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Social, cultural and gender variables

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MAKING SENSE OF EVERYDAY PAIN

Sarah Aldrich & Chris Eccleston, Pain Management Unit, Univ of Bath & The Royal National Hospital for Rheumatic Diseases, Bath, UK

Aim of Investigation: To investigate the range and diversity of explanatory frames for normal everyday pain. Methods: Following social sampling, a Q sorting pack of statements regarding everyday and normal pain was constructed and sorted by 65 respondents. A Q factor analysis study was undertaken from within a social constructionist framework.

Results: The factor analysis produced eight factors. These are reported in order of statistical strength as 1) pain as malfunction, 2) pain as self-growth, 3) pain as spiritual growth, 4) pain as alien invasion, 5) pain as coping and control, 6) pain as abuse, 7) pain as homeostatic mechanism, & 8) pain and power. These are interpreted by factor and by the responses of exemplars loading highly upon each factor.

Conclusions: These 8 factors are interpreted from the context of a theory of self and identity in pain; more specifically from within a model of pain as threat to identity.

EVALUATION OF INDIVIDUAL QUALITY OF LIFE IN CANCER PATIENTS UNDERGOING PAIN TREATMENT IN ONE ARABIC DEVELOPING COUNTRY, TUNISIA

Farhat Ben Ayed. Susanne Schleith-Amara, Henda Rai's, Dept of Medicine, National Inst for Oncology Salah Azai'z, Tunis, Tunisia

Aim of Investigation: To elicit factors determining Quality of Life (QoL)and investigate rating of present life in Tunisian cancer patients receiving pain treatment. A first step to approach evaluation ofQoL in an Arabic developing country.

Methods: Assessment ofQoL of the individual by using the Schedule for the Evaluation of Individual Quality of Life with Direct Weighting procedure for QoL domains (SEIQoL-DW) adjusted by O'Boyle C.A. et al., dept of psychology, Royal College of Surgeons in Ireland, a standardised semi-structured interview eliciting the most important areas of the patients life (cues), rating and weighting cues by visual methods. Patients suffering from various cancers, under stable pain control by drug administration or analgesic radiotherapy.

Results: 7 out of 60 interviews were incomplete. Cues elicited in descending order of frequency were Personal health, Work, Religion, Family, Future of children. Relationships, Finances, Leisure activities, Health of family members (O'Boyle et al.: Family, relationships, health, finances, living conditions, work, social life, leisure activities, religion). The highest ponderation means were attained in Personal health. Future of children, Family, Health of family members. Trend to positive correlation between educational/economic level of the individual and SEIQoL-index. No correlation between religious practice and SEIQoL - index.

Conclusion: This trial using original material, avoiding translation, may indicate discrepancy in priority of cues between this population and western Europeans. The method is applicable to our patients. Enlargement of the patient group and prospective study designs are necessary for further confrontation between PT outcome and QoL.

TALKING TO OTHERS ABOUT PAIN: SUFFERING IN SILENCE

Angela Beese, Katherine Doyle*, Stephen Morley. Division of Psychiatry & Behavioural Sciences, School of Medicine, Univ of Leeds, LS2 9JT, UK

Aims of Investigation: To investigate how and under what circumstances chronic pain sufferers communicate their pain to others,

Methods: 25 chronic low back pain (CLBP) and 20 post herpetic neuralgia (PHN) patients gave accounts of how and when they disclose pain, and their expectations of communication, to target people (spouse, friend, family & clinic doctors). Measures of pain (MPQ) and psychological states (HADS) and illness representation (PBPI) were taken.

Results: There were no marked differences between groups on standard measures of pain and psychological state. Patients reported talking to others, particularly close family members, when in pain. Most patients do not initiate talk and their expectations of others' responses are primarily negative. Reasons for not talking are: fear of being judged negatively and being perceived as a burden, and the expectation of others' failure to listen and understand. Patients reported using non-verbal communication more often with close others. CLBP patients were more likely to express a strong belief in the uncertain cause (PBPI mysterious scale) of their pain. A correlational analysis suggested that the mysterious factor may influence when and how pain is communicated to others.

Conclusions: Chronic pain patients exercise caution about how and when they disclose their pain. Whether this reflects an intention not to communicate about pain or behavioural strategy to avoid negative value judgements is not known.

Acknowledgments: Kathenne Doyle was supported by Northern & Yorkshire NHSE as a trainee clinical psychologist.

TRANSCULTURAL OR ETHNICAL DIFFERENCE OF PAIN

Hu Yu-huan, Research Inst. ofMedicopsychology, Shihezi Med. College, Xinjiang, 832002 People's Republic of China.

Aim of Investigation: To find the incidence or prevalence of some pain syndromes in Chinese people if they are different from Occidentals.

Methods: Epidemiological and clinical studies were carried out more than ten years for the patients of amputees, terminal cancer patients, migraine, herpes zoster and postoperative pain in children. Results: Incidence of phantom pain was 8% (N=100). Pain in terminal cancer patients (N=1549) were 28.6% and 35.5% in retrospective and prospective study respectively. The prevalence of migraine was 0.5-0.9%. There was no PHN in 120 herpes zosters. The pain incidence after operation (appendectomy and repair of hernia) in children was 29.8% (N=410).

Conclusions: The data mentioned above were all in the lower range as compared with that of the western people. There was transcul-tural or ethnical difference of pain between Chinese and Occidentals especially in chronic pain. The personality of Chinese is thinking type and western people is feeling type. The classical traditional Chinese culture may cause more people to cultivate the personality of thinking type which has less emotional reaction to disease or nociceptive stimulation.

THE IMPACT OF CHRONIC PAIN ON LIFE

S.M. Mohammadi*. M.A. Asghari, A.K.. Mafi*, Occupational Health Services of National Iranian Oil Company, P.O. Box 14155-7137, Tehran, Iran.

Aim of the investigation: The aim of the present study was to examine the impact of chronic pain on several aspects of patients' lives.

Method: Two-hundred and six male pain patients who meet the criteria for chronic pain (i.e., pain for more than 6 months) participated in this study. The patients rated their social and recreational activities as well as their job and marital satisfaction, currently and before pain began. The patients also reported the amount of time spent sleeping per 24 hours at the time of the study and before pain began.

Results: The means of above measures were compared with each other, using paired-samples /-test. Significant differences emerged for all measures. Specifically, at the time of the study patients reported less social activities (t = -8.26,p < . 0001) and less recreational activities (t -= 11.35./p <.0001), compared to before pain began. In addition, at the time of the study patients reported lower levels of job satisfaction (t= -8.59,/p < . 0001) and lower levels of marital satisfaction (t = -6.48,/p<.0001). Patients also reported less time spent sleeping at the time of the study, compared to before pain began (t=-6.48, p< .0001).

Conclusions: The above findings are compatible with the results of previous studies, mostly conducted in the Western societies. That is, chronic pain has negative impacts on many aspects of patient's life, including social and recreational activities as well as job and marital satisfaction. Furthermore, from the findings of the present study it can be concluded that the experience of chronic pain is associated with sleep problems. The possible clinical significance of these findings will be discussed.

EFFECTS OF ETHNICITY AND MEDICAL ROLE CONTEXT ON PAIN DESCRIPTIONS

Rod Moore'2. Inger Bredsgaard", Tao-Kum Mao3*, Yuh-Yuan Shiau4. Dept Oral Medicine", Univ of Washington, Seattle, WA, USA; Oral Epidemiology & Public Health2, Aarhus Univ, Denmark; National Defense Medical Center3 & National Taiwan Univ4, Taipei, Taiwan.

Aims: To explore differences in use of descriptors for common pains by ethnic and medical role contexts. Methods: A pain-by-descriptor matrix matching survey was filled out by 233 AngloAmericans (Am), 222 Mandarin Chinese (Ch) and 231 Scandinavians matched for age, gender and occupation. Differences by ethnicity, gender, criteria specified chronic pain (n=132) and care providers (n=181) were analyzed by multidimensional scaling (MDS), ?. Fisher exact, ?2 tests and odds ratios.

Results: MDS and y tests showed description similarities within ethnic groups, while there were differences (P<.001 to .01) between ethnic groups (? stress =.24). Greatest ethnic differences (P <0.001) were Chinese "sourish" pain concept, use of "excruciating" by Americans, use of "shooting" by Danes and use of "horrible" by Swedes. Differences of chronic pain patients vs. care providers within ethnic groups was (P<001) (? stress =.16), mostly related to consistent provider use of dull-aching, deep, heavy, sharp and recurrent vs. chronic patient responses. Gender differences within ethnic groups were only for Chinese and Scandinavian descriptions of childbirth and menstrual pains. The results by ethnicity approached theoretical generalizability based on mean informant accuracy levels o f Am=.59, Ch=.71, & Danes=.62 (all ?=.99) and Swedes=.63 (?=.98) for these samples.

Conclusions: There were significant and meaningful differences in pain descriptions by ethnicity and by chronic pain patient vs. doc tor/dentist subsamples.

Acknowledgments: Supported by Grants R29 DE09945-06 & P50-DE-08229-08 NIH/ NIDR, Bethesda, MD, USA; Danish National Health Ins Research Fund #11/215-93.

NARRATING PAIN AND CULTURE IN THE EARLY STAGES OF HEAD AND NECK CANCER

Rhonda J. Moore. Dept of Epidemiology, MD Anderson Cancer Center, Houston, TX 77030, USA

Aim of Investigation: Understanding the meanings patients attach to their experiences can help researchers understand patient's experiences with cancer pain. While treatments for head and neck cancer can alter a patient's perception of self and quality of life; few studies have investigated the cross-cultural meanings of pain in African-American and White American early stage head and neck cancer survivors.

Methods: 18 patients, clinically diagnosed with early stage squam-ous carcinoma of the head and neck, between the ages of 19-85, were recruited for this study. Using qualitative methods, including semi-structured, open-ended interviews, we examined the following issues: I) patient's perception of pain; 2) post-operative and other treatment pain; 3) impact of pain on function; and 4) the meaning of pain.

Results: 5 of 18 patients initially denied pain. There were gender and cultural differences in perceived pain. All patients' linked their pain experiences to sensations of loss, in terms of time, health, certainty, function and quality of life. All stated that pain had taken on new meanings in their lives after cancer.

Conclusions: There is no universal truth that can be used to describe patient's experiences with cancer pain. By situating the patient's cancer pain in the cultural contexts of their life narrative, researchers will better understand the meaning of cancer pain in cross-cultural patient populations.

Acknowledgments: Supported by NIH Grant R25.

INVESTIGATION THE EFFECTIVENESS OF HOLY QURAN RECITEMEMT SONG ON REDUCTION OF POST OPERATIVE PAIN IN IRANIAN PATIENTS

A.R. Nikbakht. Ashayeri, H, Mohamadi, E, Nursing Faculty of Tehran Medical Science Univ., Toohid SQ, Tehran, Iran

Aim of Investigation: To ivestigate the effectiveness of HOLY QURAN Song as religious music on relieving pain after abdominal Surgery in Iranian Patients.

Method: This sudy designed at quasi-experimental design whit 60 eligible patients on two randomized using standard scales, before and 12 hours after surgery in equal Interval in two groups and intervention of case group was listening to HOLY QURAN chapter Yousuf (versus 7-23) with the voice of Prof. Shahhat Mohammad Anvar for twenty minutes.

Results: Significant pin relief in 30 patients in experimental group was observed. Pain relief varied from 8 scores to 3 in the interven-tional group and intensity change degree was only 2 Score in control group.

Conclusion: The results show that the amount of relief obtained with QURAN song varied considerably between patients that 30% of patients obtained maximum Possible relief specially in adolescent male patients. And 30% obtained less than moderate Pain relief and others between them. Our experiment conclude that listening to the HOLY QURAN reduce Pain after abdominal surgery in Iranian patients.

Acknowledgment: Supported in part by Tarbiat Modarres uni. Tehran IRAN.

THE INDIAN PHILOSOPHY OF PAIN - ITS APPLICATION IN MODERN TIMES

G. K. Prusty, Calcutta Medical Research Inst, Dept ofNeurosur-gery, Calcutta 700 027, India

Aim of Investigation: To study the evolution of Indian philosophy on pain over the years and its practical application in modem times.

Methods: The author has reviewed literature from Vedas, Upani-shads, Tagore, Gandhi, Vivekanand and others; and interviewed persons involved in pain cure.

Results: Indian philosophy-cssentially the Hindu philosophy teaches not to regard the body and its senses as be all and end all of existence. Rather it points to the need for each of us to evolve beyond the confines placed upon by the body, the mind and the intellect to a hither to unknown and inexperienced state of consciousness where neither pain nor pleasure matter. Such evolution can be achieved through Yoga, service without attachment and desire, wisdom achieved through study and meditation or true renunciation. For individuals already in the grip of severe pain, the physical cause of which can not be eradicated, Hindu philosophy recommends therapy for the spirit. The strengthening of he patient's inner resources and development in him of an attitude that challenges pain can lead to augmentation of the known neuro-physiological mechanism for descending inhibition of pain. Prescribing large doses of potent analgesics weakens the patient's spirit. By clouding his consciousness, it will impair his ability to achieve his fullest potential during the closing phase of his life.

CANCER PAIN CULTURAL EXPRESSION IN TUNISIAN PATIENTS

Boussen H*', Gritii S*, Bouaouina N', Hamzaoui A', Kallel M', Kallel L', Benna F", Rahal K*, Ladgham A*, *Institut Salah Azaiz, 'Tunisian Association for Study of Pain, Tunis Tunisia.

Objective: To report the particularities of cultural expression of cancerous pain in Tunisian patients.

Patients and methods: From September 1995 to December 1995, we collected prospectively 40 patients (26M/14F) with a 49,3 years mean age (11 to 80) with cancer of: breast (9/40), lung (8/40) or others. Patients were of rural (25/40) and urban (15) origin. 8 patients were treatment- specific naive (20%), 11/40 are under curative and 21 under palliative therapy. Patients have been questioned about pain using the traduced Arabic version of the MGQP.

Results: 11 patients presented with acute and 29 with chronic pain. We observe a high pain level with 60% > 7 in the VAS. Noising expression have been observed in 17/40 patients with complaints, groaning and rarely crying, the rest of patients adopting a frequently silent fatalist approach with reference to religious values. Anxiety and depression are observed in 4 patients. Rare evocation of death < 10% needs to be differentiated from mortal pain. When we compare cancer pain to previous pain experiences, we note the valorizing value of delivery and circumcision pain. These later arc reported as more intense but brief and non durable.

Conclusion: In our study we see two pain approaches to cancer pain , the "traditional" fatalist Muslim (rural) and also an "occidental" (urbanised areas) view of the problem. The valorizing aspect of delivery and circumcision pain is a particular aspect.

LIVING WITH SOMEONE WITH CHRONIC PAIN: THE IMPACT ON SIGNIFICANT OTHERS MOOD AND MARITAL ADJUSTMENT

Timothy Sharp and Michael Nicholas, Univ of Sydney Pain Management and Research Centre, Royal North Shore Hospital, NSW 2065, Australia

Aim of Investigation: To assess the impact of living with someone who has chronic pain on the depression and marital (dis)satisfaction of significant others (SO). In contrast to previous research, this study will use higher, more clinically significant cut-off levels and in addition, will investigate the role of significant other cognitions.

Methods: A number of widely used, self-report psychometric questionnaires (e.g., the Beck Depression Inventory and the Dyadic Adjustment Scale) were administered to several hundred significant others who attended a large, tertiary referral Pain Centre with their partners on the occasion of their initial, multidisciplinary assessment. Analysis involved descriptive statistics and regression analyses.

Results: The average BDI score was 8.5 and the average DAS score was 110.1. Approximately 18% of SOs had BDI scores greater than 13 and 5.4% had BDI scores greater than 21. Thirty percent had DAS scores below 100 and 15.3% were below 90. Regression analyses suggested that a significant proportion of both variables could be explained by SO cognitions.

Conclusions: These results suggest that the clinically significant prevalence rates of depression and marital maladjustment was not as high in SOs as has previously been reported. Further, these results would be consistent with a cognitive-behavioural explanation, incorporating SO's cognitions about their partners' pain, rather than by simply attributing it to their partners' pain or problems such as disability, Implications for treatment will be discussed.

SOCIAL CLASS AND OCCUPATIONAL FACTORS IN NECK PAIN

Aisha Syed'. De Souza* LH', McAuley JH", Frank AO2, 'Dept of Health Studies, Brunei Univ, Isleworth TW7 5DU, UK; 'Dept of Rehabilitation, Northwick Park Hospital, Harrow HA1 3UJ, UK

Aim of Investigation: To examine the relationship between social class, occupation and disability of patients with neck pain.

Methods: 120 patients provided complete clinical and demographic data including current or previous occupation which was used to identify their social class. Disability was measured using a Neck Pain questionnaire which assessed different aspects of a patient's daily routine.

Results: Based on their current or previous occupations, patients were classified into social class 1, e.g. Medical Practitioners = 11 (13.2%); 2, e.g. Teaching Professionals = 32 (38.4%); 3NM, e.g. Secretaries = 36 (43%); 3M, e.g. Carpenters = 16 (19.2%); 4, e.g. Caretakers = 20 (24%); 5, e.g. Cleaners = 5 (6%). Additionally five of the most common occupations were examined: Drivers = 6 (4.6%), Secretaries = 43 (33.1%), Nurses = 11 (8.4%), Teachers = 10 (7.1%)), Managers = 13 (10.0%). No significant differences were found between the social class categories (F=0.66, P=0.65) or the occupational groups in terms of disability. Although managers had the highest mean score in disability (17.2), this was not significantly different from the other four occupational groups (P=0.19).

Conclusion: Three conclusions are drawn. Firstly patients attending a specialist neck pain clinic represent diverse social and occupational groups and are therefore not a homogenous group of patients. Secondly, it was found that there were no significant differences in the mean disability scores between social class and the occupational groups. Although secretaries were the most common occupational group, there was no difference in disability between this and the others. Lastly, although not significant, it was found that the managers had the highest mean disability score. This finding merits further investigation as this group may be at particular risk for developing neck pain disability.

SOCIOCULTURAL VARIABLES AND CHRONIC PAIN PATIENTS ATITTUDES

Pimenta CAM; Cruz DALM; Teixeira MJ; Castro VD; Paes AT. Nursing School of Univ ofSao Paulo, League Against Pain. Hospital das Clinicas ofUniv ofSao Paulo. Av. Eneas de C. Aguiar, 419, Sao Paulo, 05403-000, Brazil.

Aim of Investigation: To analyze the association between pain attitudes and the demographic, social-cultural and pain characteristics variables; to compare the pain attitudes in the beginning of the pain treatment and 6 to 15 months after.

Methods: The pain attitudes of 69 patients presenting cancer (24), myofascial (27), neurophatic (14), and undetermined (4) pain were assessed through Brief Version of Survey of Pain Atitudes, valited to Portuguese language. Twenty-one of these patients had a 2nd assessment. The variables studied were: sex, age, origin, schooling, religion, pain etiology, duration and intensity of pain complain, number of consultation and the attendance or not at a chronic pain program. Parametric and non-parametric tests were applied with the significance level at 0.05.

Results: The medians of the attitudes were: control-1 (best=4); incapacity-3 (best=0); harm-3 (best=0); emotion-3 (best=4); medication-3 (best=0); solicitude-2 (best=0), and medical cure-4 (best=0). Cancer pain patients had higher scores in disability and medication. Men agree stronger that medical cure is possible for chronic pain. There was a positive correlation between aging and the concept that medication is the best treatment for pain and a negative correlation between schooling and solicitude. Patients originated from most undeveloped regions of Brazil agree stronger that solicitous responses from others are appropnate and that medication is the best treatment for chronic pain. Pain attitudes don't change between the 1st and 2"'1 assessment.

Conclusion: Maladjusted chronic pain attitudes were observed. Sociocultural and demographics variables and pain etiology were associated with specific attitudes.

THE PAIN BELIEFS QUESTIONNAIRE: A STUDY INVOLVING HEALTHY SUBJECTS

Anne Rhys-Williams, School of Occupational Therapy and Physiotherapy, Univ of East Anglia, Norwich, UK.

Aim of Investigation: A comparison of the factor analysis of the Pain Beliefs Questionnaire (PBQ) as reported by Edwards et al (1992), with that of a healthy student population.

Methods: The 12 item PBQ, reflecting common beliefs regarding the experience of pain, its causes, consequences and factors influencing its seventy, designed by Edwards et al (1992) was replicated using the same format and instructions. 187 questionnaires were distributed to students of the School of Health, Univ of East Anglia.

Results: The men age of the healthy student population was 22.60 years (SD 5.35), and 88.9% were female. 153 questionnaires were completed (81.82%), and these responses were subjected to Principal Components Analysis. Five factors were obtained with an Eigenvalue over 1, accounting for 63.3% of the variance. Conclusions: The present study failed to replicate the two clear, discrete classes of beliefs about pain obtained by Edwards et al (1992). This may be due to the differences in the sample populations, predominantly young females compared with a mixed sample which included chronic pain patients. Thus, the PBQ cannot be recommended as a reliable measure of pain beliefs in a healthy student population.

Reference: Edwards LC, Pearce SA, Tumer-Stokes L and Jones A (1992). The Pain Beliefs Questionnaire: an investigation of beliefs in the causes and consequences of pain. Pain 51:267-272.

GENDER DIFFERENCES IN THE IMPACT OF PAIN: A COMPARISON OF THREE CHRONIC/ RECURRENT PAIN CONDITIONS

Linda LeResche. Michael Von Korff, Samuel Dworkin, Kathleen Saunders*, Univ of Washington Dept. of Oral Medicine, Seattle, WA 98195-6370 (USA), and Group Health Cooperative ofPuget Sound

Aim of Investigation: To investigate gender differences in measures of pain severity and pain impact.

Methods: Subjects were 574 male and 638 female back pain (BP) patients, 225 male and 554 female headache (HA) patients, and 69 male and 328 female temporo-mandibular disorder (TMD) patients making primary care visits for pain in a large health maintenance organization. Subjects reported pain intensity and interference on numeric scales; pain days, use of health care for pain and pain-related disability days in the past 6 months; and opioid use in the past month. Depression was assessed with the SCL-90.

Results: For all pain conditions, characteristic pain intensity was higher for women than for men (BP: 55 vs. 48; HA 57 vs. 51; TMD 52 vs. 44, all p's < .001). Women reported more days in pain than their male counterparts (BP: 88 vs. 68; HA: 57 vs. 50 -n.s.; TMD 96 vs. 73), more disability days (BP: 24 vs. 16; HA: 11 vs. 7; TMD 11 vs. 6 - n.s.), and more pain-related interference. Other impacts differed by pain site. Women with BP and HA were more likely to have elevated depression scores, but rates of depression in TMD did not differ by gender. Slightly more men than women with BP and TMD were unemployed, whereas unemployment in HA patients was significantly higher for women than for men. Use of opioids and health care did not differ by gender for any of the conditions.

Conclusions: Women are generally more severely impacted by pain than men, but patterns of pain impact differ somewhat by clinical condition.

Acknowledgments: Supported by N1H Grant No. DE08773 (USA).

CIRCUMCISION, CULTURE AND PAIN

Ngoitsi Henry Nono*. College of Health Sciences, Univ of Nairobi, Kenya (SPON: D. Ndetei)

Aim: To establish the influence of culture in containing the pain of male circumcision in Kenyan societies. Methods: Secondary data, Personal experience, Literature search

Results: Circumcision, which involves surgical removal of the prepuce and exposure of the glans penis, is a cultural requirement in many Kenyan societies. This involves the infliction of severe pain since no anaesthesia is used. Sometimes stinging traditional herbs are applied on the cut to serve as antiseptic. To prove his worth as a man the candidate is not expected to show any indication of suffering. Studies show that response to pain varies with culture, gender, age environment and even individuals.

Conclusion: The author concludes that cultural expectation can serve as a tool to accommodate severe pain. The pain endured at circumcision prepares the men to tackle the stress of adult life.

Acknowledgment: Prof. Violet Kimani, Dept of Community Health; Prof. D. Ndetei, Dept of Psychiatry; Dr. A.A. Indalo, Dept of Clinical Pharmacology, Univ of Nairobi.

PSYCHOPHYSICAL SCALING OF NOXIOUS ELECTRICAL PULSES: GENDER DIFFERENCES

G.B. Rollman & M. Hervieux*, Dept of Psychology, The Univ of Western Ontario, London, Ontario Canada N6A 5C2

Aim of Investigation: Many earlier studies, including some in this laboratory [Lautenbacher & Rollman, Pain, 53 (1993) 255-264; Rollman & Hams, Perception & Psychophysics, 42 (1987) 257-268] have shown that women, on average, have significantly lower pain threshold and pain tolerance to noxious electrocutanc-ous stimuli than do men. Our data have also suggested that the growth ofpsychophysical functions, relating perceived intensity to current, show a steeper slope for women than for men. Those findings, however, were based on fixed stimulus ranges. In this study, to compensate for different dynamic ranges, individually-tailored stimulus ranges were employed.

Methods: 20 male and 20 female undergraduates used a Gracely box scale, in which scaled numerical values were matched to verbal descriptors of pain intensity and unpleasantness. Seven electrical stimuli, spanning the range between pain threshold and .9 (pain tolerance), were randomly presented to the hand, 4 times each, in blocks where subjects rated intensity or unpleasantness of the resulting experience.

Results: As before, pain threshold and tolerance levels were markedly lower in women than in men. Also, as before, there are sizeable individual differences in pain responsiveness. The data suggested that both intensity and unpleasantness grew at a faster rate in women than in men.

Conclusions: Sex differences in the response to noxious stimuli, particularly those (such as electrical pulses) which may cause differential levels of anxiety, are often marked. Scaling studies which used a fixed range were unable to include some subjects, particularly female ones, whose tolerance was below the higher stimulus levels. These data, based upon all subjects, still suggest differential evaluation of these stimuli. As well, they indicate that gender differences occur for both the sensory and the affective components of the pain experience.

Acknowledgments: Supported in part by a NSERC research grant to the first author.

PAIN IN PAINTING ART

Sigmund Emhjellen, Ulleval Hospital, Dept of Anaesthesia, 0407 Oslo, Norway

Aim of Investigation: Pain, suffering and anxiety have been depicted from antiquity to present by artists. To present such work of art to health personnel involved in acute and chronic pain therapy is important.

Methods: About 30 museums in Europe and America have been visited over the last years in order to select and study paintings that incorporate suffering, pain and anxiety as a main theme.

Results: About 24 paintings will be presented. Each painting will be evaluated and its historical background presented.

Conclusions: History of Medicine and Pain is an important topic on most IASP congresses but Pain in Art has so far not been listed as a topic. It is my hope that this contribution might change this.

EUTHANASIA IN COLOMBIA

Rene Rodriguez. Coordinador de la Clinica para alivio del dolor y Cuidados Paliativos Institute de los Seguros Sociales, Cali, Colombia.

Aim of Investigation: To investigate the euthanasia concept managed by Colombian physicians who work with terminal patients; frequency of the requirement and the physicians' reactions.

Methods: The trial was developed using inquiry system in several congresses and also inquiries were mailed to physicians in the main cities of Colombia. Statistical work was done with absolute frequency, relative frequency, proportion and comparison of variables.

Results: 78 answers were considered able to be studied. 50% of the physicians had received requirements to practice euthanasia from their patients mainly. If the patients were suffering and requested euthanasia, 40% of the physicians accept to practice euthanasia. 83% of the physicians were Catholic. 30% accepted to have practiced active euthanasia and 62% passive euthanasia and 12% assisted suicide.

Conclusions: Many Colombian physicians have practiced euthanasia to terminal patients. We must improve palliative care in our institutions.

THREAT TO HUMAN PROGRESS IS MAINLY THE DRUG MENANCE, HIV/AIDS AND SOCIO-POLITICAL MISDIRECTION

Duodu Ofoe Michael*. David Nkrumah Adasa*, Charles Acheam-pong*, James Doe Sablah*, Pastor Christine Ofori Acheampong*, Emelia Adiyiah*.

Aims: To expose the courses of most kinds of pain in Africa. Methods: Many people were interviewed, district by district up to the national level.

Results: The present economic problems leading to broken down morals worldwide and loss of cultural values globally are building the scene for illicit drugs, sex and prostitution; presenting man with a dangerous and fearful harm of our age. Many young men and women take solace in drugs. Once in drugs, they become vulnerable to HIV infections as they carelessly exchange needles during their illicit drug intake; Grief, hopelessness and helplessness therefore set in, looking at the costs needed to redeem those youths. In the case of HIV infection, frustration becomes part of the problem as there is no known cure yet.

Conclusion: We need a conceited efforts to improve upon our Sociopolitical and economic bases and give good moral training to the youth. This would help discard the notion where developing nations have accepted human suffering as a necessary pain in life.

9th WORLD CONGRESS ON PAIN, 1999, Vienna, Austria, p.353 - 357

   

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