Articles: back-pain.
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Many studies have demonstrated that cancer pain can be relieved in most cases by suitable analgesic medication. Patients with a diagnosis of "intractable cancer pain", however, are referred to our pain clinic nearly every day. A retrospective study of 1140 patients was therefore performed to evaluate the pain mechanisms and whether analgesic pretreatment had been adequate. ⋯ The principal causes for the inadequacy of the analgesic pretreatment were: failure to prescribe analgesics (10% of the patients), irregular intake schedule or prolonged intervals between applications (66%), underdosage of nonopioid analgesics (27%) or opioids (42%), and withholding of nonopioid analgesics (30%), strong opioids (14%), or co-analgesic drugs (17%), although their prescription was indicated. The severe pain was thus caused in many patients by simple mistakes in the prescription of analgesics. Terms like "intractable" should be used with caution when referring to cancer pain because they are often unreflected and can make patients and physicians feel helpless or insecure.
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Despite all of the progress that has been made in diagnostic procedures and the increasing number of treatment facilities available the number of people suffering from chronic pain conditions seems to be growing constantly in all industrialized countries, a fact which is demonstrated impressively by the epidemiology of low back pain. "Chronic" means "life-determining"-chronic pain, as all chronic illnesses represent a turning point in the life situation of the people concerned. They not only affect the patients, but also the members of their immediate social environment. Chronic pain becomes a destructive stigma when society reduces the afflicted persons to the status of the chronically ill. ⋯ The introduction of the concept of the "healthy pain patient" has the goal of raising the competence of the individual and his/her social environment to improve the quality of life in spite of chronic pain. The educational aim is to enable patients with pain to be autonomous and to maximize their potential health. The therapeutic approach is demonstrated by individual case histories.
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19 patients between 23 and 65 yr. of age whose chronic back pain was caused by lumbosacral disk disease and 19 healthy volunteers matched for age and sex were studied. Pain thresholds under phasic and tonic heat stimulation and thermal thresholds for warmth and cold were measured on the right hand. ⋯ Hence, current back pain and experimental tonic pain seem to have an additive effect on pain perception because perceptual qualities are similar. Reduced somatosensory perception of chronic back pain patients could be demonstrated for temperature sensitivity and to a lesser degree for phasic pain, but as a consequence of the "opposing" effect of current back pain, not for tonic pain perception.
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The results of a retrospective 44-patient study of vocationally disabled patients who had undergone unsuccessful traditional lumbar spine surgical procedures for low back pain and/or lower extremity sciatic pain are presented. It was found that errors in patient selection and patient psychosocial pathology may have been contributory to the failures. If identified preoperatively, these conditions might have contraindicated one or more of the surgical procedures. The 24-month study required the completion of the Minnesota Multiphasic Personality Inventory by each patient; this test aids identification of patients who will be better served by treatment interventions other than surgery, or who may require psychological perioperative care.
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Chronic low back pain is lumbar-sciatic pain of more than 3 months duration. It is necessary to classify back conditions into conditions with and without nerve root affection. ⋯ Symptoms and signs, x-ray investigations, and laboratory data are dealt with in the structural and focal etiology of the pain. The relationship between psycho-social factors and low back pain is discussed.