Der Schmerz
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Freedom from cancer pain is one of the four priorities of the WHO Cancer Control Programme. Every day 3.5 million people are suffering from cancer pain, and most do not receive adequate relief. A lack of training in cancer pain management at most nursing and medical schools is the principal reason for this, coupled with limited availability of oral strong opioids in many countries. ⋯ Psychological dependence does not occur in patients receiving opioids for pain relief. 11. Patients receiving analgesics must be carefully monitored. 12. Teamwork is necessary for good results.
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The therapeutic results of operatively and conservatively treated patients with lumbar disc syndromes were reviewed in a retrospective study. The patients were treated during a 10-years period (1976-1985). A total of 330 patients with lumbar disc prolapses were treated in the hospital during this period 44% were treated surgically. ⋯ There were no definite advantages found for either of the two methods of treatment. The necessity for a specialized follow-up treatment of patients with sciatica due to herniated lumbar discs is discussed, and differentiated selection for operative therapy is given. Here the treatment of pain should be considered most important.
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Since 1982, a total of 88 patients with refractory fibrositis have received treatment as part of an integrated group program within a psychiatric outpatient clinic working closely with the department of rheumatology. The best arrangement proved to be a series of 15 weekly two-hour sessions with groups of 8 patients. The program has three main elements: information, instruction in pain control strategies, and group discussion. ⋯ Our program makes it possible for a greater proportion of patients to learn one or more techniques affording some measure of pain relief. It is important for the therapists to adopt a positive and convincing attitude while restricting themselves to helping the patients to help themselves and avoiding power struggles. They should also be ready to accept the patients and their view of the illness, and not attempt to interpret the illness as the expression of something else.