Articles: chronic-pain.
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In a cognitive perspective, chronic pain comprises at least three dimensions: First it is possible to study the relevance of pain related attitudes, beliefs and coping cognitions for the chronification of pain. Second psychological processes of learning and memory processes can be analysed. Third we can investigate uncontrolled cognitions in chronic pain patients. ⋯ The first part of the present paper deals with representations of pain events in autobiographical memory. In the second part a hindsight bias experiment is used as a prototype of altered information processing in the context of chronic pain. STUDY 1: In study one recollection of pain related events, pain experience and the sensory recalling of pain occurrences were sampled in 20 chronic pain patients, 17 psychiatric patients and 38 healthy controls. Pain patients showed a specific kind of pain related memory which had no parallel among psychiatric patients. Based on learning theory the significance of a pain related memory for chronification is discussed. STUDY 2: In the second study 18 pain patients, 13 psychiatric patients and 18 healthy controls were tested with a hindsight bias experiment. The hindsight-effect was observed in the usual extend in the student control group, but was significantly greater in the pain group and absent in the psychiatric sample. In addition to this global finding, multinomial modeling revealed group differences in specific model parameters. Basic units of information processing interact with the chronification of pain. This method of analysis thus proved as a promising tool for the assessment of cognitive aspects of clinical disorders.
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Objective. For patients with refractory angina pectoris, spinal cord stimulation (SCS) is a beneficial and safe adjuvant therapy. However, it has not yet been established whether SCS alters the quality of life (QoL) in these patients. ⋯ QoL in patients with refractory angina pectoris is poor. Both pain and health aspects of QoL improved significantly after 3 months of SCS. Social, mental, and physical aspects of QoL were found improved after 1 year of SCS.
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Central pain mechanisms are deeply embodied in the psychophysical problem of pain. They are located in the brain and spinal cord and are becoming increasingly recognised as playing a major role in the generation and maintenance of pain and disability associated with neuromusculoskeletal problems. Central mechanisms participate in all pain states, acute and chronic. ⋯ In reality, as key players in the healing process, central mechanisms are profoundly affected by manual therapy even when it is directed at a peripheral problem. Treatment of peripheral mechanisms can be performed through central techniques because both peripheral and central mechanisms are always part of the same clinical problem. Consequently, manual therapy must change its mindset from a peripheral standpoint and integrate central mechanisms into clinical practice as a means of improving therapeutic efficacy and to prevent the descent of acute pain into chronic.
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Objective. The conventional technique used to stimulate the lumbar dermatomes is by stimulation of the dorsal columns of the spinal cord. Until recently, stimulation of nerve roots had not been successfully accomplished. ⋯ Lumbar and sacral NRS trials resulted in adequate paresthesia coverage and effective pain relief in all 5 patients. Further clinical trials to evaluate long-term success rates and safety are indicated. Detailed mapping studies are needed to evaluate the relationship between electrode placement and paresthesia patterns as well as the optimal stimulation parameters.
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Objective. To examine the importance of posture on the efficacy of spinal cord stimulation in a population of chronic pain patients previously implanted with a spinal cord stimulator. Materials and Methods. ⋯ The mean range and SD of stimulation required to achieve paresthesia at all three posture levels was found to be 0.113 ± 0.062 μC for leads in the cervical region (N = 11) and 0.494 ± 0.297 μC for leads in the thoracic region (N = 19). Conclusions. To provide adequate stimulation at all postures, multiple stimulation settings (programs) would be required.