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Many believe that identifi- cation and treatment of the physical cause of their pain is the only road to- ward finding relief for their symptoms buy proscar 5mg free shipping man health review best male nhan men products. When compensation or litigation is- sues are involved purchase proscar 5mg without a prescription prostate cancer prevention, patients may be particularly sensitive to the implications of a psychological evaluation. They may wonder, “Is this psychologist try- ing to figure out if I am exaggerating my symptoms? Specifically, the provider can inform the patient that an evalua- tion helps his or her providers ensure that factors in the person’s life, such as stress, are not interfering with their treatment and not contributing to suf- fering. Patients can then be told that, used in conjunction with other treat- ments, patients with persistent pain have found that psychological tech- niques can reduce their symptoms and help them better manage their pain and their lives. Although it is not ideal, when referral agents do not prepare patients for psychological evaluations, pain psycholo- gists can provide the rationale for the evaluation themselves. One way to establish rapport with these patients is to begin the evaluation with less “psychologically charged” questions. Instead, begin by asking patients to de- scribe their pain and its onset. COMPONENTS OF A PSYCHOLOGICAL EVALUATION A comprehensive psychological evaluation covers the same information as screening but in much greater depth and breadth. Results of comprehen- sive psychological evaluations can be combined with physical and voca- TABLE 8. If third-party payers are to obtain information the patient will be alerted to this. The following is a transcript of an interaction where a health care provider is preparing a patient for a referral for a psychological evaluation. I’m referring you to a psy- chologist because I understand you have been having unremitting symptoms for a long time and I know that this can affect all areas of your life. Psychologists do not just deal with people who have severe emotional problems. They also work with patients who have to adapt to a disorder with distressing symptoms. As you know all too well, living with pain is difficult, can create many problems, and interfere with all aspects of your life—household activities, work, marital, family, and social relations, work, and more. There is no question that pain and associated symptoms cause a lot of stress. It is not surprising that people with pain become irritable, an- gry, frustrated, worried, and yes, depressed. To provide you with the best treatment, then, re- quires that we understand your situation and work with you as a whole person (not just a set of body parts that are broken) and provide you with a comprehensive treatment. Based on the psycho- logical evaluation, the psychologist may recommend ways to help you adjust your life style to re- duce pain and disability, relaxation methods to help you control your body, a number of stress management skills and ways to help you cope with your physical symptoms and your distress, and methods to help you improve your marital, family, and social relations. I hope I have ad- dressed some of your concerns about my recommending a psychological evaluation. From “Psychological Evaluation of Patients with Fibromyalgia Syndrome: A Compre- hensive Approach,” by D. Williams, 2002, Rheumatic Disease Clinics of North America, 28, 219–233. Interview A central component of a psychological evaluation is the interview. A num- ber of topics roughly fitting within 10 general areas are covered in the inter- views. Pain psychologists are interested in how pa- tients experience their pain, what types of things exacerbate or alleviate the symptoms, and what thoughts and feelings they have about their pain. For example, does the patient believe that they have no control over symp- toms? Or do they notice that their behaviors influence their symptoms to some extent and that there are predictable patterns with respect to their pain? It is also useful to ask patients to rate their pain on a 0–10 scale (e.
Health measures correlates in a French elderly community population: The PAQUID study cheap proscar 5mg free shipping prostate 5k run. An epidemiologic compar- ison of pain complaints in the general population of Catalonia (Spain) cheap proscar 5 mg free shipping prostate gland removal. A comparative study of disability, depression and pain severity in young and elderly chronic pain patients. A comparison of young and elderly patients at- tending a regional pain centre. Postoperative pain in children—Developmental and family influences on spontaneous coping strategies. Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in a Swedish population study. Discordance between self-report and behavioral pain measures in children aged 3–7 years after surgery. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Correlates of pain-related responses to venipunctures in school-age chil- dren. The prevalence of pain in the general commu- nity: The results of a postal survey in a county of Sweden. Pain, opioid use, and sur- vival in hospitalized patients with advanced cancer. Evoked action potentials and conduction velocity in human sensory nerves. Children’s concepts of physical illness: A review and cri- tique of the cognitive-developmental literature. Pain coping strategies and quality of life in women with fibromyalgia: Does age make a difference? Development and preliminary validation of a postoperative pain measure for parents. Pain assessment in cognitively impaired and unimpaired older adults: A comparison of four scales. Thermal pain: A sensory decision theory analysis of the effect of age and sex on d , various response criteria, and 50% pain threshold. Cognitive-behavioral pain management for elderly nursing home residents. The classification of patients with chronic pain: Age and sex differences. The classification of patients with chronic pain: Age as a contributing factor. Comparison of chronic pain expe- rience between young and elderly patients. An assessment of psychometric instruments used in a geriatric outpatient pain clinic. A comparison of outcome in young and eld- erly patients attending a pain clinic. A comparison of 2 measures of facial activity during pain in the newborn child. Temperament and behaviour in six- year-olds with recurrent abdominal pain: A follow-up. Journal of Child Psychology and Psychia- try and Allied Disciplines, 27, 539–544. The valuation of states of ill-health: The impact of age and disability. Systematic re- view of randomised controlled trials of psychological therapy for chronic pain in children and adolescents, with a subset meta-analysis of pain relief.
If you do not receive your letters from the editor order proscar 5mg overnight delivery prostate oncology hematology, it pays to consider these possibilities generic proscar 5 mg mastercard balance androgen hormones naturally. Philip Lake (disputing Wegener’s theory of continental drift in 1928; 1865–1949) Once your paper is submitted, the data and all of the documentation surrounding the data analyses should be stored in a durable and appropriately referenced form. Wherever possible, the original data in the form of questionnaires, data collection sheets, CDs, medical records, etc. Data should be held safely for as long as readers of publications might reasonably expect to be able to raise questions that require reference to them. Some research funding bodies stipulate that this should be at least five years, others state 10 years. Before you discard your data or the documentation of your data analyses, you must be certain that you are not contravening the policies of either your institution or your funding bodies. All references to where the data are held and how it is archived should be logged in a study handbook that is freely available to all stakeholders and research staff who have been involved in the study. Although individual researchers may hold copies or subsets of the data, a complete data set free of errors and updated with all corrections must be archived and safely stored at all times. In this way, anyone can repeat your analyses or use the data set to answer new questions as they arise. Acknowledgements The Huxley quote has been produced with permission from Collins Concise Dictionary of Quotations, 3rd edn. The Townes and Lake quotes have been produced with permission from Horvitz, LA ed. Abstract presented at Thoracic Society of Australia, Annual Scientific Meeting, Canberra, 1992. Egotism in prestige ratings of Sydney suburbs: where I live is better than you think. Similar, the same or just not different: a guide for deciding whether treatments are clinically equivalent. Dissociation in people who have near-death experiences: out of their bodies or out of their minds? African origin of modern humans in East Asia: a tale of 12,000 Y chromosomes. Losing the battle of the bulge: causes and consequences of increasing obesity. The CONSORT statement: Revised recommendations for improving the quality of reports of parallel-group randomized trials. Maidenhead: McGraw-Hill, 1995; p 113 29 Peat JK, Mellis CM, Williams K, Xuan W. A David1 The objectives of this chapter are to understand how to: • have insight into the editorial and external review processes • follow the correct procedures to get your paper in print • avoid problems with copyright and the press • become a reviewer or an editor Peer-reviewed journals Peer review exists to keep egg off authors’ faces. S Goldbeck-Wood2 A peer-reviewed journal is one that is controlled by editorial staff who send papers out to external reviewers. The external reviewers are selected because they have a reputations as experts in their fields of research. The work that is published in peer-reviewed journals is considered far superior to that published in non-peer-reviewed journals simply because it has undergone expert external review. The editorial team has the responsibility of communicating with the author, and the external reviewers have the responsibility of ensuring that the external review process is rigorous and expeditious. When you send your paper to a journal, there are usually two levels of review. The first is the internal peer review by the editorial team to decide whether your paper is the type of article that they want to see in their journal and, if so, whether 121 Scientific Writing it is of an adequate standard to be sent out for external review. Editors have the ultimate responsibility of selecting papers that will appeal to the journal’s readership. At the BMJ, about half of the submitted papers are rejected in-house by the editorial committee3 and at JAMA 42% of papers are rejected without external review. Each paper is sent to only two or three reviewers but this may vary from journal to journal. The areas that reviewers are often asked to comment on are shown in Box 5. In addition, many journals ask reviewers to give a quality or priority ranking to various aspects of the paper. If the comments from two reviewers differ markedly, the editor will often ask for comments from an arbiter reviewer.
The central control trigger is represented by a line running from the large fiber system to central control processes; these buy proscar 5 mg without prescription mens health zumba, in turn discount proscar 5mg amex prostate 44, project back to the gate control system, and to the sensory-discriminative and motiva- tional-affective systems. All three systems interact with one another, and project to the motor system. The descriptors fall into four major groups: sensory, 1–10; affective, 11–15; evaluative, 16; and miscellaneous, 17–20. The rank value for each descriptor is based on its position in the word set. This concept, generally ignored for about 10 years, is now beginning to be accepted. It represents a revolutionary ad- vance: It did not merely extend the gate; it said that pain could be gener- ated by brain mechanisms in paraplegics in the absence of spinal input be- cause the brain is completely disconnected from the cord. Psychophysical specificity, in such a concept, makes no sense; instead, we must explore how patterns of nerve impulses generated in the brain can give rise to somesthetic experience. PHANTOM LIMBS AND THE CONCEPT OF A NEUROMATRIX It is evident that the gate control theory has taken us a long way. Yet, as his- torians of science have pointed out, good theories are instrumental in pro- ducing facts that eventually require a new theory to incorporate them. It is possible to make adjustments to the gate theory so that, for example, it includes long-lasting activity of the sort Wall has described (see Melzack & Wall, 1996). But there is a set of observations on pain in paraplegics that just does not fit the theory. Peripheral and spinal processes are obviously an important part of pain, and we need to know more about the mecha- nisms of peripheral inflammation, spinal modulation, midbrain descending control, and so forth. But the data on painful phantoms below the level of total spinal section (Melzack, 1989, 1990) indicate that we need to go above the spinal cord and into the brain. Now let us make it clear that we mean more than the spinal projection areas in the thalamus and cortex. These areas are important, of course, but they are only part of the neural processes that underlie perception. The cortex, Gybels and Tasker (1999) made amply clear, is not the pain center and neither is the thalamus. The areas of the brain involved in pain experi- ence and behavior must include somatosensory projections as well as the limbic system. Furthermore, cognitive processes are known to involve widespread areas of the brain. Yet the plain fact is that we do not have an adequate theory of how the brain works. Melzack’s (1989) analysis of phantom limb phenomena, particularly the astonishing reports of a phantom body and severe phantom limb pain in people after a cordectomy—that is, complete removal of several spinal cord segments (Melzack & Loeser, 1978)—led to four conclusions that point to a new conceptual nervous system. THE GATE CONTROL THEORY 21 body part) feels so real, it is reasonable to conclude that the body we nor- mally feel is subserved by the same neural processes in the brain; these brain processes are normally activated and modulated by inputs from the body but they can act in the absence of any inputs. Second, all the qualities we normally feel from the body, including pain, are also felt in the absence of inputs from the body; from this we may conclude that the origins of the patterns that underlie the qualities of experience lie in neural networks in the brain; stimuli may trigger the patterns but do not produce them. Third, the body is perceived as a unity and is identified as the “self,” distinct from other people and the surrounding world. The experience of a unity of such diverse feelings, including the self as the point of orientation in the sur- rounding environment, is produced by central neural processes and cannot derive from the peripheral nervous system or spinal cord. Fourth, the brain processes that underlie the body-self are, to an important extent that can no longer be ignored, “built in” by genetic specification, although this built- in substrate must, of course, be modified by experience. These conclusions provide the basis of the new conceptual model (Melzack, 1989, 1990, 2001; Fig. Outline of the Theory The anatomical substrate of the body-self, Melzack proposed, is a large, widespread network of neurons that consists of loops between the thala- mus and cortex as well as between the cortex and limbic system. Factors that contribute to the patterns of activity generated by the body-self neuromatrix, which is comprised of sensory, affective, and cognitive neuromodules.
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