A search for the pathophysiology of the nonspecific "occupational overuse syndrome" in musicians.

The findings of this investigation have suggested a new theory to help explain the origin of activity-related pain. It proposes an as yet unrecognized physiologic process (the physiologic activity limitation process). When the intensity of an activity is greater than that appropriate for an individual's level of fitness for that activity, this process then generates unpleasant sensations, physiologic activity-related pain, the function of which is to limit that activity.

Out-patient cognitive-behavioural therapy with amitriptyline for chronic non-malignant pain: a comparative study with 6-month follow-up.

A study was carried out in a multidisciplinary pain clinic with the purpose of comparing the effectiveness of outpatient cognitive-behavioural therapy (CBT) with amitriptyline (AMI) to that of supportive therapy with AMI. The treatments were given weekly over 8 weeks. Global and continuous outcome measures were used.

A classification of illness behaviour in pain clinic patients.

The Illness Behaviour Questionnaire (IBQ) (Pilowsky and Spence 1983) was administered to 824 pain clinic patients over a 10-year period. Their responses to this 62-item self-report questionnaire were analysed using a numerical taxonomy programme. Of the 6 valid classes generated, 2 classes were delineated by at least 5 unique items.

A controlled study of psychotherapy and amitriptyline used individually and in combination in the treatment of chronic intractable, 'psychogenic' pain.

This paper reports an investigation into the efficacy of flexible dosage amitriptyline (AMI) and brief psychotherapy individually and together in the treatment of chronic 'psychogenic' pain. The patients included in the study were drawn from those referred to a pain clinic and were randomly assigned to 1 of 4 groups: (1) AMI + psychotherapy (N = 26), twelve 45 min weekly sessions; (2) AMI + support (N = 26), six 15 min fortnightly sessions; (3) placebo tablet + psychotherapy (N = 26), twelve 45 min weekly sessions; (4) placebo tablet + support (N = 24), six 15 min fortnightly sessions. Outcome was assessed on categorical and continuous variables administered immediately post treatment.

Clinical assessment and interpretation of abnormal illness behaviour in low back pain.

Patients with chronic low back pain present with a mixture of symptoms and signs. Some are a direct consequence of physical pathology whereas others are attributable to associated and appropriate psychological and behavioural changes. At times the latter may be out of keeping with the degree of physical pathology and thus have specific significance in terms of the affective and cognitive disturbances that are also present and which may be the basis for abnormal illness behaviour.