Der Schmerz
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This paper reviews instruments in German language for the psychological assessment and classification of pain. Usually chronic pain syndromes are classified within the International Classification of Diseases (ICD). Instead of the psychiatric chapter of the ICD, it is possible to use the Diagnostic and Statistical Manual of Mental Disorders (DSM). ⋯ The MASK-P part of the diagnosis is composed of graduation on these levels. Differential axis of the pain syndromes are described phenomenologically and specifically. MASK provides the possibility of establishing an integrative, interdisciplinary diagnosis.
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In recent years most industrialized nations have been confronted with a dramatic increase in cases dealing with back pain which, because of the associated costs, has put a strain on health care systems. Because of the tremendous costs caused by patients with chronic illnesses, there is a common interest in identifying determinants responsible for the pain becoming chronic. According to the fear-avoidance model, chronic back pain is the cause of specific patient beliefs according to their perception and appraisal of back pain and their assumptions about the connection between pain and work activities. These fear-avoidance beliefs are assumed as the main cognitive factors of adapting to chronic invalidism. In this study a German version of a self-reporting instrument that assesses fear-avoidance beliefs (FABQ, Waddell et al. 1993) is presented. ⋯ The results suggest that primary target points for further investigation include an analysis of the patients' beliefs about their pain, with special emphasis on fear-avoidance beliefs. It is also necessary to analyze the behavioral assumptions of the fear-avoidance model in an experimental design. Furthermore, our results concerning the psychometric properties of the questionnaire should be proved in a far larger sample of back pain patients.
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To provide a brief review of the current state of topical treatment with capsaicin or acetylsalicylic acid (ASA) for therapy of chronic pain syndromes. ⋯ Capsaicin is a white crystalline parent compound of a group of vanillyl fatty acid amines. Because of its highly specific action in neurons it has become an important tool in neuroscience. Because of its effects, it is obvious to try for the therapy of circumscribed neuropathic pain. Capsaicin acts by depleting stores of substance P and other neurotransmitters, resulting in a blockade of a specific group of sensory afferents. The corresponding clinical findings are initial burning and a desensitization of specific C fiber nociceptors after repeated application. The pain relieving potency was observed in various clinical investigations and even in a few controlled, double-blind studies about neuropathic pain syndromes and (osteo)arthritis. In contrast to these findings, a recent study found no significant benefit of capsaicin, probably because this study was the first to use an active placebo. Therefore, and because clinical efficacy and advantages over other therapies have not been demonstrated up to now, capsaicin cannot be classified as standard therapy. It may be a therapeutic option as an alternative or as an adjuvant treatment. Pain reduction was also observed after topical application of ASA/ether mixture in the one and only controlled double-blind study on this issue. Therefore, topical ASA therapy for (post)herpetic neuralgia is mainly based on a few enthusiastic case reports rather than on well founded investigations. Furthermore, the discrimination of local from systemic effects, the toxicological profile of longterm topical treatment, and the mechanism of action has not been evaluated. In conclusion, topical ASA cannot be recommended for routine clinical use at present.
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"Pain under Discussion" aims at the education of patients with chronic headache and back pain by applying a standardized manual with detailed instructions for seven sessions in a group setting. Apart from encouraging a reconceptualization of the patients' pain experience with reference to a bio-psycho-social model, the program provides information about the vicious circle of pain, avoidance and demoralization and relies heavily on behavioral assumptions about the process of chronicity. Patients are offered participation in progressive relaxation according to Jacobson, they learn to engage in pleasant activities, and are instructed to more and more maintain an upright body position during various activities of every day life. The study evaluates the outcome of the training. Moreover, as an algorithm for grading pain patients according to their level of chronicity has recently been developed by Gerbershagen, we use this algorithm in order to investigate the relationship between the outcome of treatment and the assigned level of chronicity. In addition, we test the assumption that a higher level of chronicity is related to a lower level of psychological functioning pre treatment. ⋯ Irrespective of the initial pain grading of the patients the training program has proven to be effective with regard to different outcome measures.
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Pain perception is a complex psychosomatic phenomenon and is influenced by different psychological variables. Apart from their pain perception, chronic pain patients also suffer from different bodily complaints. The clinical significance of this finding is not yet clear. Bodily complaints in chronic pain patients may represent (a) a bodily expression of depressive symptoms, (b) a sign of chronicity, and (c) the expression of a heightened bodily awareness in the sense of hypochondriasis. ⋯ From a cognitive-behavioral perspective the results support the hypothesis that psychological disturbance in chronic pain is a cause of long-standing pain perception and the result of the chronification process.