Der Orthopäde
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Review
[Visualisation of phantom- and backpain using imaging techniques. Implication for treatment].
If patients with chronic low back pain are stimulated in the painful region, an expanded representation of the back in the primary somatosensory cortex becomes visible that increases with chronicity. This "pain memory" might play an important role in the chronicity process. In patients with phantom limb pain, e.g. subsequent to the amputation of an arm or leg, a shift in the representation of neighboring areas into the deafferented area in primary somatosensory cortex has been observed. ⋯ The modulation of plasticity and phantom limb pain by anesthesiological manipulation, the use of NMDA receptor antagonists and opioids is presented. Behaviorally relevant stimulation, e.g. by the use of a myoelectric prosthesis or sensory discrimination training can also influence the cortical somatosensory pain memory. More recent studies focus also on brain areas such as the cingulate gyrus believed to be involved in the affective processing of pain.
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Review Comparative Study
[Questionnaires for patients with back pain. Diagnosis and outcome assessment].
Self-assessment questionnaires are becoming increasingly important in the evaluation and outcome-assessment of low back pain patients, both in the research environment and in everyday clinical practice. Questionnaires allow a standardised, patient-orientated examination of the symptoms and effects of the disease as well as the assessment of change following treatment. The aim of the current review was to provide a summary of the questionnaires that are currently available in the German language for the assessment of patients with low back pain; the review focuses on those that have been shown to be reliable and valid and widely-used on an international basis. ⋯ For the analysis of treatment effects, prospective assessment of the relevant characteristics is recommended - that is, assessments should be made before the treatment and again with identical questionnaires at follow-up. Especially within the context of scientific studies, instruments should be chosen that enable an international comparison of the data generated. In everyday clinical routine, a short standardised documentation of the most important dimensions is recommended.
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Injection of 17-20 ml of local anesthetic combined with corticosteroids via hiatus canalis sacralis or epidural between spinal processes in the lumbar region leads to distribution up to the level of the thoracolumbar junction. The indication for therapeutic peridual or epidural injections are radicular symptoms as a result of disc herniation, foraminal stenosis as well as neurogenic claudication. ⋯ Complications and side effects occur extremely seldom. There is only one RCT for radiculopathy and epidural steroids.
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At least 5 million patients with chronic and severely debilitating pain exist among the adult population in Germany, i.e. 8% of this population. Various biological and psychosocial risk factors contribute to the continuing chronicity of pain, resulting in enormous direct and indirect costs totalling an estimated 38 billion euro annually. ⋯ In contrast, more recent approaches of multimodal treatment, including medical, psychological and behavioral components, have shown a significant and lasting effect in patients with a high incidence of workplace incapacitation and sick leave. In particular, the GRIP pilot project (Göttingen Intensive Back Project) has resulted in an increased rate (to 200%) of return to the workplace and in a decrease in health system expenses to 50% of the pretreatment level.
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Clinical Trial Controlled Clinical Trial
[The Explanatory Model-Interview in the diagnosis of orthopaedic pain patients].
This study aims to clarify weather the Explanatory Model Interview (EMIC, Weiss, 1997) can detect differences between pain patients with somatoform disorders and pain patients without any psychiatric disorder. We consider the importance of psychological symptom reporting, somatic illness attribution and the subjective experience of exhaustion. ⋯ Most pain patients with somatoform disorders report psychological distress when they are encouraged. In spite of this emotional strain, most of the pain patients with somatoform disorders attribute their pain complaints to somatic causes. The conspicuous importance of exhaustion in the attribution of patients with somatoform disorders confirms clinical observations and requires further research.