and 4 weeks on amitriptyline, but no difference at 6 weeks. None of the baseline measures was predictive of response.

A study of brief psychotherapy for chronic pain.

Twenty-six patients attending the pain clinic of a large metropolitan general hospital were randomly assigned to receive either twelve sessions of psychodynamic psychotherapy or six sessions of cognitively orientated supportive psychotherapy. Questionnaires measuring aspects of illness behaviour, depression and anxiety were administered before and after treatment, but did not reveal any significant differences between the treatment groups at any time. Global subjective estimates of outcome reported to an independent observer were made after completion of therapy and showed no significant differences. All measures were repeated six and twelve months after completion of therapy and revealed significant improvement in the dynamic therapy group only with respect to levels of activity. These findings suggest that brief psychodynamically oriented psychotherapy may have a role in the management of chronic pain but further evaluation of this approach is clearly necessary, involving larger numbers of patients, before a more definitive conclusion can be reached.

An attempt to construct short scales measuring manic-depressive-like experience and behaviour.

Two nine-item self-rating questionnaire scales were developed to measure, on the one hand, features typically associated with a history of mania-like phenomena, and, on the other hand, features typically associated with a history of clinical depression. These scales were added to produce an 18-item scale which, it was hypothesized, might measure degree of history of manic-depressive-like phenomena. Results tended to support this view: (1) compared with students, manic-depressives obtained significantly higher scores on each of these three scales; (2) all scales, but especially the manic experience scale, correlated significantly positively with the MMPI Hypomania Scale; and (3) for a subset of the manic-depressives, a person's scores on two of the three new scales were significantly correlated with the number of different manic-depression-relevant medications that that person was taking.

Process in psychotherapy as decreasing asymmetry between patient and therapist: evidence from the verbal interaction.

Transcripts of over half the sessions of a psychodynamically oriented psychotherapy were coded to show amount of speech by patient and therapist, and role dimensions derived from Stiles' Verbal Response Mode system. Results indicate the process of psychotherapy as one of decreasing asymmetry between participants, in both activity and status.

The Manic Depressiveness Scale: a preliminary effort at replication and extension.

In a previous paper, an 18-item scale was presented to measure the extent to which a person had experienced symptoms resembling mania or clinical depression. There was evidence that, within a group of 37 bipolar persons, scores on this Manic Depressiveness Scale correlated significantly positively with number of manic-depression-relevant medications currently being taken by the subject. In the present study, 24 subjects (9 unipolar depressives, 15 bipolars) were administered this scale, and aspects of their clinical history were taken. For the bipolar subjects only, scores on the scale correlated significantly with number of relevant medications (r = .45, p < .05, one-tailed), with number of hospitalizations (r = .46, p < .05), and with psychiatrist-rated severity of illness (r = .45, p < .05). Bipolar patients also scored significantly higher than did unipolar patients on the Manic Experience subscale. The Manic Depressiveness Scale thus appears to have some predictive validity.

Pain and depression.

This paper explores the relationship between depression and chronic intractable pain in which somatic pathology is playing a minor role. In this study, 114 patients with chronic pain were compared with 53 patients with depression. Patients with chronic pain were older, more likely to be married, more frequently attributed difficulties in activity and sleep to pain, and reported greater impairment of motor functions. They had less dysphoria and an illness behaviour profile (on the Illness Behaviour Questionnaire) suggestive of a conversion reaction. Depressed patients recalled more life events in the year prior to presentation, whilst pain patients recalled more events of nine and ten years earlier. It is concluded that the two patient groups cannot be considered identical. It is argued that the concept of abnormal illness behavior helps to distinguish the two groups.

Psychological factors in temporomandibular joint dysfunction: life events.

Psychological and emotional factors are clearly involved in the development of temporomandibular joint dysfunction (TMJD). They also are involved in whether the patient chooses to present for treatment and how they react to the health care professional and treatment. However, many previous studies have been simplistic in that they look at a particular psychologic aspect in isolation. In this series of studies, a multivariate analysis of a broad range of psychologic and physical variables in a TMJD group (N = 105) and a matched control group (N = 90) was performed. The methodology of the study is described in detail in this paper. Patients with high life events were compared with those with low life events. A simple relationship of high life events to development of TMJD was not demonstrated. However, high life events did correlate directly with other psychological parameters and to the development of illness behaviour.

Psychological factors in temporomandibular joint dysfunction: anxiety.

This study was to clarify the relationship between anxiety and temporomandibular joint dysfunction (TMJD) in a group of patients with TMJD (N = 105) and a matched control group (N = 90) using measures of anxiety, relevant physical parameters and a number of other psychological variables. Patients were divided into high and low anxiety groups using the Spielberger Anxiety Inventory and compared using measures obtained from the Gerke-Goss Inventory on Dental and Psychological Factors. Statistical comparison revealed no significant differences between the anxiety groups in physical parameters. Both of the TMJD groups (high and low anxiety) revealed more prominent features of Abnormal Illness Behaviour as compared to the control groups (high and low anxiety). This prominence of Abnormal Illness Behaviour was most evident in the TMJD group with low anxiety, a finding which may have further clinical implications.

Psychological factors in temporomandibular joint dysfunction: depression.

This study was to clarify the relationship between anxiety and temporomandibular joint dysfunction (TMJD) in a group of patients with TMJD (N = 105) and a matched control group (N = 90) using measures of depression, relevant physical parameters and a number of other psychological variables. Patients were divided into high and low depression groups using the Zung self-rating depression scale and compared using measures obtained from the Goss-Gerke Inventory on Dental and Psychological Factors. Statistical comparison revealed no significant differences between depression groups in physical parameters. The TMJD groups were generally more depressed than the control group. The highly depressed TMJD group had a greater degree of abnormal illness behaviour and generally were similar to those patients identified in other studies as being refractory to treatment.

Childhood hospitalization and chronic intractable pain in adults: a controlled retrospective study.

Three groups of patients have been studied in order to elucidate the relationship between childhood hospitalization and chronic intractable pain in adults. The groups were: patients referred to a pain clinic, psychiatric patients with a depressive illness, and patients attending a rheumatology clinic. The findings suggest that early hospitalization is related to the genesis of both depressive illness and intractable pain: in the former occurring in the preschool years and in the latter, during school age. The significance of these relationships is discussed.