1/15. The effects of exogenous analgesia in a patient with borderline personality disorder (BPD) and severe self-injurious behaviour.In order to analyse the effects of potent exogenous analgesia with opioids in borderline personality disorder (BPD), we present a case report in which the application of morphine abolished the perception of pain during self-injury and intensified self-injurious activities. On the basis of our observations, we concluded that the use of potent analgesics might aggravate psychopathology in BPD.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/15. An integrated physiotherapy/cognitive-behavioural approach to the analysis and treatment of chronic whiplash associated disorders, WAD.PURPOSE: The aim of this paper was to describe a model for an integrated physiotherapy/cognitive-behavioural approach in the analysis and treatment of chronic WAD patients, as well as to evaluate the effectiveness of this approach in three experimental single case studies. METHOD: Three patients with a diagnosis of chronic WAD were included in the study. Psychological and physical functional analyses were used to describe the problem areas and as a basis for the management of WAD. A programme including learning of basic and applied skills, generalization, and maintenance was carried through. RESULTS AND CONCLUSION: The results showed that functional behavioural analyses can be useful in physiotherapy for structured patient assessment and in planning of treatment. It was also shown that physiotherapy integrated with cognitive behavioural components decreased the patients' pain intensity in problematic daily activities.- - - - - - - - - - ranking = 1.75keywords = behaviour (Clic here for more details about this article) |
3/15. phantom limb pain: a report of two cases.The efficacy of pre-emptive analgesia for phantom limb pain is still unclear. It is generally accepted that pre hyphen;amputation pain increases the incidence of phantom and stump pain, even if pre-emptive analgesia is performed before and during surgery and in the postoperative period. Two cases of traumatic upper limb amputations are described here with no pre-existing pain. Both received similar antinociceptive treatment by continuous block of the brachial plexus through infusion of ropivacaine 0.375% at 5 ml/h for 10 days. Treatment of case 1 was initiated immediately after surgery; however, this amputee developed intensive phantom limb pain which persisted at 6 months. Early use of the prosthesis after surgery was not possible for this patient. The intensity of phantom limb pain in case 2 decreased significantly after 6 months, even though brachial plexus blockade was not started until 5 weeks post-trauma. This patient used a functional prosthesis intensively beginning early after amputation. Serial magnetoencephalographic recordings were performed in both patients. Only case 2 showed significant changes of cortical reorganization. In case 1 markedly less cortical plasticity was found. A combination of relevant risk factors such as a painful neuroma, behavioural and cognitive coping strategies and the early functional use of prostheses are discussed as important mechanisms contributing to the development of phantom pain and cortical reorganization.- - - - - - - - - - ranking = 0.25keywords = behaviour (Clic here for more details about this article) |
4/15. Human "autotomy".We describe two cases of self-injurious behaviour. One was a man with central post-stroke pain with maximal pain in the tip of the nose, who excavated his ala nasae--in which he subsequently continued to experience phantom pain. The second case a man who, following ophthalmic herpes zoster and possibly mild postherpetic neuralgia. He subsequently scratched his anaesthetic forehead down to the bone, while denying he experienced any pain. We would describe the first case as one of true autotomy; but the second as destruction of an anaesthetic part of the body. The implications for human and animal physiopathology are discussed.- - - - - - - - - - ranking = 0.25keywords = behaviour (Clic here for more details about this article) |
5/15. Can pain-related fear be reduced? The application of cognitive-behavioural exposure in vivo.Although cognitive-behavioural treatments of patients with chronic pain generally are reported to be effective, customization might increase their effectiveness. One possible way to customize treatment is to focus the intervention on the supposed mechanism underlying the transition from acute to chronic pain disability. Evidence is accumulating in support of the conjecture that pain-related fear and associated avoidance behaviours are crucial in the development and maintenance of chronic pain disability. It seems timely to apply this knowledge to the cognitive-behavioural management of chronic pain. Two studies are presented here. Study 1 concerns a secondary analysis of data gathered in a clinical trial that was aimed at the examination of the supplementary value of coping skills training when added to an operant-behavioural treatment in patients with chronic back pain. The results show that, compared with a waiting list control, an operant-behavioural treatment with or without pain-coping skills training produced very modest and clinically negligible decreases in pain-related fear. Study 2 presents the effects of more systematic exposure in vivo treatment with behavioural experiments in two single patients reporting substantial pain-related fear. Randomization tests for AB designs revealed dramatic changes in pain-related fear and pain catastrophizing. In both cases, pain intensity also decreased significantly, but at a slower pace. Differences before and after treatment revealed clinically significant improvements in pain vigilance and pain disability.- - - - - - - - - - ranking = 2.5keywords = behaviour (Clic here for more details about this article) |
6/15. acute pain and opioid seeking behaviour.BACKGROUND: acute pain is a common presentation associated with opioid seeking behaviour. OBJECTIVE: This case study provides a practical approach for general practitioners seeing patients with acute pain whom they suspect of seeking opioids because of dependence. DISCUSSION: acute pain commonly presents as an emergency appointment 'squeezed in' between booked appointments. general practitioners have to make a rapid assessment of the possible underlying causes, relieve pain, and establish a plan for further investigation and management. Furthermore, some opioid dependent people can and do effectively feign acute pain in order to obtain opioid medication.- - - - - - - - - - ranking = 1.25keywords = behaviour (Clic here for more details about this article) |
7/15. rabies. A second Australian case, with a long incubation period.OBJECTIVE: The description of a second case of rabies in australia, stressing the clinical features and that long incubation periods are possible. CLINICAL FEATURES: A 10-year-old Vietnamese girl presented with fever, shoulder pain, subcutaneous emphysema, swallowing difficulty and agitation. After a period of maniacal behaviour all peripheral and central nervous system function was lost. INTERVENTION AND OUTCOME: Despite maximal intensive care, the patient died. The diagnosis of rabies was made at autopsy. CONCLUSIONS: rabies occurs in australia and needs to be considered in the differential diagnosis of acute encephalitis and/or the guillain-barre syndrome. Incubation periods of more than six years can occur.- - - - - - - - - - ranking = 0.25keywords = behaviour (Clic here for more details about this article) |
8/15. Needle phobia--changing venepuncture practice in ambulatory care.Needle phobia is a term used in practice to describe an anticipatory fear of needle insertion. A proportion of children display high levels of fear, pain and behavioural distress when exposed to, or anticipating, needle insertion. A difficult routine venepuncture in our ambulatory care unit led staff to review practice and develop a three-step approach to overcoming 'needle phobia': relaxation, control and graded exposure. These developments have resulted in the unit becoming a local referral centre for children and young people between the ages of 5-19 years with this problem. time and skill are needed to prevent or overcome this distressing problem which can be caused by health care professionals not listening to children and young people.- - - - - - - - - - ranking = 0.25keywords = behaviour (Clic here for more details about this article) |
9/15. Fibromyxoma of bone: a case report and review of the literature.In this study, a case of fibromyxoma of the proximal femur in a 59-year old woman is reported. The classification of this rare bone tumour is still a matter of debate and some investigators have suggested that these lesions represent a degenerative form of fibrous dysplasia. Some authors make a further distinction between fibromyxoma and myxoma of bone. In a review of 23 cases of fibromyxoma and five cases of myxoma, no differences in clinical, radiographic and biologic behaviour between fibromyxoma and myxoma were found. Apart from the age at diagnosis, the most important difference between fibromyxoma and myxoma was the degree of myxoid matrix. Therefore, we suggest that extragnathic myxoma is a regressive variant of extragnathic fibromyxoma and should be termed as the same entity. In contrast to monostotic fibrous dysplasia fibromyxoma / myxoma often causes pain and presents as a Lodwick IC lesion with a soft tissue mass. Therefore, fibromyxoma / myxoma should be distinguished from fibrous dysplasia because of its different clinical and radiographic features.- - - - - - - - - - ranking = 0.25keywords = behaviour (Clic here for more details about this article) |
10/15. A family with abdominal pain.We present the case history of a middle-aged woman with a "battle scarred" abdomen who has had abdominal pain for over 20 years and more than 36 hospital admissions in this time. Her children have also had 25 hospital admissions for abdominal pain and three normal appendices removed. This complaint of recurrent abdominal pain not due to a physical disorder is conceptualised in terms of abnormal illness behaviour rather than in traditional terms such as hysteria and hypochondriasis.- - - - - - - - - - ranking = 0.25keywords = behaviour (Clic here for more details about this article) |
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