Memory for pain after nerve-block injections.

OBJECTIVE: To examine the accuracy of memory for pain in patients with chronic pain after injection of a local anesthetic and to investigate psychological factors hypothesized to coincide with distortion of memory. DESIGN: Consecutive patients receiving nerve-block injections recorded pain before the block, during the effect of the block, approximately 2 days after the block, and 2 weeks after the block. Memory for pain during the effect of the block was assessed 2 days and 2 weeks after the block for comparison with recorded pain ratings. SETTING: Outpatient, multidisciplinary pain-treatment center of a university medical center. PATIENTS: Forty-nine adult patients with chronic pain. INTERVENTIONS: Local nerve-block injections resulted in a significant, temporary reduction in pain, thus allowing patients to rate, and later recall, intensity of reduced pain. OUTCOME MEASURES: Subjective ratings of pain intensity (numeric rating scale) were compared with recalled pain intensity. Demographic variables and psychological self-report measures were administered at evaluation. RESULTS: Memory distortions are commonplace and are more likely to involve recollection of higher pain levels than were reported at the time of the injection. Psychological self-report measures did not identify subjects who experienced distorted memory for pain relief. CONCLUSIONS: An awareness of these distortions should lead health-care professionals to monitor and refer to patients' actual pain reports made during a treatment intervention rather than relying on patients' recall to gauge the efficacy of interventions. Memory distortions could influence avoidance behaviors implicated in the development of chronic pain by some theories.

Chest pain self-management training for patients with coronary artery disease.

This study was designed to evaluate the efficacy of a brief, structured pain management program to improve control over chest pain episodes in patients diagnosed with coronary artery disease. Twenty-six male veterans who attended the three-session program were compared with twenty-six matched controls. Results indicated significant short-term reductions in self-report of number of chest pain episodes in treated subjects. Self-report of pretreatment daily physical activity level moderated treatment outcome, as individuals reporting lower levels of physical activity derived greater benefit than their high-activity counterparts. These results suggest the potential utility of incorporating chest pain control strategies into comprehensive cardiac rehabilitation programs.

Respiratory function, cognitions, and panic in chronic obstructive pulmonary patients.

The present study investigated the relationship between respiratory function, catastrophic thoughts about anxiety, and panic in 48 Chronic Obstructive Pulmonary Disease (COPD) patients. During a routine office visit which included respiratory function tests (Forced Vital Capacity, FVC; Forced Expiratory Volume--first second, FEV1) patients completed a battery of questionnaires which assessed history of panic, days with shortness of breath, general activity level, agoraphobic cognitions, perception of bodily sensations, anxiety and depression. Thirty-seven percent of the sample reported experiencing a panic attack. Subjects showed a significant impairment in respiratory functioning. Patients with a history of panic did not differ from those who had not experienced panic on demographic, physiologic, or activity variables. Patients who experienced panic reported significantly more agoraphobic cognitions and greater concern with bodily sensations than did patients who did not experience panic.