The missing p in psychiatric training: Why it is important to teach pain to psychs

Archives of General Psychiatry

Volumn 68, Issue 1, 2011, Pages 12-20

  Elman, Igor ^a   Zubieta, Jon Kar ^c   Borsook, David ^b  

^a MCLEAN HOSPITAL   (United States)

^b MASSACHUSETTS GENERAL HOSPITAL   (United States)

^c UNIVERSITY OF MICHIGAN   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

DOPAMINE; OPIATE; SEROTONIN NORADRENALIN REUPTAKE INHIBITOR; SEROTONIN UPTAKE INHIBITOR; TRICYCLIC ANTIDEPRESSANT AGENT;

ADDICTION; ALLODYNIA; BEHAVIOR THERAPY; BIPOLAR DISORDER; BRAIN DISEASE; CENTRAL NERVOUS SYSTEM; CHRONIC PAIN; COGNITION; COGNITIVE THERAPY; DECISION MAKING; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; DOPAMINERGIC TRANSMISSION; DRUG DEPENDENCE; EMOTION; FUNCTIONAL MAGNETIC RESONANCE IMAGING; GRADUATE STUDENT; HUMAN; HYPERALGESIA; LEARNING; MAJOR DEPRESSION; MEDICAL EDUCATION; MEDICAL SPECIALIST; MENTAL DISEASE; MESOLIMBIC DOPAMINERGIC SYSTEM; MOTIVATION; NEUROANATOMY; NUCLEUS ACCUMBENS; PAIN; PATHOPHYSIOLOGY; PHYSICIAN; POSTTRAUMATIC STRESS DISORDER; PRIMARY MEDICAL CARE; PSYCHIATRIST; PSYCHIATRY; PUBLIC HEALTH; REVIEW; REWARD; SCIENTIST; TEACHER; TISSUE INJURY; TRANSCRANIAL MAGNETIC STIMULATION; TRANSLATIONAL RESEARCH; VAGUS NERVE STIMULATION; VENTRAL TEGMENTUM;

BIPOLAR DISORDER; BRAIN; CHRONIC DISEASE; DEPRESSIVE DISORDER, MAJOR; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; EMOTIONS; HUMANS; MENTAL DISORDERS; MOTIVATION; PAIN; PSYCHIATRY; STRESS DISORDERS, POST-TRAUMATIC; SUBSTANCE-RELATED DISORDERS;

EID: 78650884264     PISSN: 0003990X     EISSN: 15383636     Source Type: Journal    
DOI: 10.1001/archgenpsychiatry.2010.174     Document Type: Review

References (133)

1. Sharp J, Keefe B. Psychiatry in chronic pain: a review and update. Curr Psychiatry Rep. 2005;7(3):213-219.
2. US Department of Health and Human Services, National Center for Health Statistics. Health, United States, 2006, with chartbook on trends in the health of Americans. http://www.cdc.gov/nchs/data/hus/hus06.pdf. Accessed June 29, 2010.
3. Crook J, Rideout E, Browne G. The prevalence of pain complaints in a general population. Pain. 1984;18(3):299-314.
4. National Institutes of Health. New directions in pain research. http://grants.nih.gov/grants/guide/pa-files/PA-98-102.html. Accessed June 29, 2010.
5. Vaupel JW. Biodemography of human ageing. Nature. 2010;464(7288):536-542.
6. Breuer B, Pappagallo M, Tai JY, Portenoy RK. US board-certified pain physician practices: uniformity and census data of their locations [published online ahead of print December 13, 2006]. J Pain. 2007;8(3):244-250. doi:10.1016/j.pain.2006.08.009. (Pubitemid 44959434)
7. Gianni W, Ceci M, Bustacchini S, Corsonello A, Abbatecola AM, Brancati AM, Assisi A, Scuteri A, Cipriani L, Lattanzio F. Opioids for the treatment of chronic non-cancer pain in older people. Drugs Aging. 2009;26(suppl 1):63-73.
8. Gibson SJ. IASP global year against pain in older persons: highlighting the current status and future perspectives in geriatric pain. Expert Rev Neurother. 2007; 7(6):627-635.
9. US Census Bureau. US interim projections by age, sex, race, and Hispanic origin: 2000-2050. http://www.census.gov/population/www/projections/ usinterimproj/. Accessed June 29, 2010.
10. Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being: aWorld Health Organization study in primary care. JAMA. 1998;280(2):147-151.
11. Hyman SE. Mental health in an aging population: the NIMH perspective. Am J Geriatr Psychiatry. 2001;9(4):330-339.
12. Leo RJ, Pristach CA, Streltzer J. Incorporating pain management training into the psychiatry residency curriculum. Acad Psychiatry. 2003;27(1):1-11.
13. Strigo IA, Simmons AN, Matthews SC, Craig AD, Paulus MP. Association of major depressive disorder with altered functional brain response during anticipation and processing of heat pain. Arch Gen Psychiatry. 2008;65(11):1275-1284.
14. Elman I, Borsook D, Lukas SE. Food intake and reward mechanisms in patients with schizophrenia: implications for metabolic disturbances and treatment with second-generation antipsychotic agents. Neuropsychopharmacology. 2006; 31(10):2091-2120.
15. Fishbain DA, Cole B, Lewis J, Rosomoff HL, Rosomoff RS. What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? a structured evidence-based review. Pain Med. 2008;9(4):444-459.
16. Dersh J, Polatin PB, Gatchel RJ. Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med. 2002;64(5):773-786.
17. Zhuo M. Plasticity of NMDA receptor NR2B subunit in memory and chronic pain. Mol Brain. 2009;2(1):4. doi:10.1186/1756-6606-2-4.
18. Apkarian AV, Sosa Y, Krauss BR, Thomas PS, Fredrickson BE, Levy RE, Harden RN, Chialvo DR. Chronic pain patients are impaired on an emotional decisionmaking task. Pain. 2004;108(1-2):129-136.
19. Apkarian AV, Sosa Y, Sonty S, Levy RM, Harden RN, Parrish TB, Gitelman DR. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci. 2004;24(46):10410-10415.
20. Apkarian AV, Baliki MN, Geha PY. Towards a theory of chronic pain [published online ahead of print October 5, 2008]. Prog Neurobiol. 2009;87(2):81-97. doi:10.1016/j.pneurobio.2008.09.018.
21. Kringelbach ML, Berridge KC. The functional neuroanatomy of pleasure and happiness. Discov Med. 2010;9(49):579-587.
22. Merskey H, Boduk N. Classification of Chronic Pain. 2nd ed. Seattle, WA: IASP Press; 1994.
23. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
24. Boland RJ. How could the validity of the DSM-IV pain disorder be improved in reference to the concept that it is supposed to identify? Curr Pain Headache Rep. 2002;6(1):23-29.
25. Takahashi H, Kato M, Matsuura M, Mobbs D, Suhara T, Okubo Y. When your gain is my pain and your pain is my gain: neural correlates of envy and schadenfreude. Science. 2009;323(5916):937-939.
26. Treede RD. Peripheral acute pain mechanisms. AnnMed. 1995;27(2):213-216.
27. Breitbart W, Gibson CA. Psychiatric aspects of cancer pain management. Prim Psychiatry. 2007;14(9):81-91.
28. Katz WA, Barkin RL. Dilemmas in chronic/persistent pain management. Am J Ther. 2008;15(3):256-264.
29. Melzack R. Evolution of the neuromatrix theory of pain: the Prithvi Raj Lecture: presented at the third World Congress of World Institute of Pain, Barcelona 2004. Pain Pract. 2005;5(2):85-94.
30. Melzack R. The future of pain. Nat Rev Drug Discov. 2008;7(8):629.
31. Smith MB. Chronic pain and psychopathology: one psychiatrist's view. Prim Psychiatry. 2007;14(9):55-69.
32. Borsook D, Becerra L, Carlezon WA Jr, Shaw M, Renshaw P, Elman I, Levine J. Reward-aversion circuitry in analgesia and pain: implications for psychiatric disorders. Eur J Pain. 2007;11(1):7-20.
33. O'Connor MF, Wellisch DK, Stanton AL, Eisenberger NI, Irwin MR, Lieberman MD. Craving love? enduring grief activates brain's reward center. Neuroimage. 2008;42(2):969-972.
34. Berridge KC, Robinson TE. Parsing reward. Trends Neurosci. 2003;26(9):507-513.
35. Scott DJ, Heitzeg MM, Koeppe RA, Stohler CS, Zubieta JK. Variations in the human pain stress experience mediated by ventral and dorsal basal ganglia dopamine activity. J Neurosci. 2006;26(42):10789-10795.
36. Baliki MN, Geha PY, Fields HL, Apkarian AV. Predicting value of pain and analgesia: nucleus accumbens response to noxious stimuli changes in the presence of chronic pain. Neuron. 2010;66(1):149-160.
37. Insel TR. Is social attachment an addictive disorder? Physiol Behav. 2003;79(3): 351-357.
38. de Spinoza B. The ethics - part III: on the origin and nature of the emotions. In: Elwes RHM, ed. The Ethics. Princeton, NJ: Princeton University Press; 1883: 1-132.
39. Turk DC. A diathesis-stress model of chronic pain and disability following traumatic injury. Pain Res Manag. 2002;7(1):9-19.
40. Banks S, Kerns R. Explaining high rates of depression in chronic pain: a diathesisstress framework. Psychol Bull. 1996;119:95-110.
41. Tang NK, Salkovskis PM, Hodges A, Wright KJ, Hanna M, Hester J. Effects of mood on pain responses and pain tolerance: an experimental study in chronic back pain patients. Pain. 2008;138(2):392-401.
42. Berna C, Leknes S, Holmes EA, Edwards RR, Goodwin GM, Tracey I. Induction of depressed mood disrupts emotion regulation neurocircuitry and enhances pain unpleasantness. Biol Psychiatry. 2010;67(11):1083-1090.
43. Bair MJ, Robinson RL, Eckert GJ, Stang PE, Croghan TW, Kroenke K. Impact of pain on depression treatment response in primary care. Psychosom Med. 2004;66(1):17-22.
44. Fava M, Mallinckrodt CH, Detke MJ, Watkin JG, Wohlreich MM. The effect of duloxetine on painful physical symptoms in depressed patients: do improvements in these symptoms result in higher remission rates? J Clin Psychiatry. 2004;65(4):521-530.
45. Zubieta JK, Smith YR, Bueller JA, Xu Y, Kilbourn MR, Jewett DM, Meyer CR, Koeppe RA, Stohler CS. Regional mu opioid receptor regulation of sensory and affective dimensions of pain. Science. 2001;293(5528):311-315.
46. Stohler CS, Kowalski CJ. Spatial and temporal summation of sensory and affective dimensions of deep somatic pain. Pain. 1999;79(2-3):165-173.
47. Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? a review. Clin J Pain. 1997;13(2):116-137.
48. Koike AK, Unützer J, Wells KB. Improving the care for depression in patients with comorbid medical illness. Am J Psychiatry. 2002;159(10):1738-1745.
49. Clark M. Psychopharmacology of chronic pain. Prim Psychiatry. 2007;14(9):70-79.
50. Kennedy SE, Koeppe RA, Young EA, Zubieta JK. Dysregulation of endogenous opioid emotion regulation circuitry in major depression in women. Arch Gen Psychiatry. 2006;63(11):1199-1208.
51. World Health Organization. Depression. http://www.who.int/mental-health/ management/depression/definition/en/. Accessed June 29, 2010.
52. Schmahl C, Bohus M, Esposito F, Treede RD, Di Salle F, Greffrath W, Ludaescher P, Jochims A, Lieb K, Scheffler K, Hennig J, Seifritz E. Neural correlates of antinociception in borderline personality disorder. Arch Gen Psychiatry. 2006; 63(6):659-667. (Pubitemid 43848297)
53. Ludäscher P, Bohus M, Lieb K, Philipsen A, Jochims A, Schmahl C. Elevated pain thresholds correlate with dissociation and aversive arousal in patients with borderline personality disorder. Psychiatry Res. 2007;149(1-3):291-296.
54. Prossin AR, Love TM, Koeppe RA, Zubieta JK, Silk KR. Dysregulation of regional endogenous opioid function in borderline personality disorder [published online ahead of print May 3, 2010]. Am J Psychiatry. 2010;167(8): 925-933. doi: 10.1176/appi.ajp.2010.09091348.
55. Love TM, Stohler CS, Zubieta JK. Positron emission tomography measures of endogenous opioid neurotransmission and impulsiveness traits in humans. Arch Gen Psychiatry. 2009;66(10):1124-1134.
56. Brown RL, Patterson JJ, Rounds LA, Papasouliotis O. Substance abuse among patients with chronic back pain. J Fam Pract. 1996;43(2):152-160.
57. Compton WM, Volkow ND. Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug Alcohol Depend. 2006;81(2): 103-107.
58. Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2010;35(1):217-238.
59. Kalivas PW, Volkow ND. The neural basis of addiction: a pathology of motivation and choice. Am J Psychiatry. 2005;162(8):1403-1413.
60. Hyman SE, Malenka RC, Nestler EJ. Neural mechanisms of addiction: the role of reward-related learning and memory. Annu Rev Neurosci. 2006;29:565-598.
61. Wise RA. Role of brain dopamine in food reward and reinforcement. Philos Trans R Soc Lond B Biol Sci. 2006;361(1471):1149-1158.
62. Shurman J, Koob GF, Gutstein HB. Opioids, pain, the brain, and hyperkatifeia: a framework for the rational use of opioids for pain. Pain Med. 2010;11(7): 1092-1098.
63. Hollerman JR, Schultz W. Dopamine neurons report an error in the temporal prediction of reward during learning. Nat Neurosci. 1998;1(4):304-309.
64. Brischoux F, Chakraborty S, Brierley DI, Ungless MA. Phasic excitation of dopamine neurons in ventral VTA by noxious stimuli [published online ahead of print March 4, 2009]. Proc Natl Acad Sci U S A. 2009;106(12):4894-4899. doi:10.1073/pnas.0811507106.
65. Elman I, Lowen S, Frederick BB, Chi W, Becerra L, Pitman RK. Functional neuroimaging of reward circuitry responsivity to monetary gains and losses in posttraumatic stress disorder. Biol Psychiatry. 2009;66(12):1083-1090.
66. Humphries MD, Prescott TJ. The ventral basal ganglia, a selection mechanism at the crossroads of space, strategy, and reward. Prog Neurobiol. 2010; 90(4):385-417.
67. Boutelle MG, Zetterström T, Pei Q, Svensson L, Fillenz M. In vivo neurochemical effects of tail pinch. J Neurosci Methods. 1990;34(1-3):151-157.
68. Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV. The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions. Neuron. 2008;60(4):570-581.
69. Pais-Vieira M, Mendes-Pinto MM, Lima D, Galhardo V. Cognitive impairment of prefrontal-dependent decision-making in rats after the onset of chronic pain [published online ahead of print April 8. 2009]. Neuroscience. 2009;161 (3):671-679. doi:10.1016/j.neuroscience.2009.04.011.
70. Wood PB, Schweinhardt P, Jaeger E, Dagher A, Hakyemez H, Rabiner EA, Bushnell MC, Chizh BA. Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci. 2007;25(12):3576-3582.
71. Rossetti ZL, Hmaidan Y, Gessa GL. Marked inhibition of mesolimbic dopamine release: a common feature of ethanol, morphine, cocaine and amphetamine abstinence in rats. Eur J Pharmacol. 1992;221(2-3):227-234.
72. Koob GF, Le Moal M. Drug addiction, dysregulation of reward, and allostasis. Neuropsychopharmacology. 2001;24(2):97-129.
73. Karoly P, Ruehlman LS. Motivational implications of pain: chronicity, psychological distress, and work goal construal in a national sample of adults. Health Psychol. 1996;15(5):383-390.
74. Leite-Almeida H, Almeida-Torres L, Mesquita AR, Pertovaara A, Sousa N, Cerqueira JJ, Almeida A. The impact of age on emotional and cognitive behaviours triggered by experimental neuropathy in rats [published online ahead of print April 26, 2009]. Pain. 2009;144(1-2):57-65. doi:10.1016/j.pain.2009.02.024.
75. Karoly P, Ruehlman LS. Psychosocial aspects of pain-related life task interference: an exploratory analysis in a general population sample. Pain Med. 2007; 8(7):563-572.
76. Karoly P, Lecci L. Motivational correlates of self-reported persistent pain in young adults. Clin J Pain. 1997;13(2):104-109.
77. Weissman DE, Haddox JD. Opioid pseudoaddiction: an iatrogenic syndrome. Pain. 1989;36(3):363-366.
78. Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain. 1986;25(2):171-186.
79. Fields HL. Should we be reluctant to prescribe opioids for chronic nonmalignant pain? Pain. 2007;129(3):233-234.
80. Carinci AJ, Mao J. Pain and opioid addiction: what is the connection? Curr Pain Headache Rep. 2010;14(1):17-21.
81. Upadhyay J, Maleki N, Potter J, Elman I, Rudrauf D, Knudsen J, Wallin D, Pendse G, McDonald L, Griffin M, Anderson J, Nutile L, Renshaw P, Weiss R, Becerra L, Borsook D. Alterations in brain structure and functional connectivity in prescription opioid-dependent patients [published online ahead of print June 16, 2010]. Brain. 2010;133(pt 7):2098-2114. doi: 10.1093/brain/awq138.
82. Martin TJ, Kim SA, Buechler NL, Porreca F, Eisenach JC. Opioid selfadministration in the nerve-injured rat: relevance of antiallodynic effects to drug consumption and effects of intrathecal analgesics. Anesthesiology. 2007; 106(2):312-322.
83. Gutstein HB, Akil H. Opioid analgesics. In: Hardman JG, Limbird LE, Gilman AG, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York, NY: McGraw-Hill; 2001:569-619.
84. Portenoy RK, Farrar JT, Backonja MM, Cleeland CS, Yang K, Friedman M, Colucci SV, Richards P. Long-term use of controlled-release oxycodone for noncancer pain: results of a 3-year registry study. Clin J Pain. 2007;23(4):287-299.
85. Compton WM, Volkow ND. Abuse of prescription drugs and the risk of addiction [published online ahead of print March 23, 2006]. Drug Alcohol Depend. 2006;83(suppl 1):S4-S7. doi:10.1016/j.drugalcdep.2005.10.020.
86. De Vries TJ, Shippenberg TS. Neural systems underlying opiate addiction. J Neurosci. 2002;22(9):3321-3325.
87. Stewart J. Reinstatement of heroin and cocaine self-administration behavior in the rat by intracerebral application of morphine in the ventral tegmental area. Pharmacol Biochem Behav. 1984;20(6):917-923.
88. Simmons D, Self DW. Role of mu- and delta-opioid receptors in the nucleus accumbens in cocaine-seeking behavior. Neuropsychopharmacology. 2009; 34(8):1946-1957.
89. Gear RW, Aley KO, Levine JD. Pain-induced analgesia mediated by mesolimbic reward circuits. J Neurosci. 1999;19(16):7175-7181.
90. George O, Koob GF. Individual differences in prefrontal cortex function and the transition from drug use to drug dependence [published online ahead of print May 20, 2010]. Neurosci Biobehav Rev. doi:10.1016/j.neubiorev.2010.05.002.
91. Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff RS. Validity of self-reported drug use in chronic pain patients. Clin J Pain. 1999;15(3):184-191.
92. Jamison RN, Ross EL, Michna E, Chen LQ, Holcomb C, Wasan AD. Substance misuse treatment for high-risk chronic pain patients on opioid therapy: a randomized trial [published online ahead of print March 23, 2010]. Pain. 2010; 150(3):390-400. doi:10.1016/j.pain.2010.02.033.
93. De Felice M, Porreca F. Opiate-induced persistent pronociceptive trigeminal neural adaptations: potential relevance to opiate-induced medication overuse headache [published online ahead of print May 11, 2009]. Cephalalgia. 2009; 29(12):1277-1284. doi:10.1111/j.1468-2982.2009.01873.x.
94. Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006;104(3):570-587.
95. Antelman SM, Eichler AJ, Black CA, Kocan D. Interchangeability of stress and amphetamine in sensitization. Science. 1980;207(4428):329-331.
96. Thomas MJ, Kalivas PW, Shaham Y. Neuroplasticity in the mesolimbic dopamine system and cocaine addiction. Br J Pharmacol. 2008;154(2):327-342.
97. Fishbain DA, Goldberg M, Meagher BR, Steele R, Rosomoff H. Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria. Pain. 1986;26(2):181-197.
98. Liberzon I, Sripada CS. The functional neuroanatomy of PTSD: a critical review. Prog Brain Res. 2008;167:151-169.
99. Norman SB, Stein MB, Dimsdale JE, Hoyt DB. Pain in the aftermath of trauma is a risk factor for post-traumatic stress disorder [published online ahead of print September 10, 2007]. Psychol Med. 2008;38(4):533-542. doi: 10.1017/S0033291707001389. (Pubitemid 351354883)
100. Holbrook TL, Galarneau MR, Dye JL, Quinn K, Dougherty AL. Morphine use after combat injury in Iraq and post-traumatic stress disorder. N Engl JMed. 2010; 362(2):110-117.
101. Otis JD, Keane TM, Kerns RD. An examination of the relationship between chronic pain and post-traumatic stress disorder. J Rehabil Res Dev. 2003;40(5): 397-405.
102. Villano CL, Rosenblum A, Magura S, Fong C, Cleland C, Betzler TF. Prevalence and correlates of posttraumatic stress disorder and chronic severe pain in psychiatric outpatients. J Rehabil Res Dev. 2007;44(2):167-178.
103. Crombez G, Eccleston C, Baeyens F, Eelen P. When somatic information threatens, catastrophic thinking enhances attentional interference. Pain. 1998; 75(2-3):187-198.
104. Ploghaus A, Narain C, Beckmann CF, Clare S, Bantick S, Wise R, Matthews PM, Rawlins JN, Tracey I. Exacerbation of pain by anxiety is associated with activity in a hippocampal network. J Neurosci. 2001;21(24):9896-9903.
105. Liedl A, Knaevelsrud C. Chronic pain and PTSD: the Perpetual Avoidance Model and its treatment implications. Torture. 2008;18(2):69-76.
106. Asmundson GJ, Katz J. Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. Depress Anxiety. 2009;26(10):888-901.
107. Liedl A, O'Donnell M, Creamer M, Silove D, McFarlane A, Knaevelsrud C, Bryant RA. Support for the mutual maintenance of pain and post-traumatic stress disorder symptoms. Psychol Med. 2010;40(7):1215-1223.
108. Osterman JE, Hopper J, Heran WJ, Keane TM, van der Kolk BA. Awareness under anesthesia and the development of posttraumatic stress disorder. Gen Hosp Psychiatry. 2001;23(4):198-204.
109. Jenewein J, Wittmann L, Moergeli H, Creutzig J, Schnyder U. Mutual influence of posttraumatic stress disorder symptoms and chronic pain among injured accident survivors: a longitudinal study. J Trauma Stress. 2009;22(6):540-548.
110. Pitman RK, van der Kolk BA, Orr SP, Greenberg MS. Naloxone-reversible analgesic response to combat-related stimuli in posttraumatic stress disorder: a pilot study. Arch Gen Psychiatry. 1990;47(6):541-544.
111. Glover H. A preliminary trial of nalmefene for the treatment of emotional numbing in combat veterans with post-traumatic stress disorder. Isr J Psychiatry Relat Sci. 1993;30(4):255-263.
112. Baker DG, West SA, Orth DN, Hill KK, Nicholson WE, Ekhator NN, Bruce AB, Wortman MD, Keck PE Jr, Geracioti TD Jr. Cerebrospinal fluid and plasma betaendorphin in combat veterans with post-traumatic stress disorder. Psychoneuroendocrinology. 1997;22(7):517-529.
113. Hamner MB, Hitri A. Plasma beta-endorphin levels in post-traumatic stress disorder: a preliminary report on response to exercise-induced stress. J Neuropsychiatry Clin Neurosci. 1992;4(1):59-63.
114. Mao J, Sung B, Ji RR, Lim G. Chronic morphine induces downregulation of spinal glutamate transporters: implications in morphine tolerance and abnormal pain sensitivity. J Neurosci. 2002;22(18):8312-8323.
115. Liberzon I, Taylor SF, Phan KL, Britton JC, Fig LM, Bueller JA, Koeppe RA, Zubieta JK. Altered central micro-opioid receptor binding after psychological trauma. Biol Psychiatry. 2007;61(9):1030-1038.
116. Bills LJ, Kreisler K. Treatment of flashbacks with naltrexone. Am J Psychiatry. 1993;150(9):1430.
117. Lubin G, Weizman A, Shmushkevitz M, Valevski A. Short-term treatment of posttraumatic stress disorder with naltrexone: an open-label preliminary study. Hum Psychopharmacol. 2002;17(4):181-185.
118. Kozarić-Kovacić D. Pharmacotherapy treatment of PTSD and comorbid disorders. Psychiatr Danub. 2009;21(3):411-414.
119. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in psychiatry. http://www.acgme.org/ acWebsite/RRC-400/400-prIndex.asp. Accessed June 29, 2010.
120. American Board of Psychiatry and Neurology. Psychiatry and neurology core competencies: version 4.1. http://www.abpn.com/competencies.htm. Accessed June 29, 2010.
121. Wright MT. Training psychiatrists in nonpsychiatric medicine: what do our patients and our profession need? Acad Psychiatry. 2009;33(3):181-186.
122. Yanni L, McKinney-Ketchum J, Harrington S, et al. Preparation, confidence, and attitudes about chronic noncancer pain in graduate medical education. J Graduate Med Educ. 2010;2(2):260-268.
123. International Association for the Study of Pain. IASP guidelines. http://www.iasp-pain.org/AM/Template.cfm?Section=Guidelines1&Template=/CM/ HTMLDisplay.cfm&ContentID=9113. Accessed June 28, 2010.
124. Lebovits A. Cognitive-behavioral approaches to chronic pain. Prim Psychiatry. 2007;14(9):48-54.
125. Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in pain medicine. http://www.acgme.org/acWebsite/downloads/RRC-progReq/sh-multiPainPR707.pdf. Accessed June 28, 2010.
126. Dellemijn P. Are opioids effective in relieving neuropathic pain? Pain. 1999;80 (3):453-462.
127. Geppert CMA. Navigating the straits of chronic pain and addiction. Psychiatric Times. December 1, 2007(14):30-31.
128. Evers GC. Pseudo-opioid-resistant pain. Support Care Cancer. 1997;5(6):457-460.
129. DiClemente CC, Haug N, Bellino L, Whyte S. Psychotherapy and motivational enhancement. Recent Dev Alcohol. 2003;16:115-132.
130. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. JAMA. 1996;276(4):313-318.
131. Cicero TJ, Inciardi JA. Potential for abuse of buprenorphine in office-based treatment of opioid dependence. N Engl J Med. 2005;353(17):1863- 1865.
132. Gastfriend DR, McLellan AT. Treatment matching: theoretic basis and practical implications. Med Clin North Am. 1997;81(4):945-966.
133. Turk DC. The potential of treatment matching for subgroups of patients with chronic pain: lumping versus splitting. Clin J Pain. 2005;21(1):44-55, 69-72.