Dear Editor,
The illuminating work of Geuze et al provides additional support
for the importance of diagnostic interviewing including careful
history taking in evaluating the meaning of pain symptoms on
an individual basis. [1]
It is also a memorable illustration as to why it is important to
keep in mind the influence of measuring methods on the interpretation
of results. [2] The authors' results may be
generalizable for assessment via temperature sensitivity. Nonetheless,
clinically in the same patient the reverse may be true if the
painful stimulus is reminiscent of the original traumatic stimulus.
Thus numbing, hyposensitivity, arousal, and hypersensitivity
to pain may coexist in the same patient at the same time or alternate
at different times as stimulus, mind set, and setting change.
Yours very truly,
Harold J. Bursztajn, M.D.
Associate Clinical Professor of Psychiatry
co-Founder,
Program in Psychiatry and the Law @ BIDMC Psychiatry of Harvard Medical
School
96 Larchwood Drive
Cambridge, Ma 02138
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Elbert Geuze, PhD; Herman G. M. Westenberg,
PhD; Anja Jochims, MS; Carien S. de Kloet, MD; Martin Bohus,
MD; Eric Vermetten, MD, PhD; Christian Schmahl, MD. Altered
Pain Processing in Veterans With Posttraumatic Stress Disorder.
Arch Gen Psychiatry. 2007;64:76-85.
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Bursztajn HJ, Feinbloom RI, Hamm RM, Brodsky
A. Medical Choices, Medical Chances: How
Patients, Families, and Physicians Can Cope With Uncertainty.
New York: Delacorte, 1981; New York: Routledge, Chapman & Hall,
1990
