Der Schmerz
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Randomized Controlled Trial Comparative Study
[Desire for early retirement and therapy of chronic back pain: relevance of social medical variables for outpatient psychotherapeutic treatment].
This study investigated the influence of patients' desire for early retirement on the success of an outpatient cognitive behavioural treatment (CBT) in patients with chronic back pain. Previous studies have shown that the desire for early retirement and social compensation had a negative influence on therapy outcome, e.g. pain intensity and pain disability. This study was conducted to reassess whether these results can be replicated in an outpatient CBT setting. ⋯ CBT in an outpatient setting seems to be an effective treatment for patients with chronic back pain and even patients with a desire for early retirement benefit from treatment.
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Multimodal pain therapy describes an integrated multidisciplinary treatment in small groups with a closely coordinated therapeutical approach. Somatic and psychotherapeutic procedures cooperate with physical and psychological training programs. For chronic pain syndromes with complex somatic, psychological and social consequences, a therapeutic intensity of at least 100 hours is recommended. ⋯ Medical indications are given for patients with chronic pain syndromes, but also if there is an elevated risk of chronic pain in the early stadium of the disease and aiming at delaying the process of chronification. Relative contraindications are a lack of motivation for behavioural change, severe mental disorders or psychopathologies and addiction problems. The availability of multimodal pain treatment centers in Germany is currently insufficient.
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This paper examines a new approach to managed healthcare where a network of care providers exchanges patient information through the internet. Integrating networks of clinical specialists and general care providers promises to achieve qualitative and economic improvements in the German healthcare system. ⋯ The implementation and use of a cross-spectrum computerized solution for the management of patients and their care is the key for a successful managed healthcare system. This paper documents the managed healthcare of chronic headache patients and the development of an IT-solution capable of providing distributed patient care and case management.
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Randomized Controlled Trial
[Modulation of cortical pain processing by cyclooxygenase inhibition: a functional MRI study].
Little is known about changes in brain activity with pharmacological modulation of hyperalgesia. Therefore, we sought to investigate the cerebral processing of hyperalgesia and acute pain using functional magnetic resonance imaging (fMRI) and pharmacological modulation with cyclooxygenase (COX) inhibitors. ⋯ This study provides new evidence for the involvement of COX inhibitors in modulating the cerebral activity associated with acute pain and hyperalgesia. Our results hint at a differential modulation of brain areas under either analgesia or antihyperalgesia.
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Older patients, particularly those with multimorbidity, complain about many symptoms which also occur under analgesics (especially with opioids). The goals of the study were to quantify symptoms and discuss the relationships to analgesics, pain, multimorbidity, function, age and gender. ⋯ Our results underline the difficult interpretation of symptoms as a side-effect of analgesic treatment in older patients. Pain and gender differences have to be considered. The recommendation to carefully record symptoms before analgesic treatment is supported by our results.