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In addition, these theories were plausible to many researchers and clinicians, and they suggested various workable modalities of treatment. 4. Pain Patterns Associated with Selected Cardiovascular Conditions Condition or Disorder Onset and Duration Location and Radiation Pain Quality and Intensity Pericarditis (inflammation of the pericardium) S u d d e n onset; m a y last for d a y s U n d e r the breast plate, left o f midline; radiates to back M i l d ache to severe, knife-like, sharp pain Pain decreases w h e n patient sits u p ; p a i n g e t s w o r s e w i t h deep breaths, laughing, or m o v e m e n t Angina ( L a t i n w o r d for s o r e t h r o a t ; n o w refers to chest pain d u e to G r a d u a l or s u d d e n o n s e t ; lasts several m i n u t e s (up U n d e r b r e a s t plate; radiates to back, neck, jaws, arms, e v e n M i l d to moderate "presssure"; sense o f t i g h t n e s s or N a u s e a , desire to void, belching, shortness of breath, apprehension; pain decreases t o o n e half h o u r ) to squeezing w h e n patient slows activity S u d d e n onset; lasts s e v e r a l h o u r s U n d e r the breast plate; radiates to jaws, neck, back, shoulders, one or Persistent, severe pressure, deep sensation of crushing, squeezing A p p r e h e n s i o n , feeling of i m p e n d i n g " d o o m " ; nausea, v o m i t i n g , fatigue, a n d / o r shortness of breath; occurs both arms or h e a v i n e s s e v e n w h e n p e r s o n is n o t exerting himself reduced blood flow, ischemia) fingers Behavioral/ Psychological Signs Myocardial Infarction (reduced blood flow and cellular death in t h e c o r o n a r y arteries; also c a l l e d Acute Attack Heart 33 Multimethod A s s e s s m e n t of Chronic Pain 34 electrophysiologically informed concepts of pain transmission, it would be useful to bear in mind that the accepted wisdom of 1987, like that of 1887, is naturally constrained by the limitations of our methodologies, ethics, goals, and creative imagination.

In P. D. Wall and R. ), Textbook of Pain. Edinburgh: Churchill Livingstone (p. 823). Reprinted with permission, Longman Group, Ltd. Note. 3. , obscure abdominal pain) Diagnosis of the Patient with Chronic Pain by H. Merskey, 1978, Journal 3-7. Reprinted with permission of the author, Harold Merskey, D. M. Note. Status of Contemporary Diagnostic-Classificatory of Human Stress, schemes Recent years have seen major advances in the way clinical pain is conceptualized. It is less fashionable for contemporary diagnosticians, who no longer view pain as a purely sensory event, to seek to disentangle psychogenic pain 4, The Biomedical Context 31 from true organic pain.

Has a history of generally ineffective medical and surgical intervention in the pain problem 3. Has come to be accompanied by disturbed psychosocial functioning that includes the pain complaint and the epiphenomena that accompany it B. Epiphenomena 1. Substance use disorders of varying severity with their attendant central nervous system side effects 2. Multiple operations or pharmacological treatments with their own morbid side effects separate from those related in (1) 3. Escalating physical incapacity secondary to pain, anticipated pain, and fear that this increased pain is a signal of increasing bodily harm and damage 4.

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