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For exam- ple buy female viagra 50 mg mastercard, early in life a person may learn to associate pain with others’ responses to his or her behavior (e purchase female viagra 100mg line. Later in life, the person may use pain as an unconscious defense against various bouts of emotional distress he or she experiences (much as posited by Freud). Although the former of these propositions was supported in part by findings from empiri- cal tests of social learning influences on pain (e. What type of person is most likely to do this or, in other words, to have a pain-prone personality? Engel (1959) suggested that those with psychiatric conditions, as described by diagnostic nomenclature of the day (e. Amendments to Engel’s model, such as Blumer and Heil- broon’s (1982) position on chronic pain as a variant of major depressive dis- order, or masked depression, added depressed affect, alexithymia, family history of depression and chronic pain, and discrete biological markers (e. The results of a large number of studies suggest that the prevalence of current psychiatric conditions is, indeed, elevated in patients with chronic pain relative to base rates in the general population (e. It is questionable, however, whether the presence of psychiatric morbidity makes one more likely to use pain as an unconscious defense mechanism and, thereby, more prone to persistent pain (see, e. With few exceptions (Adler, Zlot, Hürny, Minder, 1989), the psychody- namic formulations have not fared well against empirical scrutiny (see re- views by Gamsa, 1994; Large, 1986; Roth, 2000; Roy, 1985), and now have di- minished popularity in mainstream psychology. Notwithstanding, they did play a key role in drawing attention to the importance of psychological (and contextual) factors in the experience of pain at a time when treatment for pain was primarily directed by the biomedical model. This attention led to increased and continuing research into a wide array of psychosocial vari- ables (e. Indeed, the interest in psychological factors spawned by psychodynamic theorists served as an essential precursor to the development of contemporary biopsychosocial approaches. However, using Roth’s (2000) analogy of the double-edged sword, it is noteworthy that there are lingering and unwanted scars of this psychodynamic thrust. These include the general tendency to assume (a) that all cases of pain in the absence of identifiable physical pathology are the result of psychological factors, and (b) that these are equally relevant to all people with persistent pain. Although incorrect, these assumptions can (and still often do) have a negative impact on opinions and general treatment of people who suffer from persistent pain conditions. GATE CONTROL THEORY As noted earlier, Melzack and colleagues’ seminal papers on the gate con- trol theory of pain (Melzack & Casey, 1968; Melzack & Wall, 1965) are fre- quently cited as the first to integrate physiological and psychological mech- 40 ASMUNDSON AND WRIGHT anisms of pain within the context of a single model. It is beyond the scope of this chapter to provide a detailed synopsis of the theory; however, given its contribution to current conceptualizations of pain, a brief overview is warranted. Melzack and Wall (1965) proposed that a hypothetical gating mechanism within the dorsal horn of the spinal cord is responsible for allowing or disal- lowing the passage of ascending nociceptive information from the periph- ery to the brain. These essential elements are as follows: · The gating mechanism is influenced by the relative degree of excitatory activity in the spinal cord transmission cells, with excitation along the large-diameter, myelinated fibers closing the gate and along the small- diameter, unmyelinated fibers opening the gate. Since this original proposal we have, of course, moved beyond believing that the key to understanding pain is knowing what happens in the dorsal horn. Melzack and Casey (1968) further proposed that three different neural networks (i. They also recog- nized that processing of input could occur in parallel, at least at the sensory and affective level. This revised model allowed for “perceptual information regarding the location, magnitude, and spatiotemporal properties of the noxious stimulus, motivational tendency toward escape or attack, and cog- nitive information based on analysis of multimodal information, past experi- ence, and probability of outcome of different response strategies” (pp. Think back to the case of Jamie, who had pain associated with muscle strain in the low back. Applying the postulates of the gate control theory, Jamie’s pain experience might be understood as follows: Stimulation of nociceptors in the region of muscle strain facilitated transmission of infor- mation along ascending fibers, through an open gate, and on to Jamie’s brain. At the same time, Jamie’s brain was sending information about her current cognitions and emotional state (i. The summation of the ascending nociceptive input and descending information regarding cognition and 2. BIOPSYCHOSOCIAL APPROACHES TO PAIN 41 emotion, in this case, kept the gate open. Medical and behavioral interventions ultimately served to close the gate, reducing pain, and improving Jamie’s mood state and overall functional ability. Based on this brief overview it should be apparent that the gate control theory challenged the primary assumptions of the traditional biomedical and psychodynamic models. Rather than being exclusively conceptual- ized as sensation arising from physical pathology or somatic manifesta- tion of unresolved emotional conflicts, the experience of pain came to be viewed as a combination of both pathophysiology and psychological fac- tors. On this basis, then, Jamie’s depressed mood would not be viewed as a secondary reaction to pain, nor would the pain be viewed as a result of depressed mood. Rather, each would be seen as having a reciprocal influ- ence on the other. The assumptions of the gate control theory have not gone unchallenged, and advances in our understanding of the anatomy and structure of the gating mechanism have led to various revisions. The details of the changing views of the physiology of the gating mechanism are beyond the intent and scope of this chapter. We recommend that interested readers refer to arti- cles in Supplement 6 of the 1999 volume of Pain entitled “A Tribute to Pat- rick D. Wall” and to recent reviews written by Turk and Flor (1999) and Wall (1996). Notwithstanding, the essential elements of the model, as described earlier, have proven a heuristic of considerable value to both basic scien- tists and clinical scientist-practitioners. Melzack’s (1999) own words most accurately describe the most impor- tant contribution of the theory: Never again, after 1965, could anyone try to explain pain exclusively in terms of peripheral factors. The theory forced the medical and biological sciences to accept the brain as an active system that filters, selects and modulates in- puts. S123) Since 1965, but particularly over the past 25 years, there have been many advances to our understanding of the specific nature of the psychological and sociocultural factors of pain. For example, Price (2000) proposed a par- allel-serial model of pain affect that is consistent with existing literature.
A template for the order in which some of the political issues surrounding authorship cheap female viagra 100 mg with mastercard, acknowledgements and choices of journal can be considered is shown in Figure 2 best female viagra 100 mg. As such, the first author makes decisions about the main aims of the paper in consultation with the coauthors. The first author is also responsible for conducting or supervising the data analyses and ensuring that the results are presented and interpreted correctly. In effect, each author must be able to present the results, defend the implications, 31 Scientific Writing Decide authorship Agree on authors’ roles and responsibilities Agree on acknowledgements Agree on up to three journals Obtain instructions to authors Collect the “Uniform Requirements” and any other useful checklists Figure 2. These responsibilities protect coauthors and preclude “gift” authors, since no researcher should allow their names to be associated with results that they know very little about. Whatever their positions in the author list, coauthors always have both ethical and professional responsibilities for the content of the paper. Thus, only the people who have participated sufficiently in the research project to take public responsibility for the content should be included. Once the authorship list is finalised, you can work towards an agreement on the role of each coauthor and the work that they will put into the paper. There are no formal guidelines so you will have to negotiate your expectations with those of your coauthors. Although the number of authors on journal articles has tended to increase in recent years, four or five authors is usually optimal. Limiting the number of authors may be particularly important for the career advancement of students who are undertaking a higher degree and who are required to make a very substantial contribution to their papers. Having fewer authors also avoids diluting the responsibility that each author must take for the paper. In practice, more than four authors should be included only if there is a good reason for doing so and some journals set author limits. For example, the journal Thrombosis and Haemostasis sets a limit of eight and Chest sets a limit of seven. The New England Journal of Medicine sets a limit of 12 authors, after which other names must appear in a footnote. A suggested maximum number of authors for each type of publication is shown in Table 2. A study on multiple authorship showed that the mean number of authors on journal articles increased from 2·2 in 1975 to 4·5 in 1995, with a disproportionate growth in the inclusion of professors and departmental chairpersons. Some journals, for example JAMA and the New England Journal of Medicine, now ask authors to certify that they meet the Vancouver criteria when a paper is submitted, and many journals include these criteria in their instructions to authors. Journals such as the BMJ and Lancet also request a statement of each author’s exact contribution to the paper. To avoid authorship problems, research groups need to develop a departmental policy on authorship criteria that is regularly visited, discussed, and updated in a consensus forum. Many 34 Getting started research institutions also develop their own code of ethics for acknowledgements and contributions in publications. Standardised policies that are developed collaboratively and ratified by the heads of research departments within institutions are worth their weight in gold in preventing conflicts and resolving contentious and often emotional authorship and acknowledgement issues. Because authorship is such a serious issue, many journals will not consider a paper for publication without the signatures of all authors. Most journals also require a declaration of competing interests from their authors and contributors. The Lancet in its instructions to authors suggests that authors use the following statement: I declare that I participated in the (here list contributions made to the study such as design, execution or analysis of the paper) by … and colleagues entitled … and that I have seen and approved the final version. It is also a good idea to add “I also declare that I have no conflict of interest in connection with this paper other than any noted in the covering letter to the editor”. If these statements are completed on separate pages and left undated, they can be used if the paper is rejected and then submitted to another journal. There have been cases where pharmaceutical companies have applied undue pressure on researchers to avoid publishing data that suggest that their products are inferior or ineffective. In response to what editors perceive as increasing control by drug companies over how the results of sponsored studies are analysed, many journals now require that authors fully disclose their own roles and those of their sponsors. Some major medical journals will not review or publish articles based on studies that are conducted under conditions that allow the sponsor to have sole control of the data or to withhold publication. If the authors cannot satisfy these 35 Scientific Writing points, the paper will not be published. These moves are intended to prevent the publication of research results that reflect their financial backing. Role of statisticians A statistician is a person who likes to prove you wrong, 5% of the time. Taken from an internet bulletin board Statisticians often have a special place in the authorship of a paper that reflects their contribution to the design and/or reporting of the study. As such, they are a good example of how a person with specific expertise can support a study in either a minor or a major way. A statistician’s role may vary from the development of the study design and study protocol to helping prepare the grant application, implementing the study, planning and performing the data analyses, and/or interpreting the results. In general, authorship is not warranted when the statistician has contributed to only one or two aspects of the paper in an entirely consultative way. However, authorship is often warranted when the statistician has been more actively involved and has made a fundamental, intellectual contribution that fulfils at least some of the Vancouver guidelines. Author order There is intense international competition in science these days which is a kind of substitute for war. Gordon Lil and Arthur Maxwell (Science, 1959) An additional problem in deciding authorship can be the order in which coauthors are listed.
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