Der Schmerz
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Aim of the present prospective longitudinal study was the statistical foundation and thus further replication of recent findings of Hasenbring [13], who postulated a significant importance of specific, within the psychological pain research long neglected pain coping strategies as risk factors concerning pain chronification: appeals to "stick it out" on the cognitive level and endurance strategies on the behavioural level. ⋯ These results corroborate the finding that this subgroup of chronic low back pain patients might indeed carry a bad prognosis and call for further research into this area, especially with regard to rehabilitation potential and facilities of reintegration into working life.
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The prescription of strong opioids underlies a special legislation. The attitude of the pharmacists towards the long-term treatment with these analgesics and their opinion about the legislation is unknown in Germany and other European countries. ⋯ The importance of the therapy with strong opioids is well accepted by the pharmacists. An ease of the prescription is demanded to improve the situation of the patients with chronic pain. However, the majority of the pharmacists warns the patients about this medication. Contact between prescribing doctors and pharmacists and an intensified education concerning the therapy with opioids are needed in addition to the education of the medical staff and the liberalization of the prescription laws.
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In a cognitive perspective, chronic pain comprises at least three dimensions: First it is possible to study the relevance of pain related attitudes, beliefs and coping cognitions for the chronification of pain. Second psychological processes of learning and memory processes can be analysed. Third we can investigate uncontrolled cognitions in chronic pain patients. ⋯ The first part of the present paper deals with representations of pain events in autobiographical memory. In the second part a hindsight bias experiment is used as a prototype of altered information processing in the context of chronic pain. STUDY 1: In study one recollection of pain related events, pain experience and the sensory recalling of pain occurrences were sampled in 20 chronic pain patients, 17 psychiatric patients and 38 healthy controls. Pain patients showed a specific kind of pain related memory which had no parallel among psychiatric patients. Based on learning theory the significance of a pain related memory for chronification is discussed. STUDY 2: In the second study 18 pain patients, 13 psychiatric patients and 18 healthy controls were tested with a hindsight bias experiment. The hindsight-effect was observed in the usual extend in the student control group, but was significantly greater in the pain group and absent in the psychiatric sample. In addition to this global finding, multinomial modeling revealed group differences in specific model parameters. Basic units of information processing interact with the chronification of pain. This method of analysis thus proved as a promising tool for the assessment of cognitive aspects of clinical disorders.