Der Schmerz
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Using a biopsychosocial model of chronic radicular pain, we conducted a prospective study on the predictability of the therapy outcome in 41 lumbar disc patients from the Department of Neurology, University of Kiel. Before therapy, all patients had an extensive neurological and psychological examination. The criteria for the therapy outcome werepersistent pain and theduration of hospital stay in days. ⋯ Regarding the somatic factors, only paresis is a significant predictor of these criteria. Patients with clear paresis showed more pain and a longer duration of hospital stay. In general, there was no significant correlation between the organic and psychological predictors, so independent psychological screening and the prospect of psychological interventions are necessary measures to prevent persistent pain in lumbar disc patients.
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Following head trauma many different forms of headache can develop. Complaints in the early post-traumatic period appear to be organic in most cases. Later in the course post-traumatic headache frequently shows a psychogenic picture. Describing the causative factors and discussing the therapeutic guidelines, the authors explain how psychological influences can form chronic pain syndromes.
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Morphine and other strong opioids are very often needed for the treatment of severe pain. In the FRG the prescription of these analgesics is limited by law, especially for outpatients. Special prescriptions are needed for opioid medication. ⋯ Insufficient treatment of outpatients suffering from severe pain is obvious. The complex regulations in the FRG concerning the prescription of strong opioids are the main reason for insufficient treatment. It is necessary to liberalize these regulations in order to treat severe pain better.