Articles: patients.
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Studies indicate that work disabled chronic back pain patients out of work for longer than three months have a reduced probability of returning to work. The escalating personal and economic costs (indemnity and health care) associated with such long term disability have facilitated efforts at multiple levels to prevent and more effectively manage work disability. Multidisciplinary rehabilitation (MDR) targeted at return to work represents one such approach. ⋯ Research on predictors of return to work outcome following MDR were identified and included variables in five categories: demographics, medical history, physical findings, pain and psychological characteristics. The literature provides support for the use of integrated approaches that target the medical, physical, ergonomic and psychosocial factors that can exacerbate and/or maintain work disability. Future research should address current methodological limitations in the literature and focus on: 1) identifying critical treatment components of such approaches, 2) developing innovative screening methods to identify high risk cases to facilitate earlier more targeted efforts to assist such individuals, and 3) consider variations in the staging of various combinations of interventions in an effort to develop more cost-effective variations in the multidisciplinary approach.
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From August 1981 to May 1993 a total of 1263 percutaneous retrogasserian glycerol rhizotomies after Hakanson were performed. The intervention was performed with X-ray monitoring under local anaesthesia and rarely lasted longer than 20 min. It achieved good results in the treatment of idiopathic trigeminal neuralgia (TN) and symptomatic trigeminal neuralgia due to multiple sclerosis (TNMS). ⋯ Later, after 2 years, there was reduction in sensitivity of this type in only 20% of cases. In the follow-up 17.5% of our patients complained of dysaesthesia and in 21.4% corneal sensitivity was reduced or lost. We believe that glycerol rhizotomy, owing to its effectiveness, easy applicability, slight distress for the patients and low side effects, should be recommended as a first measure for non-conservative treatment of idiopathic trigeminal neuralgia as well as trigeminal neuralgia in multiple sclerosis.
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This is the first case report of a patient self-administering local anaesthetics to painful peripheral nerves in the face. Severe chronic pain of neuropathic origin was caused by a trauma of the face and head following a traffic accident 20 years ago. The patient himself chose the method of self-injection for pain control. He applies the local anaesthetic bupivacaine with an insulin syringe while looking in a mirror.
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Undertreatment of cancer pain is a well-known and worldwide problem. Every country has its specific restrictions. In Germany studies have referred undertreatment to pain states and therapeutic aspects in transverse inquiries, and others to 6-month records of regional prescription data. This study adds some long-term (3 years) information about doctors' (330 general practitioners throughout Germany) prescribing habits concerning strong opioids. ⋯ We urgently need more information on the underlying reasons for the undertreatment of cancer pain. The data presented so far make it possible to draw up guidelines and a graduated education programme for patients and health care professionals.