Der Schmerz
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The reliability and validity of a German version (MPI-D) of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) was assessed in a sample of 185 chronic pain patients. MPI-D shows high internal consistency, valid subscales, and a factor structure that is comparable to the American version. The Interference scale of part 1 includes an additional item and one other item was excluded; the Life Control scale had one item added. ⋯ The questionnaire is sensitive to therapeutic change. The German scale means are lower for the scales indicating more disturbance or severity and higher for the scales indicating less disturbance. It is not clear whether this reduced pain impact is characteristic of German pain patients in general, or whether it is due to the less severely affected sample tested in this study.
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During the long-term treatment with opioids it is sometimes important to switch the opioid or change the route of administration. The estimation of morphine-equivalents can be helpful in this range because it clarifies the dose in milligramm required for different clinical situations. The basis of this estimation is the equianalgesic potency of opioids. ⋯ Useful starting point for calculation an effective dose when changing from one opioid or route of administration to another can result in improved pain control that is more responsive to patient need. The limitations are 1. individual differences in the response to opioids, especially during long-term treatment and in the development of analgesic tolerance, 2. individual differences in the response to alternatives routes of administration, and 3. the unknown degree of cross tolerance among opioid drugs. The scientific meaning of the estimation of i.m. morphine-equivalent is discussed.
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The new orientation concerning the therapy of chronic pain has brought about essential progress during recent years. However, physical therapy is often disregarded. Therefore, various possible ways of influencing pain by physical therapy are presented. ⋯ Central pain control by physical therapy is investigated most frequently and is of essential importance. It is also of value to take into consideration the psychotherapeutic effects of physical therapy. The integration of physical therapy into a complex treatment schedule may lead to further progress in the treatment of patients with pain.
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Since 1982, a total of 88 patients with refractory fibrositis have received treatment as part of an integrated group program within a psychiatric outpatient clinic working closely with the department of rheumatology. The best arrangement proved to be a series of 15 weekly two-hour sessions with groups of 8 patients. The program has three main elements: information, instruction in pain control strategies, and group discussion. ⋯ Our program makes it possible for a greater proportion of patients to learn one or more techniques affording some measure of pain relief. It is important for the therapists to adopt a positive and convincing attitude while restricting themselves to helping the patients to help themselves and avoiding power struggles. They should also be ready to accept the patients and their view of the illness, and not attempt to interpret the illness as the expression of something else.