Update on structured pain assessment for the documentation of diagnosis-independent symptoms and signs associated with pain.

Concerning the diagnosis and therapy of pain syndromes, standardized descriptions similar to those used in the examination of psychopathological findings via the system produced by the AMDP ("Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie", i. e., the working group establishing standardized methodology and documentation within psychiatry) are still lacking. Therefore, the authors of this article have founded a working group to establish standardized methodology and documentation for symptoms and signs associated with pain, although not at a diagnosis-specific level, in order to promote standardization in the documentation of pain and rating of the symptoms associated with a given set of medical results. This article presents a system for documenting the symptoms and signs associated with pain globally and independently of the diagnosis (Structured Pain Assessment System) with nomenclature that is inspired by the AMDP system. The objective of this working group is to develop documentation for a uniform multidimensional pain assessment (with defined terminology) that serves as a comparable and unified standard in the field.

[The AMDS system for the documentation of symptoms and signs associated with pain]. / Das AMDS-System zur Dokumentation von Schmerzbefunden.

The authors present a system for nomenclature and documentation of symptoms and signs associated with pain. The system was compiled in a staged process by the study group for methods and documentation of pain-associated symptoms and signs (Arbeitsgemeinschaft für Methodik und Dokumentation von Schmerzbefunden [AMDS]). The suggested items were elaborated from terms used in current national and international guidelines and classifications and in part integrated into superordinate terms. The items that were built up by this approach aim to reflect the broad spectrum of pain diseases. The items for the description of pain-associated symptoms and signs are divided into the areas of algesiomotor, psychoalgesiological and somatoalgesiological findings. The aim is the documentation of a multidimensional algesiological description of findings with defined terminology, which can serve as a comparable and unified standard, particularly in the field of pain assessment. The AMDS system should enable a systematic description of pain, which is a reliable foundation for diagnostics, therapy planning and expert case evaluation.

Threat-sensitivity in affective disorders: A case-control study.

BACKGROUND: Anxiety disorders are highly comorbid with major depression but differ in their symptom profiles and pharmacological responses. Threat-sensitivity may explain such differences, yet research on its relationship to specific disorders is lacking. METHODS: One-hundred patients (71 women) and 35 healthy controls (23 women) were recruited. Thirty-five had Panic Disorder (PD), 32 had Generalized Anxiety Disorder (GAD) and 33 Major Depressive Disorder (MDD). Threat-sensitivity was measured via behaviour (Joystick Operated Runway Task; JORT) and self-report (Fear Survey Schedule; FSS). RESULTS: Behavioural sensitivity to simple threat was higher in females compared to males (p = .03). Self-reported sensitivity to simple threat (FSS Tissue Damage Fear) was higher in PD patients compared to other groups (p ≤ .007) and in GAD patients compared to controls (p = .02). Behavioural sensitivity to complex threat was higher in females than males (p = .03) and a group by sex interaction (p = .01) indicated that this difference was largest in PD patients. Self-reported sensitivity to complex threat (FSS Social Fear) was higher in all patients compared to controls (p ≤ .001). Females scored higher than males on FSS Tissue Damage Fear and FSS Social Fear). CONCLUSIONS: Our findings oppose the simple/complex threat dichotomy, instead suggesting elevated sensitivity to physical threat differentiates anxiety disorders from MDD, whereas elevated sensitivity to social threat is associated with both anxiety disorders and MDD.

Impact of chronic somatoform and osteoarthritis pain on conscious and preconscious cognitive processing.

UNLABELLED: The study investigates the impact of chronic pain (CP) on conscious and preconscious cognitive processes and on guessing behavior and examines the mediating effect of a depressive state. Twenty-eight patients with CP due to hip osteoarthritis, 32 patients with a somatoform disorder including pain symptoms, and 31 participants who did not have CP were examined within the framework of a modified process-dissociation-paradigm. Neutral, health-threatening, and general threatening stimuli were presented acoustically in a lexical decision task. Parameters of conscious processing, preconscious processing, and of chance were estimated by a multinomial modeling procedure. CP patients with osteoarthritis showed the lowest level of conscious processing and the highest level of guessing behavior. Patients with somatoform pain tended to react preconsciously to health threatening stimuli but overall showed a profile similar to that of control subjects who did not have CP. The impact of the threatening quality of stimuli on different levels of cognitive processing was weak. Depression did not mediate between the experience of pain and estimates of conscious and preconscious processing. PERSPECTIVE: The impact of CP on preconscious and conscious cognitive processing depends on types and causes of pain. The experience of CP caused by inflammation or physical damage tends to reduce the probability of conscious processing and to provoke memory biases. CP in the context of a somatoform disorder appears to have less impact on cognitive functions.