This volume continues some of the issues raised in Volume 2 and fo cuses more closely on therapeutic intervention. The theoretical discus sion of aggression provides a background for the presentation of pat terns of aggression and violence affecting women, as well as possible connections between physical and emotional symptoms and indirect expressions of aggression. The section on aggression against and by women is an extension of some of the content of The Woman Patient, Volume 1 (e. g. , the chapter on rape). Theoretical and clinical views that are not often linked in this fashion are included here because we are interested in understanding the development of a self-concept that incorporates the constructive aspects of "aggression" as well as an un derstanding of violence. In this context, loss, abandonment, delin quency, and child and adolescent suicide are also extensions of these issues. The chapters that follow address aspects of symptom formation and concepts of illness. There is, as yet, no definitive explanation for why women experience certain illness patterns more or less than men. Current considerations have been reviewed, but these do not answer. They are a beginning on which we must build. It is apparent that any discussion of these subjects better elucidates the complexity if it in cludes an intermingling of general problems with concrete symptoms. Those specific problems that are usually thought of as psychological such as depression, and behaviors (such as substance abuse) provide a focus for understanding wider issues.

With the growing realization that pain and its control are vital areas for both theoretical and practical research as well as clinical treatment has come the desire for an assessment of the state-of-the-art. Pain research by itself is not new. Yet, approaches to the study and control of pain are new. This book is based upon a symposium-workshop on the study and control of pain that took place at the annual meeting of the American Association for the Advance ment of Science, January, 1975. It was destgned to deal with a number of theoretical and clinical issues. We at tempted to assess previous years of research, how conceptions of pain phenomena have changed and what are some of the gaps in our knowledge. Presentations were also geared to show our increased methodological sophistication. Clinically, we have also changed our treatment conceptualization of pain control. We have not merely added a few "tricks" to deal with pain. Entirely new approaches are now available. View ing pain as a public health problem we find many areas of needed research that should be directed toward the epidemio logy of pain, the reduction of fear of obtaining health care, and unmet treatment needs. Obviously, this book cannot provide full, comprehensive treatment of all the issues involved. It can, however, pro vide the reader with an understanding of the current, major thrusts, new research and treatment goals in pain control.

Pain syndromes involve a complex interaction of medical and psychological factors. In each syndrome unique physiological mechanisms are mediated by emotional states, personality traits, and environmental pressures to determine the nature and extent of pain complaints and pain-related disability. The Handbook addresses the complexities of chronic pain in three ways. Section I describes general concerns that cross-cut the different syndromes, such as the use of narcotic pain medications, the detection of deception and malingering, and the epidemiology of pain. Section II presents comprehensive reviews of a wide range of pain syndromes. Each covers basic pathophysiology, psychological factors found to influence the course of the syndrome, and syndrome-specific multidisciplinary treatment approaches. Most of the Section II chapters are coauthored by psychologists and physicians. Section III discusses pain in special populations, including the elderly and children. The Handbook is the most up-to-date, comprehensive, and integrated single-volume resource for all those professionally concerned with pain.

Pain is an unfortunate daily experience for many individuals. Chronic pain -- lasting six or more months -- is suffered by approximately 30% of the population in the United States. These individuals wake up, function during the day and go to sleep, trying to keep pain at a minimum while, at the same time, maintaining some quality of life. They may make frequent visits to the doctor and the pharmacy. When they find relief, it is usually short-lived and comes at a cost such as dependence on narcotic medications or complete limitation of activity. Pain often becomes the central point of their existence. This practice guide describes an approach to psychological evaluation of the chronic pain patient who is being considered for surgery. A large body of research is accumulating which demonstrates that the outcome of surgical procedures aimed at chronic pain relief can be strongly influenced by psychological and emotional factors. This approach, termed "presurgical psychological screening" (PPS) uses interview and testing techniques to identify emotional, behavioral, and psychosocial difficulties which have been demonstrated to negatively impact surgical outcome. Studies show that even patients with clearly identifiable pathophysiology may respond poorly to surgery, due to issues such as pain sensitivity, medication dependence, rewards for pain behavior and personality style. Thus, some insurance carriers, rehabilitation nurses and state worker's compensation systems are encouraging, or even requiring, presurgical psychological screening in cases of surgery designed to relieve chronic pain. The first to present a comprehensive, unified approach to PPS in chronic pain syndromes, this text is designed to provide the behavioral health practitioner, as well as the trainee, with all the tools and information necessary to conduct PPS evaluations. It identifies a multitude of risk factors for poor surgical outcome and reviews research associated with each risk factor. Hands-on techniques for eliciting information from the patient about risk factors is also detailed. Toward this end, the practice guide also contains a number of forms and session outlines which can be directly utilized, or which can be altered to fit readers' needs. Models for weighing and combining surgical outcome risk factors are also provided. Thus, practitioners are able to reach valid and reliable predictions of surgical results. Finally, the text provides outlines of psychological interventions which can facilitate surgical outcome as well as surgical treatment alternatives. Upon completion of this practice guide, readers should be able to begin providing PPS evaluations which are scientifically valid, clinically sound, and which result in significant overall improvement in the treatment of chronic pain syndromes.