Der Schmerz
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In a retrospective, controlled clinical study the life events of 35 patients suffering from chronic low back pain (LBP) and a matched sample of 23 patients with neurotic depression (ICD 300.4) were investigated. The pain patients formed two groups: 19 patients with definite organic diagnosis (IASP code 530.96) and 16 without (adequate) organic lesion (IASP code 510.99). Somatic diseases (other than LBP), injuries and operations, as well as psychic trauma (feelings of shame, narcissistic traumatisations and object losses) were defined and counted as documented in the patient's histories. ⋯ Object losses occur equally often in all groups, apart from the initial year, when depressive patients have to cope with even more losses than the others. These results are discussed considering the development of chronic pain syndromes, the influence of age and their consequences for models of illness. There is convincing evidence, that physical injury is neither a necessary nor a sufficient condition for the development of chronic pain and that chronic pain is in essence an emotional disease based on unresolved unconscious conflicts requiring psychotherapy.
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A case history of therapy resistent trigeminal neuralgia was presented by Wechsung and Müller. This patient was previously treated without any succes with glycerol injections, "electrocauterisation", a Janetta operation and 2 reexplorations of the posterior fossa. Attempts with oral carbamazepine and baclofen were unsuccesful too. ⋯ The most succesful surgical procedure is the radiofrequency thermal lesion of the Gasserian ganglion (Sweet). Data from the literature from 8500 patients and own data (from over 600 patients) show that therapy resistance is very infrequent (0.5%). The costs of clinical implantation of a pump with intrathecally administered baclofen are 10-15 times higher than ambulant radiofrequency lesioning.