Articles: patients.
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Perceptual disorders in patients with migraine are common and therefore well known in the optic sense. However, a review of the literature reveals a variety of perceptual phenomena with regard to all of the senses as well as disturbances in body image and physical sensations. The criteria for interpreting these phenomena in the context of migraine disorder, even if they are not accompanied by headache, are: the reaction to migraine therapy; previous occurrence, together with a migraine headache; a family history of migraine. From a psychopathological perspective, selected features of the phenomena and questions regarding terminology are discussed: the phenomena should be referred to as hallucinations, the headache itself is real and should not be called a hallucination.
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Psychological methods for the treatment of chronic pain have been developed within the contextual framework of behavioral medicine during the past few years. Some of these self-control approaches focus on the patient's capacity to cope actively with pain. Standardized self-control training for outpatient group treatment for patients with chronic pain is described. ⋯ Thirty-three patients with chronic back pain were assigned either to one of four treatment groups (n=22) or to a waiting list control group (n=11). After 12 sessions of group treatment, patients showed significant improvement regarding daily ratings of pain intensity and mood and a significant decrease in depression and general physical complaints other than pain; the waiting list patients remained the same. Results showed good maintenance at the half-year follow-up.
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Conventional clinical dosages of local anesthetics may not be sufficient to block conduction of all afferent impulses, which is important for an effective epidural sensory blockade. Further depression of the transmission of information can be accomplished by central modulating mechanisms, preventing sensory perception. Since there are interindividual differences in the quality of modulating mechanisms, standardized depression of impulse propagation by the local anesthetic is associated with a wide variation in the total depression of afferent impulses. ⋯ Patients with a low pain threshold require a more highly concentrated local anesthetic. The addition of opioids to the local anesthetic will permit the use of lower concentrations of the local anesthetic itself. Optimal use of diagnostic, prognostic, and therapeutic epidural blockades is possible only if the influence of modulating mechanisms is taken into account.
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There is no uniform etiology of cancer pain. It is essential to understand the pathogenesis of pain as far as possible before a therapeutic modality can be conceived. The anatomical relation of the painproducing lesion to the site of pain perception should be clear (local, projected and referred pain). ⋯ Due consideration is given to neuroleptics and antidepressive drugs. Information about hormones (corticosteroids, calcitonin a. o.) in cancer pain therapy conclude this survey. Enormous differences of morphine use (Austria: 0.66 kg vs Denmark 16.59 kg per million people per year) indicate that there is a great demand for further professional education in this field.