Articles: chronic-pain.
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Tursky's pain perception profile [16] has been revised and adapted for use in German-speaking conditions, and this new modification is presented. It integrates six different methods of clinical and experimental methods of clinical and experimental pain measurement, which are intended to meet the enhanced demands put forward in pain research for multivariate measurement of pain by a variety of methods. ⋯ The results document the many aspects of chronic pain and the necessity for multimodal measurement. In addition, they supply a means of achieving a better pain-related classification of pain patients on an experimental basis.
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An outpatient treatment programme for pain control was applied in 25 chronic pain patients in three general medical practices, supervised by a medical psychologist as a group therapist. The patients has been suffering from headaches, migraines, cervical pain, shoulder and arm pain, and low back pain for at least 6 months. A sample of 20 patients with the same disorders served as a control group which waiting for treatment. ⋯ Nonetheless, all the subjects treated showed improvements in their average scores for trait anxiety, depression and symptoms complaints compared with the untreated controls. Our results indicate a long-term improvement in well-being as a result of the treatment. Treatment adherence seems to be the most important factor in the maintenance of long-term reduction of pain intensity.
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During the 1960s, it was observed that the tricyclic antidepressant imipramine was effective in the treatment of neuralgia, myalgia, and pain in carcinoma. Similarly, in other studies, clomipramine was also found to have an analgesic effect. The sedative antidepressant amitriptyline has proved effective in migraine prophylaxis, chronic tension headache, and psychogenic musculoskeletal and neuralgic facial pain. ⋯ The remaining tricyclic and the tetracyclic antidepressants have not been sufficiently well evaluated. This is also true of monoamine oxidase inhibitors, of which individual reports to date suggest are probably also effective as analgesics. A scientific investigation into the possible differences in the effectiveness of various antidepressants in specific chronic pain conditions is an important task for the future.
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The perception and expression of pain are primarily psychological phenomena and are not directly correlated with the intensity of the nociceptive stimulus. They are often influenced by earlier experiences of pain, and also by current expectations and fears. The cancer patient interprets pain as a sign of the continued existence and of the progression of the malignant disease: if the pain can be controlled the patient will take this as an indication that the underlying disease can be cured. ⋯ In particular, antidepressants and neuroleptics have become an important component of the treatment of chronic pain in cancer patients. Due consideration of the emotional and motivational status of the patient will make it possible to choose between the different effect profiles of these drugs. However, the use of psychotropic drugs should complement, and cannot replace, empathic care from the physician.
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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.