Swiss medical weekly
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The authors deal with a particular type of working alliance, called "compliance", which may be defined as mutual agreement between patient and physician with respect to prevention and therapy. This type of compliance may be influenced by the kind of disease (e.g. low compliance in psychiatric illness), by the mode of referral (verbal or written), by the kind of hospital care (an individual appointment with one particular physician in an outpatient department makes for better compliance) and by medication (intravenous or oral administration and color and size of pills). ⋯ Furthermore, the time spent in the waiting room, the amount of information given to the patient and the clarity of the instructions given by the physician play an important role. Situational factors and interaction in the physician-patient relationship seem to be more relevant than specific personality traits.
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Usually, pain is caused by the excitation of nociceptors or of nociceptive afferent fibers. The responsiveness of the nociceptors can be modulated by endogenously released algesic substances or local hormones. Lesioned and regenerating nerve fibers show enhanced excitability and spontaneous activity. ⋯ Inhibition of spinal neurons, and analgesia, can be produced by stimulation of brain stem structures. Pharmacologically, pain inhibitory systems may involve serotonin and endogenous opioids as transmitter or modulator substances. For pain therapy, pain inhibitory systems may be activated e.g. by morphine and ther analgesic drugs, focal brain stimulation, various means of somatosensory afferent stimulation and by psychological influences such as stress.