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Can anaesthetists detect depression in pain patients?
~~~~~~~~~~~~~~~~ AWEXXGH. G. De Eenedittis,A.E. LM;IC AbBJ-EW Panerai and M.A. Villamira, Pain Research & Treatment Unit, Institute of Neurosurgery, University of Milan, Italy. Aim of the Investigation. Current evidence suggests that hypnosis is effective in alleviating experimental pain and that pain reduction correlates with hypnotic susceptibility.Wchanisms of hypnotic analgesia,Wer, remain poorly understood and controversial data are reprted regarding the underlying neurochenrkal correlates. Aim of this study was to investigati the effects of hypnotically induced analgesia and hypnotizability on ~xLx?rime&al pain, with regard to psychophysiolgic and nercxzhemicalcorrel.ates. Methcds. 20 Ss (10highly and 10 law susceptibleto hypnosis) were given is pain tests. A within-subject design was used, including (a) ba_ seline, (b) waking condition and (c) hypnosis. ?*nefollc%&ng variables were studied: l)pain and distress tolerance, 2) anxietly levels (Ipat Anxiety Scale). 3) plasnn levels of beta-endorphins and ACTH. Results. Pain and distress tolerance were significantly increased du-
ring hypnosisas carrpared with the waking condition,with positivecorrelations betweenpain and distressrelief aXI hypnoticsusceptibility. Hypnctic analgesiawas unrelatedto anxietyreductionand was not equivalentto "stress-induced analgesia",sinceAClX releasewas not involved,diffexently fran waking painfulcondition.F~ally,h~notic analgesiawas not m%ii.ated by endorphins, whereas pain tolerance during waking condition appared sionificantlv related to plasma endoruhin levels. conclusions. Our results confirm-the efficacy of hypnosis in alleviating experimental pain and distress, although furtherresearchis needed in order to elucidate the underlying mechani.~.
CAN ANAESTHETISTS DETECT DEPRESSION IN PAIN PATIENTS? S. Benjamin>\& D. Barnesn (SPON: C. Spanswick), Department of Psychiatry, Manchester Royal Infirmary, Manchester, England. Aim of Investigation: In the United Kingdom pain relief clinics are usually staffed by anaesthetists and it is uncommon for psychiatrists to be involved in the assessment of pain clinic patients. Anaesthetists are therefore primarily responsible for the assessment of depressive disorders and other mental illness in this setting. The aim of this study is to determine the extent to which anaesthetists are able to detect depressive illness in pain patients. Methods: Two anaesthetists in one pain relief clinic used a five point scale to rate the presence and severity of depressive disorders, based on their clinical findings, in 106 consecutive new attenders. Independent standardised assessments of the same patients were made by a research psychiatrist using the Clinical Interview Schedule and the Montgomery and Asberg Depression Rating Scale. Results: Data presented will include the frequency and diagnoses of mental illness found by the psychiatrist and the extent to which these were identified by the anaesthetists. The characteristics of those disorders which were identified or missed will be considered. Conclusions: Mental illnesses, particularly depressive disorders, were found in a substantial proportion of new pain clinic attenders and their presence and severity were underestimated by the anaesthetists who failed to identify some of the most severe disorders. The implications for the routine involvement of psychiatrists in pain relief clinics is discussed.
ring hypnosisas carrpared with the waking condition,with positivecorrelations betweenpain and distressrelief aXI hypnoticsusceptibility. Hypnctic analgesiawas unrelatedto anxietyreductionand was not equivalentto "stress-induced analgesia",sinceAClX releasewas not involved,diffexently fran waking painfulcondition.F~ally,h~notic analgesiawas not m%ii.ated by endorphins, whereas pain tolerance during waking condition appared sionificantlv related to plasma endoruhin levels. conclusions. Our results confirm-the efficacy of hypnosis in alleviating experimental pain and distress, although furtherresearchis needed in order to elucidate the underlying mechani.~.
CAN ANAESTHETISTS DETECT DEPRESSION IN PAIN PATIENTS? S. Benjamin>\& D. Barnesn (SPON: C. Spanswick), Department of Psychiatry, Manchester Royal Infirmary, Manchester, England. Aim of Investigation: In the United Kingdom pain relief clinics are usually staffed by anaesthetists and it is uncommon for psychiatrists to be involved in the assessment of pain clinic patients. Anaesthetists are therefore primarily responsible for the assessment of depressive disorders and other mental illness in this setting. The aim of this study is to determine the extent to which anaesthetists are able to detect depressive illness in pain patients. Methods: Two anaesthetists in one pain relief clinic used a five point scale to rate the presence and severity of depressive disorders, based on their clinical findings, in 106 consecutive new attenders. Independent standardised assessments of the same patients were made by a research psychiatrist using the Clinical Interview Schedule and the Montgomery and Asberg Depression Rating Scale. Results: Data presented will include the frequency and diagnoses of mental illness found by the psychiatrist and the extent to which these were identified by the anaesthetists. The characteristics of those disorders which were identified or missed will be considered. Conclusions: Mental illnesses, particularly depressive disorders, were found in a substantial proportion of new pain clinic attenders and their presence and severity were underestimated by the anaesthetists who failed to identify some of the most severe disorders. The implications for the routine involvement of psychiatrists in pain relief clinics is discussed.