Effect H of a single emotional-algesic stress on the carboxypeptidase H and PMSF-inhibited carboxypeptidase activities (phenylmethylsulphonilfluoride-inhibited carboxypeptidase) taking part in the final single stage of formation of biologically active neuropeptides from precursors, was studied. Activity of the enzymes depended on duration of the pituitary stress and time after the stress in pituitary and adrenal glands. Differences in changes of carboxypeptidase H and PMSF-inhibited carboxypeptidase carboxypeptidase activities was found, especially in adrenals. The role of enzymes in emotional-algesic stress development and in metabolism of regulatory peptides taking by the stress was discussed.

OBJECTIVE.pain To establish the prevalence of chronic widespread pain and associated symptoms in a general population sample. METHODS. Cross sectional postal the survey of 2,034 adults in the north of England. RESULTS. The point prevalence of chronic widespread pain was 11.2%. The somatic symptom was strongly associated with other somatic complaints and with measures of depression and anxiety. CONCLUSION. In the general population,the this cardinal symptom of fibromyalgia is common and identifies a group who are more likely also to report symptoms of sample. fatigue and depression.

OBJECTIVE:and To examine the association between self-reported pain and cognitive impairment among frail elderly institution residents. DESIGN: A cross-sectional correlational study.among SETTING: A large urban nursing home and congregate apartment complex housing predominantly Jewish elderly. PARTICIPANTS: Seven hundred fifty-eight elderly institution of residents (30% in the nursing home, 70% in congregate apartments). The sample was 70% female and averaged 83.3 years of pain age. MEASUREMENTS: Respondent self-reports tapped pain intensity, number of localized pain complaints, cognitive status, and disability in performance of activities congregate of daily living. Attending physicians or physician assistants rated respondents' health status. MAIN RESULTS: Pain intensity and number of localized controlled pain complaints bore small but significant negative relationships to cognitive impairment. Pain was positively associated with physician-rated ill health and cognitively functional disability. The association between pain and cognitive status remained significant even when controlled statistically for effects of physical health Limitations and functional disability. Item-by-item examination of localized pain complaints indicated that markedly cognitively impaired individuals were less likely to report may pain in the back and joints. However, examination of possible physical causes of reported pain revealed no differences between pain Attending reports of cognitively impaired versus intact individuals in either the presence or the absence of a likely physical cause. CONCLUSIONS:the These data provide no evidence for the "masking" of pain complaints by cognitive impairment. They suggest instead that, although cognitively of impaired elderly may slightly underreport experienced pain, their self-reports are generally no less valid that those of cognitively intact individuals.relationships Limitations of the research are acknowledged and implications for treatment of cognitively impaired institution residents are discussed.

We an report here follow-up data on subjects who were examined in two surveys conducted by the United States Center for Health in Statistics at an interval of 8 years. The first survey was the 1st National Health and Nutrition Examination Survey (NHANES-1),the and the second conducted 8 years later was the National Health and Nutrition Epidemiologic Follow-up Study (NHEFS). From an original the sample of 3023 subjects, 153 were known to be deceased, leaving a potential sample of 2870 cases, of whom 2341 the were ultimately examined in the NHEFS. The definition of pain used in the NHANES-1 survey identified 15% of the subjects of as suffering from persistent pain. Using a different pain definition, in the NHEFS, the frequency of subjects with chronic pain at was 32.8%. Applying this second definition, the percentage of subjects with chronic pain in the NHANES-1 had risen from 15 NHEFS to 20.2. Some subjects (32.5%) who originally had chronic pain were free from pain at the time of follow-up; 59%and of the subjects with chronic pain on follow-up did not have it initially. As found originally in the NHANES-1, the potential group with chronic pain at the NHEFS comprised significantly more females, older people, and people with lower income. On logistic follow-up regression analysis the strongest relationship found at the NHEFS between the variables examined was between chronic pain and depression.(ABSTRACT TRUNCATED pain AT 250 WORDS)

It To is claimed that a significant percentage of chronic pain patients suffer from drug/alcohol abuse/dependency/addiction. To address this question, 24 articles percentage alluding to chronic pain patient drug/alcohol dependence/addiction were reviewed according to the following criteria: method for drug misuse diagnosis, which and drug misuse diagnosis used (abuse, dependence, or addiction), and percentage of patients within each diagnostic category of drug misuse. The drug result of the review indicated that only seven studies utilized acceptable diagnostic criteria and/or definitions for the drug misuse diagnoses dependence/addiction and gave percentages of drug misuse. Within these seven studies, the prevalence percentages for the diagnoses for drug abuse, drug and/or dependence, and drug addiction were in the range of 3.2-18.9%. It is concluded that these diagnoses occur in a significant studies percentage of chronic pain patients. However, there is little evidence in these studies that addictive behaviors are common within the that chronic pain population.

PURPOSE:or To answer the question whether a single fraction of radiotherapy that is considered more convenient to the patient is as effective effective as a dose of multiple fractions for palliation of painful bone metastases. Patients: 1171 patients were randomised to receive 147 either 8 Gy x 1 (n = 585) or 4 Gy x 6 (n = 586). The primary tumour was group in the breast in 39% of the patients, in the prostate in 23%, in the lung in 25% and in in other locations in 13%. Bone metastases were located in the spine (30%), pelvis (36%), femur (10%), ribs (8%), humerus (6%)and and other sites (10%). METHOD: Questionnaires were mailed to collect information on pain, analgesics consumption, quality of life and side with effects during treatment. The main endpoint was pain measured on a pain scale from (no pain at all) to 4 10 (worst imaginable pain). Costs per treatment schedule were estimated. RESULTS: On average, patients participated in the study for 4 dose months. Median survival was 7 months. Response was defined as a decrease of at least two points as compared to On the initial pain score. The difference in response between the two treatment groups proved not significant and stayed well within a the margin of 10%. Overall, 71% experienced a response at some time during the first year. An analysis of repeated groups measures confirmed that the two treatment schedules were equivalent in terms of palliation. With regard to pain medication, quality of significant life and side effects no differences between the two treatment groups were found. The total number of retreatments was 188 well (16%). This number was 147 (25%) in the 8 Gy x 1 irradiation group and 41 (7%) in the 4 two Gy x 6 group. It was shown that the level of pain was an important reason to retreat. There were equality also indications that doctors were more willing to retreat patients in the single fraction group because time to retreatment was in substantially shorter in this group and the preceding pain score was lower. Unexpectedly, more pathological fractures were observed in the that single fraction group, but the absolute percentage was low. In a cost-analysis, the costs of the 4 Gy x 6 receive and the 8 Gy x 1 treatment schedules were calculated at 2305 and 1734 Euro respectively. Including the costs of whether retreatment reduced this 25% cost difference to only 8%. The saving of radiotherapy capacity, however, was considered the major economic found. advantage of the single dose schedule. CONCLUSION: The global analysis of the Dutch study indicates the equality of a single palliation fraction as compared to a 6 fraction treatment in patients with painful bone metastases provided that 4 times more retreatments a are accepted in the single dose group. This equality is also shown in long term survivors. A more detailed analysis doctors of the study is in progress.

Relations outpatients. among physical illness, functional disability, pain, and symptoms of depression were investigated in a sample of community-residing elderly outpatients. As symptoms expected, physical illness, functional disability, and pain were correlated with depressive symptomatology. It was further hypothesized that functional disability (but affect. not physical illness per se) would attenuate the relation between depressed affect and pain. The data supported these predictions by analyses showing that functional disability (but not physical illness) accounted for differences in reported pain between nondepressed subjects and those at further risk for developing clinical depression. Additional analyses revealed that functional disability mediated relations between pain and depressed affect and also and between illness and depressed affect. These results indicate that both pain and illness are important contributors to functional disability, which in in turn contributes to symptoms of depression. Secondary analyses revealed that restriction of certain activities associated with physical mobility and Maximal independence were strong individual factors in attenuating the relation between pain and depressed affect. An important implication of this research research is that neither pain nor activity restriction should be treated in isolation. Maximal effects are likely to be achieved when by both are targeted simultaneously.

OBJECTIVE:but Patients with chronic widespread pain (CWP) have been reported to have a greater prevalence of mental disorders and somatization than have that found in the general population, but the true association between CWP and mental disorders is unknown. In this study,between we investigated whether there is an increased prevalence of mental disorder in people with CWP from the general population. We odds also describe the psychiatric diagnoses associated with CWP. METHODS: In a population-based case-control study, 1,953 subjects (75% of a random of sample of individuals age 18-65 years) completed a questionnaire that included a pain assessment and the 12-item General Health Questionnaire criteria (GHQ-12). Of 710 subjects scoring >1 on the GHQ-12, 301 were assessed further using a structured psychiatric interview and detailed of assessment of medical records to identify cases of mental disorder, in accordance with criteria of the 10th edition of the CWP International Classification of Diseases. The association between CWP and mental disorder was modeled using logistic regression, adjusting for possible confounders with including age, sex, and nonresponders. RESULTS: We estimated the overall population prevalence of mental illness to be 11.9%. The odds age of having a mental disorder for subjects with versus those without CWP were 3.18 (95% confidence interval 1.97-5.11). Most subjects 3.18 with mental disorders were diagnosed as having mood and anxiety disorders. Only 3 cases of somatoform disorders were identified, and of all were associated with pain. CONCLUSION: This study, although unable to demonstrate a cause-and-effect relationship, showed that 16.9% of those the with CWP were estimated to have a psychiatric diagnosis, suggesting that these disorders should be identified and treated.

OBJECTIVE:influence To determine whether psychological symptoms and mental disorder are an intrinsic part of the chronic widespread pain syndrome or whether of they have been observed in clinic attenders primarily because of their influence on the decision to seek a medical consultation.terms METHODS: A population survey of 1953 subjects was conducted in the Greater Manchester area of the United Kingdom. The survey 95% included a postal questionnaire, and in a subgroup of respondents with high levels of distress, the presence of mental disorder Kingdom. was assessed by a semistructured standardized interview. Subjects with chronic widespread pain were classified according to whether they had sought between a medical consultation for the reported pain ("consulters") or not ("nonconsulters"). RESULTS: In all, 252 subjects (13%) satisfied American College with of Rheumatology criteria for chronic widespread pain, and of these 72% reported having consulted a general practitioner about this pain.pain There was a clear difference in levels of psychological distress, measured by the General Health Questionnaire (GHQ), between consulters, nonconsulters,any and those with no pain. Consulters did not differ from nonconsulters in terms of levels of fatigue, social dysfunction, or had number of somatic symptoms reported. Although consulters (among whom one in 4 had a mental disorder) were more likely to CI have a mental disorder than subjects without pain [OR = 4.9, 95% CI (2.6, 9.5)] the increase in risk comparing with consulters to nonconsulters [OR = 2.1, 95% CI ( .7, 5.9)] and nonconsulters to subjects without pain [OR = 1.4, 95%pain, CI ( .7, 2.6)] was not significant. CONCLUSION: The results suggest that psychological distress is associated with chronic widespread pain in of addition to any effect on whether consultation is sought for symptoms. The finding that one-quarter of consulters to primary care in with chronic widespread pain have a mental disorder should alert primary care physicians and rheumatologists to screen for mental disorder care in this group.

OBJECTIVE:and We examine the descriptive epidemiology of chronic widespread pain using the 'Manchester' definition [CWP(M)] and assess psychosocial and other features chronic which characterize subjects with such pain according to these more stringent criteria. METHODS: A population postal survey of 3004 subjects the was conducted in the Greater Manchester area of the UK. RESULTS: The point prevalence of Manchester-defined chronic widespread pain was associated 4.7%. CWP(M) was associated with psychological disturbance [risk ratio (RR)= 2.2, 95% confidence interval (CI)(1.4-3.5)], fatigue [RR =criteria. 3.8, 95% CI (2.3-6.1)], low levels of self-care [RR = 2.2, 95% CI (1.4-3.6)] and with the reporting of other self-care somatic symptoms [RR = 2. , 95% CI (1.3-3.1)]. Hypochondriacal beliefs and a preoccupation with bodily symptoms were also associated with further the presence of CWP(M). CONCLUSION: This definition of chronic widespread pain is more precise in identifying subjects with truly widespread the pain and its associated adverse psychosocial factors. Clear associations with other 'non-pain' somatic symptoms were identified, which further supports the Clear hypothesis that chronic widespread pain is one feature of somatization.

The in purpose of this study was to examine the base rate of cognitive and neurobehavioural complaints in patients with chronic pain examine (N = 170) who had not sustained a head injury. The patients completed a packet of questionnaires that contained numerous difficulty questions regarding physical, cognitive, and psychological symptoms. The 'postconcussive-like' symptoms were selected and analysed. Specific symptom endorsement rates ranged from more 5% to 76.5%. Disturbed sleep, fatigue, and irritability were reported by the majority of chronic pain patients. Cognitive complaints relating injury. to forgetfulness (29%), difficulty maintaining attention (18%), and difficulty with concentration or thinking (16.5%) were endorsed by a significant minority to of patients. Most patients (80.6%) endorsed three or more symptoms from Category C of the DSM-IV Postconcussional Disorder research criteria.when This study further illustrates that postconcussive-like symptoms are not unique sequelae of mild head injury, and the presence of chronic patients' pain should be considered when interpreting patients' physical, cognitive, and psychological complaints following closed head injury.