STN DBS is a promising new surgical option for the treatment of advanced PD. The marked clinical benefits obtained in these severely disabled patients outweighed the adverse effects.
Bilateral STN DBS improves parkinsonism considerably more than unilateral STN DBS; bilateral simultaneous electrode implantation may be the most appropriate surgical option for patients with significant bilateral disability. Unilateral STN DBS results in moderate improvement in all aspects of off-period parkinsonism and improves tremor as much as is typically reported with DBS of the ventral intermedius nucleus of the thalamus (Vim). For this reason, STN DBS may be a more appropriate choice than Vim DBS or thalamotomy for parkinsonian tremor. Some patients with highly asymmetric tremor-dominant PD might be appropriately treated with unilateral instead of bilateral STN DBS.
Little is known about the factors that predict the transition of acute, time limited pain to chronic pathological pain following postero-lateral thoracotomy. The aim of the present prospective, longitudinal study was to determine the extent to which (1) pre-operative pain intensity, pain disability, and posttraumatic stress symptoms (PISS) predict post-thoracotomy pain disability 6 and 12 months later; and (2) ifthese variables, assessed at 6 months, predict 12 month pain disability. Fifty-four patients scheduled to undergo postero-lateral thoracotomy for intrathoracic malignancies were recruited before surgery and followed prospectively for one year. The incidence ofchronic post-thoracotomy pain was 68.'l% and 61.1%at the 6 and 12 month follow-ups, respectively. Multiple regression analyses showed that neither preoperative factors nor acute movement-evoked post-operative pain predicted 6 or 12 month pain disability. However, concurrent pain intensiry and emotional numbing, but not avoidance symptoms, made unique, significant contributions to the explanation of pain disability at each follow-up (total R2 =76.3.O% and 63.9% at 6 and 12 months, respectively, both p < 0.0009). The relative contribution of pain intensity decreased, while that of emotional numbing increased with time, indicating a progressive de-coupling of pain intensity and disability and a concomitant strengthening of the link between emotional numbing and disability. This suggests that pain may serye as a traumatic stressor which causes increased emotional numbing. The results also support recent suggestions that avoidance and emotional numbing constitute separate PTSS clusters. Further research is required to determine the source(s) of emotional numbing after posteroJateral thoracotomv and effective interventions.
Objectives: To (1) use structural equation modeling (SEM) to examine relationships proposed in Turk's diathesis-stress model of chronic pain and disability as well as (2) investigate what role, if any, posttraumatic stress symptoms (PTSS) play in predicting pain disability, relative to some of the other factors in the model. Methods:The study sample consisted of 208 patients scheduled for general surgery, 21 to 60 years of age (mean age= 47.18 y, SD = 9.72 y), who reported experiencing persistent pain for an average of 5.56 years (SD = 7.90 y). At their preadmission hospital visit, patients completed the Anxiety Sensitivity Index, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Disability Index, posttraumatic stress disorder Checklist, and rated the average intensity of their pain (0 to 10 numeric rating scale). SEM was used to test a model of chronic pain disability and to explore potential relationships between PTSS and factors in the diathesis-stress model.Results: SEM results provided support for a model in which anxiety sensitivity predicted fear of pain and catastrophizing, fear of pain predicted escape/avoidance, and escape/avoidance predicted pain disability. Results also provided support for a feedback loop between disability and fear of pain. SEM analyses provided preliminary support for the inclusion of PTSS in the diathesisstress model, with PTSS accounting for a significant proportion of the variance in pain disability. Discussion: Results provide empirical support for aspects of Turk's diathesis-stress model in a sample of patients with persistent pain. Findings also offer preliminary support for the role of PTSS in fear-avoidance models of chronic pain.
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