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Pain Patients: Traits and treatment
Book Reviews LIVING OR DYING, ADAPTATION TO HEMODIALYSIS, by Norman B. Levy, Springfield, l/l.s Chas. C. Thomas, 1974.
This text represents the first attempt to explore in depth the problems created by the interaction between a patient and a machine upon which his life depends. As technical and medical improvement in hemodialysis techniques improve and the threat of death diminishes, emotional rather than medical problems become the dominant complications. This ever-increasing population who would certainly have died now live in total dependence upon a hemodialysis apparatus. This book with its 13 author contributors spells out the problems patients meet. Each chapter contributes signficantly to the text with very little overlap. All the data is based on an extensive and wide experience by the authors. The chapters discuss: (1) problems in adaptation to maintenance hemodialysis; a four year study of 25 patients, (2) the uncooperative hemodialysis patient, (3) the treatment of the child receiving hemodialysis, (4) factors determining individual survival on hemodialysis, (5) personality as it affects adjustment to dialysis and, (6) the sexual lives of hemodialysis and transplantation patients. A few specific dynamic issues described in this text remind me of other life dependent man-machine problems. e.g., as seen in the cardiac or respiratory care units. Some of these descrihed at length are: the three stages of adaptation to maintenance hemodialysis ("honeymoon," state of disenchantment and long-term adaptive stage), the independency-dependency conflict and the special type of anxiety and death fear as seen in children. It is also apparent that chronic dialysis patients and survivors of the holocaust share similarities such as: "death imprint," "survival priorities," "psychic numbing," fear of contagion and impairment of mourning. The relationship of personality to adjustment is explored in a predictive study. The authors pick criteria which help in the selection of patients. This book is excellent for researcher, clinician and patient who share in the common problems associated with adapting to hemodialysis. BARNEY M. DUN, M.D. Clinical Professor of Psychiatry Temple University Health Sciences Center PHILA. PA.
tients with chronic benign pain due to an organic lesion and those with pain of psychogenic origin, the material can also be applied to patients with malignant or acute pain problems. The principal premise of the book is summed up in the author's words: "The complaint of pain by itself, is about as likely to be a sign of mental as of physical disorder. If it is a mental disorder, it is most probably a neurotic one, and it is equally likely to be a reactive depression or anxious hysteria. These are the most common diagnoses in psychogenic pain... On the other hand, patients with somatogenic pain lasting many months or longer develop hypochondrical and depressive features which made them seem to be neurotic, much like psychogenic pain patients. (p. 79)" Into the major part of the work establishing the above position, the author weaves some thought-provoking questions and findings. While some patients live with their pain and want nothing to do with doctors, others "use" pain for secondary gain or to relieve anxiety. Some are intolerant of success or exhibit much repressed anger. In many cases the pain masks a depression and studies suggest the degree of neuroticism varies directly with the degree of chronic pain. Nevertheless, he insists, however we may explain the pain, in emotional findings (psychogenic) or in physical problems (somatogenic), psychogenic and somatogenic pain feel the same, and regardless of origin, a good work-Up of a chronic pain patient must include from the outset both psychological and physical findings. In addition to these major issues developed in the book, an interesting chapter is devoted to "pain games" and the measurement of pain levels by the patient's estimate and the "tourniquet pain ratio." The book is rounded out with a study of diagnostic procedures and some suggestions for treatment and its evaluation. The book is concluded with a potpourri which the author lumps under the heading, "Special Issues." In my opinion this is an excellent book for all physicians. psychiatrist and non·psychiatrist alike, who are interested in "pain" and "pain patients." It is probably a "must" for all doctors who, while dealing with the treatment of evaluation of chronic patients, have little real interest in these often frustrating individuals. This book should whet their interest in the subject, while providing a substantial understanding of the problem. RAYMOND A. HUGER, M.D. PHOENIX, ARIZONA
* * * * PAIN PATIENTS: TRAITS AND TREATMENT: By Richard A. Sterllbach. ACldemic Press, New York, 1974, 135 pp., 35 Fi!!., 10 Case lI/ustrations, $9.50.
The title of this readily readable book by Dr. Richard Sternbach is an apt description of its contents. Intended as a practical manual for the understanding and treatment of the pain patient, it is viewed by the author as a sequel to his earlier work, "Pain: A Psychophysiological Analysis." It is a compact combination of research data, background information, practical procedures and case illustrations. From the outset he differentiates between "pain" and the "pain patient." While studies of the former are reported in abundance, the desirability of bringing together scattered studies of the latter, as they apply to practical treatment of the patient, form the purpose of this book. While the emphasis is on paApril/MaylJune. 1975
* * * * MODERN TRENDS IN PSYCHOSOMATIC MEDICINE 2: Ed. O. W. Hill. Butterworths, London 1970 (pp. "iii + 320). Price £ 4·50.
The aspiration of contributors to this volume is underlined in the statement that psychosomatic medicine "could concen· trate on the relationships between events occurring at the highest levels of central nervous system activity, and changes in visceral and musculo-skeletal function in the body, healthy and diseased." (Lader, pg. 49). It is left to Wolff and others to add for further investigation the notion that affect and perception of concomitant body function are part and parcel of human relationships, from earliest infancy, and "serve as important determinants of specific modes of communication in the adult". (Schmale, Meyerowitz, and Tinling. Pg. 8) 91
This text represents the first attempt to explore in depth the problems created by the interaction between a patient and a machine upon which his life depends. As technical and medical improvement in hemodialysis techniques improve and the threat of death diminishes, emotional rather than medical problems become the dominant complications. This ever-increasing population who would certainly have died now live in total dependence upon a hemodialysis apparatus. This book with its 13 author contributors spells out the problems patients meet. Each chapter contributes signficantly to the text with very little overlap. All the data is based on an extensive and wide experience by the authors. The chapters discuss: (1) problems in adaptation to maintenance hemodialysis; a four year study of 25 patients, (2) the uncooperative hemodialysis patient, (3) the treatment of the child receiving hemodialysis, (4) factors determining individual survival on hemodialysis, (5) personality as it affects adjustment to dialysis and, (6) the sexual lives of hemodialysis and transplantation patients. A few specific dynamic issues described in this text remind me of other life dependent man-machine problems. e.g., as seen in the cardiac or respiratory care units. Some of these descrihed at length are: the three stages of adaptation to maintenance hemodialysis ("honeymoon," state of disenchantment and long-term adaptive stage), the independency-dependency conflict and the special type of anxiety and death fear as seen in children. It is also apparent that chronic dialysis patients and survivors of the holocaust share similarities such as: "death imprint," "survival priorities," "psychic numbing," fear of contagion and impairment of mourning. The relationship of personality to adjustment is explored in a predictive study. The authors pick criteria which help in the selection of patients. This book is excellent for researcher, clinician and patient who share in the common problems associated with adapting to hemodialysis. BARNEY M. DUN, M.D. Clinical Professor of Psychiatry Temple University Health Sciences Center PHILA. PA.
tients with chronic benign pain due to an organic lesion and those with pain of psychogenic origin, the material can also be applied to patients with malignant or acute pain problems. The principal premise of the book is summed up in the author's words: "The complaint of pain by itself, is about as likely to be a sign of mental as of physical disorder. If it is a mental disorder, it is most probably a neurotic one, and it is equally likely to be a reactive depression or anxious hysteria. These are the most common diagnoses in psychogenic pain... On the other hand, patients with somatogenic pain lasting many months or longer develop hypochondrical and depressive features which made them seem to be neurotic, much like psychogenic pain patients. (p. 79)" Into the major part of the work establishing the above position, the author weaves some thought-provoking questions and findings. While some patients live with their pain and want nothing to do with doctors, others "use" pain for secondary gain or to relieve anxiety. Some are intolerant of success or exhibit much repressed anger. In many cases the pain masks a depression and studies suggest the degree of neuroticism varies directly with the degree of chronic pain. Nevertheless, he insists, however we may explain the pain, in emotional findings (psychogenic) or in physical problems (somatogenic), psychogenic and somatogenic pain feel the same, and regardless of origin, a good work-Up of a chronic pain patient must include from the outset both psychological and physical findings. In addition to these major issues developed in the book, an interesting chapter is devoted to "pain games" and the measurement of pain levels by the patient's estimate and the "tourniquet pain ratio." The book is rounded out with a study of diagnostic procedures and some suggestions for treatment and its evaluation. The book is concluded with a potpourri which the author lumps under the heading, "Special Issues." In my opinion this is an excellent book for all physicians. psychiatrist and non·psychiatrist alike, who are interested in "pain" and "pain patients." It is probably a "must" for all doctors who, while dealing with the treatment of evaluation of chronic patients, have little real interest in these often frustrating individuals. This book should whet their interest in the subject, while providing a substantial understanding of the problem. RAYMOND A. HUGER, M.D. PHOENIX, ARIZONA
* * * * PAIN PATIENTS: TRAITS AND TREATMENT: By Richard A. Sterllbach. ACldemic Press, New York, 1974, 135 pp., 35 Fi!!., 10 Case lI/ustrations, $9.50.
The title of this readily readable book by Dr. Richard Sternbach is an apt description of its contents. Intended as a practical manual for the understanding and treatment of the pain patient, it is viewed by the author as a sequel to his earlier work, "Pain: A Psychophysiological Analysis." It is a compact combination of research data, background information, practical procedures and case illustrations. From the outset he differentiates between "pain" and the "pain patient." While studies of the former are reported in abundance, the desirability of bringing together scattered studies of the latter, as they apply to practical treatment of the patient, form the purpose of this book. While the emphasis is on paApril/MaylJune. 1975
* * * * MODERN TRENDS IN PSYCHOSOMATIC MEDICINE 2: Ed. O. W. Hill. Butterworths, London 1970 (pp. "iii + 320). Price £ 4·50.
The aspiration of contributors to this volume is underlined in the statement that psychosomatic medicine "could concen· trate on the relationships between events occurring at the highest levels of central nervous system activity, and changes in visceral and musculo-skeletal function in the body, healthy and diseased." (Lader, pg. 49). It is left to Wolff and others to add for further investigation the notion that affect and perception of concomitant body function are part and parcel of human relationships, from earliest infancy, and "serve as important determinants of specific modes of communication in the adult". (Schmale, Meyerowitz, and Tinling. Pg. 8) 91