By J. Tizgar. Hamilton College.
Waddell and colleagues (Waddell safe hyzaar 50mg, McCulloch discount 12.5mg hyzaar mastercard, Kummel, & Venner, 1980) developed a system of behavioral signs designed to determine the validity of a psychological basis for a given patient’s pain report. Presumably, those patients showing a higher number of nonanatomic (nonorganic) signs with their pain report have a high degree of psychological factors contributing to their pain report. Other investigators have examined facial expressions of pain: the ability of observers to distinguish exaggerated pain expressions from healthy subjects and pain sufferers’ “real” expressions of pain (Craig, Hyde, & Patrick, 1991; Poole & Craig, 1992). Physical tests to evaluate suboptimal performance have also been used to detect malingering (Robinson, O’Connor, Riley, Kvaal, & Shirley, 1994). ASSESSMENT OF CHRONIC PAIN SUFFERERS 237 Some efforts are made to ask patients to repeat standard physical tasks and use discrepancy of performance (“index of congruence”) as an indication of motivated performance. Reviewing efforts to detect deception led Craig, Hill, and McMurtry (1999) to the following conclusion: “Definitive, empiri- cally validated procedures for distinguishing genuine and deceptive report are not available and current approaches to the detection of deception re- main to some degree intuitive” (p. There is a growing body of information concerning the ability of neuro- psychological tests to detect malingering (Inman & Berry, 2002). Additional research is needed, however, before strong conclusions should follow from performance on these measures. At best performance on neuropsycho- logical test should be combined with other confirmatory information. LINKING ASSESSMENT WITH TREATMENT During any assessment, it is helpful to think about how the data gathered will be used in treatment and, ultimately, how a patient’s assessment might be related to his or her outcome. Being mindful of treatment implications can assist the pain psychologist in asking better questions during the as- sessment. Additionally, psychologists need to ensure that their evaluations have addressed the referral question(s), that their reports are informative, and that they have made reasonable, appropriate, and helpful recommen- dations. Patient Differences and Treatment Matching There is a common assumption among many health care providers that pa- tients who have the same medical diagnosis require identical treatment. Some have suggested that there should be a general diagnosis of “chronic pain syndrome. One explanation is that there are im- portant variables beyond the common medical diagnosis that differentiate patients.
Even Osteochondrodysplasias the powerful figures of the world were not always tall and 1 order 12.5mg hyzaar with amex. Attila buy generic hyzaar 12.5 mg on line, the king of the Huns, King Charles III of Thanatophoric dysplasia Naples and Sicily and Napoleon were all said to be small Achondroplasia in stature. Short-rib dysplasias ▬ Asphyxiating thoracic dysplasia (Jeune syn- drome) ▬ Chondroectodermal dysplasia (Ellis-van-Creveld syndrome) 5. Type II collagenopathies ▬ Achondrogenesis II and hypochondrogenesis ▬ Spondyloepiphyseal dysplasia ▬ Kniest syndrome ▬ Stickler syndrome 648 4. Type XI collagenopathies Maffucci syndrome ▬ Otospondylomegaepiphyseal dysplasias Fibrous dysplasia, (monostotic, polyostotic, Mc- 10. Multiple epiphyseal dysplasia Fibrodysplasia ossificans progressiva ▬ Multiple epiphyseal dysplasia Cherubism ▬ Pseudoachondroplasia 32. Chondrodysplasia calcificans punctata Familial multicentric carpal/tarsal osteolysis ▬ Chondrodysplasia calcificans punctata, Rhizo- Torg syndrome melic type Familial expansile osteolysis 4 Zellweger syndrome Gorham syndrome ▬ Chondrodysplasia calcificans punctata, Conradi- 33. Patella dysplasias Hünermann type Nail-patella syndrome (onycho-osteodysplasia) 13. Brachyolmia spondylodysplasias Dysostoses (localized hereditary skeletal deformities) 16. Acromelic dysplasias volvement ▬ Trichorhinophalangeal syndrome Apert syndrome (Acrocephalosyndactyly) ▬ Brachydactyly B. Acromesomelic dysplasias Spondylocostal dysplasia (Jarcho-Levin syn- 19. Dysostoses with predominant involvement of the ▬ Cleidocranial dysplasia extremities 20. Dysplasias with bent bones Fanconi syndrome ▬ Camptomelic (or camptomelic) dysplasia Coffin-Siris syndrome ▬ Stüve-Wiedemann dysplasia Rubinstein-Taybi syndrome 21. Dysplasias with multiple dislocations ▬ Larsen syndrome Certain hereditary diseases with orthopaedic implications 22.
In her New England sample buy cheap hyzaar 12.5 mg, Central American cheap 50 mg hyzaar otc, Italian, and Polish groups had the greatest heritage con- sistency, whereas Irish, French Canadians, and, especially, Anglo-Ameri- cans were more assimilated. Over 80% of the Central American participants reported an external locus of control, in contrast to the Polish group, where only 10% did so. Other studies have also suggested that there may be im- portant cultural differences in responsibility, blame, and other attributional styles which moderate pain expression and suffering (Bachiocco, Credico, & Tiengo, 2002; Eccleston, Williams, & Rogers, 1997). We assume that pain and emotion mean the same thing in all cultures, but we do not well understand the interaction between semantics and cul- ture. We cannot answer the question, “Even if an Anglo-American has a headache, is the meaning the same as when a Chinese person says he or she has a headache? Shioiri, Someya, Helmeste, and Tang (1999) found that Japanese subjects experienced difficulties in recog- nizing some emotional facial expressions and misunderstood others. Rus- sell (1991) provided a detailed review of the literature that indicates both similarities and differences in how emotions are categorized in different lan- guages and cultures. We should not assume that stoicism is good and expressiveness is bad, although that impression is often taken away from many of the studies reviewed here. One can easily argue the opposite and note that what- ever cultural differences exist are not limited to pain or negative affect 6. ETHNOCULTURAL VARIATIONS IN PAIN 173 and that societies that openly express pain also seem to openly express joy or happiness. We have not clarified the definitions of race and ethnicity, often using them interchangeably. Many scholars challenge the concept of “race-as- biology,” arguing that it is, in fact, a social construct (Goodman, 2000). No genetic signature identifies individuals as members of a particular race, and even the term ethnicity leads to confusions (Dimsdale, 2000; Morris, 2001).