Articles: chronic-pain.
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The therapy of pain caused by rheumatic diseases above all must take into consideration the cause of the pain. In rheumatoid arthritis, especially in the early stages, inflammation is the primary cause of the pain. The pain decreases the inflammation subsides following the administration of non-steroidal anti-inflammatory drugs (NSAIDs), or corticosteroids, if necessary. ⋯ In most cases fibromyalgia, which is mostly of a psychosomatic nature, cannot be influenced by medical therapy. Instead repeated attempts at treatment help to make the affliction chronic with neurotic fixation. Also, as a rule, myotonolytic and tranquilizing substances are not effective.
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The problem of nociception and pain development in radicular pain syndromes is not clarified. In the pathophysiology of pain of radicular compression caused by stenosis or disc prolapse, morphological complex nerve root/ganglion is the key structure. Chronic compression forces on the nerve structure cause structural changes. ⋯ The membrane threshold shift in nociceptive fibers is an important prerequisite for pain perception in nerve root compression. New biochemical aspects in the pathophysiology of radicular syndromes are presented, which could explain the discrepancy between pain and objective clinical findings. The article concludes that a better understanding of the nerve root pathophysiology will bring a more differentiated pain-management strategy.
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Using a biopsychosocial model of chronic radicular pain, we conducted a prospective study on the predictability of the therapy outcome in 41 lumbar disc patients from the Department of Neurology, University of Kiel. Before therapy, all patients had an extensive neurological and psychological examination. The criteria for the therapy outcome werepersistent pain and theduration of hospital stay in days. ⋯ Regarding the somatic factors, only paresis is a significant predictor of these criteria. Patients with clear paresis showed more pain and a longer duration of hospital stay. In general, there was no significant correlation between the organic and psychological predictors, so independent psychological screening and the prospect of psychological interventions are necessary measures to prevent persistent pain in lumbar disc patients.
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Following head trauma many different forms of headache can develop. Complaints in the early post-traumatic period appear to be organic in most cases. Later in the course post-traumatic headache frequently shows a psychogenic picture. Describing the causative factors and discussing the therapeutic guidelines, the authors explain how psychological influences can form chronic pain syndromes.
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The reliability and validity of a German version (MPI-D) of the West Haven-Yale Multidimensional Pain Inventory (WHYMPI) was assessed in a sample of 185 chronic pain patients. MPI-D shows high internal consistency, valid subscales, and a factor structure that is comparable to the American version. The Interference scale of part 1 includes an additional item and one other item was excluded; the Life Control scale had one item added. ⋯ The questionnaire is sensitive to therapeutic change. The German scale means are lower for the scales indicating more disturbance or severity and higher for the scales indicating less disturbance. It is not clear whether this reduced pain impact is characteristic of German pain patients in general, or whether it is due to the less severely affected sample tested in this study.